NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 30 th June 2015

Transcription

1 Agenda Item No: 17 Part 1 X Part 2 NHS TRAFFORD CLINICAL COMMISSIONING GROUP GOVERNING BODY 30 th June 2015 Title of Report Purpose of the Report Tackling Health Inequalities in Trafford and CCG/Public Health Work Plan 2015/16 The paper provides an overview and progress of health inequalities in Trafford describing the impact on life expectancy, long-term conditions, public health screening, culture and ethnicity, age, gender, occupation, mental health and localities. The paper summaries the work of public health team relating to health inequalities and future developments as outlined in the joint CCG and Public Health work plan 2015/16. Actions Requested Decision Discussion Information X Strategic Objectives Supported by the Report Recommendations 1. Consistently achieving local and national quality standards. 2. Delivering an increasing proportion of services from primary care and community services from primary care and community services in an integrated way. 3. Reduce the gap in health outcomes between the most and least deprived communities in Trafford. 4. To be a financial sustainable economy. NHS Trafford CCG Governing Body is asked to note the progress on tackling health inequalities in Trafford and agree the jointly agreed CCG and Public Health 2015/16 work plan. Discussion history prior to the Governing Body Financial Implications Risk Implications Paper prepared for CCG Governing Body None Not relevant

2 Trafford Clinical Commissioning Group Agenda Item No. 17 Equality Impact Assessment Communications Issues Public Engagement Summary Prepared by Responsible Director Not relevant Not relevant Not relevant Helen Gollins, Consultant in Public Health Abdul Razzaq, Director of Public Health Page 2

3 Trafford Clinical Commissioning Group Agenda Item No. 17 HEALTH INEQUALITIES IN TRAFFORD Purpose of Paper The paper provides an overview and progress of health inequalities in Trafford describing the impact on life expectancy, long-term conditions, public health screening, culture and ethnicity, age, gender, occupation, mental health and localities. The paper summaries the work of public health team relating to health inequalities and future developments as outlined in the joint CCG and Public Health work plan 2015/ What are Health Inequalities? 1.1. Public Health England defines health inequalities as unjust disparities in health outcomes between individuals or groups. They arise from differences in social and economic conditions that influence people s behaviours and lifestyle choices, their risk of illness and actions taken to deal with illness when it occurs i. Health inequalities arising from social determinants, such as housing and occupation, are not inevitable and are therefore considered avoidable and unfair ii. This is in contrast to inequalities in health that are caused by chance, for example Down s syndrome or cystic fibrosis Inequalities in health impact on every population strata including gender, geography, sexuality, socio-economic groups, disability, age and ethnicity, (See Appendix A, Spectrum of Inequality) The Public Health Outcomes Framework, (PHOF) presents 145 national public health indicators which Trafford Council and Trafford CCG are responsible for improving. The indicators are split across five groups; overarching indicators, wider determinates of health, health improvement, health protection and healthcare and premature mortality, (See Appendix B, for a summary of key PHOF indicators). It is important to recognise that although Trafford performs well on many of these indicators that all health outcomes are subject to health inequalities. 2. Health Inequalities in Trafford 2.1. In both health iii and economic terms, the profile of Trafford is close to that of England as a whole iv. The population is amongst the healthiest in the North West, but the North West is the least healthy region in the country One of the greatest challenges in Trafford is the impact of health and social inequalities which are often masked by Trafford s good outcomes for most of its population. Using lower super output areas 1 (LSOAs) as a measure of geography, 24 Trafford LSOAs are ranked amongst the 10% most affluent in 1 LSOA is a boundary of geography; it is typically made up of 1500 people and is more sensitive measure of population demographics than wards. Page 3

4 Trafford Clinical Commissioning Group Agenda Item No. 17 England in contrast 9 are amongst the top 10% most deprived v. Communities in North Trafford, Sale West and Partington experience the highest levels of deprivation in the Borough. Deprivation has a significant impact on health outcomes, (see Appendix C, Map of Deprivation in Trafford). The indicators used to measure deprivation have been refreshed and are due to be published in July Life Expectancy 3.1. Life expectancy is an important measure of the health status within an area. Life expectancy for men and women is better than the national average, 79.9 years for men and 83.5 years for women vi. Fig 3.: Life expectancy in years for men and women in Trafford, North West and England, (2000/2002, 2011/2013) Life expectancy in years Year Men Trafford Men North West Men England Women Trafford Women North West Women England Source: Public Health England, Figure 3. shows how life expectancy in Trafford has improved over the last decade. It also clearly shows the inequalities in life expectancy between the genders; however recent data has identified a small decline in life expectancy for women in the borough. 3.3 The impact of deprivation can be clearly demonstrated using life expectancy. In Trafford, life expectancy is 8.5 years lower for men and 6.8 years lower for Page 4

5 Trafford Clinical Commissioning Group Agenda Item No. 17 women in the most deprived areas of Trafford than in the least deprived areas vii. This gap has decreased for men and increased for women. 3.4 At a local level, most wards in Trafford are similar in terms of life expectancy however there are inequalities between and amongst the genders. Women in Urmston and Bucklow St Martin s wards, (West Locality wards) live significantly shorter lives than women in Hale Central or Hale Barns, (South Locality wards). The difference in life expectancy for women in Urmston and Hale Barns is 7.9 years viii. Men in Bucklow St Martins, (West Locality) and Gorse Hill (North Locality) live significantly shorter lives than men in Hale Central (South Locality) or Brooklands (Central Locality). The difference in life expectancy for men in Bucklow St Martin s and Hale Central ward is 7.6 years ix. 4. Long-term conditions 4.1. Long-term conditions are a major cause of preventable death in Trafford. Cardiovascular disease, cancer, chronic obstructive pulmonary disease and diabetes all contribute to poor health, disability and death. Some groups are disproportionately affected by long-term conditions. In Trafford, for example, more men die from cardiovascular disease than women. Fig 4.: Trafford under 75 mortality rate per from cardiovascular diseases (CVD) considered preventable, 2001/ /2013, (PHOF 4.04ii) DSR per 100, Three year average Female Male 4.2. Evidence also shows that some black and minority ethnic (BME) communities are more likely to develop long-term conditions at an earlier age, for example South Asian populations are more likely to develop diabetes in mid-adulthood Page 5

6 Trafford Clinical Commissioning Group Agenda Item No. 17 compared to other groups. One long-term condition can increase the likelihood of developing other co-morbidities, such as CVD thus exacerbating the impact of inequality. 5. Lifestyle 5.1. The relationship between health inequalities and lifestyle is complex. Ill-health and social inequalities can increase the risk of smoking, drinking and unhealthy lifestyles just as unhealthy lifestyles can cause ill health. This mechanism can increase health inequalities Alcohol related harm is a significant public health issue both nationally and locally. Liver disease is one of the top causes of death in England, most liver disease is preventable and much in influenced by alcohol consumption and obesity x. Trafford is red on the majority of Public Health Outcome Indicators relating to liver disease. Locally the mortality rates for liver disease under the age of 75 years and liver disease considered preventable have tracked the national trend; however the most recently available data has demonstrated an increase in rates in Trafford above the national trend Between , in Trafford the death rate from liver disease was 22.7 per , compared to 17.9 per in England and 25.2 per in the North West. For men this rate was significantly higher than the national rate, 30.5 per compared to 23.6 per respectively xi. For women the local rate was 15.5 per , compared to 17.4 per in the North West and 12.5 per nationally In , the mortality rate from liver disease considered preventable in Trafford was significantly higher than the national rate, 20.3 per compared to 15.7 per respectively xii. The gap between national and local rate is increasing. Page 6

7 Trafford Clinical Commissioning Group Agenda Item No. 17 Fig 5: Under 75 year mortality rate from liver disease considered preventable, (persons, directly standardised rate per ). 25 DSR mortality per Trafford England Source: Public Health England, Although the local rate of liver disease is high across the borough, hospital admission rates demonstrate the impact of alcohol within our communities. Areas of high deprivation experience high rates of hospital admissions due to alcohol related harm, Bucklow-St Martins, Clifford and Longford wards experience the highest rates in Trafford In addition to the health related harms of alcohol, other consequences include increase rates of safeguarding risk, domestic violence, crime and disorder and high risk sexual behaviour, all of which impact on health inequalities. 6. Public Health Screening 6.1. Disease prevention and early diagnosis is essential if health outcomes and life expectancy are to improve in Trafford. National screening programmes for breast cancer, bowel cancer, cervical cancer and cardiovascular risk are delivered across Trafford and all eligible patients are invited to take part. Cervical screening and the NHS Health Check are delivered by primary care practices, breast screening and bowel screening through national programmes. Uptake for all these four screening programmes are recorded at practice level. Page 7

8 Trafford Clinical Commissioning Group Agenda Item No. 17 Table 6.: Range in Uptake of Public Health Screening Programmes in Trafford xiii. Programme Trafford Uptake National Reference average Lowest Highest target NHS Health 4.5% 0.7% 11% 20% Trafford CG Checks Score Care, 31/12/14 Breast screening 70.1% 56% 81.2% 80% Trafford CG Score Care, 31/12/14 Bowel screening 54.5% 25% 65.7% 55% Trafford CG Score Care, 31/12/14 Cervical screening 79.92% 65.81% 86.45% 80% Trafford CCG Performance 31/03/ Encouraging our residents to take up public health screening is essential if health inequalities are to reduce and life expectancy increase During 2014/15, Trafford CCG and Public Health successfully worked together to improve cervical screening rates. The team used national evidence to target interventions to improve uptake. The Only Takes A Minute campaign delivered a universal message to Trafford women, with women aged and over 50 years, women from BME communities and from areas of deprivation being specifically targeted. 7. Culture and Ethnicity 7.1. In Trafford, 80.4% of the population report their ethnicity as White British. Of the remaining 19.6%; Asian and Asian British make up the biggest proportion xiv. The communities with the highest proportion of people from BME groups are often those affected by deprivation. It is well evidenced that chronic disease risk is greater amongst certain communities, for example the risk of diabetes and CVD is greater in Afro-Caribbean and South Asian communities. 8. Age 8.1. People of different ages typically require different levels of support from public services. The level of need varies, and depends on a range of factors. For the majority of people contact with services will be short and only be required for acute episodes, but others require long-term help and support. In most populations, including Trafford, the need for services is greater at either end of the life course, infancy and old age In 2013, local residents were aged between 0-19 years, (25%), were aged between years (58%%) and (17%) were aged over 65 years old. Page 8

9 Trafford Clinical Commissioning Group Agenda Item No Children and Young People 9.1. By 2020, it is estimated that there will be more children aged 0-19 years than in This will require more school places, school nurses, and safeguarding resources, and will need the early help offer currently offered across Trafford to be strengthened Evidence shows that 1 in 5 children or 20.5% live in poverty in Trafford, 2, xv. The proportion of children living in poverty ranges considerably between wards, in Timperley ward 6.9% of children live in poverty compared to 42.8% in Clifford ward, this is a variation of 35.9%. Poverty does have a huge impact on the health and wellbeing of children, young people and their families Inequalities in oral health are an important measure of overall health, poor oral health in childhood is associated with poor health outcomes in later life. Regional comparisons shows that the levels of tooth decay in the North West are higher than any other regions with 34.8% of children in the area having one or more teeth that are decayed, extracted or filled. This compares with 27.9% in England and 21.2% in the South East. There are oral health inequalities in the Greater Manchester with the highest proportion of children affected by dental decay in Oldham (47.7%) and Salford (46.9%). In Trafford, the proportion of children affected by dental decay is 28% In the 0-19 year age group, the highest rates of hospital admissions due to dental caries were in Gorse Hill ward in 2011/12 (crude rate of 11.1 per 1 000) and in Longford ward in 2012/13 and 2013/14 with crude rate of 11.3 and 9.4 per respectively. Fig 9.: Hospital admissions due to dental caries in children and young people aged 0-19yr in Trafford, 2012/13 2 This figure is calculated as living in poverty after housing costs. Page 9

10 Trafford Clinical Commissioning Group Agenda Item No Hospital admissions due to dental caries in children aged 0-19 years in Trafford are higher for children from deprived communities. Analysis of hospital admissions due to dental caries in the 0-19 year age group shows variation across the deprivation quintiles, admissions from quintiles 1 and 2 (most deprived quintiles), accounted for 56% of all admissions in 2011/12, 49% in 2012/13 and 57% in 2013/ There are many health inequality indicators for children and young people s health and wellbeing, including breast feeding rates and prevalence of overweight and obesity. To reduce health inequalities, prevention and early intervention is fundamental as healthy children grow into health and productive adults. 10. Ageing Population Age is a key variable in the context of health inequalities. By 2020, there will be more people aged over 65 years living in Trafford of whom will be aged over 90 years. An ageing population presents a significant challenge to Trafford services and infrastructure. Currently, the borough has a slightly higher percentage of older people than the profile of Greater Manchester as a whole xvi In Trafford, as demonstrated by national evidence, the number of falls increases with age. Between 2009/2010 and 2012/13, 931 emergency admissions due to falls were for people aged 85 years and over compared to 187 for people aged 65 to 69 years Furthermore more women than men aged 65 years and over experience an emergency admission as a result of a fall. In 2012/2013, 414 women compared to 167 men were admitted to hospital following a fall. Between 2009/2010 and 2012/2013, females accounted for 70.5% of emergency admissions for falls in the borough. The risk of an admission is most markedly seen in older females, between 2009/2010 and 2012/2013, 32% of admissions for people aged 65 years and over were attributed to women aged 85 years and over. Page 10

11 Trafford Clinical Commissioning Group Agenda Item No. 17 Figure 10.: Emergency hospital admissions for injuries due to falls in Trafford residents registered with a Trafford GP by age band and gender, crude rate by 10,000 population, (2009/2010 to 2012/2013) This gender inequality is demonstrated across the age groups, with the differences between the gender groups statistically significant. One possible explanation for this is that women are more likely to have osteoporosis than men xvii, placing them at higher risk of breaking a bone following a fall. 11. Gender Gender is a significant indicator of health inequality, with men in Trafford living 3.6 years less than women. Differences in lifestyles and health service use explain some of this inequality There are many examples of health inequalities between men and women. At age 65, men and women in the UK are expected to live over half of their remaining lives free from disability, 53.2% and 58.5% for women and men, respectively. Between and , health status in terms of disability at age 65 has worsened for women but improved for men in the UK In Trafford at age 65, men have a life expectancy of about 18 years and women of 21 years. However, their disability free life expectancy is considerably less than this, as shown in table 11. Page 11

12 Trafford Clinical Commissioning Group Agenda Item No. 17 Table 11: Disability free life expectancy at age 65 in Trafford (using 3 year rolling averages) Male Female Male Female Male Female Male Female Life expectancy (yrs) Disability free life expectancy (yrs) 95% confidence intervals Proportion of life (after 65yrs) without a disability Rank of life expectancy (out of all English LAs 3 ) Rank of disability free life expectancy Rank of proportion of life disability free Source: ONS, Although life expectancy in Trafford is good, especially by Greater Manchester standards, our population is suffering from higher levels of disability and for longer than would be predicted by the life expectancy alone. Furthermore, although women live longer than men, the proportion of their lives spent living with disability is greater Between Trafford was RAG rated as red for mortality rate for causes considered preventable, Public Health Outcome Indicator The basic concept of preventable mortality is that deaths are considered preventable if, in the light of the understanding of the determinants of health at the time of death, all or most deaths from underlying causes could potentially be avoided by public health interventions in the broadest sense xviii For males this indicator is currently amber, with a rate of 247 per (n693) and for females, the indicator is red with a mortality rate of per , (n520). Although the rate has been decreasing for both genders in line with the national trend, the decrease has been significantly greater for men than women. However in terms of annual rate, there has been a decline of -2.1% for men but an increase of 5.2% for women Although mortality rate for causes considered preventable is higher for men than women in Trafford, the inequality can be seen when compared to the 3 Ranked out of 150 LAs with 1 the highest life expectancy and 150 the lowest life expectancy Page 12

13 Trafford Clinical Commissioning Group Agenda Item No. 17 national trend. Understanding this pattern in Trafford is important and may help explain the decrease in female life expectancy. 12. Occupation There is strong evidence demonstrating the relationship between socioeconomic group and health inequalities. Figure 13 shows the difference in proportions of socio-economic groups who reported Not Good health for England and Wales and selected regions, 2011 xix. Figure 12.: Proportion of Not Good health reported by men by NS-SEC class for England and Wales and selected regions, 2011 xx % Not Good Health Source: ONS, Higher managerial and professional 7. Routine Figure 12 clearly demonstrates the difference in health experienced by socioeconomic group, in the North West for example, 14.5% of higher managerial and professional workers report Not Good health compared to 33.0% of routine workers In Trafford, 19.6% of our population aged over 18 years smoke xxi compared to 20.1% in the North West and 18.4% nationally. Although overall prevalence is Page 13

14 Trafford Clinical Commissioning Group Agenda Item No. 17 low, there are significant inequalities in smoking rate between socio-economic groups. In Trafford 30.2% of routine and manual workers smoke compared to 30.1% in the North West and 28.6% nationally xxii. Trafford is currently rated as amber against this Public Health Outcomes Framework indicator; however, nationally smoking rates in these groups are declining in contrast to Trafford where it has plateaued. 13. Mental Health It is difficult to get reliable ward level data on mental health issues. However, at a borough level we know that there are high levels of mental health need in Trafford. There is also an established evidence base demonstrating mental health need and health inequalities. Deprivation and socio-economic factors are strongly associated with poor mental health Levels of mixed anxiety and depression are higher than the England average, at 11.14% of year olds suffering from this, compared to 8.92%. Rates of depression and anxiety among social care users are dramatically higher, with 51.2% of people using social services reporting that they feel moderately or extremely anxious or depressed, compared to the England average of 53.4%. These high rates of anxiety and depression among social care users mean that areas of higher deprivation can be expected to have higher rates of mental ill health. 14. Health Inequalities by Trafford Locality The four Trafford localities experience different health inequalities as a result of the communities and populations living in that area. 15. Central Locality Overall, health and wellbeing is good in Central locality. Brooklands ward has the smallest gap between male and female life expectancy in Trafford, at 1.8 years, this is mainly due to male life expectancy being the second highest in the borough. However, Sale Moor has a significant gap between male and female life expectancy with women in Sale Moor having the 4 th highest life expectancy, whilst men have the 5 th lowest in Trafford There is considerable variation in deprivation levels across the Central locality, with 8% of children living in poverty in Ashton on Mersey, compared to 26% in St Mary s ward St Mary s and Sale Moor have higher rates of alcohol admissions to hospitals than the national average. Sale Moor and Priory have two of the lowest overall cancer rates in Trafford, Page 14

15 Trafford Clinical Commissioning Group Agenda Item No Cardio vascular disease in Central locality is lower than the national average, both for heart attacks and coronary heart disease. However, COPD rates (as recorded by primary care) are higher than the average Central Trafford residents engage well in cancer screening, with high rates of bowel, breast and cervical screening. However, their uptake of NHS health checks is less good. 16. North Locality Four of the five Trafford Borough wards with the lowest male life expectancy are in this locality. Women in Gorse Hill ward live almost 7 years longer than men living in Gorse Hill, however, life expectancy for women in Gorse Hill is not high, and is 5 years less than in Hale Central North Locality has higher levels of deprivation than the Trafford average; this is also associated with higher rates of disease (including mental health issues). All wards in North Trafford have high levels of child poverty, with 43% of children living in Clifford ward living in poverty, after housing costs have been taken into account xxiii The majority of Trafford s black and minority ethnic (BME) population live in this locality. People of Black or Asian ethnicity have a higher risk of developing long-term health conditions, such as diabetes or heart disease. Using information from primary care, North Locality practices have the highest proportion of patients with diabetes Gorse Hill, Stretford and Longford wards all have high rates of emergency hospital admissions for heart attacks. Clifford, Longford, Gorse Hill and Stretford wards have high rates of emergency hospital admissions for coronary heart disease. Furthermore Longford, Gorse Hill and Clifford wards have high rates of elective or planned hospital admissions for coronary heart disease Stretford ward has the highest rate of emergency hospital admissions for injurious falls in people aged 65 years and over in Trafford Five of the seven Trafford wards with the highest alcohol-related hospital admissions are in this locality. Four of the six wards with the highest rate of lung cancer cases are in North Locality. These measures are associated with high rates of alcohol use and smoking Early diagnosis and disease prevention can significantly improve the health of a population. Primary care practices in this locality have the lowest rates of cervical screening and bowel cancer screening uptake in the borough and have low levels of flu vaccine uptake. Page 15

16 Trafford Clinical Commissioning Group Agenda Item No South Trafford Life expectancy for males and females is generally higher in the South than elsewhere in Trafford. However, female life expectancy in Village ward is the 4th lowest in Trafford. Hale Barns has the largest gap between male and female life expectancy, at 7.4 years. This is mainly due to very high female life expectancy (88.8 years) Almost a third (32%) of Trafford s population live in the South, and the South also has the largest proportion of older people, with 35% of our over 65s and 37% of our over 85s living in this area The five lowest wards for hospital admissions related to alcohol are in South Trafford locality. Village, however, is the 5th worst ward, and Broadheath is also above the national average Breast cancer incidence is generally higher in wards in South Trafford, especially Hale Central, Bowdon and Hale Barns, while lung cancer is low in these wards South Trafford is lower than the national average for heart attacks and heart disease and generally has the lowest rates in Trafford, with exception of Village ward Village is the ward in South Trafford with the highest childhood obesity rates. 18. West Locality West Locality has the ward (Bucklow St Martins) with the lowest male life expectancy in Trafford Borough,. Furthermore the three wards with the lowest female life expectancy in Trafford are also in this locality. Out of the five wards in West Locality, only Davyhulme West is in the top half of wards in Trafford for life expectancy for both males or females Although this locality does not have the highest proportion of elderly residents in Trafford, it does have the highest numbers of nursing and residential home residents of all the four localities There is a high prevalence of dementia in West Locality. The high rates of dementia may be because of better diagnosis rather than increased prevalence, and so could be seen as a positive West Locality experiences higher levels of heart and circulatory disease and stroke than other localities. The prevalence of heart attacks in this locality is generally higher than the national average and all wards in this locality are in the top half of areas in Trafford for heart attacks, coronary heart disease and emergency and elective admissions. The three wards in Trafford with the highest rates of emergency hospital admissions are in this locality, with Urmston having particularly high rates. Page 16

17 Trafford Clinical Commissioning Group Agenda Item No Urmston also has particularly high rates of admissions for falls but this is not sufficient to explain their high emergency admission rates. Emergency admission rates may be linked to a number of causes including heart disease and Chronic Obstructive Pulmonary Disease (COPD) i.e. chronic bronchitis and emphysema. This locality also experiences high levels of asthma and obesity Uptake of bowel and breast cancer screening in this locality is low although cervical screening rates have increased recently. Bucklow St Martins has the highest incidence of all cancer in Trafford. The rate of lung cancer is especially high in this ward, which is suggestive of high smoking levels. This is also linked to higher rates of deprivation. There are pockets of deprivation in this locality, for example 34% of children living in Bucklow St Martins ward live in poverty, after housing costs have been taken into account xxiv Flu vaccination rates are low, which is a concern given the number of care homes and the number of people with asthma Bucklow St Martins has highest rate of hospital admissions for alcohol in Trafford and all wards in this locality are higher than the national average. 19. Tackling Health Inequalities in Trafford Health inequalities are considered in all aspects of Trafford s Public Health work plan. Locality working is a key element of the teams approach to health inequalities, with the Director of Public Health and each Consultant having responsibility for one of the four Trafford Localities Tackling health inequalities requires working with and across different teams and organisations, community engagement and robust local intelligence. Table 19: Public Health Workplan 2015/2016: Health Inequalities Programme Public Health Lead Health Inequality Actions Measureable Outcome/ target Breastfeeding Helen Gollins/ Rebecca Fletcher Monitor and evaluate effectiveness of new Breastfeeding co-ordinator role with specific focus on Partington and vulnerable groups across Trafford Increase proportion of women breastfeeding at 6/8 weeks to 55% National Child Measurement Programme Oral Public Helen Gollins/ Rebecca Fletcher Helen Gollins/ Follow-up all overweight and obese children through the C&YP specialist weight management service Review the provision of oral health promotion for children Reduction in % school children in Year 6 (age 10-11) who are measured as obese Levels of tooth Page 17

18 Trafford Clinical Commissioning Group Agenda Item No. 17 Programme Public Health Lead Health Inequality Actions Measureable Outcome/ target Health Rebecca Fletcher from areas with high levels of tooth decay decay in children All Age Obesity Strategy Eleanor Roaf/ Rebecca Fletcher Prioritise the treatment of obese BME adults, and pregnant women to reduce diabetes and negative maternity outcomes respectively Increase in proportion of adults who are physically active Smoking and Tobacco Control Paula Whittaker Commission and monitor the Trafford Specialist Stop Smoking Service To focus quit support on routine & manual groups, BME groups and pregnant women. At least 25% of quits to be from clients from routine and manual groups At least 6% of quits to be from clients from BME groups Smoking status at time of delivery to be lower than England average Reduction in Routine & Manual smoking prevalence Alcohol Paula Whittaker/ Kylie Thornton Commission and monitor a full range of services from increasing awareness, locally commissioned services from GPs to inpatient rehab. Reduction in alcoholrelated hospital admission All license applications reviewed by public health. Awareness raising with public and frontline staff Targeting high risk drinkers for intervention Diversion of alcohol-related admissions via RAID service Promotion of MECC implementation across all Page 18

19 Trafford Clinical Commissioning Group Agenda Item No. 17 Programme Public Health Lead Health Inequality Actions Measureable Outcome/ target front line services Sexual Health Services Paula Whittaker/ Kylie Thornton Promote HIV testing by MSM, iv drug users and people from high risk countries Promote uptake of chlamydia screening by young people aged Increase chlamydia screening rates 2. Reduction in proportion of HIV diagnoses made at late stage Domestic Abuse and Violence Helen Gollins/ Kylie Thornton Monitoring of delivery of Specialist Community Based Domestic violence services provided by Victim Support and TDAS Increased number of reported cases of DA&V Implementation of IRIS programme training for primary and secondary care alongside bespoke referral route Cancer Prevention and Screening Helen Gollins Improve uptake of cervical, breast and bowel screening. Reduce inequalities in screening rates between Trafford primary care practices Maintain cervical screening uptake >80% Breast cancer screening uptake >75% Bowel cancer screening uptake >50% Influenza Paula Whittaker Advice on reaching low uptake groups such as under 65s at risk and pregnant women Joint communications to the public Uptake rates of flu immunisation in all at risk groups Priority group for 15/16: <65s at risk Reduce inequalities in practice uptake rates through targeted intervention with low uptake practices Page 19

20 Trafford Clinical Commissioning Group Agenda Item No Taking it further-next steps A refresh of the Joint Strategic Needs Assessment (JSNA) was agreed at the June 2015 Trafford Health and Wellbeing Board. A rolling programme of updating local intelligence will support effective Public Health interventions to tackle health inequalities The refreshed JSNA will include specific information on the current and future health needs related to the nine characteristics protected by the Equality Act 2010: Age Disability Gender re-assignment Marriage and civil partnership Pregnancy and maternity Race including nationality and ethnic origin Religion or belief Sex Sexual orientation The health needs identified by the refreshed JSNA will inform public health commissioning and planning decisions. This will enable us to ensure that public health action is targeted appropriately to reduce health inequalities. 21. Recommendation NHS Trafford CCG Governing Body is asked to note the progress on tackling health inequalities in Trafford and agree the jointly agreed CCG and Public Health 2015/16 work plan. Page 20

21 Trafford Clinical Commissioning Group Agenda Item No. 17 Appendices Appendix A: The Health Inequalities Umbrella xxv Page 21

22 Trafford Clinical Commissioning Group Agenda Item No. 17 Appendix B: Summary of Public Health Outcome Indicators, (the table on the following page presents the details of the corresponding indicator). Page 22

23 Trafford Clinical Commissioning Group Agenda Item No. 17 Trafford Count Indicator name 0.1i - Healthy life expectancy at birth (Male) G 1.9% i - Healthy life expectancy at birth (Female) A 1.0% ii - Life Expectancy at birth (Male) A 0.4% ii - Life Expectancy at birth (Female) A -0.2% ii - Life Expectancy at 65 (Male) A 1.1% ii - Life Expectancy at 65 (Female) G -0.9% iii - Slope index of inequality in life expectancy at birth within English local authorities, based on local deprivation deciles within each area (Male) 0.2iii - Slope index of inequality in life expectancy at birth within English local authorities, based on local deprivation deciles within each area (Female) 1.02i - School Readiness: The percentage of children achieving a good level of development at the end of reception 1.02i - School Readiness: The percentage of children with free school meal status achieving a good level of development at the end of reception 1.02ii - School Readiness: The percentage of Year 1 pupils achieving the expected level in the phonics Trafford Value Region Value England Value Worst/ Lowest Best/ Highest RAG Annual Change Trafford Trend England Trend % -0.2 NA % -0.1 NA 2, % 57.8% 60.4% 41.2% 75.3% G 12.1% 17% % 42.5% 44.8% 31.7% 68.1% A 19.5% 24% 2, % 74.1% 74.2% 64.3% 82.5% G 6.2% ii - School Readiness: The percentage of Year 1 pupils with free school meal status achieving the expected level in the phonics screening check % 61.2% 61.3% 31.8% 76.9% G 15.7% Fuel Poverty 10, % 11.3% 10.4% 21.3% 4.9% R -15.3% i - Social Isolation: % of adult social care users who % 45.6% 44.5% 35.4% 54.4% A -2.4% have as much social contact as they would like 2.06ii - Excess weight in 4-5 and year olds - 4-5y % 34.4% 33.5% 43.8% 22.3% A 9.5% ii - Excess weight in 4-5 and year olds yr % 34.4% 33.5% 43.8% 22.3% A -3.0% Excess Weight in Adults % 66.0% 63.8% 75.9% 45.9% A i - Cancer screening coverage - breast cancer 17, % 73.4% 75.9% 57.4% 85.1% R -1.7% v - Newborn Hearing screening - Coverage 2, % 98.4% 98.5% 92.7% 99.9% R i - Injuries due to falls in people aged 65 and over 287 1,826 1,883 1,661 2, A -1.3% (males/females) (Male) 2.24i - Injuries due to falls in people aged 65 and over 672 2,751 2,723 2,467 3,907 1,651 R 2.6% (males/females) (Female) 2.24ii - Injuries due to falls in people aged 65 and over , A aged (Male) 2.24ii - Injuries due to falls in people aged 65 and over - aged (Female) 189 1,301 1,346 1,180 2, A 2.24iii - Injuries due to falls in people aged 65 and over ,835 5,648 5,182 8,744 3,344 R 5.7% aged 80+ (Persons) 2.24iii - Injuries due to falls in people aged 65 and over ,716 4,579 4,162 7,663 2,149 A aged 80+ (Male) 2.24iii - Injuries due to falls in people aged 65 and over ,954 6,717 6,201 9,825 4,133 R aged 80+ (Female) Chlamydia detection rate (15-24 year olds) - CTAD 446 1,769 2,217 2, ,758 R Chlamydia detection rate (15-24 year olds) - CTAD 143 1,089 1,501 1, , % (Male) Chlamydia detection rate (15-24 year olds) - CTAD (Female) 301 2,493 2,923 2,634 1,094 6, % 3.03xiv - Population vaccination coverage - Flu (aged 65+) 30, % 75.8% 73.2% 62.9% 80.5% G 0.1% People presenting with HIV at a late stage of % 48.5% 45.0% 100.0% 14.3% R 11.5% Tooth decay in children aged A Mortality rate from causes considered preventable 1, R (Persons) Mortality rate from causes considered preventable A -2.1% (Male) Mortality rate from causes considered preventable (Female) R 5.2% Page 23

24 Trafford Clinical Commissioning Group Agenda Item No. 17 Code Initial Period Current Period Freqency Source 0.1i Annual 0.1i Annual 0.1ii Annual Source: Figures calculated by Office for National Statistics using ONS mortality data and midyear population estimates. 0.1ii Annual Source: Figures calculated by Office for National Statistics using ONS mortality data and midyear population estimates. 0.1ii Annual 0.1ii Annual 0.2iii Annual Figures calculated by Public Health England using mortality data and mid-year population estimates from the Office for National Statistics and Index of Multiple Deprivation 2010 (IMD 2010) scores from the Department for Communities and Local Government. 0.2iii Annual Figures calculated by Public Health England using mortality data and mid-year population estimates from the Office for National Statistics and Index of Multiple Deprivation 2010 (IMD 2010) scores from the Department for Communities and Local Government. 1.02i 2012/ /14 Annual 1.02i 2012/ /14 Annual 1.02ii 2011/ /14 Annual ii 2011/ /14 Annual Annual i 2010/ / ii 2006/ /14 Annual ii 2006/ /14 Annual Annual i v 2013/ /14 Annual i 2010/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates 2.24i 2010/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates 2.24ii 2013/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates 2.24ii 2013/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates 2.24iii 2013/ iii 2013/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates 2.24iii 2013/ /14 Annual Calculated by Public Health England: Knowledge and Intelligence Team (West Midlands) from data from the Health and Social Care Information Centre - Hospital Episode Statistics (HES) and Office for National Statistics (ONS) - Mid Year Population Estimates Annual xiv 2010/ /14 Annual Annual Integrated HIV surveillance data: Survey Of Prevalent HIV Infections Diagnosed (SOPHID), HIV and AIDS New Diagnoses Database (HANDD), and CD4 Surveillance held by the HIV & STI Department, Centre for Infectious Disease Surveillance & Control, PHE / /12 4 years Annual Public Health England (based on ONS source data) Page 24

25 Trafford Clinical Commissioning Group Agenda Item No. 17 Appendix C: Index of Deprivation for Trafford, 2010 Page 25

26 Trafford Clinical Commissioning Group Agenda Item No. 17 Reference i London Knowledge and Intelligence Team: Public Health England, (2012) Health Inequalities, ii London Knowledge and Intelligence Team: Public Health England, (2012) Health Inequalities, iii Public Health England, (2015) Health Profiles, 2015: Trafford. Public Health England. iv Trafford Council, (2012) Trafford Overview, v Department for Communities and Local Government, (2011) English indices of deprivation 2010, vi Public Health England, (2015) Health Profiles, 2015: Trafford. Public Health England. vii Public Health England, (2015) Health Profiles, 2015: Trafford. Public Health England. viii ONS, (2013) Life expectancy is calculated, by ward, using deaths. ix ONS, (2013) Life expectancy is calculated, by ward, using deaths. x Public Health Outcomes, (2015) Public Health Outcomes Framework, xi Public Health Outcomes, (2015) Public Health Outcomes Framework, xii Public Health England, (2015) Public Health Outcome Framework, xiii Trafford Clinical Commissioning Group, (2014) GP Score Card. xiv Office for National Statistics, (2012), 2011 Census: Ethnic group, local authorities in England and Wales, xv Office of for National Statistics, (2014) Children living in Poverty, xvi Trafford Council, (2012) Trafford Overview, xvii National Institute of Health and Care Excellence, (2012), CG146, Osteoporosis: assessing the risk of fragility fracture, xviii Public Health England, (2015) Public Health Outcome Framework, xix Office of for National Statistics, (2013) Health Gaps by Socio-economic position of occupation in England, Wales, English Regions and Local Authorities, xx Office of for National Statistics, (2013) Health Gaps by Socio-economic position of occupation in England, Wales, English Regions and Local Authorities, xxi Public Health Outcomes, (2015) Public Health Outcomes Framework, xxii Public Health Outcomes, (2015) Public Health Outcomes Framework, xxiii Office of for National Statistics, (2014) Children living in Poverty, Page 26

27 Trafford Clinical Commissioning Group Agenda Item No. 17 xxiv Office of for National Statistics, (2014) Children living in Poverty, xxv London Knowledge and Intelligence Team: Public Health England, (2012) Health Inequalities, Page 27

28 TRAFFORD PUBLIC HEALTH JOINT TRAFFORD COUNCIL AND NHS TRAFFORD CCG PUBLIC HEALTH WORK PLAN: 2015/16 June 2015

29 Public Health and NHS Trafford CCG Work Plan: Introduction The role of Public Health Public Health is concerned with proactively improving the health and wellbeing of the whole population of Trafford rather than responding to individual clinical need. In order to deliver the greatest health gain for the population within the finite resources available, Public Health examines all possible interventions based on: Health need Equity Cost-effectiveness, and Evidence-base Whilst much Public Health work does focus on prevention of ill health, Public Health is also concerned with improving outcomes and quality of life for the whole population, including those with acute and chronic conditions. For example, in tackling obesity Public Health is involved in; identifying the causes of childhood and adult obesity, assessing the evidence for and commissioning preventive and treatment interventions, and mapping the impact of changes in obesity levels on the future health of our population, for example the prevalence of diabetes. The latest health profile for Trafford 1 shows that although the health of people in Trafford is generally better than the England average stark inequalities in health remain with life expectancy 10.1 years lower for men and 6.3 years lower for women in the most deprived areas of Trafford than in the least deprived areas. Purpose of the Joint Trafford Council and NHS Trafford CCG Public Health Work Plan: 2015/16 The purpose of the Joint Trafford Council and NHS Trafford CCG Public Health work plan 2015/16 is to highlight a joint programme of activity and synergies between the Local Authority and the CCG on meeting the priorities for improving the health and population of Trafford. In addition the document provides a framework for the CCG to meet its internal audit and external NHS England requirements on Public Health in tandem with the CCG core offer for Public Health healthcare advice from the Local Authority. 1 APHO Joint Trafford Council and Trafford CCG Public Health Work Plan

30 The aim of this document is to highlight the Public Health actions and outcomes to be delivered in 2015/16, led by the Public Health team in collaboration with CCG and local authority partners. Domains of Public Health The Trafford Public Health Work Plan 2015/16 has been divided into areas of work to reflect both the domains of Public Health and the lifecourse approach to public health. The domain of Public Health are described below: 1. Health Improvement This includes working with communities to prevent ill health and promote wellbeing by facilitating healthy lifestyles and increasing access to health promoting activities and information. We work with statutory and voluntary partners to increase health literacy and understanding in the general public. We commission and manage services that help people to improve their health such as; weight management, smoking cessation, drug and alcohol services, physical activity and mental wellbeing. 2. Health Protection This includes ensuring that the public is protected from harm from communicable diseases, radiation and chemical exposure by responding to incidents and outbreaks swiftly and appropriately. We commission and manage open-access sexual health services and promote safe sexual health practice. We promote the uptake of cancer and non-cancer screening programmes targeted at the appropriate population group, and the uptake of the childhood and seasonal flu immunisation programmes. 3. Health Care Quality As well as monitoring the quality and outcomes of the services we directly commission, public health has a role in promoting quality in health care delivery by ensuring that all services address appropriate health needs, are based on sound evidence of effectiveness and cost-effectiveness, and are delivered equitably. 4. Health Inequalities The aim to reduce health inequalities runs through all the work of the Public Health. In refreshing the Joint Strategic Needs Assessment together and using it to identify gaps in provision and to inform commissioning we will be able to ensure that we address the health needs of our deprived and vulnerable groups, and commission services according to need. The equity and quality of screening programmes across our primary care practices plays a significant role in reducing inequalities and improving survival. In Trafford, Public Health is working across the CCG, Council and wider partnership to improve Joint Trafford Council and Trafford CCG Public Health Work Plan

31 screening uptake across the population and between practices. The successful model that led to increases in cervical screening uptake among women from BME groups in 2014/15 will be continued and applied to breast and bowel screening in 2015/16. Working Together to Improve Health and Well Being in Trafford Ultimately the cost savings from reduced use of secondary and social care will not be realised unless we agree and support a robust integrated Public Health agenda. Trafford Council and NHS Trafford CCG will collaborate to deliver this Public Health work plan. The priorities for the Public Health team in realising this during 2015/16 are to: Work effectively in partnership across the local authority and NHS; Reduce health inequalities in access and outcomes and; Ensure all health commissioning decisions are based on robust evidence of the impact on population health. Locality Partnerships and CCG Localities for Primary Care Trafford Council and Trafford CCG have adopted a locality partnership and locality footprint model for primary care that is synergistic. Trafford CCG Clinical Directors are represented on the Trafford Council Locality Partnership Boards. Trafford Council has established Locality Partnerships, made up of Councillors, other public sector partners including the police, health and council services, and Community Ambassadors. There are four Locality Partnerships which are coterminus with the CCG neighbourhoods. Each locality has been assigned a lead contact in the Public Health team for 2015/16 who will attend Locality Partnership meetings as required and provide Public Health information and support in developing and implementing their priorities. CCG Neighbourhood North Trafford Locality Partnerships Old Trafford & Stretford Wards covered Public Health team lead (CCG Lead) Gorse Hill, Longford, Abdul Razzaq/ Stretford, Clifford Paula Whittaker Central Sale Bucklow St Martins- Sale, Ashton upon Mersey, Brooklands, Priory, Sale (Sandy Bearing) Helen Gollins (Paul Hulme) Joint Trafford Council and Trafford CCG Public Health Work Plan

32 Moor, St Marys West Urmston & Bucklow St Martins- Partington Partington, Davyhulme East, Davyhulme West, Flixton, Urmston South South Trafford Altrincham, Bowdon, Broadheath, Hale Barns, Hale Central, Timperley, Village Abdul Razzaq/ Paula Whittaker (Joe Mcguigan) Eleanor Roaf (Julie Crossley) Trafford Strategies that Contribute towards Public Health Outcomes There are several strategies which Public Health contributes to, the public health elements of some of the main ones are detailed below: NHS Trafford 2015/16 Operational Plan There is substantial cross-over between the targets in the Public Health Work Plan and NHS Trafford CCG s Operational Plan. Plus, the Public Health team will support the CCG to deliver the Operational Plan via the core offer. In particular there are shared objectives in both the Public Health Work Plan and Operational Plan including: Redesigning the CAMHS Service Cervical screening building on the success of increased uptake in 2014/15 Palliative and blood pressure hypertension - quality premium 2015/16 Implementation of the Trafford CCG Diabetes Strategy Identification and treatment of people with hypertensions (see above) Implementation of the joint Trafford Bone Health and Falls Prevention Strategy Implementation of the Trafford CCG Dementia Strategy Implementation of the Trafford Care Co-ordination Centre Trafford Better Care Funds, focusing on the Frail and Older People NHS Trafford CCG 5 year Strategy The Public Health section of the CCG 5 year Strategy details the strategic actions we have committed to across all four domains of Public Health including key actions to deliver the following: Joint Trafford Council and Trafford CCG Public Health Work Plan

33 Reducing liver disease through reducing alcohol consumption; Reducing smoking prevalence; Reducing obesity; Picking up cardiovascular disease risk factors earlier; Screening for cancer and early detection of cancer; Reducing premature mortality in people with a learning disability; Maternal and neonatal interventions. Health and Wellbeing Strategy Together we have a duty to deliver the joint Health and Wellbeing Strategy priorities: 1. Reduce childhood obesity. 2. Improve the emotional health and wellbeing of children and young people. 3. Reduce alcohol and substance misuse and alcohol related harm. 4. Support people with long term health and disability needs to live healthier lives 5. Increase physical activity. 6. Reduce the number of early deaths from cardiovascular disease and cancer. 7. Support people with enduring mental health needs, including dementia to live healthier lives. 8. Reduce the occurrence of common mental health problems amongst adults. NHS Trafford CCG s Integrated Primary Care Development and Improvement Strategy The Public Health team will support a reduction in health inequalities by maintaining and improving primary care quality through an integrated approach with Trafford CCG, Trafford Council, Locality Partnerships, Public Health England and Trafford s primary care practices. This integrated approach will support primary care to: promote individual lifestyle changes by offering a choice of wellbeing services (e.g. NHS Health Checks, sexual health services, drugs and alcohol advice); engage with and encourage communities which are less likely to access services; ensure patients are engaged and make an informed decision about participation in national screening programmes, and ensure inequalities are addressed; promote wellbeing by treating patients holistically in terms of mental and physical illness; promote effective self-management for people with long-term conditions; and Joint Trafford Council and Trafford CCG Public Health Work Plan

34 improve the management of comorbidities by tackling the causes of premature mortality i. Public Health will support primary care to place their patients at the centre of a holistic care approach through the implementation of the Health and Wellbeing Hub. Public Health is working collaboratively with partners on the development and implementation of the Hub, which focusses on reducing the impact of the wider determinants of health such as housing, environment and lifestyle on the health and wellbeing of patients. Public Health will provide evidence based solutions to identify inequality issues, and support practices to respond to the impact that social and cultural factors have on health status and uptake of Public Health initiatives. Public Health will work with the CCG to improve the mental health resilience of Trafford s population. Primary care will be encouraged to recognise the early symptoms of mental ill-health and signpost patients appropriately. The mental health of children and young people s is an important determinant for future health and wellbeing. Public Health will work with the Primary Care Interface Team to support practices to improve the quality of their disease registers and reduce the gap between modelled expected numbers and actual numbers. Ensuring patients with conditions such as diabetes and high blood pressure are identified and appropriately managed will prevent early disability and death and will reduce health inequalities. Public Health will be fully engaged with the development of the Out of Hospital model. Public Health will work with the CCG to improve uptake of screening initiatives. Cancer screening programmes identify changes early, early diagnosis often means treatment is more successful compared to those patients who present with symptomatic disease. The NHS Health Check screens patients aged years for risk factors of cardio-vascular disease (CVD). Identifying people with risk factors and managing their care, reduces the risk of disability and death. Improving screening uptake across all our practices and reducing the gap in uptake between the poorest performing ones and the national uptake figures will have significant impact on the health of Trafford. Trafford Children and Young People s Strategy ii Trafford s Children and Young people are our most valuable asset. Protecting and promoting their health and wellbeing will support them to grow into healthy and successful adults. Trafford s Children and Young People s Partnership encourages an environment that promotes a safe and healthy childhood, supports a good educational experience and protects against accidents and disease. Joint Trafford Council and Trafford CCG Public Health Work Plan

35 To improve the outcomes for our children and young people this strategy is underpinned by the Marmot review, Fair Society Healthy Lives iii. Its three strategic aims, A Positive Start, Here and Now and A Bright Future reflect the Marmot principles, which are: Give every child the best start in life. Enable all children, young people and adults to maximise their capabilities and have control over their lives. Create fair employment and good work for all. Ensure healthy standard of living for all. Create and develop healthy and sustainable places and communities. Strengthen the role and impact of ill-health prevention. By taking better care of children s and young people s health and development we can improve educational attainment, reduce the risks of mental illness, unhealthy lifestyles, road deaths and hospital admissions. Key themes for the preschool and school aged children to improve their health and wellbeing are: Nutrition, active play, physical activity and obesity prevention; Immunisation; Personal, social and emotional development; Keeping children safe. The impact of the family environment on the health and wellbeing of children can be considerable iv. The transition from childhood to adulthood is a complex time with many challenges. Teenagers and young people can be the biggest risk takers e.g. misusing drugs and alcohol, and engaging in risky sexual behaviours. The teenage years are also a crucial time for health and wellbeing in later life. Half of lifetime mental illness starts by the age of 14. More than 8 out of 10 adults who have ever smoked regularly started smoking before the age of 19. One study has found that 8 in 10 teenagers who were obese went on to be obese adults v. Alcohol is a rising problem for young people and accidents due to alcohol, including drink driving, are a leading cause of death among year olds vi. Trafford s population is increasing. By 2030, the number of children and young people aged 0-17 years living in our borough is estimated to increase by 7,000 from 48,500 in 2011 to 55,400 vii. One of the greatest challenges for Trafford is the impact of health and social inequalities which can be masked by generally positive outcomes for children and young people in Trafford. 15% of Trafford s children live in poverty viii. Social inequalities have been shown to have a considerable impact on the life chances and Joint Trafford Council and Trafford CCG Public Health Work Plan

36 outcomes of children and young people ix. 26.3% of Trafford s school children are from a minority ethnic group x. The communities with the highest proportion of people from black and minority ethnic (BME) groups are often those affected by deprivation. Addressing lifestyle factors, including smoking, obesity and alcohol is central to preventing early deaths and reducing health inequalities. For example, overweight and obese children are more likely to become obese adults, and have a higher risk of ill health, disability and premature death in adulthood. In Trafford, 21.4% of 4-5 year olds and 33% of year olds are overweight or obese. Mental health difficulties are increasing in children and young people, national evidence estimates 1 in 10 under 16s have a diagnosable mental health disorder. A child who experiences a physical illness is 2-5 times more likely to develop an emotional disorder and early onset mental disorders are more likely to persist in adult life xi. Oral health, like general health, is linked with levels of material deprivation. In 2012, 28% of our 5 year olds had decayed teeth; this is marginally higher than the England percentage xii. Wide variation in hospital admission rates for dental caries between wards reflect levels of deprivation xiii. Good sexual health is intrinsic to health and wellbeing. Preventing unplanned teenage pregnancies and sexually transmitted infections (STIs) is essential for reducing social inequalities. Although Trafford has lower rates of teenage pregnancy compared to regional or national rates xiv, it is important to recognise that it is young women and men in areas of economic deprivation who are more likely to become a teenage parent. Chlamydia, which is most prevalent in the year olds, is a problematic sexually transmitted infection as there are often no symptoms but it can lead to infertility in later life, therefore active engagement with young people in addition to the universal screening programme is essential. As part of the National Chlamydia Screening Programme (NCSP) we need to test and treat more young people to protect their future reproductive health. Supporting children and young people to become healthy and successful adult s requires collaborative energy from all partners and a purposeful focus on meaningful and effective interventions. Mandatory Public Health services Trafford Council has, since 1 April 2013, a legal duty to improve the health of the local population and for Public Health services. Public Health England (PHE) sets out the list of Public Health functions of local authorities: Prescribed functions: i. Sexual health services - STI testing and treatment Joint Trafford Council and Trafford CCG Public Health Work Plan

37 ii. iii. iv. Sexual health services Contraception NHS Health Check programme Local authority role in health protection v. Public health advice vi. vii. National Child Measurement Programme Prescribed Children 0-5 services Non-prescribed functions: viii. ix. Sexual health services - Advice, prevention and promotion Obesity adults x. Obesity - children xi. xii. xiii. xiv. xv. xvi. xvii. xviii. xix. xx. Physical activity adults Physical activity - children Drug misuse - adults Alcohol misuse - adults Substance misuse (drugs and alcohol) - youth services Stop smoking services and interventions Wider tobacco control Children 5-19 public health programmes Non-prescribed Children 0-5 services Miscellaneous, which includes: a. Non-mandatory elements of the NHS Health Check programme b. Nutrition initiatives c. Health at work d. Programmes to prevent accidents e. Public mental health f. General prevention activities Joint Trafford Council and Trafford CCG Public Health Work Plan

38 g. Community safety, violence prevention & social exclusion h. Dental public health i. Fluoridation j. Local authority role in surveillance and control of infectious disease k. Information & Intelligence l. Any public health spend on environmental hazards protection m. Local initiatives to reduce excess deaths from seasonal mortality n. Population level interventions to reduce and prevent birth defects o. Wider determinants The responsibility for children's public health commissioning for 0-5 year olds will transfer from NHS England to local authorities on 1 October This will mark the final part of the public health transfer. The Public Health Outcomes Framework (PHOF) sets out the key indicators the Department of Health expects local authorities to work towards. PHOF targets for From the PHOF, the following indicators are our priority population outcomes for 2015/16. Details of actions that will be taken to deliver these targets and the Public Health functions of the LA are listed in appendix 1. The Public Health budget schedule shows how the Public Health Grant is distributed across these area is shown in Appendix 2. PHOF indicator Baseline Trend from previous values Target value for Breastfeeding prevalence at 6-8 weeks after birth 2014/15-54% 2013/ % 55% 2. Smoking prevalence in routine & manual groups % Up from 28.9% % 3. Percentage of physically % Down from 58% Joint Trafford Council and Trafford CCG Public Health Work Plan

39 PHOF indicator Baseline Trend from previous values Target value for active adults 57.5% Number of pregnancies to women aged inclusive 2013/14-66 pregnancies in Trafford Down from 20% 2012/ Uptake rate of NHS Health Check 6. People presenting with HIV at a late stage of infection 2014/15-47% No change from 2013/ % Up from 48% % 50% 7. Chlamydia detection rate (15-24 year olds) - CTAD ,769 per 100,000 Down from 1, ,960 per 100, Injuries due to falls in people aged 65 and over 2012/13-2,266 per 100,000 Up from 2, /12 2, Hip fractures in people aged 65 and over 2012/ per 100,000 Down from / Flu vaccination coverage of at risk individuals < Breast cancer screening coverage 12. Cervical cancer screening coverage 2013/ % Up from 52.8% 2012/ % Down from 75% in % Down from 73.9% % 75% 80% Mechanisms for delivery 1. Refresh of Health and Wellbeing Strategy action plan for JSNA refresh Joint Trafford Council and Trafford CCG Public Health Work Plan

40 3. Implementation of Shaping Demand Strategy across TMBC 4. CCG Public Health Core Offer review and refresh, including public health input into delivery of CCG service strategies and review- Trafford Patient Coordination Centre, falls and bone health, end of life care, community nursing 5. Partnership working including Locality Partnerships Joint Trafford Council and Trafford CCG Public Health Work Plan

41 Appendix 1: Trafford Public Health and NHS Trafford CCG Work Plan: 2015/16 No. Strategic Objective System Objective 1 Consistently achieve local and national quality standards. To reduce unplanned hospitalisation by 15% by Deliver an increasing proportion of services from primary care and To reduce planned hospitalisation by 10% by community services in an integrated way. 3 Reduce the gap in health outcomes between the most and least To improve patient experience by achieving a single point of access. deprived communities in Trafford. 4 Ensure a financially sustainable health economy. Demonstrate that all integrated care services are fully utilised and achieving targeted outcomes and improvements. 5 To ensure that the work of Public Health and Social Care are informed by and contribute to, the CCG s strategic objectives. 6 To continually review commissioned services to ensure they deliver value for money. 1. Children and Young People Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measureable Outcome Trafford CCG Strategic Objectives System (1,2,3,4) * Objectives* Breastfeeding Helen Gollins/ Rebecca Fletcher Implement local strategy and action plan for breastfeeding promotion and support Monitor and evaluate effectiveness of new Increase proportion of women breastfeeding at 6/8 weeks to 55% 1. Breastfeeding levels are low in deprived areas in the borough 1, 5, * See key above for description

42 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measureable Outcome Trafford CCG Strategic Objectives System (1,2,3,4) * Objectives* Breastfeeding co-ordinator role National Child Measurement Programme, (NCMP) * Helen Gollins/ Rebecca Fletcher Weigh all reception and year 6 children annually Provide written results to all parents/ carers Follow-up all overweight and obese children through the C&YP specialist weight management service Reduction in % school children in Year 6 (age 10-11) who are measured as obese 1. National standard of 85% participation rate 2. k 3. Childhood obesity rates are greatest in areas of socioeconomic deprivation 4. Early intervention provided to children at risk of or who are obese, this prevents expensive treatment downstream. 4, 5 Mental Health and Wellbeing: Children and Young People Helen Gollins/ Jill Colbert Redesign of CAMHS service LA ADP outcomes. 1. National 5 ways to wellbeing 3. Mental health ill health is associated with loss of employment and family breakdown 1, 5 Oral Public Health Helen Gollins/ Rebecca Fletcher Review the provision and guidance on oral health promotion for children Work as a partnership to Levels of tooth decay in children 1. Health visitor workforce deliver integrated care 2. Dental caries are commonest in 1, 5 * Mandatory Public Health Commissioned Service Joint Trafford Council and Trafford CCG Public Health Work Plan

43 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measureable Outcome Trafford CCG Strategic Objectives System (1,2,3,4) * Objectives* strategically review the provision and contributions to oral health children from deprived families 3. Prevention of expensive treatment Childhood Immunisation Programmes Abdul Razzaq Work with NHS England and local services to ensure that this occurs effectively Work with local services to deliver immunisations including school nursing To provide advice on quality assurance of childhood immunisation programmes in partnership with CCG, PHE and NHS England Childhood immunisation programme coverage rates Number of serious and untoward incidents 1. Assurance that services meet National quality standards 3. Ensure consistency of quality across Trafford 4. Immunisation from flu prevents the ill effects of disease. 1, 5, 6 Joint Trafford Council and Trafford CCG Public Health Work Plan

44 2. Working Age People Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives (1,2,3,4) * System Objectives* All Age Obesity Strategy Eleanor Roaf/ Rebecca Fletcher Prioritise the treatment of obese BME adults, and pregnant women to reduce diabetes and negative maternity outcomes respectively To halt the rise in children and young people who are overweight or obese through an integrated and co-ordinated partnership response. Reduction in % school children in Year 6 (age 10-11) who are measured as obese Increase in proportion of adults who are physically active 3. The negative impact of excess weight is associated with deprivation 4. Reducing obesity in the two priority groups will prevent high cost interventions 3. Childhood obesity rates are greatest in areas of socio-economic deprivation. 5, 6 4. Evidence demonstrates early interventions reduce costs for health services. NHS Health Checks * Paula Whittaker Increase rate of hypertension identification and treatment Increase uptake of NHS Health Check Evaluation of community pharmacy pilot scheme in 10% of eligible population to have received a NHS Health Check annually Increase the number of people aged 40+ who have had their blood pressure recorded in the past 5 1. National standard of 20% of eligible population to be invited each year and 10% of eligible population to receive NHS Health Check each year. 2. Use of pharmacy pilot. 3. CVD deaths and risk factors are 1, 2, 5, 6 * See key above for description * Mandatory Public Health Commissioned Service Joint Trafford Council and Trafford CCG Public Health Work Plan

45 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives (1,2,3,4) * System Objectives* Urmston Evaluation of Tesco pilot for nonresponding patients from general practice Review of delivery model with LMC and LPC years greatest in areas of socio-economic deprivation- appropriate advice and follow-up after the NHS Health Check will reduce this 4. Early identification of risk enables risk reduction with subsequent reduction in development of diabetes, stroke, CHD. Smoking and Tobacco Control Paula Whittaker Commission and monitor the Trafford Specialist Stop Smoking Service At least 25% of quits to be from clients from routine and manual groups At least 6% of quits to be from clients from BME groups Smoking status at time of delivery to be lower than England average Reduction in Routine & Manuel smoking prevalence 1. Stop smoking compliance with NICE quality standards 2. Strong links between stop smoking service and other wellbeing and behaviour change services 3. Smoking rates are greatest in areas of socio-economic deprivation. 4. Every 4-week quit achieved directly saves the NHS costs of 250 of secondary care activity xv. 1, 2, 5 Joint Trafford Council and Trafford CCG Public Health Work Plan

46 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives (1,2,3,4) * System Objectives* Alcohol * Paula Whittaker/ Kylie Thornton Commission and monitor a full range of services from increasing awareness, locally commissioned services from GPs to inpatient rehab. All license applications reviewed by public health. Awareness raising with public and frontline staff Targeting high risk drinkers for intervention Reduction in alcoholrelated hospital admission 1. NICE alcohol dependence and harmful alcohol use quality standard 2. Early intervention and wellbeing hub will integrate health and social care needs 3. Alcohol misuse is associated with unemployment. 4. NICE calculates that opportunistic screening and brief advice for alcohol use is cost saving. 1, 2, 4, 5 Diversion of alcohol-related admissions via RAID service Promotion of MECC implementation across all front line services Sexual Health Services * Paula Whittaker/ Kylie Commission and monitor the mandatory requirement of open access community based services are provided by Bridgewater 1. Increase chlamydia screening rates 2. Reduction in proportion 2. National standard for universal open access service 3. Talkshop provides a holistic 5, 6 * Mandatory Public Health Commissioned Service * Mandatory Public Health Commissioned Service Joint Trafford Council and Trafford CCG Public Health Work Plan

47 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives (1,2,3,4) * System Objectives* Thornton across the borough. Promote HIV testing by MSM, iv drug users and people from high risk countries Promote uptake of chlamydia screening by young people aged Retender integrated sexual health service to start delivery in September 2016 of HIV diagnoses made at late stage integrated service to young people. 4. Teenage pregnancy rates are greatest in areas of socio-economic deprivation- accessible services reduce this gap 5. Retendering process for new provider in collaboration with GM commissioners Domestic Abuse and Violence Helen Gollins/ Kylie Thornton Monitoring of delivery of Specialist Community Based Domestic violence services provided by Victim Support and TDAS Increased number of reported cases of DA&V 1. National Indicator 4. DA&V results in considerable costs for both health and social care. 1, 5 Implementation of IRIS programme training for primary and secondary care alongside bespoke referral route Cancer Prevention and Screening Helen Gollins Improve uptake of cervical, breast and bowel screening. Reduce inequalities in screening rates between Trafford primary care practices Maintain cervical screening uptake >80% Breast cancer screening uptake >75% Bowel cancer screening 1, National and local Standards 3.Cancer deaths impact disproportionately on the more deprived communities. 4. Early diagnosis and treatment saves 2, 5 Joint Trafford Council and Trafford CCG Public Health Work Plan

48 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives (1,2,3,4) * System Objectives* uptake >50% costs further up the system. 3. Healthy Ageing Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives System (1,2,3,4) * Objectives* Falls reduction and bone health Eleanor Roaf The implementation of the Trafford Bone Health and Falls Prevention Strategy For all fallers: Single point of access for falls assessment Community based falls team reducing future risk of falls Reduction in rate of admission for fragility fracture per 1000 population aged over 65 Reduction in rate of admission of older people into long term nursing care due to falls Dementia Eleanor Support implementation of Trafford Diagnosis and treatment rates for people with 1. Injurious falls is a national indicator and NICE has several guidance documents. 2. Services and initiatives will be community based and incorporate a wider range of local stakeholders. 3. j 4. Reduces the impact of falls, the consequences of which are expensive for health, rehabilitation and social care services. 5. 1, 2, 3, 5, 6 * See key above for description Joint Trafford Council and Trafford CCG Public Health Work Plan

49 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objectives System (1,2,3,4) * Objectives* Roaf CCG Dementia Strategy dementia End of Life Care Eleanor Roaf Support delivery of End of Life Care Strategy Deaths at usual place of residence 2, 4 1, 4, 5, 6 Public Health input to service redesign 4. Public Health Intelligence Public Health Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Strategic Objs (1,2,3,4) Trafford CCG System Objs Joint Strategic Needs Assessment Helen Gollins/ Tim Gillibrand Coordination of annual updates to JSNA pages published on Info Trafford JSNA updated annually 1. The JSNA shows our joint performance against national standards 4, 5, 6 Joint Trafford Council and Trafford CCG Public Health Work Plan

50 5. Health Protection Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objs (1,2,3,4) System Objs Outbreak control and incident management * Abdul Razzaq Oversight and assurance of mandated health protection Public Health function through Health Protection Forum and HERG. Commissioning of Community Infection Control Team Assurance of Sepsis quality improvement-infection Control Team to provide advice via Health protection Forum via Health Protection Forum Assurance of HCAIs root cause analysis via Health Protection Forum Emergency plans in place Incidents responded to and controlled appropriately Number of health care acquired infections Monitor infectious organisms MRSA bacteraemia (NHS Trafford CCG target = zero tolerance) CDI (NHS Trafford CCG target = 63) Ecoli bacteraemia MSSA bacteraemia Emerging organisms e.g. CPE 1. Mandatory function of public health. g 1, 2, 5 Influenza Paula Whittaker Assurance of delivery of National immunisation campaign. Advice on reaching low uptake groups such as under 65s at risk and pregnant women Uptake rates of flu immunisation in all at risk groups Priority group for 15/16: <65s at risk 1, National target of 70% uptake 3, Ensure increased uptake in most deprived populations 1 * Mandatory Public Health Commissioned Service Joint Trafford Council and Trafford CCG Public Health Work Plan

51 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objs (1,2,3,4) System Objs Infection Prevention and Control Teamprovided by Pennine Care NHS Foundation Trust Phil Broad Joint communications to the public 1. IP&C support provided for health & social care providers in relation to assurance framework: Education and training Audit Policies Hand hygiene 2. Contribute to monitoring, management and reduction of alert organisms MRSA bacteraemia ( target = zero tolerance) Community attributed Clostridium Difficile Infection (CDI) (NHS Trafford CCG target = 63, community attributed cases generally expected to remain 50% of Trafford CCG target) 4, Flu immunisation delivers efficiencies by preventing consultations and admissions 1. Compliance with infection control standards 1 A] MRSA: Participate in Post infection reviews (PIR) and report to relevant stakeholders. Follow up positive lab results for community patients and provide IP&C advice and support to GP s and other stakeholders B] Clostridium Difficile Infection (CDI): Follow up & carry out root cause analysis (RCA). Provide IP&C advice and support to patients (including green card and information leaflets), GP s and other stakeholders. Monitor prescribing of antibiotics, PPIs and other immune-therapies, refer to medicines management team as appropriate. Monitor relapses Joint Trafford Council and Trafford CCG Public Health Work Plan

52 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objs (1,2,3,4) System Objs 3. Delivery of support and advice to health and social care providers commissioned by Trafford Council and NHS Trafford CCG A] Care homes Nursing (total 14), residential (total 21): Training and inspections, carried out annually where possible, plus ad hoc inspections, following safeguarding reports, incidents & other concerns from commissioners and regulators. Outbreak management monitoring and follow up of all reported episodes. Advice service and visits on request B] Care agencies training for up to approx. 480 staff (where possible, 2 sessions per month, delivered at TTH) 4. Outbreak management support advice and guidance for A] care homes and supported living centres B] schools and nurseries including ongoing support and advice, monitoring of progress and follow-up of all reported episodes, visits carried out as required reporting of outbreaks to key stakeholders including PHE, Local authority, commissioners and Joint Trafford Council and Trafford CCG Public Health Work Plan

53 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objs (1,2,3,4) System Objs community and acute provider services Collaborative working with PHE GM HPU 5. Delivery of bespoke IP&C Training and education to health and social care providers within the Trafford health economy including Community provider services Care homes and care agencies General medical and dental practices voluntary sector and patient groups 6. Delivery of support and advice to General Medical Practices in Trafford CCG (total 35. Also provided for Master call and Out of hours GP service) Training, by arrangement inspection & review of premises/buildings (on request, or frequency dependent upon responsibility for GP premises) 7. Delivery of support and advice to General Dental Practices in Trafford CCG (including specialist advice on decontamination and for LAT and CQC, following performance visits) Training by arrangement Joint Trafford Council and Trafford CCG Public Health Work Plan

54 Programme Public Health Lead Actions (actions in italics are also included in the CCG Operational Plan 2015/16) Measured Outcomes Trafford CCG Strategic Objs (1,2,3,4) System Objs inspection & review of premises/buildings by arrangement Attendance at and participation in activities of LDC meetings 8. IP&C service collaborative working across the Trafford health economy Attendance at stakeholder meetings, including: Acute provider IP&C committees local authority care consortium group POIG GM confederation/collaborative partnership (including participation in workstreams) 9. Health and social care act (2008), code of practice for the prevention & control of infections and associated guidance. Provision of support to all community stake holders building evidence for assurance with regulation 12 outcome 8. Joint Trafford Council and Trafford CCG Public Health Work Plan

55 Trafford Council Public Health Team Structure