Transcript JSNA April 2010 CYP - Lewisham Strategic Partnership

Health, Well-being and Care
Version 1.2 of the
Lewisham Joint Strategic Needs Assessment
Dr Danny Ruta
Joint Director of Public Health
April 2010
What is the Joint Strategic Needs Assessment?
• A profile of health, well-being and care in Lewisham, in
terms of outcomes, service delivery and the wider social
determinants of health;
• A joint analysis of current and predicted health and
social care needs.
• Evidence for an analysis of the needs of Lewisham’s
citizens
• Reflects local and national health priorities
• Draws on and is supplemented by more detailed needs
assessments
Developed using
• Partnership working
– NHS, Local Authority, other key stakeholders
• Community engagement
- community groups, public events, consultations
• Evidence of effectiveness
- research
• Constantly developing work-in-progress
Lewisham’s health priorities
•
Reduce health inequalities (making health and healthcare fairer)
- Reduce gap in Life Expectancy
- Reduce premature death from Cardiovascular Disease.
Living longer
- Reduce premature death from Cancer.
- Improve the health of children and young people.
- Reduce teenage conceptions.
- Improve Mental Health.
- Improve quality of care for people with Long-term Conditions.
- Improve End of Life Care.
Health & life
chances for
children & young
people
Quality of life
Content of the JSNA
• Demography:
the growth, change and structure of the local
population
• Social and Environmental Context: poverty, employment,
housing, transport and the local environment
• Lifestyle and Risk Factors:
e.g., smoking, alcohol
consumption, eating habits and physical activity
• Burden of Ill-health:
life expectancy, mortality, ill-health,
disease, accidents and injury
• Social Care:
the number of people receiving social care
services now and projections on service use in the future
• Health Inequalities:
key disparities in heath outcomes
within Lewisham and in comparison with London and England
• Community Intelligence:
what our local
population has told us about their health and care needs
The JSNA informs…
• Lewisham Children and Young People’s
Plan
• Lewisham’s Health Inequalities Strategy
• Lewisham Primary Care Trust’s
Commissioning Strategy Plan
• Lewisham Council’s Corporate Strategy
• University Hospital Lewisham’s Annual
Delivery Plan
Key Commissioning Themes
1) Improve children’s health and well being in Lewisham with a particular
focus on prevention and education
2) Reduce childhood obesity
3) Support people in Lewisham to maintain healthier lifestyles through the
delivery of health promoting strategies and programmes for sexual
health, smoking and tobacco control, alcohol and drugs, healthy eating
and physical activity
4) Improve take up of preventive health measures such as immunisation and
screening
5) Improve access to mental health services in primary care
6) Improve the life expectancy for the residents of Lewisham, with a particular
focus on premature mortality from circulatory diseases and cancers
7) Improve the quality of care for those with long term conditions
8) Support adults with social care needs to shape and control their services,
empowering them to live independently within the community
Demography: Lewisham’s population
Population projection pyramid, annual percentage of males and females,
by single year of age, Lewisham and England 2008/9
90
85
80
75
70
65
60
55
50
45
40
35
30
25
20
15
10
5
0
1.5%
1.0%
0.5%
0.0%
Males
0.5%
1.0%
1.5%
Females
Source: GLA Round 2008 PLP Low (Copyright) and ONS Mid 2008 England estimate
Demography: total population changes to 2015
• Between 2009 and 2015 the population of
Lewisham is expected to grow by 7.6%.
• The 5-14 year old age group is expected to grow
by 14%
• Every ward is expected to experience some
growth
• The large growth will be in Evelyn Ward, which
will grow by abut 50%
Social and Environmental Context – Deprivation
National
quintiles
No area in
Lewisham is
in the least
deprived 20%
of England
Lewisham is
the 39th most
deprived LA in
England
Source: DCLG, IMD 2007 & ONS
Key Theme 1: Improve children’s health(1)
• 1in 5 people in Lewisham are aged <15, 1 in 4 are <19.
• Varies across Lewisham from 14% <15 in Lewisham
Central to 23% in Downham.
• Nationally, smoking rates in the 11-15 year old age group
remains high. Preventing the uptake of smoking is a
priority.
Key Theme 1: Improve children’s health(2)
• Uptake of childhood
vaccinations is low.
• Levels are below those
needed for herd
immunity, and Lewisham
has seen outbreaks of
measles and mumps.
Photo courtesy of Centers for Disease Control and Prevention
Key Theme 1: Improve children’s health(3)
Nationally, smoking rates in
the 11-15 year old age
group remain high.
Preventing the uptake of
smoking is a priority.
Photo © Roy Castle Lung Cancer Foundation
Key Theme 2: Reduce childhood obesity(1)
Lewisham has high levels of
childhood obesity in Year 6
children, 22.1% in 2008-9
compared with 18.3% for
England. The equivalent figure
for Lewisham in 2007/8 was
25.3%.
Obesity is a major risk factor
for cardiovascular disease,
cancer and diabetes.
Photo courtesy of fitness63.blogspot.com
Key Theme 2: Reduce childhood obesity(2)
A local survey in Lewisham
schools found that 12% of
children rarely or never ate
vegetables and 12% had
not had any physical
exercise in the previous
week.
Photo courtesy of fitness63.blogspot.com
Key Theme 3: Support healthy lifestyles
Data show high rates of
sexually transmitted infections
and teenage conceptions
among young people.
Key Theme 4: Preventive heath measures(1)
During 2008/09, the
percentage of 2 year olds
immunised for Measles
Mumps and Rubella was
74% compared to 85% in
England .
The WHO recommendation
is 95%
Key Theme 4: Preventive heath measures(2)
During 2008/09, the
percentage of 1 year olds
immunised for Diphtheria,
Tetanus, Polio, Pertussis,
Hib was 83% compared
to 92% in England .
The WHO
recommendation is 95%
Demography: Ethnicity
Lewisham population by broad ethnic group 2009
Bangladeshi
0%
Indian
2%
Pakistani
1%
Chinese
1%
Other Asian
2%
Other
3%
Black Other
6%
Black African
11%
Black Caribbean
13%
White
61%
60% of the population
of Lewisham are in
White ethnic groups.
30% are in Black
ethnic groups.
7% are Asian.
3% are classified as
“Other”.
Over 60% of school
pupils are in BME
groups.
Demography: Births
• Births in Lewisham have increased by
30% since 2002, and are expected to
continue to increase annually to 2015.
• 10% are to women <20, and 10% to
women >40.
• In 2008/9 60% were normal deliveries,
30% Caesarean, 10% were assisted.
• The majority gave birth at UHL, but those
living nearer the borders of the borough
tended to choose the nearest hospital .
Photo courtesy of pregnancy.about.com
Social and Environmental Context –
Children in poverty
• Lewisham has a higher proportion of secondary school
pupils who are entitled to free school meals than
England.
• The proportion of children living in income-deprived
household varies across the borough from about 10% to
about 75%.
• Over 30% of Lewisham children live in families on key
benefits, in the top 10% in Great Britain.
Social and Environmental Context
–Childcare and Tax Credit
• In March 2008, 29% of Lewisham’s families receiving
Working Tax Credit had their children in formal child care
and received Child Tax Credit, compared with the
Borough’s statistical neighbours at 23%.
• The was an increase from 26.5% in March 2006, while
the statistical neighbours’ rate was essentially
unchanged.
Social and Environmental Context - Crime
• Reported crime in Lewisham fell by 3% in the year to
July 2009.
• Lewisham has the highest rates of both offences and
sanction detections for domestic violence in the
Metropolitan Police Service.
• The proportion of young people supervised by the Youth
Offending Service in full time education training and
employment has risen from 69% in 2006-07 up to 85.5%
in 2008-09.
Social and Environmental Context
- Education and Attainment (1)
• Attainment at key stages 1, 2 and 3 is below the London
average.
• 60% of Lewisham pupils achieved 5+ GCSEs at grade
A-C, slightly below the England rate but comparing well
with the Borough’s Statistical neighbours.
• White and Black Caribbean boys on free school meals
have increased their GCSE attainment from 24% in 2003
to 40% in 2008.
• The gap between those receiving free school meals and
those who do not has narrowed by 28% to 18%.
Social and Environmental Context
- Education and Attainment (2)
• Lewisham has reduced the number of young people in
vulnerable groups not in education, employment or
training (NEET), between August 2007 and August 2009.
NEETs
70%
50%
Aug-07
40%
Aug-08
30%
Aug-09
20%
10%
Vulnerable groups
D
LD
ot
he
rs
M
ge
Te
en
a
O
ffe
nd
er
s
Yo
ut
h
M
isu
se
Ca
re
r
Su
bs
ta
nc
e
RA
S
0%
LA
C
Percentage
60%
Drug Abuse by Young People
• There is evidence of widespread substance misuse by young people
in Lewisham. Local treatment data suggest this is higher than the
England average.
• Estimates suggest 6-7% of 11 year olds have taken drugs in the last
year, rising to about 45% of 15 year olds.
• The main drug of choice used by young people in Lewisham is
cannabis.
• The ethnic mix of young people in drug treatment varies from year to
year.
• There has been an increase in the number of young people entering
the treatment system but there is considerable unmet need.
Nutrition and Fruit and Vegetable Consumption
• For children and young people, there are a number
of indicators which highlight concern in relation to
eating habits. The Schools Health Education Unit
survey data of Lewisham school children in 2008
found that:
- 48% of primary pupils had eaten less than 3
portions of fruit or vegetables the previous day and
4% had nothing to eat or drink for breakfast that
day
- 19% of secondary pupils had nothing for
breakfast the day of the survey
Photo courtesy of University of California Davis Medical School
Physical Activity
• Among children, participation
in sport is significantly higher
(88.9%) that in England as a
whole (85.7%).
• Of those surveyed, 57% of
young people were satisfied
with physical and sporting
activities within the Borough.
16% were dissatisfied.
Teenage Pregnancy
• In 2007, there were 316 pregnancies
in women aged 15-17.
Under 18 Conception rates 1998-2007
90.0
80.0
• 21% of these involved girls under 16
years old.
rate/1,000 women
70.0
60.0
Lewisham
50.0
London
40.0
England
30.0
20.0
10.0
0.0
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
prov
• Lewisham’s rate of under-16
pregnancy (15/1000 females) is
almost double that of England.
year
• 56% of pregnancies in the 15-17 age
group were terminated.
Infant Mortality
• Infant mortality (children aged under 1 year old) in Lewisham fell
steadily from 7.2/1000 births in1999-2001 to 4.6/1000 in 2005-7.
• Neonatal mortality (deaths under 7 days old) fell in the same period
from 9/1000 to 2.6/1000.
• In 2006 stillbirths were 5.2/1000.
• For each of these figures Lewisham’s most recent data is slightly
below the England rates, though not significantly different.
• Data for 2006-8, which became available after the JSNA was
written, show rises in Infant and Neonatal mortality rates that take
the borough above the England rate. This is not significantly
different, but is currently under investigation.
Low Birth Weight – under 2,500 grams
• Low birth weight is a risk factor for infant mortality.
• Lewisham generally has significantly higher rates than England, but
has usually not been statistically significantly different from the
London Cosmopolitan benchmark group and London overall.
• Local provisional analysis for 2009 shows Lewisham’s rate reducing
to 7.7%
Percent of babies born <2,500 gm, with 95% confidence interval 2003-2007
14
12
8
6
4
2
2003
2004
2005
2006
2007
Lewisham LB
LONDON
LONDON
COSMOPOLITAN
ENGLAND
Lewisham LB
LONDON
COSMOPOLITAN
LONDON
ENGLAND
Lewisham LB
LONDON
LONDON
COSMOPOLITAN
ENGLAND
Lewisham LB
LONDON
COSMOPOLITAN
LONDON
ENGLAND
Lewisham LB
LONDON
COSMOPOLITAN
LONDON
0
ENGLAND
percentage
10
Very Low Birth Weight – under 1,500 grams
• The most common reason for very low birth weight is extreme
prematurity.
• Since 2005, Lewisham has had significantly higher rates of very low
birth weight babies than London and England, though not statistically
different from the benchmark London Cosmopolitan group.
Percent of babies born <1,500 gm, with 95% confidence interval 20032007
3.5
3
2
1.5
1
0.5
2003
2004
2005
2006
2007
Lewisham LB
LONDON
LONDON
COSMOPOLITAN
ENGLAND
Lewisham LB
LONDON
LONDON
COSMOPOLITAN
ENGLAND
Lewisham LB
LONDON
COSMOPOLITAN
LONDON
ENGLAND
Lewisham LB
LONDON
COSMOPOLITAN
LONDON
ENGLAND
Lewisham LB
LONDON
LONDON
COSMOPOLITAN
0
ENGLAND
percentage
2.5
Dental Health
• Children’s tooth decay at age 5 is much
better in Lewisham than in London and
England overall. The mean number of
decayed missing and filled teeth is 0.9
compared to 1.7 for London and 1.5 for
England.
• In 2006/07 on average, 70% of children
were decay-free aged 5 although this varied
between 62% and 77% across the Borough.
• In 2006/07 73% of 12-year-old children had
no experience of dental disease although
this varied between 71% and 81% across
the Borough.
• At the end of 2007 67.5% of children were
accessing dentistry services in Lewisham.
Disabilities and or Learning Difficulties
• Referrals for Autistic Spectrum Disorders increased from
26 referrals in 1994 to 265 referrals in 2008. Some
children experience lengthy waits for assessment and
treatment.
• The estimate prevalence of children with disabilities in
Lewisham at 6.2% There are more male than female
children with disabilities.
Looked after Children
• The health needs of looked after children and young
people (LAC) are significantly greater than those within
the general child population.
• Between March 2006 and July 2009, the proportion of
LAC who had had health checks rose from 79% to 84%.