JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) Key findings from the Leicestershire JSNA and Charnwood summary

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1 JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) Key findings from the Leicestershire JSNA and Charnwood summary 1

2 What is a JSNA? Joint Strategic Needs Assessment (JSNA) identifies the big picture in terms of the health and wellbeing needs and inequalities of a local population JSNA describes a process that identifies current and future health and wellbeing needs in light of existing services, and informs future service planning taking into account evidence of effectiveness 2

3 JSNAs and joint health and wellbeing strategies Health and Wellbeing Board What does our population and place look like? Collect the evidence What are we doing now, how well is it working? JSNA Joint Health & Wellbeing Strategy What does this mean now and for the future? A narrative on the evidence So what are our collective priorities for action, and how can we achieve them? Engagement with users and the public Commissioning plans What services do we need to commission (or decommission)? Outcomes framework How do we measure success? 3

4 Timescales JSNA March 2012 Joint Health & Wellbeing Strategy Summer 2012 Commissioning plans Autumn 2012 Outcomes framework Winter

5 JSNA 22 detailed chapters Demography Deprivation and the Economy Housing Children and Young People Health Inequalities Staying Healthy Sexual Health Long Term Conditions Cancer Mental Health Learning Disabilities Physical Disabilities Older People Dementia End of Life Care Carers Offender Health Wellbeing / Happiness Primary Care NHS Hospital Care Adult Social Care Service Usage, Assessment and Development in Social Care Assets 5

6 JSNA 22 detailed chapters Background and wider determinants Demography Deprivation and the Economy Housing Children and Young People Health Inequalities Staying Healthy Sexual Health Long Term Conditions Cancer Mental Health Learning Disabilities Physical Disabilities Older People Dementia End of Life Care Carers Offender Health Wellbeing / Happiness Primary Care NHS Hospital Care Adult Social Care Service Usage, Assessment and Development in Social Care Assets 6

7 JSNA 22 detailed chapters Chapters on need Demography Deprivation and the Economy Housing Children and Young People Health Inequalities Staying Healthy Sexual Health Long Term Conditions Cancer Mental Health Learning Disabilities Physical Disabilities Older People Dementia End of Life Care Carers Offender Health Wellbeing / Happiness Primary Care NHS Hospital Care Adult Social Care Service Usage, Assessment and Development in Social Care Assets 7

8 JSNA 22 detailed chapters Service provision Demography Deprivation and the Economy Housing Children and Young People Health Inequalities Staying Healthy Sexual Health Long Term Conditions Cancer Mental Health Learning Disabilities Physical Disabilities Older People Dementia End of Life Care Carers Offender Health Wellbeing / Happiness Primary Care NHS Hospital Care Adult Social Care Service Usage, Assessment and Development in Social Care Assets 8

9 2012 JSNA key priorities Giving children the best start in life Managing the shift to early intervention and prevention Supporting the ageing population In addition to targeting specific parts of the life course the following cross cutting themes have been identified: Targeting the communities with the greatest needs Improving mental health and wellbeing 9

10 2012 JSNA key priorities Leicestershire Together recognises that addressing these health needs can only be done in partnership with the other commissioning hubs of Leicestershire Together influencing other boards has been identified as a key priority for ensuring that the Health and Wellbeing Board delivers improved health outcomes across the life course. E.g. Children and Young People Commissioning Board The Leicester and Leicestershire Enterprise Partnership Environment Board Safer Communities Commissioning Board Stronger Communities Board Housing Services Partnership Housing Planning Infrastructure Group Leicestershire Rural Partnership Community Budget Programme Board Voluntary and Community Sector Strategy Group 10

11 What does this mean for Charnwood? Background and wider determinants In 2008/ % of the residents of Charnwood surveyed reported their health and wellbeing status as being 'very good' or 'good'. This was higher than the England average (75.8%) Life expectancy for males and females in Charnwood is significantly higher than the England average. Males in Charnwood can expect to live for 79.4 years compared to the England average of 78.3 years and females can expect to live 83.1 years compared to the England average of However, the gap in life expectancy between the best-off and worstoff males in Charnwood can be estimated as 9.6 years, and for females as 6.4 years. Although these gaps are not significantly higher than the England averages (8.9 for males and 5.9 for females) it suggests inequalities exist. 11

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14 Causes of inequality in life expectancy 14

15 What does this mean for Charnwood? Giving children the best start in life The infant mortality rate in Charnwood is similar to the England average (5.3 deaths for every 1000 births compared to 4.7 in England). Breastfeeding rates in Charnwood are better than the England average with 47% of women still breastfeeding at 6-8 weeks compared to 44.9% nationally). Children in Charnwood were less likely to be obese than the national average, with 16.3% of year 6 children obese compared to 18.7% nationally. However, this is still a 6 th of children in this year. The teenage conception rate in Charnwood is lower than the England average, with 27 births per 1000 women aged compared to the England average (40.2). 15

16 In 2009/10 in year 6 children in Charnwood the Loughborough Ashby ward had a significantly high rate of obesity compared to the LCR average. New data for 2010/11 shows no wards in Charnwood are significantly high. 16

17 What does this mean for Charnwood? Early intervention and prevention Smoking In 2009/10 it was estimated that around adults in Charnwood smoke (18.3%). However, in the same year 1742 adults in Charnwood set a date to quit smoking, and of these 1077 (61.8%) had quit at 4 weeks. Obesity In 2006/08 it was estimated that (22.6%) adults in Charnwood were obese. This is not significantly different to the England average (24.2%). In 2006/08 it was estimated that 31.1% of adults in Charnwood ate 5 or more portions of fruit and vegetables per day, and in 2008/09 it was estimated that 25.4% of adults in Charnwood took part in physical activity. 17

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19 What does this mean for Charnwood? Early intervention and prevention Alcohol In 2009/10 there were 1451 admissions to hospital for alcohol related conditions per 100,000 population in Charnwood. This is lower than the England average (1743 per 100,000 population) There are estimated to be around adults in Charnwood who binge drink (20% of the population). 19

20 What does this mean for Charnwood? Burden of ill health In LCR in 2010 the top causes of premature (under 75) mortality were cancer (45%), circulatory disease (24 %) and respiratory disease (8%). 20

21 What does this mean for Charnwood? Burden of ill health In LCR in 2010 the top causes of premature (under 75) mortality were cancer (45%), circulatory disease (24 %) and respiratory disease (8%). 21

22 What does this mean for Charnwood? Burden of ill health Mortality rates from cancer, circulatory disease and chronic obstructive pulmonary disease (COPD) in Charnwood are significantly lower than the England average. Comparing modelled estimates of disease to the GP recorded prevalence suggests that in Charnwood there are approximately: 1810 patients with undiagnosed CHD Over 17,000 patients with undiagnosed hypertension 22

23 What does this mean for Charnwood? Older people In 2010 there are approximately people aged over 60 in Charnwood, and 7300 aged over 80. The population of Charnwood aged over 60 is estimated to increase by around 60% by

24 What does this mean for Charnwood? Older people In life expectancy for men at age 65 in Charnwood is 18.7 years and life expectancy for women at age 65 is 21.2 years. Around 6300 people aged over 75 in Charnwood are predicted to live alone in 2010, and this number is predicted to increase to by 2030 (a 77% increase). In 2010 there are estimated to be around people in Charnwood over the age of 65 with a limiting long term illness. By 2030 this is estimated to increase to around 19090, an increase of 63.2%. 24

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27 What does this mean for Charnwood? Impact of the ageing population In 2010 there are estimated to be around 1800 people in Charnwood with dementia. By 2030 this is estimated to increase to around 3600 people, an increase of 93%. The Census 2001 estimates that in 2001 there were around people in Charnwood who were providing unpaid care. This equates to 9.9% of the population. The increase in the older population is likely to impact substantially on the numbers of carers, particularly older carers. In 2010 there were estimated to be around 3060 carers aged over 65 in Charnwood, by 2030 this is estimated to increase to around 4610, a 51% increase. 27

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29 How will the JSNA be used locally? How can Charnwood help deliver the priorities identified in the JSNA? How will you use the JSNA locally to inform local priority setting? What are the issues that are specific to Charnwood that need to be addressed locally? 29

30 Where can you find the JSNA? ssessment_jsna_2012_key_documents 30

31 LEICESTERSHIRE JOINT STRATEGIC NEEDS ASSESSMENT LOCALITY PROFILES Charnwood District APRIL 2012 Produced by NHS Leicestershire County and Rutland Public Health Directorate For more information contact: Verity Bellamy at

Introduction The Joint Strategic Needs Assessment (JSNA) is our overarching assessment of the health and wellbeing needs of our population across the wider health and social care economy.

The Health and Social Care Bill, emphasizes the importance of the JSNA as the starting point for developing health and wellbeing strategies and underpinning commissioning decisions.

32 Introduction The Joint Strategic Needs Assessment (JSNA) is our overarching assessment of the health and wellbeing needs of our population across the wider health and social care economy. The JSNA is driven by the Shadow Health and Wellbeing Board in Leicestershire and is the basis for developing the Health and Wellbeing Strategy. The Health and Social Care Bill, emphasizes the importance of the JSNA as the starting point for developing health and wellbeing strategies and underpinning commissioning decisions. The Bill proposes the new statutory health and wellbeing boards will have three required functions: To oversee the production of the Joint Strategic Needs Assessment To develop a Joint Health and Wellbeing Strategy (JHWS) To develop joint commissioning intentions and ensure all commissioning intentions meet the needs identified by the JSNA and are in line with the JHWS The Shadow Health and Wellbeing Board will monitor progress towards the objectives of the Joint Health and Wellbeing Strategy through the public health outcomes framework. Page 2

2012 Leicestershire JSNA Priorities The strategic objective for the Health and Wellbeing Board is to add quality and years to life, by improving health throughout people s lives, reducing

33 2012 Leicestershire JSNA Priorities The strategic objective for the Health and Wellbeing Board is to add quality and years to life, by improving health throughout people s lives, reducing inequalities and focusing on the needs of the local population. The key priorities identified across the life course from the 2012 JSNA are: Giving children the best start in life Managing the shift to early intervention and prevention Supporting the aging population In addition to targeting specific parts of the life course the following cross cutting themes have been identified: Targeting the communities with the greatest needs Improving mental health and wellbeing Addressing these health needs can only be done in partnership with the other commissioning hubs of Leicestershire Together, influencing other boards has been identified as a key priority for ensuring that the Health and Wellbeing Board delivers improved health outcomes across the life course. Children and Young People Commissioning Board The Leicester and Leicestershire Enterprise Partnership Environment Board Safer Communities Commissioning Board Stronger Communities Board Housing Services Partnership Housing Planning Infrastructure Group Leicestershire Rural Partnership Community Budget Programme Board Voluntary and Community Sector Strategy Group Page 3

Note Wherever possible this summary provides data at Charnwood level, however where this is not possible a population weighted average has been calculated or the Leicestershire / LCR value reported.

34 Note Wherever possible this summary provides data at Charnwood level, however where this is not possible a population weighted average has been calculated or the Leicestershire / LCR value reported. Population of Charnwood In 2010 the population of Charnwood was estimated to be (mid 2010 population estimates). Around 22% of the population are aged 60 years and over. In 2010 there were 1911 live births in Charnwood, this is a rate of 54.1 births per 1000 women aged years. This is significantly lower than the England average (65.5 per 1000 women). In % of the population of Charnwood are estimated to be from a non-white ethnic background. This is higher than the England average (12.5%). Deprivation Based on the indices of deprivation 2010, the average deprivation score for Charnwood is Life expectancy Males In life expectancy for males in Charnwood was 79.4 years, this is significantly higher than the England average (78.3). The gap in life expectancy between the best-off and worst-off males in Charnwood for (the Slope Index of Inequality) is 9.6 years. This is not significantly different to the median gap in life expectancy for all upper tier local authorities in England (8.9 years). Females In life expectancy for females in Charnwood was 83.1 years, this is significantly higher than the England average (82.3). The gap in life expectancy between the best-off and worst-off females in Charnwood for (the Slope Index of Inequality) is 6.4 years. This is not significantly different to the median gap in life expectancy for all upper tier local authorities in England (5.9 years). Page 4

35 Children's health In 2010 there were an estimated children and young people under the age of 20 in Charnwood. Infant mortality In 2007/09 the infant mortality rate in Charnwood was 5.3 deaths in infants under one year per 1000 live births. This is not significantly different to the England average (4.7). These figures represent very small numbers of deaths, and so should be interpreted with caution. Children in poverty At the beginning of 2011 an estimated (10.5%) of children under the age of 16 in Leicestershire were classed as living in poverty. This is lower than the England average (20.9%). (Data is not available at a lower geographical level). Breastfeeding In 2009/10 the proportion of women still breastfeeding at 6-8 weeks in Charnwood was 47%. This is higher than the England average (44.9%). Children's tooth decay In 2007/08 in Charnwood the average number of decayed, missing or filled teeth in 5 year old children was This is not significantly different to the England average (1.11). Accidental injury In 2008/09 in Leicestershire there were emergency admissions for unintentional and deliberate injury to children and young people for every 10,000 children aged 0 to 17 years in the population. This is lower than the England average (117.4). (Data is not available at lower geographical levels). Page 5

36 Childhood obesity In 2009/10 9% of children in reception year in Charnwood were obese. This is not significantly different to the England average (9.8%). In 2009/ % of children in year 6 in Charnwood were obese. This is significantly lower than the England average (18.7%). Special educational needs In 2010 in Leicestershire there were 57 children in primary school with Special Educational Needs (with a statement) (2.2%). This is higher than the England average (1.4%). There were 92 children in secondary school in Leicestershire with Special Educational Needs (with a statement) (3.6%). This is higher than the England average (2%). Teenage conceptions Between 2007 and 2009 the under-18 conception rate in Charnwood was 27 births per 1000 women aged This is lower than the England average (40.2). The teenage conception rate in Charnwood has decreased by 28% since the 1998 baseline. Page 6

Staying healthy Smoking In 2009/10 it was estimated that around 24700 adults in Charnwood smoke (18.3%). This is not significantly different to the England average (21%).

37 Staying healthy Smoking In 2009/10 it was estimated that around adults in Charnwood smoke (18.3%). This is not significantly different to the England average (21%). However, in the same year 1742 adults in Charnwood set a date to quit smoking, and of these 1077 (61.8%) had quit at 4 weeks. Obesity In 2006/08 it was estimated that (22.6%) adults in Charnwood were obese. This is not significantly different to the England average (24.2%). In 2006/08 it was estimated that 31.1% of adults in Charnwood ate 5 or more portions of fruit and vegetables per day. This is not significantly different to the England average (28.7%). In 2008/09 it was estimated that 25.4% of adults in Charnwood took part in physical activity. This is higher than the England average (21.6%). Alcohol In 2009/10 there were 1451 admissions to hospital for alcohol related conditions per 100,000 population in Charnwood. This is lower than the England average (1743 per 100,000 population.) There are estimated to be around adults in Charnwood who binge drink (20%). This is not significantly different to the England average (20.1%.) Accidental injury In 2007/09 there were 48 people killed or seriously injured on the road in Charnwood. This is a rate of 29.6 per 100,000 population, which is significantly lower than the England average (48 per 100,000 population). Sexual health In 2010/11 there were around attendances at GUM clinics in Leicestershire County and Rutland, 73.1% of these were first attendances. 93% of these first attendances at GUM clinics were seen within 48 hours. (Data not available at a lower geographical level) In 2009 there were 1552 NHS funded abortions in Leicestershire County and Rutland, of these 70% were conducted at under 10 weeks. This is lower than the England average (74.4%). (Data not available at a smaller geographical level). Page 7

38 Burden of ill health In 2008/ % of the residents of Charnwood surveyed reported their health and wellbeing status as being 'very good' or 'good'. This was higher than the England average (75.8%). In 2009 there were 5382 deaths in Leicestershire County and Rutland, 1691 of these were premature (i.e. before the age of 75). Among the premature deaths the highest proportion were from cancer (46.6%), followed by circulatory disease (24.3%) and respiratory disease (9%). In 2007/09 there were 425 deaths in Charnwood considered amenable to healthcare. This is a rate of 85.1 per 100,000 population, which is significantly lower than the England average (96.4 per 100,000 population). Circulatory disease In 2007/09 there were 298 premature deaths from circulatory disease in Charnwood. This is a rate of 57.8 per 100,000 population, which is significantly lower than the England average (70.5 per 100,000 population). CHD In 2010/11 there were 5376 patients registered with Coronary Heart Disease (CHD) in Charnwood. This is a GP recorded prevalence of 3%. However, model based estimates suggest that the actual prevalence is 4.5%, which would suggest there are approximately 1810 patients with undiagnosed CHD in Charnwood. Cancer In 2007/09 there were 513 premature deaths from cancer in Charnwood. This is a rate of 98.7 per 100,000 population, which is significantly lower than the England average (112.1 per 100,000 population). Respiratory disease In 2007/09 there were 35 deaths from chronic obstructive pulmonary disease (COPD) in Charnwood. This is a rate of 6.4 per 100,000 population, which is significantly lower than the England average (11.8 per 100,000 population). Diabetes In 2010/11 there were 7949 patients in Charnwood registered with their GP as having diabetes. This is an estimated diabetes age-specific prevalence rate of 5.5%, which is not significantly different to the England average (5.5%). In 2005 there were an estimated 290 deaths in people aged between 20 and 79 years in Leicestershire County and Rutland from diabetes, which made up approximately 10.6% of all deaths in that year. Hypertension In 2010/11 there were patients registered with hypertension in Charnwood. This is GP a recorded prevalence of 13.1%. However, model based estimates estimate that the actual prevalence is 26.6%, which would suggest there are approximately patients with undiagnosed hypertension in Charnwood. Mental health In 2010/11 there were 1175 people in Charnwood registered with their GP as having a mental health disorder including schizophrenia, bipolar disorder and other psychoses. This equates to 0.7% of the population, which is lower than the England average (0.8%). Page 8

Older people In 2010 there are approximately 36700 people aged over 60 in Charnwood, and 7300 aged over 80. The population of Charnwood aged over 60 is estimated to increase by around 60% by 2030.

39 Older people In 2010 there are approximately people aged over 60 in Charnwood, and 7300 aged over 80. The population of Charnwood aged over 60 is estimated to increase by around 60% by In life expectancy for men at age 65 in Charnwood is 18.7 years. However, the 2001 Census estimated that healthy life expectancy in Charnwood at 65 was 13.3 years. This was significantly higher than the England average (12.5 years). In life expectancy for women at age 65 in Charnwood is 21.2 years. However, the Census 2001 estimated that healthy life expectancy at age 65 in Charnwood was 15 years. This is significantly higher than the England average (14.5 years). Around 6300 of the population aged over 75 in Charnwood are predicted to live alone in 2010, and this number is predicted to increase to by 2030 (77% increase). In 2010 there are estimated to be around people in Charnwood over the age of 65 with a limiting long term illness. By 2030 this is estimated to increase to around 19090, an increase of 63.2%. Falls In 2009/10 in males in Charnwood there were 57.7 emergency admissions for hip fracture (which can be used as a proxy for falls) per 100,000 population, this was not significantly different to the England average (70.1 per 100,000 population). In 2009/10 in females in Charnwood the rate of emergency admissions for falls was per 100,000 population, this was not significantly different to the England average (119.2 per 100,000 population). Knee and hip replacements In 2008/09 there were 182 knee replacements in Charnwood, which is a rate of per 100,000 population, this is not significantly different to than the England average (128 per 100,000 population) In 2008/09 there were 144 hip replacements in Charnwood, which is a rate of 89.1 per 100,000 population, this is significantly lower than than the England average (113.9 per 100,000 population) Page 9

Dementia In 2010 there are estimated to be around 1800 people in Charnwood with dementia. By 2030 this is estimated to increase to around 3600 people, an increase of 93%.

40 Dementia In 2010 there are estimated to be around 1800 people in Charnwood with dementia. By 2030 this is estimated to increase to around 3600 people, an increase of 93%. End of life care National studies indicate that over half of people would prefer to die at home. In % of deaths in Charnwood took place in hospital and 22.4% took place at home. Disabilities Learning disabilities In 2011 there are estimated to be around 3250 people in Charnwood with a learning disability. This equates to 2.4% of the population. Physical disabilities In 2011 there are estimated to be around 8160 people in Charnwoodaged with a moderate physical disability (7.5%), this is lower than the England average (7.8%). This is estimated to increase to around 8486 people by There are estimated to be a further 2380 people in Charnwood aged with a serious physical disability (2.2%), this is lower than the England average (2.3%). This is estimated to increase to around 2480 people by Carers The Census 2001 estimates that in 2001 there were around people in Charnwood who were providing unpaid care. This equates to 9.9% of the population. The increase in the older population is likely to impact substantially on the numbers of carers, particularly older carers. In 2010 there were estimated to be around 3060 carers aged over 65 in Charnwood, by 2030 this is estimated to increase to around 4610, a 51% increase. References This report is driven by the JSNA core dataset and all data references are available from: Page 10

have been a number of high level and expert reviews including the most recent, the Marmot review.

have been a number of high level and expert reviews including the most recent, the Marmot review. QUESTIONS 5. Role of GPs and GP practices in public health: Are there additional ways in which we can ensure that GPs and GP practices will continue to play a key role in areas for which Public Health