D
Sheffield - Where Everyone’s Health Matters
Sheffield Director of Public Health Report 2009
1 Contents
Page
Welcome and Introduction 3 Profiles of Health: Community Assemblies 7 South East CA 10 South CA 14 South West CA 18 Central CA 22 Northern CA 28 North East CA 32 East CA 38 Recommendations 43 Sheffield Health and Well Being Atlas 56 More Information 57
2 Welcome and Introduction
Welcome to my Annual Report for 2009. The main body of the report this year presents an overview of the health status of the 7 Community Assemblies in Sheffield. The establishment of Community Assemblies is a major new initiative undertaken by Sheffield City Council. The assemblies have responsibilities devolved to them for making decisions which affect services in their areas. As part of this, they have scope to take decisions which will impact on the health of the population they serve. It is therefore important that Communities Assemblies should be fully informed about the health of those populations.
All the information on the health of the community assembly populations is available on the website – www.publichealthsheffield2009.nhs.uk . I strongly recommend that anyone interested in the detail should go to this website to find it. Information is available there in both tabular and graphical form.
For each Community Assembly, the Public Health Consultant lead for that assembly has analysed the data available and identified the most important health issues. These analyses are the bulk of the written report (and are also available on the website). In each case, recommendations are made to the Community Assembly as to what each should consider investing in to further improve the health of the local population.
Last year, my annual report was a vehicle for publishing the Joint Strategic Needs Assessment (JSNA). I have not done that again this year because the JSNA is developing as a continuing process by which our joint stock of needs assessment work is continually being expanded. A position statement will be published this autumn, and the full range of needs assessments will be available on-line. Work included in the JSNA will inform the revision of NHS Sheffield’s Strategy, Achieving Balanced Health 3 .
The health of Sheffield
Mortality rates continue to fall and life expectancy continues to increase in Sheffield, as shown in the table below. This is of course absolutely to be welcomed.
Health Outcome Sheffield England
Male life expectancy at birth (years) 77.2 77.7
Female life expectancy at birth (years) 81.2 81.8
Early deaths from heart disease and strokes per 100,000 83.8 79.1 population
Early deaths from cancer per 100,000 population 122.6 115.5
Infant deaths per 1,000 live births 6.0 4.9
Road traffic injuries and deaths per 100,000 population 54.3 54.3
All figures relate to the average over the period 2005-2007
3 However, last year I reported that the gap in life expectancy between the most deprived quintile (one fifth) of the population and the City average had started to increase for men and was levelling off for women. The latest data shows that for both men and women that gap has stayed constant. This is demonstrated in figures 1 and 2.
Figure 1
Male Life Expectancy - Gap between Most Deprived Neighbourhood Quintile and Sheffield
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3.5
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1.0 Life Expectancy GapLife Expectancy (Years)
0.5
0.0 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Actual gap 3.4 3.4 3.1 2.9 2.8 3.0 3.2 3.2 Exponential projection 3.0 2.9 2.9 2.9 2.8 2.8 2.7 2.7 2.7 2.6 Linear projection 2.9 2.9 2.9 2.8 2.8 2.7 2.7 2.7 2.6 2.6 2010 Target Gap 3.4 3.4 3.4 3.3 3.3 3.3 3.2 3.2 3.2 3.1 3.1 3.1
Actual gap Exponential projection Linear projection 2010 Target Gap Source: Public Health Analysis Team, Sheffield PCT ( 5 year rates)
Figure 2
Female Life Expectancy Gap between Most Deprived Neighbourhood Quintile and Sheffield
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0.5 Life Expectancy GapLife Expectancy (Years)
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-0.5 1997- 1998- 1999- 2000- 2001- 2002- 2003- 2004- 2005- 2006- 2007- 2008- 2009- 2010- 2011- 2012- 2013- 2014- 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Actual gap 2.9 2.4 2.3 2.2 2.0 1.8 1.8 1.8 Exponential projection 1.5 1.3 1.2 1.0 0.9 0.7 0.6 0.4 0.3 0.1 Linear projection 1.5 1.3 1.1 1.0 0.8 0.7 0.5 0.3 0.1 0.0 Target Gap 2.9 2.9 2.9 2.8 2.8 2.8 2.8 2.7 2.7 2.7 2.6 2.6
Actual gap Exponential projection Linear projection Target Gap
Source: Public Health Analysis Team, Sheffield PCT( 5 year rates)
4 This is because whilst mortality rates are on average falling, mortality rates in the more deprived parts of the population, particularly in men aged 55 to 70, are not falling as fast as they have done in the past or as fast as elsewhere in the City. Linked to this, we are not making as much progress towards preventing premature death (i.e. below the age of 75 years) as we need to, if we are to meet NHS Sheffield’s ambitious target of saving 400 lives (i.e. avoiding 400 premature deaths) by 2012. Figure 3 shows what progress is being made.
Figure 3
Target Annual Lives to be Saved NHS Sheffield Saving 400 Lives Ambition: Baseline Number of under 75 MDQ Deaths, Sheffield, 2000 onwards Baseline Projection Saving 400 Lives Target Post 2006 Actuals 600
500 32 62 400 91 119 147 163 178 193 207 300 220
200 Number of < 75 MDQ Deaths MDQ 75 < of Number 100
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
SOURCE: PH Mortality Year NOTE: All data extracted 2007 for Saving 400 lives baseline, except extracted June 2009 MDQ = Most Deprived Quintile of Sheffield Neighbourhoods based on % households claiming IS/JSA/PC during year NHS Sheffield, Public Health Analysis team (GA), 09/06/2009
Recommendation: Work to address the major causes of mortality in the more socio-economically deprived parts of the City should be re-invigorated in order to get the reduction in health inequalities in the City back on track and to hit the target of saving 400 lives. This must in particular include every effort to reduce smoking prevalence, including aggressive actions to reduce the availability of smuggled tobacco.
During the course of this year, the new H1N1 strain of the influenza virus – swine flu – has emerged and caused a pandemic. There were many cases in Sheffield in July, but numbers fell substantially through August. With the start of the new school term, the number of cases in children has increased again, and it is clearly possible that this may be the start of a second wave of infection. It remains the case that this is a new strain of influenza, to which the vast majority of the younger population have no immunity. It is therefore likely that during the course of the coming “flu season” we will see large numbers of people being infected. Although the majority of people suffer a relatively mild self limiting illness, a small minority need hospital care, and of these a number are likely to die.
We are therefore working hard to ensure that the health and social care system in the City is as well prepared as possible for this likely second wave
5 of infection. Key to this will be a vaccination programme (once a vaccine is available) but everyone can contribute to minimising spread of infection through personal hygiene measures.
Recommendation: All front line health and social care staff should take up the offer of vaccination when it is available, as should those vulnerable members of the public who are in priority groups. For all of us, personal hygiene remains of paramount importance: - ‘Catch it, bin it, kill it.’
As is customary, this report also contains an update on actions taken following the recommendations made in previous year’s reports. There is one issue which I highlighted in my annual report in 2006 which remains a major concern and is arguably the largest single public health threat to human 1 populations for the medium and longer term. Although climate change has moved well up the national and health agendas over the last 3 years, all the evidence is that we are not, collectively, doing enough to address it.
During the course of this year the NHS nationally has started to address this, and NHS Sheffield has adopted a carbon management plan. Sheffield City Council has led the development of the City's Carbon Reduction Framework which sets out a route map for emissions reduction in the medium term. The City has seen a reduction in carbon emissions since 2005, but sustained effort will be needed in both the short and medium term to ensure continuing progress. And we all need to do much more by way of reducing our own carbon emissions, both as individuals and as organisations, if catastrophic global warming is going to be prevented.
Recommendation: As a first step, I recommend that everyone should calculate their own carbon footprint, and find ways to reduce it. One possible step to doing this would be to sign up to the 10:10 initiative http://www.1010uk.org .
I hope you enjoy reading this report, and find it useful. As always, any comments as to its content would be welcomed.
Dr Jeremy Wight Sheffield Director of Public Health September 2009
1 Costello, A et al (2009). Managing the health effects of climate change. The Lancet, 373(9676) p1693-1733. Editorial: A Commission on climate change (2009). The Lancet, 373(9676) p1659.
6 Profiles of Health
Community Assembly Profiles
Sheffield City Council has this year established community assemblies (CAs) in the City. This is a major new initiative which is intended to localise much decision making and make elected councillors more accountable to the populations they serve. There are seven such assemblies in the City, each comprising four electoral wards. The map in Figure 4 below shows this in more detail. The competency of these assemblies includes responsibility for budgets that can be used for initiatives to improve public health. The health of community assembly populations is therefore of direct relevance and specific interest to community assembly members.
Figure 4
Some background information about each community assembly, including how to get involved in your local assembly and details of meetings, is available on the Sheffield City Council website at: http://www.sheffield.gov.uk/in-your-area/community-assemblies
7 In the following section, a health and well being profile of each community assembly is presented. The profile first gives an overview of health in the area before exploring issues in more detail including a closer look at life expectancy, premature death and ill health, healthy lifestyles and the wider determinants of ill health. The profiles consider the state of health for the CA as a whole as well as any major variation at electoral ward level.
Constructing the community assembly profiles
The community assembly profiles have been constructed using routinely available data. These include hospital activity data on admissions and A&E attendances and Public Health mortality data.
Statistics on deprivation have been taken from the Department for Communities and Local Government’s Index of Multiple Deprivation 2007 (IMD). The IMD is an electoral ward-level index made up from six dimensions of deprivation (income; employment; health deprivation and disability; education, skills and training; housing; and geographical access to services) that allow comparison between different wards.
Lifestyle data relating to various health behaviours such as levels of obesity and fruit and vegetable consumption, have been obtained from the National Centre for Social Research Lifestyle Behaviour. Estimated prevalence of smoking has been taken from the Household Survey for England (2007). The Active People Survey 2005/06, Sport England provided data on physical activity.
The overall health status of the community assemblies and electoral wards is described with reference to a product called ‘HealthACORN’. This is a social segmentation tool that classifies the population of Great Britain into a number of health status groups. These group descriptions are derived from the analysis of diet, illness and exercise patterns of the population alongside various demographic attributes such as age and ethnic origin. The four main population groups are hierarchical and are identified as: ‘existing problems’, ‘future problems’, ‘possible future concerns’ and ‘healthy’.
More data about community assemblies
The profiles highlight some of the most important statistics about health and health related characteristics in each community assembly and any variation between the electoral wards. The profiles are also available as pdf files to download from the DPH Report website. There are also a number of resources where a more comprehensive set of health and well being facts and figures is available for each CA and its wards. These include:
• New Sheffield health and well-being atlases showing geographical and performance data for community assemblies and wards http://www.sheffield.nhs.uk/healthdata/atlas.php
8 • Health Indicator tool to show population, deprivation, hospital activity, mortality and other lifestyle indicators for each community assembly and ward.
• Proportions of the community assembly and ward population in each HealthACORN health status groups.
• Maps showing the geographical boundaries of the community assemblies and electoral wards, their relationship with Enhanced Public Health Programme areas, and the GP surgeries located in these areas.
For more information about how to access these resources, please visit the DPH Report at www.publichealthsheffield2009.nhs.uk
What are we doing to improve health in the community assemblies?
The profiles also describe what NHS Sheffield and partner organisations are doing to improve the health of people in each area.
First and foremost, there are a wide range of health and well being services that are provided across all parts of Sheffield. These are referred to as ‘universal services’ and include vital public health services such as the Stop Smoking Service, ‘Five a Day’ campaign (to support fruit and vegetable consumption), Active Sheffield (supporting physical activity), various vaccination and screening programmes and Healthy Schools.
In addition to these universal services, Sheffield has established 15 ‘Enhanced Public Health Programmes’ (EPHP) in areas with the poorest health. The EPHPs work with local communities to promote healthy lifestyles, improve access to services for prevention, treatment and care, and tackle the root causes of ill health. Whilst the EPHP areas cross community assembly boundaries, for the purpose of this report, each has been allocated to the community assembly in which the EPHP predominantly lies. Each profile describes the work that is going on in the EPHPs that relate to that CA.
Recommendations
Each profile also makes a number of recommendations about what should be done to improve the health of the local population. These recommendations are addressed either to the community assemblies themselves, or to relevant partner organisations who commission health services. All the recommendations for individual community assemblies are listed together in the Recommendations section of this report.
What you can do to improve health
In the recommendations section of the report, attention is also drawn to what individual residents can do to improve their own, their family’s and their community’s health and well being. These recommendations apply regardless of the community assembly area in which they live.
9 South East Community Assembly
Health at a glance
South East Sheffield Community Assembly (CA) comprises the electoral wards of Beighton, Birley, Mosborough and Woodhouse. These wards have a total population of around 71,000 which accounts for 13% of the total Sheffield figure – the smallest CA in the City.
Overall, the health of the people of South East Sheffield is similar to, or slightly better than, that of the City as a whole. However, there is also a higher than average proportion of older and less well off people with existing health problems. However the biggest positive difference between the CA and Sheffield overall is that the proportion of people who are likely to develop health problems in the future is considerably lower.
Within the area, Birley and Woodhouse are the wards with the highest proportions of older and less well off people with existing health problems, whilst Beighton and Mosborough wards are generally healthier. (However they do have a higher proportion of their populations at possible risk of developing ill-health as a result of life-style).
The population profile is broadly similar to that of the rest of the City, with the most striking difference being that the South East does not have as many people in the 20-24 year age group as elsewhere. This is because the figure for the City overall is heavily influenced by the large numbers of university students, few of whom live in South East Sheffield. There are no significant differences between the population profiles of the constituent wards within the CA. As elsewhere in the City (and Country), women significantly outnumber men in the older and very old age groups.
Although with regard to most health indicators the population of South East Sheffield does not differ significantly from the rest of Sheffield, indicators relating to the use of health services show that hospital admissions for mental illness and attendances at the Accident and Emergency department in the CA are lower than in the rest of the City.
Estimated prevalence of adult obesity is higher, and consumption of the recommended ‘Five a day’ portions of fruit and vegetables lower, than in the rest of the City.
Headline health indicators
Life expectancy Male life expectancy at birth in South East Sheffield is similar to that in the rest of the City. In 2006-08 it was 78.7 years (vs. 78.1 for Sheffield). However female life expectancy is slightly but significantly higher in South East Sheffield than in the rest of the City – 82.9 years vs. 81.7 years.
10 Woodhouse has a significantly lower life expectancy for men than the other three wards (Woodhouse 75.2 years, Beighton 79.5, Birley 80.0, Mosborough 80.6). For all wards, and both sexes, life expectancy has increased in recent years.
Mortality rates All age, all cause mortality shows a similar pattern. For men it is similar to the City level overall (698 deaths per 100,000 population vs 704), with significantly higher mortality rates in Woodhouse (913 per 100,000) than in the other three wards (Beighton 644, Birley 637, Mosborough 644). For women, mortality rates are lower, but not significantly so, than the rest of the City, (491 per 100,000 vs 520), with little variation between wards.
Premature death and ill health
Under 75 mortality rates from heart disease, strokes and cancers are similar in South East Sheffield to the rest of the City. However at individual ward level the premature (< 75 years) mortality rate for men in Woodhouse, at 479 per 100,000, is higher than in the rest of South East Sheffield (330) and the City overall (357). This is largely due to higher premature mortality from cardiovascular disease.
Hospital admissions for physical illnesses are in line with the rest of the City. However admission rates for mental illness are significantly lower than elsewhere, at 116 per 100,000 population, compared to 148 in the City overall. Admissions from Beighton and Mosborough, in particular, are very low at 109 and 70 respectively. This may reflect underlying lower levels of mental ill health than elsewhere in the City, or alternatively it may be that people with mental ill health in the area either do not contact health services or are managed within the community.
Accident and emergency attendances by people from South East Sheffield are also lower than from elsewhere in the City. The overall figure for all ages for the CA is 236 attendances per 100,000, compared to 286 from the rest of the City. Again, attendances from Beighton (195) and Mosborough (197) wards are particularly low. The relatively low A&E attendance from South East Sheffield is undoubtedly in part due to the distance to the Children’s and Northern General Hospitals. However accidental injury is also known to be correlated with socioeconomic deprivation, so the lower levels are also likely to be due, in part, to the relative affluence of South East Sheffield compared to some other parts of the City. The low attendance levels are also seen when the analysis is confined to younger (under 20 year olds) or older (over 65s) age groups.
11 Healthy lifestyles
The prevalence of smoking, both in the general population and amongst pregnant mothers, is similar to the rest of the City. However estimated consumption of fruit and vegetables is significantly lower. Only 22% of the population consume the recommended 5 portions of fruit and vegetables per day, compared to 25% of the City overall. Woodhouse (21%) and Birley (20%) wards have particularly low levels. Fewer than one in five adults in South East CA are estimated to participate in physical activity to recommended levels (at least 30 minutes of moderate activity at least 3 days a week). All four of the CA’s electoral wards are below the City average of 20%.
The relatively poor diet and lower than average level of physical activity is reflected in higher levels of obesity in the area than elsewhere in the City. The estimated prevalence of obesity in adults is 27%, compared to 23 % in Sheffield. Levels are estimated to be higher in Woodhouse (28%) and Birley (27%) than in Beighton or Mosborough (both 26%). High levels of obesity will lead in future years to increased levels of diabetes, heart disease, cancers, arthritis, depression and death.
Wider determinants of ill health and well being
Socio-economic deprivation is a major determinant of health and well being. South East Sheffield is less deprived on the whole than many other parts of the City. Woodhouse and Birley experienced a greater level of deprivation however than Mosborough or Beighton.
In spite of the relatively low levels of deprivation, educational attainment in South East Sheffield is less good than in the City overall. In 2007/08 only 33% of students gained 5 or more A-C grades at GCSE (including English and Maths) compared to 40% in the City. Attainment in Birley (30%) and Woodhouse (31%) was worse than in Mosborough (34.3%) or Beighton (38.7%). Since educational attainment correlates strongly with health in later life, this is clearly a matter of concern.
The proportion of Year 11 students staying in learning is the lowest in South East Sheffield of any of the community assembly areas. (South East Sheffield 65%, Sheffield overall 76%). Three of the South East Sheffield wards – Woodhouse, Beighton and Birley have the lowest rates of all wards in Sheffield, at 62%, 63% and 65%. Mosborough is eighth lowest at 69%. Again, this low level of educational engagement must give rise to concerns regarding future health.
12 What are we doing?
City-wide initiatives All of the universal public health programmes are active in South East Sheffield. These include the Sheffield Stop Smoking Service, 5-a day (fruit and vegetable) campaign, Active Sheffield (supporting physical activity), the full range of child and adult vaccination and screening programmes and a number of GP surgeries. In view of the relatively low level of socio-economic deprivation within the area however there are no Enhanced Public Health Programmes currently active.
Recommendations for the Community Assembly
The South East Sheffield Community Assembly should:
Consider how levels of physical activity can be increased in South East Sheffield. In particular, consideration should be given to undertaking a neighbourhood audit to identify barriers to walking and cycling, and ways to increase active travel.
In partnership with NHS Sheffield, commission more work to promote healthy eating in South East Sheffield. Extending the use of allotments locally would be particularly beneficial, since it could lead to an increase in levels of physical activity as well as healthier eating.
For more information contact
Dr Jeremy Wight Director of Public Health
13 South Community Assembly
Health at a glance
The South Community Assembly (CA) has a total population of approximately 74,000 residents, covers around 8 square miles and consists of four wards – Beauchief & Greenhill, Gleadless Valley, Graves Park and Nether Edge. Each of these wards has quite different population, geographic and socio- economic characteristics. As such, there is quite significant variation in health between the four wards such that focusing solely on the overall health of the CA could miss some important areas of need.
For example, two of the four wards – Beauchief & Greenhill and Gleadless Valley - tend to experience poorer health than Nether Edge and Graves Park. It is recognised that some of the most deprived neighbourhoods in the City – Gleadless/Hemsworth, Lowedges, Batemoor and Jordanthorpe are located within this Community Assembly area. These neighbourhoods can be described as predominantly white working class with higher than the City average number of older people with long term limiting illness and disease (especially diabetes and chronic respiratory) and social isolation. These neighbourhoods also have some of the highest rates of teenage conceptions in the City, and higher than average alcohol & drug-related hospital admissions.
Although Beauchief & Greenhill ward has a health status broadly comparable to the City average, it contains pockets of high deprivation. For example, the Lowedges, Batemoor & Jordanthorpe neighbourhoods experience poor under-5 dental health, low breastfeeding take up and high maternal smoking rates. Gleadless Valley is a traditional predominantly white working class area. There are higher than average mental health-related admissions, diabetes, teenage conception and smoking during pregnancy.
Conversely many of the health indicators for Graves Park are better than the City average, although obesity figures for Y6 children (ages 10-11 years) are much higher than would be expected. Within Nether Edge, again health indicators are either better than, or close to, the City average. Despite this, mental health, diabetes and stroke are key health issues for this ward.
Headline health indicators
Life Expectancy Life expectancy within the South CA area is better than the City average with male life expectancy at birth of 78.2 years (versus 78.1 years for the City) and female life expectancy 82 years (versus a City average of 81.7 years). However, there is variation between the four electoral wards with Nether Edge having the longest life expectancy for both males (79.8 years) and females (83 years).
14 All age all cause mortality
A similar picture is presented in relation to deaths occurring in the South CA although there is greater variability between the four wards. For example Gleadless Valley, with an average mortality rate of 722 per 100,000 population (over the period 2006-2008), has a significantly higher rate than Nether Edge, at 537 per 100,000 population.
Premature death and ill health
For both male and females aged under 75, South CA all-cause mortality rates are slightly below the Sheffield average. Under 75 mortality rates from cancer, circulatory disorders, coronary heart disease and respiratory disease are close to the Sheffield average. Within the CA, the rates for all these conditions are highest in Gleadless and lowest in Nether Edge. All wards in South CA have lower mortality rates from respiratory disease than the City average. Whilst premature mortality rates from circulatory disease, coronary heart disease and respiratory conditions are high in Beauchief and Greenhill, relative to the other wards in the CA, there are low rates of cancer deaths.
Hospital admission rates in South CA are significantly lower than Sheffield overall for asthma, and for emergency chronic conditions. The CA as a whole has significantly lower A&E attendance rates, although the rates in Gleadless are significantly above the City average.
Graves Park has significantly more hospital admissions for cancer, compared with Sheffield as a whole, whilst Nether Edge and Gleadless have significantly fewer. Respiratory admissions are significantly higher in Gleadless, and lower in Graves Park and Nether Edge. Graves Park has significantly fewer mental health admissions than the City average. Alcohol related admissions are significantly higher than for Sheffield in Beauchief & Greenhill and Gleadless, but lower in Nether Edge and Graves Park.
Healthy lifestyles
The physical activity levels and diet in the South CA are estimated to be slightly better than the Sheffield average although this masks significant variation between the wards. Around 21% of the CA are physically active although this varies from 18% in Beauchief & Greenhill to 27% in Nether Edge. Similarly, 37% of adults in Nether Edge eat the recommended five portions of fruit and vegetables per day compared with only 23% in Gleadless.
These two wards also have the lowest and highest levels of adult and child obesity, respectively within the CA. Around 22% of the CA population are estimated to be smokers, compared with a City average of 23%. This varies from 18% in Graves Park to 26% in Gleadless. The number of mothers smoking at delivery is significantly higher in Beauchief & Greenhill and Gleadless, and significantly lower in Nether Edge and Graves Park.
15 Under 18 conceptions follow a similar pattern, in that overall rates are close to the City average but there is a five-fold variation across the CA. Rates are significantly higher in Beauchief & Greenhill and Gleadless and significantly lower in Nether Edge and Graves Park.
Wider determinants of ill health and well being
Avoidable health inequalities arise because of the circumstances in which people grow, work, live and age – and the services put in place to deal with illness. These in turn depend on social, political and economic forces. All can have a determining impact on whether a child grows to develop his or her full potential or is betrayed by under-achievement.
On the whole, South CA is relatively less deprived than other Sheffield CAs. Three of its wards (Nether Edge, Graves Park and Beauchief & Greenhill) are above or equal to average levels across the City. Gleadless however, experiences a higher level of deprivation.
This pattern is reflected in educational achievement, where only 30% of students in Gleadless gained 5 or more A-C grades at GCSE compared to over 50% in Nether Edge and Graves Park, and 40% in the City as a whole. Similarly, variation exists in the numbers of students continuing education beyond age 16. In Nether Edge this is 93% compared with 77% in Gleadless.
What are we doing?
City-wide initiatives
The main focus is on interventions to tackle the ‘big killers’ which are still heart disease and cancer. These are being tackled by the universal Public Health services, all of which are active within South CA. These include the full range of specialist services to support people with chronic illness, the Sheffield Stop Smoking Service, Active Sheffield (increasing opportunities for physical activity), the ‘5 A Day’ (fruit and vegetable) campaign, Healthy Schools programme and a comprehensive range of vaccination and health screening programmes. There are also a number of GP surgeries located throughout the CA.
Enhanced Public Health Programmes
In addition there are several projects being delivered through Enhanced Public Health Programmes (EPHPs) relating to high alcohol and drug consumption which impact on teen conceptions, anti social behaviours and domestic abuse, which in turn damage community safety and cohesion. In addition, people are beginning to demand more knowledge and action on reducing weight and improving their physical stamina, improving their nutrition on low fixed incomes, and reducing smoking. South CA has two EPHPs: Lowedges, Batemoor & Jordanthorpe, and Gleadless Valley.
16
Lowedges, Batemoor & Jordanthorpe
Initiatives to improve nutrition have involved developing community allotments, providing cook and eat sessions, and engaging with parents and older people on healthy eating and weight management. Older people are being supported by activity groups and lifestyle courses. Mental health support groups have been set up for men and women and multi agency work has been targeted to reduce teenage pregnancies. Increased community capacity for health has been increased by a ten week lifestyle programme and an accredited course for community development and health. The EPHP commissions work through Lowedges Community Safety Forum, Sheffield Futures, Food in Sheffield and Activity Sheffield.
Gleadless Valley
The programme is commissioned through, and managed by, Gleadless Valley Community Forum and overseen by the local multi agency partnership group ‘Healthy Valley’. Programme areas consist of: improving mental health and well being; family support in relation to drug and alcohol use; self management of long term conditions; reducing teenage pregnancies and increasing community capacity for health and lifestyle choices.
Recommendations for the Community Assembly
The South Community Assembly should:
Continue joint working with all partner organisations within the area to ensure that targeted resources are spent on sustainable initiatives which are proven to be effective in improving health and wellbeing.
Maintain specific additional resource for existing Public Health programmes on physical activity, diet and nutrition, vulnerable family support, sexual health, breastfeeding and smoking within the Enhanced Public Health Programme areas.
Continue representation on and direct linkages with Enhanced Public Health Programme steering groups, contributing to plans for further initiatives addressing older adults’ health needs. These will, for example, tackle sedentary lifestyles and high fat diets, to combat the onset of diabetes and improve the self management of chronic illness.
For more information contact
Dr Paul Redgrave Deputy Director of Public Health
17 South West Community Assembly
Health at a glance
The South West Community Assembly (CA) comprises the four electoral wards of Crookes, Dore and Totley, Ecclesall and Fulwood. With a population of 72,000 it covers approximately 13% of the Sheffield population.
People living in South West Sheffield tend to be much healthier than in other parts of the City, and on most measures of health the CA is significantly better than the Sheffield average.
The population profile of South West Sheffield (the number of men and women in each age group) is similar to that of Sheffield as a whole. However the area has the highest percentage of people aged 85 years and over, with all of the wards in the area above the Sheffield average. Crookes has significantly more 20-24 year olds compared with any other ward in the CA although this is in large part down to the number of university students living in the area. Also the Fulwood ward (9.8%) has significantly more males aged 20-24 years compared to other wards (5.6%) in the CA.
When compared with the other community assemblies, South West experiences significantly lower levels of deprivation and this is almost certainly the cause of the higher levels of good health experienced.
Headline health indicators
Life Expectancy Average male life expectancy at birth in South West Sheffield is significantly longer than the rest of the City. In 2006-08 it was 82.1 years compared with 78.1 years for Sheffield. There is some variation between the wards with male life expectancy over the same period in Crookes (79.4 years) being significantly lower than in Fulwood (84.2 years).
Female life expectancy at birth in South West Sheffield is also significantly higher than the rest of the City. In 2006-08 it was 84.7 years compared with the Sheffield average of 81.7 years. There is some variation between the wards, ranging from 83.2 years in Crookes to 85.7 in Fulwood.
All Age All Cause Mortality The mortality rate from all causes in all age groups is significantly lower in the South West Community Assembly than in the rest of Sheffield. For males over the period 2006-08 there were 489 deaths per 100,000 population in the CA vs 704 across Sheffield. A similar pattern of variation is observed across the four wards with the mortality rate for Crookes (602) being slightly higher that for Fulwood (431) and Ecclesall (497). Mortality rates continue to decrease across all four wards.
18 For females, all age all cause mortality is also lower than that in Sheffield at 386 deaths per 100,000 population versus 520 in Sheffield. There is little variation between the wards, with female mortality ranging from 363 deaths per 100,000 population in Ecclesall to 461 in Crookes. This mortality rate has remained fairly constant across all four wards.
Premature death and ill health
Premature mortality rates for males from all causes are much lower in this CA (222 per 100,000 population) than in Sheffield as a whole (358 per 100,000 population). Fulwood’s rate (153 per 100,000 population) is significantly better. This is true for females as well (165 versus 242 for Sheffield). Ecclesall has a significantly better rate (130).
Mortality rates in people under the age of 75 years from heart disease, respiratory diseases and cancers are all lower in South West Sheffield than the rest of the City. However, Dore and Totley has a slightly higher premature mortality rate from strokes than average (12.4 per 100, 000 population versus 12 per 100, 000 in Sheffield).
Hospital admissions for physical illnesses and mental illness are significantly lower than for the rest of the City. However across the four wards, Crookes is above the Sheffield average for both cancer and asthma admissions. This may reflect the industrial past of the Crookes ward.
Accident and emergency attendances by people from South West Sheffield are significantly lower than from elsewhere in the City. The overall figure for all ages for South West Sheffield is 207 attendances per 100,000, compared to 286 from the rest of the City. The low level of A&E attendance may in part be due to effective use of primary health care services as well as generally better health in the local population.
Healthy lifestyles
The prevalence of smoking both in the general population and amongst pregnant mothers in South West CA is significantly lower than the rest of the City. During 2008, 1.7% of mothers living in South West Sheffield were recorded as smoking at the point of delivery, compared with 14.3% across Sheffield. This figure of 1.7% is exceptionally low.
36% of adults in the South West are estimated to consume the recommended 5 portions of fruit and vegetables per day, compared with 25% in Sheffield overall. The higher levels of fruit and vegetable consumption indicate that people living in the South West are, on the whole, eating a healthier diet. The CA is also estimated to have the highest proportion of its adult population participating in the recommended levels of physical activity (27% compared with an average of 20%). This is consistent across its wards.
19 These figures are reflected in much lower adult and childhood obesity levels than in the rest of the City. 16% of adults are estimated to be obese, compared with the City average of 23%. In 10-11 year olds, obesity prevalence is half the City average.
However, more detailed analysis of data relating to lifestyles (particularly dietary habits) suggests that Fulwood, Dore and Totley and Ecclesall have relatively high numbers of affluent pensioners and professionals who dine out and the latter group have high alcohol consumption. Whilst such groups may currently be healthy, these lifestyle choices could give rise to health problems in the future.
Wider determinants of ill health and well being
Socio-economic status plays a major role in health and well being. The South West Community Assembly includes some of the most affluent wards in the City. Within the CA, Fulwood is the most affluent ward.
As to be expected , all four wards in the South West Assembly area are in the top five for educational attainment. 75% of students living in the South West gained 5 or more GCSEs at grade C or above, compared with 40% across Sheffield. In addition, a significantly higher than average number of Year 11 pupils (94%) living in South West Sheffield remain in learning compared to the City as a whole (76%).
Perhaps in view of the high proportion of very elderly living in the area, the CA has the highest proportion of its population claiming widows’ benefit, bereavement benefit and industrial death benefit. This is consistent across all four wards. This may indicate that, for a number of older people in the South West, income level could be a cause for concern particularly where this may be impacting on ability to keep a home warm, access services further from home and in maintaining a healthy lifestyle. On the other hand this could be due to the population within the wards understanding the process and being willing to claim the benefits.
What are we doing?
All the universal public health services, programmes and initiatives are active within the South West of Sheffield. These include the Sheffield Stop Smoking Service, 5 a Day (fruit and vegetable) campaign, Active Sheffield (promoting opportunities for physical activity), Healthy Schools programme and the full range of vaccination and health screening services. Currently there are no Enhanced Public Health Programmes operating within the CA.
Recommendations for the Community Assembly
20 The South West Community Assembly should:
Consider the health of the older population across its wards. It is also important to ensure that the higher levels of good health experienced across the CA are maintained. Given the affluent populations represented in the wards it is important to ensure that healthy lifestyles are promoted and for those professionals and affluent pensioners consistent messages are delivered relating to health eating, physical activity and alcohol consumption.
It would be beneficial for the CA to better understand if benefit claims are being made due to financial need as against individuals’ ability to understand processes and claim entitlements. This will support maintaining good health in areas where individuals could be capital rich but cash poor.
For more information contact
Frances Cunning Consultant in Public Health
21 Central Community Assembly
Health at a glance
Central CA is made up of the electoral wards of Broomhill, Central, Hillsborough and Walkley which account for around 86,000 residents (16% of the Sheffield total). Overall the health of residents in the Central Community Assembly is better than Sheffield as a whole. This is particularly the case in Broomhill. However, there is some variation within the CA and the proportion of the local population in the CA likely to develop lifestyle related diseases in later life is higher than that for Sheffield as a whole.
Whilst health in the CA does not differ significantly from the rest of Sheffield in many respects, overall mortality rates from coronary heart disease and strokes are significantly higher than the Sheffield average. Alcohol-related hospital admissions are also higher than the Sheffield average – especially in the Central and Walkley wards. Mental health hospital admissions are the highest in Sheffield (with Walkley, Central and Broomhill electoral wards being higher and Hillsborough being lower than the Sheffield average). Attendances at A&E are also significantly higher than for Sheffield, especially from Walkley and Central wards.
The age and gender profile of the CA helps to explain some of this pattern. The area as a whole has a greater proportion of young people particularly in the 20 to 24 year age group. This reflects the high numbers of students and young professionals living in the Central and Broomhill electoral wards (where 20-24 year olds comprise 29% and 38% of the ward population respectively). The area has a lower proportion of people aged 65 and over, compared to Sheffield as a whole (only 10% of the population are aged 65 years and older compared to 15% in Sheffield), and has the lowest proportion of 0-4 year olds and 0 to 19 year olds of all of Sheffield’s Community Assemblies. The CA is also ethnically diverse, having a thriving and cosmopolitan combination of ethnic identities including Chinese, Asian, African and Eastern European, although routine data sources such as the Census are not collected frequently enough to capture the detail of this.
Headline health indicators
Life Expectancy Average life expectancy at birth in the Central Community Assembly area is shorter than for Sheffield as a whole. For men, it is 76.7 years (versus 78.1 years for Sheffield) and for women 80.4 years (versus 81.7 years in Sheffield).
There is some variation within the area. For example, looking at neighbourhoods, the difference in life expectancy between Netherthorpe and Wisewood is 8 years for men and over 5 years for women. Men in Central and Walkley wards have a significantly shorter life expectancy than in the other two electoral wards (76.2 and 74.9 years respectively). Conversely,
22 compared to Sheffield, male life expectancy is significantly longer in Hillsborough (79.9 years) and similar in Broomhill (76.5 years). For women, life expectancy is on a par with the average for Sheffield in all wards, with the exception of Hillsborough, which has longer life expectancy at 83.7 years.
Mortality rates All cause, all age mortality rates are higher in the CA (659 per 100,000 population) than Sheffield (589 per 100,000). Within the Community Assembly, rates are significantly lower in Hillsborough than the other electoral wards.
The picture differs for men compared to women. The male mortality rate is higher than Sheffield (at 779 deaths per 100,000 population compared to 690 for Sheffield). During 2006-8, Walkley had the highest all age all cause mortality rate among men of all electoral wards in the City. For women, mortality rates are similar to the Sheffield average (with 554 deaths per 100,000 population in the CA compared to 506 for Sheffield). Again, there is variation between electoral wards. Over the period 2006-8, female all age all cause mortality in Broomhill and Central wards was higher than Walkley and Hillsborough (with 993, 562, 542 and 442 deaths per 100,000 population respectively).
Premature death and ill health
Citywide, the major causes of death are coronary heart disease, cancer, stroke and respiratory disease. Within the CA, under 75 mortality rates from lung disease, stroke and cancer are similar to the rest of the City. Of concern however, is the level of premature death from coronary heart disease, which is the highest of all the community assembly areas.
Once again there is variation within the area. Central and Walkley wards have the highest rates of premature deaths from coronary heart disease and circulatory disorders of all electoral wards in the City. Walkley also has the second highest rate of premature death from respiratory disease in the City (49 per 100,000 versus 26 per 100,000 in Sheffield).
Hospital admissions for a range of physical illnesses are, on average, similar to the rest of Sheffield. There is some variation across electoral wards. Adult admissions for mental health, however, are significantly higher than all other community assemblies (220 per 100,000 people compared to 148 per 100,000 in Sheffield). Admissions from Central, Broomhill and Walkley wards are among the highest in Sheffield. Of concern, in 2006-08 the CA also had a higher rate of adult admissions to hospital linked to alcohol. It had the second highest level of alcohol-specific admissions and third highest level of alcohol attributable admissions of all the CAs. Alcohol attributable deaths were, however, similar to the rest of the City although Central and Walkley wards had the highest level of alcohol attributable deaths of all electoral wards.
23 The rate of emergency admissions to hospital for all ages is on average lower than for Sheffield as a whole, although this varies across the area. Rates in Broomhill and Hillsborough tend to be lower and in Central tend to be higher than Sheffield as a whole. For people aged 65 years and over, emergency admissions are generally higher than the Sheffield average.
Accident and Emergency attendances by people in CA are also higher than the Sheffield average (292 versus 285 attendances per 1,000 population). Rates are particularly high from Central (319) and Walkley (316) wards, and much lower from residents of Broomhill (257).
Healthy lifestyles
The proportion of mothers breastfeeding at delivery is higher in Central CA than the Sheffield average. The proportion of babies born with low birthweight, levels of obesity in children in reception year, and the amount of dental decay in children at age 5 are all on a par with Sheffield. Encouragingly, levels of smoking during pregnancy are lower than the Sheffield average. During 2006-8, Broomhill had the lowest proportion of low birthweight babies of all Sheffield wards (5% versus 9% in Sheffield). Rates of teenage pregnancy overall are similar to the Sheffield average – although the rate in Walkley is significantly higher than average, whilst in Broomhill it is significantly lower.
The prevalence of smoking in the area overall, as well as smoking amongst pregnant women, is lower than the Sheffield average. However over 1 in 10 mothers are smoking at delivery, and more than one in five people aged 16 years and older are smokers. Rates of smoking are higher than average in Central and Walkley wards.
29% of the population aged 16 or over are estimated to consume the recommended five portions of fruit and vegetables a day (vs 25% in Sheffield and 26% nationally). Walkley and Hillsborough have slightly lower levels (25% and 23% respectively). A similar picture is present for physical activity with a higher than average proportion of adults estimated to participate in physical activity. This is largely due to Broomhill with almost one in three adults participating to the recommended level (the highest in any of the City’s wards). Conversely, the level in Hillsborough is below average.
Childhood obesity at year 6 is similar to the Sheffield average (16% versus 17%). The prevalence of adult obesity is highest in Hillsborough ward (24%) and Walkley (19%) compared to 15% in Central and 12% in Broomhill. The overall level of adult obesity in the CA is 17% compared to the Sheffield average of 23%.
Wider determinants of ill health and well being
Many aspects of health and wellbeing are linked to socioeconomic deprivation. The CA overall has a lower level of deprivation compared to
24 some of the other community assemblies. At ward level however, Central and Walkley experience a greater level of deprivation than Hillsborough or Broomhill. This pattern holds true for the various measures of deprivation, such as the proportion of benefits claimants and educational attainment. The CA had a lower proportion of households claiming Income Support/Job Seekers’ Allowance and Pensions Credit compared to the Sheffield rates. It also has the lowest proportion of working age residents (5%) claiming Carers Allowance.
Overall, educational attainment in Central CA is higher than Sheffield as a whole. In 2007/8 for example, 46% of young people gained 5 or more A-C grades at GCSE versus 40% in Sheffield. This level of attainment was much higher in Broomhill (77%) than the other three wards. Three wards had a higher proportion of Year 11 students staying in learning compared to Sheffield as a whole. Broomhill had the highest proportion of all wards in Sheffield at 97%. Rates in Walkley and Hillsborough were lower at 81% and 77% respectively.
What are we doing?
City-wide interventions All of the universal public health programmes are active in the Central Community Assembly, including the Sheffield Stop Smoking Service, 5-a day (fruit and vegetable) campaign, Active Sheffield (physical activity), various vaccination, immunisation and health screening programmes.
Enhanced Public Health Areas In addition, the CA overlaps with five Enhanced Public Health Programmes (EPHPs) covering the neighbourhoods of City Centre, Sharrow, Broomhall, Winn Gardens, Upperthorpe, Netherthorpe and Langsett.
City Centre The City Centre EPHP is working to support some of the most vulnerable groups in the City. This includes work with Ben’s Place to support the mental and physical health of street drinkers, work with the Cathedral Archer Project and Turning Point to support homeless people through participation in volunteering and educational activities. The programme is also working with refugees and asylum seekers to address social isolation and mental health issues in a safe environment as well as improving their access to local services. Work is being done with local primary care services to support health promotion through the use of exercise facilities. The City Centre is undergoing a number of changes, and the EPHP is also working with other agencies to support community cohesion through the development of a new ‘City Centre Forum’.
Sharrow In partnership with Sharrow Community Forum, the Sharrow EPHP is working to improve people’s access to public health and primary care services and supports the ‘Sharrow Shipshape’ one-stop shop for health information. The
25 EPHP provides support to help people self manage conditions such as cardiovascular disease through weight management and stop smoking services, targeting people aged 50 and over, as well as a programme of intensive support for people newly diagnosed with diabetes. Other projects include increasing emotional wellbeing in two of the local primary schools in partnership with the YMCA and the local Children’s Service District. There is a health trainer post covering both Sharrow and Broomhall.
Broomhall Broomhall EPHP is working with local organisations on a number of projects covering diabetes self management and drug awareness sessions. It is also providing citizen’s advice support through primary care, an art therapy project for children and families at a local school, healthy eating sessions, health trainers and an older people’s worker developing health promoting activities for older people.
Winn Gardens Winn Gardens EPHP is working to establish family and parenting support programmes and with Sheffield Futures, to provide youth development work and physical activity programmes for children and young people. The EPHP is conducting work to identify health needs in the local area to improve people’s access to services. Other work includes support for the development of open spaces on the estate and for community safety initiatives. Support for mental health and well being includes the delivery of counselling and anger management services.
Upperthorpe, Netherthorpe and Langsett The Upperthorpe, Netherthorpe and Langsett EPHP is provided by ZEST and supports a community food worker to deliver local food initiatives, support for family learning by linking a local school with various services to increase access to learning; supporting a sexual health drop in service for young people; undertaking a range of initiatives to raise awareness of health issues with local people, numerous opportunities to increase physical activity including a gym buddying scheme and support to improve mental wellbeing through mental health ‘First Aid’ training for local workers. The Programme is delivered in partnership with the Upperthorpe Healthy Living Centre, where many of the above activities and services are located.
Recommendations for the Community Assembly
The Central Community Assembly should:
Consider how coronary heart disease, circulatory disease and alcohol admissions can be reduced in the area by encouraging healthier lifestyles through healthy eating, increasing access to physical activity and other preventative services such as the Stop Smoking Service.
26 Invest in programmes to support healthy living to prevent coronary heart disease, circulatory disease and diabetes, and to support more people with these conditions (such as the Expert Patient Programme)
Promote measures to reduce alcohol harm across the area. For example, it should work in partnership with other relevant agencies to support vulnerable groups who reside in and use the City Centre as regeneration of the area progresses, and support partnership working in the City Centre around alcohol and drug use, including exploring the possibility of ‘Wet Centre’ provision.
Consider asking the local community about health improving activity needed in the area as part of its ‘ Big Voice ’ consultation. This should include questions about coronary heart disease, circulatory disease, alcohol and mental health to help identify and act on health needs in the area.
For more information contact
Dr Sheila Paul Consultant in Public Health
27 Northern Community Assembly
Health at a glance
The Northern Community Assembly consists of the electoral wards of East Ecclesfield, Stannington, Stocksbridge and West Ecclesfield. With a population of 75,000, it represents around 14% of the Sheffield total.
The health of the people of the Northern Community Assembly (CA) is generally better than that for Sheffield as a whole. Fewer people on average are expected to develop lifestyle-related health problems in the future. The level of health problems experienced in the CA relating to old age or deprivation are similar to the Sheffield average. However there are higher than average numbers of older people living in deprived areas whose diet is poor, and older people in slightly better off areas with health problems.
The population profile of Northern Sheffield CA is slightly older than that of the rest of the City, with the greatest difference being that Northern Sheffield has a higher proportion of people aged 55-69 years and a lower proportion of people aged 20-24 years. There are no significant differences between the population profiles of the constituent wards within Northern Sheffield. There are more women than men in the older and very old age groups, which reflects the Sheffield and national pictures.
Northern Sheffield is significantly better than Sheffield as a whole in terms of life expectancy and mortality rates. Perhaps as a reflection of this, emergency admissions to hospital, and accident and emergency attendance rates also tend to be lower. The rate of smoking in adults, and level of obesity in children, are both lower than the Sheffield average. However, estimated prevalence of adult obesity is higher with consumption of the recommended ‘Five a day’ portions of fruit and vegetables lower than in the rest of the City.
Headline health indicators
Life Expectancy On average, male life expectancy at birth in Northern Sheffield CA is significantly better than in the rest of the City. In 2006-08, it was 80.3 years compared to 78.1 for Sheffield. Female life expectancy is also significantly higher in Northern Sheffield at 83.0 years than in the rest of the City (81.7 years). East Ecclesfield ward (78.3) has a significantly lower life expectancy for men at 78.3 years than the other three wards (West Ecclesfield 81.7 years, Stocksbridge and Upper Don 80.0 years, and Stannington 81.7 years). There has been no significant increase in life expectancy across the community assembly area in recent years.
Mortality rates All age all cause mortality rates are significantly lower in the Northern CA area for both men and women, although the difference for women is not so marked
28 as for men. For men, the rate is 585 per 100,000 population compared with 690 for Sheffield. At ward level, for men, East Ecclesfield has a similar rate to the Sheffield average at 721 per 100,000 population, whilst in West Ecclesfield (504 per 100,000 population), Stocksbridge and Upper Don (605 per 100,000 population), and Stannington (517 per 100,000 population) the mortality rates are significantly lower. For women, mortality rates in Northern Sheffield are also significantly lower than for the City as whole at 451 per 100,000 population compared to 507 across Sheffield. However, there is considerable variation between wards with West Ecclesfield having the lowest rate at 366 per 100,000 population and East Ecclesfield having the highest at 534 per 100,000.
Premature death and ill health
Mortality rates for people aged under 75 years from the common killers such as heart disease, strokes and cancers are similar in Northern Sheffield to the rest of the City. However the rates in East Ecclesfield and Stocksbridge and Upper Don, at 278 and 271 per 100,000 population, are higher than in the rest of the CA area (243 per 100,000 population). This is largely due to higher premature mortality from cardiovascular disease in East Ecclesfield and from cancers in Stocksbridge and Upper Don.
There are fewer hospital admissions for physical and mental illnesses from the CA area than for the rest of the City, although admissions for cancer and diabetes are similar. Alcohol related admissions to hospital are significantly lower than for the City as a whole. This pattern is similar across all the wards.
Use of accident and emergency services by people from Northern Sheffield is significantly lower than from elsewhere in the City at 261 A&E attendances per 1000 population compared to 286 for the rest of the City. At ward level, attendances are lower in all wards except for East Ecclesfield (296). Lower A&E use than the City average is also seen for those aged under 20 years. However, for people aged 65 years and older, A&E attendance is significantly higher than the Sheffield average from East Ecclesfield and West Ecclesfield. This is probably a reflection of the higher numbers of older people in Northern Sheffield.
Healthy lifestyles
The prevalence of smoking, both in the local population generally and among pregnant mothers, is significantly lower in the Northern CA than for the rest of the City at approximately 19% across all four wards. However, smoking in pregnancy varies from 6 % in Stannington to 12% in Stocksbridge and Upper Don (12%).
Twenty-five percent of the population of Northern Sheffield is estimated to consume the recommended five portions of fruit and vegetables per day and this is on a par with the rest of the City. Similarly, estimated levels of physical
29 activity in adults in the Northern CA are similar to the Sheffield average with little difference across the four wards.
Despite this, the prevalence of adult obesity in Northern Sheffield, at 26%, is higher than the City-wide average of 23%.
Wider determinants of ill health and well being
People living in less affluent areas generally have poorer levels of health compared to their more affluent counterparts. The Northern Sheffield CA area is generally less deprived than many other parts of the City. Within the CA, East Ecclesfield, West Ecclesfield, and Stocksbridge/ Upper Don have higher levels of deprivation than Stannington.
Level of educational attainment has also been shown to impact on future health and well being. Educational attainment in Northern Sheffield is better than in the City overall. In 2007/08, 51% of students gained five or more A-C grades at GCSE (including English and Maths) compared to 40% in the City. Attainment in East Ecclesfield (39%) however, was substantially lower than in Stannington (53%), Stocksbridge and Upper Don (56%) and West Ecclesfield (56%).
The proportion of Year 11 students staying in education is significantly higher in Northern Sheffield (82%) than for Sheffield as a whole (76%). This pattern is reflected across all four wards.
What are we doing?
City-wide initiatives Public health programmes active in the Northern CA area include the Sheffield Stop Smoking Service, the Five-a Day (fruit and vegetable) campaign, Active Sheffield which supports opportunities for physical activity, vaccination and health screening programmes and the Healthy Schools programme.
Enhanced Public Health Programmes In addition to the various universal health services, the High Green Enhanced Public Health Programme (EPHP) operates in the northern area of West Ecclesfield. The EPHP comprises a combination of health promotion activities, improving access to services, and developing community capacity to empower local people to deliver health improvements. Last year the ‘Introduction to Community Development and Health’ (ICDH) course was delivered in High Green for the first time. The course gives participants an understanding of the key determinants of health and provides them with an opportunity to gain the knowledge and skills to access employment or volunteering roles in health, social care, and community work. All those who completed the course have started to volunteer within their community and have signed up to become health champions.
30 This coming year, the focus of the Enhanced Public Health Programme will be on continuing to develop the community infrastructure, communication networks and partnership working through funding a community development worker. In addition, a modular version of the ICDH course will be piloted and a wider range of activities will be promoted, including Tai Chi, singing for health and cook and eat classes. There will be a particular focus on the health needs of young people with a new project aimed at promoting healthy lifestyle choices.
Recommendations for the Community Assembly
The Northern Community Assembly should:
Support the High Green Enhanced Public Health Programme.
Promote healthy eating, particularly for older people, and ensure the availability and accessibility of affordable fresh fruit and vegetables.
Ensure opportunities for safe walking and cycling are maximised in the area and that these are promoted as ways to travel.
For more information contact
Kate Jones Director of Dental Public Health
31 North East Community Assembly
Health at a glance
North East Sheffield Community Assembly (CA) has a population of approximately 93,000 living in the four electoral wards of Southey, Shiregreen & Brightside, Burngreave and Firth Park. The health status of people in North East CA is significantly worse than that of the City as a whole for most health indicators, as evidenced by lower life expectancy, higher mortality and hospital admission rates and fewer people adopting health lifestyles. Not surprisingly poor health status in the North East CA is associated with high levels of deprivation; 28% of people in the North East area claim benefits compared with a City average of 17%.
For some indicators relating to maternal and child health (namely infant mortality, low birth weight, childhood obesity) most of North East CA fares better, with rates not significantly different from the City as a whole. The exception is Firth Park ward where infant mortality is the highest in Sheffield.
According to ‘HealthACORN’, a high proportion of the population are in the ‘current health problems ’ category. The exception to this however is Burngreave, which includes substantial numbers expected to develop future lifestyle related illnesses.
The population in the area is slightly younger than Sheffield as a whole, particularly in Burngreave where there is a higher proportion of people under 20 years. Southey ward is the only part of the North East area with a slightly older age profile, with more over 65s than the City as a whole.
Headline health indicators
Life expectancy People in North East CA live 2.3 years less than the average person in Sheffield; the life expectancy gap between the North East and the South West assembly areas is 6.3 years for men and 5.3 years for women. Male life expectancy varies little across the North East CA, in contrast to female life expectancy which is lowest in Burngreave and highest in Southey ward, where it is not significantly different from the City wide average. From 2005 to 2007 life expectancy improved in all areas for both men and women, except in Southey ward where male life expectancy decreased over the same period.
Mortality rates Mortality rates for all causes and at all ages show a similar pattern. They are significantly higher than the City wide average for both men and women, except in Southey ward where the female all age all cause mortality rate is not significantly different from the Sheffield rate. The trend is improving for men but not for women.
32 North East CA has the lowest life expectancy and highest all age all cause mortality rates of all the assembly areas.
Premature death and ill health
The pattern of ill health and death in the North East CA is similar to Sheffield as a whole, the major causes of premature deaths (ie under 75 years) being cancers, heart disease, stroke and respiratory disease. However in the North East CA the risk of premature death from each of these causes is significantly greater than for the Sheffield population as a whole. There is considerable variation at ward level. The risk of dying prematurely from circulatory disease, and within that heart disease, is significantly higher only in Firth Park and Burngreave compared to Citywide. Firth Park is the only ward within the North East area with a premature mortality rate for stroke significantly higher than the City average. Premature cancer mortality is significantly higher in Shiregreen and Brightside ward only. In Southey ward the risk of premature death from any of these major causes is not significantly different from the City average.
The pattern of hospital utilisation is one of significantly higher hospital admission in general, and emergency attendances and admissions in particular, in the North East area compared with the City as a whole. Emergency hospital use is higher in the North East than any other CA area in the City, although Shiregreen and Brightside ward are an exception, having emergency admission rates for over 65s and under 20s not significantly different than the City average. Cancer admissions however do not follow this pattern, the North East area (Burngreave and Southey wards) having a significantly lower cancer admission rate than the City as a whole. This, taken together with a significantly higher rate of premature mortality from cancer, suggests presentation at later stages of disease and/or poorer access to treatment services and requires further investigation.
At ward level the pattern of hospital admissions varies for different health conditions. Stroke and mental health admissions are similar to the City average in Shiregreen & Brightside and Southey wards. Only Burngreave ward is significantly higher than the City average for asthma admissions. Firth Park has a similar level of diabetes admissions as the City average. Hospital admissions data are both an indicator of underlying health need and access to services and as such need to be interpreted cautiously and in conjunction with other indicators of morbidity and mortality.
Healthy lifestyles
In North East CA around one in three people are estimated to be smokers (31%) compared with one in four in the City as a whole (23%) and less than one in six in the ‘best’ CA area in the City.
Fruit and vegetable consumption (proportion of adults eating 5 portions of fruit and vegetables per day) is lower than City average (20% in North East
33 compared with 25% in Sheffield); only Burngreave, at 24%, has levels similar to the City average. The population in North East CA has the lowest level of physical activity in the City, with only 15% participating in at least 30 minutes of exercise on at least 3 days per week, compared with 20% for the City population as a whole. The four North East CA wards are in the bottom five wards (together with Darnall) when ranked for physical activity levels across the City. Given the above it is perhaps not surprising that the North East CA population has higher levels of adult obesity than the City as a whole (26.3% compared with Sheffield 22.6%). In Burngreave adult obesity is estimated to be 23.5%, the lowest in the CA area and similar to the City average.
The North East CA, and all four wards within it, have significantly higher rates of both alcohol specific and alcohol attributable hospital admissions compared to Sheffield as a whole (and the highest rates of any CA area). However mortality attributed to alcohol is not significantly higher than the City average.
The picture with respect to maternal and child health is more mixed, especially at ward level. Overall the CA area has a significantly higher proportion of mothers smoking at delivery than Sheffield as a whole (19% compared with 14%). However the level in Burngreave, at 9.3%, is significantly better than the City average in Southey (29%) Firth Park (28%) and Shiregreen & Brightside (21%) it is significantly worse.
Breast feeding at delivery shows a similar mixed picture. Overall the breast feeding prevalence in North East CA is significantly lower than the City average (71% compared with 76%). However there is a 27% difference between wards within the CA area.
In Burngreave 84% mothers are breast feeding at delivery (significantly higher than the City average), whereas in Firth Park and Southey the corresponding figures are 61% and 57% respectively, significantly worse than the City average. In Shiregreen and Brightside the figure is 71% - similar to the City average.
North East CA has twice the level of childhood obesity at both Reception and Year 6 compared with those of the ‘best’ CA, but this is not significantly different to the City average. The picture with respect to oral health however is more concerning. Five year olds in the North East CA area have on average 2.7 decayed, missing or filled teeth, significantly higher than the City average of 1.7. All four wards within the area have levels significantly higher than the City average, the highest in Shiregreen and Brightside (2.9) and the lowest in Southey (2.4).
The rate of teenage conceptions in the North East CA is 50% higher than the City average and over three times higher than that of the ‘best’ CA in the City. In the North East approx one in fifteen 16-17 year olds will conceive each year. Three wards within the area have teenage conceptions rates significantly higher than the City average, the exception is Shiregreen and Brightside ward where conception rates are similar to the City average.
34 Although there is a mixed picture, and some indication that maternal and child health is faring better than overall population health (especially for example in Burngreave) the lifestyle indicators outlined above all point to rising health problems in future years.
Wider determinants of ill health and well being
The North East CA has the lowest IMD score in the City. Burngreave, Firth Park and Southey are all in the most deprived quintile of wards in the City. The area has the highest proportion households claiming benefits (28%) of any CA area, significantly higher than that of Sheffield as a whole (17%). All four wards have levels of benefit dependence which are significantly higher than the City average.
Educational achievement in the area is significantly worse than the City average, with under one in four students achieving at least 5 good (A-C including English and maths) GCSEs. However Burngreave and Shiregreen and Brightside wards achieve similar rates of any pass at GCSE to the City as a whole. A lower proportion (71%) of Y11 students stay in learning compared to the City as a whole (76%); however in Burngreave the proportion increases to 79.3%. This is higher, but not significantly so, than the City average.
What are we doing?
City-wide initiatives North East CA is actively implementing the universal public health preventative initiatives of Stop Smoking, 5 a day, Active Sheffield, and the vaccination and screening programmes.
Enhanced Public Health Programmes In addition, the North East Community Assembly area benefits from a number of targeted initiatives through the three Enhanced Public Health Programmes in Burngreave; Flower, Shiregreen, Stubbin & Brushes; and Southey and Owlerton.
Burngreave Burngreave EPHP has developed a programme of health support and interventions built upon a range of initiatives originally established through the health strand of the New Deal for Communities programme. The programme ended in April 2009 but a key legacy has been the opening of the Health Matters health information shop, and a team of five health trainers providing one to one information, support and advocacy. Their work has included a successful diabetes education programme piloted with black and minority ethnic communities, and an intervention to raise asthma awareness (in response to particularly high rates of asthma admissions in the area). In addition a programme of targeted work with the Kurdish community has been developed through a multiagency group and will be delivered through community members, focusing particularly on mental health and access to employment and training. Health visitors have developed a programme of
35 work with the Slovak Roma community; a drop in has been established to improve access to maternal and child health services and address specific health needs.
Flower, Shiregreen, Stubbin & Brushes Flower, Shiregreen, Stubbin & Brushes EPHP has a strong healthy lifestyle focus. Initiatives include one to one and group support to promote physical activity, healthy cooking and eating, weight management, and stopping smoking. A programme of community training is delivered, including courses on ‘What is health?’, ‘Anger management’, ‘Active friends’ and ‘Mental health first aid’. There is also a small grants scheme to support community based lifestyle interventions, a teenage girls activity club and ‘Spike into shape’ - a volley ball project.
Southey and Owlerton Southey and Owlerton EPHP delivers a health programme in the area which is coordinated by the SOAR healthy living group. The programme includes a Stop Smoking Worker who also delivers a weight management programme for quitters. There is also a range of activities for older adults including chair based exercise. The Healthy Cross Personal Health Improvement Target (PHITS) programme provides one to one information and support including help to lose weight, eat more healthily and become more physically active. A small grants scheme is available (up to £1000) to support community based interventions on chronic disease, alcohol and substance misuse, sexual health, mental health, obesity and general health and well being. More recently a debt advice worker has been recruited to work alongside the existing advocacy worker.
Recommendations for the Community Assembly
The North East Community Assembly should
Consider how levels of physical activity can be increased through better take up of referral for exercise programmes and give local support to those whose health can benefit most.
In partnership with NHS Sheffield, commission services which will lead to less use of emergency services, better use of primary care and preventative screening services and provide more health trainer support.
For more information contact
Dr Sue Greig Consultant in Public Health
36 East Community Assembly
Health at a glance
The East Community Assembly (CA) is made up of the 4 wards of Arbourthorne, Darnall, Manor Castle and Richmond. Together, the 82,000 population represents almost 15% of the population of Sheffield.
The East CA has a relatively high proportion of people in poor health relative to the rest of Sheffield, and is one of the most deprived community assembly areas in the City. Other indicators of deprivation include a high number of benefits claimants, low educational attainment and high unemployment.
People do not tend to eat the recommended amount of fruit and vegetables and there are more smokers than in Sheffield as a whole. More mothers smoke during pregnancy and childhood obesity is also a cause for concern.
People in the East CA do not tend to live as long as people living in other parts of the City. Mortality rates for under 75s, particularly from cancer, circulatory and respiratory disease, as well as for all causes taken together, are the highest for any community assembly area in Sheffield. Accident and emergency attendances are more common than from other CA areas and people are also more likely to be admitted routinely for asthma, stroke and respiratory disease.
There are notable demographic differences within the CA. For example, Darnall is one of the most culturally diverse parts of Sheffield, with a large and established South Asian population (Indian, Pakistani or Bangladesh descent). There are slightly fewer people in their early 20s in East CA than for Sheffield as a whole.
Headline health indicators
Life Expectancy Men in the East CA can on average expect to live until they are almost 76 and women about 80. This is significantly lower than for Sheffield (78 for men and nearly 82 for women). Life expectancy for women in Richmond and Darnall (at 79.4 years), is significantly shorter than the rest of Sheffield. Male life expectancy is significantly shorter than the City average in Darnall (75.1 years) and Manor Castle (75.6 years).
Mortality rates The East CA has the second highest all ages all cause mortality rate in Sheffield. This is true for both men and women (583.8 per 100,000 population for women and 819.3 for men) and across the CA’s four electoral wards.
Premature death and ill health
37
For men and women under the age of 75 years, there are higher mortality rates in the East CA from cancer, circulatory disorders, respiratory disease and all causes taken together, than any other CA area in Sheffield.
For all causes taken together, Richmond and Manor Castle have higher under 75 mortality rates for women. In Manor Castle, Arbourthorne and Darnall the male under 75 mortality rates are significantly higher than the Sheffield average. Manor Castle is the ward with the highest under 75 mortality rates for cancer and respiratory disease in the City. For circulatory disorders, Richmond and Manor Castle have significantly worse rates than Sheffield as a whole.
In comparison with the Sheffield population accident and emergency attendances are more common, and this is especially true for the under 20s and over 65s. The CA also has the greatest rate of admissions to hospital for asthma, stroke and chronic respiratory disease. However, Richmond is not significantly different from Sheffield for these conditions and Darnall is not significantly different for stroke.
Healthy lifestyles
East CA is characterised by issues of poor diet, smoking and people with long term illness. It is estimated to have the lowest fruit and vegetable consumption rate in Sheffield. Manor Castle is the ward with the lowest rate with only 18% of the population estimated to be eating 5 or more portions of fruit and vegetables a day, compared with 25% for Sheffield.
The level of smoking in East CA is the second highest in Sheffield at 29%, compared with the Sheffield average of 23%. The East CA also has the second highest level of women smoking during pregnancy (19% compared with 14% for Sheffield). Darnall has high numbers of young adults from minority ethnic groups who smoke.
East CA has the second lowest rate (16%) of participation in physical activity (at least 30 minutes of moderate activity at least 3 times per week) when compared with the other community assembly areas in Sheffield. For Sheffield overall this is estimated to be 20%. Manor Castle has relatively high numbers of people who are likely to develop future health problems associated with sedentary lifestyles and low fruit and vegetable consumption.
In terms of child health, the picture is equally worrying. Childhood obesity is a cause for concern in the East CA. It has the highest prevalence for both reception and Y6 children (11% in East compared with 8% for Sheffield at reception and 22% compared with 17% in Year 6). Manor Castle has the highest prevalence of all wards in Sheffield for Y6. The East CA has the greatest proportion of all CA areas of babies born with low birth weight. Arbourthorne has the highest proportion across all wards in Sheffield. Similarly tooth decay in children aged 5 is significantly worse in East CA than
38 for Sheffield. The average number of decayed, missing or filled teeth for East CA is 2.4 whilst it is 1.7 across Sheffield.
Wider determinants of ill health and well being
East is the second most deprived community assembly in Sheffield. All four of its wards experience greater deprivation than the Sheffield average, with Manor Castle being the most predominantly deprived, particularly in relation to childhood deprivation, employment, health and disability, educational attainment, skills and training.
There are significantly more lone parents claiming benefits in Arbourthorne and Manor Castle than in Sheffield as a whole, with East CA having the second highest percentage of its population claiming benefits. Darnall is the ward with the greatest number of people claiming carers allowance in Sheffield. East CA has the second highest rate of benefits claimants across the community assemblies in Sheffield.
Educational attainment is significantly worse in East CA than for Sheffield as a whole. The percentage of students achieving grades A-C in their GCSEs is 27%, compared with the Sheffield average of 40%. East CA has the lowest percentage pass rate for any grade of GCSE in the City (91% compared to the City score of 95%). Equally, the number of pupils continuing their education beyond Y11 is significantly lower in East CA than for Sheffield as a whole.
What are we doing?
City-wide interventions The full range of public health interventions and services is available to people living in East CA. These include; specialist programmes for people living with long term conditions; the Sheffield Stop Smoking Service; the Expert Patient programme; Active Sheffield (supporting increased participation in physical activity); 5-a-day (fruit and vegetable) campaign, all child and adult vaccination and screening programmes.
Enhanced Public Health Programmes East CA has four Enhanced Public Health Programmes (EPHPs), covering the local neighbourhoods of Norfolk Park, Arbourthorne, Darnall, Tinsley, Acres Hill, Manor, Park Hill, Woodthorpe and Wybourn. These Programmes, designed and delivered in partnership with the local communities concerned, aim to provide health and lifestyle interventions, improve access to services and tackle some of the wider determinants of ill health and early death experienced within these areas.
Darnall and Tinsley In Darnall the Programme is provided by the Darnall Wellbeing Project which delivers activities across Darnall and Acres Hill including swimming, walking, Tai Chi, community gym sessions and a community allotments project. In
39 Tinsley, the Enhanced Public Health Programme works closely with the Tinsley Forum and Activity Sheffield to increase opportunities for improving health. There are also social prescribing schemes running in both these areas, where, for example, people with depression and anxiety can be signposted to activities that benefit their wellbeing. In addition to the Sheffield Stop Smoking service, there is a Community Stop Smoking Service provided in locations that works with people, mostly on a 1 to 1 basis, bringing support out to people in their own homes.
Manor, Park Hill, Woodthorpe EPHP and Wybourn EPHP These two Enhanced Public Health Programmes are provided by Manor & Castle Development Trust. A community health worker delivers physical activity and health sessions including; box and tone, weight management, health advice and exercise drop-in. There is also a course available free to local residents to help them if they have poor confidence or self-esteem. This ‘STEPS to Excellence for Personal Success’ course supports people to achieve their aspirations and goals. A health trainer in Manor works with people on a 1 to 1 basis to help them achieve positive changes in their health and wellbeing. As with Darnall EPHP, there is a Community Stop Smoking Service.
Norfolk Park and Arbourthorne In the Norfolk Park and Arbourthorne areas there is a community health worker implementing the local Enhanced Public Health Programme. This has four main strands of work; comprising: physical activity, stop smoking, healthy eating and managing chronic disease. The Norfolk Park Diabetes Support Group for example meets monthly and is linked into a number of professionals. The group has regular speakers on a variety of health topics and issues linked to diabetes. An allotment programme is starting to be developed within Norfolk Park, to encourage the local community to grow their own food and increase gardening activity. A health trainer also covers the area, supporting people to make positive changes to their health and wellbeing.
Across all the Enhanced Public Health Arogramme areas a free course is available to the public called ‘Introduction to Community Development and Health’ (ICDH). This is a course that enables people to make informed choices about their own health, to act as signposts for others, to become involved with partnerships with statutory and voluntary bodies and to become ‘Community Health Educators’ or ‘Health Champions’ within their community. The EPHPs in East CA have supported ICDH courses with great success.
Recommendations for the Community Assembly
The East Community Assembly should:
Develop strong partnerships with NHS Sheffield, Public Health and the Enhanced Public Health Programmes to address the wider social determinants that impact on health in the area.
40
Develop the local public health agenda and support initiatives and services from the statutory, voluntary and community sector which will improve health and well being in East Sheffield.
Continue to support partnership working and recognise the benefits of investing in community based projects that can develop locally-based programmes of work to address health inequalities. This includes work around healthier lifestyle choices and opportunities.
Encourage the Practice-Based Commissioning consortium to identify, develop links with and support projects in their locality that are providing public health activities. This should include making full use of referral schemes such as social prescribing, Health Trainers and other schemes that can assist in breaking down barriers to accessing services and supporting people in most need.
For more information contact
Chris Nield Consultant in Public Health
41 Recommendations
Every year the Director of Public Health Annual Report makes a set of recommendations. The extent to which these are implemented is monitored by the Care Quality Commission as part of its assessment of all NHS organisations. Here we provide a summary of the recommendations being made in this year’s report, together with a report on progress against the recommendations made in the 2008 Report.
Summary of Recommendations for 2009
South East Consider how levels of physical activity can be increased in South East Sheffield. In particular, consideration should be given to undertaking a neighbourhood audit to identify barriers to walking and cycling, and ways to increase active travel.
In partnership with NHS Sheffield, commission more work to promote healthy eating in South East Sheffield. Extending the use of allotments locally would be particularly beneficial, since it could lead to an increase in levels of physical activity as well as healthier eating.
South Continue joint working with all partner organisations within the area to ensure that targeted resources are spent on sustainable initiatives which are proven to be effective in improving health and wellbeing.
Maintain specific additional resource for existing Public Health programmes on physical activity, diet and nutrition, vulnerable family support, sexual health, breastfeeding and smoking within the Enhanced Public Health Programme areas.
Continue representation on and direct linkages with Enhanced Public Health Programme steering groups, contributing to plans for further initiatives addressing older adults’ health needs for example to tackle sedentary lifestyles and high fat diets, to combat onset of diabetes and improve self management of chronic illness.
South West Consider the health of the older population across its wards. It is also important to ensure that the higher levels of good health experienced across the CA are maintained. Given the affluent populations represented in the wards it is important to ensure that healthy lifestyles are promoted and for those professionals and affluent pensioners consistent messages are delivered relating to health eating, physical
42 activity and alcohol consumption.
It would be beneficial for the CA to better understand if benefit claims are being made due to financial need as against individuals’ ability to understand processes and claim entitlements. This will support maintaining good health in areas where individuals could be capital rich but cash poor.
Central Consider how coronary heart disease, circulatory disease and alcohol admissions can be reduced in the area by encouraging healthier lifestyles through healthy eating, increasing access to physical activity and other preventative services such as the Stop Smoking Service.
Invest in programmes to support healthy living to prevent coronary heart disease, circulatory disease and diabetes and to support more people with these conditions (such as the Expert Patient Programme)
Promote measures to reduce alcohol harm across the area. For example, it should work in partnership with other relevant agencies to support vulnerable groups who reside in and use the City Centre as regeneration of the area progresses, and support partnership working in the City Centre around alcohol and drug use, including exploring the possibility of ‘Wet Centre’ provision.
Consider asking the local community about health improving activity needed in the area as part of its ‘ Big Voice ’ consultation. This should include questions about coronary heart disease, circulatory disease, alcohol and mental health to help identify and act on health needs in the area.
Northern Support the High Green Enhanced Public Health Programme.
Promote healthy eating, particularly for older people, and ensure the availability and accessibility of affordable fresh fruit and vegetables.
Ensure opportunities for safe walking and cycling are maximised in the area and that these are promoted as ways to travel. North East Consider how levels of physical activity can be increased through better take up of referral for exercise programmes and give local support to those whose health can benefit most.
43 In partnership with NHS Sheffield, commission services which will lead to less use of emergency services, better use of primary care and preventative screening services and provide more health trainer support. East Develop strong partnerships with NHS Sheffield, Public Health and the Enhanced Public Health Programmes to address the wider social determinants that impact on health in the area.
Develop the local public health agenda and support initiatives and services from the statutory, voluntary and community sector which will improve health and well being in East Sheffield.
Continue to support partnership working and recognise the benefits of investing in community based projects that can develop locally-based programmes of work to address health inequalities. This includes work around healthier lifestyle choices and opportunities.
Encourage the local Practice-Based Commissioning Consortium to identify, develop links with and support projects in their locality that are providing public health activities. This should include making full use of referral schemes such as social prescribing, Health Trainers and other schemes that can assist in breaking down barriers to accessing services and supporting people in most need.
What can I do?
As well as the recommendations to community assemblies, there are many ways in which you and your family can make a big difference to health, regardless of the community assembly you live in. Some of the most important things you can do are listed below. Even if you decide to take just one of the recommended actions it will be step in the right direction.
The most significant thing anyone can do to preserve health is not to smoke. More than three quarters of all adults in Sheffield are already non-smokers. Those who still smoke should make every effort to give up, and the Sheffield Stop Smoking Service on telephone number 0900 068 4490 can help them to do so.
Levels of obesity are a major problem. Part of the reason for this is that people are not being as physically active as is necessary to preserve health. Half an hour of moderate physical activity, such as brisk walking (enough to make you feel warm), five times a week, will make you fitter and healthier, improve your mental well being and reduce your risk of becoming (or remaining) overweight or obese. The best way to sustain this is to build it into your every day routines, for example by walking or cycling to work, or some of the way.
44 There is great scope for improvement in diet. The percentage of the population eating the recommended 5 portions of fruit and vegetables per day clearly needs to increase. A portion is a handful, and one of these (not more) can be taken in the form of fruit juice. Eating the recommended levels of fruit and vegetables will help protect you and your family against cancer, hypertension and heart disease.
Know your limits in relation to alcohol consumption. You should not drink more than 2-3 units of alcohol a day if you are a woman and no more than 3-4 units a day if you are a man. A pint of beer or lager, or a standard glass of wine is broadly equivalent to 2 units. A pint of cider is closer to 3 units.
Make sure you and your family are up to date with all necessary vaccinations and health screening. This includes the MMR vaccine which will protect your children against serious diseases such as mumps and measles. Another important vaccination is for seasonal ‘flu. This is offered in the autumn, in preparation for the winter months. If you are over 65 years of age or you have a serious health condition, this vaccination is for you.
If you or someone you know has flu-like symptoms and you are concerned you may have swine flu, stay at home and check your condition with the National Pandemic Flu Service on: www.pandemicflu.direct.gov.uk or telephone 0800 151 3100 . Telephone your GP if you have a serious underlying health condition, or you are pregnant, or you are concerned about a child under the age of one year, or your condition suddenly becomes a lot worse, or your symptoms do not get better after 7 days (5 days for a child).
Choose well and help us to reduce the intense pressure on emergency health services. Choose the most appropriate health service to use at the right time. For symptoms of serious illness (such as chest pain, blood loss, blacking out or choking) or for major accidents choose A&E or telephone 999.
Join ‘Change 4 Life’ to help you and your family get started on a happier healthier life. Send off for the information pack today by registering on the Change 4 Life website at www.nhs.uk/Change4Life or telephone 0300 123 1018 .
Be part of the ‘lifestyle revolution’ by passing on your enthusiasm and encouraging others to make the changes which can improve their health. If you live in one of the Enhanced Public Health Programme areas, find out about becoming a ‘Health Champion’ and support your family, neighbours and friends. For more information telephone: Nigel West on telephone number 0114 227 0551 or email him at [email protected]
We are interested in what you would like to see in terms of services to improve health and in working with you to make a difference to the health of your community. We encourage you to find out more about your local community assembly and how to get involved. A first step would be to visit the Council’s website on: http://www.sheffield.gov.uk/in-your-area/community-assemblies
45 Progress on recommendations from 2008
Diabetes NHS Sheffield and PBC Consortia should
Recommendation Progress (Sept 09)
Commission a model for enhanced diabetes The model is being developed in partnership care in primary care settings. with practice-based commissioners as part of their commissioning plans for 2009-10. This is to ensure people with diabetes are on optimal treatment to reduce cardiovascular disease risk and optimal blood glucose levels.
Improve outcomes in practices that have Included in the model above. more than 50% of people with diabetes having blood glucose levels greater than 7.5%.
Ensure eye screening service is A number of improvements have been appropriately resourced to produce high introduced in 2009-10 with further significant quality outcomes and accessible to enable expansion planned for 2010-11. All people with 80% of patients offered screening to take it diabetes are offered screening every year. up.
Offer comprehensive diabetes education Existing programme has been extended to programmes to all people with diabetes people from BME communities and people with (adults, young people and children) to established disease. Also raised awareness in support ongoing self-care. the general population via the ‘Save Your Life’ campaign.
Stroke NHS Sheffield and PBC Consortia should
Recommendation Progress (Sept 09)
Run local campaigns to raise awareness of Stroke awareness campaign underway together the symptoms of stroke using the FAST with additional targeted campaign with deprived test. and BME communities. General awareness raised via the ‘Save Your Life’ and ‘Know Your Numbers’ campaigns (linked to knowing and managing blood pressure). Commission TIA service running 7 days per New investment will come on-stream in week to provide rapid access to patients 2010-11. within 24 hours of onset of symptoms.
Commission a new pathway for acute Developing local hyper-acute response to services for stroke, ensuring equitable stroke as a medical emergency with new access to timely thrombolysis and specialist investment due to come on stream in 2010-11. stroke care.
Commission jointly across the City to Developments being worked up focussing on ensure patients who survive a stroke and long term needs of stroke survivors, access to their carers have access to timely support & early rehabilitation in or near own home, rehabilitation, and continue to receive the enhancing services in medium post stroke long term support services they need. period, support for carers and virtual integration of service provision.
46
Heart Disease NHS Sheffield and PBC Consortia should
Recommendation Progress (Sept 09)
Undertake a review of the diagnosis and New diagnostic and clinic follow-up pathway in treatment pathways for heart failure, atrial place for patients with suspected heart failure. fibrillation and chest pain. Next step is to review specialist nursing provision for heart failure. Completed national pilot work on case identification and treatment review for atrial fibrillation. Review of chest pain will commence later in the year.
Introduce a systematic approach to offering Phased implementation being taken forward vascular checks through primary care with phase one due to commence in October services. 2009 and full implementation by end of 2010- 11. Also raised broader awareness in general population through the ‘Save Your Life’ campaign.
Expand the active programmes nurse & This will be included in the review of chest pain therapist based service to support for patients with angina. individuals with heart disease.
Chronic Obstructive Pulmonary Disease NHS Sheffield and PBC Consortia should:
Recommendation Progress (Sept 09)
Commission an enhanced model of care in Working with practice-based commissioners the community that leads to proactive to develop a locally based service with the management of people with chronic intention of commissioning the service later in obstructive pulmonary disease (COPD). 2009-10. Also raised awareness in general population through the ‘Save Your Life’ campaign.
Provide increased access to supportive Increased access provided through existing technology for people with COPD. community nursing services and, in partnership with the Met Office, a project to provide early weather warnings for patients with mild/moderate COPD.
Sexual Health NHS Sheffield should
Recommendation Progress (Sept 09)
Develop sexual health provision in primary Approach being taken forward to support all care, including Chlamydia screening, ‘You’re GP practices in delivering chlamydia Welcome’ (young people friendly) screening, condom distribution, ‘You’re accreditation and condom distribution. Welcome’ accreditation and sign-posting to specialist contraceptive services.
Invest in the expansion of the chlamydia Programme expanded to increase coverage screening programme, community based STI including increasing the number of clinicians screening and testing and Long Acting trained and providing an enhanced
47 Reversible Contraceptive (LARC) provision. contraceptive review for vulnerable women.
Drugs The DAAT, as the commissioner of adult drug services on behalf of the Safer Communities Partnership is recommended to
Recommendation Progress (Sept 09)
Expand GP Shared Care Drugs and Now have 15 GP Practices and 13 Pharmacy Supervised consultation and Pharmacies participating respectively. This is needle exchange. facilitating expansion of the geographical reach of treatment services beyond the City centre.
Ensure the National Treatment Agency’s The NTA toolkit is still going through ‘Value for Money’ toolkit is used to underpin consultation on “Value for Money” in which the Sheffield 2009-10 Adult Treatment Plan. Sheffield DAAT has been an active participant; Sheffield DAAT commissioned services participated in the NTA’s unit costs exercise. Adult Drug & Alcohol treatment services are being re-tendered in line with national unit costs.
Alcohol The DAAT, as the commissioner of adult alcohol services on behalf of the Safer Communities Partnership is recommended to commission
Recommendation Progre ss (Sept 09)
Screening and brief intervention training in ‘Identification and Brief Advice’ training for all primary care in areas of highest health need GP practices commissioned in 2009-10. In and areas of increased alcohol-related crime addition, through NHS Sheffield 16 trainers and social disorder. trained to deliver in their own organisations (e.g. Police, Probation, Housing, and Sheffield Teaching Hospitals Foundation Trust) as well as providing additional capacity for delivering training to GP surgeries.
The use of brief interventions in primary care Brief interventions training commissioned for and across NHS services. all GP practices in 2009-10 together with Brief Interventions practice development for A&E staff. Additional service and referral pathway Waiting times for alcohol treatment have capacity to increase the number of treatment been benchmarked to maximum national places and reduce waiting times. waiting times for drug treatment of 3 weeks. Additional treatment places will be commissioned 2009/10 against the target of 4,200 by 2011. New investment to increase shared care, create a single service entry point, increase treatment places for psychosocial interventions and prescribing interventions and medically assisted withdrawal from alcohol. Alcohol medical services will be re-tendered in 2009-10. Enhanced support for carers was also commissioned by NHS Sheffield.
48 Tobacco NHS Sheffield should
Recommendation Progress (Sept 09)
Invest in additional stop smoking posts to New investment has had to be deferred to increase to increase the number of providers future years. However, the Sheffield Stop delivering brief interventions. Smoking Service exceeded its quit target for 2008-09 by 12% and good progress is being made in 2009-10.
Commission the systematic use of brief Redesign work undertaken to increase interventions and referral and to increase referrals from dentists, the Sheffield Teaching access to Nicotine Replacement Therapy. Hospitals Foundation Trust and targeted work with people from Black and minority ethnic communities.
Invest in social marketing and in different Social marketing campaign commissioned forms of proven stop smoking support. together with further market research focussing on young men in routine and manual occupations. Additional time-limited investment was secured to enhance communication around key ‘quit’ dates such as new year and ‘No Smoking Day’.
Invest in local and regional recommended Funding secured to employ a ‘Cheap and tobacco control initiatives. Illicit Tobacco’ enforcement officer based in Sheffield City Council and to provide further tailored social marketing work as part of a regional tobacco control campaign.
Adult Obesity NHS Sheffield should:
Recommendation Progress (Sept 09)
Commission Tier 1 population wide basic Existing investment in Tier 1 services are intervention and prevention through a being reviewed to improve targeting of Community Weight Management Service services, achieve better outcomes and (BMI 25-40). ensure value for money.
Commission Tier 2 specialist adult obesity New investment will come on-stream in Service for people with BMI >35 with co 2010-11. morbidities. Commission Tier 3 specialist adult obesity Since April 2009, commissioned as a surgery for those with a BMI >50. specialist service through the North Trent Commissioning Consortium.
49 Children and Young People NHS Sheffield and Sheffield City Council should prioritise investment in the following areas
Recommendation Progress (Se pt 09)
Introduce city-wide programme to reduce Following successful application to the childhood obesity (focussing on weight national Healthy Communities Challenge management and early intervention). Fund, funding secured to implement ‘Healthy Towns’ model.
Develop early intervention and prevention Programme expanded to enable schools to work in school settings using the Healthy deliver primary prevention and early Schools, whole-school approach model. intervention to pupils. This includes establishing the ‘Aspire for Life’ programme, targeted mental health support in two families of schools and further support into primary schools with high levels of overweight and obesity. New investment also made into mainstream public health services.
Child health promotion programme (linked to New commissioning arrangements will be maternity, health visitor, school nursing and implemented as part of the Child Health immunisation services). Review. Implementation scheduled to start in October 2009.
Support services for disabled children and Health Needs Assessment undertaken and their carers including short breaks and respite recommendations fed into the ‘Aiming High’ care. strategy for children with disabilities. This will also inform the strategy for children with additional needs.
Development of age-appropriate mental Review and redesign of the Child and health services, mental health promotion and Adolescent Mental Health Service being early intervention. undertaken, including for 16-17 year olds.
50 Enhanced Public Health Programmes Recommendation Progress (Sept 09)
Support the sustainability and further New investment secured for mainstream development of the Enhanced Public development from NHS Sheffield and for 2009-10 Health Programmes (EPHPs). programme development from the Sheffield City Council Area Based Grant and Communities for Health Fund. Further invest in primary care Within the resources identified above, lifestyle interventions within EPHP areas, such programmes including community stop smoking as the community Stop Smoking services are prioritised. service.
Increase investment in interventions Within the resources identified above, interventions which focus on communities of interest. which focus on communities of interest, principally improving access to and uptake of services by people from BME communities is prioritised.
Further invest in building community Within the resources identified above, a number of capacity and infrastructure. interventions to strengthen infrastructure are being taken forward – in particular, ‘Health Champions’ and ‘Health Trainers’.
Learning Disabilities Sheffield City Council and NHS Sheffield should:
Recommendation Progress (Sept 09)
Produce a joint needs analysis of Analysis of people with complex needs and people with learning disabilities. profound and multiple disabilities published earlier. Analysis of people with autistic spectrum disorder informed the Autism Strategy. Analysis of people with challenging behaviour informed the publication of the Challenging Behaviour Strategy. Further analysis of the population will occur in relation to a planned review of the Community Learning Disability Teams Commission new approaches to PMLD Development Team is targeting work with providing for the needs of those with the people with the most complex PMLD needs. most profound and multiple disabilities. Currently working on prevention of out of town placements through the Out Of City Team. Looking at the health interventions that will be offered through respite care (short breaks) for people with profound and multiple impairment, challenging behaviour and autism. Invest in improvements in respite and Redesign work being undertaken to develop a new challenging behaviour services for model for assessment and treatment services, people with learning disabilities including looking at the potential for including those with complex needs. relocation/improvement to current facilities and identifying best practice models and pathways of care through joint commissioning plans. Development of a Short Break Strategy to remodel the current respite service. Implement a Direct Enhanced Service Virtually all practices in Sheffield expressed an (DES) in general practice for annual interest in delivering the DES. Consequently, in health checks for people with learning excess of 300 GPs and practice staff have been disabilities. trained and the specification developed. Implementation will taken place over 2009-10.
51 Mental Health Sheffield City Council and NHS Sheffield should expect to make commissioning decisions in the following areas:
Recommendation Progress (Sept 09)
Mental health promotion and suicide Through a combination of new investment prevention, joint working between primary and and redesign, the on-going development of secondary care, day services and the following areas is being supported in employment opportunities, acute in-patient 2009-10: Improving Access to Psychological services and alternatives to in-patient Therapies service (IAPT), appointment of a admission and specialist services, including medical advisor for IAPT, mental health first maternal mental health, eating disorders and aid training, re-modelling of day services personality disorders. (linked to promoting social inclusion and employment), reducing pressure on acute hospital services and improving services for people with personality disorder.
52 Older People Sheffield City Council and NHS Sheffield should: Recommendation Progress (Sept 09) Develop the citywide The new model of bed-based intermediate care opened at Intermediate Care Service. Beech Hill in June 2009. The unit is available for both ortho- medical and stroke patients. Procurement of a range of community based services will commence later in the year.
Jointly commission relevant A locally enhanced GP service (LES) has been commissioned actions in the Sheffield for people in residential care homes. A social marketing Strategy for an Ageing campaign has been undertaken with results expected later in Population. the year. The dementia and functional illness strategies are in the process of being implemented. A Falls Co-ordinator is now in post and falls pathway development in place. The South Yorkshire Energy Network were commissioned to train local health practitioners in affordable warmth. South Yorkshire Fire and Rescue Service firefighters have also been trained in affordable warmth and supporting smoking cessation.
Develop a prevention Prevention strategy completed covering joint case funding and strategy to support older risk reduction affecting support for carers re-enablement; people to live independently effective rollout of the assistive technology strategy; at home. underpinned by robust evaluation of effectiveness of intervention. Implementation plan in place.
Physical, Sensory and Cognitive Disability Sheffield City Council and NHS Sheffield should:
Recommendation Progress (Sept 09)
Initiate a formal joint needs Initial scoping of the range of conditions, population groups, assessment of people with data sources and services to be included undertaken. physical sensory and Limitations of systematic data sources identified, some of which cognitive disabilities in require national solutions. An interim local approach is being Sheffield. piloted for people with Parkinson’s Disease and Parkinsonism.
Carers Sheffield City Council and NHS Sheffield should: Recommendation Progress (Sept 09)
Commission flexible breaks NHS Sheffield has not been able to commission carer breaks for carers. this financial year. Funding is due to come on stream again in April 2010 and the PCT will be reviewing this in the new financial year.
Produce information for In partnership with the City Council, Sheffield Teaching carers in health and social Hospitals and the Carers Centre, NHS Sheffield commissioned care settings. a DVD to highlight carers issues. This will be used as part of staff training within the Teaching Hospital. The DVD features carers talking about their caring responsibilities and how medical staff can help them in their caring role when they visit the hospital. NHS Sheffield and the Carers Centre have been disseminating carer support information, such as leaflets and display boards to GP practices across the City. Carers Centre link workers have been talking to practice staff on identifying and supporting carers.
53 Increase carer identification GP practice carer protocols have been reviewed as part of the and support of carers within Quality Outcomes Framework to increase and strengthen carer primary care. identification.
NHS Sheffield in partnership with the Drug and Alcohol Action Team, Relatives of Drug Abusers and the Sheffield Alcohol Advisory Service has set up a support group for those looking after people with alcohol addiction. This meets regularly and provides emotional and practical support to family and friends.
Work is also being taken forward to develop long term support for people who have had a stroke and their carers, and developing support for those looking after someone with a mental health problem. The PCT has applied to pilot a national programme for personal health budgets for those receiving continuing healthcare and for those with long term conditions. Key partners for this will be service users and their carers, and this work will increase support to carers.
Finally, good progress has been made on developing a citywide carers’ strategy. Consultation will take place over Autumn 2009.
54 Sheffield Health and Wellbeing Atlas
The Sheffield Health and Well-being Atlas is an interactive display of health data for all community assemblies, electoral wards, neighbourhoods and service districts in Sheffield. If you want to find out more details about the health of your area you can access it through the web site: http://www.sheffield.nhs.uk/atlas
Data are grouped under the headings of births, dental health, deprivation, disease groups, education, environment, housing, life expectancy, mortality, and population. Data are available for several years for some geographies allowing time trend analysis.
The Atlas contains themed maps, data tables, trend tables, graphs covering all of the areas, and graphs showing the quintiles of areas, details of data sources and data notes. See the user guide for full instructions on how to use the Sheffield Health Atlas »
There are several options for viewing the data. You can easily move between different types of views, different geographies and different time periods.
A Single map view allows you to look at a single area.
A Double map view allows you to look at the relationship between two different indicators or time periods.
An Area Profiles view is a bar chart display showing all of the indicators on one page and a comparison to the base Sheffield value. It also allows comparison between two areas.
Please note: to use the Atlas you will need to have Adobe Flash version 8 or higher viewer installed on your PC. They are available to download for free from Adobe Flash Player and Adobe Reader
55 More Information
More Information Your Views
An on-line version of this report, and the We’re keen to hear your views on summary version are available at the the report. If you would like to following web site: make any comments please www.publichealthsheffield2009.nhs.uk contact the Director of Public Health:
The following applications will be Dr Jeremy Wight needed to view the report in full. They Director of Public Health are available to download for free via the NHS Sheffield links below: 722 Prince of Wales Road Sheffield • Adobe Flash Player S9 4EU • Adobe Reader Email: [email protected] Telephone: (0114) 305 1000 More copies of the summary version of the report can be obtained from:
Dr John Skinner NHS Sheffield Email: [email protected] Telephone: (0114) 305 1044
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