Joint Strategic Needs Assessment

2017West Hampshire CCG

Hampshire Public Health TeamHampshire Health and Wellbeing Board

Population headlines 2016 Children (0-19 years) – 124,944 (22.5%) (23.1% County)Adults (20-64 years) - 302,893 (54.4%) (55.8% County)Older people • (65+) – 127,849 (23.0%) (21.2% County)• (90+) – 7,624 (1.4%) (1.2% County)

Total West Hampshire Population555,686

Key Issues for West Hampshire

Long term conditions /multi-morbidity:• Diabetes • Cardiovascular Disease • Chronic Obstructive

Pulmonary Disease • Mental Health (including

Dementia)• Musculoskeletal

(including Falls/Fractured hips)

Lifestyle risks• Smoking• Obesity • Alcohol• Inactivity• Poor diet

Demographic Growth by 2023 • Aged 0-19 years – increase by 11,347 (9.08%) • Aged 65 and over – increase by 20,120 (15.7%)• Aged 90 and over – increase by 2,759 (36.19%)

Working age: • Healthy carers,• Workplace health• Community Resilience

Health and social inequalities• Education• Employment• Isolation

Source: The 2016-based Hampshire County Council (HCC) Small Area Population Forecasts (SAPF)

Life Expectancy • Men – 81.6 years• Women – 84.9 years

2016 2023 % Change 2016 2023 % Change 2016 2023 % ChangeAge0To14 93,692 103,306 10.26% 244,126 262,901 7.7% 9,886,800 10,476,600 6.0%Age15To29 85,934 86,643 0.83% 221,518 220,572 -0.4% 10,584,800 10,387,000 -1.9%Age30To44 95,202 103,087 8.28% 253,444 271,509 7.1% 10,822,400 11,487,900 6.1%Age45To59 119,189 120,187 0.84% 301,676 303,444 0.6% 11,109,300 10,945,100 -1.5%Age60To74 101,570 110,531 8.82% 238,618 261,952 9.8% 8,334,500 9,052,900 8.6%Age75+ 60,099 77,986 29.76% 137,258 179,965 31.1% 4,481,100 5,667,600 26.5%Total 555,686 601,740 8.29% 1,396,640 1,500,344 7.4% 55,218,700 58,017,200 0.9%

Age bandNHS West Hampshire Hampshire

Population Change 2016 to 2023England

Source: The 2016-based HCC SAPF

Demography: Current structure and forecast

• The OADR provides an idea of the relationship between the working age population compared to those of pensionable age. A higher OADR value indicates a fewer people of working age

• Ratio of people of state pension age is increasing compared to working age population

• Difference across the CCG – Highest in New Forest and Test Valley

• By 2025 for every 2 people of working age there will be 1 person of pensionable age in Test Valley and Winchester; in New Forest the ratio will be less than 2:1; in Eastleigh the ratio will be closer to 4:1

• Predominantly White British; with 7.0% non-White British

Demography: Old Age Dependency Ratio (OADR);Ethnicity

Source: Office for National Statistics (ONS) 2014-based Subnational Population Projections, OADRs

Demography: Life expectancy

Life expectancy is significantly better than the England average for males and femalesSource: Local Health

Deprivation12th least deprived CCG in the country

IMD score: 10.6

The map shows the extent of the 2015 IMD in the lower super output areas (LSOAs) that make up the West Hampshire CCG area

Inequalities• Across the CCG health inequalities impact differently, as shown in the

life expectancy gap between most and least deprived and between genders

• Main impacts are by Circulatory disease, Cancer and Respiratory disease

• Notable differences: – Eastleigh (Digestive disease including alcohol related disease in

women)

– Winchester (Digestive disease including alcohol related disease in women)

– Test Valley and New Forest (Mental and behavioural causes including Dementia)

Inequalities

EastleighLife expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12

East HampshireLife expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12

Source: PHE Segment Tool 2015

InequalitiesTest ValleyLife expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12

WinchesterLife expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12

New ForestLife expectancy gap between most deprived and least deprived quintiles, by broad cause of death 2010-12

Source: PHE Segment Tool 2015

Demography: Key messages

• Population is changing – growth in both young and oldest age bands, diverse

• Proportion of working aged population is reducing; pressure on services and caring

• Good life expectancy at birth for males and females; significantly better than England average

• Health inequalities; pockets of socio-economic deprivation

Starting Well• A wide number of factors influence and determine good

health

• No single definitive measure

• Infant and child mortality, and birth weight tend to be regarded as good indicators of health now and in the future

Starting Well: Low Birth Weight

• Babies born with low birth weight (LBW) at risk of poorer health developmental issues

• Risk factors for LBW include maternal smoking (8.5%) and deprivation

Source: Child Health Profiles, PHE 2017

Starting Well: Breast feeding

Source: Child Health Profiles, PHE 2017

Breast feeding gets off to a good start with 79.2% mothers breast feeding at birth but drops at 6-8 weeks to 51.6% Note that data collection on breast feeding at 6-8 weeks maybe incomplete

Starting Well: Healthy Weight

Levels of excess weight increase over primary school years, and obesity levels double

Source: Child Health Profiles, PHE 2017

Starting Well: Morbidity

Source: Child Health Profiles, PHE 2017Suggested rise in emergency admissions

Starting Well: Injuries

• Significantly higher than national for hospital admissions due to injuries in 15-24 year olds

• Need to understand better social and emotional factors affecting young people that impact on these indicators Source: Child Health Profiles, PHE 2017

Starting Well – Emotional health and wellbeing

Source: Children and Young People's Mental Health and Wellbeing, PHE 2017

Hospital admissions for self-harm in 10-24 year olds similar to comparators

Starting Well: Vulnerable children

Source: Vulnerable children and young people , PHE 2017Hampshire level data suggest increases in social care and safeguarding activity

Source: Child Health Profiles, PHE 2017

Starting Well: Mortality

Starting Well: Key messages

• Work with families to minimise excess weight and achieve healthy weight in childhood (improve healthy eating and physical activity)

• Understand levels of self harm/injuries; collaborative working to support improvements in children and young people’s mental health and wellbeing

• Work to maximise the impact of Public Health Nursing Services to give children the best start in life, improve healthy eating, reduce accidents, identify families at risk of poorer health and emotional wellbeing

• Focus on surge in emergency admissions for unwell children; prevent inappropriate admissions and embed best practice e.g. new Royal College of Paediatrics and Child Health (RCPCH) initiatives

• Better understanding of the needs of vulnerable children

Living WellDifficulties measuring how well we live, repertoire tends to represent only negative outcomes (disease, disability, death) we hope to avoid or delay …..

• Quantifying prevalence of health conditions can provide a measure of the public’s health

• The extent of premature mortality (as defined by potential years of life lost (PYLL) before age 75) is another important measure

• Disability/impairment

– Certain illnesses (e.g. mental health and diabetes) not only cause morbidity but can also cause significant disability impacting on employment and future wellbeing

– Main causes of premature death are cancer, heart and respiratory disease.

Living Well: Prevalence of conditions

Source: National General Practice Profiles, PHE 2017

Recorded 2015/16 QOF prevalence

West Hampshire CCG (%) England (%)Smoking (GP survey) 13.8 16.4 Obesity 7.9 9.5 Hypertension 14.8 13.8 CHD 3.3 3.2 Stroke 2.1 1.7 Heart failure 0.8 0.8 Atrial fibrillation 2.2 1.7 Diabetes 5.5 6.5 Chronic kidney disease 3.6 4.1 Cancer 3.1 2.4 Depression 8.4 8.3 Dementia 0.9 0.8 Mental health 0.74 0.90 Learning disability 0.4 0.5 Osteoporosis 0.4 0.3 Rheumatoid arthritis 0.8 0.7 COPD 1.6 1.9 Asthma 6.2 5.9

Note that population prevalence of obesity

and smoking is higher

than GP QOF register

rates

Living Well: Heart disease

Source: Cardiovascular disease profiles, PHE 2017

Early CHD mortality (under 75 years) rates are significantly lower than the national rate

Note that there are variations within the CCG geographical area

Living Well: Cancer overview

Source: Cancerdata, NHS England, PHE 2017

Living Well: Premature mortality due to cancer

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All registered patients in England

NHS West Hampshire CCG

Source: GP registered patient counts from NHAIS (Exeter), Primary Care Mortality Database (PCMD) and ONS mid-year England population estimates

• Lower premature cancer mortality rates compared to England

• Suggests a rising trend

• Improvement in early detection and screening uptake are important

Source: GP registered patient counts from NHAIS (Exeter), Primary Care Mortality Database (PCMD) and ONS mid-year England population estimates

Please note that the data is old!

Source: Diabetes, PHE 2017

Living Well: Diabetes –care processes treatment targets

Living Well: Diabetes - complications

Source: Diabetes, PHE 2017

Living Well: Respiratory disease

Source: Inhale - INteractive Health Atlas of Lung conditions in England , PHE 2017

Living Well: Mental illness

Source: Severe Mental Illness Profiles, PHE 2017

Premature mortality ratio for SMI and suicide rate are not significantly different to national averagesEngland

10.1 per 100,000

England 337.2 per 100

Living Well: Complex patients

Source: NHS RightCare and Public Health England (PHE) Commissioning for Value toolkit, January 2017

2015/16West

Hampshire CCG

National

Complex patients age profile≥65 years 68% 61%≥75 years 48% 38%≥85 years 20% 14%

Admissions/year 6 7Most common conditions of admissions

circulatory, gastro-intestinal

& cancer

circulatory, cancer & gastro-

intestinal Total complex patients

1,627

Living Well: Disabilities

• Some conditions causing disability don't necessarily cause mortality• There is benefit in reviewing this data as it becomes more established

to identify areas where input could have greatest impact

Impact of disabilities – Personal Independence Payments (PIP)

Source: Department for Work and Pensions

Potential years of life lost (PYLL) from causes considered amenable to healthcare

Source: NHS England Level of Ambition Tool (http://ccgtools.england.nhs.uk/loa/flash/atlas.html)

Living well: Potential Years of Life Lost (PYLL)Conditions of focus:

• CVD – Hypertensive disease, Stroke, Ischaemic Heart Disease (IHD)

• Cancer – Breast, colon

• Respiratory – Asthma, pneumonia

Source: ONS Primary Care Mortality Database

Living Well: Key messages

• Focus on prevention and control, improving lifestyles and self management of health conditions, particularly diabetes, respiratory and heart disease

• Improving early diagnosis and screening uptake to reduce premature cancer mortality

• Optimise management of long term conditions

• Collectively work to improve societal wellbeing and access to services to reduce levels of preventable mortality for serious mental illness (SMI)

• Better understand the impact of health conditions on disability (mental health, cancer, neurological conditions, MSK) and premature mortality

Ageing Well• Life expectancy at 65 and disability-free life expectancy at 65 give

us a measure of the health of our older population

• Falls and fractures in older people can lead to loss of independence and death – preventing falls has a major impact on health and wellbeing

• Social isolation and loneliness impact on health and wellbeing particularly for conditions such as dementia – reducing isolation can improve outcomes for all ages but particularly our older population

The gap in HLE at birth was 13.4 years for males and 15.5 years for femalesAt 65 the gap in HLE 8.5 years for males and 10.3 years for females

.

Healthy Life Expectancy (HLE) at birth, 2010-12

Healthy Life Expectancy (HLE) at 65, 2010-12

Male LE at birth

Male HLE at birth Rank

Proportion of life in 'Good' health

Female LE at birth

Female HLE at birth Rank

Proportion of life in 'Good' health

(years) (years) % Rank (years) (years) % RankWest Hampshire CCG

81.7 68.3* 10 83.6 20 85.2 69.7* 9 81.8 20

England 79.2 63.5 80.2 83 64.8 78

Male LE at 65

Male HLE at 65 Rank

Proportion of life in 'Good' health

Female LE at 65

Female HLE at 65 Rank

Proportion of life in 'Good' health

(years) (years) % Rank (years) (years) % RankWest Hampshire CCG

19.9 11.4* 10 57.2 18 22.6 12.3* 7 54.4 10

England 18.5 9.2 49.7 21.1 9.7 46.1

Ageing Well: Healthy Life Expectancy (HLE)

Source: Office for National Statistics, Crown Copyright 2014

* Significantly better than the England average

Living longer but healthier? or with associated frailty?

Ageing Well: Bone health and hip fractures

England437/100,000

CCG ranks within the 2nd best quartile in England for hip fracture incidence

Source: Hip fracture incidence Jan – Dec 2016 NHS Outcomes Tool, HSCIC indicator portal and RightCare

Ageing Well: Benefits of an effective hip fracture programme

Source: The National Hip Fracture Database Annual Report 2016

Ageing Well: Sight and hearing loss/impairment

Source: National GP Practice Profiles, PHE 2017

CCG appears to rank favourablyagainst England values for reporting ofvisual impairment but relatively higherhearing impairment

Ageing Well: Dementia in age 65+

Source: 2016 Dementia Profile, PHE 2017

Rising trend in dementia mortality rate

Declining trend in dementia emergencyadmission rate

Recorded prevalence 4.15, significantly lowerthan England 4.31

• The UK has one of the highest EWD rates in Europe; majority of these deaths were those 75+, with greatest EWDs in females 85+ in 2014/15

• CCG had 430 EWD in 2014/15 • Large fluctuation in EWDs is common and trends over time are not smooth• Fuel poverty and keeping warm, major factor in increasing susceptibility• Link to social isolation – identification of individuals at risk is key issue

Ageing Well: Excess Winter Deaths (EWD)

Source: Office for National Statistics (ONS) on excess winter mortality in England and Wales

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20.6

13.911.9

18.420.1

17.1

13.7

30.8

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17.3

20.9

9.7

25.7

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5.0

10.0

15.0

20.0

25.0

30.0

35.0

2000/01 2001/02 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

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Excess winter death index (single year, all ages, persons) in West Hampshire CCG, 2000/01 to 2014/15

Ageing well: Mapping social isolation and loneliness in Hampshire’s older population

Social Isolation

Loneliness

Predictive analytics identified social isolation and loneliness in Andover

More than half of people 75 and over live alone

Around 10% of people over 65 report being ‘lonely’ most or all of the time

Older people are vulnerable to social isolation and loneliness

Ageing Well: Key messages• Promote healthy active ageing to reduce frailty; invest in prevention initiatives to

improve healthy life expectancy

• Strengthen work on falls prevention and the fragility fractures pathway; opportunity for joint commissioning

• Focus on preventable disabilities; particularly blindness (AMD/reducing smoking, diabetic retinopathy/screening); improve mobility. Better longevity implies increases in the very oldest age groups and demands on hearing loss services

• Prevent people getting dementia where possible through supporting healthy lifestyles and reducing vascular disease

• Collaboratively work with relevant local authority departments, to identify and support patients affected by fuel poverty through signposting

• Partnership working on initiatives to reduce the impact of social isolation and improve social relationships among older people