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Southend Localities Needs Profile

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Southend Localities Needs Profile Southend Localities Needs Profile: West Central Authors Sally Watkins, Senior Public Health Intelligence Analyst October 2017 1 Acknowledgements The authors of this report wish to thank the following people who have contributed to this report: Andrea Bann, NHS Southend CCG Chris Campos, NHS Southend CCG DACTeam, Southend Borough Council Gemma Robinson, Community Safety Officer, Southend Borough Council Lee Watson, Health Improvement Practitioner Advanced, Southend-on-Sea Borough Council Luke Wood, Business Intelligence Officer, Department for people, Southend Borough Council Pearl Ray, Health Checks Co-Ordinator, Southend-on-Sea Borough Council Samantha Reed, Adaptations Officer, Southend-on-Sea Borough Council Simon Ford, Senior Public Health Manager (Sexual Health), Southend-on-Sea Borough Council Tim Winters, Head of Public Health Information, Public Heath, Norfolk County Council Tony Mardle, Stop Smoking Service Manager, Southend Borough Council With special thanks to Thurrock Council Public Health Information Team 2 Contents Acknowledgements 2 1. INTRODUCTION 7 2. BACKGROUND 8 PART 1: WHAT ARE THE NEEDS OF OUR POPULATION? 9 3. DEMOGRAPHY 9 3.1 Age and sex distribution of the current population 9 3.2 Ethnicity 10 3.3 Fertility Rate 11 3.4 Pensioners living alone 12 3.5 Care Homes 13 3.6 Population projections 14 3.7 How can the new Primary Care Centre help? 15 4. WIDER DETERMINANTS OF HEALTH 16 4.1 Deprivation 16 4.1.1 How does deprivation impact on health? 16 4.1.2 Deprivation in West Central Locality 17 4.2 Housing 17 4.2.1 How does poor housing impact on health? 17 4.2.2 Persons per household 18 4.2.3 Overcrowded Households 18 4.2.4 Households with central heating 19 4.2.5 Needs of residents living in West Central Locality council homes 20 4.2.6 Future known housing developments 20 4.3 Employment 21 4.3.1 How does employment impact on health? 21 4.3.3 Benefits claimants 21 4.4 Education and skills 23 4.4.1 How do education and skills impact on health? 23 4.4.2 Good level of development 23 4.4.3 Residents with no qualifications 23 4.4.4 Digital skills 24 4.5 Air Quality 24 4.5.1 How does air quality impact on health? 24 4.5.2 Air quality in West Central Locality 25 4.6 Crime 25 4.6.1 How does crime impact on health? 25 4.6.2 Crime in West Central Locality 26 4.7 Access to Transport 27 4.7.1 How does accessing services impact on health? 27 4.7.2 Accessibility in West Central Locality 27 3 4.8 Summary of needs: Wider Determinants of Health; How can the new West Central Primary Care Centre help? 27 5 HEALTH LIFESTYLE BEHAVIOUR 30 5.1 Breastfeeding 30 5.1.1 How does breastfeeding impact on health? 30 5.1.2 Breastfeeding prevalence 30 5.2 Smoking 30 5.2.1 Smoking Prevalence 30 5.2.2 How does smoking impact on health? 32 5.2.3 The financial impact of smoking 32 5.2.4 Use of current commissioned stop smoking services 33 5.3 Obesity 34 5.3.1 How does obesity impact on health? 34 5.3.2 Child obesity Prevalence 35 5.3.3Adult Obesity Prevalence 37 5.3.4 Use of current services 37 5.4 Substance Misuse 38 5.4.1 Current service 39 5.4.2 How does substance misuse impact on health? 39 5.5 Sexual Health 40 5.5.1 Sexual Health in West Central locality 40 5.5.2 Teenage Pregnancy 41 5.5.3 Current Services 41 5.5.4 How does poor sexual health further impact on health? 42 5.5.5How does teenage pregnancy impact on health? 43 5.6 Summary of needs: Health Lifestyle Behaviour; How can the new West Central Primary Care Centre help? 44 6. EPIDEMIOLOGY – The Current Disease Burden Experienced by People in West Central Locality 45 6.1 Self-reported health 45 6.2 Life expectancy 46 6.2.1 Males 46 6.2.2 Females 47 6.2.3 Premature mortality 48 PART 2: WHAT DO WE CURRENTLY HAVE AND HOW DO WE USE IT? 49 7. PRIMARY CARE 49 7.1 General Practice 49 7.1.1 General Practice Workforce - 51 - 7.1.2 Practice Nurses - 52 - 7.2 Long Term Conditions Management Clinics - 53 - 7.3 Pharmacies - 54 - 7.4 Dentists - 55 - 4 7.4.1 Current Dental Provision - 55 - 7.4.2 Use of Current Provision - 56 - 7.5 Opticians - 57 - 7.6 Primary Care Out of Hours Service - 57 - 7.6.1 Current Service Provision - 57 - 7.6.2 Use of Current Service - 58 - 7.7 Summary of Current Primary Care Provision - 59 - 8. LONG TERM CONDITIONS AND THEIR MANAGEMENT - 61 - 8.1 Long term conditions in West Central Locality - 61 - 8.2 Non-diagnosed Long Term Conditions - 61 - 8.3 Quality Outcomes Framework (QOF) - 63 - 7.4 Clinical Management of Patients with Hypertension - 64 - 7.4.1 Summary of hypertension care. - 71 - 8.5 Clinical Management of patients with Heart Failure (HF) and Atrial Fibrillation (AF) - 72 - 8.5.1 Summary of HF and AF Care - 78 - 8.6 Clinical Management of Stroke, Transient Ischaemic Attack (TIA) - 78 - 8.6.1 Stroke care summary - 84 - 8.7 Clinical Management of Patients with Diabetes - 85 - 8.7.1 Summary of Diabetes Care - 91 - 8.8 Care of Patients with Respiratory Disease - 92 - 8.8.2 Summary of respiratory care - 98 - 9. MENTAL HEALTH AND WELLBEING - 99 - 9.1 Mental Ill Health prevalence - 99 - 9.1.1 Recorded Prevalence of Depression - 99 - 9.1.2 Prevalence of Serious Mental Ill Health (SMI) - 100 - 9.2 Referral of Patients with Depression to Talking Therapies - 101 - 9.3 Clinical Management of Patients with Mental Ill Health including depression and dementia in Primary Care - 101 - 9.4 Mental ill health and co-morbidities - 108 - 9.5 Mental health and wellbeing summary - 110 - 10. SECONDARY CARE - 111 - 10.1 Current Service Provision - 111 - 10.2 Outpatients Clinics - 111 - 10.3 A&E Attendance - 112 - 10.3.1 A&E Attendances that could have been treated elsewhere - 114 - 10.3.2 A&E Diagnoses (all HRG coded attendances) - 116 - 10.4 Unplanned Care Admissions - 117 - 10.5 Summary – Secondary Care - 119 - Bibliography - 120 - Appendix 1 – List of Figures - 122 - Appendix 2 – List of Tables - 126 - 5 Appendix 3 - 127 - 6 1. INTRODUCTION This report was requested by NHS Southend Clinical Commissioning Group and Southend- on-Sea Borough Council to assess the health and wellbeing needs of the population of the West Central Locality. The West Central Locality is comprised of the following Wards: Blenheim Park Chalkwell Milton Prittlewell St Laurence Westborough This report aims to examine the quality of the current primary care provision and the defined ‘blue print’ for a new Primary Care Centre which would encompass services and enhance primary care facility together with wellbeing services and potentially other clinical and social services traditionally provided in alternative settings. It is divided into 3 parts: Part one considers the needs of the population of West Central locality Part two considers the current level of service provision and how it is being used Part three attempts to define a possible future ‘blue print’ for a new Primary Care Centre. 7 2. BACKGROUND There are eight GP practices in the West Central locality. We know that under-doctoring and nursing is a huge issue and people are waiting for an unacceptable length of time in order to obtain a GP appointment. We also know that if people cannot get a GP appointment they are more likely to use more expensive parts of the system such as A&E, and that under-doctoring leads to a reduced ability of GP practices to care proactively for patients with long term conditions, increasing the risk of patients experiencing an adverse event. In Southend we have a vision to provide more integrated health and social care services, and provide a more holistic population health approach to the way in which we commission services. In West Central our vision is to create a new Primary Care Centre which incorporates Primary Care, but also aspects of Secondary Care, and wellbeing services to address to underlying causes of ill-health. Influences on health and wellbeing can be thought of as a chain of events set out in figure 1. This report is structured to mirror this chain of events. Figure 1: Influences on health and wellbeing chain of events 8 PART 1: WHAT ARE THE NEEDS OF OUR POPULATION? 3. DEMOGRAPHY 3.1 Age and sex distribution of the current population Data from October 2016 shows that the practice registers for the GPs in West Central have a combined population of 34,929 patients (NHS Digital, October 2016). 51.3% are male and 48.7% are female. When looking at the age breakdown of this population, it can be seen there are some differences compared to the rest of the Southend-on-Sea population. West Central has a smaller proportion of children and young people under 25 years, and a larger proportion of adults of working age, particularly males between 25 and 54. The population of people aged over 65 is similar to Southend-on-Sea, although slightly lower for females. Figure 2: West Central Locality GP Registered Population by Age and Sex, October 2016 Data Source: NHS Digital When comparing the GP registered figures to the ONS population estimates of the 6 wards that are in West Central Locality, the GP registers have a much lower number registered (34,929) compared to the ward population size (64,219, ONS Mid-Year Estimates, 2015).
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