Agenda item

The Strategic Director, Adult Social Care and Health to present an Annual Report on Public Health.  A presentation on the report will be made at the meeting.

 

The Strategic Director, Adult Social Care and Health presented her Annual Report as the Director of Public Health.  A presentation on the report was also made at the meeting, a copy of which is attached to these minutes.

 

In presenting the report the following comments were made in addition to those listed in the presentation:-

 

·         Although there was a statutory requirement to produce a report there was no guidance on what should be included in the report.  However it was customary to include an assessment of the health of population and to make recommendations about things that could be done to improve the health of population.

 

·         One of the report’s purposes was also to inform the City Council, Health and Wellbeing Board, Clinical Commissioning Group, NHS England, Public Health England and other partners about the health of the resident population and to identify key areas where improvements could be made that would benefit the health of the population.  The plan also provides information on health needs overall which informs the planning and the commissioning process within all partner organisations.

 

·         The report also sat alongside the Joint Strategic Needs Assessment which had enabled the Board to produce its Joint Health and Wellbeing Strategy ‘Closing the Gap’.

 

·         The report also helps to provide a record of the health of the population which allows a comparison to be made over a period of time and with other places, both locally and nationally.

 

·         The striking differences for Leicester from these comparisons were:-

 

o   Leicester was ranked 25^th most deprived area out of 326 local authorities in England, it was noted that deprivation probably had the greatest single impact upon the health of the population.

 

o   Deprivation was also linked to lifestyle factors and material conditions that can affect the health of people, e.g people living in cold damp conditions have a greater risk of heart problems etc.

 

o   The population of Leicester has a very rich diversity.  There are 18 different ethnic groups in the City with populations of 1,000 or more identified in the 2011 census.  (37% Asian/Asian British, 6% Black/Black British, 46% White and 4% Other White groups from Poland and other EU succession countries).

 

o   Different ethnic backgrounds have different predispositions to health conditions.  Lifestyle factors are deeply embedded in the lives of people from different cultures and can impact upon health either to increase the risk of, or be a protective factor against, particular health conditions.

 

o   Leicester’s population is relatively young in nature.  34.5% of households have dependent children (29% nationally) and 20% of the population in Leicester are aged 20 – 29 years old compared to 14% nationally.

 

o   There are also significant socio-economic challenges in Leicester.  29% of adults have no educational qualification and 35% of 16-74 year olds were economically inactive compared to 30% nationally.

 

o   All these factors had a high impact upon health and health needs.

 

·         The top three causes of deaths in the Leicester population under 75 years old were cancer, cardio-vascular disease and respiratory diseases.  Although the highest cause of deaths in Leicester was cancer, the rate of deaths was comparable to the national death rate in the population.  The two biggest impacts upon health in Leicester which made the most difference to life expectancy in Leicester compared to elsewhere were cardio-vascular disease (e.g. heart attacks and strokes) and respiratory diseases.

 

·         Life expectancy at birth (which is derived from mortality rates) are used as an overall summary measure as it reflects all factors which have influenced a person’s health during their lifetime.

 

·         There were also differences in health conditions between different groups.  For example, there are high rates of diabetes and cardio vascular disease in the South Asian and Black population compared to the white population.  By contrast there are high rates of respiratory diseases in the white population resulting mainly from the higher prevalence of smoking among deprived white communities.

 

The average life expectancy for people in Leicester compared to the national averages had been widening for a number of years leading up to 2010.  However there were some encouraging indications that the gap had been reducing over the last four years, and whilst it was too early to identify it as a trend, there had been numerous partnership efforts in the last four years to improve the health of the population and it was hoped that these had contributed to a cumulative positive effect upon the general health of the population.

 

The main lifestyle issues affecting the local population were:-

 

a)    Whilst the majority of adults were non-or low risk drinkers, there were higher rates of alcohol related conditions and harm and higher rates of hospital admissions in Leicester compared to the East Midlands.  However, young people were less likely to report ever having an alcoholic drink - 20% of 11-15 year olds in Leicester compared to the national rate of 42%.

 

b)    Smoking was the greatest single cause of preventable premature deaths and over 20% of adults in Leicester smoke.  On average 0.5% of 11 year olds smoked which rose to 11% for 15 years olds.  Public Health staff work closely with schools using creative engagement techniques to avoid young people becoming ‘replacement smokers’ in future years.

 

c)    The levels of overweight and obesity is increasing in the population.  Whilst the rates for adults were similar to national rates, there were significantly higher rates of obesity for children aged 4-5 and 10-11 years old.  Efforts needed to be concentrated around these groups.

 

d)    Diagnosis for acute sexually transmitted infections (STIs) were above the regional and national averages and Leicester was the 6^th highest prevalence area for HIV outside of London.  This was an area for concern and needed work in the future to reduce these rates.

 

e)    Rates of teenage pregnancy had dropped since 1998 and the rate in 2011 was 30.7% per 1,000 15-17 year old girls which is almost a 50% fall since 1998.

 

f)     Oral health for children at age 5 years old having decayed, missing and filled teeth was the worst in England and a strategy had been put in place to promote oral health in pre-school children.

It was also noted that 23% of the total burden of ill health in UK was attributable to mental health diseases and illness.  In Leicester this equated to 10-15% of children and young people having a recognised mental health problem and 36,000 people of working age had a common mental health condition such as depression or anxiety.  Approximately 8,000 of people over 65 years old suffer from depression and 3,000 have dementia.  There were a number of recommendations in the strategy in relation to mental health, particularly that all partners should promote the use of the Five Ways to Wellbeing with staff as well as those who use services.

 

The report also showed that the long term conditions affecting the population aged 65 years and above were predominately diabetes, depression, dementia, CHD, strokes, bronchitis and emphysema and all these conditions were expected to continue to rise over time.

 

Other health factors mentioned in the report were:-

 

a)    The rates of tuberculosis in Leicester were the highest in the East Midlands and higher than England but the rates was consistently falling.

 

b)    There had been good uptake of childhood vaccinations in recent years and this was important to maintain.  It was noted that there had been some deterioration in the up-take in 2013/14 compared with the previous year.

 

c)    Cervical screening rates have also been declining locally and nationally and up-take of smear test remained significantly lower in Leicester than the national average.

 

d)    Bowel cancer screening rates are lower in Leicester than elsewhere and twice as many tests in Leicester had a positive result, suggesting the need to significantly improve up-take of this screening test.

Leicester had one of the highest up-takes of NHS Health Checks in the Country with approximately 72% of those eligible between the ages of 40 and 74 years old having received an NHS Check by the end of 2013/14.  It was noted that this had been a significant partnership effort over recent years and that Leicester City CCG had worked hard to ensure that GP practices deliver the checks.  20% of those receiving the checks needed further treatment for previously undiagnosed conditions.  4,900 people were now being treated to prevent more serious conditions or existing conditions from deteriorating.  Work on prevention of illness and stopping conditions deteriorating was an essential element of the Better Care Fund Plan.

 

In conclusion, the Strategic Director acknowledged the time and hard work of public health staff who had produced the detailed analysis presented in the report and thanked the Divisional Director Public Health for leading this work.

 

Following a general discussion and questions on the report, the following comments and observations were noted:-

 

a)         It would be desirable for data on all health inequalities to be broken down to the same level of statistical analysis for all protected characteristics, as it would enable a more targeted approach to be taken to develop strategies to tackle health inequalities related to protected characteristics.  However, it was noted that this was not always possible as some health data was collected nationally and other data was collected locally without accompanying information about each person’s ethnicity, sexuality or religion etc.

 

b)         Where local data on protected characteristics was not available, national data was often extrapolated as an indicator provided it was felt that the local position was not considered to be largely different from the national picture.

 

c)         The Director of Public Health’s Annual Report provided a snapshot in time of the health of the population.  The Public Health Team also undertook individual work on joint specific needs assessments on specific issues and/or groups where it was felt that particular groups were vulnerable.

 

d)         The report’s findings were also intended to be used to refine and improve existing strategies and to assist with the development of new strategies and their implementation.

 

e)         Everyone that commissioned services for the population should consider the findings in the Annual Report to identify where there were higher or different needs in parts of the community and take these into account in order to target the limited resources available in the health economy to address them.  Deprivation is a key issue.

 

f)          It was noted that the CCG had been carrying out low level analysis to test a number of hypotheses to see if suggested health inequalities were a determinant of health outcomes.  It was difficult to get sufficient data to provide a definitive answer.

 

g)         An analysis of the take up of NHS Health Checks showed that there was no apparent differential in the take up of health checks by different ethnic groups or in different areas of the City.

 

h)        The CCG also felt that testing a hypothesis at a low level could provide useful indications of whether health inequalities were amenable to health interventions or subject to wider determinants of health.

 

i)          There should be a greater use of health equality audits by commissioners of services, both in relation to the protected characteristics and in relation to deprivation.

 

j)          If all stakeholders undertook detailed health equality audits on 1 or 2 services each year it would to build a picture over time of ethnicity and other factors affecting health in the City.

 

k)         Further work needed to be undertaken on understanding why the change in the reduction between the national and local life expectancy rates had occurred.  Both deprivation and ethnicity had implications for the health of the population.  Alcohol related illnesses and diabetes affected different parts of communities and there was a need to focus services where they would have the greatest impact.

 

l)          Many of the recommendations were aimed at the strategic or system level and a number of the recommendations resonated closely with the ‘Closing The Gap’ strategic aims and priorities.  The Board already received six monthly updates on the progress with this strategy so this would also indicate to some extent whether the recommendations were being taken up and acted upon by health partners.

 

m)        Progress against the recommendations in the Annual Report would also feature in next year’s Annual Report.

 

n)        In addition to data provided by the Office of National Statistics and health episode statistics, there was also qualitative data held by all stakeholders and more could be done to have a stronger and collective understanding of the issues by sharing the information each stakeholder held.

 

o)         All stakeholders should respond in brief to the Director of Public Health’s Annual Report and the recommendations to outline what action they intended to take as a result or whether there were any elements they disagreed with.

 

RESOLVED:

1)         That the Director of Public Health’s Annual Report 2013/14 be received.

 

2)         That all partner organisations and other stakeholders be commended to consider the recommendations and respond in brief to them to outline what action they intended to take as a result or whether there were any elements they disagreed with.

 

3)         That Healthwatch’s offer to suggest areas of questioning to help with developing Health Equality Audits be welcomed.

 

4)         That the Director of Public Health be thanked for producing and extremely informative, user friendly and accessible report.