THE HEALTH OF THE PEOPLE OF WEST DUNBARTONSHIRE Needs Assessment Report August 2007 Contents Page No. Foreword 2 SUMMARY 4 1. Introduction and general aspects 16 2. Historical aspects and geography 20 3. Demography and socio-economic determinants of health 21 4. Life-style and behaviour 26 5. Mortality and life-expectancy 31 6. Cancer 33 7. Coronary Heart Disease 36 8. Cerebrovascular Disease - Stroke/TIA 46 9. Diabetes 50 10. Chronic Obstructive Pulmonary Disease 52 11. Child Health 55 12. Mental Health 56 13. Local provision of Primary Care Services 59 14. Local provision of Secondary Care Services 61 15. Activity in Secondary Care 62 16. Waiting lists 66 17. Palliative care 67 18. Healthcare provided by the independent sector 71 19. Transport and Access 73 20. Conclusions 75 21. Recommendations 76 22. Bibliography 79 23. Appendices 82 1 Foreword Understanding the health needs of communities is pivotal to designing and developing effective interventions and services to improve population health and reduce health inequalities. In Autumn 2006 the Scottish Executive requested that the NHS undertake a comprehensive analysis of the health needs of the North of Clyde population. The work consequently undertaken by NHS Greater Glasgow and Clyde and detailed here concerns the West Dunbartonshire component of that geography. In tandem with this, a parallel piece of work was undertaken and has been reported by NHS Highland for the relevant population residing within their area of responsibility. Staff in both areas have worked together throughout this process and both reports should be considered together. This has provided us with a valuable opportunity to take an in-depth and objective look at the health status of the communities of West Dunbartonshire. Its findings highlight significant challenges for all stakeholders (public bodies, private business, voluntary organisations and community groups alike). The report concludes with important recommendations which all stakeholders need to consider and respond to. While the NHS has an important role to play, as the report makes clear, it can only provide part of a meaningful and sustainable solution. Critically, we must not under-value the responsibilities that individuals have for their health choices, both in terms of the impact on their own quality of life and for the examples that they set for those around them (especially our children and young people). This work has been jointly led by Public Health colleagues at Greater Glasgow and Clyde Health Board and West Dunbartonshire Community Health Partnership. In addition to thanking those of our staff who have invested considerable energy and thought in the work detailed here, we also would like to acknowledge the critical contribution of the Steering Group who oversaw the assessment process. We would also like to thank the many people who attended the public events held at the Beardmore Hotel in Clydebank in February 2006. Throughout this process local organisations, groups and fora have consistently demonstrated a strong interest in the assessment and expressed their commitment to reflect upon its findings with an open-mind. Such commitments provide an important platform for moving forward in a constructive fashion. We hope that this report stimulates informed debate and further action to enable us to work together to drive forward health improvement across West Dunbartonshire. Dr Linda de Caestecker R Keith Redpath Director of Public Health Director Greater Glasgow and Clyde Health Board West Dunbartonshire Community Health Partnership August 2007 This report is available in electronic format on http://www.chps.org.uk/westdunbartonshire and http://www.nhsggc.org.uk . It is also accompanied by a summary version highlighting the key findings and recommendations. 2 Health Needs Assessment Steering Group: - Sharon Adamson, Acute Services, NHS Greater Glasgow and Clyde Bill Clark, Social Work Services, West Dunbartonshire Council Dr Gordon Crawford, GP, Clydebank Health Centre, NHS Greater Glasgow and Clyde David McMillan, Chief Executives Department, West Dunbartonshire Council Dr Linda De Caestecker, Public Health, NHS Greater Glasgow and Clyde Deb Den Herder, Director of Clyde Acute, NHS Greater Glasgow and Clyde Dr Ed Robertson, GP, NHS Greater Glasgow and Clyde Dr. Fiona Coulter, Psychiatry Services, NHS Greater Glasgow and Clyde Lorna Fitzpatrick, West Dunbartonshire CHP, NHS Greater Glasgow and Clyde Dr Helene Irvine, Public Health, NHS Greater Glasgow and Clyde Margaret Hastings, Physiotherapy Services, NHS Greater Glasgow and Clyde Dr. Alan McDevitt, GP, Clydebank Health Centre, NHS Greater Glasgow and Clyde Muriel Robertson, Community Engagement Group Keith Redpath, West Dunbartonshire CHP, NHS Greater Glasgow and Clyde Selina Ross, West Dunbartonshire Community Voluntary Services Soumen Sengupta, West Dunbartonshire CHP, NHS Greater Glasgow and Clyde Dr Steve Haggerty, GP, NHS Greater Glasgow and Clyde Tom Nimmo, Community Engagement Group/Community representative Patrick Trust, West Dunbartonshire CHP, NHS Greater Glasgow and Clyde Health Needs Assessment Technical Group:- Linda de Caestecker, NHS Greater Glasgow and Clyde Khalid Bashir, NHS Greater Glasgow and Clyde Emilia Crighton, NHS Greater Glasgow and Clyde Elaine Garman, Highland Health Board Helene Irvine, NHS Greater Glasgow and Clyde David Morrison, NHS Greater Glasgow and Clyde Stan Murray, NHS Greater Glasgow and Clyde Soumen Sengupta, West Dunbartonshire CHP Margaret Walker, West Dunbartonshire CHP 3 1. SUMMARY OF KEY FINDINGS The term ‘Needs Assessment’ is often used synonymously with the term ‘Health Needs Assessment,’ to mean an assessment of need based on the health status of the population. For the purposes of this report, we are accepting a broad definition of ‘health needs’ to include those needs that are amenable to both clinical (NHS) and non-clinical (socioeconomic) interventions, in keeping with the ‘wider determinants of health’ theme of the report. This assessment of the health needs of West Dunbartonshire residents emphasises the importance of poverty and disadvantage in the creation of poor health. The key findings of high levels of health damaging behaviour and chronic diseases emphasise the need for effective community and primary care health improvement services. Geographical and historical aspects West Dunbartonshire is located to the West of Scotland with a total population of approximately 92,000. The area of West Dunbartonshire CHP is coterminous with that of West Dunbartonshire council. West Dunbartonshire lies north of the River Clyde and encompasses the urban communities of Clydebank, Dumbarton, Balloch, Alexandria and Renton. There is also a more rural area that runs south of Loch Lomond. The area conforms, in many respects, to the pattern of industrial and post-industrial phases of other urban centres in Scotland and elsewhere in the UK. Clydebank, Dumbarton and the Vale of Leven were important urban centres for manufacturing and shipbuilding during the industrial revolution, and this led to the development of a large local working class mainly dependent on shipbuilding for employment. Small residual clusters of asbestos-related disease are an unwelcome part of the legacy of that bygone industrial and shipbuilding era. The status of Clydebank as an important industrial centre meant that it became a target for bombing raids during the 2nd World War and had to be largely rebuilt in the years that followed. In the post-industrial phase of its development, the area also became host to ‘overspill’ populations from Glasgow, and in consequence of this, it shares some of the social problems of the peripheral housing estates in its city neighbour Demography Like many council areas of the West of Scotland, West Dunbartonshire has a falling population, particularly in the younger age groups. As death rates continue to fall in West Dunbartonshire, the elderly will make up an increasing fraction of this smaller population. The resulting age distribution is similar to that for the rest of Scotland. At the same time, it is predicted that there will be more individual households, and therefore greater demand for housing, as more people will be living alone or in single parent families. Single parent households in West Dunbartonshire (14.3%) are significantly more common in West Dunbartonshire than in Scotland as a whole (10.5%). Single lone mothers are rising most rapidly as the head of a subgroup of single parent families in West Dunbartonshire as well as across Scotland. Pensioner households now make up 23% of households in West Dunbartonshire (similar to the Scottish average); many of these elderly people will have 4 multiple chronic diseases and some will be living in isolation and deprived conditions. All these demographic changes have implications for healthcare and social services, particularly community care and services for older people. Socioeconomic determinants of health West Dunbartonshire is a socio-economically mixed area that has considerable pockets of severe under-privilege. According to the Scottish Index of Multiple Deprivation (SIMD), West Dunbartonshire has far less of its population living in the most deprived 1% of data zones than either Greater Glasgow and Glasgow City. In 2004, 37% of the West Dunbartonshire population lived in the 20% most deprived datazones compared to 20% for the Scottish population. According to the Carstairs Deprivation Score, the socioeconomic profile of West Dunbartonshire deteriorated significantly