The LAA, Health Inequalities and Staying Healthy

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The LAA, Health Inequalities and Staying Healthy

• Dr Mandy Bretman
• Director of Public Health Partnerships

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Local Area Agreements

• Following publication of Local Government White
  Paper Strong and Prosperous Communities and Local
  Government and Public Involvement in Health Act
  LAAs will become the main delivery agreement
  between central government and local authorities
  and their partners
• 2. From June 2008 each LAA will consist of up to
  35 targets chosen locally from a national
  indicator set of approximately 198 indicators.
  Local Authorities will report back on progress
  against these targets, in conjunction with the
  PCTs strategic intentions timescale

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Local Area Agreements

• All areas have an LAA (county-level)
• Three year agreement
• Consists of indicators targets
• National refresh, complete in June
• LAA is part of Lincolnshire Sustainable Community
  Strategy

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Indicators

• NI 8 Adult participation in sport
• NI 39 Alcohol-harm related hospital admissions
• NI 47 People killed or seriously injured in road
  traffic accidents
• N1 53 Breastfeeding indicator
• NI 55 and 56 Obesity among primary school age
  children in Reception and Year 6
• NI 57 Children and young people's participation
  in sport
• NI 58 Emotional and behavioural health of
  children in care
• NI 70 Hospital admissions caused by unintentional
  and deliberate injuries to children and young
  people
• NI 123 16 current smoking rate prevalence

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Indicators

• NI 124 People with LTC supported to be
  independent and in control of their condition
• NI 125 Independence of older people through
  rehabilitation / intermediate care
• NI 130 Social care clients receiving self
  directed support
• NI 135 Carers receiving assessment or review
• NI 139 The extent of older people receive support
  to live at home
• NI 141 Vulnerable people achieving independent
  living
• NI 142 Vulnerable people supported to maintain
  independent living
• NI 146 Adults with learning disabilities in
  employment
• N1 187 Tackling Fuel Poverty

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Central, National and Regional Government
Strategy Policy and Performance
County Council
Wellbeing Social Care Transport Education
LAA
Public Health Health Protection Healthcare
Wellbeing Housing Leisure Waste
District or Borough Council
NHS
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Current LAA Governance 2007-08

Lincolnshire Assembly


Strategy Board

SB Planning Group
LAA Team

Children Young People Board
Safer Stronger Communities Board
Economic Development and Environment Board
Healthier Communities Older People Board

Lincolnshire Community Cohesion Partnership
Lincolnshire Accessibility Partnership
Geographical Priority Areas Lincoln City East
Lindsey LSPs
District LSPs
Headline Leads
Environment and Climate Change Partnership
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What is a JSNA?
Joint

• A framework for communities, local government and
  the NHS to work together in partnership
• Using shared sources of evidence to identify what
  matters most to local people, solutions that work
  and gaps that need to be filled
• Based on peoples wants and needs, regardless of
  whats gone before

Strategic
Needs Assessment
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Lincolnshire A good place to live

• One of the most rural counties in England
• Low population density
• Relatively cheap housing
• Good schools
• Low crime rates
• Historic and cultural heritage
• Big sky landscapes and many areas of outstanding
  natural beauty
• Good air quality and low level of carbon
  emissions

Population density people per sq km
Lincolnshire 116 East Midlands 279 England 390
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Our population is growing fast

• Issue
• One of the fastest-growing areas in the UK

In-migration from other counties
Small increase in birth rate (2.8 between 2000
and 2006)
In-migration from the EU
By 2029, forecast increase of 32 to 856,000

• Challenge
• Meeting the increased demand for services
• Reducing demand by focusing on prevention

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Our population is ageing

• Issues
• Since 2002, pre-retirement population has
  increased by 3.1 and over 65s by 1.8
• Projections to 2020
• 73,000 more older people
• Over 85s increasing to 57,000 (with increasing
  dependency)
• Varied impact across county - housing
  developments a major factor
• 15.8 rise in Mid Kesteven PBC
• 1.1 fall in Lincoln South PBC

• Challenges
• Planning for changes in the distribution of
  population
• Meeting demand for services for older people

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Young people do not settle in the county

• Issues
• 1,000 fewer young people by 2020
• Young people who leave for university tend not to
  return until later in life
• Few Lincoln University graduates stay in the
  county

• Challenges
• Developing educational and professional
  opportunities for young people
• Ensuring appropriate and affordable housing

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We have some high levels of economic deprivation

• Issues
• Some very prosperous areas
• North Kesteven among the 20 of least deprived LA
  areas in the UK
• But overall ranking on deprivation indices high
• 25 wards among 20 most deprived in UK
• Some anomalies in healthcare resource allocation
• Differential movement by PCT to help underfunded
  districts

• Challenges
• Continuing to address funding anomalies
• Identifying and addressing other inequalities in
  resourcing
• Attracting further EU funding

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Our infrastructure makes access difficult

• Issues
• Undeveloped single lane roads
• One of the worst road safety rates in the country
• After falling in 2006, fatalities and casualties
  have risen in 2007
• Health and social services struggle with
  viability
• People in remote areas struggle to access
  services
• Proposed solutions seen as threat to countys
  unspoiled character

• Challenges
• Contuing road safety campaigns
• Developing innovative transport solutions
• Finding ways of improving access without damaging
  the environment

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We have significant health inequalities across
the county

• Issues
• Significant differences in life expectancy and
  death rates across county
• Broadly inequalities equate with deprivation
• Some exceptions, linked to lifestyle and quality
  of healthcare
• Premature mortality rates higher than expected in
  Mid Kesteven lower than expected in Skegness
  Coast

• Challenges
• PSA target to reduce health inequalities by 10
  by 2010
• Providing more focussed and effective prevention
  and healthcare services
• Continuing to reduce healthcare funding anomalies

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Lincoln City remains a hotspot for health

• Issues
• Designated national Spearhead area in 2005
• Special funding for range of measures to improve
  health
• Least improvement of all county LAs 1993 - 2005
• Lincoln Health Board responsible for meeting
  targets

• Challenges
• Commissioning evidence-based interventions that
  support people in changing their lifestyles
• Focus on improving the range and effectiveness of
  services

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Management of Long Term Conditions (LTCs) could
be better

• Issues
• 37 of deaths under 75 from conditions amenable
  to healthcare
• Eg coronary heart disease (CHD), stroke,
  hypertension, diabetes, dementia
• Poor management in some areas, eg
• Monitoring blood pressure and cholesterol levels
• Identifying dementia

• Challenges
• Improving management of LTCs
• Providing information and support to patients to
  improve self-care
• Addressing lifestyle issues
• Improving the diagnosis and care of dementia
  patients

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Clinical Interventions

• By providing excellent clinical care, we could
• prevent
• 44 of ischaemic heart disease deaths
• 10 of bowel cancer deaths
• 10 of breast cancer deaths
• 6 of premature deaths from pneumonia
• 4 of perinatal and childhood diseases

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Staying Healthy

• Short-term
• Health Inequalities- 2010 targets and action plan
  following RST assessment (particularly Lincoln)
  better targeting
• Identification, assessment and effective clinical
  management in Primary Care of patients with
  lifestyle at-risk factors and morbidity
• Obesity childhood programmes (Fit Kids CHOMP)
• Smoking cessation-further uptake of services
• Sexual health- teenage pregnancy, Chlamydia
  screening and access to GUM

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Infant Mortality

• Diabetes

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Staying Healthy

• Medium-term
• Tobacco Control- reduce smoking prevalence
• Healthy Weight, Healthy Lives adults children
• Alcohol-sensible drinking, consequences of
  alcohol misuse
• Vulnerable Adults/Older People- supporting
  independence
• Children Young People- Every Child Matters
• Workforce development front line staff and
  public health skills

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Staying Healthy

• Public Protection
• Infection Control- increase immunisation rates,
  new HPV programme, reduce HCAIs waste management
  
• Emergency Planning- update and develop detail of
  generic Emergency Plans and Procedures, those for
  responding to a Flu Pandemic and those for the
  related Business Continuity arrangements

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Staying Healthy

• Noting
• Application of health inequalities impact
  assessments (HIIA)
• Utilisation of the shared evidence base
  mechanisms (SEB)
• Exploration of Programme Budgeting, e.g. CVD
  pathways
• Evaluation

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Promoting health lifestyles

• In 2007, additional resources from the Choosing
  Health initiative to tackle
• Smoking
• Obesity
• Sexual health
• Mental health problems
• Alcohol misuse
• Reflecting health disadvantages
• In 2008, health well-being fund (PCT / LCC)

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Sustainable Community Strategy 2008 Emerging
framework
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Structures
Clinical Services