joint strategic needs assessment

www.portsmouth.gov.uk1

Joint Strategic Needs Assessment

Summary for Commissioners, 2012

www.portsmouth.gov.uk

About this year’s summary

• Presented as slides• Data, charts, maps, reports at www.jsna.portsmouth.gov.uk• Uses framework of draft Health and Wellbeing Strategy (2012)...• ...But also incorporates key themes from “Fair Society, Healthy Lives: The

Marmot Strategic Review of Health Inequalities in England, post2010”

• The Joint Strategic Needs Assessment presents:

“the big picture”

2


Objectives in the Draft Health and Wellbeing Strategy, 2012

The priorities of the Shadow Health and Wellbeing Board, in the short to medium term, are to:

1: Enhance quality of life for people with dementia

- improve the quality of dementia services and the care that those with dementia receive.

2: Support people to maintain their independence and dignity

- strengthen community-based provision to support independence and avoid unnecessary admissions to hospital.

3: Ensure all children get the best possible start in life by concentrating on the pre-birth to 5 years old age group

- deliver an integrated pathway pre-birth to 5 years old that is easily understood and accessed by parents and carers as well as professionals.

4: Improve outcomes for local people’s health and wellbeing by driving up the quality, and ensuring the safety, of all services

-ensure that the commissioners represented on the board are checking that all providers of care have effective safeguarding procedures in place.

Further information at: http://www.portsmouth.gov.uk/yourcouncil/24885.html


Background - researchNew information obtained this year

Prison health and wellbeing

Adults with autistic spectrum disorders

Armed Services’ Veterans

Children with autistic spectrum disorders

Sexual health

LSP Conference “Our Health, Our City, Together”

Refresh crime and anti-social behaviour

Surveys carried out this year

• Young people’s substance misuse

Ongoing needs assessments or research

Fratton

Adults with learning disabilities

Refresh young person’s substance misuse

School meals

Refresh prison health and wellbeing

Young people’s aspirations and attainments

Refresh alcohol needs assessment

Planned needs assessment or research

• Children with speech, language and communication difficulties

• Social isolation in older people in Hilsea and Nelson wards

• Health and wellbeing needs of City Council housing tenants

4


Place: Portsmouth• Population: 205,100 residents. GPs serve 215,622 registered patients • Area: 15.5 square miles• Population density: Highly urbanised city. 51 people per hectare (most

densely populated local authority outside London)• Neighbours: Havant and Fareham Borough Councils, Winchester City

Council. South Eastern Hampshire and Fareham and Gosport CCGs...• ... But ONS group the local authority with areas such as Southampton,

Brighton and Hove, Plymouth, Bristol, Newcastle, Liverpool, Sheffield, Leeds, Salford

• Transport routes: Well-connected with motorway, A-road and mainline rail connections to/from the city. Domestic and international ferry routes. Major passenger and freight port

• An employment hub for suburban hinterland especially Havant, Fareham and Gosport. Major employers: health and social work, administration and support services, public administration and defence, information and communication. Home of Royal Navy. Associated heritage industry.

• High public sector employment, and sizeable proportion of industry directly or indirectly dependent on public sector, leads to increased vulnerability to public sector job cuts


People: Demography

15 10 5 0 5 10 15

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90 and over

% total population

Males England

Females England

Males Portsmouth

Females Portsmouth

Source: ONS Census, 2011

Resident population by gender and 5 year age bands, Portsmouth City and England, 2011

• 69% of Portsmouth’s population is aged 15-64 yrs (England 66% and SE 65%)

• Strong population growth especially young adults aged 15-29 years

• 11% are aged 20-24 years (7% nationally) – a good source of skilled workers to fill jobs

• Nearly 18,400 full-time students and about 4,000 part-time students at University of Portsmouth


People: Demography

15000 10000 5000 0 5000 10000 15000

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85+

Resident population (number)

Males HCC Forecast

Females HCC Forecast

Males Census 2011

Females Census 2011

Source: ONS Census, 2011. HCC Small Area Population Forecasts for 2011

Resident population by gender and 5 year age bands from Census 2011 and Hampshire County Council Small Area Population Forecasts, Portsmouth City, 2011

Chart shows differences in population forecasts we have been using (Hampshire County Council) and 2011 Census

And about 3,200 more children and young people (0-19 yrs) (of whom about 1,900 are aged 15-19 yrs) than we expected

Census shows about 4,900 fewer people aged 65+ years (of whom about 1,300 are aged 85+ years) than we expected

More Census data to be released in November 2012... JSNA website resources will be updated


1500 1000 500 0 500 1000 1500

50515253545556575859606162636465666768697071727374757677787980818283848586878889

90 and over

Number of people aged 50+ yearsSource: Mid-yr estimates for 2012 based on Census, 2011. ONS

Resident population aged 50+ years by gender and single year age bandsPortsmouth City, 2012

People: Demography

Post-war baby boom evident in increase in numbers of people in their mid 60s

About 1,670 people are aged 90+ years


People: Diversity

Estimated resident population by ethnic group and broad age groupPortsmouth City, mid 2009

29,800

1,100

1,900600

500

119,500

1,900

7,600 3,6004,600

31,500

100 400 100 300

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

White Mixed Asian or Asian British Black or Black British Chinese or other ethnicgroup

% o

f to

tal p

opula

tion

0-15 years Working age (16 to 59/64) Retirement age or over (60/65+)

Source: ONS Experimental Statistics (EE2,EE3)

15.5% from Black and minority ethnic communities (including White Irish and other White non-British communities) compared with 17% in England

Other White, Indian and Chinese communities are largest ethnic groups in the city

Non-White ethnic groups tend to have:

• Lower proportion of people aged 65+ yrs and,

•Higher proportion of children and young people


People: Deprivation Portsmouth is ranked 76th out of 326 local

authorities in England (where 1 is the most deprived)

Most deprivation is experienced by people in Charles Dickens, Paulsgrove, Cosham and St Thomas wards

Of all Portsmouth wards, Charles Dickens has the highest number of deprived smaller areas for income, employment, health, crime and education, skills and training

Male life expectancy is significantly shorter than England. And within the City, male life expectancy is 10.8 yrs shorter in deprived compared to less deprived areas


Compared to England

Indicator - Rank

Hasti

ngs C

D

Plym

outh

UA

Sout

ham

pton

UA

Brist

ol U

A

Port

smou

th U

A

Brig

hton

and

Hov

e U

A

Sout

hend

-on-

Sea

UA

East

bour

ne C

D

Bour

nem

outh

UA

Exet

er C

D

Wor

thin

g CD Po

rtsm

outh

tren

d co

mpa

red

to P

rofil

e 20

11

Com

pare

d to

Eng

land

Deprivation 3 9 10 11 12 13 14 16 17 18 19 $% children in poverty (*) 4 14 6 7 8 15 11 13 16 18 19 $

Statutory homelessness (*) 14 4 10 13 1 3 16 19 17 6 18 $GCSE achieved 2 14 6 5 1 9 18 11 15 7 17 $

Recorded crimes of violence v the person 10 5 1 2 3 9 12 8 4 13 15 $Long term unemployment 2 14 18 10 15 13 6 11 16 19 12 $Smoking in pregnancy (*) 1 3 9 16 7 19 13 11 15 18 17 $

Breastfeeding initiation (*) 14 4 9 16 10 19 6 17 13 12 18 $Obese children yr 6 (*) 4 10 8 12 9 19 15 13 16 14 17 $

Alcohol-specific hospital stays (under 18) 8 6 4 15 14 9 17 10 13 3 16 n/aTeenage pregnancy under 18 (*) 4 11 5 9 10 17 15 13 16 14 19 $

Estimated prevalence adults smoking (*) 5 4 15 11 2 6 16 18 12 14 19 $Est prev increasing & high risk drinking 15 8 7 9 3 2 13 18 5 1 11 $

Est prev healthy eating adults 8 5 9 12 7 18 15 19 17 13 16 -Est prev physically active adults (*) 7 12 8 4 16 19 3 9 11 17 15 -

Est prev obese adults (*) 1 6 14 13 8 19 4 5 15 16 3 -Incidence malignant melanoma 17 1 6 14 7 4 16 13 3 2 5 $

Self-harm hospital stays (*) 12 14 2 9 5 6 17 16 15 11 3 $Alcohol-related hospital stays (*) 7 6 19 4 10 11 9 17 5 15 12 $

Est prev opiate &/or crack cocaine users 5 8 17 6 16 11 13 7 2 14 19 $Diabetes prevalence (*) 4 9 13 16 12 19 5 10 15 17 7 $

New cases TB 18 15 8 1 7 10 6 12 11 16 14 $Acute sexually transmitted disease 16 10 3 14 4 2 18 17 5 12 19 n/a

Hip fracture 65+ yrs (*) 2 7 19 11 10 15 14 12 3 13 9 $Excess winter deaths (*) 19 8 10 13 1 6 12 4 17 15 2 $

Male life expectancy 5 8 18 7 11 10 14 17 15 19 9 $Female life expectancy 3 8 14 11 15 16 9 18 13 17 12 $

Infant deaths (*) 1 7 8 17 14 12 18 16 19 4 3 $Smoking related deaths (*) 5 11 10 9 4 14 15 18 16 19 17 $

Heart disease & stroke premature mortality (*) 7 5 13 11 10 14 15 18 17 19 16 $Cancer premature mortality (*) 4 13 9 7 6 11 15 19 18 16 17 $

Road injuries and deaths (*) 3 18 9 17 4 2 6 5 8 19 15 $

Local authorities in ONS Regional Centres Group ranked in descending order of deprivation Compared to England

Six highest or worst ranking Improving trend $Seven to 13th ranking Worsening trend $Lowest six ranking Significantly worse

(*) indicator substantially similar to indicator proposed in Public Health Outcomes Framework No different

Significantly better

Health Profile, 2012

Portsmouth is in a group of 19 local authorities (LAs) with similar socio-economic profiles

[The chart shows only those LAs in the group of 19 who are in the south of England.]

Portsmouth is ranked 8th best of 19 LAs for deprivation

But we are in the worst six for:

• Statutory homelessness

• GCSE achievement

• Violent crime

• Smoking

• Drinking alcohol

• Hospital stays for self-harm

• Sexually transmitted diseases

• Excess winter deaths

• Smoking-related deaths

• Early death due to cancer

• Road injuries and deaths


Community safety

12

Crime has increased slightly since 2010/11, but is still well below the levels seen six years ago. Violent crime has increased by 7%.

54% of Portsmouth residents reported that they either “agreed” or “strongly agreed” that anti-social behaviour was a problem in the area where they live

•Domestic Abuse accounts for about a quarter of all violent crimes

• The number of crimes committed by young people, and the number of young offenders, have both reduced since 2010/11

• Drug misuse – 27% of offenders supervised by probation misuse drugs and 53% have alcohol issues

• Alcohol misuse – drunk and rowdy behaviour was the most commonly reported type of anti- social behaviour

Priorities for the Safer Portsmouth Partnership based on the strategic assessment 2011/12, and how they are linked


Getting the best possible start in life

Black and minority ethnic communities have a younger age profile.

Highest percentages of Black and Minority Ethnic pupils are in St Thomas (43%), St Jude (32%) and Charles Dickens (30%) wards

Most common first languages for school pupils are English, Bengali, Polish and Arabic

About 24% of children live in poverty but highest rates are in Landport (67%) and City Centre North (66%) areas of Charles Dickens ward

22% of 0-15 year olds live in households dependent on out-of-work benefits


2009/10 2010/11 2011/12

England 44.9 45.7 46.9

Southampton City PCT 37.1 45.0 49.6

Portsmouth City tPCT 42.8 43.5 41.7

0

10

20

30

40

50

60

70

80

90

100

% in

itiat

ing

bre

astf

ee

din

g w

ithin

48

ho

urs

of

de

live

ry

Prevalence of breastfeeding at 6-8 weeks, as % of all infants due a checkPortsmouth City teaching Primary Care Trust and comparators, 2009/10 - 2011/12

Source: DH Breast Feeding statistical bulletin (totally or partially breastfed), average of four quarters


74% of Portsmouth new mums start breastfeeding

their babies

But only 42% are still breastfeeding 6-8 weeks

later

0

5

10

15

20

25

2009/10 2010/11 2011/12

% s

mo

kin

g a

t tim

e o

f d

eliv

ery

(SA

TO

D)

Percentage of women smoking at time of delivery (SATOD)Portsmouth City and comparators

England South Central SHA Portsmouth Southampton

All pregnant women who smoke are offered smoking cessation

advice and/or referred to smoking cessation services.

Last year, 62 pregnant women set a quit date and 42 successfully quit.

464 women were still smoking at the time their babies were born



But there are local inequalities – children in our deprived

areas have lower Early Years Foundation Stage results

“Ensure high quality maternity services, parenting programmes, childcare and early years’ education to meet need across the social gradient” – Marmot Policy objective

Early Years Foundation Stage

64% of city children aged 4 to 5 years achieved a good level of personal, social and emotional development

when assessed in the reception year at school (compared to 59% nationally)


0

5

10

15

20

25

30

35

40

45

Year R Year 6

% o

verw

eig

ht o

r o

bes

e

Percentage of Year R and Year 6 pupils overweight or obesePortsmouth City 2006/07 to 2010/11

2006/07 2007/08 2008/09 2009/10 2010/11

Source: National Obesity Observatory (NOO) e-atlas, National Child Measurement Programme

Over these years, Portsmouth’s Year 6

children had the greatest decrease in obesity of all

PCTs (-5%)

7th highest rate of 152 PCTs


Position improved to 62nd highest rate of 151 PCTs



Compared to last year, more students have never tried tobacco or alcohol

Male students were more likely than females to have tried tobacco, smoke every day, and less likely to find alcohol and drug advice in schools to be helpful


Acute respiratory diseases (eg acute laryngitis,

tonsillitis, common cold) are the main causes of

emergency hospital admission for 0-14 yr olds

Most are admitted for only a few hours

Lower respiratory tract infection (eg acute

bronchiolitis, influenza, pneumonia) emergency

hospital admission rate is declining but remains

higher than comparator areas



0

10

20

30

40

50

60

70

baseline

1998/00 1999/01 2000/02 2001/03 2002/04 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10

rate

/ 1

,00

0 fe

ma

les

ag

ed

15-

17y

rs

Conception Rates for females aged under 18 yearsper 1,000 females aged 15-17 years, 1998/00 - 2008/10

England Government Office of the South East Portsmouth City Southampton City

Declining teenage pregnancy rates

But higher rates in more deprived areas

Young people and Chlamydia

47.9% of young people aged 15-24 years screened (England average 28.5%)

Higher rates of positive diagnoses than England, SHA or Southampton



0

10

20

30

40

50

60

70

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

% p

up

ils a

chie

vin

g5

+A

*-C

incl

En

glis

h &

Ma

ths

Percentage with 5 GCSEs at A*-C grade including English and MathsPortsmouth City and comparators, 2004/05 onwards

England Government Office of the South East Portsmouth City

Source: http://media.education.gov.uk/assets/files/xls/s/sfr02-2012atadditionaltables7to21.xls[GCSE AND EQUIVALENT RESULTS IN ENGLAND 2010/11 (REVISED)]

Improving GCSE attainment but in

2010/11 we still had the lowest attainment of

comparable local authorities.

Provisional results for 2011/12 suggest a local

7% improvement.

The improvement is particularly marked in

Maths

Helping young people to be ready, willing and able to work


• Between 2007 and 2009, 40% of Portsmouth’s state school pupils went onto higher education – the lowest of our neighbouring local authorities

• Raising educational attainment remains a key issue for the city

• The evidence shows that we can best achieve this by:

• Supporting schools to become good and outstanding

• Ensuring all pupils have basic literacy and numeracy skills

• Raising the expectations of teachers, parents, pupils and the wider community

• Ensuring all pupils achieve their potential – nobody is left behind and high achievers are stretched

• The key vehicle for delivery of this work is the improving schools strategy – Effective Learning for Every Pupil http://www.portsmouth.gov.uk/achieving-excellent-schools.html


“Ensure that schools, families and communities work in

partnership to reduce the gradient in health, wellbeing

and resilience of children and young

people”Marmot Priority Objective



• Levels of young people not in education, employment or training are higher than regionally, but are in line with Southampton and national levels

• However, young people are over-represented in the total group of unemployed people in the city

“Need to ensure those currently excluded from the

workforce are able to participate. This will often

mean working with people to tackle multiple barriers. In particular, must avoid any

lasting effects from the recession on unemployed

young people, ensuring they do not become excluded from

the workforce.”

Recommendation of a report to the Economic Development, Culture and

Leisure Scrutiny Panel, Nov 2011

0

5

10

15

England Government Office of the South East

Bristol Plymouth Brighton and Hove Southampton Portsmouth City Southend Bournemouth

DSR

/ 10

0,00

0 p

erso

ns a

ll ag

es

Young people aged 16-18 yrs not in education, employment or training% NEET of young people aged 16-18 yrs known to Connexions, 2011

Source: Dept for Education


Create a better environment for people to live, work and play

Portsmouth is an employment hub for wider region – attracting more commuters in than go out of Portsmouth to work.

In-commuters tend to occupy the ‘better’/higher level jobs

Prosperity (Gross Value Added per head) is satisfactory but not as high as similar areas

Productivity (Gross Value Added per job filled) is improving but remains low

Possible reasons for Portsmouth’s lower prosperity and productivity:

• Skills - Current residents of working age, and those entering workforce, continue to have low skill levels

• Innovation - Portsmouth has potential for innovativeness – we can build on what is already here, remove barriers to firms wanting to expand”

• Competition - Low business density (implying lack of competitiveness), due to higher proportion of, and greater size of large firms, in Portsmouth

• Entrepreneurship - improving survival rates of new businesses

Economic Area Assessment, 2012


3.5% of Portsmouth’s working population are claiming out-of-work benefits

Job Seekers Allowance claimant rates are highest in Charles Dickens (6.6% of working age population), Nelson (4.8%) and Fratton (4.2%) (August 2012)

Unemployment increases the chance of being ill, especially for those who have never worked or have had poorly paid jobs

Unemployment increases rates of depression – especially in younger workers People in secure employment recover more quickly from illnessSource: Unemployment and health. Dorling D. BMJ 2009;338:b829


60

62

64

66

68

70

72

74

76

78

80

Apr 2004-Mar 2005

Jul 2004-Jun 2005

Oct 2004-Sep 2005

Jan 2005-Dec 2005

Apr 2005-Mar 2006

Jul 2005-Jun 2006

Oct 2005-Sep 2006

Jan 2006-Dec 2006

Apr 2006-Mar 2007

Jul 2006-Jun 2007

Oct 2006-Sep 2007

Jan 2007-Dec 2007

Apr 2007-Mar 2008

Jul 2007-Jun 2008

Oct 2007-Sep 2008

Jan 2008-Dec 2008

Apr 2008-Mar 2009

Jul 2008-Jun 2009

Oct 2008-Sep 2009

Jan 2009-Dec 2009

Apr 2009-Mar 2010

Jul 2009-Jun 2010

Oct 2009-Sep 2010

Jan 2010-Dec 2010

Apr 2010-Mar 2011

Jul 2010-Jun 2011

Oct 2010-Sep 2011

Jan 2011-Dec 2011

Apr 2011-Mar 2012

% w

ork

ing

ag

e p

op

ulat

ion

Employment rate trends of working-age populationPortsmouth City, April 2004 onwards

Source: Annual population survey ONS Crown Copyright Reserved

Portsmouth’s employment rate is usually slightly higher than the GB rate, but slightly

lower than the SE rate.

The local rate has not changed significantly over time


Most densely populated local authority outside London. 79% of us live on Portsea Island

Our open and green spaces are integral to quality of life, conserving biodiversity and mitigating effects of climate change

The City’s CO2 emissions are just over 1M tonnes in total:

43% from Industry and Commercial

32% from Domestic and,

25% from road transport sources

The planned Public Service (Social Value) Act 2012 will place a requirement on public bodies to consider economic, social and environmental wellbeing in relation to public service contracts as part of their pre-procurement discussions



Tenure, Portsmouth, 2008

Portsmouth percentage of rented properties is above average for urban areas in the SE

Much of the city’s housing stock is over a century old

Demand for affordable renting is substantial and rising – priority given for over-crowding, those in poor health and those who are homeless


Housing issues that impact on health and wellbeing include:

• Homelessness

• Overcrowding

• Damp, draughts and cold

• Indoor pollutants and infestation

• Housing form – stairs, narrow doorways, inaccessible toilets and bathrooms

• Relative location

• Crime and safety

• Neighbourhood condition – ‘liveability’



81% of housing in Portsmouth is in the private sector.

Just over one third of private housing fails to meet the Decent Homes Standard, with the main reason being ‘insufficient thermal comfort’ (eg lack of central heating)

Fuel poverty is also more prevalent in the private sector (15% of households)

Fuel poverty affects 48% of those households on the lowest incomes in Portsmouth

Highest proportions of fuel poverty in parts of Southsea and Paulsgrove/Wymering

Households in fuel poverty, 2009



• Climate change scenarios for Portsmouth show:

• Sea level likely to rise by about 70cm. Extreme sea levels will be experienced more frequently

• Summer mean temperatures will increase, and higher summer temperatures will become more frequent. Predicted increase in urban heat island effect, health-related health impact, water shortages, fire risk etc

• Warmer, wetter winters with likely increase in heavy winter precipitation (rain, sleet, snow). Impact seen in increased risk of flooding

• Likely to be increased variability in weather events, particularly storminess (including wind and lightening). Impacts include infrastructure damage, flooding etc

• Portsmouth Plan includes climate change projections. Challenge to ensure that key climate change risks are taken into account as regeneration takes place

• Actions to improve active travel options (eg walking, cycling), public transport, energy-efficient housing, green space, healthy eating, reduced carbon-based pollution will also benefit the sustainability agenda

Develop common policies to reduce scale and impact of climate change and health inequalities


Encourage healthy lifestyles by helping people to stop smoking, lose weight and drink responsibly

• Male life expectancy is significantly shorter than the England average (female life expectancy is not significantly different to the England average)• Males in the most deprived areas live nearly 11 years fewer than males in the least deprived areas of the city



To increase male life expectancy, we need to tackle:

1 Coronary heart disease

2 Chronic cirrhosis of the liver

3 Pneumonia

4 ‘Other’ cancers

5 Lung cancer

(Greatest impact listed first)

Main causes of the gap in life expectancy between males and females in the most and least deprived quintiles, Portsmouth

“Prioritise prevention and early detection of

the conditions most strongly related to

health inequalities.”

Sir Michael Marmot


Encourage healthy lifestyles by helping people to: Stop smoking

0

50

100

150

200

250

300

England Government Of f ice South

East

South Central SHA

Portsmouth *Bristol *Southampton *Plymouth *Brighton and Hove

*Southend-on-Sea

*Bournemouth

DS

R (

pe

r 10

0,0

00

Eu

rop

ea

n s

tan

da

rd p

op

ula

tion

)

Deaths attributable to smoking, persons aged 35+ yrrPortsmouth City and comparators, 2008-2010

Directly age-Standardised Rate (per 100,000) and 95% confidence intervals

Source: APHO community health profiles.*Unitary Authorities in the same ONS Regional Centre comparator group as Portsmouth.

Smoking is the main reason for the gap in life expectancy between rich and poor

Compared to England, Portsmouth has significantly higher levels of:

Smoking in pregnancy Lung cancer registrations Smoking attributable deaths from heart disease Smoking attributable deaths overall Deaths from lung cancer, and Chronic Obstructive Pulmonary Disease (COPD)


0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

5500

6000

Qtr1

2008/09 2009/10 2010/11 2011/12 2012/13 (cumulative)

Num

ber o

f peo

ple

setti

ng a

qui

t dat

e

Number of people setting a quit date by age band, NHS Smoking Cessation Service, Portsmouth, 2008/09 onwards

Under 35 35-44 45-59 60+

Encourage healthy lifestyles by helping people to: Stop smoking

22% fewer smokers set a quit date in 2011/12 - with the biggest drop in the under 35 year old age group

Fewer males set a quit date than females ... but males were more likely to successfully quit

People who use Portsmouth’s NHS Smoking Cessation Service are significantly more likely successfully to quit smoking than the England average

Successful quitters service includes Fitness for Surgery programme for pre-op patients National pilot for Secondary Care smoking cessation


Encourage healthy lifestyles by helping people to: Drink responsibly

0

500

1000

1500

2000

2500

baseline revised baseline target

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

rate

/ 1

00

,00

0 p

op

ula

tion

Alcohol-related hospital admission rate per 100,000 populationPortsmouth City tPCT, 2002/03-2010/11

England GOSE South Central SHA Southampton City Portsmouth City Portsmouth City targets

Source: North West Public Health Observatory

0

5

10

15

20

25

30

35

40

2006-08 2007-09 2008/10

DS

R p

er 1

00

,00

0 p

op

ula

tion

Mortality from alcohol-specific conditions, MALESDirectly age-standardised rates per 100,000 population, all ages

Portsmouth City and comparators, 2006-08 to 2008/10

England Government Of f ice of South East Portsmouth City Southampton City

Source: North West Public Health Observatory (NWPHO)

Compared to the South East or England, Portsmouth has significantly higher rates of:

People claiming incapacity benefit or severe disability allowance due to alcoholism

Alcohol-attributable crime, violent crime and sexual crimes

Alcohol-attributable hospital admissions – and the male trend is increasing

Alcohol-specific mortality rate for males


Encourage healthy lifestyles by helping people to: Drink responsibly

Alcohol-related hospital admissions are significantly higher than the City rate for people from Charles Dickens, Fratton, Nelson, Paulsgrove and St Thomas wards

Alcohol-specific hospital admissions significantly higher than the City rate for Charles Dickens, Nelson, St Thomas and Eastney and Craneswater wards. Very strong positive relationship (0.84) between these admissions and deprivation


Encourage healthy lifestyles by helping people to:Be a healthy weight

0

10

20

30

40

50

Southend-on-Sea UA Plymouth UA Portsmouth UA Southampton UA Bristol UA Bournemouth UA Brighton and Hove UA

Est

ima

ted

pre

vale

nce

/10

0 a

du

ltsEstimated prevalence of adults who are obese

Southern Unitary Authorities within ONS Regional Centres Comparator Group, 2006-2008

UAs South East Region EnglandSources: NatCen for Health Profiles, 2012

Modelled prevalence suggests 23% of adults are obese Highest modelled prevalence of adult obesity in Stamshaw, Paulsgrove and Wymering Comprehensive adult weight management pathway Healthy Pompey programme supports the city with healthy weight initiatives


0

20

40

60

80

100

120

140

160

180

200

1993 1994 1995 1996baseline

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

DS

R (p

er 1

00,0

00 E

uro

pea

n st

anda

rd p

opul

atio

n)

Trend of mortality from all circulatory diseases (ICD9 390-459, ICD10 I00-I99)Portsmouth City and comparators, persons aged under 75 years, 1993 - 2010

Directly age-Standardised Rate (per 100,000 population)

England Government Office South East South Central SHA Portsmouth City ONS classification - Regional Centres

Source: Compendium of Clinical and Health Indicators, Office for National Statistics and the NHS Information Centre for health and social care. © Crown Copyright.

Progress in reducing premature deaths:Circulatory diseases

Circulatory diseases (including coronary heart disease) are the most frequent causes of death locally and nationally

Our circulatory disease mortality rates are falling but remain higher than the national rate, and the rate of comparator local authorities

Highest rates of premature death due to coronary heart disease are in Buckland, Paulsgrove, Wymering, Somerstown and Fawcett areas

Male emergency hospital admission rates for coronary heart

disease are significantly higher than female rates


Progress in reducing premature deaths: Cancer

Very strong positive relationship between smoking and premature deaths due to all cancers

Lung cancer is the second most frequent cause of death to Portsmouth males


Progress in reducing premature deaths: Respiratory diseases• Fourth most frequent cause of death in Portsmouth

• Primary care management of respiratory disease is good but practices serving the most deprived communities have higher COPD and asthma prevalence, respiratory conditions admission rate and exception rate for asthma indicators; and lower levels of inhaled Corticosteroids per STAR-PU

Significantly higher rates of emergency admission for chronic obstructive respiratory disease in City Centre, Buckland, Paulsgrove, Somerstown and Wymering


Progress in addressing specific causes of ill health... Diabetes

39

• About 8,700 people have diabetes – 4.1% of adults• BUT…• Modelled prevalence, suggests there may be an additional 1,800 patients with unrecognised

and/or unrecorded diabetes in the city


Progress in addressing specific causes of ill health... Diabetes

40

Portsmouth PCT is in the lowest 25% of all PCTs in terms of people with diabetes:

•Receiving all nine care processes

•Having foot examinations

•Having urinary albumin measurements

PCT also in second lowest quintile for % of people with diabetes screened for diabetic retinopathy but we were the fourth highest PCT for issuing Certificates of Vision Impairment caused by diabetic eye disease


Progress in addressing specific causes of ill health: Mental Health

]

All PCTs spend most of their programme budgets on mental health services

Portsmouth PCT is in the highest quartile for expenditure on mental health services (£274 per weighted head vs £265 per weighted head for ONS cluster )

[This includes all NHS expenditure on secondary and tertiary mental health services (for all ages) and expenditure on mental health drugs by GPs]

Deprivation is strongly correlated with the level of adults receiving services from Adult Social Care for mental health problems

• = significantly higher than England


Progress in addressing specific causes of ill health: Mental Health

Significantly higher rate of hospital admissions for self-harm than all six of our most local comparator local authorities

Local suicide rate has declined by 39% since 1995/97.

Local rate is now significantly lower than England and ONS comparator group averages


Progress in identifying needs of specific groups: People with a Learning Disability

In general, people with a learning disability have higher rates of gastrointestinal cancer, coronary heart disease, respiratory disease, mental ill health and challenging behaviour, dementia, epilepsy, sensory impairments, physical impairment, poor oral health, dysphagia

At risk of inequalities related to: Poverty, poor housing, unemployment, social isolation, discrimination Risks associated with genetic and biological causes of learning disabilities Communication difficulties and reduced health ‘literacy’ Personal health risks and behaviours Deficiencies in access to, and quality of, healthcare provision

GPs have identified about 700 adults with a learning disability

Last year, Adult Social Care provided a service to 451 clients

Highest Adult Social Care client rates in Hilsea ward – reflecting historic provision of residential

services


Progress in identifying needs of specific groups: Armed Forces VeteransEstimated 16,200 to 17,000 veterans live in Portsmouth

We do not know the actual number of veterans

Most recommendations in the needs assessment relate to improving identification of veterans, and increasing services’ knowledge of veteran issues

About 125 people receive Armed Forces Compensation Scheme payments (injuries etc arising after 6 April 2005)

All recipients are aged under 50 years

About 670 people receive War Disablement Pension (injuries etc which arose before 6

April 2005)

52% of recipients are aged 65+ years

After 65+ years, veterans are likely to have higher prevalence of mental health and sensory disorders.

And lower prevalence of musculoskeletal, circulatory and respiratory conditions

Between 16-64 years, veterans are likely to have higher prevalence of musculoskeletal, mental health, circulatory and respiratory conditions compared to general population


Progress in identifying needs of specific groups: Armed Forces Veterans

Recommendations from veteran questionnaire survey and one-to-one interviews:• Improve links between the local authority and the MOD• Military medics to train civilian medics• Mainstream services to have a greater awareness of Post Traumatic Stress Disorder• Set-up peer support service for individuals leaving the services• Better publicity for NHS Priority Treatment• The Council could provide more information for veterans on the services available to them, perhaps via council website• All services to ask individuals if they have served in the armed forces so that we are recognised as a specific group and can be signposted to relevant services more efficiently. Healthcare providers should be made aware of personnel coming into the area after service.

Mental health problems were the main issue faced by veterans in the survey. Post Traumatic Stress Disorder was their most common mental health problem


Help older people maintain maximum independence and dignity in old age

More than half of the people aged 60+ years in Sultan Road South (53%), Blackfriars (51%) and Bridge Centre (50%) areas are living in income deprivation

Research planned to look into extent of social isolation being experienced by people aged 60+ years


75% of registered patients aged 65+ years received the ‘flu vaccine – we’ve achieved better than the England rate for the past six years. But three Practices did not achieve 70% uptake

Over 5 years, the highest excess winter deaths rates were in

Francis Avenue, Portsdown,

Wymering, Alexandra and Palmerston areas


Portsmouth had highest excess winter death rate of 19 comparator authorities


Life expectancy after age 65 years which is disability-free is shortest in City Centre, Buckland, Wymering, Somerstown and Stamshaw areas

NB Shortest disability-free life expectancy shown in palest areas in this map


Adult Social Care provides significantly higher levels of services in the community to people with physical disabilities in Charles Dickens and Paulsgrove wards


Dementia is a local and national priority

Local GPs have recorded dementia in 0.64% of all registered patients

About 1,000 people are missing from dementia registers – probably those with mild dementia

Unhealthy lifestyles followed by today’s cohort of middle-aged people will impact on prevalence of vascular-related disease in older age, including dementia

Portsmouth patients aged 65+ yrs with dementia who are admitted for more than two days, stay in hospital seven days longer than those without dementia

National change in coding death certificates has increased the local number of deaths coded to Dementia and Alzheimer’s disease (now 5th most frequent cause of death locally, and 3rd most frequent for females)

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Leading causes of death for Portsmouth residents, by gender, all ages and electoral ward5) Dementia and Alzheimer’s disease, 2009/11

Directly age-Standardised Rate (per 100,000 population) and 95% confidence intervals

Males

Females

Persons

Sources: ONS Public Health Mortality Files & Hampshire County Council Small Area Population Forecasts

Highest mortality rates in Eastney and Craneswater, St Jude, Hilsea,

Cosham and Drayton and Farlington wards



Cancers are the main cause of elective hospital admission (18% of

all elective admissions by this age group)

“Symptoms and signs” are the main cause of emergency admission (23% of all emergency admissions by this

age group

These ten causes of admission account for 48%

of all elective admissions and 55% of all emergency

admissions by this age group



Use of hospital services – adults aged under 65 years

51

Diseases of the musculoskeletal system and connective tissue are the main cause of elective hospital admission (15% of all

elective admissions by this age group)

“Symptoms and signs” are the main cause of emergency admission (20% of all

emergency admissions by this age group)

These ten causes of admission account for 48% of all elective

admissions and 45% of all emergency admissions by this age

group

Overall there were 4,092 admissions for Pregnancy, Childbirth and the Puerperium

(ie elective, emergency, maternity ante-partum and transfers. Total in graph shows only those

coded as elective or emergency)


People: Demography Need to use fresh data from 2011 Census to understand local population, and

population trends particularly as they affect young people and older people Need to understand changing characteristics of populations served – particularly in

deprived areasPeople: Diversity Need to use fresh data from 2011 Census to understand local population, and

population trends – particularly the younger profile of black and minority ethnic communities

People: Deprivation Comparatively, we are not particularly deprived but the most deprived areas within

the city have poorer outcomes for health and wellbeing Major inequalities:

Between genders – poor male life expectancy Between different areas of the city - deprivation

Conclusions


Community Safety Safer Portsmouth Priorities are inter-related and are often the driving factors

behind, or contributors to, a range of crime and anti-social behaviour types. Priorities are alcohol misuse, domestic abuse, young people at risk, drug misuse and adult re-offending

Getting the best possible start in life 24% of children live in poverty – but rates are much higher in most deprived parts of

the city More pregnant women who smoke need to quit More women need to breastfeed their babies for longer Teenage pregnancy rates are declining Results for Early Years Foundation Stage show inequalities Substance misuse issues are improving Obesity rates for children are declining High rate of emergency admissions for respiratory conditions is an ongoing issue

Conclusions


Helping young people to be ready willing and able to work GCSE results are improving but still poor More young people need to be encouraged to go to higher education

Create a better environment for people to live, work and play Employment rates are better than national average Adult skills are below national level Older housing stock, higher percentage of rented properties and one third of private

housing failing Decent Homes Standard have implications for health and wellbeing Fuel poverty more prevalent in private sector

Conclusions



Relatively high levels of smoking and alcohol misuse need preventive and treatment services and continued joint working with local authorities, the voluntary sector and businesses

Reducing smoking prevalence requires continued joint working and services tailored to different stages of life from teenagers through to older age, and to the different needs of each gender at each stage

Tackling the ‘causes of the causes’ of short male life expectancy requires reducing high levels of smoking, alcohol misuse and obesity in men

Relatively high levels of smoking, obesity and alcohol misuse need preventive and treatment services and continued joint working with local authorities, the voluntary sector and businesses

Reducing smoking and obesity prevalence requires continued joint working and tailored services tailored to different stages of life from teenagers through to older age, and different needs of each gender at each stage

Conclusions



Diabetes Need to continue to address whole pathway of diabetes care to reduce poor

outcomes Preventive services involving joint working with local authorities and the voluntary

sector are essential to promote lifestyle changes to prevent onset of diabetes and to prevent diabetic-related complications

Mental health Relatively lower prevalence of depression may indicate need for case finding Relatively high prevalence of severe mental illness – need for appropriate primary

care and specialist mental health services Role of community support services in meeting needs of people with severe mental

illness Potential to examine care of people with dementia at home to prevent unnecessary

admissions and also discharge arrangements

Conclusions


Adults with a learning disability At risk of inequalities – report due by Christmas 2012Veterans• All services need to ensure veterans are identified and supported• All services need increased knowledge of their particular needs

Help older people maintain maximum independence and dignity in old age Over half of older people in most deprived areas live in poverty Excess winter deaths are an ongoing problem Potential to examine care of people with dementia at home to prevent unnecessary

admissions and also discharge arrangements

Conclusions


Evidence base to support commissioning• Overarching

– Kings Fund: Transforming our health care system – 10 priorities for commissioners– Portsmouth JSNA: www.jsna.portsmouth.gov.uk

• General health and lifestyle– NICE PH1: Brief interventions and referral for smoking cessation– NICE PH15: Reducing the rate of premature deaths from cardiovascular disease and other smoking-related diseases: finding

and supporting those most at risk and improving access to services– NICE PH24: Alcohol-use disorders: preventing the development of hazardous and harmful drinking– NICE CG115: Alcohol-use disorders. Diagnosis, assessment and management of harmful drinking and alcohol dependence

• Circulatory disease– NICE Quality Standard: Stroke (includes all relevant NICE guidance and relates to the DH National Stroke Strategy)– NICE Quality Standard: Chronic heart failure (in development)

• Cancer– NICE Quality Standard: Breast cancer (in development)– NICE: Improving outcomes in cancer series

• Diabetes– NICE Quality Standard: Diabetes in adults– NICE Quality Standard: Chronic kidney disease in adults

• Respiratory disease– NICE Quality Standard: COPD (in development) (will include all relevant NICE guidance published to date, and will relate to the

forthcoming National COPD Strategy)– Hospital admission rates for COPD: the inverse care law is alive and well. Jones R. Thorax 2011;66:185-186

• Mental health– NICE Quality Standard: Depression in adults– NICE Quality Standard: Dementia

• Hospital admissions- Kings Fund: Avoiding hospital admissions - what does the research evidence say? NICE Quality Standard: Dementia


Comments and suggestions welcome

What do you think are the main issues facing people in Portsmouth?

What do you think are the causes of the issues you’ve identified?

What issues do you think we ought to include in the Joint Strategic Needs Assessment, and why?

Do you have any information or data which could help our investigations of needs in Portsmouth?

After assessing needs, commissioners make decisions about how and where to spend public money on improving the well-being of people in Portsmouth:

• Is there anything taking place which, in your view, is not effective? What should we stop doing?

• What ought to happen to improve well-being in Portsmouth? What should we do?

What assets do we have in Portsmouth to tackle the issues you’ve identified?

Thank you for responding to this document.


Thank you for responding to this document.

Please email your responses to [email protected]

Or post your response to:

Joint Strategic Needs AssessmentPortsmouth City Council

Strategy UnitFREEPOST PT705Guildhall SquarePORTSMOUTH

PO1 2YX

Comments and suggestions welcome


Acknowledgements

61

Joint Strategic Needs Assessment Responsible Directors

Joint Strategic Needs Assessment Steering Group

Joint Strategic Needs Assessment Analysts’ Group

All photos credited to Portsmouth City Council

joint strategic needs assessment

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