Partnerships and Health Inequalities in Hertfordshire
Raymond Jankowski
Item 4
Top priorities
Tackling health inequalities Smoking Childhood obesity Alcohol consumption Sexual health Screening Immunisation
Health promotion and disease prevention in adults:challenges in Hertfordshire
Smoking 15% - 30%
Tackling obesity 15% - 21.3%
Alcohol (binge) 15.9% - 18.9%
Falls prevention: Hip fractures per 100,000 386 - 566
10 major enablers for health inequalities
Bentley, June 2008
enablers Local
Clear vision and strategy 5 year strategy, action plan, LAA, LSPs
Raise the bar on target achievement 5 year strategy, action plan, LAA, LSPs
Use population health intelligence 5 year strategy, action plan, LAA, LSPs
Leadership and engagement PCT leadership through partnerships
Making partnership work PCT leadership through partnerships
Capitalise on community engagement PCT leadership through partnerships
Getting scale and systems right Primary care and provider ALTO
Changing the workforce Primary care and provider ALTO
Strengthening primary care Primary care
Finding the missing “thousands” Primary care
Health inequalities action plan
Initial plan approved by boards in July 2008 Update to board in January 2009 Top 30 key areas (includes 16% most deprived wards) Also specifies vulnerable groups such migrant workers, gypsy
and travellers, ethnic minorities Making links with housing, education and domestic violence Focusing on smoking cessation, obesity and immunisation Need to use social marketing techniques
Importance of broader tobacco control measures
10-20% fall in prevalence due to NHS smoking cessation services
80-90% fall to broader tobacco control measures, including:– Taxation– Action to reduce illegal (cheaper) supplies– Environmental controls and enforcement (smoke –free)– Restrictions of tobacco advertising– Population-based health promotion campaigns– Local initiatives to discourage starting– Brief advice re quitting/self-motivated quitting
Future actions to reduce smoking levels
Reduce recruitment, particularly young people and teenagers
CSF, Trading Standards, Health, LSPs
Action to reduce illegal (cheaper) supplies
Trading Standards
Increase levels of quitting out with NHS services
Environmental
Health, LSPs
Increase numbers of people quitting via NHS services
Partners as employers, Health (inc acute – eg. antenatal smokers)
Key priorities for tobacco control (2009/10)
County wide strategy group established
CSF, Trading Standards, PCT commissioners, stop smoking service, environmental health, links to district/borough council CEOs
Main priorities established– Improved community profiling/ targetting – Focus on workplaces / routine & manual– Increase resource – co-ordination of work, smoking cessation
team– Strengthen joint working including tobacco alliance networks– Increase capacity in quitting support services
Obesity in Hertfordshire
Second biggest lifestyle issue in Hertfordshire after smoking Estimated to cost £400M of £1.4B NHS budget Large obesity monitoring project for children, not case for adults 20% + of adults obese Five a day programmes LAA for adults physical activity programmes – challenging Obesity clinics with PBCs ? Community agent projects (LAA funded ?) Targeting parents at 50+ children centres ?
Childhood obesity: of obese/overweight children *
West Herts East and North Herts
National average
4-5 yrs 25% 21.3% 22.9%
10-11 yrs 27.6% 27.9% 31.6%
*Survey of over 85% of schools in 2007/8
Action on childhood obesity
Prevention Supporting antenatal women Promoting breast feeding Healthy schools: five a day programme Increase regular exercise by children Increase healthy school meal options Improve user friendliness of parks and open spaces
Personalised support Local clinical pathways for management of overweight/obesity Ensure health visitor/school nurse capacity to manage need Pilot antenatal dietician scheme to support obese women Evaluate and extend anti-obesity programmes e.g. MEND, Fun schemes
Alcohol misuse
Binge drinking and hospital admission data Underage drinking, selling of alcohol Those drinking more than recommended limits at home Perception of difficulty of NHS access for drinking addiction ?
Alcohol misuse: actions
National drinkwise campaign targeting all drinkers (units) Hertfordshire Alcohol Harm Reduction Closer working with DAAT CDRP partnerships New data sharing –e.g. incidence data collection form A&E
departments Development of Brief interventions for alcohol misuse in primary care Drugs Education Forum working with healthy schools initiative Working with Young Persons Substance Misuse Commissioning
Group Working with Herts Foundation Partnership Trust to target dual
diagnosis patients
Sexual health
Increasing in GUM attendances in Hertfordshire– Increase in young people– Increase in those over 50 years old
Teenage pregnancy rates – Varies across county– Some district rates are above national average
Sexual health: action
Integration of services– Sexual health clinical network– Holistic model: 5 levels of service– Development of GP based service– Contraception services for teenagers– Screening for HIV/chlamydia
Increase education and prevention– Teenage pregnancy strategy with partners– Specific services for looked after children, six form and 16-24 years– Condom availability, C- card scheme
Increase awareness– To inform about services and how to access– Specific messages to young people, young parents, parents, carers and
professionals– Teenage pregnancy strategy
Screening programmes
Antenatal– Down’s syndrome– Sickle cell and thalassaemia
Newborn– Hearing– Blood spot
Cancer– Bowel– Breast– Cervical
Adult – Heart disease– Aortic aneurysm– Diabetic retinopathy
Immunisation
MMR HPV Seasonal flu
Falls prevention
Commonest cause in older people of:– Serious injury– Injury-related hospital attendance– Precipitating care home admission
Reducing confidence and independence 30% fall aged over 65 years in a year 50% fall aged over 85 years in a year
52,000 falls in >65 year olds
18,000 ambulance 999 calls
9,000 A&E attendances
4,141 hospital admissions
942 hip fractures
45-50 deaths from falls
The epidemiology of falls in Hertfordshire: in one year
Action for Falls prevention
Nottingham tool for identification Effectiveness in NICE guidance
– Improve balance, gait, mobility– Environmental factors
15-30% reduction in falls – financial savings– At least £2.65M per annum savings in Hertfordshire (hospital
admissions)– 7,800 fewer older falling – less residential/nursing home care
Importance of exercise in prevention Impact on intermediate care ?
Future focus
Agreeing priorities with 12 PBCs, LAAs, 10 LSPs Making links across LAA groups Reinforcing links with LAs and voluntary sector Opportunities within world class commissioning e.g.
intermediate care Consideration to continue second year of £100,000 to the
10 LSPs
Key documents
Health inequalities action plan July 2008 Health inequalities action plan update January 2009 PCTs’ 5 year strategy In draft Sexual Health strategy 2007