Tameside Strategic Partnership

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3. Health Improvement

3.1 Low birth weight and Infant mortality

Outcomes framework:

Public Health 2.1; 4.1; NHS 1.6

Implications for the population’s health and well-being:

Low birth weight reflects the health of mothers and babies and is associated with poor outcomes for babies including increased infant mortality. Good maternity and infant health care can make a significant difference, as can good social and family support.

At risk or vulnerable groups:

There is a strong social gradient for low birth weight, with lower income groups more likely to have babies with low birth weight. There is also variation between ethnic groups.

Benchmarking:

Low birth weight is more common in Tameside than in the North West (NW) and England. However, this is not associated with higher infant mortality, which is consistently below the NW and England averages.

Figure 23: Percentage of all births (live and still births) where the baby has a low birth weight 2010

Graph showing percentage of all births where the baby has a low birth weight

Source: NHS Information Centre, 2011

Figure 24: Infant, neonatal and perinatal* mortality rates** per 1000 live births, 2003-2005 to 2007-2009 [*including still births] [**each age group excludes the deaths from the younger age groups].

Graph showing mortality rates per 1000 live births

Source: NHS Information Centre, 2011

Policy context:

Low birth weight is highlighted by the Marmot Review as an important indicator of population health, and is included in the DH Business Plan for 2011-15 within the context of addressing issues of premature mortality, avoidable ill health and inequalities in health, particularly in relation to child poverty.

What interventions work?

Good maternity and infant health care can make a significant difference, as can good social and family support. NICE have produced detailed guidance for maternity care and the Healthy Child Programme and National Service Framework for Children provide extensive evidence-based framework for maternal and infant care.

Reducing smoking in pregnancy will help to reduce the percentage of babies born with low birth weight. The Sure Start/Children’s Centre programme initiatives to reduce domestic violence, enhance maternal health, reduce child poverty and increase family income through access to work and benefit entitlements can all make important contributions. General improvements in the determinants of health will be reflected in improvements in maternal and child health.

What are we doing now?

Local women have good access to maternity services from Tameside Hospital, with additional support for vulnerable women. Stop Smoking Services are tailored to support pregnant women (for more information see the Indicator relating to smoking). Children’s Centre core offer services are available in priority areas.

What needs to happen next, and by whom?

It is vital that current local services for pregnant women that meet NICE guidelines continue to be available and readily accessible, and that the Health Child Programme and Children’s Centre services are provided in line with national guidance. Continued action to reduce smoking at the time of delivery (SATOD)

3.2 Breastfeeding at 6-8 weeks

Outcomes framework:

Public Health 2.2

Implications for the population’s health and well-being:

There is significant immediate and long term health benefits associated with breastfeeding. Current World Health Organisation (WHO) and Department of Health (DH) policy is to promote exclusive breastfeeding for the first 6 months. Increasing the number of women who initiate and continue to breastfeed at 6-8 weeks will help to realise the following benefits cited by NICE:

  • Increasing the number of women who breastfeed exclusively for 6 months.
  • Reducing the number of hospital admissions for diarrhoea and respiratory infections in infants.
  • Reducing the risk of ovarian and breast cancer in women who breastfeed.
  • Reducing the risk of obesity in children, and lowering the risks of developing coronary heart disease and diabetes in later life.
  • Raising public awareness of the benefits of breastfeeding.
  • Reducing inequalities and improving access to breastfeeding support for women in low income groups.

At risk or vulnerable groups:

There is a strong social gradient for initiation and continuation of breastfeeding. Current local priority areas in Tameside and Glossop are Ashton Hurst, Ashton St Michael’s, Ashton St Peter’s, Denton South, Hyde, Hattersley and Gamesley. Breastfeeding mums can be vulnerable to discrimination, particularly when trying to feed in public. This prevents and discourages many women from breastfeeding.

Benchmarking:

The Infant Feeding Survey (2005) showed that 78% of women in England breastfeed their babies immediately after birth, but by 6 weeks, the proportion had dropped to 50%. In Tameside and Glossop breastfeeding rates are below the national average.

Rates are increasing since the establishment of a local Infant Feeding Team, and investment in a peer support programme as part of the local World Class Commissioning process.

Figure 25: Prevalence of breastfeeding at 6-8 weeks, 2009-2011.

Graph showing prevalence of breastfeeding at 6-8 weeks, 2009-2011

Source: Department of Health Statistical Release on Breastfeeding; Tameside and Glossop CHC; NHS Tameside and Glossop

Policy context:

Current DH policy is to promote exclusive breastfeeding for the first 6 months, continuing for as long as the mother and baby wish while gradually introducing a more varied diet. Promotion of breastfeeding is part of the national and local Healthy Child Programme. Local strategy reflects the recommendations of the NW Breastfeeding Strategy.

What interventions work?

NICE guidance highlights the impact of peer support as part of a comprehensive strategy to promote breastfeeding. Further effective approaches to promoting breastfeeding are included in NICE guidance on antenatal and postnatal maternity care.

UNICEF Baby Friendly accreditation requires the adoption of best practice to support initiation and maintenance of breastfeeding, including staff training and audits to demonstrate compliance.

What are we doing now?

Key local initiatives to achieve improvements include:

  • the work of the Infant Feeding Team, who have also led the work to achieve WHO Baby Friendly accreditation for local services.
  • work to achieve UNICEF Baby Friendly Initiative accreditation.
  • Breast Feeding Peer Support Programme.
  • listing as a priority area in the current services specifications for Maternity, Health Visiting and Neonatal Care.
  • enabling public attitudes that are supportive of breastfeeding.
  • applying for accreditation by National Autistic Society to enable us to provide better support for people with Autism within their own homes.

What needs to happen next, and by whom?

NHS Tameside and Glossop (NHS T&G) have set a target of 42.5% of babies to be breastfeeding at 6-8 weeks by 2013 and service investments are resulting in good progress towards this.

  • NHS Tameside and Glossop/NHS Clinical Commissioning Group (CCG), in collaboration with Tameside MBC, needs to commission a comprehensive range of services to promote and support breast feeding, including a peer support programme and social marketing.
  • Tameside and Glossop Community Health Care (T&GCHC) and Tameside Hospital Foundation Trust (THFT) need to continue to provide the Infant Feeding Team service, and lead the UNICEF Baby Friendly accreditation of local services.
  • THFT and T&GCHC also need to continue to provide maternity and health visiting services that promote breastfeeding in-line with WHO, DH and NICE guidance.
  • TMBC need to regularly review local strategies to breastfeeding promotion though their Health and Well-being Boards, and support breastfeeding within the work of Children Centres.
  • All service providers, retail, leisure and catering outlets need to ensure that their facilities are suitable for women to breastfeed.
  • Continue to challenge public attitudes that are not supportive of breastfeeding.

3.3 Tooth decay in children aged 5

Outcomes framework:

Public Health 4.2

Implications for the population’s health and well-being:

  • Tooth decay causes pain, sepsis, loss of appearance and confidence, loss nights’ sleep, missed school, and required avoidable and unpleasant dental treatment including extractions under general anaesthetic which represent an avoidable risk to life.
  • Good oral health in five year olds is an indicator of healthy infant feeding and nutrition.
  • Decay levels in five year olds are a good indicator of oral health of the population as a whole.
  • Decay in five year olds is an indicator of future tooth decay and oral health.

Programme spend:

Tameside and Glossop spend on treatment of dental disease for 2010-11 was £11,572,000. This was spent on the provision of general and specialist (mainly orthodontic) primary dental care services including dental access services, urgent treatment services (in hours and out of hours), and domiciliary services.

At risk or vulnerable groups:

Children and young peoples’ health indicators published for the North West of England dental health, status are related to levels of socio-economic deprivation.

Inequalities exist between communities in Tameside and Glossop, with the severest of decay existing in areas of highest socio-economic deprivation including Ashton St Peters, Hyde North, Hyde Werneth and Hattersley.

Ethnicity - The highest decay levels (severity and prevalence) were found in Bangladeshi children. More than 70% of Bangladeshi children examined had dome decay with an average of nearly four teeth affected. Pakistani children also show higher decay levels than white children and other ethnic groups (over 60% of Pakistani children affected with an average of nearly 3 teeth decayed).

Benchmarking:

Every four years a nationally co-ordinated survey of the oral health of five year old children’s teeth is carried out. The sampling frame is children attending mainstream schools who are five years old at the time of the survey. Calibrated examiners examine children and record the number of decayed (d), missing (m) and filled (f) primary teeth making up the dmft index.

Table 11: Decayed, missing and filled teeth (dmft) in Tameside and Glossop 5 year olds compared to England and the North West.

Area

Average dmft (severity of decay)

% dmft greater than 1 (Prevalence of decay)

2005-6

2007-8

2005-6

2007-8

Tameside and Glossop

2.2

1.4

55

37.4

North West

2.0

1.5

47

38.1

England

1.5

1.1

38

30.9

Source: The Dental epidemiology Programme for England: Oral health Survey.

There appear to have been big improvements in oral health nationally, in the North West as well as in Tameside and Glossop. The caveat is that due to low participation rates it is possible that the North West or England figures are not accurate and may reflect an improvement where none exists. However in Tameside and Glossop participation rates were high (90% of the sample, highest for England) and therefore the improvement is likely to be a real one.

This is the first time since surveys began that significant improvements in the oral health of five year olds have been seen. Up to 2005-6 there had been only marginal improvements – nationally, regionally or locally - since national surveys began in 1991-2. Tameside and Glossop has also seen an improvement relative to the North West, with 5 year old dental health slightly better than the North West average while traditionally it has been slightly worse. There is however no room for complacency. The North West has among the poorest levels of oral health in England.

Policy context:

What interventions work?

According to Choosing better oral health:

Improving diet and reducing sugars intake: promoting breastfeeding and recommended weaning practices; reducing both the frequency and amount of added sugars consumed in line with Department of Health target; increasing the consumption of fruit and vegetables to at least 5 portions per day; reducing consumption of acidic soft drinks; and promoting use of sugar free medicines.

Improving oral hygiene: encouraging the early adoption of oral hygiene practices in young children; promoting effective oral hygiene self care practices across the population; and supporting parents, health professionals and carers of people who need help in maintaining their oral hygiene.

Optimising exposure to fluorides: promoting water fluoridation in areas with poor oral health and where local communities support this action; encouraging the use of fluoride toothpastes across the population, especially young children in disadvantaged areas.

Professional training and support: developing the health promoting knowledge and skills of the dental team; incorporating oral health input into the training of other health professionals; providing support if implementing and evaluating the oral health component of the LDPs; and developing oral health links with other areas of health improvement.

What are we doing now?

  • All 6 month babies receive toothbrush and paste. Those most at risk (Looked After Children, Hyde Bangladeshis, medically compromised) receive additional support and advice.
  • Health visiting team give brush, paste and advice at 12 month check. Bangladeshi parents may be referred to the bi-lingual advisor.
  • Cost price brushes and paste are sold through children’s centres, family support, homestart and supported housing schemes.
  • School nurse assistants deliver oral health sessions to children and parents in reception class.
  • Under fives child care providers get a nutrition and oral health award if they fulfill criteria.
  • Training and resources are provided to all the teams who work with Early Years and vulnerable families including pre-school, childminders, general dental practitioners.
  • Fluoride varnish scheme for 3-6 year olds attending Hyde primary schools.
  • Bi-lingual oral health advisor in Hyde supporting healthy weaning through home visits.
  • Oral health support for Cornerstones, very vulnerable families.
  • Supporting oral health advice in vaccination and immunisation sessions in pilot practices.

What needs to happen next, and by whom?

Tameside and Glossop has a strong record in partnership working to deliver evidence based strategies to improve health and address inequalities. The effectiveness of this approach has been shown in the recent improvements. Current initiatives are targeted at improving diet and reducing sugar intake and to increase tooth brushing with a family strength fluoride toothpaste from when teeth come through. In order to reduce inequalities between Tameside and Glossop children and those in England as a whole, and those within Tameside and Glossop this programme must be maintained and strengthened.

There is a particular need to address inequalities relating to ethnicity and socio-economic deprivation – maintaining Tameside-wide initiatives while extending targeted work including fluoride toothpaste schemes and bi-lingual weaning support and home visit to Ashton.

3.4 Smoking prevalence

Outcomes framework:

  • Public Health 2.3: Smoking status at time of delivery
  • Public Health 2.9: Smoking prevalence in 15 year olds
  • Public Health 2.14:Smoking prevalence in adults (over 18)
  • NHS Operating Framework PHQ 30: Smoking Quitters

Implications for the population’s health and well-being:

26% of adults in Tameside and Glossop smoke (about 59,000 people); this is higher than North West (23%) and England (21%). Each year smoking costs Tameside £66 million and causes over 500 deaths and 2,500 hospital admissions. Smoking-related deaths are a major contributor to the low male and female life expectancy in Tameside and Glossop.

Smoking is the single most modifiable risk factor for adverse outcomes in pregnancy; contributing to 40% of all infant deaths, 12.5% increased risk of premature birth and 26.3% increased risk of intrauterine growth restriction (DH, 2009).

At risk or vulnerable groups:

Smoking accounts for half the difference in life expectancy between social class 1 and 5 (ASH, 2008), and helps to perpetuate poverty, deprivation and health inequality. In Tameside, those most exposed are; men from low socio-economic or routine and manual groups, children and unborn babies exposed to second hand smoke (SHS), and those with existing health conditions, e.g. Mental Health problems, CVD, COPD.

Children exposed to SHS are at much greater risk of cot death, meningitis, lung infections and ear disease. Children from more deprived households are more likely to be exposed to SHS. If both parents smoke children are four times more likely to start smoking than if neither parent smokes.

Smoking during pregnancy is strongly associated with age and social economic position. Pregnant women under 20 are five times more likely to smoke than those aged over 35 (45% and 9%) (Market Research Bureau, 2007). Pregnant women in routine and manual occupations are over four times as likely to smoke as those in managerial and professional occupations (29% and 7%). Pregnant women are also more likely to smoke if they are less educated, live in rented accommodation, are single or have a partner who smokes.

Benchmarking:

26% of adults in Tameside and Glossop smoke (about 59,000 people); this is higher than the North West (23%) and England (21%). This has fallen from 32% in 2006/07, but the gap between Tameside and Glossop and England as a whole has not been closed. Last year our stop smoking service (SSS) helped 2,037 people quit.

Figure 26: Smoking Quitters per 100,000 aged 16 yrs and over 2011/12 Qtr1

Graph showing smoking quitters per 1000 aged 16 years and over 2011/12 Qtr 1

Source: NHS Information Centre Omnibus, 2012

In 2010/11 23% (692/3023) of pregnant women in Tameside smoked at the time of delivery (SATOD). This is the highest rate in Greatest Manchester, and much higher than England (14%). We have achieved a small fall in the SATOD rate from 25% in 2006/07 but we are failing to close the gap between Tameside and Glossop and the regional and England average.

Figure 27: Mothers smoking at delivery in the North West 2010/11

Graph showing percentage of mothers smoking at delivery in the North West 2010/11

Source: NHS Information Centre Omnibus 2012

Policy context:

  • DH Healthy Lives; Healthy People: a tobacco control plan for England
    • To reduce adult (aged 18 or over) smoking prevalence in England to 18.5% by 2015
    • To reduce rates of regular smoking among 15 year olds in England to 12% 2015
    • To reduce rates of smoking throughout pregnancy to 11% by 2015

What interventions work?

  • Advise all patients, including pregnant women and people with smoking-related diseases, who smoke to quit, and refer those who want to stop to NHS Stop Smoking Services.
  • Local mass-media campaigns can prevent the uptake of smoking among young people.
  • Integrate information on smoking into school curriculum, and deliver anti-smoking activities as part of Personal, Health and Social Education (PHSE).
  • Effective enforcement to prevent the sale of illicit tobacco and underage sales of tobacco products reduces the opportunities to start smoking for children and young people.
  • Smoke-free homes and cars reduce exposure to SHS.

What are we doing now?

  • Social marketing targeting routine and manual groups Jan- March 2012.
  • Very brief advice training for over 400 front line staff last year and at least 300 this year.
  • Last year 37 test purchases were conducted by the Tameside Trading Standards Department, resulting in 19 sales and 9 successful prosecutions for sales to under age young people.
  • Trading Standards are working acting on any intelligence they receive regarding illegal and illicit tobacco and the number of complaints and intelligence coming into Tameside MBC has risen.
  • Trading Standards work with Greater Manchester Police, where necessary, in executing warrants on premises that may be storing or selling illegal and/or illicit cigarettes. A number of investigations are ongoing.
  • Opt-out system of referring all pregnant smokers to SSS is in place.
  • A Workplace Health Improvement Officer has been appointed who will support employers who want to help their employees to stop smoking.
  • Take 7 Steps Out smoke free action plan for Children’s Centres as part of Youth and Family team including Youth & family apprentices targeting baby clinics to give out messages.
  • Chemical soup training in four hot spot areas.

What needs to happen next, and by whom?

  • Universal implementation of Ask, Advise, Act across primary, secondary and community services including full choice of available support is needed to support more smokers in Tameside to quit.
    • All front line healthcare (primary care secondary care, pharmacists, dentists), social care and community services staff.
  • Universal enforcement of smoke-free grounds, including in cars, playgrounds, school gates and support for staff to quit smoking.
    • Local Authorities, District Assembles, Environmental health services, local employers.
  • To increase the quit rate among routine and manual groups and young women, sustained recruitment campaigns need to target these hard to reach groups.
    • Local authority and primary care trust.
  • Increase the number of families that sign up to ‘Take 7 Steps Out’ and work closely with Tobacco Free Future’s Chemical Soup initiative.
    • Schools, Youth and family team and health mentors, community nurses, maternity services.
  • Link in with the regional work on Smoke and Mirrors initiative and strengthen communication methods for young people.
    • Schools, youth & family team and health mentors.

3.5 Under 18 conceptions

Outcomes framework:

Public Health 2.4

Implications for the population’s health and well-being:

Babies born to teenage parents are more likely to have poorer health outcomes in comparison to babies born to older mothers, including higher rates of infant mortality, premature birth, and higher rates of admissions to A&E. In the longer term, children of teenage mothers are more likely to experience lower educational attainment and are at higher risk of economic inactivity as adults. Young mothers can also experience poor maternal emotional health and well being and can find it difficult to progress their education or find childcare to enable their participation in education, training or employment. These issues mean that there are increased chances of both teenage parents and their children living in poverty, which contribute to health inequalities and ongoing child poverty.

At risk or vulnerable groups:

Young people with low educational attainment, and poor attendance and a dislike of school. In contact with the police; poor emotional and mental health and those living in and leaving care. Often these young people are not engaged in current services.

Benchmarking:

The local under 18s conception rate has fallen over the past year, but remains much higher than comparator areas.

Figure 28: Trend in teenage conceptions, rolling average rate per 1,000 women aged 15-17 years, 1998-2000 to 2008-10.

Graph showing trend in teenage conceptions per 1000 women aged 15-17 years, 1998-2000 to 2008-10

Source: Office of National Statistics and Department of Education, 2012

Policy context:

The National Teenage Pregnancy Strategy was published in 1999, and was updated in 2010: ‘Teenage Pregnancy Strategy: Beyond 2010’.

A new national Sexual Health Policy Framework is due to be published in 2012. This new strategy will replace the existing 2001 strategy: “National Strategy for Sexual Health and HIV”. It is expected that the new strategy will include an ongoing commitment to reducing conceptions in the under 18s as this indicator has been included within the new Public Health Outcomes Framework which local organisations need to achieve during 2013-16.

The current local Sexual Health strategy has been refreshed and is due for publication shortly. It includes reducing teenage conceptions as one of the key areas for attention.

What interventions work?

The 2010 national strategy update recommends two factors for which the evidence of impact on teenage pregnancy rate reductions is strongest:

  • The delivery of comprehensive Sex and Relationship Education (SRE) programmes which can be effective in delaying initiation of sex as well as increasing condom and/or contraception use.
  • The provision of accessible, young people-centred contraceptive and sexual health (CaSH) services to enable increased access and use of contraception.

What are we doing now?

Jointly:

  • YOUthink are jointly commissioned by the NHS and Tameside MBC. The team consists of Family Planning Agency (FPA) trained youth workers that deliver brief interventions, sexual health awareness and prevention sessions and promote local services. This includes offering all schools sexual health workshops for year 10 pupils and targeted support for vulnerable or high risk young people.
  • YOUthink also train frontline staff that work with children and young to have the skills and feel confident to discuss sex, relationships and sexual health with young people, and promote local sexual health services.
  • The Tameside Teenage Pregnancy Board (TTPB) is the local strategic partnership group that develops and implements local strategy to reduce under 18s conceptions, the sits under the Children’s Trust. This work is complemented by the Tameside and Glossop Sexual Health Clinical Advisory Group which is responsible for implementing the local Sexual Health Strategy. Links also exist with the Derbyshire via Derbyshire Health and Well-being Board.
  • Developing an interagency pathway for teenagers who are pregnant.
  • Mystery shopper exercise to get feedback from local young people on the quality of services in an innovative way.

NHS Tameside and Glossop:

  • Provision of a community based Contraception And Sexual Health (CaSH) service which opens at times to suit young people and meets the ‘Your Welcome’ quality standards for young people friendly services.
  • Sexual health Advice For Everyone (SAFE) promotion campaign is being delivered to raise awareness of sexual health information and local services.
  • Young women that have undergone a pregnancy termination are given targeted support and contraception advice to help them avoid the need for additional terminations in the future.
  • The Early Attachment Service is being extended to include a full time teenage pregnancy worker.

Tameside MBC:

  • Members of the Local Authority’s Youth and Family Teams have received FPA training to enable them to support the young people, who are often vulnerable, that they come into contact with regarding sexual health issues.
  • Roll out of the FPA’s ‘Speakeasy’ Train the Trainer training which supports parents to discuss sex and relationships with their children.
  • A Teens and Toddlers programme supports vulnerable young people to develop skills and confidence to support them to make informed choices.

What needs to happen next, and by whom?

Jointly:

  • Senior engagement within the Local Authority and NHS organisations needs to be maintained to ensure an integrated and partnership approach to tackling teenage pregnancy, driven by the Children’s Trust and Health and Well-being Board.
  • The Healthy Schools programme to be rolled out during 2012, which will support delivery of sexual health programmes in secondary schools.
  • The TTPB need to ensure all groups of frontline staff that work with children and young people have the skills and feel confident to discuss sex, relationships, contraception and sexual health with young people.

Tameside MBC:

  • Needs to strategically and operationally prioritise delivery of an effective SRE programme within schools.

NHS:

  • Provision and ongoing performance management of a dedicated and responsive contraception and sexual health service for young people to ensure targeting of young people and delivery of required outcomes. (N.B. The commissioning of sexual health will transfer from the NHS to Tameside MBC in April 2012)
  • Ensure primary care professionals recognise their contribution to reducing under 18’s conceptions, and respond accordingly, e.g. ensuring primary care contraception services (Pharmacies and GP practices) are delivered to a quality standard, are accessible to young people, and include an offer of a range of contraception options.

3.6 Excess weight in children and adults

Outcomes framework:

Public Health 2.6 and 2.12

Implications for the population’s health and well-being:

In the last twenty years there has been an unprecedented increase in obesity in the UK, and this trend is predicted to continue due to a wide range of factors related to modern day living including our diets, levels of physical activity and inactive leisure pursuits. Latest estimates suggest that a quarter of all adults (24%) and one sixth (16.4%) of children under 16 in England are obese. People who are overweight or obese are at a greater risk of diabetes, coronary heart disease and cancer. On average obesity reduces life expectancy by 11 years.

Indicative programme spend:

The total PCT spend on obesity for 2011/2012 was £156,866 for children and £804,293 for adults.

At risk or vulnerable groups:

  • Looked After Children (LAC)/Care Leavers
  • Children from low income families
  • Children with obese parents
  • Young parents (under 21 years) and single mothers
  • People living in areas of deprivation
  • Adults who are unemployed or in semi-routine and routine occupations
  • Individuals with a physical or learning disability
  • Individuals with a mental health condition
  • Older people

National and local policy context:

The Tameside and Glossop Healthy Weight Strategy (2010 -2015) set out clear objectives for collective action from local partners to tackle obesity which is supported by an annual delivery plan.

Benchmarking:

Since 2008/09 the prevalence of overweight children in Reception Year has fallen in Tameside and Glossop to be more in line with regional and national figures. The prevalence of overweight children in Year 6 in Tameside and Glossop is also in line with regional prevalence and below that for England.

For obese children in Reception since 2008/09 the prevalence has fallen and is now below the regional and England figure. The prevalence for children in Year 6 has decreased, and although below the regional prevalence in 2010/11, Tameside and Glossop is still higher that England.

Excess weight in 4 -5 (Reception Year) and 10 -11 year olds (Year 6):

Figure 29: Prevalence of Obese Children in Reception: 2008/09 – 2010/11

Graph showing prevalence of Obese Children in Reception: 2008/09 – 2010/11

Source: NHS Information Centre, 2012

Figure 30: Prevalence of Obese Children in Year 6: 2008/09 – 2010/11

Graph showing prevalence of Obese Children in Year 6: 2008/09 – 2010/11

Source: NHS Information Centre, 2012

Excess weight adults:

The percentage of obese adults is lower in Greater Manchester in comparison to regional and England average.

Figure 31: Percentage of population aged 16+ classified as obese (BMI greater than 30)

Graph showing percentage of population aged 16+ classified as obese (BMI greater than 30)

Source: Health Survey of England 2012

What interventions work?

  • Empowering individuals through guidance, information, encouragement and a tailored approach on weight management and behavioural change.
  • Helping people to make healthy food and drink choices, and to be active.
  • Promoting healthy growth and healthy weight in children.
  • Commissioning a comprehensive and integrated range of interventions which will focus on prevention, brief advice, weight management service and clinical interventions.
  • Transforming the environment for health and the economy through initiatives such as healthy workplace, maximising the potential of planning system to support health and economic development and speaking directly to families through initiatives such as Change4Life.
  • Promoting active travel.
  • Breastfeeding initiatives.

What are we doing now?

  • Various children’s programmes such as – promoting infant feeding, weaning and pre-school nutrition guideline, Leap4Life, nutrition training, awards scheme for under 5s care providers, promoting the uptake of Healthy Start vitamins, primary school cook and eat and brief intervention healthy weight in children, Leap 4 Life under 5s prevention programme, Change 4 Life in primary schools, coaches in school programme.
  • Child and Family Weight Management Services.
  • Local breastfeeding initiative and peer support programme to women in the hospital and community across the borough in areas where breastfeeding rates are low have been identified as target areas.
  • Promote healthy lifestyles to workplaces via workplace health improvement programme to increase the responsibility of organisations for the health of their employees.
  • Health Trainer service and Family Health Mentors support people to adopt healthy behaviours.
  • Well-being Advisors supporting healthy behaviour change in older adults, people with disabilities and mental illness.
  • Brief intervention training on lifestyle.
  • Provision of adult exercise facilities in community settings and priority neighbourhoods.
  • Provision of Weight Matters programme for overweight/obese.
  • Provision of Weight Management LES via GP specialist weight management services.
  • Dieticians work with adults through specialist clinics and also provide support to mental health and ante-natal clinics.
  • A weekly programme of mainstream; swim, sport, health & fitness gyms and workout classes per week, including low impact and ‘back to’ sessions.
  • Discounted mainstream sport & physical activity sessions across all Sports Trust sites for adults and a range of health & fitness membership packages across for adults to provide an affordable way of participating in regular, varied exercise.
  • The My Active Life, 3 month physical activity behaviour change programme for local people aged 40-74 who are not currently meeting recommended physical activity guidelines.

What needs to happen next, and by whom?

The Healthy Weight Strategy Group with its wide representation is committed to the delivery of the local strategy. Some of the key areas around which more work needs to happen includes:

  • Active travel programme to promote walking and cycling.
  • Teenage Healthy Weight Pathway.
  • Health checks pathway.
  • Development of supplementary planning guidance (controlling takeaways etc) and promotion of healthy environment.
  • Social marketing campaign.
  • Promotion of the Responsibility Deal with local retailers and a need for greater involvement from the private sector in the local strategy.
  • Importance of healthy weight built in all care pathways.
  • Increased access to NHS (Clinical Commissioning Group) funding for healthy weight services.
  • Better recording and access to data on adult prevalence of overweight and obesity.
  • Ensure that all parents are able to access weaning advice that is equitable across Tameside and Glossop.

3.7 Proportion of physically active and inactive adults

Outcomes framework:

Public Health 2.13

Implications for the population’s health and well-being:

During the past 30 years evidence suggests there has been a decrease in physical activity as part of daily routines. The cost of inactivity in England through sickness absence is currently £1.8 billion a year. This does not include the contribution of inactivity to obesity, which in itself has been estimated to cost £2.5b annually; £0.5b in NHS costs and a further £2b across the economy as a whole. The health cost of inactivity in Tameside is at least £3.6m per year (Be Active, Be Healthy – 2006).

Programme Spend:

Locally, Tameside MBC and Tameside Sports Trust spends around £7,298,885 each year on providing sport and physical activity opportunities to the population of Tameside.

Specific health improvement areas of physical activity expenditure for 2012-13 Sports Trust & Sports Development:

  • May Active Life £98,000
  • Cardiac Rehab £29,000
  • Healthy Weight £12,000
  • Total Expenditure £139,000

Total Sports Trust & Sports Development Expenditure 2012-13:

  • Total Expenditure Sport and Physical Activity £ 7,298,885

75.5% of total expenditure in 2012/13 by the Sports Trust and Sports Development will be from income from grants and fees charges.

At risk or vulnerable groups:

It is important that all groups have the opportunity to be physically active in order to achieve a population shift in participation. There is a significant reduction in participation post 16 with levels of physical activity declining with age in both genders, with women and girls being less physically active than men at all ages. Levels of physical activity are also lower in low income households as well as people from BME groups.

Benchmarking:

The NI8 APS5 result for Tameside shows that 21.7% of adults undertake sport or active recreation for 30 minutes on 3 or more days a week demonstrating a positive direction of travel. The results highlight a 3.8% increase in participation from APS 1, the highest increase in Greater Manchester, which is statistically significant.

Figure 32: Greater Manchester results for N18

Graph showing Greater Manchester results for N18

The APS 4/5 results for England and the North West have yet to be released on the Active People Diagnostic tool so the information in the chart shows the ASP4 results for each area. The APS4 result for England was 21.1% while in the North West the result was 22.6%.

Policy context:

The 2012-17 Youth and Community Strategy for Sport England ‘Creating a Sporting Habit for Life’ was launched in January 2012 by the Department for Culture, Media and Sport (DCMS). The strategy aims to increase the proportion of people regularly playing sport, in particular, the proportion of 14-25 year olds who play sport and to establish a lasting network of links between schools and sports clubs in local communities so that young people keep playing sport up to and beyond the age of 25.

The DCMS and Sport England aim to do this by:

  • Building a lasting legacy of competitive sport in schools.
  • Improving links between schools and community sports clubs.
  • Working with the sports governing bodies: focusing on youth.
  • Investing in facilities.
  • Communities and the voluntary sector.

In July 2011 the Department of Health produced the new physical activity guidelines for all four UK countries covering early years; children and young people; adults; and older adults.

The guidelines highlight that physical activity should be encouraged across the population and that the risks of poor health resulting from inactivity are high. There is a clear link between physical activity and chronic disease.

Locally the ‘Get Active, Be Healthy, Enjoy and Achieve’ Sport and Physical Activity Strategy for Tameside 2010-2020 highlights the need to support people to start being more physically active and to create more accessible opportunities for all to stay active and succeed through the achievement of personal goals.

What interventions work?

  • Early intervention and prevention models that encourage people to be more regularly active that provide outcomes around positive mental health and well-being and maintaining healthy weight.
  • Interventions that reduce barriers to participation. Provision tailored to local need using market segmentation data, widen access and entry level provision available to new starters at affordable cost to encourage regular participation, effective marketing campaigns including the use of social media, providing expertise and resources to pump prime and sustain voluntary groups/clubs who provide sport and physical activity opportunities.

What are we doing now?

Targeted Interventions:

  • The Tameside Sports Trust in partnership with the public health team are supporting the ‘My Active Life’ programme a physical activity behaviour change programme for 40 – 74 year olds.
  • Sports Development undertakes the sport and physical activity delivery for the family weight management service Leap 4 Life and Jumps 4 Life programmes.
  • The Sports Trust delivers physical activity sessions to older people as part of the 5 ways to wellbeing programme including Zumba gold and Aquafit.
  • A range of weekly health walks are offered for older people encouraging more active lifestyles whilst promoting social interaction.

Population level interventions:

  • Sports Development delivers a coaching in primary schools scheme and evening/weekend community programme which engages around 6,500 people a week.
  • The Sports Trust has a wide range of health and fitness memberships for adults and young people which promote regular physical activity. The membership packages provide a flexible, broad, low cost and high quality offer to meet the needs of most residents.

What needs to happen next, and by whom?

  • The local authority and public health need to ensure that everyone receive quality information about sport and physical activity opportunities.
  • GPs and their practice staff should provide information to their patients about the benefits of physical activity and signpost them to local services.
  • The re-establishment of the Sport & Physical Activity Alliance (SPAA) which engages providers to ensure limited resources are targeted effectively, using best practice models to ensure maximum impact and value for money. The SPAA would enable a strategically coordinated approach to delivery and intervention avoiding duplication and identify effective commissioning opportunities.
  • Sports Development and the Sports Trust to work with National Governing Bodies of Sport, sports clubs, community groups and health organisations to develop programmes which contribute to the DCMS ‘Creating a Sporting Habit for Life’ strategy.
  • Development of the Tameside built environment to facilitate an increased take up of sport and physical activity, including establishing the urban parks as activity hubs and encouraging the development of walking and cycling routes to increase the number of journeys made by walking and cycling.

3.8 Hospital admissions caused by unintentional and deliberate injuries in the under 18s

Outcomes framework:

Public Health 2.7

Implications for the population’s health and well-being:

Injuries are a leading cause of hospitalisation, death, disability and ill health among children. The World Health Organisation (WHO) predicts that by 2020, injury will be the biggest single cause for loss of healthy human life years. The NHS spends around £131 million a year on emergency hospital admissions due to injuries among children.

The National Indicator NI70 is a ‘Stay Safe’ indicator defined as ‘The number of finished in-year emergency admissions of children and young people to hospital as a result of unintentional and deliberate injury per 10,000 children and young people. Childhood Injuries are the cause of 20% of all child deaths in UK.

In 2008/11 in Tameside, the commonest cause for injury admissions are due to falls followed by intentional self poisoning. However, in 2010/11, the commonest injury was fracture of forearm (7% of all injury admissions).

In Tameside, over a third of all injuries took place in the home and most of these were in the 0-4 age group.

At risk or vulnerable groups:

In general, across all the age groups, boys in Tameside are more likely to be admitted with injuries than girls. In 2010/11-the commonest injury among all boys in Tameside was fracture of forearm (5% of all injury admissions), and the commonest injury among all girls in Tameside was intentional self poisoning (3% of all injury admissions).

Childhood injuries disproportionately affect children from lower socioeconomic groups.

Benchmarking:

In Tameside, between 2008/09 to 2010/11 there were 2,164 emergency hospital admissions caused by unintentional and deliberate injuries in children and young people aged 0-17. At the end of the financial year of 2010/11 number of admissions were 704, just below the target figure of 706 set for Tameside.

The rate of admissions (per 10,000 population) reached a peak in 2007/08, and since then have been decreasing, but have remained higher than the North West and England rates. However, performance against statistical neighbours is better and Tameside was ranked in 6th position when comparing admission rates (out of 11 other statistical neighbours).

Figure 33: Admission rates for deliberate and unintentional injury for 0-17 year olds in Tameside 2003/4 to 2010/11

Graph showing admission rates for deliberate and unintentional injury for 0-17 year olds in Tameside 2003/4 to 2010/11

Source: NHS Tameside and Glossop 2012

Figure 34: Comparative admission rates for deliberate and unintentional injury for 0-17 year olds 2003/04 to 2009/10

Graph showing comparative admission rates for deliberate and unintentional injury for 0-17 year olds 2003/04 to 2009/10

Source: NHS Tameside and Glossop 2012, Department of Health 2012

Figure 35: Rates of Injuries (0-17 year olds) 2009/10

Graph showing rates of injuries (0-17 year olds) 2009/10

Source: Association of Public Health Observatories Health Profiles 2012

Policy context:

The most recent national guidance available is NICE Guidance 2010 on the prevention of unintentional injuries in 0-15 year olds for local authorities, Safeguarding Boards, NHS Trusts, the fire service and police, published in three sets:

During 2011/12, in response to the high number of hospital admissions, a review of 3 year data from 2008/09 to 2010/11 was undertaken in Tameside as well as a review of local compliance with NICE guidance. A report was received by the Tameside Safeguarding Children Board, and the recommendations referred to the Tameside Children’s Trust for consideration.

What interventions work?

The main points of the national guidance listed above are -

General measures-planning & co-ordination:

  • Local plans should commit to preventing injuries among under-15s, focusing on those most at risk.
  • Trained child and young person injury prevention coordinator in each locality.
  • Provide a wider childcare workforce with access to injury prevention training.

Home safety:

  • Identify and prioritise households most at risk and offer home assessments.
  • Ensure the assessment, supply and installation of equipment is tailored to need and includes the provision of information and advice.
  • Provide practitioners who visit children and young people at home with mechanisms for sharing information.

Outdoor play:

  • Ensure a prevention policy is in place which balances fun, physical activity and learning.
  • Encourage cycle training and promote use of cycle helmets.
  • Conduct local injury prevention campaigns for all events where fireworks may be used.

Road safety:

  • Partnerships: Maintain road safety partnerships to help plan, coordinate and manage road safety activities.

Speed reduction:

  • Engineering measures to reduce speed in streets primarily residential or where pedestrian and cyclist movements are high.
  • 20 mph zones be introduced.

What are we doing now?

A review of currently local activity against the NICE recommendations was very positive, highlighting good coverage of most elements and scope for increasing input on home safety.

What needs to happen next, and by whom?

The initial review included recommendations for further local and strategic action-

Local actions:

  • Need for high quality data from Tameside Trauma and Injury Intelligence Group (TIIG).
  • Develop a business case to deliver targets and universal approaches.
  • Targeted and universal approaches by frontline health and early years staff, and schools.
  • Focus on injury prevention work, home safety, falls on stairs and steps among 0-4.
  • Need for training in injury prevention.

Strategic actions:

  • Opportunities for local partnership work.
  • Engage children & families & wider community (1/3 families want advice).
  • LAs leadership opportunities arising in a new Public Health landscape.
  • Enable frontline health staff to implement the recommendations.
  • Development of programmes for environmental improvements including homes, play areas and roads.

3.9 Emotional well-being of looked-after children

Outcomes framework:

Public Health 2.8

Implications for the population’s health and well-being:

Central to young people’s ability to fulfil their potential as they develop from childhood and through the teenage years is the need to be well – both physically and emotionally. Good physical and emotional health and well-being are key contributors to broader outcomes such as improved learning and achievement and to the long-term prospects of young people as they move into adulthood.

Nearly 60,000 children are placed into care and looked after by local authorities in England, which represents approximately 0.5% of all children. Experiences which lead to children being forced into care very often also place them at risk for poor mental health and emotional well-being. Research indicates that a child’s emotional well-being can influence not only their future health, but can also create barriers in school and social prospects.

At risk or vulnerable groups:

All looked after children. This includes children from other areas placed in Tameside. Some children are more vulnerable than others in adapting to difficult situations and challenges that they face on their way to adulthood:

  • 53% of looked after children leave school without passing any GCSEs.
  • 29% of looked after children are not in education, employment or training by the age of 19, compared with 13% of all young people.
  • 20% of women who leave care between 16 and 19 become a mother within a year.
  • 30% of children in custody have been in care.
  • 45% of children in care are assessed as having a mental health disorder.

Benchmarking:

Table 12: Looked After Children in Tameside

Looked After Children in Tameside

No.

Total number of Looked After Children (LAC) in Tameside
394
Number of LAC placed in Tameside (from other areas)
159
Number of LAC placed in other areas by Tameside
119
Total number of medical assessments
362
Total number of dental assessments
342

Source: Tameside MBC 2012

Policy context:

Good mental health underlines all aspirations in Every Child Matters (2003). Policy guidance places emphasis on agencies working together in a co-ordinated manner to focus on identification and early intervention to support children and families.The local Tameside and Glossop Mental Well-being Strategy for 2011-13 calls for committed leadership and innovative thinking on investment in health and well-being for the successful implementation of the local strategy. The strategy emphasises on the social determinants of mental well-being and focuses on prevention, early intervention and the promotion of positive mental health alongside physical health.

What interventions work?

Early intervention and support for vulnerable children placed in care.

  • Children’s services should actively engage and support schools in developing knowledge and skills related to promoting good mental health, early identification and to support children’s emotional well-being.
  • School should adopt a systematic approach to assessing and meeting the needs of children and young people.
  • Identification of children and young people who need referral for specialist individual interventions.
  • Systematic monitoring of children and young people’s outcomes.
  • Promotion and delivery of individual mental health support to children through the Youth and Family Team.
  • Giving equal importance to good physical and mental health, and recognising the importance of one for the other.

What are we doing now?

Targeted support for children and young people at risk of developing mental health problems: comprehensive specialist services for all children and young people, with CAMHS (Child and Adolescent Mental Health Services) LAC (Looked after Children) workers to identify and broker support for LAC.

The Goodman Strengths and Difficulties Questionnaire is used with each child as they come into care and the results are discussed with the LAC CAMHS workers. Children requiring a specialist service are fast tracked into CAMHS. Off the Record Counselling Service are commissioned to work with targeted groups including children in care.

The Young People’s Health Team work with looked after children though pupil referral units, youth offending team and care leavers.As named health professionals, School Nurses and Health Visitors play an active role in working with looked after children and work with them and their carers to carry out health assessment reviews and develop a health action plan.

NHS Tameside and Glossop is working to the NW Looked After Children’s Agreement to ensure that all looked after children living in Tameside and Glossop do not experience any barriers to accessing NHS care.

What needs to happen next, and by whom?

All looked after children must have a good quality health assessment and health plan which ensures individual health needs are met. Emotional and mental health elements need to be fully assessed, captured within the health plan intervention, offered as required and outcomes monitored.

3.10 Diet

Outcomes framework:

Public Health 2.11

Implications for the population’s health and well-being:

Britain is in the grip of an obesity epidemic. A third of all children and over half of all adults are now either overweight or obese. Obesity is one of the leading threats to achieving a healthier Tameside and Glossop.

Competitive markets along with new technology have enabled the food industry to produce food cheaply and in high quantities to meet consumer demand. This has led to an increased production of processed food and ready meals, with many of these being high in fat, sugar and salt. Fatty and sugary food are also heavily advertised and marketed which has increased consumer demand. These trends have contributed to people consuming too much saturated fat, sugar and salt and not enough fruit and vegetables.

Patterns of growth early in life contribute to excess weight, e.g. if there are low breastfeeding rates. Eating practices are also influenced by social and psychological stress. There is a need for a systematic approach to tackling lifestyle issues across Tameside and Glossop including improving diet as the underlying cause of obesity, a major risk factor for Type 2 diabetes and heart disease.

At risk or vulnerable groups:

  • Looked After Children (LAC)/ Care Leavers
  • Children from low income families
  • Children with obese parents
  • Young Parents (Under 21) & Single Mothers
  • Adults who are unemployed or in semi-routine & routine occupations
  • Individuals with a physical or learning disability
  • Individuals with a mental health condition
  • Older People

Policy context:

The Tameside and Glossop Healthy Weight Strategy (2010 -2015) set out clear objectives for collective action from local partners to tackle obesity which is supported by an annual delivery plan.

Benchmarking:

The National Diet and Nutrition Survey is jointly funded by the Department of Health and UK Food Standards Agency and investigates the nutritional status and nutrient intake of the UK population. Key findings from years 1 and 2 (2008/09 – 2009/10) of the Survey are as follows:

  • 30% of adults aged 19 to 64 and 37% of adults 65 and over met the recommended five portions of fruit and vegetables daily.
  • Consumption of oily fish is well below the recommended one portion per week.
  • The recommended mean daily intake of total fat (thirty five % of total energy consumption) was met by all age/gender groups, except women and men over 65 years.
  • Mean intake of saturated fat exceeded the recommended daily amount in all age groups.
  • The recommended daily intake of vitamins was met or exceeded in all groups.
  • Mean intakes of minerals was below the recommended daily intake in some age groups, particularly women aged 11-18 years.

Figure 36: Percentage consuming 5 or more fruits and vegetable daily 2003/05 to 2007/09

Graph showing percentage consuming 5 or more fruits and vegetable daily 2003/05 to 2007/09

Source: Health Survey of England 2012

Figure 37: Percentage consuming 5 or more fruits and vegetable daily in England (2010)

Graph showing percentage consuming 5 or more fruits and vegetable daily in England (2010)

Source: Health Survey of England 2012

What works?

  • Focus on promoting healthy eating in children through a range of programmes targeted at children and families, and through schools.
  • Promoting healthier food choices by working with food and drinks industry.
  • Creating incentives for better health through workplace health programmes.
  • Personalised advice and support for people to make healthy choices.
  • Effective and accessible weight management services.
  • Healthy eating in pregnancy.
  • Consistent information on weaning.

What are we doing now?

  • Child and family weight management courses.
  • Prevention programme e.g. healthy lifestyle courses focussing on children aged 18 months to 5 years and their families.
  • Programmes to prevent obesity in childhood e.g. promoting evidence based infant feeding, weaning and pre-school nutrition guidelines.
  • Promoting breastfeeding e.g. Baby Friendly Initiative.
  • Provide Food and Nutrition Training in schools.
  • Promoting Healthy Start scheme.
  • Early Years Food and Nutrition Training.
  • Healthy Choice for Kids Award to premises aimed at children and families.
  • Nutrition and Oral Health Award Scheme for under 5s child care providers.
  • Primary school family ‘cook and be active’ programmes at school sites.
  • Helping people to make healthy food and drink choices.
  • Weight management service in GP practices.
  • Weight Matters – community weight management programme.
  • Transforming the environment for health and the economy through initiatives such as healthy workplace, maximising the potential of planning system to support health and economic development and speaking directly to families through initiatives such as Change4Life.
  • Delivery of maternal, adult and children’s healthy weight pathways.
  • Dieticians work with adults through specialist clinics and also provide support to mental health and ante-natal clinics. They offer visits to provide specialist support, e.g. to learning disabilities group.
  • The dietetics team also provides support for patients with co-morbidities (and BMI of over 30) e.g. patients with diabetes, celiac disease.

What needs to happen next, and who needs to do it?

The Healthy Weight Strategy Group is committed to the delivery of the local strategy. There is need for continued commitment from partners and for a more joined up approach on tackling healthy eating. Public Health and partners are currently in the process of developing an integrated obesity prevention programme for adults that will provide more choice and access to a range of services focussing of information and advice related to healthy diet as well as access to physical activity.

3.11 Alcohol related illness

Outcomes framework:

  • Public Health 2.18: Alcohol related admissions to hospital.
  • Public Health 4.6(i): Mortality from liver disease for persons aged U75 per 100,000.
  • Public Health 4.6 (ii): Mortality that is considered preventable from liver disease in persons less than 75 years per 100,000.
  • NHS 1.3: Under 75 mortality rate from liver disease.

Implications for the population’s health and well-being:

Alcohol is the 3rd highest risk factor for ill health in countries like the UK after smoking and high blood pressure. Health effects include liver and pancreatic disease, cardio vascular disease, an increased risk of certain cancers and mental illness. Social effects include crime and violence (including domestic violence) and public perception of violence, increased antisocial behaviour, unwanted pregnancy and its effects on the workplace and economy. Other effects are on families and society, road traffic accidents, increased attendance at A and E and admissions to hospital.

Synthetic estimates’ of alcohol consumption patterns for Tameside mid 2005, produced by the Centre for Public Health show approximately 23% of the population are hazardous drinkers and approximately 7% are harmful drinkers. Centre for Public Health data also show that alcohol specific mortality for Tameside was higher than that nationally.

The Tameside and Glossop Alcohol Needs Assessment 2009 includes an analysis of admissions data for local residents. Binge drinking is prevalent. There are high rates of admissions for acute intoxications among Tameside and Glossop residents, with a peak at ages 20-25. However there are high rates in the range of age groups from 15-49 years, especially among males. Females are likely to be admitted with acute intoxication, however the gap between male and female admissions is narrower in groups aged 35-49. Female acute intoxication admissions aged 10-14 outnumber males. Admissions show a positive relationship with socio-economic deprivation of area of residence.

Indicative Programme Spend:

The total programme spend for the NHS in Tameside and Glossop is £929,292.

At risk or vulnerable groups:

  • Children and Young People.
  • Young men involved in binge drinking and Under 15s including girls.
  • Chronic drinkers at risk of developing alcohol related ill health.
  • Those living in areas with the highest deprivation scores.
  • Children and Families with Multiple need.
  • Adults with Multiple needs and those in the Criminal Justice System.
  • Lesbian, gay, bisexual and transgender (LGBT) communities.
  • Victims of Domestic Abuse.
  • Pregnant Women.
  • People recovering from Drug Addiction.

Benchmarking:

Table 13: Alcohol Related Admissions, Directly Standardised Rate per 100,000 Population, 2002/03 to 2010/11.

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

2008/09

2009/10

2010/11

England
926
1023
1145
1291
1389
1473
1582
1743
1898
North West
1235
1362
1510
1697
1840
1940
2068
2295
2429
Tameside & Glossop
878
1088
1445
1623
1830
1991
2139
2336
2444

Source: North West Public Health Observatory, 2011

Figure 38: Admission episodes for alcohol attributable conditions all ages DSR/100,000 population, 2009/10, Greater Manchester PCTs.

Graph showing admission episodes for alcohol attributable conditions all ages DSR/100,000 population, 2009/10, Greater Manchester PCTs

Source: Local Alcohol Profiles for England (LAPE)

Figure 39: Age standardised mortality rate from liver disease for persons under 75 per 100,000 by age and sex (2008-2010)

Graph showing age standardised mortality rate from liver disease for persons under 75 per 100,000 by age and sex (2008-2010)

Source: ONS Public Health Mortality File and 2008-2010 mid-year population estimates

Policy context:

What interventions work?

The Department of Health has identified 7 high impact changes for addressing alcohol-related harm. These are practical measures that can be implemented at local level and which are calculated to have the greatest impact on health commissioned outcomes:

  • Work in Partnership – Developing and implementing the local Alcohol Strategy to improve services and address wider community issues associated with alcohol for example minimum unit pricing, the night time economy and violent crime.
  • Develop activities to control the impact of alcohol misuse in the community for example tackling binge drinking, under age sales, peer education programmes.
  • Influence change through advocacy.
  • Improve the effectiveness and capacity of specialist treatment.
  • Alcohol Specialist Teams in the acute sector and improving links to community services and identification and brief interventions are all key elements of good practice with the hospital setting.
  • Identification and Brief Advice (IBA) – provide more help to encourage people to drink less. Delivery of IBA a variety of settings for example, primary care, housing, probation service, ambulance services and social services.
  • Amplify national social marketing priorities aimed at both children and young people and adults.

What are we doing now?

  • Tameside Alcohol Strategy Group - Implementation and evaluation of the Action Plans in the Tameside Alcohol Harm Reduction Strategy. The Tameside Alcohol Strategy is under review to reflect changes to the structure and resources available to partnerships.
  • Alcohol Children and Young People Task and Finish Group - To review the current and refresh the Tameside Alcohol Strategy and action plan for Children and Young People.
  • Commissioning services and activities to support the delivery of local action plans including the use of Commissioning for Quality and Innovation (CQUINS) indicators in the acute and community contracts.
    • Tier 1 Service – IBA and very Brief Advice (VBA) on lifestyle delivered by a range of partners, Hypertension Locally Enhanced Service (LES) and a Directly Enhanced Service (DES) in Primary Care. CQUINS with Tameside and Glossop Community Healthcare and Tameside Hospital Foundation Trust.
    • Tier 2 Service – Brief Intervention (BI) delivered in a range of settings, BI LES in Primary Care.
    • Tier 2 and 3 - Nationally Enhanced Service (NES) in primary Care, DAS, ADS and Branching Out.
    • Tier 4 – Smithfield and Chapman Barker Unit.
  • Commissioned Services through the Tameside Drug and Alcohol Team (DAAT):
    • Community based Tier 3 Drugs Service plus the Drug Intervention Programme for Criminal Justice Clients deals with Alcohol use by clients.
    • Tier 2 Early Intervention and Prevention Service commissioned from Lifeline.
    • Recovery and Reintegration Service commissioned from Acorn.
    • Alcohol Treatment Requirement (Court ordered treatment) commissioned form ADS.
    • Peer Mentoring Programme.
    • Substance Using Family Support Service commissioned from Turning Point.
    • Residential Rehabilitation and the operation of the Drug and Alcohol Panel.
    • Spot Purchasing of in- patient detoxification.
  • Work on Street Drinking via a multiagency group to jointly plan interventions and improving services.
  • Integrated Offender Management and Multi-agency Reduction Reoffending Group dealing with the impact of alcohol us by Offenders.

What needs to happen next?

  • Tameside Alcohol Strategy Group to be reconvened and priorities set with clear action plans to tackle all the wide ranging issues associated with alcohol including service provision and developing an Acute Specialist Alcohol Team, work around the Minimum Unit Price, and Children and Young Person Programme, including advertising of alcohol to children.
  • Align Alcohol use with the Troubled Families agenda.
  • Social Marketing Campaign.
  • Alcohol Pathway for Young People.
  • Alcohol training, education and prevention as part of the Healthy Schools Programme.
  • Development of Workplace Health Improvement Programme to include Alcohol.
  • Increase in Tier 2 provision in acute and community.
  • Development of existing Tier 2 and 3 services including the option of integration with Drug Services in the future. This is especially important for Young People who mix recreational drugs with alcohol use.
  • Development of Tier 4 provision to support day care detox, improve appropriate access to residential rehabilitation and also provide inpatient support.
  • Better access to treatment for certain groups – Black and Minority Ethnic (BME), Women, LGTB and Young People.

Who needs to do this?

The Tameside DAAT, The Tameside Strategic Partnership, Alcohol Strategy Group and Alcohol Children and Young People’s Task and Finish Group.

3.12 Successful completion of drug treatment

  • People (adults) who complete drug treatment successfully as a percentage of the total number in treatment;
  • Proportion of people who successfully complete who then re-present within 6 months.

Outcomes framework:

Public Health 2.15

Implications for the population’s health and well-being:

Effective drug treatment prevents crime, reduces NHS costs and improves the quantity and quality of life of service users. Recovery brings both individual and public health gains including limiting the spread of blood borne viruses. Therefore, it is essential that the Tameside Drug and Alcohol Action team (DAAT) use its partnership to commission accessible and appropriate community based services. Recovery also improves family relationships – especially important where there are safeguarding concerns and domestic abuse. There are economic benefits also. Nationally, 8% of working age benefits claimants are dependent on drugs or alcohol. The NHS National Treatment Agency has a presentation on the benefits of investing in local recovery services.

At risk or vulnerable groups:

All drug users are, or at risk of being, at the margins of society. In addition, the DAAT has identified a lack of access for (and demand from) women, Black and Minority Ethnic (BME) groups, under 25s and Lesbian, Gay, Bisexual and Transgender (LGBT) communities. This potentially reflects both awareness of current services and perceptions of how applicable and effective services are for these groups of people. Also, there is a recognised association between mental illness and drug and alcohol dependence. For disabled people, a restricted existence is more likely to cause depression and the misuse of substances.

There are particular difficulties in engaging female drug users - a combination of the particular social pressures faced by women and the way in which drugs services have developed. Drug misuse can make women more exposed to the risk of unsafe sex and sexually transmitted disease, unwanted pregnancies and a high incidence of violence. Drug use during pregnancy can have a direct impact on the pregnancy and the baby’s health, while drug users with childcare responsibilities may face problems with parenting and issues of child protection.

The health of young adults is seriously threatened by the growing recreational use of ‘legal highs’. These new psychoactive substances are often combined with other drugs and alcohol creating damaging mixtures for the body to deal with. Government is responding more quickly to outlaw these substances. Young adults are using body enhancing drugs; again often dangerously combined with recreational drugs and alcohol. The risk to health is that young adults do not recognise their use as problematic, but the norm.

Our services help the most problematic offenders tackle their drug or alcohol dependence through robust offender management, testing and treatment. We continue to deliver the Drug Intervention Programme to ensure that offenders are encouraged to seek treatment and recovery at every opportunity in their contact with the criminal justice system (CJS).

Programme Spend:

Table 14: Tameside DAAT received the following Government grants for Drug Services in 2012-13

Budgets

Amount (£)

Dept. of Health Area Pooled Treatment Budget
2,072,694
Dept. of Health Drug Intervention Programme
502,722
Home Office Drug Intervention Programme
267,000
Total Grant
2,843,116

Source: Tameside MBC, 2012

In addition, financial contributions are made to community based drug provision supported by the DAAT from the Primary Care Trust, Adult Social Care, Tameside MBC, Probation Services and the Crime and Disorder Reduction Partnership. For 2012-13, the total financial allocation amounts to £3,855,156.67. Most of the drug services impact greatly on alcohol misuse as well. The DAAT directly commissions its own provision or makes a financial contribution to PCT provision.

Benchmarking:

The Drug Treatment annual grant from the Department of Health depends on local performance. Success gained with Opiate and Crack service users is more significant than success with non-opiate use at a ration of 2:1. Tameside DAAT has been allocated to cluster group ‘C’ of partnerships by the National Treatment Agency to compare local performance for opiate users with other areas that have similar characteristics.

A suggested ambition is to improve local proportion of successful completions to 12% in 2012-13.This is in the context nationally of adults newly entering treatment for heroin and crack falling by 10,000 in two years. The number of 18- 24 year olds opiate users entering treatment is halving. However, good outcomes with non opiate users are helpful for overall performance, and local comparison against national averages is possible.

DAATs are provided with quarterly performance reports termed DOMES; Diagnostic Outcomes Monitoring Executive Summary by the National Treatment Agency (soon to be part of Public Health England). Quarter 3 2011-12 is included here. The reports use NDTMS data – National Drug Treatment Monitoring System, and local commissioned treatment providers input data onto this system. However, this only applies to the most complex therapeutic interventions such as prescribing and psycho-social services. The local partnership commissions a wider range of services than this which does not register in these performance figures.

Policy context:

The Government’s ‘Drug Strategy 2010 Reducing Demand; Restricting Supply; Building Recovery 2010: Supporting people to live a drug free life’ places a strong emphasis on supporting treatment and recovery, taking a holistic view by putting individuals at the heart of recovery and working with a range of services, such as training, housing and wider health and social care services.

Government priorities 2012:

  • More education on the risks and harms of drugs - young people informed and confident – Personal, Health and Social Education (PHSE) review.
  • Break intergenerational cycles of drugs misuse and incentivize early intervention e.g. Troubled Families programme, Family Nurse Partnerships.
  • Work with the highest risk groups.
  • Continue high quality information and advice on drugs using FRANK but review relevancy – consider other channels of communication.
  • Provide stronger evidence for the local system on what works, develop the evidence base, put data in the hands of local commissioners.

What are we doing now?

The Tameside Crime and Disorder Reduction Partnership (CDRP) three year Adults Drug Strategy 2010 focuses on re-balancing the existing community drug treatment system to one that addresses improved equality of access, improved throughput and care co-ordination and increased focus and activity on recovery and re-integration. It mirrors the national focus and we have embarked on a widespread re-configuration of our services. The first year of the strategy aimed to embed the concept of Recovery and the need to re-shape the treatment system. A new service for early intervention and prevention has been commissioned from Lifeline. The second year focused on achieving Recovery and developing the capacity and support to enable people to re-integrate into their communities in a positive and contributory way. A new Recovery and Re-integration service has been commissioned from Acorn from their new recovery centre in Dukinfield.

A needs assessment for Hepatitis C (HCV) prevention for Greater Manchester recommends that we improve integration between needle exchanges and other local services. Currently, we have supported the PCT in establishing a network of trained community pharmacists offering advice and screening in addition to needle exchanges and supervised consumption in each locality.

What needs to happen next, and by whom?

Tier 3 or “the Structured Community Substance Misuse Service” is to be re-commissioned. It will provide structured community prescribing, psycho social interventions and day programmes. In addition, it is intended that the contract will cover Treatment for criminal justice clients, Harm Minimisation (blood tests etc) and support for peer mentoring and mutual support groups.

In 2015, the intention is to commission a much larger contract covering most of the recovery system and with a payment by results element to the price. The contract in 2013 is a step towards this.

In 2013, following a Key Decision by Tameside Council, a new contract for a family crisis service covering support for domestic abuse and for substance using parents will commence.

Another current proposal is that Tameside puts a Local Area Single Assessment and Referral Systems (LASARS) service in place alongside the complex treatment service planned for 2013. Local Area Single Assessment and Referral Systems are independent services offering triage, assessment and referral for all service users based on their individual needs. The outcome is a personalised package of care, drawing on a menu of options available in the local recovery system. This service will additionally provide criminal justice workers to support the Drug Intervention Programme.

The DAAT intends to modernise the commissioning of in patient provision by setting up an approved list of suppliers and improving performance management. The operation of the Drug and Alcohol Panel that decides on referrals to residential rehabilitation is to be improved.

Peer mentoring, mutual or post treatment support is the “community capital” that can prevent re-presentation into formal treatment provision. The DAAT supports this provision in Tameside. The Tameside Offender Mentoring Service will be developed further. More family support is needed and there is a family and women focussed provision which will link to help for female offenders and victims.

3.13 People entering prison with substance dependence issues who are previously not known to community treatment

Outcomes framework:

Public Health 2.16

Implications for the population’s health and well-being:

Effective recovery from drug dependence will reduce crime, cut the cost of drug-related harm to society, and make communities safer for everyone. Therefore, access to and choice of treatment for drug misuse should be the same whether people participate voluntarily or are legally obliged to do so. The aim is to break the link between drug use and criminal behaviour, so that individuals do not reoffend on release and have the opportunity to recover and reintegrate with society. In this way, effective treatment can liberate them, their families, and their communities from the harms they suffer as a result of drug-related crime.

Recent evidence from the National Institute for Health and Clinical Excellence (NICE) suggests the health and crime cost of each injecting drug user is £480,000 over a lifetime, while other studies have shown that the average amount offenders spent on drugs fell from £400 a week at the start of treatment to £25 a week at the follow-up stage.

A report published by the National Treatment Agency estimates that current drug treatment provision prevents 4.9 million crimes in England a year, with an estimated saving to society of £960 million in costs to the public, business, the criminal justice system and the NHS. The findings are in Estimating the Crime Reduction Benefits of Drug Treatment and Recovery.

Indicative Programme Spend:

Responsibility for funding substance misuse services for prisoners in England transferred from the Ministry of Justice to the Department of Health (DH) from April 2011.

Existing contracts for Prison services expired in March 2012, resulting in significant commissioning activity to establish new prison based services. Tameside DAAT (Drug and Alcohol Action Team) is not responsible for commissioning Prison based services as we do not have a Prison in our geographic area. Obviously, Tameside residents enter prisons in other areas that offer these services. Our Tameside Crime and Disorder Reduction Partnership is responsible however, for investing Government funding for the Drug Intervention Programme which amounts to £7,704,25 allocated to Tameside in 2012-13.

At risk or vulnerable groups:

  • Remand Prisoners.
  • Sentenced Prisoners.
  • Prisoners Friends and Families.
  • Women prisoners. Estimates suggest 60-70% of women who enter prison have drug problems. They are more likely to self-harm than men, have higher rates of attempted suicide, and are more likely to suffer drug-related deaths in prison and soon after release. Many women arrive in prison pregnant or have dependent children. They may be held in establishments far away from their families.

Benchmarking:

The National Treatment Agency reports that:

  • Each year, 75,000 problem drug users enter the prison system.
  • 16% of all problem drug users are in prison at any one time.
  • On average, 55% of prisoners are problem drug users.
  • Two thirds of suicides among prisoners are those who are drug dependent.
  • On release from prison, drug misusers are especially vulnerable to death from overdose.

National and Local Policy context:

‘Breaking the Link’ is recent research by the National Treatment Agency (NTA) on the role of drug treatment in tackling crime.

The ‘Why Invest’ presentation from the National Treatment Agency explains the benefits of an effective recovery system.

The Tameside Crime and Disorder Reduction Partnership governs the work of the Tameside Drug and Alcohol Action Team, and their local strategy mirrors that of the national strategy 2010, seeking to build easier access to recovery services. The value of local agencies working together to offer an integrated approach to tackling re-offending linked to substance misuse is stressed within this local strategy.

What interventions work?

The Government accepts that treatment in the criminal justice system, whether in the community or in prison, can be highly effective. The aim is to engage and work with offenders at every stage of the criminal justice system, creating an end-to-end support structure. In 2010, former NTA board member, Lord Patel of Bradford OBE reported on the drug treatment and interventions in prisons and for people on release from prisons in England.

The Government’s vision is a locally commissioned, recovery-focused prison based treatment system, described in the Green Paper “Breaking the Cycle” Tameside DAAT benefits from funding from the Home Office and Department of Health to deliver the Drug Interventions Programme (DIP). The government introduced DIP in 2003 and it brings together a range of agencies including the police, courts, prison and probation services, treatment providers, government departments and Drug Action Teams (DATs). A number of other initiatives operate under DIP, including Test on Arrest, Required Assessment and Restrictions on Bail.

IDTS is the primary drug treatment regime in many prisons. The Prison system should work closely with DIP to ensure that offenders receive seamless support and are kept in treatment even after release, when relapse becomes more of a threat. It is envisaged that substance misuse services are commissioned to offer seamless case management across both community and prisons.

What are we doing now across Tameside and Glossop?

  • The Drug and Alcohol Team (DAAT) commissions community based drug and alcohol services and a significant priority is meeting the needs of offenders.
  • The DAAT works alongside the Integrated Offender Management Programme to offer a multi-agency approach to reducing re-offending linked to substance misuse.
  • Tameside DAAT commissions a Criminal Justice treatment service providing Drug workers who undertake assessment and encourage engagement with treatment providers. They operate within the DIP and undertake in-reach or outreach with service users in prison.
  • Tameside Offending Mentoring programme is a successful initiative using volunteers to support offenders with substance misuse issues.
  • Criminal Justice System (CJS) workers undertake prison in-reach including protocols with local prisons to facilitate IDTS. Additionally this will also include continuity of through care and aftercare, (ensuring that clients can access treatment on entry and release from prison).
  • The DAAT chairs the monthly Case Intervention group for adults with multiple problems. This multi-agency process seeks to limit the anti-social behaviour caused by adults who frequently drink and take drugs in public. In addition to looking at enforcement options, the group co-operates to offer support and protection to these adults – many of whom are responsible for committing many low level crimes, rough sleeping and will spend short periods in Prison.

What needs to happen next?

  • The continued development of a responsive, flexible and effective adult drug treatment system through effective commissioning.
  • Monitoring to establish whether IDTS protocols or agreements are in place and how effective they are.
  • Develop the multiagency management of a cohort of offenders committing a high volume of offences where there is a link to substance misuse.
  • Introduction of Payment by Results that will expect outcomes around reducing re-offending.
  • Decide on the future development of the peer mentoring service and ensure support for families.
  • Establish a new resource targeting women and families and as a priority, female offenders. This will be led by Probation Services.

Who needs to do this?

Tameside DAAT, Criminal Justice Agencies, NHS, Housing providers alongside those support agencies and organisations commissioned to deliver drug interventions in Tameside.

3.14 Recorded Diabetes

Outcomes framework:

Public Health 2.17

Implications for the population’s health and well-being:

The first ever report into mortality from the National Diabetes Audit was released in December 2011. The findings concluded that 24,000 people with diabetes are dying each year from causes that could be avoided through better management of their condition. The audit, which is managed by the NHS Information Centre and commissioned by the Healthcare Quality Improvement Partnership (HQIP), also showed how women with diabetes are nine times more likely to die young.

Benchmarking:

The report compared PCTs in England and it indicated that NHS Tameside and Glossop has a higher than average mortality rate. The role of NHS Diabetes is to work to transform diabetes care across the NHS.

The number of patients on GP diabetes registers has been on the increase – figures for the past 3 years are as follows:

Table 15: Number of patients on GP diabetes registers

Mar-10

Mar-11

Mar-12

10,481
11,768
12,326

Source: NHS Comparators 2012

Figure 40: Registered Prevalence of Diabetes in Adults 2010/11

Graph showing registered Prevalence of Diabetes in Adults 2010/11

Source: NHS Information Centre 2012

Policy context:

What are we doing now?

A clinical lead for the NHS Clinical Commissioning Group (CCG) will be identified by the end of April 2012, and will lead the redesign and improvement of local services for patients with diabetes, and will ensure the offer of support from NHS Diabetes is taken up and that the issues raised in the national report are addressed.

Diabetes care is included in the Quality, Innovation, Productivity and Prevention (QIPP) plans for 2012-13, with plans to deliver improved and increased care in the community and further develop the “self care” model for patients with diabetes.

What needs to happen next, and by whom?

With leadership from the CCG, the Commissioning lead for diabetes/long term conditions will support the clinical lead, once identified, to take forward the improvements needed.

Work across commissioning and public health to increase the number of patients on disease registers and improve the clinical management of patients on those registers. The commissioning team is leading a piece of work via the Quality and Outcomes Framework (QOF) team to support Practices to improve recording and management of patients with long term conditions, including diabetes.

3.15 Cancer screening coverage

Breast screening and cervical screening

Outcomes framework:

Public Health 2.20 (i) and (ii)

Implications for the population’s health and well-being:

Breast cancer is the commonest cancer in women in Tameside, and a significant cause of long term illness and death, but early detection and effective treatment have improved the outlook over the past 20 years. Cervical screening enables the early detection and treatment to prevent the development of, and progression of, cervical cancer and the national programme is estimated to prevent about 4,000 cases of cancer and save about 4,500 lives each year.

The likelihood of developing breast or cervical cancer increases with age, which means that as the number of older people in Tameside increases there will be more cases of breast and cervical cancer. Obesity increases the risk of breast cancer, so the increasing obesity in Tameside will also result in an increase the number of women with breast cancer.

At risk or vulnerable groups:

Whilst breast cancer occurs in both man and women, the risk is much greater in women, so the breast screening programme is only offered to women. Women who have a family history of breast cancer are at greater risk, and those at highest risk are screened more often in line with NICE guidance. There is evidence that Lesbian, Gay, Bisexual and Transgender (LGBT) women do not access breast or cervical screening services as readily as most women (NHS Cervical Screening Programme, 2009).

Women with learning difficulties generally require additional support when accessing screening services, and this has been recognised in guidance developed by the breast and cervical screening programmes (NHS Cancer Screening Programme , 2006).

Invitations for breast and cervical screening are restricted to specific age groups at greatest risk (47 to 73 years for breast, and 25 to 64 years for cervical). Women over the target age groups may choose to be screened, but younger women may not.

Benchmarking:

Local uptake of breast screening is consistently above the national standard. Uptake of cervical screening has been reducing in recent years in line with a national trend for fewer young women to be screened.

Table 16: Cancer Screening Uptake (2007/08 to 2010/11)

NHS Tameside and Glossop

National Target

2007/08

2008/09

2009/10

2010/11

Cervical cancer screening
80.0%
79.3%
79.6%
79.2%
78.8%
Breast cancer screening
70.0%
74.7%
76.3%
76.4%
75.1%

Source: NHS Breast Screening Programme, England Statistical Bulletin 2008/09 and 2009/10.

Table 17: Breast screening coverage (2007/08 t0 2009/10)

Breast screening coverage (%)

 

2007/8

2008/9

2009/10

NHS Ashton, Leigh and Wigan
73.4
76.3
76.4
NHS Bolton
77.9
76.1
75.4
NHS Bury
78.4
78.6
77.9
NHS Heywood, Middleton and Rochdale
71.0
74.2
72.8
NHS Manchester
63.5
64.3
64.0
NHS Oldham
73.2
75.1
74.0
NHS Salford
71.6
71.4
70.0
NHS Stockport
76.1
76.1
75.5
NHS Tameside and Glossop
74.7
76.3
76.4
NHS Trafford
73.4
75.9
76.1

Measure

The proportion of women resident and eligible at a particular point in time who have had a test with a recorded result at least once in the previous 3 years.

National Target

70%

Source: NHS Breast Screening Programme, England Statistical Bulletin 2008/09 and 2009/10.

Policy context:

Breast and cervical screening are national programmes provided in line with national guidance from the National Screening Committee which is regularly reviewed and updated.

The age range of the breast screening programme is currently being extended beyond 50-70 years to 47 to 73 years. The programmes are the subject of continuous monitoring and three yearly visits by their North West Quality Assurance Reference Centres.

What interventions work?

It is important to provide good information to women about the benefits of screening, and what examinations involve. The most effective approach to good uptake of breast and cervical screening programmes is the sending of invitation and reminder letters when screening is due. Further reminders of appointments once booked, and reminders for those who do not attend to re-book are also very effective. Social marketing programmes can have an impact on specific groups, but are less cost-effective than reminders (GMPHE, 2009).

The national programmes provide guidance on promotion of breast and cervical screening to minority ethnic groups ( NHS Breast Screening Programme and NHS Cervical Screening Programme).

What are we doing now?

  • Routine invitations and reminders are sent to eligible women.
  • Pilots of new approaches using additional targeted written reminders and text messages are in progress within Greater Manchester.
  • An Equity Audit of uptake of breast screening in Tameside and Glossop has recently been completed. NHS Tameside and Glossop has been part of recent social marketing programmes to promote early detection of cancer.
  • Tameside and Glossop is part of the three year Macmillan funded pilot Community Cancer Awareness Project in Greater Manchester.

What needs to happen next, and by whom?

Current priorities are:

  • The Community Cancer Awareness Project.
  • Local response to national Be Clear on Cancer social marketing campaigns.
  • Action on issues identified by breast screening Equity Audit.

3.16 Access to non-cancer screening programmes

Outcomes framework:

Public Health 2.21

Antenatal and Newborn:

  • Infectious Diseases in Pregnancy.
    • HIV.
    • Syphilis, hepatitis B and rubella.
  • Antenatal sickle cell and Thalassaemia.
  • Newborn bloodspot.
  • Newborn hearing.
  • Newborn physical examination.
  • Adult:

    • Diabetic retinopathy.

    Implications for the population’s health and well-being:

    Antenatal and Newborn screening programmes all make important contributions to the early identification of conditions that can be treated or require further support and follow up. Diabetic retinopathy is the commonest cause of blindness in people of working age in the UK, and early detection and treatment can preserve sight.

    At risk or vulnerable groups:

    Antenatal and newborn screening is offered to all pregnant women and new mothers. Retinopathy screening is offered to all newly identified patients with diabetes, and then annually.

    Benchmarking:

    The measures for the antenatal and newborn screening programmes detailed in the Public Health Outcomes Framework are currently under development, but some indicative information about local activity is available.

    Table 18: Local performance of antenatal and newborn, and adult non-cancer screening

    Programme

    Local Information

    Local Performance

    Antenatal and Newborn
    Infectious Diseases in Pregnancy
     
     
    HIV
    HIV: 99.3% tested 2009/10
    HIV: well over national target of 90%
    Syphilis, hepatitis B and rubella
    Syphilis, hepatitis B and rubella: 99.6% tested 2009/10
    Syphilis, hepatitis B and rubella: well over national target of 90%
    Antenatal sickle cell and thalassaemia
    99.9% tested 2009/10
    Well over national core target of 85% and developmental target of 95%
    Newborn bloodspot
    National quality programme under development
    Pilot data currently suggests average uptake
    Newborn hearing
    National quality programme under development
    Quality assurance data currently suggests good uptake
    Newborn physical examination
    National quality programme under development
    No data currently available
    Adult
    Diabetic retinopathy
    Uptake 77.8% for Quarter 3 2011/12
    Achieved national 70% minimum standard

    Source: NHS Tameside and Glossop, 2012

    Policy context:

    NHS screening programmes are developed, adopted and overseen by the National Screening Committee, and there are operating and quality assurance standards in place or under development for all programmes. A national set of KPIs are currently being piloted, and some of these are included in the Public Health Outcomes Framework.

    What interventions work?

    The National Screening Committee will not approve a screening programme for use in the NHS unless there are associated interventions that can improve outcomes for anyone found to have the condition screened for. There is detailed guidance for all national screening programmes.

    What are we doing now?

    All maternity units employ a Screening Midwife who takes a lead in ensuring that the antenatal and newborn screening programmes are running in line with national guidance and screen-positive cases are followed up. Newborn hearing screening for local babies is provided by Tameside Hospital. Health Visitors and local GPs also have significant roles particularly in the newborn bloodspot and physical examination programmes.

    Diabetic retinopathy screening is provided by high street optometrists and Tameside and Glossop Community Health Care as part the South Manchester Programme.

    What needs to happen next, and by whom?

    Tameside Hospital took part in a pilot of a new national quality assurance programme for antenatal and newborn screening. Recommendations included the formation of a local coordinating group to oversee this activity. Emerging guidance as part of the transfer of Public Health to local councils suggests a continuing role for the local Director of Public Health in this work. This will focus on ensuring quality standards are in place plus equitable access and outcomes for different populations groups.

    3.17 Take up of the NHS Health Checks Programme

    Outcomes framework:

    Public Health 2.22

    Implications for the population’s health and well-being:

    Collectively, vascular disease (heart disease and stroke), diabetes and kidney disease, affect the lives of more than four million people and kill 170,000 every year. They also account for more than half the mortality gap between rich and poor.

    • Heart and circulatory disease is the UK’s biggest killer - in 2009, deaths of around one in five men and one in eight women died were from coronary heart disease.
    • Stroke is the main cause of disability in the UK. It's the third most common cause of death. But many strokes can be prevented, through small and long-term changes to your lifestyle.
    • Approximately 2.9 million in UK suffer from diabetes. It can also increase risk of vascular diseases, such as heart disease. Type 2 diabetes is linked to being overweight, and accounts for 90% of cases of diabetes.
    • Chronic kidney disease is thought to affect between one and four people out of every 1,000 in the UK. But risks can be minimised making small, long-lasting changes to your lifestyle.

    Modelling work undertaken by the Department of Health found that offering NHS Health Checks to people between 40 and 74 years, and recalling them every five years would be clinically and cost effective.

    At risk or vulnerable groups:

    Patients aged 40 -74 years who are not currently on a disease register for heart disease, stroke, hypertension, and diabetes and kidney disease.

    Benchmarking:

    Table 19: NHS Health Checks – Local target and performance

    Indicator

    Target

    Local Performance (T&G)

    Percentage of eligible people who have been offered an NHS Health Check in 2011/12:
    18%
    23.7% (provisional)
    Percentage of eligible people that have received an NHS Health Check in 2011/12:
    7.6% (locally determined)
    9.9%

    Source: Integrated Performance Measures Return (IPMR) NHS Tameside and Glossop 2012 and System.improvement.nhs.uk /measuring for improvement guidance pdf.

    Due to low uptake of the NHS Health Checks Local Enhanced Service (LES) in 2010/11, the LES has been redesigned and has been operational since 1st September 2011. 41 Practices have now signed up to the revised LES. Figures received from Practices for activity in Q3 2011-12 (the first quarter for the revised NHS Health Check) show that 5,629 people have been offered a health check in the 3 months, with 2,449 people attending for their check. This level of activity has significantly improved performance against this indicator.

    Policy context:

    In 2008, the Government announced its intention to shift the focus of the NHS towards empowering patients and preventing illness. As part of this, the health checks programme was outlined to dramatically extend the availability of ‘predict and prevent’ checks. The NHS Health Checks programme was designed to provide people with information about their health, support lifestyle changes and, in some cases, offer early interventions.

    What are we doing now?

    To support this renewed approach to NHS Health Checks, additional non-recurrent funding has been secured for:

    • Healthcare Assistant and Practice Nurse capacity to support delivery of NHS Health Check LES in General Practice.
    • Communications Support to increase uptake of NHS Health Check.
    • Increased Health Trainer capacity to support patients following Health Check.

    In December 2011, Public Health developed a community model for delivering the NHS health checks to support the ongoing GP led work. The main aim of the community model is to target the harder to reach and those less likely to attend GP practice for a full NHS Health Check. These hard to reach groups include men, people from disadvantaged communities, Black and Minority Ethnic (BME) groups, carers and people in full time work, particularly those in routine and manual occupations.

    Both areas of the Health Check project have been supported by a communications campaign aimed to increase the awareness of the Health Check and the services available across Tameside and Glossop.

    What needs to happen next, and by whom?

    • Review 2011-12 audit data.
    • Continue with GP LES in 2012-13
    • Work across commissioning and public health to ensure:
      • uptake of health checks is optimised.
      • health trainer capacity sufficient to support general practice.
      • general practice capacity is sufficient to meet demand for health checks.
  • Community programme to target group with lower uptake through GP practices.
  • Healthy equity audit to understand gaps and barriers to accessing the health checks.
  • 3.18 Self-reported well-being

    Outcomes framework:

    Public Health 2.23

    The final Indicator for Well Being will be developed in line with ONS’s measuring National Well-being Programme and is expected to be ready in 2013. The current measure of well-being is the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and is used on adults (16+), designed specifically to measure positive mental health, rather than mental illness.

    Implications for the population’s health and well-being:

    Well-being can be defined simply as, “feeling good and functioning well”. The term ‘well-being’ moves individuals into a more ‘personal’ space of positive feelings of happiness, comfort and lack of stress. This includes having sufficient material resources, feeling in control and having the capability to manage problems, and experiencing a sense of belonging and meaning with people and place. There is a strong correlation between physical and mental well-being.

    People with higher well-being have lower rates of illness, recover more quickly and for longer and generally have better physical and mental health. Improving well-being can lead to better outcomes in employment and productivity, educational attainment, healthy lifestyle behaviours and life expectancy, and better quality of life for the individual, their family and the wider communities by broadening and strengthening networks. Therefore a range of partnership strategies support this objective and the outcome of this indicator is integral to most of the indicators across the JSNA.

    At risk or vulnerable groups:

    Certain groups experience poorer mental health and well-being particularly those people experiencing socio-economic deprivation. Particular groups at risk of poorer mental health and well-being include:

    • Black and other minority ethnic (BME) groups-especially from the Bangladeshi and Pakistani communities.
    • People with long-term physical illness, low incomes and unemployed, low or no qualifications.

    Benchmarking:

    The Mental Health and Well-being Needs Assessment (MHWBNA) and the Mental Health Needs Assessment –Children and Young People (MHNA –CYP) completed in 2010 all showed that the mental well-being being of the Tameside and Glossop was poorer than national and regional averages.

    The North West Mental Well-being Survey of 2009 helped shift the focus from measuring mental illness to measuring mental well-being using the Warwick Edinburgh Mental Well-being Scale (WEMWBS), designed specifically to measure positive mental health. Eighteen Primary Care Trusts in the North West of England participated in the survey.

    The mean WEMWBS score for the North West region was 27.7 with that for Tameside and Glossop lower, at 26.5. By regional standards, Tameside and Glossop experiences moderate mental well-being.

    Figure 41: Mean WEMWBS Scores for Eighteen Primary Care Trusts in the North West

    Graph showing mean WEMWBS Scores for Eighteen Primary Care Trusts in the North West

    Source: North West WEMWBS (Warwick-Edinburgh Mental Well-being Scale) Survey 2009

    Further analysis of the survey data relating to Tameside and Glossop revealed that:

    • 21% of the population had low mental well-being.
    • 66% of the population of Tameside and Glossop had moderate mental well-being.
    • 13 % of the population had high mental well-being.

    Policy context:

    The Tameside and Glossop Mental Health and Well-being Strategy was published in March 2011. The approach adopted is in line with the government mental health strategy ”No health without mental health – a cross-government mental health outcomes strategy for people of all ages”. It builds on a lot of recent work to highlight mental well-being as an important public health issue. It takes a life course approach, paying attention to the mental well-being of parents and infants; children and young people; adults of working age as well as older people. This approach sees mental health as being central to improving health outcomes for the whole population and highlights the importance of addressing the social determinants of health as key to improving mental well-being. It also recognises the important link between mental health and physical health.

    What interventions work?

    Public services can make a significant contribution to improving well-being by tackling poverty and reducing inequalities so that local people can access:

    • Affordable, quality and warm housing.
    • Secure and meaningful employmen.
    • Education, training and learning.
    • Sports, leisure, culture and arts access to services.
    • Green space and nature.
    • Safe and pleasant built environment.
    • Maximising household income.

    The New Economics Foundation produced a report providing the evidence base for improving the mental health and well-being of the whole population. From the available evidence the approaches were summarised into “Five ways to well-being”:

    • Take Notice.
    • Give.
    • Connect.
    • Be Active.
    • Keep Learning.

    More specific examples of targeted approaches for targeted groups are:

    • Health visiting and reducing post natal depression.
    • Parenting skills and support.
    • Healthy schools, and social and emotional learning (SEL) and reducing bullying.
    • Debt advice.
    • Promoting well-being in the workplace.
    • Befriending older people.
    • Time-banking.
    • Community navigators to improve service access and reduce vulnerability.
    • Alcohol brief interventions.

    What are we doing now?

    The mental health and well-being action plan links to the key strategic priorities of the national mental health strategy and adopts a life course and settings approach to delivering interventions. An important element has been raising awareness by launching 2012 as Tameside and Glossop’s Year of Health and Well-being. The Five Ways to Well-being is an important communications campaign using different methods to distribute the message across Tameside and Glossop. In addition, this is being reinforced by local community organisations supported by a health funded grant scheme. Their projects will start later in 2012 to increase awareness across different communities using the Five Ways to Well-being approach.

    What needs to happen next, and by whom?

    • The mental health and well-being network will oversee the continued implementation of the action plan.
    • Continued implementation and evaluation of the Five Ways to Well-being communications campaign.
    • Implementation and evaluation of the Five Ways to Well-being Community Projects.
    • Commissioners to ensure that evidenced based well-being outcomes are contained in relevant contracts.

    3.19 Falls and injuries in the over 65s

    Outcomes framework:

    • Public Health 2.24:Falls and injuries in the over 65s.
    • Public Health 4.14: Hip fractures in over 65s.
    • NHS 3.5: Improving recovery from fragility fractures.

    Implications for the population’s health and well-being:

    Falls in the over 65s is a significant cause of admissions, morbidity and mortality, accounting for over 4 million bed days per year in England and costing the NHS over £2 billion. In Tameside and Glossop the cost of inpatient spells alone for fractures, falls and osteoporosis for people over 55 was over £5 million in 2010/11. Falls are the leading cause of accident-related mortality in older people; 35% of people over 65 fall and 45% of people over 80 living in the community fall each year. 10% result in a serious injury requiring admission and 5% result in a fracture.

    Hip fractures account for 25% of fractures from all falls in the community. 10% of people who sustain an osteoporotic hip fractures die within one month and 33% die within 12 months. Fewer than half of older people return home after hip fracture and half of all fallers who fracture their hips are never functional walkers again. Frequent falls are a contributing factor in 40% of admissions to nursing homes.

    At risk or vulnerable groups:

    Older people are most at risk from falls, in particular those aged over 85, females, and those from the least advantaged social groups. Our ageing population in Tameside and Glossop means that the rate of falls and hip fractures will increase unless preventative measures are put into place.

    Policy context:

    Benchmarking:

    The rate of hip fracture in Tameside and Glossop continues to be higher than the England average but the gap has narrowed considerably in the last few years.

    Figure 42: Rate of fractured hip in Tameside and Glossop in comparison to England 2002/3 to 2009/10.

    Graph showing rate of fractured hip in Tameside and Glossop in comparison to England 2002/3 to 2009/10.

    Source: Compendium of Clinical and Health Indicators / Clinical and Health Outcomes Knowledge Base (www.nchod.nhs.uk)

    The percentage of people returning to their own home after hip fracture has been low in Tameside and Glossop compared to the England average, but this gap appears to have closed.

    Figure 43: Percentage of patients returning to their residence following fractured hip (Tameside and Glossop and England) 2000/01 to 2009/10.

    Graph showing percentage of patients returning to their residence following fractured hip (Tameside and Glossop and England) 2000/01 to 2009/10.

    Source: Compendium of Population Health Indicators (www.indicators.ic.nhs.uk)

    What interventions work?

    Well organised services, based on national standards and evidence-based guidelines can prevent future falls, and reduce death and disability from fractures.

    • Rapid admission (within 4 hours) and early surgery (within 48 hours) of hip fracture patients.
    • A care bundle approach to the initial management of hip fracture patients (to include, as a minimum, pain relief, pressure sore prevention and intravenous fluids).
    • Mobilisation on the day after surgery, and daily thereafter, improves recovery from hip fracture.
    • Fracture liaison services following the best-evidenced models either for acute-based services (e.g. Glasgow) or primary care-based services (West Sussex).
    • Routine screening for falls of older people presenting to Emergency Departments or minor injury units (MIUs).
    • Therapeutic exercise programmes and falls prevention programmes, particularly for those older people who have fallen and fractured or who are at risk of fracture.
    • Individualised multi-factorial interventions, for older people with recurrent falls or at risk of falling, including strength and balance training, home hazard assessment, vision assessment and medication review.
    • Multidisciplinary assessment following a fall to identify and address future risk and individualised intervention aimed at promoting independence and improving physical and psychological function.
    • Treatment with bisphosphonates for primary and secondary prevention of fragility fractures in postmenopausal women who have osteoporosis.

    What are we doing now?

    • We are currently undertaking a redesign of the community-based falls pathway.
    • Age UK provide a local falls prevention programme, home assessments and an exercise programme.
    • Tameside Foundation Trust is progressing with compliance with the British Orthopaedic Association and British Geriatrics Society ‘Blue Book’ standards for hip fracture care and participates in the National Hip Fracture Database and the Best Practice Tariff.
    • Tameside Foundation Trust has reduced the number of in-patients falls.

    What needs to happen next, and by whom?

    • Tameside Foundation Trust to comply with the Department of Health falls and fractures standards and NICE guidance.
    • Primary care and community services to screen older people for falls and refer those at risk for intervention.
    • Primary care to identify, and treat according to NICE guidance, people with osteoporosis.
    • Commissioners to ensure there is a comprehensive falls pathway available to all those at risk in Tameside and Glossop.
    • Local authority to ensure that community activities are available to all older people to reduce their risk of future falls and to promote active ageing.
     
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