Health Inequalities CCG Governing Board Presentation 14/11/2019 Dr - PowerPoint PPT Presentation

Health Inequalities CCG Governing Board Presentation 14/11/2019 Dr Rashmi Sawhney Clinical Director - Health Inequalities

Index • Context – What are Health Inequalities • Buckinghamshire • Patient stories • Portfolio work • Gaps & Challenges • Results so far this year • Involvement of Patients • Next Steps 2

What are Health Inequalities? Health inequalities are avoidable differences in health across the population, and between different groups within society. Health inequalities arise because of the conditions in which we are born, grow, live, work and age. These conditions influence our opportunities for good health, and how we think, feel and act, and this shapes our mental health, physical health and wellbeing. Action on health inequalities requires improving the lives of those with the worst health outcomes, fastest. 3

Dimensions Of Health Inequalities Variables Socio-economic/ Deprivation Equality and diversity e.g. e.g., low income, unemployed/ age, sex, race deprived areas Inclusion health e.g. homeless Geography e.g. urban, people; Gypsy, Roma and Travellers; rural. Sex Workers; vulnerable migrants

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IMD 2019 for PCN, GP Practices and Bucks CCG 10

Variation in Life expectancy in Buckinghamshire Population Life Expectancy in Buckinghamshire Women 84.8 Men 81.8 Life Expectancy in England Women 83.1 Men 79.6 13

Babies born in poorer wards have a shorter life span than those born in affluent wards 14

Babies born in poorer wards have a shorter life span than those born in affluent wards PCNs with significantly lower life expectancy at birth for persons are BMW, Maple, Dashwood and South Bucks 15

Gap for 5+ LTCs between DQ1 & DQ5 16

People from most deprived areas have higher emergency admissions for all causes BMW, Dashwood, Maple and South Bucks are significantly higher (compared to Bucks and England) for emergency all-cause admissions rates. Cygnet is similar to Bucks and England for emergency all-cause admissions rates. All other PCNs are lower than England and Bucks.

Inequalities in Mental Health Mental health admissions – working age Health Inequalities in Buckinghamshire

Inequalities in Mental Health Mental health admissions – older age Health Inequalities in Buckinghamshire

Key Facts for Buckinghamshire • Most deprived have 60% higher prevalence of long term conditions than the least deprived • Multi-morbidity is more common & develops 10- 15 years earlier in deprived areas • Key groups with poorer health are: Those with mental illness, learning disabilities and those from BAME ethnicity

In our most deprived areas: • Higher prevalence of low birthweight, infant mortality • Lower levels of children developing well • Higher levels of children in need and children looked after • Higher prevalence of long term conditions and multi-morbidity • Lower uptake of screening • Higher emergency admissions for all causes : adult mental health, self harm alcohol misuse, heart disease, stroke, respiratory , falls • Higher early death rates

What’s fair?

Long Term Plan Vision Maternity -continuity of midwifery care -smoking cessation SMI Physical health checks : Target: 60%; -Strengthening health checks LD & Autism - accelerate LeDeR initiative Rough -Specialist mental health support Sleepers -Carer friendly GP practices Carers -Carers passports -Advanced care planning - Young Carers Top Tips to GPs adopted Increased accessibility to specialist clinics for serious gamblers Gambling Encourage innovation and new ways of working to address inequalities Partnerships - 3 rd Sector -wellbeing: to include mental health support Workforce 23

Bucks CCG’s Priorities - the next 5 years • Smoking: reduction overall, with a focus on the most deprived populations • Mental health for young people: increasing mental health support teams in schools in deprived areas • Care & support planning: improving the gap in patient experience between the Black and minority ethnic (BAME) & white communities • Improving the detection of hypertension and it’s management in our deprived and BAME communities

Patient stories - Child with asthma living in a flat with lots of mould getting recurrent exacerbations of asthma and attending A&E

Patient stories - Homeless person with multiple issues: social, physical and mental health, drug and alcohol issues, chaotic access to services and poor outcomes: Pilots locally have been useful for support

Patient stories - Elderly couple living at home. Both frail . Wife the sole carer of husband who has dementia. Lack of family support and struggling to cope

Patient stories - 80 year old Asian lady with memory problems: Case brought up issues with diagnosis, cultural barriers to accepting a diagnosis of dementia and a review of services available: this led to the project : Raising awareness of dementia in BAME communities

Examples of Portfolio Initiatives

Urgent Care Falls alls and nd fr frail ailty ty – Elderly patients – paramedic to • continue- 5 days a week for 22 weeks based on demand Me Mental ntal Heal Health th – SCAS and OHFT to get people to the • Whiteleaf Centre rather than A&E 30

Pregnancy, smoking and low birth weight % of low birth weight (<2500g), all births, by deprivation quintile (DQ1 to DQ5*) in Bucks, 2014 31

Smoking and Health Inequalities Smoking is the single biggest cause of the difference in mortality rates between the least and most deprived populations. It accounts more than half of the difference in risk of premature death between social classes .  Live Well Stay Well provides universal support to all smokers but targets their work to groups with higher rates of smoking (for example: routine and manual workers, areas of higher deprivation and people with a mental health condition)  There is a smoking in pregnancy task and finish group, with BHT, working to ensure that pregnant women are encouraged to access stop smoking support and quit

Children Hubs 33

Gaps and Challenges • Ethnicity recording • Carer recording • Closing the prevalence gaps • Improving uptake of screening • Cancer diagnosis • Smoking • Improving uptake of immunisation • prevention, early diagnosis and management of long term conditions • Ownership of Gambling – PHE evidence based review expected Dec 2019 • Development of key partners for the inequalities advisory group meetings • Workforce development of Mental Health support • Resources to address the issues

Results so far this year % Patients with Ethnicity Coding Target: 5% Increase 89.21% 100% 85.97% 85.58% 84.03% 81.37% 80.60% 80.48% 77.97% 75.35% 74.79% 80% 67.90% 84.21% 61.00% 80.97% 80.58% 79.03% 76.37% 75.60% 75.48% 72.97% 70.35% 60% 69.79% 62.90% 56.00% 40% 20% 0% 35

Involvement of Patients • Review and presentation at the Patient Participation Groups event • Working closely with Healthwatch Bucks in terms of achievement and the way forward • Working with local community and voluntary organisations • Presentation at Governing Body (held in public) 36

Next Steps • Link with the PCNs: -share the ICP priorities -understand PCNs priorities -develop joined up plans with the PCNs to address inequalities • Link with PPGs, and the voluntary sector to support the PCNs to address inequalities • Inequalities Steering Group: Partner organisations coming together: agree ICP inequalities priorities • Link with the BOB/ICS partners for shared understanding and learning • Support for the Rough Sleeper/Homeless – Expression of Interest and follow on work •

How can we work together to close the inequalities gap?

Thanks to Public Health, Consultants Louise Hurst and Tiffany Burch for their contribution.