Dr Pat Riordan, Director of Public Health, NHSBE

GP MasterclassWindsor, Maidenhead & Ascot

Health and Wellbeing priorities for Royal Borough

Windsor, Maidenhead & Ascot from the 2010 JSNA and the New Public Health System

Source: Marmot Review, 2010

Marmot Themes

1. Giving every child the best start in life

2. Enabling children, young people and adults to maximise their capabilities

3. Fair employment and good work for all

4. Ensuring a healthy standard of living for all

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and impact of ill health prevention

Marmot Indicators for Royal Borough of Windsor and Maidenhead

Population

Source: ONS mid year estimates, 2009

Population RBWM

Registered* 176,570

Resident** 143,900

Difference +32,670Source: * Open Exeter, July 2010;**ONS 2009 Mid-Year Estimates

Future: RBWM population projection, 2010 to 2025Current: RBWM population

-8,000 -6,000 -4,000 -2,000 - 2,000 4,000 6,000 8,000

0-4

5-9

10-14

15-19

20-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65-69

70-74

75-79

80-84

85-89

90+

Ag

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rou

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Number of residents

Female Male 2015 2020 2025

Giving every child the best start in life: Improve births and maternity outcomes

Actual birth rates in Slough remain above the England average and continue to place demands on maternity and early years services

Higher birth rates continue in the existing population and among new entrants (4,947 in 2009)

Birth rates in Berkshire East PCT (live births per 1000 women aged 15-44)

0

20

40

60

80

100

120

140

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

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er

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Bracknell Forest UA Slough UA Windsor and Maidenhead UA

England and Wales Linear (England and Wales)

Causes of ill health Long term conditions above England and/or PCT average (QoF prevalence, 2009/10)

Source: Quality Outcome Framework (QoF) Prevalence 2009/10 - NB not true prevalence as age-limited and based only on GP registered patients

Above England and PCT averageAbove PCT average only

Prevalence of depression in Bracknell and diabetes in Slough is statistically significantly above national average

Condition Bracknell Slough RBWM Berkshire East NationalAsthma 5.98% 5.35% 5.15% 5.43% 5.94%Atrial Fibrilation 1.02% 0.73% 1.38% 1.08% 1.39%Cancer 1.28% 0.80% 1.43% 1.19% 1.41%

Coronary Heart Disease 2.49% 2.73% 2.76% 2.68% 3.44%Depression (age 18+) 11.73% 9.05% 8.88% 9.66% 10.91%Dementia 0.32% 0.21% 0.44% 0.33% 0.45%

Diabetes (ages 17+) 4.66% 7.13% 4.42% 5.34% 5.40%Hypothyroidism 2.83% 2.51% 2.91% 2.76% 2.92%Mental Health 0.59% 0.83% 0.58% 0.66% 0.77%Obesity (age 16+) 10.22% 10.64% 7.36% 9.13% 10.52%Stroke/TIA 1.19% 1.14% 1.44% 1.28% 1.68%

Unequal mortality outcomes

Inequality of Outcome Bracknell Forest Slough RBWM

All age all cause mortality S

All cause mortality <75 years E, S

Cardiovascular disease mortality S S S

Cardiovascular disease mortality <75 S E, S

Coronary heart disease mortality S E, S S

Colorectal cancer E, S E, S

Prostate cancer mortality E, S E, S

Skin cancer mortality E, S E

Breast cancer mortality E, S

Diabetes mortality E, S

Stroke mortality <75 S

Statistically Significantly above England (E) and/or South East (S) level

Above England (E) and/or South East (S) level (not statistically significant)

Further inequalitiesInequality of outcome Bracknell Forest Slough RBWM

Atrial fibrillation* E

Tuberculosis (TB) incidence E, S

HIV prevalence E

Hip fracture rates over 65 E

Heart Failure* E

Asthma* E

Diabetes* E, S

Depression* E E E

Dementia* E

Obesity in adults* E

Childhood obesity in Reception S

Childhood obesity in year 6 E, S

Statistically significantly above England (E) and/or South East (S) level

Above England (E) and/or South East (S) level (not statistically significant)

*Quality Outcome Framework (QoF) Prevalence 2009/10- NB not true prevalence as age-limited and based only on registered patients

Dementia, Depression Falls and Fractures

Rate of Hip Fractures per 100,000

RBWM = 615.4

England = 479.2

statistically significant

Ageing population with impact on Long Term Conditions

Ageing population is projected to increase by 2025

Causes of ill health

Stroke care and communitycare improvements

QoF Prevalence of Dementia

RBWM = 0.44%

(Ascot 0.66% - statistically significant)

England = 0.45%

PCT = 0.33%

Cancer

Coronary Heart Disease

QoF Prevalence of Cancer

RBWM = 1.43%

England = 1.41%

PCT = 1.19%

(not statistically significant)

Per

10

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00

Male Female Person

CHD (all age) mortality rate

Breast cancer mortality rate

Per

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0,0

00

Causes of ill health

Per

10

0,0

00

Colorectal cancer mortality rate

Male Female Person

ENG SE RBWM

Domestic abuse rates remain greatest in deprived wards, e.g. Oldfield

Non domestic abuse

Non-domestic abuse rate increased up to 14.3 per 1,000 in some wards

Domestic abuse

Children46% of domestic abuse incidents where children involved (Apr-Jun 2010)

Reduce domestic

abuse, violent crime,

sexual abuse &

alcohol harm

Alcohol• Alcohol attributable crimes in RBWM above national and regional rates (statistically significant)

• Alcohol attributable mortality in women above national and regional rates (not statistically significant)

5) Falls and Fractures

6) Alcohol

7) Reduce domestic abuse, sexual abuse and violent crime

4) Cancer

(Breast, Colorectal, Prostate)

3) Coronary Heart Disease

1) Ageing population with impact on long term conditions

2) Dementia

Windsor and Maidenhead

Priority Needs

A new public health system

The Director of Public Health, a proposed role

and GP consortia)

Public health funding and commissioning

Public health funding and commissioning-public health and the NHS

Public health funding and commissioning-allocations and the health premium

Public health funding and commissioning-accountability

Transition- a timetable