Healtheast CCG - developing an understanding of health and wellbeing needs. Public Health NHS Norfolk and Waveney Cluster and Norfolk County Council

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1 Healtheast CCG - developing an understanding of health and wellbeing needs Public Health NHS Norfolk and Waveney Cluster and Norfolk County Council

2 Acknowledgements Norfolk County Council Children s Services Norfolk County Council Adult Social Services Norfolk Insight Team NHS Norfolk and Waveney Business Intelligence Teams NHS Norfolk and Waveney Public Health Information Team For further information contact tim.winters@nhs.net

3 Fair society healthy lives P Goldblatt UCL Principals Social justice Material, psychosocial, political empowerment Creating the conditions for people to have control of their lives

4 Health and wellbeing What part can these actors play? Primary Care Acute hospitals County council District council CCGs Government policy Mental health services Third sector Public health Health Inequalities support programme e/dh_115113

5 Commissioning Assessing current and future need, understanding service provision, developing priorities, expenditure vs. outcome, long term conditions, what about individual practices, patient feedback Evaluating performance + what do patients think? Planning/designing services what works? Plan capacity, manage demand

6 Population structure now and future

7 Assessing need - health and wellbeing overview Great Yarmouth Indicator Waveney

8 Practice location and key MSOAs (middle super output areas) MSOA E (Great Yarmouth most deprived ) MSOA E (Waveney most deprived )

9 Understanding the types of people that are registered with Clinical Commissioning Group (CCG) practices Three mosaic types make up the majority of the population in the most deprived MSOAs in Great Yarmouth (E % of the total MSOA) and Waveney (E % of the total MSOA)

10 Social determinants of health deprivation Great Yarmouth and Waveney are the 54 th and 115 th deprived districts in England respectively with 28 LSOAs (large super output areas) in the most deprived quintile in England, HealthEast CCG has 5 practices in the most deprived quintile in England and 7 practices in the most deprived 10 in Norfolk and Waveney.

11 Social determinants of health working age benefits Association with DFLE (disability free life expectancy) Long term unemployment JSA (job seekers allowance)12 months or more

12 Social determinants of health working age benefits IB/SDA (incapacity benefit/severe disablement allowance) where reason is mental health Association with DFLE (disability free life expectancy) IB/SDA where reason is for mental health

13 Social determinants of health school age achievement (foundation stage) Foundation Stage Good Level of Attainment 2009/10

14 Social determinants of health school age achievement (Key Stage 4) KS4 5 or more GCSE A* to C inc. English and Maths 2009/10

15 Teenage pregnancy Ward level

16 Life expectancy Female Great Yarmouth gap = 7.2 years Waveney gap = 7.3 years

17 Life expectancy Male NHS GYW Inequality Great Yarmouth gap =11.6 years Waveney gap = 9.2 years

18 Premature mortality causes Female Male

19 Assessing need life expectancy gap Breakdown of life expectancy gap between the Most Deprived Quintile (MDQ) of Great Yarmouth and Waveney and the average for the four other quintiles in the local authority by cause of death- LHO (London Health Observatory) inequalities tool

20 What can we do about the life expectancy gap?

21 Premature circulatory mortality female Female Direct Standardised Rate (DSR) per 100,000

22 Premature circulatory mortality male Male DSR per 100,000

23 Premature cancer mortality female Female DSR per 100,000

24 Premature cancer mortality male Male DSR per 100,000

25 Contribution of different cancers to premature cancer mortality Information Centre Indicator Portal

26 All emergency admissions CCG benchmark 2008/ /11 (pooled) 2008/ /11 Trend

27 All emergency admissions all ages 2008/ /11 pooled Practice Variation 2008/ /11 (pooled)

28 Ambulatory Care Sensitive (ACS) emergency admissions (Dr Foster) Break down of HealthEast ACS admissions by type and age 2010/2011

29 Flu immunisation 2010/2011

30 Emergency admissions for circulatory conditions 2008/ /11 Trend CCG benchmark 2008/ /11 (pooled)

31 Emergency admissions for circulatory conditions 2008/ /11 pooled Practice Variation 2008/ /11 (pooled)

32 Variation in secondary prevention Coronary Heart Disease (CHD) and Diabetes CHD: Cholesterol 5.0 mmol/l or less Diabetes: HbA1c 8 or less

33 Emergency admissions for Chronic Obstructive Pulmonary Disease (COPD) 2008/ /11 Trend CCG benchmark 2008/ /11 (pooled)

34 Emergency admissions for COPD 2008/ /11 pooled Practice Variation 2008/ /11 (pooled)

35 Emergency admissions for fractures in the over 65s 2008/ /11 Trend CCG benchmark 2008/ /11 (pooled)

36 Emergency admissions for fractures in the over 65s Practice Variation 2008/ /11 (pooled)

37 Lifestyles - obesity Prevalence of Diabetes Norfolk and Waveney 2006 to Red is the estimated proportion of diabetics who are obese, blue is the proportion who are not obese.

38 Lifestyles childhood healthy weight reception Healthy weight % is decreasing implying that overweight and/or obese is increasing

39 Lifestyles childhood healthy weight year 6 Healthy weight % is decreasing implying that overweight and/or obese is increasing

40 Lifestyles smoking 1

41 Lifestyles smoking 2 Prevalence Female SAM (Smoking Attributable Mortality) DSR per 100,000 Male SAM DSR per 100,000

42 Lifestyles alcohol binge drinking Alcohol admissions (bars) and Hospital Episode Statistics (HES) teenage conceptions (line) by deprivation quintile

43 Lifestyles alcohol more than five days per week (Mosaic) NI39 alcohol related admissions

44 Liver disease premature mortality Female DSR per 100,000 Male DSR per 100,000

45 What else? Could include PROMs (Patient reported outcome measures) or GP access data, perhaps the CCG have data on this that they would like to share? Programme budgeting data Practice profiles Other data available e.g. Immunisation Uptake, Cervical Screening, Infant Mortality, Excess Winter Deaths, Fuel Poverty, Road Traffic Accidents, Breastfeeding Initiation, All QOF (Quality and Outcomes Framework) data, Prescribing

46 Summary Deprivation, unemployment and IB/SDA for mental health issues Improve educational attainment Reduce inequality in outcome through reducing circulatory deaths and cancer deaths in more deprived areas Emergency admissions who, why, when Variation in secondary prevention is this acceptable? Obesity will lead to increased prevalence of diabetes, chd, stroke, cancer, hypertension and associated costs (childhood healthy weight decreasing and watch out for inequalities) Chronic alcohol consumption middle aged and older people? Targeted primary prevention to reduce variation e.g. flu immunisation, smoking, health checks etc.

47 Prioritisation Identify a priority problem Cost and/or return on investment Availability of solutions Impact of problem Availability of resources (staff, time, money, equipment) to solve problem Urgency of solving problem Size of problem (e.g. # of individuals affected) Identify an intervention Expertise to implement solution Return on investment (social?) Effectiveness of solution Ease of implementation/maintenance Potential negative consequences Legal considerations Impact on systems or health Feasibility of intervention