Ipswich and East Clinical Commissioning Group Equality and diversity information – January 2014

Our Public Duty

Under the Equality Act 2010 (Specific Duties) Regulations 2011, there is a specific duty the and East Suffolk CCG to publish its equality information annually. This specific public sector equality duty is intended to enable public authorities to demonstrate their compliance with the general public sector equality duty.

Under the duty to publish equality information, a public authority must publish information no later than 31 January 2014 to demonstrate its compliance with the general equality duty including, in particular, information relating to persons who share a relevant protected characteristic who are its employees; and/or other persons affected by its policies and practices (such as patients)

NHS Ipswich and East Suffolk CCG equality data

People in Ipswich and east Suffolk are relatively healthy compared to those in other parts of the country although there are still some significant issues to be addressed, including tackling health inequalities in some areas. In addition, the growth in the elderly population brings with it extra demands for age-related services and support.

Life expectancy at birth for Suffolk in 2007-09 for both males and females was higher than in as a whole by 2 and 1.5 years respectively. However, there are significant health inequalities with a 5.5 year gap for men and a 4.3 year gap for women in life expectancy between those living in the most deprived areas, many of which are in Ipswich, and the least deprived areas.

The main causes of death in the Ipswich and East Suffolk area are similar to England with over three quarters of all deaths caused by cancer, circulatory disease (including coronary heart disease and stroke) and respiratory diseases. Coronary heart disease (CHD) is the most prevalent cause of health inequalities in NHS Suffolk, and cancer is the leading cause of premature mortality.

This document outlines some of the key demographic information about Ipswich and east Suffolk’s communities, where this information is available. Information and data is collated from: Equality and diversity data summary (Public Health), October 2012, Ipswich and East Suffolk CCG Equality and Diversity Plan 2012-15 and NHS Suffolk Diversity toolkit to support commissioning, December 2011.

Age Age discrimination can be direct when a person is treated less favourably because of their age or indirect where care is offered in such a way that a particular age group is more heavily disadvantaged than people in other age groups.

Page 1 of 16

At 1 July 2013, 392,790 patients were registered with a GP in Ipswich and east Suffolk. Of these 109,202 (27.8%) were aged 24 years or under and 80,866 (20.5%) were aged over 65 years.

Page 2 of 16

The age distribution of the east Suffolk population (excluding Ipswich) includes a lower proportion of children and young people (up to age 44 years) and a higher proportion of middle-aged and elderly people compared with Suffolk overall and with England. The age distribution of the Ipswich population is similar to that of England but has a higher proportion of children and young people (up to age 44 years) and a lower proportion of middle aged and elderly people compared with Suffolk overall.

The population of east Suffolk (excluding Ipswich) is projected to increase by 16-32% between 2008 and 2031. The projected population growth will be accompanied by substantial growth in the elderly population. The population of Ipswich is also growing and is projected to increase by 33% between 2008 and 2031. However, the projected population growth will not be accompanied by substantial change in the population age distribution.

Disability Disability can arise from many health problems including hearing and visual impairment, physical disabilities both congenital and acquired, and learning difficulties. People’s needs vary greatly and many people will experience several disabilities or be caring for another family member or friend with health problems (NHS Suffolk & Arana Ltd, 2009).

Physical disability The Department of Health defines physical disability as a physical impairment, which has a substantial and long-term effect on individuals’ ability to carry out day-to-day activities. People with physical disability may experience difficulties with access to care, and communication as well as poorer levels of self reported health and an increased risk of depression.

Projecting Adult Needs and Service Information (PANSI) have produced prevalence estimates for moderate (e.g. unable to manage stairs, and need aids or assistance to walk) and serious (e.g. unable to walk and dependent on a carer for mobility) physical disability in England based on the Health Survey for England 2001.

The estimates show a clear relationship between physical disability and age, with the prevalence of moderate physical disability increasing by a factor of 4 between the ages of 18 and 64 and serious disability increasing by a factor of 7 (see graph overleaf).

Page 3 of 16

It is estimated that in Ipswich and east Suffolk there are 18,840 people with a moderate physical disability and 5,692 people with a severe physical disability.

Mental health People with mental health disorders and disabilities have a higher risk of poor physical health and premature mortality than the general population (Phelan et al, 2001). Reasons for this include the impact on physical health of deprivation and poverty, but also associated lifestyle behaviours with poor nutrition, obesity, higher levels of smoking, heavy alcohol use and lack of exercise contributing to higher rates of morbidity and life expectancy among people with mental health problems (Friedli and Dardis, 2002).

The prevalence of different types of mental health disorders experienced by the population can be seen below (PANSI 2011). There are large variations in prevalence between disorders and gender (see graph overleaf).

In Ipswich and east Suffolk it is estimated that there are approximately 45,766 people with common mental health disorders; 1,279 people with a borderline personality disorder; 998 people with antisocial personality disorder; 1,137 with psychotic disorders and 20,477 with psychiatric comorbidity.

Page 4 of 16

Learning disability The term learning disability (LD) is used to describe a significant, lifelong experience that has three components:

 significantly reduced ability to understand new or complex information, to learn new skills (significantly impaired intelligence), and  reduced ability to cope independently (impaired social/adaptive functioning), and  onset before the age of 18 years, with a lasting effect on development (National Institute for Health and Clinical Excellence, 2009)

People with LD have higher rates of mental health problems, respiratory and heart disease, higher levels of obesity and may have additional physical disability (Royal College of Nursing, 2011) and therefore shorter life expectancy and higher risk of premature death.

Evidence suggests that nationally the number of people with severe LD may increase by around 1% per annum for the next 15 years as a result of:

 increased life expectancy, especially among people with Down’s syndrome  growing numbers of children and young people with complex and multiple disabilities who survive into adulthood

Page 5 of 16

 a sharp rise in the reported numbers of school-aged children with autistic spectrum disorders, some of whom will have learning disabilities  greater prevalence among some populations of South Asian origin. (Emerson and Hatton, 2004)

Dementia The term ‘dementia’ is used to describe a collection of symptoms, including a decline in memory, reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. These symptoms are caused by structural and chemical changes in the brain as a result of physical diseases such as Alzheimer’s disease. Dementia can affect people of any age, but is most common in older people. Dementia is a progressive condition and has a disproportionate impact on capacity for independent living (LSE; KCL & Alzheimer’s Society 2007).

Page 6 of 16

Dementia beginning before the age of 65 is known as early onset dementia and although rare does affect people in their 30s.

Estimated number of people with early onset dementia in Ipswich and east Suffolk, as of September 2011:

Age East group Suffolk Ipswich Total 30-34 1 1 2 35-39 1 1 2 40-44 2 2 4 45-49 5 3 8 50-54 9 6 15 55-59 20 13 33 60-64 27 15 42 Total 66 40 106

It should be noted that 6.1% of all people with dementia among BME groups in the UK are early onset, compared with only 2.2% for the UK population as a whole, reflecting the younger age profile of BME communities.

Page 7 of 16

Serious visual impairment People with severe visual impairments may experience difficulties with access to care, and communication.

It is estimated that there may be approximately 6,861 people with a moderate or severe visual impairment in Ipswich and east Suffolk.

Hearing impairment People with hearing impairments may experience difficulties with access to care, and communication.

The definition of hearing impairment includes:  Moderate deafness: People with moderate deafness have difficulty in following speech without a hearing aid. The quietest sounds they can hear in their better ear average between 35 and 49 decibels.  Severe deafness: People with severe deafness rely a lot on lip reading, even with a hearing aid. British Sign Language (BSL) may be their first or preferred

Page 8 of 16

language. The quietest sounds they can hear in their better ear average between 50 and 94 decibels.  Profound deafness: People who are profoundly deaf communicate by lip reading. BSL may be their first or preferred language. The quietest sounds they can hear in their better ear average 95 decibels or more.

Gender reassignment According to the 2010 review of evidence of the equality strands in the East of England:

“Transgender people are highly susceptible to depression and more than one in three adult transgender people (34%) have attempted suicide (DoH 2007). Discrimination and prejudice in every-day lives also places many transgender people at risk of alcohol abuse, self harm, violence, substance abuse and HIV (DH 2007). Transgender people, especially those in need of gender reassignment services, require access to specific health services such as assessment, counselling or psychotherapy, hormonal treatments, and gender reassignment surgeries. Evidence suggests that large numbers

Page 9 of 16 of transgender people face a high level of discrimination when accessing these services.”

Data is not currently collected on the number of transgender people in England. Moreover, many people who have been through the gender reassignment process may not wish to be identified as transgender, but as male or female. Estimates vary from 0.1% to 0.6% for all adults ( County Council, 2011). By applying these estimates to Ipswich and East Suffolk CCG, it is estimated that there may be 388 to 2,328 transgender people.

Pregnancy and maternity In 2012 there were 4,256 births in Ipswich and east Suffolk, a 14% increase on 2003.

Race Race and ethnicity can have a variety of impacts on a person's health, from the way they are treated in the health service to a person's susceptibility to conditions or diseases.

Page 10 of 16

There is evidence which shows that certain health conditions including high blood pressure, diabetes and coronary heart disease (CHD) are more common in BME communities living in Britain and therefore these communities are at higher risk of ill health than the rest of the population. (NHS Scotland 2011).

Many BME groups also experience higher rates of poverty, in terms of income, benefits use, worklessness, lacking basic necessities and area deprivation. Much of the variation in self-reported health between and within BME groups can be explained by differences in socio-economic status. However, there is a complex interplay of factors affecting ethnic health, such as the long-term impact of migration, racism and discrimination, poor delivery and take-up of health care, differences in culture and lifestyles, and biological susceptibility (Parliamentary Office for Science and Technology, 2007).

2013 data estimates based on ONS estimates are now available for the Ipswich and East Suffolk CCG commissioning area. According to these estimates, the largest black and minority ethnic group in Ipswich is White: Other White(12,093), followed by Asian/Asian British(8,702)

Population at a county and local authority level by ethnic group for 2013 estimated that 8.86%(34,199) of the NHS Ipswich and East Suffolk population were from a non-white British ethnic group.

Data held on the number of calls made to NHS Suffolk’s telephone interpreting service can give an indication of the range and prevalence of particular communities. In 2011/12, Polish (31%), Kurdish (10.2%) and Lithuanian (12.3%) accounted for the greatest number of calls.

Page 11 of 16

Gypsies and travelers Gypsies and Travelers experience some of the worst health in all BME groups, (Suffolk Travelers’ Health Needs Assessment 2009). On average, Gypsy and Traveler infants are 2-3 times more likely to die than infants in the general population. Twice as many Gypsies and Travelers report anxiety or depression compared to the general population. Up to 16% are not registered with a GP, and immunisation rates are low. Barriers to healthcare access include low levels of literacy and fear of racism (NHS Suffolk Annual Public Health Report, 2008)

Approximately 10% of Gypsies and Travelers in the Eastern region live in Suffolk giving a total estimated population of between 3,000-5,000 Gypsies and Travelers in the county as a whole.

Religion or belief There is now very current data on religious diversity 2013 data for Ipswich showed Christianity as the largest proportion at 235,854 (60%), with the Muslim population of Ipswich and East Suffolk standing at 4,314 (1.09%).

Page 12 of 16

Sex The proportion of males and females in Ipswich and east Suffolk is equal at 31 March 2012. There are more females in each age group with the exception of those aged 0-4 years, however this gap becomes more significant in the age group 75-84 years (2.8% more females) and over 85 years (13.4% more females).

Sexual orientation Lesbian, gay and bisexual people experience a number of health inequalities which are often unrecognised in health and social care settings (Department of Health, 2007).

 Lesbians are more likely to have smoked and to drink heavily than women in general. At various ages they are less likely to have had a smear test and more likely to have had breast cancer. Levels of self harm and suicide are significantly higher than in the wider population (Stonewall, 2008).  Gay men may have higher rates of drug, tobacco and alcohol use, which may increase their risk of lung and liver cancer. They may be more susceptible to eating disorders and have higher rates of mental health problems (DH 2007).

Page 13 of 16

 Evidence shows a two fold excess in suicide attempts in lesbian, gay and bisexual people, the risk for depression and anxiety disorders are at least 1.5 times higher, and alcohol and other substance dependence is also 1.5 times higher (Mental Health: 2009 Annual Public Health Report, NHS Suffolk)

Estimates for the lesbian, gay or bisexual population in England vary from 0.3% to 7%. By applying these estimates to the number of registered patients in Ipswich and east Suffolk, it is estimated that there may be 1,164 – 27,160 lesbian, gay or bisexual people in Ipswich and east Suffolk.

Inequalities Groups suffering inequality, particularly health inequality, are not limited to the nine protected characteristics listed in 2.2 above. We will take an inclusive approach which will not only deliver on our legal obligations but also support our work to improve the quality of services and address health inequalities.

We will extend our analysis and engagement beyond the protected characteristics to other groups and communities who face stigma and challenges in accessing, using or working in the NHS, such as carers, the homeless and those living in areas of deprivation. Ararna was commissioned in 2009 to map ‘hard to reach groups’ in Suffolk and the common themes experienced by those groups in accessing health care. This can be seen in diagram one overleaf.

Deprivation, for example, can be a key factor in health inequality. While wards in Ipswich can be clearly defined for their level of deprivation, there is ‘hidden’ deprivation in rural areas of east Suffolk where the data is not statistically significant. The CCG will work, through this strategy and with its partners, to define other factors to health inequality and develop actions accordingly.

Page 14 of 16

References Parliamentary Office for Science and Technology. (2007) Ethnicity and health, Number 276. http://www.parliament.uk/documents/post/postpn276.pdf (accessed 3rd November 2013)

Kings Fund (2000) Briefing note: age discrimination in health and social care. http://www.kingsfund.org.uk/publications/age.html (accessed 10th November 2013)

Office for National Statistics (2010) – 2008 based sub-national population projections http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Sub- national+Population+Projections (accessed 3rd November 2013)

NHS Suffolk and Arana Ltd (2009) Improving GP access for marginalised communities. National Institute for Health and Clinical Excellence (2009) QOF briefing paper 2010/11: learning disability http://www.nice.org.uk/media/F40/35/QOFAdvisoryCommitteeBriefingPaperLearningDis ability.pdf (accessed 01-11-13)

Royal College of Nursing (2011) Meeting the health needs of people with learning disabilities - RCN guidance for nursing staff www.rcn.org.uk/__data/assets/pdf_file/0004/78691/003024.pdf (accessed 4th November 2013)

Emerson, E. and Hatton, C. (2004) Estimating future need/demand for support for adults with learning disabilities in England. Institute for Health Research, Lancaster University http://www.lancs.ac.uk/shm/dhr/research/learning/download/estimatingfutureneed.pdf (accessed 2nd November 2013)

Institute of Public Care (2011) Projecting adult needs and service information http://www.pansi.org.uk/ (accessed 19th October 2013)

Institute of Public Care (2011) Projecting older people population information http://www.poppi.org.uk/ (accessed 20th October 2013)

S. McManus et al. 2009 Adult psychiatric morbidity in England 2007: results of a household survey estimates. (Leeds the information centre) referenced in NHS and Waveney mental health needs assessment 2013. (Pg.40)

Friedli, L and Dardis, C. (2002) Not all in the mind: mental health service user perspectives in mental health, Journal of Mental Health Promotion, 1, 1, pp. 36-46

London School of Economics; Kings College London & Alzheimer’s Society 2007). Dementia UK: the full report. http://alzheimers.org.uk/site/scripts/download_info.php?fileID=2 (accessed 4th November 2013)

NHS Scotland (2011)http://www.healthscotland.com/equalities/race.aspx (accessed 3rd November 2013)

Page 15 of 16

Office for National Statistics (2011) Population estimates by ethnic group mid-2009 for primary care organisations (experimental) http://www.ons.gov.uk/ons/rel/peeg/population-estimates-by-ethnic-group--experimental- /current-estimates/population-estimates-by-ethnic-group-mid-2009-for-primary-care- organisations--experimental-.xls (accessed 4th November 2013)

Department for Work and Pensions (2011) National Insurance number allocations to adult overseas nationals entering the UK http://research.dwp.gov.uk/asd/asd1/niall/index.php?page=nino_allocation (accessed 4th November 2013)

NHS Suffolk (2009). Suffolk Travellers’ health needs assessment 2009.

NHS Suffolk (2008). 2008 NHS Suffolk annual public health report: health inequalities and diversity in Suffolk. http://www.suffolkobservatory.info/JSNASection.aspx?Section=82&AreaBased=False (accessed 15th November 2013)

Ahmed, T. Cock, J.C. Irurita, M.I. Hammerton, C. and Pilmer. B. (2010) A review of evidence of the equality strands in the East of England. http://www.edf.org.uk/blog/wp- content/uploads/2010/12/A-review-of-Equalities-Evidence-final-design.pdf (accessed 3rd November 2013)

NHS Suffolk (2009). Mental health: 2009 annual public health report http://www.suffolkobservatory.info/JSNASection.aspx?Section=82&AreaBased=False (accessed 14th November 2013)

Stonewall (2008) Prescription for change: lesbian and bisexual women’s health check 2008. http://www.stonewall.org.uk/documents/prescription_for_change_1.pdf (accessed 15th November 2013)

Department of Health (2007) Reducing health inequalities for lesbian, gay, bisexual and transgender? people - briefings for health and social care staff. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGui dance/DH_078347 (accessed 14th November 2013)

Huntingdonshire County Council (2011). Equality mapping: potential inequalities faced by people who are lesbian, gay, bisexual and transgender (LGBT) in Huntingdonshire. http://www.huntingdonshire.gov.uk/SiteCollectionDocuments/HDCCMS/Documents/Polic y%20documents/Equality%20Impact%20Assesment/Lesbian%20Gay%20Bisexual%20T ransgender%20equality%20mapping%20in%20Huntingdonshire.pdf (accessed 16th November 2013)

Page 16 of 16