Joint Strategic Needs Assessment 2013

Transcription

1 North Tyneside Joint Strategic Needs Assessment 2013 North Tyneside Clinical Commissioning Group

2 Drafted by: Paul Murphy Wendy Burke Rachel Davison Kevin Allan Haley Hudson Charlotte Hodges Johanne Mears Public Health Intelligence Analyst Acting Consultant in Public Health Research and Intelligence Team Manager (CYP&L) Project Manager, Integrated Care for Older People Senior Manager, Strategic Planning, Partnerships & Business Transformation Commissioning Analyst Local Healthwatch Development Officer September 2013 Acknowledgements: A wide range of people have contributed to the Joint Strategic Needs Assessment (JSNA), including professionals working within the Council, CCG, NHCFT and the voluntary sector.

3 North Tyneside Joint Strategic Needs Assessment Introduction The Joint Strategic Needs Assessment (JSNA) is an overarching assessment of the health and wellbeing needs of our population across the wider health and social care economy. The JSNA is driven by the Health and Wellbeing Board in North Tyneside and is the basis for developing the Health and Wellbeing Strategy. The Health and Social Care Act 2012, emphasises the importance of the JSNA as the starting point for developing health and wellbeing strategies and underpinning commissioning decisions. The Act requires the new statutory health and wellbeing boards: To oversee the production of the Joint Strategic Needs Assessment. To develop a Joint Health and Wellbeing Strategy (JHWS). To develop joint commissioning intentions and ensure all commissioning intentions meet the needs identified by the JSNA and are in line with the JHWS. The JSNA brings together a wide range of information about the current and future health and well-being needs of the local population. It provides an opportunity to look forward so that we can plan to ensure that we are able to meet the needs of local communities in the future. The JSNA is one of the major influences in directing our commissioning priorities and planning service developments. The JSNA describes the future health, social care and well-being needs of the population so that the North Tyneside Council and local NHS commissioners can take co-ordinated action to improve health and wellbeing and reduce health inequalities. There has been a JSNA in place in North Tyneside since The JSNA process is live, evolving and iterative in nature we have undertaken a refresh of the JSNA produced in December last year. Where new data is available we have provided a refresh, there are new sections on the impact of the welfare reforms and long term conditions and we have completed full needs assessments for sexual health, autism, breast feeding, practice based registers and emergency hospital admissions. Community engagement is an essential element of the JSNA. Citizens and communities know what they want from local 1 services and what needs to be done where they live. Local people can tell us Did services deliver what was expected? Were service user s needs met?, however it is a resource intensive process and takes time and effort. Information for this refresh of the JSNA has been drawn from a wide range of engagement activity carried out by a number of agencies including statutory bodies, service providers, community and voluntary sector organisations and individual members of the community drawn together through the North Tyneside Engagement Board through the joint commissioning structures. Many of the recommendations are unchanged from last year as the challenges facing North Tyneside remain. Health inequalities are a major challenge and require a change in approach. The gap between our most affluent and least affluent communities remains wide and has not narrowed in the last decade which means that we need to find new approaches that are effective in reducing the gap. Marietta Evans Director of Public Health Paul Hanson Deputy Chief Executive Jean Griffiths Head of Children Young People and Learning John Matthews Chair, North Tyneside Clinical Commissioning Group

4 2 Key Messages The population of North Tyneside is projected to grow by 9.8% by 2030 with an increasingly ageing population. The borough of North Tyneside as a whole is now one of the least deprived areas in the North East of England. However, stark inequalities persist within the borough in relation to income, unemployment, health and educational attainment. The economic downturn and the current welfare reforms are impacting on the income of residents with the inevitable consequences for their health and wellbeing. The principal cause of premature death in North Tyneside is cancer, followed by cardiovascular disease. People are living longer with the average life expectancy for North Tyneside being 79 years (77 years for males and 81 for females). The gap in life expectancy within the borough is wide (11.6 years for males and 9.2 years for females) and has also remained constant throughout the last decade. At 65 years the disability free life expectancy (DFLE) in North Tyneside is significantly lower compared to England, in addition DFLE is significantly lower in the most deprived populations of North Tyneside. Poor mental health and wellbeing in parts of the borough are inextricably linked to socio economic deprivation and vulnerability. Alcohol is the second biggest lifestyle health risk factor after tobacco use. Alcohol misuse is a major problem within North Tyneside in terms of the health, social and economic consequences which affect a wide cross section of the borough at a considerable cost. 1 in 5 children and young people live in poverty in North Tyneside. Vulnerable children and young people in the borough suffer from poorer outcomes socially, educationally, economically and educationally. The number of people aged 85 and over is projected to increase in North Tyneside by 46% by the year 2030 creating additional demand for social care, housing, support, and health services. Long Term Conditions and dementia will be among our biggest challenges going forward. The proportion of people with a disability is also likely to increase with an ageing population creating additional demands for service provision. Smoking is the major contributor to cancer and cardiovascular disease mortality and morbidity and accounts for half the gap in life expectancy between the most and least affluent groups. 3 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011 Fair Society Healthy Lives Marmot Review Executive Summary

5 North Tyneside Joint Strategic Needs Assessment Recommendations for Develop long term planning across all services in response to the changes in demography of North Tyneside in order to anticipate the changes in demands resulting from an older population, increases in the population of children young people and families and an increasing population of minority groups. Inequalities 2 Identify actions to systematically tackle the social determinants of health and well being rather than just simply focussing on the more apparent and immediate causes of poor health such as smoking, obesity and alcohol. 3 Ensure that clear information is available to all partners around welfare reform, their impacts and the local support that is in place to help mitigate the effects. 4 Build greater resilience into the borough by supporting community led and delivered programmes that create more sustainable communities. 5 Continue to deliver crisis support where needed but develop longer term opportunities that moves more towards self sufficient support rather than crisis driven support. 6 Focus on increasing labour market engagement amongst deprived and more vulnerable groups to help reduce economic disadvantage including opportunities for apprenticeships and work experience. 7 Increase the availability of quality affordable homes. 8 Explore specialist independent living housing models for example for young people with disability. 9 Develop a North Tyneside approach to reducing poor housing conditions for vulnerable group which includes improving energy efficiency and reducing hazards in the home to prevent falls. 10 Extend diversionary and engagement activities in key areas in the borough to reduce youth alcohol related anti-social behaviour. 11 Commission community based violence/domestic violence prevention and perpetrator programmes. 12 Influence transport planning in order to address the issue of equity of access to services. 13 Develop and commission programmes that identify people at risk of or with disease and promote evidence based management. 14 Undertake health equity audits across all service areas to understand how fairly resources are distributed in relation to the health needs of different groups and to implement actions to make services more equitable. 15 Develop programmes within the borough that empower, engage and promote better awareness of local people to improve health and increase access to services within their communities. Children Young People and Families 16 Commission integrated approaches to support and promote the health and wellbeing of children and families across health, social care, early years and education by providing universal and targeted services that are preventative in nature and intervene early. 17 Prevent avoidable admissions to hospital for children and young people. 18 Promote healthy lifestyles for children and young people including positive sexual health and contraception, reducing substance misuse, positive mental health, healthy eating, and physical activity. 19 Establish integrated service approaches for providing targeted support to children and families with complex and challenging difficulties. 20 Ensure all children and young people can fulfil their educational potential and are prepared for future progression and supported to find employment. 21 Improve transition arrangements for children with disabilities into adult care services. 22 Ensure all vulnerable adolescents are kept safe through joint working arrangements that are effectively coordinated to respond to safeguarding issues and that any emerging themes are identified and shared through the NTSCB.

6 4 Healthy Lifestyles 23 Commission integrated structured community based services for drug and alcohol treatment and recovery services including systematic and co-ordinated approach to Identification and Brief Advice including those for young people. 24 Commission a new efficient and effective stop smoking service based on the evidence base targeting areas with high smoking rates, routine and manual occupational groups, unemployed, pregnant women and those with long term condition. 25 Consider how new areas, like nicotine harm reduction, tobacco licensing, harder hitting media campaigns, standardised packing with health warnings could help to make North Tyneside a smoke free borough. 26 Continue to forge strong partnerships in tackling the obesogenic environment and scale up interventions which effectively improve access to healthy food, help individuals to increase the levels of physical activity and support people to maintain a healthy weight across the life course. 27 Review sexual health services including the provision in schools and procure integrated sexual health services in line with best evidence in order to reduce STIs, unintended pregnancies, and increase the use of longer acting contraception. 33 Review of commissioning arrangements across social care and health of high cost care packages and for people with complex needs to ensure they offer value for money and meet agreed quality outcomes. 34 Reduce health inequalities for people with a disability. 35 Develop a commissioning framework in response to the Winterbourne Review. Older People 36 Promote the uptake of Flu and pneumococcal vaccination in the over 65s and at risk groups and address the variation across the Borough. 37 Increase public awareness of Chronic Obstructive Pulmonary Disease (COPD) and early diagnosis of symptoms. 38 Provide preventative activities for older people that promote self care, maintain independence, and promote health and a good sense of wellbeing in order to prevent falls, ill health and delay the onset of long term conditions. 39 Further develop intermediate care and reablement programmes to avoid hospital admissions. 40 Develop a clear integrated pathway for the care of frail elderly patients with complex needs. 41 Value, recognise and support the critical role of carers and promote their health and wellbeing through the implementation the North Tyneside Adult Carers Strategy. Mental Health and Learning Disabilities 28 Review the use of adult and elderly secondary mental health services to understand further detail around diagnosis and need and alternative service models in primary care and community settings. 29 Undertake a procurement process to provide effective psychological therapies and counselling services. 30 Review the nine priorities for dementia, develop service and aim for North Tyneside to become a Dementia Friendly Community. 31 Offer those with a physical and learning disability choice and control over the services they use. 32 Implement the recommendations from the Autism Health Needs Assessment.

7 North Tyneside Joint Strategic Needs Assessment What is the JSNA telling us? 1. Population and Demography Population The population of North Tyneside is growing year on year with an increasing aging population. The population of North Tyneside is very similar to the population of England. North Tyneside has a slightly higher proportion of those aged 65 and over (18.3% compared to 16.9%). It has a slightly smaller proportion of 0-19 yr olds compared to England, 22.1% compared to 23.9%. With increasing life expectancy the projections indicate an increase in the older population. It is estimated that the number of people aged 65 years and over will increase by 43% to 51,000 by 2030 and the number of people aged 85 years or over will increase by 46% to 7000 (ONS 2010.) The number of children and young people in the Borough is projected to increase by 9.4% by the year The biggest increase is projected to be in the 5-19 age group which is expected to increase by 12% by The estimated number of births in North Tyneside was 2403 in This is projected to rise by 4.9% by 2015 before falling back to the current number by Based upon the 2011 Census, Black and Minority Ethnic (BME) groups account for 4.6% of North Tyneside s population (when mixed/multiple white ethnic minority groups are included). This population represented 2.7% of the population in the 2001 census. The largest minority ethnic group is the Asian/Asian British group, constituting 1.9% of the resident population. Approximately 24% of people in North Tyneside have some kind of disability; this figure is expected to increase with an increasingly aging population. Lesbian gay bisexual transsexual (LGBT) people may account for as many as 11,500 adults in North Tyneside; numbers are likely to be in line with those for the UK. Older people use health and social care services more often than any others and so the increasing absolute number of older people in North Tyneside and increasing proportion of older people has strong implications for the planning of health and care services. The growing number of children in the borough has implications for adequate services such as childcare, early years provision, education, health and youth provision. Understanding the needs of minority groups in those areas where their populations are concentrated is important in securing appropriate and accessible services.

8 6 1. Population and Demography Deprivation 23.3% of the population in North Tyneside lives in the most deprived national quintile. 21.3% of the population lives in the least deprived quintile. Of the 326 local authorities in England, North Tyneside is 113th most deprived (IMD 2010). This is an improvement from a national ranking of 102 in The most deprived area in the borough is around Waterville Road in Riverside Ward. The least deprived area is in St Mary s Ward. Wards in which > 50% of the population live in the most 20% deprived LSOA nationally are: - Riverside (around 90%) - Chirton (around 70%) - Wallsend (around 70%) - Howdon (around 50%) - Camperdown (around 50%). North Tyneside is now one of the least deprived areas in the North East of England (only Northumberland less deprived) however it is important to be aware that stark inequalities exist within the borough. Health inequalities are caused by social inequalities There is a clear social gradient in health and the lower a person s social position, the worse his or her health. Recommendations Long term planning across all services in response to the changes in demography of North Tyneside is required in order to anticipate the changes in demands resulting from an older population, increases in the population of children young people and families and an increasing population of minority groups. Actions to systematically tackle the social determinants of health and well being are required rather than just simply focussing on the more apparent and immediate causes of poor health such as smoking, obesity, alcohol.

9 North Tyneside Joint Strategic Needs Assessment What is the JSNA telling us? 2. Wider Determinants The health and well-being of a population is greatly shaped by a wide variety of social, economic and environmental factors which act across the life course and lead to an accumulation of relative social and economic advantage or disadvantage. North Tyneside has enjoyed advantages that have helped it grow and prosper a little more than its neighbours, although some areas of high deprivation and economic decline remain. These advantages include the availability of suitable land, which has enabled sustained growth in private sector housing, and the availability of modern office buildings in new business parks, such as Cobalt and Quorum. In common with other areas, North Tyneside was affected by the economic downturn in Claimants of the main unemployment benefit, Jobseeker s Allowance (JSA), rose sharply and the number of registered businesses fell. More recently there have been signs of recovery, with the number of JSA claimants falling and the number of businesses returning to the level seen in Increasingly, actions to improve the competitiveness of the local economy will be delivered with the North East Local Enterprise Partnership (NELEP). Two sites on the River Tyne North Bank are part of an Enterprise Zone which will support economic growth. Welfare reforms The introduction of the government s welfare reforms has seen a number of key changes introduced throughout 2012 and 2013 and further changes will continue for a number of years as Universal Credit will not be fully phased in until It should be noted that the changes impact on persons of working age only. Persons of pensionable age are protected from the reforms. The Department for Work and Pensions (DWP) stated the policy objective of the changes as:- The (Welfare Reform) Act legislates for the biggest change to the welfare system for over 60 years. It introduces a wide range of reforms to make the benefits and tax credits systems fairer and simpler. It will do this by creating the right incentives to get people into work as well as protecting the most vulnerable in our society whilst delivering fairness to those claiming benefit and to the taxpayer. This will save around 18 billion from the annual welfare bill. Key challenges include increasing the number of higher quality private sector jobs, increasing levels of entrepreneurial activity and increasing the number of residents with higher skills. In the UK the socio-economic consequences of the current financial crisis are thought to be worse than the great depression of the 1930s. In response to the financial crisis and economic downturn the Government has implement a welfare reform package as part of its austerity programme which may exacerbate or mitigate the negative health and inequality impacts of economic decline.

10 8 2. Wider Determinants (cont.) Reduction of Local Housing Allowance (LHA) for Housing Benefit Claimants aged between 25 and 35 (January 2012). This means a reduction of around 30 per week in Housing Benefit for up to 300 claimants in North Tyneside. Council Tax Benefit abolished and replaced with a Local Council Tax Support Scheme. This means 11,700 residents who previously paid no Council Tax, are now paying between 50 and 75 per year.(april 2013) From April 2013 there are 3,300 social housing tenants affected by the under occupancy changes (Bedroom Tax) to Housing Benefit, including those living in adapted properties. Dependant on circumstances, tenants are seeing a reduction in their Housing Benefit entitlement of between 14% and 25%. ( 2.4m less paid out in North Tyneside) Disability Living Allowance replaced by Personal Independence Payments (April 2013 for new claimants, then ongoing to 2017 for existing claimants) 2800 households in North Tyneside will be affected by this change. (10.9m less paid out per year in North Tyneside) Benefit Cap on the amount of benefits that can be paid. Maximum 500 per week for couples with or without children or lone parents. Maximum 350 per week for single adult households. (approx 40 households in North Tyneside affected) Contributory Employment Support Allowance (ESA) now time limited to a maximum 52 week period. (April 2012) Start of roll out of Universal Credit from 1 October There is a shortage of suitably sized homes for those social sector tenants affected by welfare reform. The most significant proportion of estimated financial loss within the Borough is attributable to changes to the benefits of disabled people. The number of people needing food parcels has increased and there is a greater need for food bank support in the Borough. Advice services operated by the Council and its partners in the Community and Voluntary Sector are experiencing unprecedented demands on services. While the social impacts of welfare reform are less clear, colleagues in the Voluntary and Community Sector are experiencing residents asking for help on many issues as the consequences of additional financial stress in the household. This has included relationship breakdown, mental health issues and general emotional distress. Within North Tyneside the wards of the borough that are most impacted by the welfare reform changes are Riverside, Howdon, Chirton, Valley and Longbenton.

11 North Tyneside Joint Strategic Needs Assessment Wider Determinants (cont.) Employment The proportion of the population aged years estimated to be economically active in North Tyneside (Jan 2012 to Dec 2012) was 77.5%, this was higher than the figure for both the North East and Britain but not significantly so. In November 2012, 15.2% of males aged were claiming out-of-work benefits in North Tyneside, compared to 17.5% in the NE and 12.3% in Britain. For females in the borough the corresponding figure was 12.0%, compared to 13.8% regionally and 10.8% nationally. The age cohort with the largest percentage of out-ofwork benefits claimants in North Tyneside were those aged yrs. (16.6% compared to 19.2% regionally and 14.8% nationally). The largest percentage of claimants was in the group. In May 2013, the rate of those claiming Jobseeker s Allowance (JSA) was highest in Riverside ward, followed by Chirton ward and Wallsend ward. St. Mary s ward had the lowest rate of claimants. 5.0% of young people aged were estimated to be NEET (not in education, employment or training) in 2012; this was below the NE average of 8.3%. Unemployment can adversely affect both physical and mental health, particularly long term unemployment. Strategies that increase opportunities for work particularly aimed at young people and in those areas disproportionately affected by unemployment are required. Employment initiatives that meet the needs of disadvantaged communities and groups and support people into employment can reduce health inequalities. Initiatives that support the transition from school to work particularly for vulnerable and disadvantaged groups of young people will prevent the number of young people who are not in education or employment. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

12 10 2. Wider Determinants (cont.) Housing There is a shortfall of 479 affordable homes each year in North Tyneside. There is a lack of specialist independent living housing models e.g. for younger people with physical disabilities. 35% (25,503) of homes in the private sector fail the decent homes standard and 20% (14,344) of homes in the private sector are likely to have a category 1 hazard in relation to the Housing Health and Safety Rating System. In North Tyneside 16,996 households are fuel poor. Last year (April 2012 to March 2013) 2,942 households contacted the housing advice team with issues about their housing situation. 570 of these households were roofless and required further assistance. 168 households were classed as homeless and in priority need. Since 2008 the North Tyneside Warm Zone insulated over 19,300 cavity walls and lofts in over 15,600 homes. This work has saved residents over 2.3m in annual fuel bills. The insulation measures were often targeted at households with health problems. Increasing population and/or household demographic changes will affect the number, size, and type of homes required in the borough (including affordable housing). Poor housing increases the likelihood of an incidence of an accident or ill health. There is an ageing housing stock and lack of resources in the future to improve and maintain private sector housing conditions. Rising fuel prices mean that the numbers of people in fuel poverty will rise in coming years which may impact upon excess winter mortality particularly deaths from Cardiovascular Disease (CVD) and respiratory disease. Council tenants and those in private rented accommodation suffer a disproportionate impact from the reform of welfare benefits and this is likely to lead to an increase in homelessness. The Council has contracted a new partner to deliver energy efficiency measures in cross tenure homes and will continue to focus on households in fuel poverty and with health problems.

13 North Tyneside Joint Strategic Needs Assessment Wider Determinants (cont.) Community Safety North Tyneside was the safest of the 36 metropolitan Boroughs in England for the fourth consecutive year and in the top 10% of all 326 CSP areas in England and Wales in 2012/13. The most prevalent of the 12 main Home Office crime types were other theft, criminal damage and violence against the person. In North Tyneside there four priority wards with high unemployment - Riverside, Chirton, Howdon and Wallsend, that suffer a disproportionately high level of both crime and anti-social behaviour. There was an increase in recorded sexual offences. However, 26% of these occurred before 2012/13. The increased reporting of historic sexual offences is a national phenomenon that has been linked to a heightened profile of the issue in the wake of Operation Yewtree. 18% of all recorded crime was flagged as having alcohol as an influencing factor. This figure rises to 47% for crimes of violence against the person and 54% of those also flagged as involving domestic violence. Anti social behaviour (ASB) has decreased by 10% compared to last year. Incidents of ASB are most concentrated in Whitley Bay s night-time economy area, Chirton (Meadowell), Longbenton, Wallsend town centre and Tynemouth Front St. 14% of ASB was alcohol related. There were 329 high or very high risk domestic violence cases discussed at MARAC in 2012/13. 31% were repeat cases and 642 children lived in households associated with domestic violence incidents. Drug usage is highest in the age group, while it is falling among young people aged especially in relation to opiate use. North Tyneside has the North East s highest proportion of drug users with benzodiazepines as a secondary drug. Violence and abuse (mainly experienced by women and children, from all backgrounds), often remains undisclosed with devastating consequences for longterm mental and physical health. Fear of crime and a sense of safety remain a key concern for many older people. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

14 12 2. Wider Determinants (cont.) Transport and the environment Three North Tyneside resort beaches obtained the prestigious Blue Flag award and 4 North Tyneside beaches received international and national recognition for their cleanliness and environmental management in North Tyneside Council was the National Award winner in 2012 Clean Britain Award, medium sized authority overall winner 2012 and five star status for two years running. North Tyneside Council has a Joint Biodiversity Plan with Newcastle City Council. Carbon emissions (per head) in North Tyneside have reduced by 27 percent since 2005, placing the borough 15th nationally and 3rd regionally. North Tyneside has over 100 miles of maintained waggonways, public right of ways, bridal ways and cycle paths which are used by residents for a number of leisure activities such as cycling, running and dog walking. North Tyneside has 6 prestigious green flags for the quality of its parks and green spaces. North Tyneside Council has established Clean-Up teams who will be involved in street cleansing, tackling and taking away fly-tipping, the removal of graffiti, as well as installing no dog fouling signs and issuing fixed penalty 1 notices to those seen littering or people failing to pick up after their dog. Through North Tyneside Council s work in schools, 16,000 junior wardens have made three pledges to protect and improve the environment by not dropping litter, encouraging friends and family to not drop litter and to recycle as much as they can. Health and well-being is influenced by the communities in which people live and is affected by the nature of their physical environment. While the borough is well served with excellent parks, beaches and good public transport, access is not equitable for all. For some groups of people for example those living in the NW and NE of the borough access to health and wellbeing facilities is more challenging. The air quality monitoring carried out in North Tyneside confirms that the health based air quality objective levels are being achieved. In essence, the air quality in the borough is at an acceptable level. Housing, neighbourhoods and access to food, sporting, recreational and cultural facilities and green space contributes to reducing inequalities as well as helping to create sustainable communities. Integrated transport planning which promotes health and wellbeing and addresses inequalities is important in spatial planning. Reducing local car travel in order to reduce emissions and promote active travel is becoming increasingly important. Access to good transport links is a key issue to ensure that older people engage in community activity. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

15 North Tyneside Joint Strategic Needs Assessment Wider Determinants (cont.) Vehicle ownership The 2011 Census suggested that 31.6% of households in North Tyneside had no cars or vans that were owned, or available for use, by one or more members of the household. This includes company cars and vans available for private use. It does not include motorbikes or scooters, or any cars or vans belonging to visitors. This was higher than the 25.6% of households with no cars or vans in England and Wales and similar to the 31.5% for the North East of England. Access to services One measure suggests that around 14% (around 28,400 people) of the population of North Tyneside lived in the most deprived 20% of areas in England for the accessibility of key services. This includes the road distance to a GP surgery, food shop, primary school and Post Office. (The Geographical Barriers sub-domain of the Department for Communities and Local Government Index of Multiple Deprivation 2010). Lack of vehicle ownership for a significant part of the population has implications in relation to access to services. There are inequalities in access to services within the borough. Recommendations Ensure that clear information is available to all partners around welfare reform, their impacts and the local support that is in place to help mitigate the effects. Build greater resilience into the borough by supporting community led and delivered programmes that create more sustainable communities. Continue to deliver crisis support where needed but develop longer term opportunities that moves more towards self sufficient support rather than crisis driven support. Focus on increasing labour market engagement amongst deprived and more vulnerable groups to help reduce economic disadvantage including opportunities for apprenticeships and work experience. Increase the availability of quality affordable homes. Explore specialist independent living housing models for example for young people with disability. Develop a North Tyneside approach to reducing poor housing conditions for vulnerable group which includes improving energy efficiency and reducing hazards in the home to prevent falls. Extend diversionary and engagement activities in key areas in the borough to reduce youth alcohol related anti-social behaviour. Commission community based violence/domestic violence prevention and perpetrator programmes. Influence transport planning in order to address the issue of equity of access to services.

16 14 What is the JSNA telling us? 3. Preventing people from dying prematurely Life Expectancy Refers to the average length of time people can expect to live at a given age, given the current patterns of mortality. It is a useful summary indicator of the mortality and health of a nation, an area, or a group of people. Life expectancy at birth 7 Refers to the average length of time people can expect to live when they are born. People are living longer in North Tyneside with the average life expectancy currently being 79 years (for men it is 77 and for women is 81). There has been an upward trend i in North Tyneside over the last 2 decades. Men consistently have poorer life expectancy than women. There is approximately a 4 year difference in life expectancy between men and women in North Tyneside The difference in life expectancy BETWEEN North Tyneside and England is relatively small. North Tyneside remains slightly below the national average for both men and women. Male life expectancy at birth in North Tyneside lags behind the national average by 1.3 years and female life expectancy is by 1.5 years. The difference in life expectancy WITHIN North Tyneside between the most deprived and least deprived areas is much wider than the gap between North Tyneside and England. There is a clear social gradient for Life Expectancy across the Borough. Between the most and least deprived sections of the population, there is a life expectancy gap of 11.6 years for men and 9.2 years for women. This gap has remained constant for the last decade. The wards of Riverside, Chirton, Howdon, Wallsend and Longbenton all have significantly poorer life expectancy than the Borough average of 79 years. Riverside ward has the lowest average life expectancy in the Borough of 73 years while St Mary s has a Life Expectancy value of 84 years. The ambition of Public Health England and the NHS in England is for people to live longer and with a better quality of life. The population of North Tyneside is living longer and this is the reason for the changing demographics and an aging population. Wide inequalities in life expectancy represent a social injustice because they reflect an unfair distribution of the underlying social determinants of health. Reducing health inequalities is a matter of fairness and social justice. Many people are dying prematurely each year as a result of health inequalities. There is a social gradient in health the lower a persons social position the worse his or her health. Action should focus on reducing the gradient in health. Actions to narrow the gap in life expectancy in recent years have not had the desired impact in North Tyneside. Focussing solely on the most disadvantaged will not reduce health inequalities. Action to reduce the steepness of the social gradient requires universal policies with the scale and intensity proportionate to the level of disadvantage Proportionate universalism Healthy Lives, Healthy People; the Marmot Review, Effective local delivery is required across the life course with a specific focus on giving every child the best start in life and empowering individuals and local communities. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

17 North Tyneside Joint Strategic Needs Assessment Preventing people from dying prematurely (cont.) Life expectancy at 75 years This refers to the average number of additional years a person aged 75 can expect to live when they are 75 years old. Life expectancy at 75 has increased in the last two decades from 8 years to 10.5 years for males and years to 12.1 years for females. The social gradient that exists for LE at birth persists for LE at 75. Disability Free Life Expectancy (DFLE) Disability Free Life Expectancy measures the number of years a person can expect to live free from a limiting persistent illness and disability. (Estimates are in part subjective based upon national surveys) At age 65 years there are significant differences in terms of disability- free life expectancy in North Tyneside compared with England. For England DFLE at 65 yrs is 10.8 years for men but only 7.7years for men in NT and for women the figures are 11.4years (England) and 8.7yrs (North Tyneside). There is a greater burden of ill health in North Tyneside than England for over 65s. Within North Tyneside, the gap in DFLE between the most and least deprived community is 12.3 years for men and 11.2 years for women. (This is the slope index of inequality for DFLE at birth.) The corresponding gaps for England are 10.9 years for men and 9.2 years for women. ( Data) As life expectancy increases it is important to ascertain whether the additional years of life are spent in favourable health. It is important that ageing population is vibrant and independent, and does not suffer from chronic ill health. The proportion of life spent with a condition that limits day to day activities for those aged 65 and over in North Tyneside is greater than it is on average for England There is a greater burden of ill health in the most deprived populations across England but this inequality is even greater within North Tyneside. The consequences of an ageing population suffering from conditions that limit day to day activities has major implications for service planning and resources. This measure will be replaced by Healthy Life Expectancy at Birth in the Public Health Outcomes Framework. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

18 16 3. Preventing people from dying prematurely (cont.) Premature Mortality in North Tyneside Premature mortality is an important measure of a population s health and identifies deaths that occur before a person reaches an expected age i.e. 75 years. Many of these deaths are considered to be preventable. The most common cause of premature mortality in North Tyneside is Cancer 7 followed closely by Cardiovascular Disease (CVD). In , 63% of all premature deaths were due to either cancer or CVD. The main contributor to the gap in life expectancy between North Tyneside and England and within the Borough is cancer followed by CVD in both men and women. Many deaths in England are avoidable - those caused by certain conditions, for which effective public health and medical interventions are available, these deaths should be rare, and ideally should not occur. Avoidable deaths are all those defined as preventable, amenable, or both. Social factors, lifestyle choices and late presentation, diagnosis and treatment contribute to the premature mortality. Smoking is the single largest cause of preventable death in the UK accounting for 1in 5 adult deaths. Cancer Death rates from all cancers have decreased significantly over the last 2 decades due to a combination of early detection and the efficacy of treatment. However within the Borough; cancer remains a significant cause of premature death (death under 75 years) and health inequalities. Cancer is the commonest cause of premature death in North Tyneside closely followed by CVD. In approximately 834 people died prematurely of Cancer (39% of all premature deaths in the Borough) In the same time period, approximately 1827 people of all ages died from cancer, accounting for about 29% of all deaths in the Borough a significantly higher percentage than the England average. Mortality rates are significantly higher than the England average for all cancers combined for both men and women. In death rates from all cancers, at ages under 75 years, were 10% higher in North Tyneside than for England as a whole. The cancer with the highest premature mortality rate in North Tyneside is lung cancer. Lung cancer mortality rates are declining but it kills significantly more people under 75 than any other cancer. 86% of lung cancer is directly attributable to smoking. Breast cancer is the most commonly diagnosed cancer in females in England and in North Tyneside. Mortality rates are declining. Half of all cancers could be prevented by changes to lifestyle. The proportion of deaths under 75 years due to cancer considered to be amenable to healthcare intervention is 17% for males and 42% for females. Excess mortality from cancer is linked to later presentations to health care and the consequent delay in diagnosis. This may be due to lack of awareness of signs and symptoms of cancer which tends to be lower in the less affluent groups than the population as a whole. For cancers where there is a national screening programme, uptake of screening is also lower. Cancer is therefore a major contributor to health inequalities in North Tyneside, with premature deaths from cancer accounting for a significant proportion of the gap in life expectancy between North Tyneside and the national average. Efforts to promote early detection of disease through improved uptake of screening and increased awareness of early symptoms particularly across the social gradient is important. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

19 North Tyneside Joint Strategic Needs Assessment Preventing people from dying prematurely (cont.) Cardiovascular Disease (CVD) CVD includes a set of conditions including Coronary Heart Disease, Stroke and Transient Ischaemic Attack (TIA) and impacts on the population both in terms of premature mortality and the burden of health and social care resulting from the morbidity of the disease. Deaths from CVD 7 have reduced dramatically over the last two decades. However, together with cancer, CVD remains one of the main causes of death and premature mortality in the Borough. Around a half (45%) of all CVD deaths are from coronary heart disease (CHD) and more than a quarter are from stroke (27%). The CVD Mortality rate for persons under 75 years was higher than the England value. In NT this figure was 75.1 and in England 67.3 ( Directly Age-Standardised Rate (DASR) per 100,000). Deaths due to CVD are not evenly spread across the social gradient. There are 1.6 times more deaths in the most deprived quintile than in the least deprived. Much of the mortality due to CVD is avoidable. The Department of Health estimates that the proportion of deaths under 75 years due to CVD amenable to healthcare is 64% for males and 37% for females. There is a well established evidence base for both the prevention and management of cardiovascular disease. Hypertension (raised blood pressure) is the most important modifiable risk factor for cardiovascular disease. There are established approaches for identifying those most at risk of CVD and for managing and reducing risk factors. Patients not on disease registers are missing this opportunity for optimal care and improved life chances. The outcomes for these patients are likely to be maximised by being on practice registers. There is the potential to reduce the impact of this disease through changes in lifestyle, early diagnosis and improved clinical management. There should be targeted action across the social gradient. This is an important priority area as CVD is the second highest area of spend by North Tyneside Clinical Commissioning Group. Respiratory Disease (Chronic Obstructive Pulmonary Disease - COPD) There has been a slowly decreasing trend in premature deaths due to COPD. Smoking is the most important factor in determining respiratory mortality and morbidity. There is a strong link with seasonal excess mortality with up to a third of excess winter deaths being from respiratory disease. There were 3.8 times more deaths attributable to COPD in the most deprived quintile compared to the least deprived quintile ( ). Mortality rates in for bronchitis, emphysema and other forms of COPD for people aged <75ys were 15.0 for NT which is higher than for England (not significantly different). A large proportion of COPD can be prevented through stopping smoking. The proportion of deaths under 75 due to respiratory disease considered to be amenable to health care intervention is 7% for males and 8% for females. 3 Making Sense of Early Intervention: A Framework for Professionals. The Centre for Social Justice 2011

20 18 3. Preventing people from dying prematurely (cont.) Liver Disease Liver disease causes approximately 2% of all deaths in England. While other major causes of death are falling, the number of people who die from liver disease is rising and younger age groups are disproportionately affected. The mortality rates from chronic liver disease in North Tyneside are significantly higher than those of both the North East and England ( North Tyneside value 17.4, North East 14.0, England 10.3, all age DASR). There is an average of 40 deaths per year from chronic liver disease in North Tyneside. The rate of deaths for females in North Tyneside is the highest in the North East and the 6th worst in England. The rate of deaths for males in North Tyneside is also higher than the North East average and significantly higher than the England average. Cancer of the liver accounts for 20% of all deaths from liver disease and in the majority of cases develop from cirrhosis of the live.r Chronic liver disease accounts for 67% of all deaths from liver disease. Alcohol is the major risk factor for liver disease and the availability of alcohol is a major factor in the increasing trend in premature deaths. Among the other causes are obesity, undiagnosed hepatitis infection. Better awareness is needed amongst the public of their liver health and service providers need to continue to improve efforts to detect early stages of the disease. Recommendations Develop and commission programmes that identify people at risk of or with disease and promote evidence based management. Health equity audits should be undertaken across all service areas to understand how fairly resources are distributed in relation to the health needs of different groups and to implement actions to make services more equitable.

21 North Tyneside Joint Strategic Needs Assessment What is the JSNA telling us? 4. Enhancing the quality of life for people with long term conditions A long term condition (LTC) is a condition that cannot, at present, be cured but is controlled by medication and/ or other intervention. It is estimated that around 30% of the population have one or more. Although there is no definitive list Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Cardio 7 vascular Disease (both CHD and Stroke), Cancer and Chronic Kidney Disease are often included. Using the General Practice Quality and Outcomes Framework (QOF) there is evidence of under recording of patients with certain diseases on practice registers within GP practices in North Tyneside. The number of diagnosed cases is significantly less than the expected number for COPD, asthma, heart failure, hypertension, obesity, chronic kidney disease, palliative care and dementia. To a lesser degree there is also evidence that both Diabetes and CHD may also be under recorded on practice systems. The reported prevalence in NT is broadly similar to the expected number for epilepsy, atrial fibrillation, and stroke/tia. Figures are above the expected numbers for hypothyroidism, depression, cancer, and learning difficulties. This could be due to a genuine difference in the numbers present in the North Tyneside population, or to the way data has been recorded. The Department of Health challenges a new, modernised NHS to improve the lives of people with long term conditions by giving them more support to self-care, helping them to remain independent for longer using new technology, simplifying who cares most for a person and training health professionals to focus on the overall health and wellbeing of a person rather than just managing one of their conditions. The impact on the NHS and social care is significant with 70% of the health and social care being spent on long term conditions. Supporting the 30% of the population who have one or more long term condition is essential for the viability of the health economy. People with long term conditions continue to see variation in care and services. Patients not on disease registers are missing this opportunity for optimal care and improved life chances. The outcomes for these patients are likely to be maximised by being on practice registers. Emergency admissions suggest patients are not being managed in an optimal way. This appears to be happening disproportionately to those in the more disadvantaged areas. Coronary Heart Disease (CHD) CHD is the principle condition within the group of conditions known as cardio vascular disease (CVD). Reported prevalence in North Tyneside is close to the expected value % of those patients with CHD are estimated not to be receiving recommended care processes or outcomes. There were 694 CHD emergency admissions in 2012/13 at a cost of 1,769k. Emergency admissions for CHD demonstrate a clear social gradient with the rate in the most deprived quintile being almost double that in the least deprived quintile. Risk should be assessed according to NICE CG 76 Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease.