1 Hull Clinical Commissioning Group l l u H f o y r o t S e Th s Health and Wellbeing Needs and it A Summary of Hull's Joint Strategic Needs Assessment 2012 Together we can influence the outcome of this story
2 Contents What s the story? 3 The key JSNA findings 5 Who are our residents? 6 What outside factors affect residents health? 7 The most important health issues 10 What do we know about the health of children and young people? 13 What does this tell us? 14 What will happen next? 15 2
3 What s the story? There are numerous facts, figures and pieces of information from many different sources that help us to understand our City. These are often very lengthy and complicated, so The Story of Hull has been produced to help everyone understand what they mean. If you would like to see the full background data, reports and surveys, please visit Health and Wellbeing Board The Health and Social Care Act 2012 made significant changes to the NHS, and required local authorities to form Health and Wellbeing Boards to deliver improvements to the health and wellbeing of the local population. Hull s Board includes councillors and officers of Hull City Council, GPs from NHS Hull s Clinical Commissioning Group and a representative of HealthWatch. What s a JSNA? This gathering together of information about a City s current and future health and wellbeing issues, and the services that address them, is called a Joint Strategic Needs Assessment, or JSNA for short. The Health and Social Care Act of 2012 states that each Health and Wellbeing Board must produce a JSNA for the following reasons: It helps the Board set its priorities effectively. It helps people who buy health and social services for the city to assess current services and plan for the future demand. It helps everyone in the city understand the situation and how we can all help to improve it for the future. At a time of reduced funding for health and wellbeing services, we have to decide the main priorities for the Board to focus on, and use budgets as efficiently as possible to achieve them. The JSNA helps us to base those decisions on the best information available. 3
4 Where do we go from here? The Board is committed to reducing health inequalities between people living in different parts of the city and between Hull and England as a whole, but we can t do it alone. We are producing a Joint Health and Wellbeing Strategy so that everyone knows how we are going to tackle the key challenges. This will lead to a detailed action plan, setting out what will be delivered, giving timeframes, and showing how we will measure the improvements. Most importantly, we will keep listening to residents, letting you know how things are going, and encouraging everyone to play their part in improving health and wellbeing in the city. Chair, Health and Wellbeing Board - Councillor Colin Inglis Chair, Clinical Commissioning Group - Dr. Tony Banerjee 4
5 The key JSNA findings The main finding of the JSNA is that Hull is one of the most deprived cities in the country. The 2010 Index of Multiple Deprivation which uses a broad range of indicators to measure poverty and other problems in a neighbourhood, identifies Hull as the 10th most deprived local authority in the country out of 326. If we look at other cities, we usually see that deprivation is strongly associated with poor physical and mental health, and this is true in Hull. Life expectancy is lower in Hull than in many other parts of England and there is a life expectancy gap of up to 10 years within Hull between the least deprived and the most deprived electoral wards. Hull has high levels of smoking, obesity and binge drinking. The city also has high levels of cancers, heart disease and diabetes. wellbeing problems. The new City Plan will focus the efforts of committed employers and stakeholders from the public and voluntary sector, to create and sustain jobs and develop a healthy workforce. As employment increases, there is good evidence to suggest that health and wellbeing will improve accordingly. In addition, the more we work together, by promoting good health and wellbeing in the workplace and at home, the greater the improvements will be over time. This document is a summary of the key JSNA findings and cannot cover every health issue or group of residents affected. The various JSNA resources give us a lot more detail and can be accessed at Whilst NHS and social care services can address some of the symptoms of deprivation, all organisations in the public, private and community/voluntary sectors need to cooperate to fully address the fundamental inequalities that lie at the core of health and 5
6 Who are our residents? Population According to the 2011 census Hull has 256,400 residents. Since Hull is a university city and has a relatively high birth rate, Hull s population has higher proportions of children and young adults when compared to England. The biggest population challenge for health is that the percentage of people aged 65 years and over in Hull is currently estimated to be around 14% but is expected to increase to 17% by This means a potential increase in the number of people in the city with significant health and social care needs. Ethnicity Historically Hull has had very low levels of Black and Minority Ethnic (BME) residents. According to the 2011 census Hull has 89.7% white British residents - compared to 79.8% for England, 4.4% white non-british residents mainly from EU accession countries (5.7% for England) and 5.7% non-white residents (14.3% for England). 96% of households have at least one person who speaks English as their main language. Disability Many of our residents are living with disabilities that may affect their physical and mental health. Their ability to access appropriate services is a key priority. In Hull there are 760 people who are registered blind, with 330 of them having an additional disability; a further 935 people are registered as partially sighted. 870 people are registered as deaf. 6 Adults with learning difficulties recorded by General Practices are at a similar level in Hull to the national average; there are an estimated 1,300 people with severe learning disabilities in Hull.
7 What outside factors affect residents health? Deprivation Using the Index of Multiple Deprivation (IMD) 2010 score, Hull is ranked as the 10th most deprived local authority out of 326, with 43% of Hull s smaller geographic areas being in the most deprived 10% of areas nationally. The score is based on: Education Educational attainment of Year 11 pupils (15-16 year olds) is considerably lower than England. The percentage of year olds achieving five or more A-C grade GCSEs (or equivalent) is 42% compared to 54% for England. Income Employment Health and disability Education, skills and training Housing and services Crime Living environment 3.3% of Hull s mainstream school population have a statement of special educational needs (SEN), this compares to a national average of 2.8%. The local figure is artificially inflated by the specialist provision in the city, which accepts SEN pupils from other local authority areas. A statement is the highest level of SEN provision and reflects the particular needs of the pupil concerned. Pupils may have an identified SEN without a formal statement being issued, and in Hull there are a further 18.4% of pupils at these lower levels of SEN provision. However, overall Hull is similar to many other cities and urban areas in northern England; and those that score particularly badly on the IMD are all characterised by relatively tight The working-age population have fewer qualifications, boundaries around their urban centre, meaning their more with 17% having no qualifications compared to 13% for prosperous (and healthier) outer suburbs are in a different the region and 11% for Great Britain. local authority. However, this is not to underestimate the impact that poverty and deprivation have in Hull, and this Adults are 15% less likely to be educated to degree level will be made worse by the effects of Welfare Reforms over the or higher compared to Great Britain. coming years. 7
8 Employment 8 A higher proportion of employees work in manufacturing (17%) compared to the Yorkshire and Humber region (13%) and Great Britain (10%). A higher proportion of employees also work in public administration, education and health. Hull has significantly fewer people in employment and more benefit claimants (over twice the national rate). 16% of men and 12% of women are unemployed (model-based unemployment estimates). 10.4% of year olds are not in education, employment or training compared to 6.1% for England. Child poverty in Hull is 33%, and is higher than for England where 21% of children live in poor households.
9 Housing There are substantially fewer detached houses or bungalows (6%) compared to the Yorkshire and Humber region (20%) or the national average (23%), fewer semi-detached properties (26% versus 37% for the region and 32% for England), and a higher percentage of terraced housing (53% versus 29% for the region and 26% for England). The total number of dwellings is estimated to be 112,860. These are owned by:- ūū ūū ūū ūū 27,126 local authority 6,892 housing association 192 other public sector 78,650 private (estimated) Owing to high levels of deprivation, there is a greater need for local authority housing. Homeless people are at increased risk of suffering from physical and mental health conditions. Homelessness in Hull is 4.37 per 1,000 households (England 2.03) and 0.3 per 1,000 households have been placed in temporary accommodation (England 2.22). 9
10 The most important health issues The high level of deprivation in the city is reflected in the relatively large gap between Hull and England in life expectancy at birth. Whilst life expectancy is improving within Hull it is not improving sufficiently to allow a substantial reduction in the difference between Hull and England. Life expectancy for males in Hull is 75.7 years compared to 78.6 for England, and 80.2 for females in Hull compared to 82.6 for England. There is also a discrepancy in life expectancy between areas. Male life expectancy differs by up to 10.1 years across Hull wards, ranging from 71.1 years in St Andrews to 81.2 years in Beverley ward. Female life expectancy differs by up to 9.9 years, with St Andrews having the lowest female life expectancy of 74.4 years and Bricknell the highest, of 84.3 years. The mortality rate from all causes under the age of 75 years is 30% higher than the mortality rate for England. The largest causes of death in Hull are cancer and coronary heart disease (CHD), and these two diseases account for more than half of all deaths under the age of 75 years. The mortality rate from cardiovascular disease for under 75s is 39% higher for males and 50% higher for females compared to England. The under 75 years CHD mortality rate is 44% higher for males and 58% higher for females compared to England. Given the high prevalence of smoking in Hull, the high lung cancer rates are not surprising. Hull also has high levels of other lung problems, with some death rates for those under 75 being twice the national average. The under 75 years mortality rate from cancer is 30% higher than England. The under 75 years mortality rate from lung cancer is 82% higher in men and 98% higher in women compared to England. 70% of men and 61% of women are overweight or obese (the national average is 68% and 58% respectively). 10
11 Smoking Alcohol Despite major initiatives by Hull s Public Health Directorate in recent years, smoking continues to be the single greatest cause of preventable disease and death. Unsurprisingly, given the higher than national prevalence of smoking in young women, the percentage of women known to be smokers at the time of giving birth is higher (23%) than England overall (14%) and higher than most other similar cities. Smoking prevalence is 34% for males and females, higher than the England average of 22% and 18% for males and females, respectively. As well as numerous short-term effects including injuries resulting from accidents and violence, alcohol is a risk factor for some cancers, particularly of the colon and breast, and excessive alcohol consumption can lead to liver damage, stomach problems, fatal alcohol poisoning and increased risk of cardiovascular disease. Men in Hull in 2011 were slightly more likely than men in England in 2010 to drink more alcohol than the recommended maximum guideline of 21 units per week, Women in Hull were much more likely to exceed the recommended maximum alcohol guideline of 14 units per week. Local alcohol harm-related hospital admission rates for Hull have risen in recent years and are significantly worse than both regional and national averages. This shows a growing burden of ill-health due to alcohol consumption. 11
12 Mental Health 1 in 4 of us will experience mental health problems in our lifetime. The prevalence of diagnosed serious mental health for Hull (0.8%) is similar to that for England. In Hull mental health is worse for women, the younger ages and those living in the most deprived areas. Mental health is the most common medical reason for entitlement of working-age claimants to Incapacity Benefit and Severe Disablement allowance in Hull (39% of claimants). Dementia The number of people diagnosed with dementia by Hull GPs is 1,062 ; in the next ten years we expect there to be an increase of around 500 in the number of dementia sufferers. 12
13 What do we know about the health of children and young people? The infant mortality rate is 5.5 per 1,000 live births (national average is 4.6 per 1,000 live births). The rate of under 18 conceptions per 1,000 female population aged years is 55, which is a fall of 35% from 1998 (the rate for England is 35 per 1,000). The breastfeeding initiation rates (57%) are lower than the Yorkshire and Humber region (69%) and England (74%). The prevalence of smoking among 15 year olds in Hull is well above the national average at 22%. despite falls in recent years, this remains a concern since once they are addicted people find it hard to stop smoking. The prevalence of obesity is 24% in Year 6 boys (10-11 year olds) and 22% in Year 6 girls, with a further 14% of boys and 16% of girls classified as overweight. Although only a few percent above the national average, the fact that nearly a quarter of our young people are obese and face increased health problems is a major concern. Among Year 11 girls, 80% have been drunk, half of whom get drunk at least once a month. Among boys, 71% have been drunk, again with half of those getting drunk at least once a month. There is a lower percentage (51%) of children achieving a good level of development at age five compared to England (56%). The crude rate for unintentional and deliberate injuries to those aged 0-17 years per 10,000 residents is higher (152 per 10,000) compared to the England average (123 per 10,000). The prevalence of obesity is 10% in Reception Year boys (4-5 year olds) and 9% in Reception Year girls, with a further 14% of boys and 13% of girls classified as overweight. 13
14 What does this tell us? All of the information we have gathered in the JSNA helps us to put together a picture of health and wellbeing in Hull. We know that some of our biggest challenges affect all ages and especially key groups, including people with mental and physical disabilities, carers and those from black and minority ethnic groups. Being able to access appropriate services in the right place and at the right time is vital if we are to see improvements in the health and wellbeing of all residents. We know that external factors such as education levels, employment rates, housing conditions and income all have an impact on the health and mental wellbeing of our residents. We will be working closely with the people in the city who lead on these, and helping them to understand the contribution they can make to our priorities. We know that giving children the best start in life and getting them into healthy habits is the best way to ensure their health in the future. We will be working with families, and the organisations that support them, to make this a reality. We know that working-age adults are our biggest challenge. They may already lead unhealthy lifestyles, eat the wrong diet, not get enough exercise, and have developed addictive behaviour such as smoking and drinking too much. We will work with partners to encourage this age group to take more responsibility for making changes to their lifestyles, in turn reducing premature deaths from cancer and heart disease. We know that some older people face the same health and wellbeing challenges as younger people. These include mental health problems, diet, physical activity, smoking and alcohol consumption. In addition to these, many have concerns about maintaining their independence, and need help and support especially if they are living with long-term conditions that affect their lifestyle. We know that some young people face particular problems linked to their physical health and mental wellbeing. They often face difficult decisions, including choosing a more healthy lifestyle than their families and friends. We will ensure that they are provided with all of the support they need at this key time in their growth and development. 14
15 What Will Happen Next? Our next step will be to consider the evidence, and the views of service users and residents, to agree our priorities for action. This will, in turn, lead to the production of a Joint Health and Wellbeing Strategy so that everyone understands how we are going to tackle the key challenges, and can consider how they might contribute. This will be developed into a detailed action plan, setting out what will happen by when, and showing how we will measure that we have made the improvements our residents need. We look forward to keeping you informed of our progress. 15
16 For further information, please contact: Strategy and Partnerships Team Hull City Council Guildhall Guildhall Road HULL HU1 2AA Telephone: (01482) This document can be made available in other languages and formats (large print, Braille, audio and easy-read as appropriate). Please contact us directly or ask someone to contact us on your behalf using the address, or telephone number above. December 2012