Dr Agnes Marossy Consultant in Public Health Medicine JSNA 2015 Dr Agnes Marossy Consultant in Public Health Medicine

What is the JSNA? The purpose of the JSNA is to identify the current and future health and wellbeing needs of the people of Bromley, taking into account existing services.

JSNA Content The Population of Bromley: Numbers and types of people The Health of People in Bromley In Depth Areas Housing and Homelessness Older People’s Health People in Care Homes Excess Winter Deaths Vulnerable Young People

JSNA Content Populations of Interest Children & Young People Older People Learning Disability Physical Disability & Sensory Impairment Mental Health End of Life Care Carers Substance Misuse Alcohol

KEY POINTS FROM JSNA 2015

Demography Population: 320,100 Population is rising and is expected to increase to 327,100 by 2020 The proportion of older people (17.7%) is expected to continue to increase 17.9% of the population is made up of BME groups 3.2% (9,904) of the population described their health as ‘bad’ (2011 census) What this means: Older people and people with children are higher users of services – access to GPs, hospitals, clinics and pharmacies

Life Expectancy Inequalities in life expectancy, although improving, still exist. Gap between most and least deprived areas, 9 years for men, 6.6 years for women. Lowest LE for men: Crystal Palace (76.4y), Mottingham & Chislehurst North Lowest LE for women: Crystal Palace (80.8y), Plaistow & Sundridge

Burden of Disease Causes of Mortality (2010-14): Circulatory Disease – 30.4% Cancer – 30% Respiratory Disease – 13.2%

Homelessness More than 3000 households present at imminent risk of homelessness each year Of those in priority need for housing support, 66% have dependent children. There is an increasing demand for housing support for young people aged 16 to 24 years, for people with mental health needs, and for private and intermediate older person’s accommodation in Bromley.

Older People’s Health in Bromley, the DFLE was 12.6 years for men and 14.4 years for women, both significantly higher than the England estimate. Over 65s make a significant contribution to the burden of long term conditions overall, representing over 75% of the overall disease burden for most conditions. 30.3% of total A&E attendances In 2013-14, there were 11,511 emergency admissions to hospital of Bromley registered patients over the age of 65 years. This represented almost 54% of all emergency admissions, and was almost 53% of the A&E attendance figure. The most frequent primary diagnoses recorded for emergency hospital admissions of Bromley patients in 2013 -14 were pneumonia, urinary tract infection, and ischaemic heart disease The most frequent underlying diagnoses recorded for emergency hospital admissions of Bromley patients in 2013 -14 were hypertension, ischaemic heart disease, atrial fibrillation and cancer.

People in Care Homes 67 nursing and residential care homes in Bromley with a total of 2055 beds In comparison with the over 65 year population in Bromley as a whole, care home residents are far more likely to have a diagnosis of dementia or stroke, and overall more likely to be suffering from heart disease, kidney disease, cancer or diabetes. People in care homes are more likely than the general population over the age of 65 years to have two or more comorbidities. Of the 1,110 patients identified in 2015, a significant proportion, 48.9% (543) were found to be new to the practice during that 18 month period. The proportion of people over the age of 85 years in extra care housing is lower than that in care homes, the extra care housing residents tend to have a higher number of comorbidities than the care home residents, but care home residents are more likely to suffer from dementia, and to have mobility problems (arthropathies, fractures) than the extra care housing residents.

Excess Winter Deaths Excess Winter Deaths are higher in Bromley than England and there are around 150 potentially preventable winter deaths each year, accounting for 6% of all Bromley deaths. People especially at risk include those living in poorly heated or expensive to heat homes, the elderly and those with underlying respiratory and cardiac conditions. Relative deprivation in Bromley is not necessarily associated with excess winter mortality and poorly heated housing can occur in the owner occupier or privately rented sector. This means the risk of Excess Winter Deaths is widely distributed across the elderly population.

Children & Young People ~8000 children in Bromley schools with Special Educational Needs ~ 1600 with Statements of Special Educational Needs Both above the national and London average In particular, the proportion of pupils with speech, language and communication needs is significantly above average

Children & Young People Looked after Children 72% have special educational needs 20% placed out of the borough and more than 20 miles from where they used to live 43% not in education, employment or training most common presenting problems were extreme neglect and emotional abuse

Hypertension – 46,266 Rising prevalence, lower level than predicted by modelling (? not all cases identified).

Battling the Dragons of Obesity and Diabetes

And the challenge becomes greater… 29,800 people at risk of diabetes

Dementia - 4102 GP register data – 1902 patients. By 2030, estimated increase in numbers to 6,153. Needs assessment recommendations: Staff training, expansion of memory service, better information, offer of social needs assessment to become default position, better provision for respite.

Alcohol Over a quarter of the Bromley population over 16 are drinking above the levels recommended by the Department of Health. Also around 30,000 people drinking alcohol at harmful or hazardous levels in Bromley. More men are drinking at hazardous and harmful levels than women at every age. The proportion of men drinking at harmful levels between the ages of 16-75 years is three to four times that for women. In 2013 there were 107 alcohol-related deaths in Bromley. Amongst those aged 15 years and under the most common cause of admission was for mental and behavioural disorders. Alcoholic liver disease contributed significantly to hospital admissions for men across all ages. Falls contributed significantly to hospital admissions for both men and women across all the age groups.

CORONARY HEART DISEASE/STROKE CANCER SMOKING DIABETES ADULT OBESITY LIFE EXPECTANCY CORONARY HEART DISEASE/STROKE CANCER SMOKING DIABETES ADULT OBESITY ALCOHOL MISUSE DEMENTIA HIGH BURDEN HIGH BLOOD PRESSURE TEENAGE PREGNANCY SUICIDE IN ADULTS SUBSTANCE MISUSE HIV SELF HARM AND EMOTIONAL WELLBEING IN YOUNG PEOPLE HOMELESSNESS LOW BURDEN CHILDHOOD OBESITY IMPROVING WORSENING

Health & Wellbeing Strategy Priorities Diabetes Obesity Dementia Emotional Wellbeing of Young People