South Devon Locality Health Plans 2014-15

Nicola Glassbrook Public Health Devon, February 2015 Partnership org NHS Commissioner Local authority Department of Health NHS Provider Regulatory body

Public Health NHS England HealthWatch England England Area Team Director Steve Moore

Line of accountability Public Health Northern, Eastern & Western Devon CCG Advisory (Devon County Council) Chair: Dr Tim Burke, MD: Rebecca Harriott Director of Public Health South Devon and Torbay CCG Regulation Dr Virginia Pearson Chair: Dr Derek Greatorex, MD: Steve Wallwork

Scrutiny

Health and Wellbeing Board Chair:Cllr Andrea Davis Health service providers Primary Care Services Royal Devon and Exeter NHS (GPs, dentists, pharmacists Foundation Trust, Northern Devon and optometrists) Healthcare NHS Trust, and others

CQC - quality Overview and Scrutiny Monitor - financial regulator Local HealthWatch Committees Protect patients’ interests regulator WHAT DOES PUBLIC HEALTH DEVON DO?

Supporting partnership work on health and wellbeing Providing expert advice and support across the health, care and wellbeing agenda, including to the Health and Wellbeing Board, district local authorities, service providers, community organisations, NHS local area Health teams and other Devon County Council services. protection

Commissioning Public Health Services Supporting Protecting The direct Population and commissioning of Health and Informing services from the Reducing Public Health Inequalities budget based on local intelligence Healthcare Health Public Health Improvement Supporting Clinical Commissioning Groups (CCGs) Providing expert advice and support through the ‘core offer’ to inform wider commissioning and improve services and outcomes Population Pyramid - Teignbridge Population - 2013

The table and population pyramid below show the population broken down by age and sex for the area against England. The age and gender of your population can have a significant impact on their health and social care needs.

Population Pyramid (% compared to England) Age Group Female Male 85+ 2.6 1.3 0-4 2936 3225 80-84 1.9 1.5 5-9 3073 3278 75-79 2.3 2.0 10-14 3077 3457 70-74 2.9 2.6 15-19 3344 3633 65-69 4.0 3.8 20-24 2796 2902 60-64 3.8 3.4 25-29 2845 2969 55-59 3.6 3.3 50-54 3.9 3.6 30-34 3015 2877 45-49 4.0 3.7 35-39 3135 2918 40-44 3.4 3.1 40-44 4281 3884 35-39 2.5 2.3 45-49 5014 4677 30-34 2.4 2.3 50-54 4859 4534 25-29 2.3 2.4 55-59 4488 4175 20-24 2.2 2.3 60-64 4801 4309 15-19 2.7 2.9 65-69 5083 4846 10-14 2.4 2.7 70-74 3647 3280 5-9 2.4 2.6 75-79 2938 2581 0-4 2.3 2.6 80-84 2453 1834 6 4 2 0 2 4 6 85+ 3261 1576 Teignbridge England Total 65046 60955 South & West Population

Population Pyramid - South Hams Population - 2011

The table and population pyramid below show the population broken down by age and sex for the area against England. The age and gender of your population can have a significant impact on their health and social care needs.

Population Pyramid (% compared to England) Age Group Female Male 85+ 2.2 1.2 0-4 1788 1932 80-84 1.9 1.4 5-9 1937 2028 75-79 2.4 2.1 10-14 2208 2378 70-74 2.7 2.6 15-19 2284 2473 65-69 3.9 3.6 20-24 1637 2190 60-64 4.6 4.2 25-29 1720 1802 55-59 3.9 3.6 50-54 4.0 3.5 30-34 1689 1569 45-49 4.2 3.7 35-39 2061 1895 40-44 3.5 3.0 40-44 2940 2531 35-39 2.5 2.3 45-49 3469 3106 30-34 2.0 1.9 50-54 3375 2941 25-29 2.1 2.2 55-59 3235 2974 20-24 2.0 2.6 60-64 3849 3542 15-19 2.7 3.0 65-69 3237 3024 10-14 2.6 2.8 70-74 2252 2178 5-9 2.3 2.4 75-79 2016 1728 0-4 2.1 2.3 80-84 1553 1195 6 4 2 0 2 4 6 85+ 1856 971 South Hams England Total 43106 40457

Population Pyramid - West Devon Population - 2011

The table and population pyramid below show the population broken down by age and sex for the area against England. The age and gender of your population can have a significant impact on their health and social care needs.

Population Pyramid (% compared to England) Age Group Female Male 85+ 2.3 1.0 0-4 1276 1298 80-84 1.9 1.3 5-9 1253 1381 75-79 2.2 2.0 10-14 1483 1546 70-74 2.7 2.6 15-19 1411 1603 65-69 3.6 3.6 20-24 1134 1240 60-64 4.3 4.0 25-29 1118 1169 55-59 3.7 3.4 50-54 3.8 3.6 30-34 1198 1170 45-49 4.1 3.9 35-39 1435 1306 40-44 3.4 3.3 40-44 1813 1762 35-39 2.7 2.4 45-49 2195 2073 30-34 2.2 2.2 50-54 2059 1941 25-29 2.1 2.2 55-59 1984 1814 20-24 2.1 2.3 60-64 2323 2168 15-19 2.6 3.0 65-69 1947 1951 10-14 2.8 2.9 70-74 1462 1413 5-9 2.3 2.6 75-79 1166 1074 0-4 2.4 2.4 80-84 1017 707 6 4 2 0 2 4 6 85+ 1209 556 West Devon England Total 27483 26172 Teignbridge: Over 85 Population, 2012

TEIGNMOUTH CHUDLEIGH ENGLAND DEVON TEIGNBRIDGE EAST

1.89% 2.28% 3.52% 3.81% 7.14% Like England 2004 2012 2028 2029 2066 in Health inequalities

“Health inequalities are unjust disparities in health outcomes between individuals or groups. They arise from differences in social and economic conditions that influence people’s behaviours and lifestyle choices, their risk of illness and actions taken to deal with illness when it occurs .” Deaths of under 75’s in Teignbridge by main cause and risk factor (2010-2012) Health Inequalities

CAUSES OF DEATH CONTRIBUTING TO THE LIFE EXPECTANCY GAP IN SOUTH HAMS

Other Cancers (excludes lung, breast, bowel & stomach), 15% CAUSES OF DEATH CONTRIBUTING TO THE LIFE EXPECTANCY GAP IN WEST DEVON

CHD, 11% Other, 45% Mental and Behavioural, 10%

Other CVD, 11% CHD, 9%

Suicide and IU, Pneumonia, 8% 9% Other, 53% COPD, 9% Other Digestive, 7% Blank, 0%

MSK system, 7%

Lung Cancer, 6% Rural Deprivation

National Urban National Overall National Rural National Urban National Overall National Rural Urban Rural Overall Urban Rural Overall

28 28 26 26 24 24 22 22 20 20 18 18 16 16 14 14 12 12 10 10 8 8 6 6 4 4 2 2

0 0

Devon

Devon

Totnes

Ivybridge

Tavistock

Dartmouth

South West South

South West South

Kingsbridge

South Hams South

West West Devon Okehampton Health inequalities How can we narrow the gap?

1. Reducing smoking

2. Increasing the proportion of the population that are a healthy weight

3. Detecting and treating disease earlier, such as heart disease, high blood pressure, diabetes and cancer

4. Targeting preventative interventions at those vulnerable groups with the worst health, including those who may be at risk of domestic or sexual violence and abuse

5. Investing in the health and wellbeing of children and young people

6. Improving mental health and emotional health and wellbeing, and preventing loneliness

7. Increasing income levels and employment, and reducing poverty

8. Improving the quality and warmth of housing

9. Reducing misuse of substances, including alcohol and drugs

10. Helping people in their neighbourhoods to live healthier and happier lives.

Adult Smoking

Adult Smoking (%), South Hams and West Devon, 2010-11

District South Hams Linear (Devon) Linear (South West) Linear (England) West Devon 0 5 10 15 20 25

East Devon 14.2

Exeter 21.4

Mid Devon 16.6

North 18.2 Devon

South Hams 19.2

Teignbridge 19.3

Torridge 21.6

West Devon 14.5 Fuel Poverty

Households in Fuel Poverty (%), South Hams and West Devon, 2010

District South Hams Linear (Devon) Linear (South West) Linear (England) 0.0% 5.0% 10.0% 15.0% 20.0% 25.0% West Devon

East Devon 17.4%

Exeter 13.0%

Mid Devon 18.6%

North Devon 19.2%

South Hams 18.3%

Teignbridge 16.3%

Torridge 21.6%

West Devon 21.1% Emergency Admissions for Hip Fractures

Emergencydirectly Admissions age standardised for Hip fractures aged rate 65+, DASR per per 100,000, 100,000, Teignbridge, 2013 -2012/1313

District Teignbridge Devon South West England .00 100.00 200.00 300.00 400.00 500.00 600.00 700.00 800.00

East Devon 469.45

Exeter 462.75

Mid Devon 482.23

North Devon 539.60

South Hams 557.03

Teignbridge 530.67

Torridge 576.55

West Devon 534.38 Accidental Falls

Accidental Falls Emergency Admissions by District 2009 to 2011 Crude Rate per 100,000 1200 District Devon

1000

800 Crude100,000 perRate

600

400

200

0 East Devon Exeter Mid Devon North Devon South Hams Teignbridge Torridge West Devon Incidence of Malignant Melanoma,

ageIncidence standardised of Malignant Melanoma, rate DASR per per 100,000,100,000, Teignbridge, 2009 2009- to11 2011

District Teignbridge Devon South West England .00 5.00 10.00 15.00 20.00 25.00 30.00 35.00 40.00

East Devon 23.58

Exeter 24.39

Mid Devon 20.53

North Devon 17.05

South Hams 18.57

Teignbridge 28.57

Torridge 27.51

West Devon 18.11 Alcohol Related Hospital Admissions directly age standardised rate per 100,000, 2013-14 Alcohol Related Hospital Admissions, Teignbridge, 2013-14

District Teignbridge Devon South West England 0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0 900.0

East Devon 599.1

Exeter 722.4

Mid Devon 613.2

North Devon 690.9

South Hams 581.9

Teignbridge 612.6

Torridge 685.2

West Devon 570.9 Alcohol Related Admissions in Devon

Alcohol Related Admissions by Condition Type and Age Group (% share within condition type), 2009 to 2011 16% Acute Chronic Mental 14%

12%

10%

8%

6%

4%

2%

0% 0 to 4 5 to 9 10 to 15 to 20 to 25 to 30 to 35 to 40 to 45 to 50 to 55 to 60 to 65 to 70 to 75 to 80 to 85 and 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 over

Alcohol Related Hospital Admissions

Direct Age Standardised Rate of hospital admissions for alcohol-related harm per 100,000, South Hams, 2002-03 to 2011-12 2,200

2,000

1,800

1,600

1,400

1,200

1,000

800

600 Direct Age Standardised Rate of hospital admissions for alcohol-related harm per 100,000, West Devon, 2002-03 to 2011-12 400 2,200

200 2,000

0 1,800 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 South Hams 803 904 915 1,096 1,232 1,298 1,314 1,334 1,489 1,653 1,600 Devon 866 973 1,079 1,191 1,262 1,352 1,395 1,436 1,593 1,586 1,400 South West 925 1,025 1,146 1,251 1,319 1,363 1,484 1,605 1,754 1,825 1,200 England 926 1,023 1,145 1,291 1,389 1,473 1,582 1,743 1,895 1,974 1,000

800

600

400

200

0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 West Devon 814 889 879 1,079 1,089 1,197 1,354 1,421 1,558 1,591 Devon 866 973 1,079 1,191 1,262 1,352 1,395 1,436 1,593 1,586 South West 925 1,025 1,146 1,251 1,319 1,363 1,484 1,605 1,754 1,825 England 926 1,023 1,145 1,291 1,389 1,473 1,582 1,743 1,895 1,974 Vulnerabilities in Young People

The rate of under 18 conceptions can be used as a useful benchmark to indicate need in the local Under 18 ConceptionsUnder 18 Conceptions per per 1,0001,000 females females aged 15 to 17, aged Teignbridge, 15 -201017, to 20102012 -2012 District Teignbridge Devon South West England young population. 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

East Devon 23.4

Local needs include: Exeter 35.3

• Mental Health Mid Devon 28.7

• Self Harm North 23.3 • Alcohol Use Devon • Domestic Abuse South Hams 23.9

• Educational Teignbridge 34.0 underachievement Torridge 26.1

West Devon 23.9 Childhood Obesity

% of Children recorded as obese, South Hams, NCMP 2011-12 25.00%

20.00%

15.00%

10.00%

5.00% % of Children recorded as obese, West Devon, NCMP 2011-12 25.00%

0.00% Reception Year Year Six 20.00% South Hams 7.24% 13.53% Devon 8.18% 15.72% South West 8.69% 16.62% England 9.49% 19.20% 15.00%

10.00%

5.00%

0.00% Reception Year Year Six West Devon 10.20% 19.66% Devon 8.18% 15.72% South West 8.69% 16.62% England 9.49% 19.20% Experiencing Domestic Abuse

Domestic abuse and sexual violence can affect anyone. Estimated number people who experienced domestic abuse in the previous 12 months (based on prevalence estimates for those aged 16-59) Experiencing abuse causes or exacerbates a wide range of other vulnerabilities and needs. Including: • Mental Health Issues • Suicide Attempts and Self-harm • Alcohol abuse and drug abuse • Financial Problems • Homelessness and housing issues • Parenting Problems Prevalence of mental health disorders in 2014 (those aged 18-64)

Number in Number in Type of disorder % males % females Teignbridge Teignbridge Common mental disorder 12.5% 4,313 19.7% 7,092 Borderline personality disorder 0.3% 104 0.6% 216 Antisocial personality disorder 0.6% 207 0.1% 36 Psychotic disorder 0.3% 104 0.5% 180 Two or more psychiatric disorders 6.9% 2,381 7.5% 2,700

Source: PANSI http://www.pansi.org.uk/, based on Adult psychiatric morbidity in England, 2007: Results of a household survey, published by the Health and Social Care Information Centre in 2009.

Diagnosed Depression

Prevalence of depression by Devon Town 2013 Number of Devon Town Prevalence patients Dawlish 1,029 5% Newton Abbot 3,713 6% Sidmouth 839 6% Devon Total 33,759 4%

Across Devon rates vary from 2% in Moretonhampsted to 7% in Honiton and Axminster.

Source: QOF 2012-13, Health and Social Care Information Centre

Hospital admissions for self-harm (all ages)

Hospital Stays for Self-Harm, DASR per 100,000, Teignbridge, 2009 to 2011

District Teignbridge Linear (Devon) Linear (South West) Linear (England) 0.0 50.0 100.0 150.0 200.0 250.0 300.0

East Devon 257.0

Exeter 269.7

Mid Devon 198.7

North Devon 224.1

South Hams 142.3

Teignbridge 217.0

Torridge 219.0

West Devon 207.5 Hospital Admissions for self-harm aged 10-24 (in 2012-13) Deaths from Suicide and Injury Undermined

Deaths from Suicide or Injury Undetermined, DASR per 100,000, Teignbridge, 2008 to 2010

District Teignbridge Linear (Devon) Linear (South West) Linear (England) 0 2 4 6 8 10 12

East Devon 7.95

Exeter 7.75

Mid Devon 7.85

North 6.63 Devon

South Hams 8.18

Teignbridge 10.83

Torridge 8.24

West Devon 9.61 Public Health Budget

2013-14 Devon County Council Physical Activity, £197 Public Health Budget (£k) National Child Contribution to support Health Protection, £121 Measurement services, £320 Programme, £87 Obesity, £396 Public Health Expert Advice, £501 NHS Health Check Programme, £1,055

Development Budget, £1,120

Overall Public Health Devon budget £20.748 million

Public Health Devon budget per Substance Misuse, £5,951 head of population (ranked 144 out of 152 local authorities nationally) Smoking & Tobacco, £1,357 £27 per head Local Public Health Average local authority budget per Programmes*, £1,396 head of population £49 per head

Highest local authority budget per Children 5-19 Public Health head of population Programmes, £2,926 Sexual Health, £5,322 £192 per head

Public Health Devon 2014-15 budget £22.060 million (£29 per head) * includes areas such as accident prevention and community safety Health and Wellbeing Website [email protected] 01392 386390 Mob: 07583165806