Partnerships and Health Inequalities in Hertfordshire

1. Item 4 Partnerships and Health Inequalities in Hertfordshire Raymond Jankowski

2. Top priorities • Tackling health inequalities • Smoking • Childhood obesity • Alcohol consumption • Sexual health • Screening • Immunisation

3. Health promotion and disease prevention in adults:challenges in Hertfordshire

4. 10 major enablers for health inequalities Bentley, June 2008

5. Health inequalities action plan • Initial plan approved by boards in July 2008 • Update to board in January 2009 • Top 30 key areas (includes 16% most deprived wards) • Also specifies vulnerable groups such migrant workers, gypsy and travellers, ethnic minorities • Making links with housing, education and domestic violence • Focusing on smoking cessation, obesity and immunisation • Need to use social marketing techniques

6. Importance of broader tobacco control measures • 10-20% fall in prevalence due to NHS smoking cessation services • 80-90% fall to broader tobacco control measures, including: • Taxation • Action to reduce illegal (cheaper) supplies • Environmental controls and enforcement (smoke –free) • Restrictions of tobacco advertising • Population-based health promotion campaigns • Local initiatives to discourage starting • Brief advice re quitting/self-motivated quitting

7. Future actions to reduce smoking levels

8. Key priorities for tobacco control (2009/10) • County wide strategy group established CSF, Trading Standards, PCT commissioners, stop smoking service, environmental health, links to district/borough council CEOs • Main priorities established • Improved community profiling/ targetting • Focus on workplaces / routine & manual • Increase resource – co-ordination of work, smoking cessation team • Strengthen joint working including tobacco alliance networks • Increase capacity in quitting support services

9. Obesity in Hertfordshire • Second biggest lifestyle issue in Hertfordshire after smoking • Estimated to cost £400M of £1.4B NHS budget • Large obesity monitoring project for children, not case for adults • 20% + of adults obese • Five a day programmes • LAA for adults physical activity programmes – challenging • Obesity clinics with PBCs ? • Community agent projects (LAA funded ?) • Targeting parents at 50+ children centres ?

10. Childhood obesity: of obese/overweight children * *Survey of over 85% of schools in 2007/8

11. Action on childhood obesity Prevention • Supporting antenatal women • Promoting breast feeding • Healthy schools: five a day programme • Increase regular exercise by children • Increase healthy school meal options • Improve user friendliness of parks and open spaces Personalised support • Local clinical pathways for management of overweight/obesity • Ensure health visitor/school nurse capacity to manage need • Pilot antenatal dietician scheme to support obese women • Evaluate and extend anti-obesity programmes e.g. MEND, Fun schemes

12. Alcohol misuse • Binge drinking and hospital admission data • Underage drinking, selling of alcohol • Those drinking more than recommended limits at home • Perception of difficulty of NHS access for drinking addiction ?

13. Alcohol misuse: actions • National drinkwise campaign targeting all drinkers (units) • Hertfordshire Alcohol Harm Reduction • Closer working with DAAT • CDRP partnerships • New data sharing –e.g. incidence data collection form A&E departments • Development of Brief interventions for alcohol misuse in primary care • Drugs Education Forum working with healthy schools initiative • Working with Young Persons Substance Misuse Commissioning Group • Working with Herts Foundation Partnership Trust to target dual diagnosis patients

14. Sexual health • Increasing in GUM attendances in Hertfordshire • Increase in young people • Increase in those over 50 years old • Teenage pregnancy rates • Varies across county • Some district rates are above national average

15. Sexual health: action • Integration of services • Sexual health clinical network • Holistic model: 5 levels of service • Development of GP based service • Contraception services for teenagers • Screening for HIV/chlamydia • Increase education and prevention • Teenage pregnancy strategy with partners • Specific services for looked after children, six form and 16-24 years • Condom availability, C- card scheme • Increase awareness • To inform about services and how to access • Specific messages to young people, young parents, parents, carers and professionals • Teenage pregnancy strategy

16. Screening programmes • Antenatal • Down’s syndrome • Sickle cell and thalassaemia • Newborn • Hearing • Blood spot • Cancer • Bowel • Breast • Cervical • Adult • Heart disease • Aortic aneurysm • Diabetic retinopathy

17. Immunisation • MMR • HPV • Seasonal flu

18. Falls prevention • Commonest cause in older people of: • Serious injury • Injury-related hospital attendance • Precipitating care home admission • Reducing confidence and independence • 30% fall aged over 65 years in a year • 50% fall aged over 85 years in a year

19. The epidemiology of falls in Hertfordshire: in one year 45-50 deaths from falls 942 hip fractures 4,141 hospital admissions 9,000 A&E attendances 18,000 ambulance 999 calls 52,000 falls in >65 year olds

20. Action for Falls prevention • Nottingham tool for identification • Effectiveness in NICE guidance • Improve balance, gait, mobility • Environmental factors • 15-30% reduction in falls – financial savings • At least £2.65M per annum savings in Hertfordshire (hospital admissions) • 7,800 fewer older falling – less residential/nursing home care • Importance of exercise in prevention • Impact on intermediate care ?

21. Future focus • Agreeing priorities with 12 PBCs, LAAs, 10 LSPs • Making links across LAA groups • Reinforcing links with LAs and voluntary sector • Opportunities within world class commissioning e.g. intermediate care • Consideration to continue second year of £100,000 to the 10 LSPs

22. Key documents • Health inequalities action plan July 2008 • Health inequalities action plan update January 2009 • PCTs’ 5 year strategy In draft • Sexual Health strategy 2007