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

2. 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

3. 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

4. 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

5. DDES CCG summary

6. 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%.

7. Deprivation in County Durham (variation within areas)

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

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

11. 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 %

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

13. 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 

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

16. 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

17. 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)

18. 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)

19. 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

20. 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?

21. 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
Healthy life expectancy
Years in poor health
DDES
Men Women
Life expectancy
Healthy life expectancy
Years in poor health

22. 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)

23. The scale of the challenge
Registered prevalence in County Durham

25. 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 obesity levels are
1.5 x
higher in our most deprived communities
68% adults with excess weight 46 71

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

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

29. 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

30. Aligning recommendations to the JHWS priorities

31. Aligning recommendations to the JHWS priorities