Joint Strategic Needs Assessment

Joint Strategic Needs Assessment Summary for Commissioners, 2012

About this year’s summary • Presented as slides • Data, charts, maps, reports at www.jsna.portsmouth.gov.uk • Uses framework of draft Health and Wellbeing Strategy (2012)... • ...But also incorporates key themes from “Fair Society, Healthy Lives: The Marmot Strategic Review of Health Inequalities in England, post2010” • The Joint Strategic Needs Assessment presents: “the big picture”

Objectives in the Draft Health and Wellbeing Strategy, 2012 • The priorities of the Shadow Health and Wellbeing Board, in the short to medium term, are to: • 1: Enhance quality of life for people with dementia • - improve the quality of dementia services and the care that those with dementia receive. • 2: Support people to maintain their independence and dignity • - strengthen community-based provision to support independence and avoid unnecessary admissions to hospital. • 3: Ensure all children get the best possible start in life by concentrating on the pre-birth to 5 years old age group • - deliver an integrated pathway pre-birth to 5 years old that is easily understood and accessed by parents and carers as well as professionals. • 4: Improve outcomes for local people’s health and wellbeing by driving up the quality, and ensuring the safety, of all services • ensure that the commissioners represented on the board are checking that all providers of care have effective safeguarding procedures in place. • Further information at: http://www.portsmouth.gov.uk/yourcouncil/24885.html

Background - research New information obtained this year • Prison health and wellbeing • Adults with autistic spectrum disorders • Armed Services’ Veterans • Children with autistic spectrum disorders • Sexual health • LSP Conference “Our Health, Our City, Together” • Refresh crime and anti-social behaviour • Surveys carried out this year • Young people’s substance misuse Ongoing needs assessments or research • Fratton • Adults with learning disabilities • Refresh young person’s substance misuse • School meals • Refresh prison health and wellbeing • Young people’s aspirations and attainments • Refresh alcohol needs assessment • Planned needs assessment or research • Children with speech, language and communication difficulties • Social isolation in older people in Hilsea and Nelson wards • Health and wellbeing needs of City Council housing tenants

Population: 205,100 residents. GPs serve 215,622 registered patients Area: 15.5 square miles Population density: Highly urbanised city. 51 people per hectare (most densely populated local authority outside London) Neighbours: Havant and Fareham Borough Councils, Winchester City Council. South Eastern Hampshire and Fareham and Gosport CCGs... ... But ONS group the local authority with areas such as Southampton, Brighton and Hove, Plymouth, Bristol, Newcastle, Liverpool, Sheffield, Leeds, Salford Transport routes: Well-connected with motorway, A-road and mainline rail connections to/from the city. Domestic and international ferry routes. Major passenger and freight port An employment hub for suburban hinterland especially Havant, Fareham and Gosport. Major employers: health and social work, administration and support services, public administration and defence, information and communication. Home of Royal Navy. Associated heritage industry. High public sector employment, and sizeable proportion of industry directly or indirectly dependent on public sector, leads to increased vulnerability to public sector job cuts Place: Portsmouth

People: Demography • 69% of Portsmouth’s population is aged 15-64 yrs (England 66% and SE 65%) • Strong population growth especially young adults aged 15-29 years • 11% are aged 20-24 years (7% nationally) – a good source of skilled workers to fill jobs • Nearly 18,400 full-time students and about 4,000 part-time students at University of Portsmouth

People: Demography Chart shows differences in population forecasts we have been using (Hampshire County Council) and 2011 Census Census shows about 4,900 fewer people aged 65+ years (of whom about 1,300 are aged 85+ years) than we expected And about 3,200 more children and young people (0-19 yrs) (of whom about 1,900 are aged 15-19 yrs) than we expected More Census data to be released in November 2012... JSNA website resources will be updated

People: Demography About 1,670 people are aged 90+ years Post-war baby boom evident in increase in numbers of people in their mid 60s

People: Diversity • 15.5% from Black and minority ethnic communities (including White Irish and other White non-British communities) compared with 17% in England • Other White, Indian and Chinese communities are largest ethnic groups in the city • Non-White ethnic groups tend to have: • Lower proportion of people aged 65+ yrs and, • Higher proportion of children and young people

People: Deprivation • Portsmouth is ranked 76th out of 326 local authorities in England (where 1 is the most deprived) • Most deprivation is experienced by people in Charles Dickens, Paulsgrove, Cosham and St Thomas wards • Of all Portsmouth wards, Charles Dickens has the highest number of deprived smaller areas for income, employment, health, crime and education, skills and training • Male life expectancy is significantly shorter than England. And within the City, male life expectancy is 10.8 yrs shorter in deprived compared to less deprived areas

Health Profile, 2012 • Portsmouth is in a group of 19 local authorities (LAs) with similar socio-economic profiles • [The chart shows only those LAs in the group of 19 who are in the south of England.] • Portsmouth is ranked 8th best of 19 LAs for deprivation • But we are in the worst six for: • Statutory homelessness • GCSE achievement • Violent crime • Smoking • Drinking alcohol • Hospital stays for self-harm • Sexually transmitted diseases • Excess winter deaths • Smoking-related deaths • Early death due to cancer • Road injuries and deaths

Community safety Crime has increased slightly since 2010/11, but is still well below the levels seen six years ago. Violent crime has increased by 7%. 54% of Portsmouth residents reported that they either “agreed” or “strongly agreed” that anti-social behaviour was a problem in the area where they live Priorities for the Safer Portsmouth Partnership based on the strategic assessment 2011/12, and how they are linked • Domestic Abuse accounts for about a quarter of all violent crimes • The number of crimes committed by young people, and the number of young offenders, have both reduced since 2010/11 • Drug misuse – 27% of offenders supervised by probation misuse drugs and 53% have alcohol issues • Alcohol misuse – drunk and rowdy behaviour was the most commonly reported type of anti- social behaviour

Getting the best possible start in life About 24% of children live in poverty but highest rates are in Landport (67%) and City Centre North (66%) areas of Charles Dickens ward 22% of 0-15 year olds live in households dependent on out-of-work benefits • Black and minority ethnic communities have a younger age profile. • Highest percentages of Black and Minority Ethnic pupils are in St Thomas (43%), St Jude (32%) and Charles Dickens (30%) wards • Most common first languages for school pupils are English, Bengali, Polish and Arabic

Getting the best possible start in life All pregnant women who smoke are offered smoking cessation advice and/or referred to smoking cessation services. Last year, 62 pregnant women set a quit date and 42 successfully quit. 464 women were still smoking at the time their babies were born 74% of Portsmouth new mums start breastfeeding their babies But only 42% are still breastfeeding 6-8 weeks later

Getting the best possible start in life Early Years Foundation Stage 64% of city children aged 4 to 5 years achieved a good level of personal, social and emotional development when assessed in the reception year at school (compared to 59% nationally) “Ensure high quality maternity services, parenting programmes, childcare and early years’ education to meet need across the social gradient” – Marmot Policy objective But there are local inequalities – children in our deprived areas have lower Early Years Foundation Stage results

Getting the best possible start in life Over these years, Portsmouth’s Year 6 children had the greatest decrease in obesity of all PCTs (-5%) 7th highest rate of 152 PCTs Position improved to 62nd highest rate of 151 PCTs

Getting the best possible start in life Compared to last year, more students have never tried tobacco or alcohol Male students were more likely than females to have tried tobacco, smoke every day, and less likely to find alcohol and drug advice in schools to be helpful

Getting the best possible start in life Acute respiratory diseases (eg acute laryngitis, tonsillitis, common cold) are the main causes of emergency hospital admission for 0-14 yr olds Most are admitted for only a few hours Lower respiratory tract infection (eg acute bronchiolitis, influenza, pneumonia) emergency hospital admission rate is declining but remains higher than comparator areas

Getting the best possible start in life Declining teenage pregnancy rates But higher rates in more deprived areas Young people and Chlamydia • 47.9% of young people aged 15-24 years screened (England average 28.5%) • Higher rates of positive diagnoses than England, SHA or Southampton

Helping young people to be ready, willing and able to work Improving GCSE attainment but in 2010/11 we still had the lowest attainment of comparable local authorities. Provisional results for 2011/12 suggest a local 7% improvement. The improvement is particularly marked in Maths

Helping young people to be ready, willing and able to work “Ensure that schools, families and communities work in partnership to reduce the gradient in health, wellbeing and resilience of children and young people” Marmot Priority Objective • Between 2007 and 2009, 40% of Portsmouth’s state school pupils went onto higher education – the lowest of our neighbouring local authorities • Raising educational attainment remains a key issue for the city • The evidence shows that we can best achieve this by: • Supporting schools to become good and outstanding • Ensuring all pupils have basic literacy and numeracy skills • Raising the expectations of teachers, parents, pupils and the wider community • Ensuring all pupils achieve their potential – nobody is left behind and high achievers are stretched • The key vehicle for delivery of this work is the improving schools strategy – Effective Learning for Every Pupil http://www.portsmouth.gov.uk/achieving-excellent-schools.html

Helping young people to be ready, willing and able to work “Need to ensure those currently excluded from the workforce are able to participate. This will often mean working with people to tackle multiple barriers. In particular, must avoid any lasting effects from the recession on unemployed young people, ensuring they do not become excluded from the workforce.” Recommendation of a report to the Economic Development, Culture and Leisure Scrutiny Panel, Nov 2011 • Levels of young people not in education, employment or training are higher than regionally, but are in line with Southampton and national levels • However, young people are over-represented in the total group of unemployed people in the city

Create a better environment for people to live, work and play • Portsmouth is an employment hub for wider region – attracting more commuters in than go out of Portsmouth to work. • In-commuters tend to occupy the ‘better’/higher level jobs • Prosperity (Gross Value Added per head) is satisfactory but not as high as similar areas • Productivity (Gross Value Added per job filled) is improving but remains low • Possible reasons for Portsmouth’s lower prosperity and productivity: • Skills - Current residents of working age, and those entering workforce, continue to have low skill levels • Innovation - Portsmouth has potential for innovativeness – we can build on what is already here, remove barriers to firms wanting to expand” • Competition - Low business density (implying lack of competitiveness), due to higher proportion of, and greater size of large firms, in Portsmouth • Entrepreneurship - improving survival rates of new businesses • Economic Area Assessment, 2012

Create a better environment for people to live, work and play Portsmouth’s employment rate is usually slightly higher than the GB rate, but slightly lower than the SE rate. The local rate has not changed significantly over time • 3.5% of Portsmouth’s working population are claiming out-of-work benefits • Job Seekers Allowance claimant rates are highest in Charles Dickens (6.6% of working age population), Nelson (4.8%) and Fratton (4.2%) (August 2012) • Unemployment increases the chance of being ill, especially for those who have never worked or have had poorly paid jobs • Unemployment increases rates of depression – especially in younger workers • People in secure employment recover more quickly from illness Source: Unemployment and health. Dorling D. BMJ 2009;338:b829

Create a better environment for people to live, work and play • Most densely populated local authority outside London. 79% of us live on Portsea Island • Our open and green spaces are integral to quality of life, conserving biodiversity and mitigating effects of climate change • The City’s CO2 emissions are just over 1M tonnes in total: • 43% from Industry and Commercial • 32% from Domestic and, • 25% from road transport sources • The planned Public Service (Social Value) Act 2012 will place a requirement on public bodies to consider economic, social and environmental wellbeing in relation to public service contracts as part of their pre-procurement discussions

Create a better environment for people to live, work and play Tenure, Portsmouth, 2008 • Housing issues that impact on health and wellbeing include: • Homelessness • Overcrowding • Damp, draughts and cold • Indoor pollutants and infestation • Housing form – stairs, narrow doorways, inaccessible toilets and bathrooms • Relative location • Crime and safety • Neighbourhood condition – ‘liveability’ • Portsmouth percentage of rented properties is above average for urban areas in the SE • Much of the city’s housing stock is over a century old • Demand for affordable renting is substantial and rising – priority given for over-crowding, those in poor health and those who are homeless

Create a better environment for people to live, work and play Households in fuel poverty, 2009 • 81% of housing in Portsmouth is in the private sector. • Just over one third of private housing fails to meet the Decent Homes Standard, with the main reason being ‘insufficient thermal comfort’ (eg lack of central heating) • Fuel poverty is also more prevalent in the private sector (15% of households) • Fuel poverty affects 48% of those households on the lowest incomes in Portsmouth • Highest proportions of fuel poverty in parts of Southsea and Paulsgrove/Wymering

Create a better environment for people to live, work and play • Climate change scenarios for Portsmouth show: • Sea level likely to rise by about 70cm. Extreme sea levels will be experienced more frequently • Summer mean temperatures will increase, and higher summer temperatures will become more frequent. Predicted increase in urban heat island effect, health-related health impact, water shortages, fire risk etc • Warmer, wetter winters with likely increase in heavy winter precipitation (rain, sleet, snow). Impact seen in increased risk of flooding • Likely to be increased variability in weather events, particularly storminess (including wind and lightening). Impacts include infrastructure damage, flooding etc • Portsmouth Plan includes climate change projections. Challenge to ensure that key climate change risks are taken into account as regeneration takes place • Actions to improve active travel options (eg walking, cycling), public transport, energy-efficient housing, green space, healthy eating, reduced carbon-based pollution will also benefit the sustainability agenda Develop common policies to reduce scale and impact of climate change and health inequalities

Encourage healthy lifestyles by helping people to stop smoking, lose weight and drink responsibly • Male life expectancy is significantly shorter than the England average (female life expectancy is not significantly different to the England average) • Males in the most deprived areas live nearly 11 years fewer than males in the least deprived areas of the city

“Prioritise prevention and early detection of the conditions most strongly related to health inequalities.” Sir Michael Marmot Encourage healthy lifestyles by helping people to stop smoking, lose weight and drink responsibly To increase male life expectancy, we need to tackle: 1 Coronary heart disease 2 Chronic cirrhosis of the liver 3 Pneumonia 4 ‘Other’ cancers 5 Lung cancer (Greatest impact listed first) Main causes of the gap in life expectancy between males and females in the most and least deprived quintiles, Portsmouth

Encourage healthy lifestyles by helping people to: Stop smoking • Smoking is the main reason for the gap in life expectancy between rich and poor Compared to England, Portsmouth has significantly higher levels of: • Smoking in pregnancy • Lung cancer registrations • Smoking attributable deaths from heart disease • Smoking attributable deaths overall • Deaths from lung cancer, and Chronic Obstructive Pulmonary Disease (COPD)

Encourage healthy lifestyles by helping people to: Stop smoking 22% fewer smokers set a quit date in 2011/12 - with the biggest drop in the under 35 year old age group Fewer males set a quit date than females ... but males were more likely to successfully quit • People who use Portsmouth’s NHS Smoking Cessation Service are significantly more likely successfully to quit smoking than the England average • Successful quitters service includes Fitness for Surgery programme for pre-op patients • National pilot for Secondary Care smoking cessation

Encourage healthy lifestyles by helping people to: Drink responsibly Compared to the South East or England, Portsmouth has significantly higher rates of: • People claiming incapacity benefit or severe disability allowance due to alcoholism • Alcohol-attributable crime, violent crime and sexual crimes • Alcohol-attributable hospital admissions – and the male trend is increasing • Alcohol-specific mortality rate for males

Encourage healthy lifestyles by helping people to: Drink responsibly Alcohol-specific hospital admissions significantly higher than the City rate for Charles Dickens, Nelson, St Thomas and Eastney and Craneswater wards. Very strong positive relationship (0.84) between these admissions and deprivation • Alcohol-related hospital admissions are significantly higher than the City rate for people from Charles Dickens, Fratton, Nelson, Paulsgrove and St Thomas wards

Encourage healthy lifestyles by helping people to:Be a healthy weight • Modelled prevalence suggests 23% of adults are obese • Highest modelled prevalence of adult obesity in Stamshaw, Paulsgrove and Wymering • Comprehensive adult weight management pathway • Healthy Pompey programme supports the city with healthy weight initiatives

Progress in reducing premature deaths:Circulatory diseases Circulatory diseases (including coronary heart disease) are the most frequent causes of death locally and nationally Our circulatory disease mortality rates are falling but remain higher than the national rate, and the rate of comparator local authorities Highest rates of premature death due to coronary heart disease are in Buckland, Paulsgrove, Wymering, Somerstown and Fawcett areas Male emergency hospital admission rates for coronary heart disease are significantly higher than female rates

Progress in reducing premature deaths: Cancer Lung cancer is the second most frequent cause of death to Portsmouth males Very strong positive relationship between smoking and premature deaths due to all cancers

Progress in reducing premature deaths: Respiratory diseases Significantly higher rates of emergency admission for chronic obstructive respiratory disease in City Centre, Buckland, Paulsgrove, Somerstown and Wymering • Fourth most frequent cause of death in Portsmouth • Primary care management of respiratory disease is good but practices serving the most deprived communities have higher COPD and asthma prevalence, respiratory conditions admission rate and exception rate for asthma indicators; and lower levels of inhaled Corticosteroids per STAR-PU

Progress in addressing specific causes of ill health... Diabetes • About 8,700 people have diabetes – 4.1% of adults • BUT… • Modelled prevalence, suggests there may be an additional 1,800 patients with unrecognised and/or unrecorded diabetes in the city

Progress in addressing specific causes of ill health... Diabetes • Portsmouth PCT is in the lowest 25% of all PCTs in terms of people with diabetes: • Receiving all nine care processes • Having foot examinations • Having urinary albumin measurements • PCT also in second lowest quintile for % of people with diabetes screened for diabetic retinopathy but we were the fourth highest PCT for issuing Certificates of Vision Impairment caused by diabetic eye disease

Progress in addressing specific causes of ill health: Mental Health Deprivation is strongly correlated with the level of adults receiving services from Adult Social Care for mental health problems • ] All PCTs spend most of their programme budgets on mental health services Portsmouth PCT is in the highest quartile for expenditure on mental health services (£274 per weighted head vs £265 per weighted head for ONS cluster ) [This includes all NHS expenditure on secondary and tertiary mental health services (for all ages) and expenditure on mental health drugs by GPs] • = significantly higher than England

Progress in addressing specific causes of ill health: Mental Health Significantly higher rate of hospital admissions for self-harm than all six of our most local comparator local authorities Local suicide rate has declined by 39% since 1995/97. Local rate is now significantly lower than England and ONS comparator group averages

Progress in identifying needs of specific groups: People with a Learning Disability GPs have identified about 700 adults with a learning disability Last year, Adult Social Care provided a service to 451 clients Highest Adult Social Care client rates in Hilsea ward – reflecting historic provision of residential services • In general, people with a learning disability have higher rates of gastrointestinal cancer, coronary heart disease, respiratory disease, mental ill health and challenging behaviour, dementia, epilepsy, sensory impairments, physical impairment, poor oral health, dysphagia • At risk of inequalities related to: • Poverty, poor housing, unemployment, social isolation, discrimination • Risks associated with genetic and biological causes of learning disabilities • Communication difficulties and reduced health ‘literacy’ • Personal health risks and behaviours • Deficiencies in access to, and quality of, healthcare provision

Progress in identifying needs of specific groups: Armed Forces Veterans • Estimated 16,200 to 17,000 veterans live in Portsmouth • We do not know the actual number of veterans • Most recommendations in the needs assessment relate to improving identification of veterans, and increasing services’ knowledge of veteran issues About 125 people receive Armed Forces Compensation Scheme payments (injuries etc arising after 6 April 2005) All recipients are aged under 50 years About 670 people receive War Disablement Pension (injuries etc which arose before 6 April 2005) 52% of recipients are aged 65+ years • Between 16-64 years, veterans are likely to have higher prevalence of musculoskeletal, mental health, circulatory and respiratory conditions compared to general population • After 65+ years, veterans are likely to have higher prevalence of mental health and sensory disorders. • And lower prevalence of musculoskeletal, circulatory and respiratory conditions

Progress in identifying needs of specific groups: Armed Forces Veterans • Recommendations from veteran questionnaire survey and one-to-one interviews: • Improve links between the local authority and the MOD • Military medics to train civilian medics • Mainstream services to have a greater awareness of Post Traumatic Stress Disorder • Set-up peer support service for individuals leaving the services • Better publicity for NHS Priority Treatment • The Council could provide more information for veterans on the services available to them, perhaps via council website • All services to ask individuals if they have served in the armed forces so that we are recognised as a specific group and can be signposted to relevant services more efficiently. Healthcare providers should be made aware of personnel coming into the area after service. Mental health problems were the main issue faced by veterans in the survey. Post Traumatic Stress Disorder was their most common mental health problem

Help older people maintain maximum independence and dignity in old age • More than half of the people aged 60+ years in Sultan Road South (53%), Blackfriars (51%) and Bridge Centre (50%) areas are living in income deprivation • Research planned to look into extent of social isolation being experienced by people aged 60+ years

Help older people maintain maximum independence and dignity in old age • Portsmouth had highest excess winter death rate of 19 comparator authorities Over 5 years, the highest excess winter deaths rates were in Francis Avenue, Portsdown, Wymering, Alexandra and Palmerston areas • 75% of registered patients aged 65+ years received the ‘flu vaccine – we’ve achieved better than the England rate for the past six years. But three Practices did not achieve 70% uptake

Help older people maintain maximum independence and dignity in old age Life expectancy after age 65 years which is disability-free is shortest in City Centre, Buckland, Wymering, Somerstown and Stamshaw areas NB Shortest disability-free life expectancy shown in palest areas in this map Adult Social Care provides significantly higher levels of services in the community to people with physical disabilities in Charles Dickens and Paulsgrove wards

Help older people maintain maximum independence and dignity in old age • Dementia is a local and national priority • Local GPs have recorded dementia in 0.64% of all registered patients • About 1,000 people are missing from dementia registers – probably those with mild dementia • Unhealthy lifestyles followed by today’s cohort of middle-aged people will impact on prevalence of vascular-related disease in older age, including dementia • Portsmouth patients aged 65+ yrs with dementia who are admitted for more than two days, stay in hospital seven days longer than those without dementia • National change in coding death certificates has increased the local number of deaths coded to Dementia and Alzheimer’s disease (now 5th most frequent cause of death locally, and 3rd most frequent for females) Highest mortality rates in Eastney and Craneswater, St Jude, Hilsea, Cosham and Drayton and Farlington wards

Help older people maintain maximum independence and dignity in old age These ten causes of admission account for 48% of all elective admissions and 55% of all emergency admissions by this age group Cancers are the main cause of elective hospital admission (18% of all elective admissions by this age group) “Symptoms and signs” are the main cause of emergency admission (23% of all emergency admissions by this age group

Joint Strategic Needs Assessment