Southend-on-Sea Localities Needs Profile: West Authors Sally Watkins, Senior Public Health Intelligence Analyst October 2017 1 Acknowledgements The authors of this report wish to thank the following people who have contributed to this report: Andrea Bann, NHS Southend CCG Chris Campos, NHS Southend CCG DACTeam, Southend-on-Sea Borough Council Gemma Robinson, Community Safety Officer, Southend-on-Sea Borough Council Lee Watson, Health Improvement Practitioner Advanced, Southend-on-Sea Borough Council Luke Wood, Business Intelligence Officer, Department for people, Southend-on-Sea Borough Council Pearl Ray, Health Checks Co-Ordinator, Southend-on-Sea Borough Council Samantha Reed, Adaptations Officer, Southend-on-Sea Borough Council Simon Ford, Senior Public Health Manager (Sexual Health), Southend-on-Sea Borough Council Tim Winters, Head of Public Health Information, Public Heath, Norfolk County Council Tony Mardle, Stop Smoking Service Manager, Southend-on-Sea Borough Council With special thanks to Thurrock Council Public Health Information Team 2 Contents Acknowledgements 2 1. INTRODUCTION 6 2. BACKGROUND 7 PART 1: WHAT ARE THE NEEDS OF OUR POPULATION? 8 3. DEMOGRAPHY 8 3.1 Age and sex distribution of the current population 8 3.2 Ethnicity 9 3.3 Fertility Rate 10 3.4 Pensioners living alone 11 3.5 Care Homes 12 3.6 Population projections 14 3.7 How can the new Primary Care Centre help? 14 4. WIDER DETERMINANTS OF HEALTH 15 4.1 Deprivation 15 4.1.1 How does deprivation impact on health? 15 4.1.2 Deprivation in West Locality 16 4.2 Housing 16 4.2.1 How does poor housing impact on health? 16 4.2.2 Persons per household 17 4.2.3 Overcrowded Households 17 4.2.4 Households with central heating 18 4.2.5 Needs of residents living in West Locality council homes 19 4.2.6 Future known housing developments 20 4.3 Employment 20 4.3.1 How does employment impact on health? 20 4.3.3 Benefits claimants 21 4.4 Education and skills 22 4.4.1 How do education and skills impact on health? 22 4.4.2 Good level of development 23 4.4.3 Residents with no qualifications 23 4.4.4 Digital skills 23 4.5 Air Quality 24 4.5.1 How does air quality impact on health? 24 4.5.2 Air quality in West Locality 24 4.6 Crime 25 4.6.1 How does crime impact on health? 25 4.6.2 Crime in West Locality 25 4.7 Access to Transport 26 4.7.1 How does accessing services impact on health? 26 4.7.2 Accessibility in West Locality 26 3 4.8 Summary of needs: Wider Determinants of Health; How can the new West Primary Care Centre help? 27 5 HEALTH LIFESTYLE BEHAVIOUR 29 5.1 Breastfeeding 29 5.1.1 How does breastfeeding impact on health? 29 5.1.2 Breastfeeding prevalence 29 5.2 Smoking 29 5.2.1 Smoking Prevalence 29 5.2.2 How does smoking impact on health? 31 5.2.3 The financial impact of smoking 31 5.2.4 Use of current commissioned stop smoking services 32 5.3 Obesity 33 5.3.1 How does obesity impact on health? 33 5.3.2 Child obesity Prevalence 34 5.3.3Adult Obesity Prevalence 36 5.3.4 Use of current services 36 5.4 Substance Misuse 37 5.4.1 Current service 38 5.4.2 How does substance misuse impact on health? 38 5.5 Sexual Health 39 5.5.1 Sexual Health in West locality 39 5.5.2 Teenage Pregnancy 40 5.5.3 Current Services 40 5.5.4 How does poor sexual health further impact on health? 41 5.5.5How does teenage pregnancy impact on health? 42 5.6 Summary of needs: Health Lifestyle Behaviour; How can the new West Primary Care Centre help? 43 6. EPIDEMIOLOGY – The Current Disease Burden Experienced by People in West Locality 44 6.1 Self-reported health 44 6.2 Life expectancy 45 6.2.1 Males 45 6.2.2 Females 46 6.2.3 Premature mortality 47 PART 2: WHAT DO WE CURRENTLY HAVE AND HOW DO WE USE IT? 48 7. PRIMARY CARE 48 7.1 General Practice 48 7.1.1 General Practice Workforce - 50 - 7.1.2 Practice Nurses - 51 - 7.2 Long Term Conditions Management Clinics - 52 - 7.3 Pharmacies - 53 - 7.4 Dentists - 54 - 7.4.1 Current Dental Provision - 54 - 4 7.4.2 Use of Current Provision - 55 - 7.5 Opticians - 56 - 7.6 Primary Care Out of Hours Service - 56 - 7.6.1 Current Service Provision - 56 - 7.6.2 Use of Current Service - 56 - 7.7 Summary of Current Primary Care Provision - 57 - 8. LONG TERM CONDITIONS AND THEIR MANAGEMENT - 59 - 8.1 Long term conditions in West Locality - 59 - 8.2 Non-diagnosed Long Term Conditions - 59 - 8.3 Quality Outcomes Framework (QOF) - 61 - 7.4 Clinical Management of Patients with Hypertension - 62 - 7.4.1 Summary of hypertension care. - 69 - 8.5 Clinical Management of patients with Heart Failure (HF) and Atrial Fibrillation (AF) - 70 - 8.5.1 Summary of HF and AF Care - 76 - 8.6 Clinical Management of Stroke, Transient Ischaemic Attack (TIA) - 76 - 8.6.1 Stroke care summary - 82 - 8.7 Clinical Management of Patients with Diabetes - 83 - 8.7.1 Summary of Diabetes Care - 90 - 8.8 Care of Patients with Respiratory Disease - 90 - 8.8.2 Summary of respiratory care - 97 - 9. MENTAL HEALTH AND WELLBEING - 98 - 9.1 Mental Ill Health prevalence - 98 - 9.1.1 Recorded Prevalence of Depression - 98 - 9.1.2 Prevalence of Serious Mental Ill Health (SMI) - 99 - 9.2 Referral of Patients with Depression to Talking Therapies - 100 - 9.3 Clinical Management of Patients with Mental Ill Health including depression and dementia in Primary Care - 100 - 9.4 Mental ill health and co-morbidities - 107 - 9.5 Mental health and wellbeing summary - 109 - 10. SECONDARY CARE - 110 - 10.1 Current Service Provision - 110 - 10.2 Outpatients Clinics - 110 - 10.3 A&E Attendance - 111 - 10.3.1 A&E Attendances that could have been treated elsewhere - 113 - 10.3.2 A&E Diagnoses (all HRG coded attendances) - 115 - 10.4 Unplanned Care Admissions - 116 - 10.5 Summary – Secondary Care - 118 - Bibliography - 119 - Appendix 1 – List of Figures - 121 - Appendix 2 – List of Tables - 125 - Appendix 3 - 126 - 5 1. INTRODUCTION This report was requested by NHS Southend Clinical Commissioning Group and Southend- on-Sea Borough Council to assess the health and wellbeing profile of the population of the West Locality. The West Locality is comprised of the following wards: Belfairs Eastwood Park Leigh West Leigh This report aims to examine the quality of the current primary care provision and the defined ‘blue print’ for a new Primary Care Centre which would encompass services and enhance primary care facility together with wellbeing services and potentially other clinical and social services traditionally provided in alternative settings. It is divided into 3 parts: Part one considers the needs of the population of West locality Part two considers the current level of service provision and how it is being used Part three attempts to define a possible future ‘blue print’ for a new Primary Care Centre. 6 2. BACKGROUND There are seven GP practices in the West Locality. We know that under-doctoring and nursing is a huge issue and people are waiting for an unacceptable length of time in order to obtain a GP appointment. We also know that if people cannot get a GP appointment they are more likely to use more expensive parts of the system such as A&E, and that under-doctoring leads to a reduced ability of GP practices to care proactively for patients with long term conditions, increasing the risk of patients experiencing an adverse event. In Southend-on-Sea we have a vision to provide more integrated health and social care services, and provide a more holistic population health approach to the way in which we commission services. In West our vision is to create a new Primary Care Centre which incorporates Primary Care, but also aspects of Secondary Care, and wellbeing services to address to underlying causes of ill-health. Influences on health and wellbeing can be thought of as a chain of events set out in figure 1. This report is structured to mirror this chain of events. Figure 1: Influences on health and wellbeing chain of events 7 PART 1: WHAT ARE THE NEEDS OF OUR POPULATION? 3. DEMOGRAPHY 3.1 Age and sex distribution of the current population Data from October 2016 shows that the practice registers for the GPs in West have a combined population of 54,291 (NHS Digital, October 2016). 48.6% are male and 51.4% are female. When looking at the age breakdown of this population, it can be seen there are some differences compared to the rest of the Southend-on-Sea population. West has a smaller proportion of adults of working age, particularly between 20 and 34 (both male and female) and a higher population of people aged over 65, particularly males between 65 and 79. Figure 2: West Locality GP Registered Population by Age and Sex, October 2016 Data Source: NHS Digital When comparing the GP registered figures to the ONS population estimates of the four wards that are in West Locality, the GP registers have a much higher number registered (54,291) compared to the ward population size (38,842 ONS Mid-Year Estimates, 2015). It should be noted that the GP registered figure may include patients registered with two of the largest practices within Southend-on-Sea aligned to neighbouring localities, located near the border of this locality (Pall Mall; 17,534 and Queensway Surgery; 21,065).