Agenda item

Kerry Dove, Interim Head of Policy and Insight

Wendy Tompson, Research and Development Manager

A statutory duty of the H&WB was to produce Joint Strategic Needs Assessments (JSNAs) to identify the current and future health and social care needs of the local community. The March 2020 JSNA highlighted that performance across a number of areas had remained stable and similar to national performance figures. Areas of improvement included:

·         smoking related deaths falling by almost 10% in two years, with a lower rate than the national average;

·         a decline in teenage conception rates, now being in line with the national average;

·         a reduction in fuel poverty, now lower than the national position, with the Staffordshire Warmer Homes Fund supporting 130 of 1000 eligible homes to date;

·         death rates relating to cancer, respiratory and cardiovascular diseases having reduced over the last 15 years.

Six current health and care key issues had been identified within the JSNA for Staffordshire.

Wider determinants had significant impact on people’s health outcomes and therefore played a role in reducing health inequalities. Two thirds of Staffordshire’s young people don’t achieve a core level of attainment by the time they leave school. Whilst Staffordshire had higher than average employment the annual earnings were below the national average. One in ten residents (and 13% of children) lived in low-income households. Poor housing was estimated to cost the NHS between £22-£39m in Staffordshire per year. 559 homeless households were recorded in Staffordshire, with 256 of these being in priority need.

Frustrations were shared around persuading investment into housing projects to help address issues of the poor housing.

Members suggested that tackling homelessness/risk of homelessness could usefully be divided to target work around youth homelessness separately. Some work was already undertaken in schools through PHSE classes and Stafford Borough Council had developed a “Supporting Stafford Schools” website which addressed a range issues including homelessness, drugs and alcohol, and mental health.

Ageing well, with healthy life expectancy having a significant impact on demand for acute services. There were 65,900 more people in Staffordshire aged over 65+ than 20 years ago and it was estimated that by 2030 there would be 50% more older people aged 85+. Healthy life expectancy in Staffordshire was 63 years for men and 65 years for women. 22% of Staffordshire adults had limiting long term illness, rising to 53% for older people, both figures were above the national average. There were 3,900 fall admissions in Staffordshire per year. There was also a high proportion of delayed days due to transfer of care, attributed to both NHS and social care. Staffordshire was the worst performing of its 15 statistical neighbours for excess winter deaths, and ranked fourth worst in England, with Stafford ranked fifth worst in the country.

Concern was shared around excess winter deaths, and whilst this figure had not been standardised against the age profiles of its statistical neighbours, the figure highlighted an issue for concern. Preventative work was key to tackling this and digital technologies could also play a part. Many of the wider determinants would influence ageing well and it was important to work towards a more active and healthy older life. There was a desire to change the system from the current more top heavy approach where resources focused on acute services, to more preventative and proactive measures that enable individuals to have a longer healthy life expectancy.

Staying mentally well, with mental health and wellbeing a key issue in Staffordshire for both young people and adults, placing significant demand on acute services. In Staffordshire one in eight (12%) of emergency hospital admissions had a mental health diagnosis in under 25s, which was lower than nationally (15%). This increased to one in four for adults (26%) against a national picture of 30%. Newcastle had the highest prevalence for both recorded depression and severe mental health. Mental health was also the second most common factor cited in 60% of children’s social care assessments in 2018/19, up from 56% in 2017/18.

The Family Strategic Partnership Board had identified children’s mental health as their main priority. Members shared concerns around the impact of social media use, particularly during late evening, and the effect this could have on individual’s mental health and wellbeing.

Healthy lifestyles, with one in four Staffordshire adults being physically inactive, the second highest of its 15 statistical neighbours and the tenth worst area in England. Excess weight in both children and adults was a key concern, with one in four reception children, one in three Year 6 children and two in three adults being overweight or obese. The worst performing areas in Staffordshire were in more deprived localities, with Newcastle the third worst area in the country for reception aged obesity and Cannock being the fifth worst area in the country for excess weight in adults.  The diabetes prevalence trend was rising faster in Staffordshire than in England as a whole. There was also a higher than average prevalence of heart disease.

40% of ill health was preventable and frustration was shared that despite healthy lifestyle initiatives improvements had not been made. Consideration needed to be given to how generations could be inspired to take their own health seriously, with a suggestion that the 20 and 30 year old aged groups should be targeting as those most likely to effect lifestyle changes. Family learning around healthy lifestyles was already in place and community based approaches to improved healthy lifestyles such as Park Run were also encouraging. The need for a more integrated community approach was suggested, with initiatives implemented in Leeds given as examples successful initiatives.

Substance misuse, with alcohol admission rates in Staffordshire having increased from 692 per 100,000 to 814 per 100,000 in the last four years. This rate was consistently higher than the national average and the worst amongst its 15 statistical neighbours. The highest districts for alcohol admission rates were in Cannock Chase and Stafford. Key risk factors of substance abuse impacting on acute services were regarding preventable liver disease rates, which had risen by 22% during a five year period. Substance misuse was also the third most common factor in 54% of social care assessments, with alcohol (85%) more common than drugs (81%).

Alcohol admissions to hospital were normally those with chronic disease over a long period of time. There was no correlation between the reported consumption rate for alcohol and the amount of alcohol purchased nationally, with approximately 50% of all alcohol bought not being consumed according to the anomaly between the figures.

Maternal and Infant Health. Staffordshire was experiencing rising Infant Mortality, with 121 infant deaths in 2012-2014 to 141 during 2015-17. This was statistically higher than the national picture and was the highest rate amongst its statistical neighbours.  Half of all infant deaths in Staffordshire occurred in the top two deprived quintiles of the County, Tamworth and East Staffordshire, ranked 5^th and 6^th worst areas in England respectively. Several risk factors were identified where Staffordshire performed below average, and these included smoking during pregnancy and access to early infant healthcare checks.

Smoking during pregnancy was a continued concern and a new approach had been developed which worked with the whole family towards stopping smoking.

The JSNA findings and discussion by the Board would be collated and sent to Board Members for comment/addition. This would then form the basis of future work. This work would also be considered by the STP Partnership Board, looking at a joined-up approach, the actions required and who was responsible for implementing these.

Next steps included producing data matrices that broke information down to a district level, with these being made available on-line.

RESOLVED – That the detail within the JSNA be noted and that the comment and discussion by the Board be collated for comment and/or addition and used to inform future work.