Summarising health needs in DDES CCG Michael Fleming Public Health Epidemiologist Durham County Council

What is JSNA? A statutory responsibility of the Health and Wellbeing Board (HWB). The Health and Social Care Act 2012 placed clear duties on local authorities and Clinical Commissioning Groups (CCGs) to prepare a Joint Strategic Needs Assessment (JSNA) JSNA is an assessment of the current and future health, wellbeing and social care needs of County Durham’s population, and distinct communities within. It informs the Joint Health and Wellbeing Strategy It is not just about health and social care, but reflects the many factors that can influence and affect the health and wellbeing (the social determinants of health) Focusses on reducing health inequalities between County Durham and other areas, within County Durham, and between different population groups It brings together information from different sources and partners to create a shared evidence base, to support service planning, decision-making, and delivery JSNAs are continuous processes and are integral to commissioning cycles

What is INA? The Integrated Needs Assessment (INA) for County Durham aims to bring together the evidence base and a wide range of strategic assessments used to inform strategic planning across the council and by the county's thematic partnerships It provides links to data, analysis, external frameworks, local profiles, strategies and plans relevant to life in County Durham. The INA is intended to be the 'entry point' for up to date information on health and wellbeing in the county and for wider economic, community safety and environmental data. It comprises a number of linked downloadable documents (all PDF) grouped under the following themes: Strategies and Plans Economy, Housing and Transport Education, Qualifications and Skills Health, Social Care and Wellbeing (JSNA) Community safety Environment Population, Poverty and Deprivation Profiles

County Durham Joint Health and Wellbeing Strategy 2018 – 21 Informed by the INA it will have the following priorities: Children and young people make healthy choices and have the best start in life Reduce health inequalities and early deaths Improve the quality of life, independence and care and support for people with long term conditions and their carers Improve the mental and physical wellbeing of the population Improve early diagnosis and intervention and enable people to live well with dementia Tackle the issues which result in people of all ages becoming obese

DDES CCG summary

Deprivation in County Durham % of LSOAs in the most deprived 30% nationally (ID2015): • County Durham. 42.9%. • North Durham CCG. 29.7%. • DDES CCG. 53.6%.

Deprivation in County Durham (variation within areas)

Despite sustained improvements in health and wellbeing in County Durham over time, health inequalities remain persistent and pervasive

What’s happened over time? CVD mortality rates, County Durham and England, 2001-03 to 2013-15. Statistically significantly higher than England Not statistically significantly different to England   Men Persons Women Reduction in premature CVD mortality (%) 2001-03 to 2013-15   Persons Men Women County Durham 50.9 53.1 47.6 England 50.2 46 46.7

What’s happened over time? Teenage conception rates per 1,000 females aged 15-17, County Durham, North East and England   Statistically significantly higher than England Not statistically significantly different to England   Reduction in teenage conceptions (%) 1998 to 2014 The absolute gap between County Durham and England has reduced (from 7.8/1,000 to 5.7/1,000) But the relative gap* has not (from 17% to 25%)  County Durham -47.6 North East -46.5 England -51.1 *absolute gap divided by the England value, expressed as a %

What’s happened over time? Smoking prevalence, County Durham and England, 2012-2016 Statistically significantly worse than England Not statistically significantly different to England Significantly better than England   

What’s happened over time? 4 week quit rate per 100,000 What’s happened over time? 4 week quit rate per 100,000, 2013/14 to 2015/15 Statistically significantly worse than England Not statistically significantly different to England Significantly better than England   

Selected indicators for child health. Source: Child health profiles, PHE

Wider/social determinants of health Deprivation - higher locally than the national average Long term unemployment- higher locally than the national average Fuel poverty- significantly higher than England Good level of development- end of reception GCSE attainment First time entrants to the youth justice system Around 25% of our children live in poverty (around 13,000 CYP in DDES) Key points from the JSNA 85% reduction between 2007/08 and 2016/17 5 per 1,000 working age population (almost 1,600 people) Similar to national levels More than 1 in 10 households (over 27,500 locally Similar to national levels

LE and HLE for men and women is lower than England Health and wellbeing Overall health and wellbeing has improved significantly in County Durham LE and HLE for men and women is lower than England Smoking prevalence Childhood obesity (Y6) – significantly higher than England, and rising Excess weight (Y6) Poor mental health Significant inequality remains in County Durham (social gradient) But it remains worse than the England average Key points from the JSNA Men – 6.9 years Women – 7.6 years Are all higher in the most deprived areas Breastfeeding, SATOD, childhood obesity, premature mortality) LE gap between most and least deprived within County Durham Over 50,000 locally have a common mental disorder (anxiety or depression) Reducing over time, now not significantly different to England 37% classified with excess weight (almost 2,000) 22% classified as obese (over 1,100)

Health and care Key points from the JSNA Alcohol related harm admissions Alcohol specific hospital stays for under 18s Self harm admissions Unintentional and deliberate injury admissions (0-24 years) Estimated excess weight in adults Rates of sexually transmitted infections and TB Smoking attributable mortality Key points from the JSNA Significantly higher than England (almost 4,000 admissions) Significantly higher than England (around 1,100 deaths per year) Significantly higher than England (over 200 admissions) Better than the England average Significantly higher than England (over 1,000 admissions) Significantly higher than England (67% of the adult population) Significantly higher than England (almost 1,500 admissions)

Around 50,000 in DDES are recorded smokers Almost 600 mothers in DDES who smoke at delivery Around 50,000 in DDES are recorded smokers Babies Young people Adults Poverty Hospital admissions Mortality Cost Focus on: Smoking Over 96,000 smoking related sick days costing £8.6 million 11% of 15 year olds are current smokers Almost 1 in 3 deaths (35 +) are attributable to smoking Almost 1 in 5 adults are current smokers Around 7,000 hospital admissions each year, attributable to smoking Not smoking would lift over 11,000 people out of poverty

The average age of people admitted to residential and nursing care increased between 2007/08 and 15/16. Residential care from 84.9 years to 86.5 years Nursing care from 83.4 years to 84.3 years The scale of the challenge 1. An ageing population in DDES Our older population is getting bigger Population growth is different in different age strata Are these additional years of life are being spent in good health or prolonged poor health and dependency? Multi-morbidities?

The scale of the challenge An ageing population and healthy life expectancy? Healthy life expectancy adds a quality of life dimension to life expectancy Men Women Life expectancy 77.7 81.4 Healthy life expectancy 59.2 60.6 Years in poor health 18.5 20.8 DDES Men Women Life expectancy 77.3 80.9 Healthy life expectancy 57.9 59.3 Years in poor health 19.4 21.6

The scale of the challenge An ageing population and healthy life expectancy? Men Women LE is increasing in County Durham, HLE is not (locally or nationally)

The scale of the challenge Registered prevalence in County Durham

Early death Mental wellbeing Obesity 46 71 19,000 45% 1.5 x The gap in life expectancy years between the most and least deprived Deaths from cardio vascular disease, under the age over 75, have reduced by 45% Cancer is responsible for 1 in 4 deaths in adults aged 35 and over Mental wellbeing Annual deaths by suicide Around 19,000 people aged 65+ are lonely 10% children have a classifiable mental health disorder Obesity Classrooms of 4-5 year olds with excess weight At age 10-11 obesity levels are 1.5 x higher in our most deprived communities 68% adults with excess weight 46 71

Premature mortality – variation across County Durham Premature all-cause mortality rates per 100,000, County Durham, DDES and North Durham CCG and constituencies, 2013-15 pooled. Source: PH mortality file 2016. .

Premature mortality – variation within DDES The distribution of early death within DDES is not equal. It is higher in the more deprived areas .

What’s next? JSNA(A) A further development of the JSNA. One which highlights the importance of always considering the people, locations, and services that are already out there addressing needs in communities across County Durham A health asset is defined as any factor or resource which enhances the ability of individuals, communities and populations to maintain and sustain health and wellbeing “What makes me healthy?” How? Locate – embed and develop AAPs – closest to communities

Aligning recommendations to the JHWS priorities

Aligning recommendations to the JHWS priorities