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
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
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sUnder 75 mortality from cancer
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
12.1
20.6
13.911.9
18.420.1
17.1
13.7
30.8
21.0
13.0
17.3
20.9
9.7
25.7
0.0
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
Exce
ss w
inte
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th in
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(rat
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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