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