Agenda item

The Joint Strategic Needs Assessment of Cardiovascular disease providing information on risk factors, impact on Leicester’s population, current services, service gaps and recommendations.

Helen Reeve (Senior Intelligence Manager, Public Health, LCC) presented the Cardiovascular Disease Joint Strategic Needs Assessment (JSNA). The full document can be viewed on the LCC Website. The Presenting Officer went through each of the Reports headings in turn as below:-

•           Risk factors associated with Cardiovascular Diseases (CVD):

-           The unmodifiable and modifiable risks are listed in the report.

-           Lifestyle factors such as inactivity and poor diet impact, and these are higher in the City than the UK average.

•           Impact of cardiovascular diseases on Leicester’s population:

-           Leicester City has a relatively young population compared to County - and this may be impacting the low “crude prevalence” rates for cardiovascular diseases because prevalence is not age-standardised.

-           Most cardiovascular diseases show no significantly differing rates for different ethnicities – apart from Coronary Heart Disease (which is higher in the Asian/Asian British communities).

-           Hospital admission rates are significantly higher in residents from the most deprived deciles.

•           Current services:

-           Early detection and support for managing lifestyle factors will impact – and locally we have services that do this, including:-

         NHS Health Checks; Leicester performs better than the national average for completed NHS Health Checks.

         Live Well (the Councils Lifestyle Services Hub).

         Integrated CVD Service.

•           Unmet needs and service gaps:

-           There are some gaps in diagnosis based on what we expect rates to be.

-           There are some inequalities (as noted above) where rates are higher in the most deprived or certain ethnic groups. We have ambitions to address these through:-

         Proportionate universalism

         The “Core 20 Plus 5” (NHS)

         The National CVD Prevalence Programme

         Closing the inequality gap

•           Recommendations

-           In addition to the recommendations listed in the report, the presenting officer asked Members to note the unmet needs and service gaps in the report, and provide comment on areas identified for improvement.

Comments and questions from the Board:-

•           The Chair thanked the presenting officer for the information - and asked whether the data could be extracted for over 50s only. The presenting officer noted that this is not currently available within the Quality and Outcomes Framework (QOF).

•           Members felt that CVD prevalence by five-year age banding would be useful at Middle Layer Super Output Area (MSOA) level – but the presenting officer noted this is not currently available.

•           The Chair noted that the map of Coronary Heart Disease prevalence in the City looks similar to maps for other aspects such as smoking prevalence – but the one for Stroke looks very different. Adding age to MSOA data would help us better understand this locally.

•           Cllr Clarke noted that the impact of air pollution is lacking from the report – and particularly information about the burden on the NHS caused by poor air quality. The Director of Public Health (DPH) responded that air quality can be modelled at 5% of cause mortality – but it is difficult to be precise at neighbourhood level. We are unable to, for example, state how much poor air quality contributes to a cardiovascular death. The DPH did, however, agree that air quality is an important part of the Council’s strategies.

•           The DPH noted that we can state whether a patient has a high BMI or smokes – but cannot say for certain that they are being impacted by poor air quality (ie the data is modelled rather than accessible). Cllr Clarke however felt that we can state whether a patient lives in an area within an air quality management system – and there are monitoring stations across the City that can be utilised to join up the data.

•           Cllr Clarke asked that air quality be recognised as a wider determinant in future reports, and The Chair asked that future reports note air quality as a “contributory factor” and incorporate available data.

•           Dr Packham asked members to revisit the commitment to invest in prevention (and particularly to revisit the ICB’s Five Year Plan’s chapter on prevention), even in the current financial climate. Without this investment/commitment she felt that patterns of cardiovascular disease will not be broken. The Chair felt that the data in the current JSNA suggests that investment is needed in the County more so than the City - so it would be difficult to argue for additional CVD prevention money for the City as it stands. She felt that the City has a younger population – but we know that our older population has high rates of ill health, so asked that this be reflected if possible.

•           The COO of the ICB noted that, between Public Health and the ICB, we have the data to enable a comparison of age-standardised hospital admissions, mortality and overall costs to the NHS. She suggested that members re-read the Marmot Report which lists how we can work out return on investment for prevention. She also noted that the obesogenic environment is something we can impact on if all agencies work together.

•           The City Place Lead noted that obesity and diabetes in children will result in cardiovascular disease as adults. The Chair felt that there is also an issue of a reduction in physical activity when children transition from primary to secondary school; she felt this would be a topic that can be explored at a future Health & Wellbeing Board meeting.

•           Dr Packham noted that the Head of the ONS recently lectured on covid data once it has been rationalised in terms of age and ethnicity.

•           Members noted that the data in the JSNA states that 50% of city residents do not consume alcohol – but this is via self-reporting. If 50% of the city genuinely do not drink at all, then it is likely this is obscuring some high consuming communities.

•           The DPH noted that mortality data is the key indicator that shows the City has higher levels of preventable avoidable deaths. He felt that the JSNA should not be amended – but was happy for the slides to be reviewed to reflect this better and take into acount the above comments.

RESOLVED:

•           That the Board thanked Officers for the presentation and asked them to take Members comments into account.

•           That Members will consider ways to obtain age-standardised data at MSOA level – to give a more useful picture.

•           That future reports will include reference to Air Quality as a “contributory factor and/or wider determinant of health” – and include any data available.

•           That the slides can be reviewed, in light of the above comments, to see whether the data can be presented differently.

•           That the HWB Programme Manager will add “drop-off in physical activity at the transition from primary to secondary school” to a future Board. agenda.