Doncaster PCT. Joint Strategic Needs Assessment (JSNA)

Transcription

1 Doncaster PCT Joint Strategic Needs Assessment (JSNA)

2 DONCASTER PRIMARY CARE TRUST ENC F TRUST BOARD - 4 TH SEPTEMBER 2008 JOINT STRATEGIC NEEDS ASSESSMENT 2008 EXECUTIVE SUMMARY Lead Director: Presenting Officer: Trust Board Action Required: Dr Tony Baxter Dr Tony Baxter/Laurie Mott For noting only For approval For information only Details of Risk Assessment including Financial, Legal, Human Resources, Equality Impact Assessment Moderate. Health, care and financial burden on health community if inequalities not effectively addressed Alignment to Strategic Objectives and Standards for Better Health Strategic Objectives Standards for Better Health Address/invest in health inequalities Safety by targeting the areas with greatest need Implement health improvements Clinical & Cost Effectiveness plans with clearly defined sustainable quality outcomes Commission and provide high Governance quality, evidence based, accessible services closest to the patient s home Design/invest in safe care pathways Patient Focus Value and develop our people Accessible and Responsive Care through leadership, training & development Encourage research & development Care Environment & Amenities Promote joint working to maintain Public Health high performance & continuous improvement Seek engagement to maximise potential from joint resources Executive Summary (analysis of Key issues) This paper illustrates the outputs of Doncaster s first Joint Strategic Needs Assessment (JSNA). The paper describes the purpose of JSNA, the local process for JSNA development and some headline messages. Tony Baxter 11 August 2008

3 Doncaster s Joint Strategic Needs Assessment 2008 Board Summary 1. Background The concept of Joint Strategic Needs Assessment (JSNA) was introduced in the Commissioning Framework for Health and Wellbeing (2007) and, later in 2007, guidance about its aims and scope were published. JSNA is described as a process that will identify the current and future health and wellbeing needs of a local population, informing the priorities and targets set by Local Area Agreements and leading to agreed commissioning priorities that will improve outcomes and reduce inequalities. JSNA is undertaken by PCTs and local authorities working in cooperation with key partner organisations. 2. Content Doncaster s JSNA has three components: A core dataset of resources which is accessible to partner organisations A series of updated and expanded community profiles A series of reports relating to joint commissioning priorities Core dataset: The guidance documents on JSNA provide an indication on what range of data should be collected on the health and wellbeing of local people, and also encourages new ways of combining different datasets. Achieving this will provide an improved picture of the kinds of issues and challenges faced by Doncaster s various communities. Community profiles: These were first featured in Doncaster s DPH annual report in 2004 and describe health profiles of Doncaster s 88 communities. These were fully updated in The community profiles formed the basis of a set of 11 enhanced public health profiles focused on the 20% most disadvantaged communities in the borough. These profiles contain data on health, crime, social care, and demography as well as service accessibility. They have provided a starting point for a series of community conferences, one in each of these communities (Denaby Main, Clay Lane, Highfields, Stainforth, Carcroft, Askern, Hyde Park, New Rossington, Toll Bar & Almholme, Woodlands, and Mexborough). Joint commissioning: The third element of the JSNA process in Doncaster will be a series of reports about issues affecting joint commissioning. Joint commissioning relates to areas where the PCT and Doncaster MBC work together to commission services. These reports will cover older people, children, learning disabilities, and obesity. 3. Key issues emerging from Doncaster s first JSNA In common with most other parts of the country Doncaster has an aging population the number aged over 65 looks set to increase by more than 5,000 to 54,000 by 2012.

4 Doncaster birth rate has been increasing since More than 1/3rd of Doncaster s population reside in areas classed as the 20% most deprived areas. The Index of Multiple deprivation shows that almost half of the population of the borough are in the 20% most deprived areas for Education, Skills and services. Breast feeding rates remain well below national rates and do not appear at the moment to be improving. Alcohol misuse related mortality has been increasing and much faster than in the country as a whole. This seems to be a particular problem in men. Male life expectancy at birth is likely to remain below the national level. Premature mortality due to circulatory diseases is improving faster than the national rate, but stroke mortality rates in Doncaster are not falling as fast. New cases of lung cancer and stomach cancer mortality are high in Doncaster and the trend analysis shows that this is set to continue. Respiratory disease mortality has been falling but not as fast country as a whole. The ageing population will see increases in the numbers of elderly people with mental health problems and dementia. Uptake of cancer screening services has been high in Doncaster but there have been declines. 4. How JSNA will support commissioning Doncaster s JSNA is a resource to support commissioning. It will be integrated into planning and commissioning processes across partner agencies in Doncaster. A data sharing pilot project called the Neighbourhood Knowledge Management (NKM) project has provided new insights into the social and economic conditions, and how they relate to health and wellbeing in Doncaster. Reports on teenage motherhood, childhood obesity and educational attainment have revealed new risk factors and will inform new social marketing strategies to address these issues. The enhanced public health profiles have provided an opportunity for the PCT to work with local authority colleagues to produce profiles for Doncaster s most deprived communities. These will provide a template for expanding the range and scopes of locality based profiles in the future, and ensure services are focussed more closely onto areas of need. Joint commissioning reports will be written this year to cover a range of agreed commissioning priorities. These reports were commissioned by the director of public health together with the directors of children s services and adult services at the local authority. The reports will provide data and analysis to enable commissioning bodies

5 tailor commissioning priorities to fit with immerging needs in Doncaster s communities. 5. Recommendation Trust Board is asked to receive the JSNA for information. Dr Tony Baxter Director of Public Health Laurie Mott Assistant Director of Public Health Head of Public Health Intelligence Unit

6 Joint Strategic Needs Assessment Doncaster 2008 Contents: 1. Joint Strategic Needs Assessment Core Dataset A report outlining major heath and wellbeing indicators and focusing on issues and developments at the district level 2. Neighbourhood Knowledge Management Selection of reports from a partnership pilot project to look at joined datasets and new methods of assessing need. 3. Community Profiles Example of one of 88 updated community profiles. These reports provide an analysis of health data at the community level 4. Enhanced Public Health Profiles Example of an enhanced community profile. The data are from both the local authority and the PCT and provide needs assessment data to support the enhanced public health programmes in Doncaster s most deprived communities.

7 Joint Strategic Needs Assessment Core Dataset 5 th August 2008

8 Introduction Joint strategic Needs assessment is a process that will identify the current and future health and wellbeing needs of a local population, informing the priorities and targets set by Local Area Agreements and leading to agreed commissioning priorities that will improve outcomes and reduce inequalities. 1 In Doncaster JSNA is not a single output but will be viewed as a continual process. The focus of this process is to understand the current state of health and social wellbeing in Doncaster and also to try to measure changes in the future, both in the short term (3-5 years) and in the long term (5-10 years). The JSNA process will be undertaken in consultation with the Director of Public Health as well as directors of Adult services, Children s Services and relevant commissioning leads. The input of the third sector will also be incorporated. The JSNA will but supervised by the Public Health Partnership Board. The JSNA will, where possible, fit with existing planning cycles so that data and analysis are available to inform the targets and milestones of the local authority and the PCT. Doncaster s JSNA has three components: Core data set Core data set report A report outlining major heath and wellbeing indicators and focusing on issues and developments at the district level (this report). Development of a local data observatory To explore the opportunities to follow up on the NKM project completed in April This work stream will enable major DtS partner to share data and enable new methods of needs assessment with joined up datasets. Community profiles Joint community profiles Doncaster PCT and local authority has produced a number of community profiles in recent years. This project will build on this work Enhanced public health profiles Joint commissioning This will be a set of individual reports that will support joint commissioning priorities. Children Older people Mental health Obesity Work Some of the elements of all of these pieces of work will be incorporated in to the Director of Public Health s annual report. This report of the core data for JSNA has been divided up into 5 sections, reflecting the domains of the JSNA: Demography, Social & Environmental Context, Lifestyle & Risk Factors, Burden of Ill-health & Disease, and Services. 1 Guidance on Joint Strategic Needs Assessment (2007) Department of Health 1

9 Index 1. Demography a. Population b. Births c. Ethnicity d. Migration 2. Social & Environmental Context a. Deprivation b. Living arrangements c. Economy d. Environment 3. Lifestyle & Risk Factors a. Behaviours b. Sexual behaviour c. Other risk factors 4. Ill-health & Disability a. All cause mortality b. Diabetes c. Circulatory disease d. Cancer e. Respiratory disease f. Infectious diseases g. Dental health h. Mental health i. Trauma 5. Services a. Health services b. Other services 2

10 Domain: Demography Doncaster has a resident population of about 290,300. Compared to England & Wales, Doncaster has a smaller proportion of the population aged There are more women aged over 65 than men. By 2012 the population is expected to have increased to 293,900 an average population increase of 900 people each year. By 2020 the Doncaster population is expected to top 300,000. Doncaster, in common with most of England & Wales is expected to have in increasingly elderly population. By 2012 the numbers of 0-19 year olds will have declined from 71,500 in 2006 to 68,600 a fall of almost 4,000. In the same period the number over 65 will have increased from 48,500 to around 54,000 an increase of more than 5,000. The birth rate, declining through most of the 1990s, has been increasing steadily since The proportion of the population from ethnic minorities remains smaller in Doncaster than in England & Wales. However certain groups have increased noticeably in recent years. The graph called Changes in ethnic populations illustrates these relative changes. Other important population present in Doncaster include: approximately 600 asylum seekers, 4,000-6,000 gypsy/travellers, and around 2,800 prisoners. Population Figure 1: 2006 population mid-year estimates by age group in Doncaster and England & Wales 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% % England & Wales Doncaster Source: Office of National Statistics 3

11 Figure 2: 2006 population mid-year estimates for Doncaster by age and sex ' Source: Office of National Statistics Male Female Figure 3: 2004 based population projections for Doncaster by broad age group ( ) ' Source: Office of National Statistics 4

12 Figure 4: 2004 based population projections in Doncaster by age group at 2010 and ' Source: Office of National Statistics Births Figure 5: Live Birth rates in Doncaster and England & Wales by year with forecast ( ) Live births per 1,000 population Source: Office of National Statistics England & Wales rate Doncaster rate Doncaster forcast 95% forcast interval 5

13 Ethnicity Figure 6: 2005 Ethnic population estimates (excluding White: British) in England and Doncaster White: Irish White: Other White Mixed: White and Black Caribbean Mixed: White and Black African Mixed: White and Asian Mixed: Other Mixed Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Asian Black or Black British: Black Caribbean Black or Black British: Black African Black or Black British: Other Black Chinese or Other Ethnic Group: Chinese Chinese or Other Ethnic Group: Other % Source: Office for National Statistics (Experimental statistics) England Doncaster Figure 7: Changes in ethnic populations (excluding White: British) in Doncaster White: Irish White: Other White Mixed: White and Black Caribbean Mixed: White and Black African Mixed: White and Asian Mixed: Other Mixed Asian or Asian British: Indian Asian or Asian British: Pakistani Asian or Asian British: Bangladeshi Asian or Asian British: Other Asian Black or Black British: Black Caribbean Black or Black British: Black African Black or Black British: Other Black Chinese or Other Ethnic Group: Chinese Chinese or Other Ethnic Group: Other '000 Mid 2001 Mid 2005 Source: Office for National Statistics (Experimental Statistics) 6

14 Migration Figure 8: Estimated migration projections in Doncaster ( ) ' Internal Migration Into Area International Migration Into Area Total Net Migration Source: Office of National Statistics Internal Migration Out of Area International Migration Out of Area 7

15 Domain: Social & Environmental Context Doncaster has an Index of Multiple Deprivation (IMD) score of and is the 41 st (out of 345) most deprived district in England. England has been divided into roughly similar sized areas called LSOAs (Large Super Output Areas). Doncaster has 193 LSOAs. Of these 21% are in the 10% most deprived LSOAs in the country. This figure increases to 36% in the Education, skills and training domain of the IMD. Doncaster has a higher proportion of its population in accommodation rented from the local authority. Levels of overcrowding in domestic households are lower in Doncaster (3.9%) compared to England & Wales (7.0%). The numbers of elderly people living alone are set in increase from 17,566 in 2008 to 20,042 in 2015, an increase of approximately 354 each year. A consistently lower proportion of the working age population is economically inactive. Economic inactive individuals are not employed and are not seeking work. This may be due to family commitments, ill-health or study. Doncaster has higher numbers of benefit claimants compared to England & Wales, especially incapacity benefits. However the numbers of claimants have been dropping, but not as fast as nationally. Average gross weekly earnings for both part-time and full-time workers in the district are lower than the national average, although they have been increasing at the same pace as nationally. Deprivation Figure 9: Areas of Doncaster in the nationally defined 10% most deprived LSOAs from the Index of Multiple Deprivation (2007) Source: Department of Communities & Local Government LSOA: Lower Super Output Area a small area geography with around 1,500 residents in each. Doncaster is divided into 193 LSOAs. Key: Red areas are LSOAs in the most deprived 10% 8

16 Figure 10: The proportion of the Doncaster population in the most deprived 10% and 20% of England s LSOAs according to the IMD 2007 and its domains 10% most deprived 20% most deprived Population % Population % IMD 61, , Income 38, , Employment 38, , Health Deprivation & Disability 63, , Education, Skills & Training 102, , Barriers to Housing & Services 23, , Crime & Disorder 66, , Living Environment 14, , IDACI 4, , IDAOPI 6, , Source: Department of Communities & Local Government IDACI: Income Deprivation Affecting Children Index; IDAOPI: Income Deprivation Affecting Older People Index LSOA: Lower Super Output Area a small area geography with around 1,500 residents in each. Doncaster is divided into 193 LSOAs. Each domain relates to the whole population with the exceptions of: Employment (16-59/64); ICACI (0-15); IDAOPI (60+) Populations as at 2005 excluding prisoners Living arrangements Figure 11: Housing tenure in England & Wales and Doncaster by household (2001) England & Wales Doncaster H/holds % H/holds % Owned 14,916, , Owns outright 6,380, , Owns with a mortgage 8,396, , Shared ownership 139, Social rented 4,157, , Rented from local authority 2,868, , Other social rented 1,288, , Private rented 2,141, , Private landlord or letting agency 1,888, , Employer of a household member 55, Relative or friend of household member 133, Other 63, Living rent free 445, , Total 21,660, , Source: Census 2001 Household: one person lining alone or a group of people (not necessarily related) lining at the same address with common housekeeping sharing either a living room or sitting room, or at least one meal a day. 9

17 Figure 12: Housing tenure in England & Wales and Doncaster by population (2001) England & Wales Doncaster Population % Population % Owned 36,462, , Owns outright 12,310, , Owns with a mortgage 23,528, , Shared ownership 323, Social rented 9,127, , Rented from local authority 6,339, , Other social rented 2,788, , Private rented 4,650, , Private landlord or letting agency 4,061, , Employer of a household member 149, Relative or friend of household member 284, , Other 155, Living rent free 866, , Total 51,107, , Source: Census 2001 Figure 13: Household over-crowding in England & Wales (2001) England & Wales Doncaster H/holds % H/holds % Very under occupied 10,731, , Under occupied 5,522, , Average 3,895, , Over crowded 1,066, , Very Over crowded 443, Total 21,660, , Source: Census 2001 Overcrowding is measured as the number of common rooms (excluding bathroom) per member of the household. An overcrowded household has 1 room less than required a very overcrowded one 2 or more room less than required. 10

18 Figure 14: Population in Doncaster aged 65 and over estimated to be living alone ( ) 14,000 12,000 10,000 8,000 6,000 4,000 2, Males Males 75+ Females Females 75+ Source: Projecting Older People Population Information System (POPPI) Figure 15: People living in dwellings without central heating (2001) England Doncaster No central % No central % heating heating People aged , , People aged , , People aged , Total aged , , Source: Projecting Older People Population Information System (POPPI) Figure 16: People in households without regular access to a car or van (2001) England & Wales Doncaster No access % No access % to a car to a car Aged 0 to 4 583, , Aged 5 to 15 1,192, , Aged 16 to , , Aged 18 to , , Aged 20 to , , Aged 25 to 44 2,267, , Aged 45 to 59 1,214, , Aged 60 to , , Aged 65 to 74 1,195, , Aged 75+ 1,925, , All 9,934, , Source: Census

19 Economy Figure 17: Economic inactivity and unemployment rates in England & Wales by sex (rolling annual rates) Persons - Unemployment Persons - Economic Inactivity % 4.0 % Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep 2007 England & Wales Doncaster England & Wales Doncaster Male - Unemployment Male - Economic Inactivity % 4.0 % Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep 2007 Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep 2007 England & Wales Doncaster England & Wales Doncaster Female - Unemployment Female - Economic Inactivity % % Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep 2007 England & Wales Doncaster Source: NOMIS (Official Labour Market Statistics) Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Dec 2004 Mar 2005 Jun 2005 Sep 2005 Dec 2005 Mar 2006 Jun 2006 Sep 2006 Dec 2006 Mar 2007 Jun 2007 Sep 2007 England & Wales Doncaster Figure 18: Benefit claimants of working age in Doncaster and England & Wales by benefit type (November 2007) Doncaster England & Wales Claimants % % Total claimants 31, Job seekers 4, Incapacity benefits 17, Lone parents 3, Carers 2, Others on income related benefits Disabled 2, Bereaved Source: NOMIS (Official Labour Market Statistics) Working age: Males 16-64, Females Clients categorised by the main reason for claiming benefit 12

20 Figure 19: Incapacity benefit claimants of working age in Doncaster and England & Wales ( ) 2,460,000 20,000 England & Wales (count) 2,440,000 2,420,000 2,400,000 2,380,000 2,360,000 2,340,000 2,320,000 2,300,000 2,280,000 2,260,000 19,500 19,000 18,500 18,000 17,500 17,000 16,500 16,000 Doncaster (count) 2,240,000 15,500 Aug-99 Nov-99 Feb-00 May-00 Aug-00 Nov-00 Feb-01 May-01 Aug-01 Nov-01 Feb-02 May-02 Aug-02 Nov-02 Feb-03 May-03 Aug-03 Nov-03 Feb-04 May-04 Aug-04 Nov-04 Feb-05 May-05 Aug-05 Nov-05 Feb-06 May-06 Aug-06 Nov-06 Feb-07 May-07 Aug-07 Nov-07 Source: NOMIS (Official Labour Market Statistics) Working age: Males 16-64, Females England & Wales Doncaster Figure 20: Median gross weekly earnings in Doncaster and England & Wales ( ) England & Wales Male Full Time Workers Doncaster Male Full Time Workers England & Wales Female Full Time Workers Doncaster Female Full Time Workers 13

21 Environment Figure 21: Urban and rural classification by area and population (2005) Area Population Hectares % Number % Urban 17, , Rural Town and Fringe 4, , Village 19, , Hamlet & isolated dwellings 15, , Total 56, ,828 Source: Department for Environment, Food & Rural Affairs, Office of National Statistics Urban areas are areas with more than 10,000 residents Figure 22: Population density in Doncaster Source: Public Health Intelligence Unit, Doncaster PCT Darker blue indicates greater population density 14

22 Figure 23: Area classification by population in Doncaster (2005) OA area classification (Supergroup) OA area classification (Group) Population % Blue collar communities Older blue collar 38, Terraced blue collar 21, Younger blue collar 51, City living Settled in the city 1, Constrained by circumstances Older workers 20, Public housing 4, Senior communities 2, Countryside Accessible countryside 6, Agricultural 4, Village life 9, Multicultural Asian communities 5, Prospering suburbs Prospering older families 27, Prospering semis 38, Prospering younger families 12, Thriving suburbs 6, Typical traits Aspiring households 3, Least divergent 8, Settled households 15, Young families in terraced homes 12, Source: Office for National Statistics Access to services See Figure 10 for barriers to services from the IMD

23 Domain: Lifestyle & risk factors It is estimated that Doncaster has between 67,000 and 68,100 smokers aged over 16. This translates to a rate of about 29.1% compared to the England & Wales rate of 25.5%. 19.7% of deaths in Doncaster are smoking related. The proportion of women who are still smoking at delivery has remains the same over the last 2 years. Around 21% of people in Doncaster are thought to have consumed 5 or more portions of fruit or vegetables a day in the last week. A similar proportion (22%) have consumed more than the recommended intake of alcohol. Alcohol related mortality rates have been increasing in Doncaster (particularly amongst men). A trend analysis shows that Doncaster mortality rate will increase at a greater rate than England & Wales. Hospital admissions relating to drug mis use have increase in the last year. Breastfeeding uptake rates have been falling in Doncaster. Teenage conceptions rates in Doncaster are significantly higher than England and do not appear to be reducing. Rates of obesity (BMI 30+) among people aged over 16 are estimated to be 22.8% compared to the national rate of 22.6%. Childhood obesity appears to be broadly in line with national trends. Behaviours Smoking Smoking is estimated to be more prevalent in Doncaster compared to England. Around 25.5% of the population aged 16 and over, smoke in the country as a whole. In Doncaster this figure is estimated to be around 29.1%. This means that between 67,083 and 68,104 people in this age group smoke. In the years between 2001 and 2005 Doncaster saw 15,392 deaths of these 3,026 (19.7%) were smoking related. Source: Health survey for England (2006) & Office for National Statistics, PHIU Doncaster PCT Figure 24: Women smoking at delivery in Doncaster ( ) Apr-06 May-06 Jun-06 Jul-06 Aug-06 Sep-06 Oct-06 Nov-06 Dec-06 Jan-07 Feb-07 Mar-07 Apr-07 May-07 Jun-07 Jul-07 Aug-07 Sep-07 Oct-07 Nov-07 Dec-07 % Source: Performance and Information Directorate, Doncaster PCT The rate is calculated using confinements at Doncaster Royal Infirmary 16

24 Figure 25: Breastfeeding rates in England & Wales and Doncaster ( ) % England & Wales Doncaster (Discharge) Doncaster (6-8 days) Doncaster (6-8 weeks) Source: Infant Feeding Surveys, NHS Information Centre (IC), DBH Child Health England & Wales data are breastfeeding initiation rates. Alcohol Alcohol consumption levels in Doncaster have been estimated by ONS (Office for National Statistics). These figures show that between 19.8% and 28.8% of people aged over 16 have been binge drinking in the past week. Binge drinking is men drinking 8 or more and women 6 or more units of alcohol in one day. Source: Office for National Statistics A unit is equivalent to 8g or 10ml of pure alcohol Estimates apply to the period

25 Figure 26: Alcohol related mortality rates in Doncaster ( ) Rate per 100, Males Females 95% Confidence Interval Rate Source: Office for National Statistics (Heath Trends) Alcohol related causes of deaths include: accidental poisoning by and exposure to alcohol, alcoholic liver disease, cardiomyopathy, chronic hepatitis, fibrosis and cirrhosis of liver, mental and behavioural disorders due to use of alcohol. Figure 27: Age standardised mortality rates from chronic liver disease including cirrhosis in England & Wales and Doncaster with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Chronic liver disease: ICD9 571 adjusted, ICD10 K70, K73-K74) 18

26 Figure 28: Directly standardised hospital admission rates in people age 18+ for drug misuse in Doncaster (2002/ /07) Rate per 100, / / / / /07 95% confindence Interval Rate Source: Doncaster PCT: Public Health Intelligence Unit & Performance and Information Directorate Drug related admissions: ICD10: F11 - F16, F19, X40 - X44, X60 - X64, X85, Y10 - Y14 Diet The Office for National Statistics estimate that in Doncaster between 19.3% and 23.3% of the 16+ population eat 5 or more portions of fresh fruit a day. Source: Office for National Statistics Obesity The prevalence of obesity is estimated to be higher in adults in Doncaster than England & Wales. The heath survey for England shows that amongst people aged over 15 about 22.6% are obese. In Doncaster it is estimated that this figure is between 25.5% and 30.3%. (or between 57,192 and 58,134 people) Source: Health Survey for England 2004, Office for National Statistics Obesity is a Body Mass Index (BMI) greater then 30 (BMI = weight (Kg)/height (m) 2 19

27 Figure 29: Children who are over-weight or obese in Doncaster and England & Wales (2006/07) % Reception Year 6 Reception Year 6 Overweight Obese Doncaster England & Wales Source: National Child Measurement Programme Overweight: children above 85 th percentile and below 95 th percentile. Obese: Children above 95 th percentile Reception: 4 to 5 year olds. Year 6: 10 to 11 year olds Hypertension It has been estimated that Doncaster will have about 70,793 (or between 70,272 and 71,316) with hypertension. This is about 24.4% of the population aged 16 or over. Source: Doncaster PCT, PHIU Hypertension is chronically high blood pressure (blood pressure exceeding 140 over 90 mmhg -- a systolic pressure above 140 with a diastolic pressure above 90) 20

28 Sexual behaviour Figure 30: Conception rates in Doncaster and England among females aged under 18 with forecast and 95% confidence intervals ( ) Rate per 1,000 females Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: Teenage pregnancy Unit and Office for National Statistics Under 18 conceptions are calculated as the number of births, still births and abortions amongst females aged under 18 as a rate per 1,000 females aged Other risk factors Figure 31: Low birth weight rates in Doncaster and England & Wales with forecast and 95% confidence intervals ( ) % Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) and Doncaster PCT 21

29 Domain: Ill-health and disability All cause mortality rates in Doncaster have been falling since the early 1990s, but Doncaster s rate has remained consistently higher than England & Wales. Male life expectancy, if current trends continue will remain significantly lower than the nations. Infant mortality rates appear to have reduced slightly over time but the high amount of variation from year to year makes a trend difficult to discern. 35.5% of men and 43.7% of women die from cancer, and 34.4% of men and 27.1% of women die from circulatory diseases (CHD, Stroke). Premature mortality from circulatory disease has been falling dramatically in Doncaster and look to be indistinguishable from the national rate in the next few years. Stroke mortality is not falling as dramatically as deaths from Coronary heart disease. Premature cancer mortality in Doncaster is significantly higher in Doncaster; especially lung cancer and stomach cancer. Respiratory disease mortality in Doncaster s very high compared to national levels. Children s dental health is worse than the national rate. Doncaster, in common with most other parts of the country has an ageing population and with this will come increasing number of elderly people with severe mental health problems and dementia. All cause mortality Figure 32: All age, all cause, age standardised mortality rates in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) 22

30 Figure 33: Male life expectancy at birth in Doncaster and England & Wales with forecast ( to ) Age Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Figure 34: Female life expectancy at birth in Doncaster and England & Wales with forecast ( to ) Age Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) 23

31 Figure 35: Infant mortality rates in Doncaster and England & Wales with forecast ( ) Rate per 1, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: PHIU Doncaster PCT & ONS Infant mortality rate: deaths under 1 year per 1,000 live births 24

32 Figure 36: Underlying cause of death aged under 75 in men and women in Doncaster ( ) Males Females Infant deaths 1.4% 1.9% Infectious Diseases 0.5% 0.3% Oesophageal cancer 1.6% 0.9% Stomach Cancer 2.2% 1.9% Colorectal Cancer 3.5% 3.4% Pancreatic cancer 1.4% 1.8% Lung cancer 10.2% 10.8% Breast cancer - 7.4% Cervical cancer - 0.8% Ovarian cancer - 3.0% Prostate cancer 2.7% - Bladder cancer 0.9% 0.6% Kidney Cancer 1.3% 1.1% Other Cancer 11.2% 11.7% Diabetes Mellitus 0.9% 1.0% Mental disorders 1.6% 0.6% Diseases of the central nervous system 2.6% 2.7% Coronary heart disease 23.5% 14.9% Stroke 5.3% 5.9% Aortic Aneurysm 1.6% 1.1% Other circulatory diseases 4.0% 5.2% Pneumonia 1.9% 2.1% Respiratory diseases Chronic obstructive lung disease 5.7% 7.3% Other respiratory diseases 1.6% 1.7% Diseases of the digestive system 5.6% 5.6% Accidents 3.3% 1.8% Suicide 2.7% 1.0% Other causes 2.8% 3.5% Source: PHIU, Doncaster PCT 25

33 Self reported measures of Ill health Figure 37: Limiting long-term illness rates in men and women in England & Wales and Doncaster (2001) % England & Wales Doncaster England & Wales Doncaster England & Wales Doncaster All ages Males (all ages) Females (all ages) Source: 2001 Census Limiting long-term illness covers any long-term illness, health problem or disability which limits daily activities or the work a person can do. Rates are age standardised Figure 38: Limiting long-term illness rates by age group in England & Wales and Doncaster (2001) % England & Wales Doncaster England & Wales Doncaster England & Wales Doncaster under Source: 2001 Census Limiting long-term illness covers any long-term illness, health problem or disability which limits daily activities or the work a person can do. Rates are age standardised 26

34 Figure 39: Age standardised mortality rates from causes considered amenable to healthcare in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Causes considered amenable to healthcare: Intestinal infections (ICD-10 A00-A09, ICD , ages 0-14 years; Tuberculosis (ICD-10 A15-A19, B90; ICD , 137), ages 0-74 years; Other infectious diseases (diptheria, tetanus, poliomyelitis) (ICD-10 A36, A35, A80; ICD-9 032, 037, 045), ages 0-74 years; Whooping cough (ICD-10 A37, ICD-9 033), ages 0-14 years; Septicaemia (ICD-10 A40-A41, ICD-9 038), ages 0-74 years; Measles (ICD-10 B05, ICD-9 055), ages 1-14 years; Malignant neoplasm of colon and rectum (ICD-10 C18-C21, ICD ), ages 0-74 years; Malignant neoplasm of skin (ICD-10 C44, ICD-9 173), ages 0-74 years; Malignant neoplasm of female breast (ICD-10 C50, ICD-9 174), ages 0-74 years; Malignant neoplasm of cervix uteri (ICD-10 C53, ICD-9 180), ages 0-74 years; Malignant neoplasm of unspecified part of the uterus and body of the uterus (ICD-10 C54-C55, ICD-9 179, 182), ages 0-44 years; Malignant neoplasm of testis (ICD-10 C62, ICD-9 186), 0-74 years; Hodgkin's disease (ICD-10 C81, ICD-9 201), ages 0-74 years; Leukaemia (ICD-10 C91-C95, ICD ), ages 0-44 years; Diseases of the thyroid (ICD-10 E00-E07, ICD ), ages 0-74 years; Diabetes mellitus (ICD-10 E10-E14, ICD-9 250), ages 0-49 years; Epilepsy (ICD-10 G40-G41, ICD-9 345), 0-74 years; Chronic rheumatic heart disease (ICD-10 I05- I09, ICD ), ages 0-74 years; Hypertensive disease (ICD-10 I10-I13, I15; ICD ), ages 0-74 years; Ischaemic heart disease (ICD-10 I20-I25, ICD ), ages 0-74 years; Cerebrovascular disease (ICD-10 I60- I69, ICD ), ages 0-74 years; All respiratory diseases (excl. pneumonia, influenza and asthma) (ICD-10 J00- J09, J20-J44, J47-J99; ICD , , ), ages 1-14 years; Influenza (ICD-10 J10-J11, ICD-9 487), ages 0-74 years; Pneumonia (ICD-10 J12-J18, ICD ), ages 0-74 years; Asthma (ICD-10 J45-J46, ICD-9 493), ages 0-44 years; Peptic ulcer (ICD-10 K25-K27, ICD ), ages 0-74 years; Appendicitis (ICD-10 K35- K38, ICD ), ages 0-74 years; Abdominal hernia (ICD-10 K40-K46, ICD ), ages 0-74 years; Cholelithiasis & cholecystitis (ICD-10 K80-K81, ICD ), ages 0-74 years; Nephritis and nephrosis (ICD-10 N00-N07, N17-N19, N25-N27; ICD ), ages 0-74 years; Benign prostatic hyperplasia (ICD-10 N40, ICD-9 600), ages 0-74 years; Maternal deaths (ICD-10 O00-O99, ICD ), ages 0-74 years; Congenital cardiovascular anomalies (ICD-10 Q20-Q28, ICD ), ages 0-74 years; Perinatal deaths (all causes excl. stillbirths), ages 0-6 days; Misadventures to patients during surgical and medical care (ICD-10 Y60-Y69, Y83-Y84; ICD-9 E870-E876, E878-E879), ages 0-74 years Diabetes Data from general practice in Doncaster show that Doncaster has 14,242 patients aged over 16 who are registered with Doncaster practices and have Diabetes. The estimated number is between 12,743 and 13,452. Source: QMAS (Quality Management and Analysis System) and Doncaster PHIU 27

35 Circulatory disease Figure 40: Age standardised circulatory disease mortality rates (under 75) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Circulatory diseases: (ICD-10 I00-I99, ICD ). Figure 41: Age standardised coronary heart disease mortality rates (under 75) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Coronary heart disease: (ICD-10 I20-I25, ICD ). 28

36 Coronary Heart Disease (CHD) prevalence (2008) Data from general practice in Doncaster show that Doncaster has 14,397 patients registered with Doncaster practices who have CHD. The estimated number is between 15,232 and 16,005. Source: QMAS (Quality Management and Analysis System) and Doncaster PHIU Figure 42: Age standardised stroke mortality rates (under 75) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Stroke: (ICD-10 I60-I69, ICD ). Stroke and TIA (Transient Ischaemic Attack) prevalence (2008) Data from general practice in Doncaster show that Doncaster has 6,448 patients, registered with Doncaster practices, who have had a stroke or TIA. The estimated number is between 5,530 and 6,000. Source: QMAS (Quality Management and Analysis System) and Doncaster PHIU 29

37 Cancer Figure 43: Age standardised all cancer mortality rates (under 75) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) All cancers: (ICD-10 C00-C97, ICD ). Figure 44: Age standardised colorectal cancer mortality rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Colorectal cancer: (ICD-10 C17-C21, ICD ). 30

38 Figure 45: Age standardised lung cancer mortality rates (under 75) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Lung cancer: (ICD-10 C33-C34, ICD-9 162). Figure 46: Age standardised female breast cancer mortality rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Breast cancer: (ICD-10 C50, ICD-9 174). 31

39 Figure 47: All cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of all cancers (ICD exc. 173, ICD10 C00-C99 exc. C44) Figure 48: Breast cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of breast cancer (ICD9 174, ICD10 C50) 32

40 Figure 49: Colorectal cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of colorectal cancer (ICD , ICD10 C17-C21) Figure 50: Lung cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of lung cancer (ICD9 162, ICD10 C33-C34) 33

41 Figure 51: Prostate cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of prostate cancer (ICD9 185, ICD10 C61) Figure 52: Stomach cancer registrations in Doncaster and England & Wales with forecast ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Incidence of stomach cancer (ICD9 151, ICD10 C16) 34

42 Respiratory disease Figure 53: Age standardised respiratory disease mortality rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Respiratory disease: (ICD-10 J40-J44, ICD , 496). Respiratory disease prevalence (2008) Data from general practice in Doncaster show that Doncaster has 7,551 patients, registered with Doncaster practices, who have respiratory disease. The estimated number is between 6,870 and 7,393. Source: QMAS (Quality Management and Analysis System) and Doncaster PHIU Figure 54: Incidence of tuberculosis in Doncaster & England & Wales with 95% confidence intervals ( ) Rate per 100, England & Wales Doncaster England & Wales Doncaster England & Wales Doncaster England & Wales Doncaster Source: Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) 35

43 Infectious diseases Figure 55: Numbers of Gonorrhoea diagnoses in Doncaster Heath services ( ) Number Source: GUM Medicine, Doncaster and Bassetlaw HNS Trust Male Female Figure 56: Numbers of HIV positive diagnoses in Doncaster Heath services ( ) Numbers Source: GUM Medicine, Doncaster and Bassetlaw HNS Trust Diagnoses 36

44 Dental health Figure 57: Changes in Dental Health in 5 Year Olds in Doncaster Decayed Teeth Missing Teeth Filled Teeth Teeth Affected / / / /92 England Doncaster England Doncaster England Doncaster England Doncaster England Doncaster England Doncaster England Doncaster Year 1993/ / / / / / /06 37

45 Mental health Figure 58: Age standardised suicides & undetermined injuries rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Suicide & injury undetermined: (ICD-10 X60-X84, Y10-Y34 exc. Y33.9, ICD-9 E950-E959 and E980-E989 exc. E988.8). Figure 59: Projected estimated prevalence of depression and severe depression amongst 65+ population in Doncaster ( ) Year Depression Lowest estimate 4,960 5,140 5,760 6,230 6,840 Highest estimate 7,440 7,710 8,640 9,345 10,260 Severe Lowest estimate 1,488 1,542 1,728 1,869 2,052 depression Highest estimate 2,480 2,570 2,880 3,115 3,420 Source: Projecting Older People Population Information System (POPPI) Figure 60: Projected estimated prevalence of dementia in men and women by age group among 65+ in Doncaster Age group Males ,169 1,221 1,410 1,614 1,844 Females ,033 1,134 1,260 1, ,161 2,234 2,405 2,652 3,030 Persons 65+ 3,330 3,455 3,814 4,265 4,874 Source: Projecting Older People Population Information System (POPPI) 38

46 Trauma Figure 61: Age standardised mortality due to falls rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Falls: (ICD-10 W00-W19, ICD-9 E exc. E887). Figure 62: Age standardised transport accidents mortality rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Land transport accidents (ICD-10 V01-V89, ICD-9 E800-E829). 39

47 Figure 63: Age standardised accident mortality rates (all ages) in England & Wales and Doncaster with forecasts ( ) Rate per 100, Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Accidents: (ICD-10 V01-X59, ICD-9 E800-E928 excluding E870-E879). Figure 64: Age standardised serious accident admission rates (all ages) in England & Wales and Doncaster with forecasts (1995/ /16) Rate per 100, / / / / / / / / / / / / / / / / / / / / /16 Doncaster Doncaster Forcast 95% Confidence Intervals England & Wales England Forcast Source: National Clinical and Health Outcomes Knowledge Base (NCHOD) Hospital admissions for serious accidental injury, with a length of stay exceeding 3 days (ICD-10 primary diagnosis in the range S00-T98 and external cause code in the following ranges: V01-V99, W00-X59, Y40-Y84). 40

48 Domain: Services Smoking cessation services are continuing to increase both the numbers using the service and the numbers of successful quitters. The proportions of eligible women using cancer screening services remains above the national rate, but along with England there appears to be a decline. Health services Figure 65: Numbers of clients who set a quit data and successfully quit smoking at Doncaster s Smoking Service (2002/03 to 2007/08) 6,000 5,000 4,000 Numbers 3,000 2,000 1, / / / / / /08 Set quit data Quiters Source: Doncaster Stop Smoking Service Quitters have either had their status confirmed by CO monitor or self confirmed their status 41

49 Cancer screening Figure 66: Breast screening coverage amongst women aged in Doncaster and England ( ) % England Doncaster Source: NHS screening programmes ( Figure 67: Cervical screening amongst women aged in Doncaster and England ( to ) % England Doncaster Source: NHS screening programmes ( 42

50 Doncaster Community Profiles 2007 Balby This profile of the health of the population of Balby presents a range of indicators of health and the determinants of health. It is hoped that these profiles will be used to improve health, reduce health and social inequalities and monitor local services. Additional resources are available at: Population and Demography Balby Doncaster Total Population 19, ,828 Geographical Area 8.0km² 567km² Population Density 2,463 people per km² 511 people per km² Balby Doncaster Balby Doncaster Age Distribution Ethnicity Age-band 0-4 1,336 ( 6.8%) 5.8% White 18,596 (94.0%) 96.6% Age-band ,560 (12.9%) 12.7% Mixed 247 ( 1.2%) 0.8% Age-band ,929 (65.3%) 64.9% Asian/Asian British 511 ( 2.6%) 1.5% Age-band ,589 ( 8.0%) 9.0% Black/Black British 306 ( 1.5%) 0.7% Age-band 75+ 1,379 ( 7.0%) 7.7% Chinese/Other 132 ( 0.7%) 0.5%

51 Balby Population Pyramid Age Groups Males Females People in each age group Deaths and Life Expectancy Balby Doncaster M ale Life Expectancy at birth Female Life Expectancy at birth 72.6 (72.2, 73.1) 75.1 (76.6, 78.2) 79.9 Across all ages there were 1161 deaths of Balby residents in Of these it is estimated that 210 (18%) were caused by smoking A ty R % Deaths % +/ average Relative to Doncaster ll Cause Mortali ate All Cancers % Colorectal Cancer 6 52% Lung Cancer % Breast Cancer (Females) % Circulatory Disease % CHD % Stroke % Chronic Lung Disease % Accidents (all ages) % Death rates per 100, 000 resident population per year, , directly standardised for age and sex wi th 95% confidence intervals (in brackets). Ages under 75 unless stated. and indicate, respectively, significantly lower and higher death rates than the Doncaster average (p<5) and not significantly different from the avarage. or indicate extremely high or low values (p<02). Where there are fewer than 5 deaths the number is not shown. Source: ONS Annual Death Extracts and 2001 Census populations.

52 Cancer Incidence Rates Balby Number % +/ average Relative to Doncaster All Cancers 468 6% Colorectal Cancer 46 6% Lung Cancer 62 4% Breast Cancer (females) 51 8% Prostate Cancer (males) 23 20% Skin Cancer % Cancer registration rates per 100,000 resident population per year, , directly standardised for age and sex with 95% confidence intervals (in brackets), for all ages. Symbols indicate significance as described for death rates. Where there are fewer than 5 deaths the number is not shown. Source: Trent Cancer Registry registration data and 2001 Census populations. Cancer Screening Cervical Cytology (Feb 2004) Balby 79.1% (77.9%, 80.3%) Doncaster 82.8% Population Health Indicators Balby Number % +/ average Relative to Doncaster People with limiting long-term illness 4, % People with 'not good' general health 2, % The percentages above/below average show comparisons with the Doncaster average. A positive score indicates that there are proportionately more people in Balby with limiting long-term illness/disability or 'not good' health than expected. The comparative percentages have been standardised to take account of the age of the local population. General Deprivation Indicators Classification of Household Deprivation Source: Census 2001 Table UV067 Balby 35.3% deprived, ranked 22 of the 88 Doncaster Communities Quintile 3 (middle quintile) 2004 Indices of Deprivation Doncaster rank Quintile ranking Overall Deprivation Score 12 of 88 Quintile 1 Barriers to Housing & Services Domain 44 of 88 Quintile 2 Crime Domain 13 of 88 Quintile 2 Education, Skills & Training Domain 18 of 88 Quintile 2 Employment Domain 14 of 88 Quintile 2 Health & Disability Domain 19 of 88 Quintile 2 Income Domain 13 of 88 Quintile 1 Living Environment Domain 7 of 88 Quintile 1 In all the above domains, rank 1 is the most deprived community in Doncaster and quintile 1 contains the most deprived 20% of the population of Doncaster. Source: DETR Indices of Deprivation 2004

53 Hospital Admission Rates Emergency Admissions (all ages) Emergency Admissions (over 75s) Admissions for Serious Accidents Balby Doncaster (101.5, 106.4) (322.4, 354.2) (299.1, 389.8) Emergency admission rates per 1,000 resident population per year. Serious accident admission rates per 100,000 resident population per year. All rates for 2001/2 2003/4, directly standardised for age and sex, with 95% confidence intervals (in brackets). Symbols indicate significance as described for death rates. For small communities, the numbers of cases are too small to release. Source: Contract data sets from Acute Trusts and 2001 Census populations. Births and Child Health There were 857 births in Balby between 2003 and The general period fertility rate is 68.0 live births per 1,000 women aged 15 44, significantly above the Doncaster average of 62.2 per 1,000. Balby Doncaster % low birth weight 9.7% (7.8%, 7.9% 11.9%) Low birth weight babies (below 2.5kg) as a percentage of all live and still births with 95% confidence intervals (in brackets). Source: ONS Annual Birth Extracts, Dental Health Data The 2001/2 survey of 5 year-old school pupils gives the extent of dental decay: Balby % +/ average Relative to Doncaster Decayed, missing or filled teeth per child % Number of decayed, missing or filled teeth per child with 95% confidence intervals (in brackets). Source: Doncaster 5 Year-Old School Survey, 2001/2. Modelled Prevalence Data Using national survey data, we can predict that, in Balby: 987 adults (5.0% of the 16+ population) have CHD 317 people (3.5% of the population) have diabetes 476 people (2.4% of the population) have COPD 1,830 people (9.2% of the population) have asthma 218 adults (1.1% of the population) have dementia 348 adults (1.8% of the population) have had a stroke 265 people (1.3% of the population) have heart disease?? 4,505 adults (22.8% of the population) have hypertension 3,651 adults (18.4% of the 16+ population) are obese 78 adults (0.4% of the population) have mental health problems Socio-economic Indicators Balby Number % +/ average Relative to Doncaster Children in households with no earner 1, % People in households with Lone parents 2, % Carers (providing unpaid care) 2,017 2% People with no qualifications 5, % People working over 48 hours a week % People not employed 3, % People in low social grades 4, % Households with no car 3, % Overcrowded households % Households without central heating % Vacant properties % Housing Tenure Balby Doncaster Owned (including mortgaged) 61.1% 72.1% Social rented (Council, housing assoc., etc) Private rented 28.0% 8.0% 19.8% 5.7% Living rent-free 2.9% 2.3% The percentages above/below average show comparisons with the Doncaster average. A positive score indicates th at there are proportionately more people or households in Balby meeting the criteria than expected. The car ownership figure is standardised to take account of household composition and the qualifications figure is standardised for age. Housing tenure figures are percentages of population according to tenure of their household. Source: 2001 Census (except for Vacant properties - calculated by Rotherham MBC from Council Tax data).

54 Balby Contacts and General Information Doncaster PCT White Rose House, Ten Pound Walk, Doncaster, DN4 5DJ Tel: Fax: Jayne Brown Chief Executive Tony Baxter Director of Public Health Electoral Wards: Parliamentary Constituency: Member of Parliament: Government Balby and Central Doncaster Central Rosie Winterton Community Development Neighbourhood Management Area: Urban Centre Community Forum: Central 2 Schools Balby falls within the catchment area of Balby Carr Community College The primary schools attended by most children in Balby are: Balby Central Primary and Mallard Primary (note: this information is approximate and varies from year to year) Sure Start / New Deal for Communities Projects Part of Balby is included in the New Deal for Communities Project Health Visitors Balby is covered by the Balby & Hexthorpe and Hyde Park & Belle Vue teams Nearest Young Peoples / Sexual Health Clinics Choices, Chequer Road Clinic, Doncaster Medical Centre, 2 Francis Street, Doncaster GP Practices The practices listed below either serve at least 20% of Balby's resident population or are attended by at least 20% of Balby's resident population: Dr AM LeVann & partners, The Scott Practice, Greenfield Lane, Balby Dr HW Orridge & partners, St John s Group Practice, Greenfield Lane, Balby The Dove Primary Care Centre, Devonshire House, Cavendish Court, South Parade, Doncaster Public Health Intelligence Unit The Doncaster Public Health Intelligence Unit provides analytical support to the public health directorate in Doncaster Primary Care Trust Doncaster Public Health Intelligence Unit Doncaster PCT, White Rose House, Ten Pound Walk, Doncaster, DN4 5DJ Tel: , Fax: See the PHIU Website for the Interactive Community Database

55 NEIGHBOURHOOD KNOWLEDGE MANAGEMENT Key Stage 2 Attainment in Doncaster Tailoring services to local needs Aims Doncaster MBC and Doncaster PCT, using neighbourhood renewal funding, commissioned Mayhew Associates (MA) to undertake a detailed assessment of population and deprivation in Doncaster. Based on administrative data sources, MA nkm techniques were used to estimate the Doncaster population. Using the database created, this case study identifies sub-groups most at risk of achieving lower quartile scores at Key Stage 2 (KS2 LQ). KS 2 tests are sat at age 11 by all pupils in all state schools. By lower quartile we mean that, after aggregating the scores for each test and then ranking the combined scores from high to low, we identified those in the lower quartile of results and used this as our risk outcome. Understanding the kinds of factors that may be associated with or contribute to a child being in the lower quartile can help to tailor interventions to particular schools and children. Our starting point was all children sitting KS2 in What we did In partnership with the PCT and local authority, we obtained and linked data from each agency to the Local Property Gazetteer. We then risk assessed 2006 KS2 pupils using the following socio-demographic risk factors: single-parent household, local authority housing tenure, English as a second language and Special Educational Needs (SEN) to see which were most linked to being in the lower quartile score (see table). Row number in category singleparent household live in local authority housing English as a second language special educational needs (SEN) % in KS1 lower quartile 95% confidence interval 1 22 Y Y 90.9 (70.8, 98.9) 2 9 Y Y Y 88.9 (51.8, 99.7) Y Y 83.5 (77.0, 88.9) 4 83 Y Y Y 80.7 (70.6, 88.6) Y 70.5 (66.0, 74.7) Y Y 69.0 (60.7, 76.5) 7 3 Y Y Y 66.7 (9.4, 99.2) 8 9 Y Y 33.3 (7.5, 70.1) 9 33 Y 30.3 (15.6, 48.7) Y 27.3 (21.5, 33.8) Y Y 22.6 (16.4, 29.7) Y 17.8 (14.4, 21.6) 13 1, (12.3, 15.5) 14 4 Y Y (, 52.7) 15 0 Y Y Y 16 0 Y Y Y Y NEIG HB OURHOOD KNOWLEDG E MANAG EMENT Mayhew Associates Ltd lesmayhew@ googl .com Outputs total 3, (29.1, 32.1) Risk table demonstrating relative risk factors for KS2 LQ: Base: all KS2 pupils 2006 Our logistic regression model confirmed that each of the factors was statistically significant, with the exception of single-parent households, and each had the tendency to increase the odds of falling into the lower quartile. Odds increased by 1.9 times for those living in local authority housing and 2.3 times where English was a child s second language. The results are very similar to those obtained for pupils sitting KS1 at age 7. SEN is obviously a strong predictor of lower quartile KS2 results, increasing the odds of 14 times (compared with 19 times at KS1). A quarter of SEN children are not in the lower quartile at KS2, as for KS1.

56 NEIGHBOURHOOD KNOWLEDGE MANAGEMENT Teenage Motherhood in Doncaster Tailoring services to local needs NEIG HB OURHOOD KNOWLEDG E MANAG EMENT Mayhew Associates Ltd lesmayhew@ googl .com Aims Doncaster MBC and Doncaster PCT, using neighbourhood renewal funding, commissioned Mayhew Associates (MA) to undertake a detailed assessment of population and deprivation in Doncaster. Based on administrative data sources, MA nkm techniques were used to estimate the Doncaster population. Using the database created, this case study identifies sub-groups and areas most at risk of teenage mothers. Doncaster has one of the highest rate of teenage pregnancy in the country and so it was important to generate a detailed risk profile. We therefore undertook an analysis of pregnancies that went to term among 13 to 19 year olds over the last 6 years. Map showing the density of females aged 13 to 19 at highest risk of What we did In partnership with the PCT and local authority, we obtained and linked data from each agency to the Local Property Gazetteer. We then risk assessed all current teenage mothers using the following socio-demographic risk factors: local authority housing tenure, single-parent household and Free School Meal eligibility (a proxy for low-income) to see which were most linked to teenage motherhood. We mapped the density of girls with the highest risk profiles so as to enable the PCT to identify the areas and sub-groups most at risk (see map). Outputs Row number in category live in local authority housing singleparent household free school meal eligible household % giving birth when aged <20 95% confidence interval Y 5.1 (3.6, 6.9) Y Y 5.0 (3.1, 7.6) Y Y Y 3.3 (1.6, 6.0) Y Y 2.3 (1.1, 4.2) 5 1,431 Y 2.2 (1.5, 3.1) Y 1.8 (0.7, 3.9) 7 7, (1.1, 1.6) Y Y 1.0 (0.1, 3.6) total 11,378 1,885 2,333 1, (1.7, 2.2) Risk table demonstrating relative risk factors for teenage births: Base: all females aged Dec 2006; births time period from 01/01/2000 to 31/12/2006 The table shows that the overall birth rate was 1.9%, rising to 5.1% if living in social housing. Our logistic regression model showed that local authority housing was the most important of the three risk factors increasing the odds of giving birth 3.1 times, with living in a single-parent household increasing odds 1.4 times. However, if a low income household with 1+ children on FSM was present, this reduced the odds of birth 0.6 times. All three risk factors were statistically significant.

57 NEIGHBOURHOOD KNOWLEDGE MANAGEMENT Childhood Obesity in Doncaster Tailoring services to local needs NEIG HB OURHOOD KNOWLEDG E MANAG EMENT Mayhew Associates Ltd lesmayhew@ googl .com Aims Childhood obesity is on the rise in the UK and is linked to the increase in unhealthy diets and the reduction in exercise among children. However, like many health problems, obesity is thought to be influenced by many different socio-economic, environmental and behavioural factors. This study aimed to analyse local risk factors for childhood obesity. What we did We used nkm matching techniques to link data from school survey data on children s body mass index (BMI) with health and socio-economic data from other local administrative data sets. From these matched data we were able to identify factors significantly associated with obesity. Using statistical models we studied the influence of: Gender Breastfeeding history Single Parent households Eligibility for Free School Meals Outputs The analysis showed significant associations between obesity and gender, breastfeeding history and single-parent status, with no significant link with eligibility for free school meals. Row number in category We used data from the school survey of children in Reception (age 4-5) for 2004/5, 2005/6 and 2006/7. We had 6,298 children with valid data for all the factors. The odds of being obese were 38% higher for boys than for girls and 34% higher for children in single-adult households than for other children. However, the odds of being obese were 21% lower for children who had been breast fed (at least initially in hospital) than for those who had not. These factors from the statistical model are illustrated in the graph above. The prevalence varies from 4% to 9%, depending on the combination of factors. The table shows the numbers of children in the study with each combination of factors and the actual prevalence of obesity in each group, which are similar to the results of the statistical model. The results reinforce the importance of breast feeding, and may be used, along with emerging evidence of effective interventions, to help target future initiatives to tackle the obesity epidemic. male breast fed as a baby single parent household % obese 95% confidence interval Y Y 9.1 (6.7, 12.0) Y Y Y 8.5 (5.5, 12.5) Y 6.7 (4.6, 9.4) 4 1,285 Y 6.5 (5.2, 7.9) 5 1,200 Y Y 6.1 (4.8, 7.6) 6 1, (4.6, 7.3) Y Y 4.8 (2.6, 8.1) 8 1,050 Y 3.5 (2.5, 4.8) total 6,298 3,240 2,791 1, (5.4, 6.6) Risk factor segmentation of Doncaster five year-olds according to obesity. Base: all children surveyed with a valid height and weight measurement between 2004/5 and 2006/7

58 NEIGHBOURHOOD KNOWLEDGE MANAGEMENT Breastfeeding in Doncaster Tailoring services to local needs NEIG HB OURHOOD KNOWLEDG E MANAG EMENT Mayhew Associates Ltd lesmayhew@ googl .co.uk Aims There is a wealth of evidence that breastfeeding babies has wideranging positive impacts on the health of babies and their mothers. Doncaster has poor rates of breastfeeding, compared with many other parts of the UK, and aims to improve the rates of breastfeeding, particularly in more deprived communities where the rates are particularly low. This study set out to reveal some of the socioeconomic factors which may be affecting the breastfeeding rates, with the aim of helping services to target the support offered to mothers more effectively in their differing home circumstances. What we did We used nkm matching techniques to link data on breastfeeding (on discharge from hospital) with socio-economic data from administrative data sets. From these matched data we identified the factors which are associated with higher or lower breastfeeding rates. We then assessed all women of child-bearing age (15-44) using these risk factors to identify the areas where mothers are more and less likely to breastfeed if and when they become mothers. Outputs The analysis showed significant associations between breastfeeding rates and several socioeconomic indicators. Overall, 43% of the babies were being breastfed on discharge from hospital. The Row number in category council tax band A Map showing concentrations of mothers most and least likely to breastfeed in Doncaster single parent household live in local authority housing teenage mother % breastfeeding on discharge 95% confidence interval 1 5, (61.3, 64.0) Y 60.5 (57.1, 63.8) 3 6,115 Y 41.5 (40.2, 42.7) 4 1,969 Y Y 39.2 (37.0, 41.4) 5 1,836 Y Y 27.8 (25.8, 29.9) Y 24.8 (17.3, 33.6) Y Y 24.3 (21.1, 27.6) 8 1,377 Y Y Y 24.1 (21.9, 26.5) Y Y Y 21.5 (16.9, 26.7) Y Y Y 17.5 (14.3, 21.2) Y Y Y Y 16.8 (13.0, 21.2) total 19,370 13,131 4,857 4,064 1, (42.5, 43.9) statistical model suggests the odds of Risk factor segmentation of Doncaster population according to breastfeeding status. breastfeeding are reduced by 57% if the mother lives in a council tax band A house, 55% if she is under 20 years old, 46% if she lives in local authority housing and 11% if she is a single mother. These factors all had independent effects on the rates. The table shows the numbers of babies in the study with each combination of factors and the actual breastfeeding rates (categories with small numbers have been omitted). The map shows the results of mapping the risk assessments across all women of child-bearing age in Doncaster. There are clear areas of higher and lower risk of not breastfeeding. In order to tackle the resulting inequalities in health, services may be able to offer targeted help and support at these areas of greatest need.