Newmarket INT: place-based needs assessment: Executive Summary (v1.0, 2019)

Executive Summary

Page 1 of 9 Public Health Suffolk Newmarket INT: place-based needs assessment: Executive Summary (v1.0, 2019)

Main authors

Tom Delaney, Alliance JSNA Researcher

Alison Matthews, Senior JSNA researcher

Tess Zermanos, Health and Care Programme Manager

Main editors

Natacha Bines, Head of Population Insight

Anna Crispe, Head of Knowledge & Intelligence

Consultant reviewers

Dr Padmanabhan Badrinath, Consultant in Public Health Medicine

Dr Jeptepkeny Ronoh, Consultant in Public Health Medicine

With many thanks to Integrated Neighbourhood Team colleagues and wider Suffolk colleagues for their input, collaboration and consultation.

This is version 1 created on 4th September 2019

Page 2 of 9 Public Health Suffolk Newmarket INT: place-based needs assessment: Executive Summary (v1.0, 2019)

Contents Executive summary ...... 4 Demographics ...... 4 Wider determinants of health ...... 5 Primary care ...... 5 Hospital admissions ...... 6 Children and young people ...... 6 Older people’s health and wellbeing ...... 7 Overview of Newmarket INT’s data ...... 7

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Executive summary This Place-Based Needs Assessment (PBNA) gives an overview of the Newmarket Integrated Neighbourhood Team’s (INT) locality to support understanding of the area’s health, needs, and wider determinants of health so that community-based, evidence-led work can be prioritised to improve health and reduce inequalities.

PBNAs focus on a place, not a condition or a specific population group. They mainly use publicly available data. Published data is robust and enables comparisons with areas outside Suffolk and with England, but publication is often delayed by some months and so can only give a snapshot rather than reflect the current situation. The Knowledge and Intelligence Team (Public Health Suffolk) are looking to add more up to date, local, unpublished data from INT members (for example data from adult social care, children and young people’s services, and Suffolk Fire and Rescue Service) to the PBNAs where appropriate: please check the link below for the latest version.

PBNAs should be considered alongside the work that INTs are delivering in their area, that cannot easily be captured in national statistics (for example social prescribing, and health improvement initiatives).

The latest versions of the Suffolk PBNAs are available here, together with presentations or other supporting information: www.healthysuffolk.org.uk/jsna/pbna

If you have any questions about this PBNA, please contact [email protected]

INT members include staff from Suffolk County Council’s adult social care and children and young people’s services, health (including local GP practices), police, mental health, district and borough teams, and the voluntary sector. Demographics Population projections The Newmarket INT has fewer residents aged 10 – 17 compared to West Suffolk Clinical Commissioning Group (WSCCG). However, the population projections indicate that the 0 – 17 age banding will see the largest estimated population increase by 2028, rising by 14.9% (compared to 4.9% across WSCCG).

Ethnic composition The Newmarket INT locality has a significantly higher proportion of Black and Minority Ethnic (BAME) residents (17.2%) compared to Suffolk (9.2%).

English as a second language Overall, 23.9% of pupils in the Newmarket INT locality were recorded as having English as their second language, above the estimated Suffolk figure (8.7%). This is likely to be as a result of the higher proportion of BAME residents in the Newmarket INT locality.

Learning disabilities 0.3% (81) of all patients (any age) registered with GP practices in Newmarket INT are recorded as having a learning disability. 0.5% of patients registered with a Suffolk GP practice are recorded as having a learning disability.

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Wider determinants of health Deprivation There is variation in relative deprivation across the Newmarket INT area. Areas to the east, located around Moulton, are relatively affluent (in the 40% least deprived England areas), whereas the central Newmarket area residents are relatively deprived (in the 40% most deprived England areas). Crime The Indices of Multiple Deprivation shows that crime is the main driver of deprivation for almost half of Newmarket INT neighbourhoods (5 out of 12 LSOAs). This measures the risk of personal and material victimisation at local level. The highest proportion of crime in the Newmarket INT locality was in the violence and sexual offences classification at 31 per 1,000 persons. However, this is not significantly different to Suffolk. Housing The Indices of Multiple Deprivation show that housing is a key driver of deprivation for 33% of Newmarket INT neighbourhoods. This includes the physical and financial accessibility of housing and local services and is consistent with the 2018 Housing waiting list for Forest Heath (764 households waiting, mainly due to insanitary or overcrowded housing). Transient renters Unlike (WSCCG) and Suffolk residents overall, the Newmarket INT area has a high proportion of ‘Transient Renters’ (16.2% of the INT population), which is low cost, short term renting, and ‘Rental Hubs’ (12.7%). Childhood poverty The Newmarket INT area has a lower percentage of children living in low income families than England and Suffolk (10.0% compared to 17.0% and 13.8%, respectively). Income deprivation affecting children mirrors the overall deprivation spread across Newmarket INT area (the most deprived populations are concentrated in central INT area).

Primary care Cancer The Newmarket INT may want to consider improving all cancer screening programme awareness and uptake, as it is short of all three national targets. Screening for bowel cancer and cervical cancer is significantly lower than WSCCG average uptake. Cardiovascular Disease (CVD) The Newmarket INT may want to consider if CVD detection can be improved, especially for atrial fibrillation. The Newmarket INT GP practices should also continue the good recorded practise of CVD management and ongoing engagement with smoking cessation support as smoking prevalence is high. Respiratory health The Newmarket INT should continue its positive engagement with smoking cessation support to prevent respiratory disease as the current recorded smoking prevalence in Newmarket is high. Additionally, the INT may want to investigate if there are opportunities for better chronic obstructive pulmonary disease (COPD) detection in adults and asthma management in children as there are high emergency admissions for these groups.

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Mental health Mental and behavioural disorders due to use of alcohol is the 3rd most common emergency admissions in 18-64 year olds. The INT may want to investigate alcohol consumption habits further, and explore any possible links between alcohol consumption and poor mental health. The INT may also want to examine whether there is under-detection or under-recording of serious mental health illness.

Hospital admissions Asthma In children (aged 0-17) there are high rates of emergency admission for asthma (3.3 per 1,000 compared to 1.8 per 1,000 for Suffolk). The INT may want to investigate opportunities for improved asthma management in primary care. Mental health Newmarket residents (aged 18-64) have significantly higher rate of mental and behaviour disorders due to use of alcohol compared to Suffolk. The INT may want to investigate if there is under-detection or under-recording of serious mental health illness in primary care and act on opportunities to create targeted support around drugs, alcohol and mental health. Respiratory conditions Pneumonia and COPD are one of the most common emergency admissions in adults aged 65 and over in the Newmarket INT locality. The INT may want to review opportunities for better pneumococcal and flu vaccine (PPV) vaccine uptake and COPD detection and management. Femur fractures The Newmarket INT may want to consider improving early osteoporosis diagnosis and increasing treatment with bone-sparing agents, especially as Newmarket residents over the age of 85 have a significantly higher rate of femur fractures compared to Suffolk average. This should be a long-term priority for the INT leadership team as the proportion of residents aged 85 and over in Newmarket INT locality are projected to increase by 38.9% by 2028.

Children and young people

Childhood obesity There are no schools within the Newmarket INT locality that have a significantly higher proportion of overweight or obese children compared to Suffolk. This is a positive indicator of wider health determinants. The prevalence of overweight or obese children in the Newmarket INT locality is 16.7%, this is not significantly different from Suffolk. However, this still means that 1 in 6 children and young people in Newmarket are obese or overweight, and there is room to reduce this, for example through targeted initiatives that increase physical activity and highlight the importance of a healthy balanced diet. Respiratory health CCG-level data shows that admissions for asthma are significantly higher in West Suffolk than England. As discussed in primary and secondary care, respiratory health is a priority for both children and adults in the Newmarket INT.

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Older people’s health and wellbeing The Electronic Frailty Index Newmarket INT should consider more consistent use of the eFI (Frailty Index) in primary care as early identification can help prevent and manage frailty. Once frailty has been identified, capacity should be prioritised to help prevent deterioration of frailty (e.g., referrals to social prescribing and physical activity)

Vaccinations The INT may want to explore raising both the PPV vaccine uptake in the 65 and over population as the current uptake is significantly lower than the Suffolk average. This will also help prevent pneumonia- related emergency admissions.

End-of-Life The Newmarket INT had a significantly higher proportion of residents over the age of 65 dying in care homes compared to Suffolk (33.3% compared to 28.2%, respectively). The INT should continue to provide advanced care planning to support people’s wishes around their end-of-life care.

Overview of Newmarket INT’s data Please note that only data relating to the Newmarket INT locality has been included in the tables below. For more data pertaining to larger geographies, such as WSCCG and West Suffolk (Forest Heath District Council), please see the subsections within this report.

Table 1: Population by broad age band, 2017, Newmarket INT Higher , lower or the same as Age Percent / number WSCCG 0-17 Lower 19.6% / 4,129 18-64 Higher 61.4% / 12,939 65-84 Lower 15.9% / 3,350 85+ Higher 3.2% / 668 Black and minority ethnic Higher 17.2% / 3,474 population

Table 2: GP practice deprivation score, 2015, Mildenhall and Brandon INT Levels of deprivation compared to England (21.8) Deprivation Area lower , the same as , higher score Orchard House Surgery Lower 16.6 The Rookery Medical Centre Lower 16.9 Oakfield Surgery Lower 15.4

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Table 3: Primary care indicators, 2017-18, Newmarket INT Higher , lower or the same as Indicator Percent / rate WSCCG Asthma Lower 6.6% Atrial fibrillation Lower 1.8% Cancer Lower 3.3% Cancer review within 6 months Lower 65.3% Cervical cancer screening Lower 76.0% Cessation support offered Higher 94.4% Chronic kidney disease Lower 3.5% Coronary heart disease Lower 2.7% Dementia Lower 0.7% Depression Same 10.0% Depression: review 10-56 days after Same 65.6% diagnosis Diabetes Lower 5.3% Diabetes: education programme Same 61.0% referrals Diabetes: foot examination Higher 81.9% Females aged 50-70 screened for Lower 75.6% breast cancer Heart failure Lower 0.8% Hypertension Lower 13.1% Mental health: care plans Same 82.9% Obesity Lower 7.9% Overweight and obese children Same 16.7% Persons aged 60-74 screened for Lower 59.0% bowel cancer Severe mental health Same 0.7% Smoking Higher 19.1% Stroke Lower 1.5% Two-week wait referrals for bowel Lower 469.3 per cancer 100,000 Two-week wait referrals for breast Same 562.2 per cancer 100,000 Two-week wait referrals for lung Lower 88.3 per cancer 100,000 Two-week wait referrals for skin Lower 492.2 per cancer 100,000

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Table 4: Hospital admissions, top three by age, Newmarket INT 0 -17-year olds Type Top Three Rate per 1,000 Viral infection of unspecified site 4.1 Emergency Asthma 3.3 admissions Acute tonsillitis 2.9 Lymphoid leukaemia 3.3 Elective admissions Acute tonsillitis 2.5 Chronic diseases of tonsils and adenoids 2.0 18 - 64-year olds Type Top Three Rate per 1,000 Abdominal and pelvic pain 4.0 Emergency Pain in throat and chest 2.3 admissions Mental and behavioural disorders due to use of alcohol 1.0 Medical abortion 4.2 Elective admissions Multiple myeloma and malignant plasma cell neoplasms 2.5 Abdominal and pelvic pain 2.2 65-84-year olds Type Top Three Rate per 1,000 Pneumonia, organism unspecified 11.0 Emergency Other sepsis 9.0 admissions Pain in throat and chest 8.0 Senile cataract 26.5 Elective admissions Other malignant neoplasms of skin 12.5 Benign neoplasm of colon, rectum, anus and anal canal 8.0 85 years and over Type Top Three Rate per 1,000 Pneumonia, organism unspecified 40.3 Emergency Other sepsis 32.7 admissions Other symptoms and signs involving the nervous and musculoskeletal systems 30.2 Senile cataract 35.3 Elective admissions Other malignant neoplasms of skin 22.7 Myelodysplastic syndromes 17.6

Table 5: Older people's health and wellbeing, Newmarket INT Higher, lower or the same as Indicator Percent / rate Suffolk Seasonal flu vaccine uptake (65 and over) Lower 72.0% Pneumococcal vaccine uptake (65 and Lower 71.9% over) Osteoporosis Same 1.2%

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