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Overview of the JSNA

Summary :: Executive summary :: Overview of the JSNA

Our people and place

According to the Office for National Statistics (ONS) mid-2017 population estimate, Medway's resident population is 277,616, an increase of 13,691 (5.2%) since 2011[1]. The population has increased naturally every year since 2011, with 3,657 live births in 2016[2]. Migration to Medway has dropped since peaking around 2011/12. For the first time in six years Medway saw an outward flow in internal migration - that is to other parts of the country - while international migration to Medway remained constant at +1,000 in 2016.

Approximately 2,150 Medway residents die each year (2,197 deaths in 2017)[3]. Life expectancy from birth (a summary measure of current mortality patterns) in Medway is 3.5 years greater in females (82.3 years) than in males (78.8 years) over the period 2013 to 2017.[4]. There is also considerable variation in life expectancy between the wards. Average life expectancy in Cuxton and Halling, Hempstead and Wigmore, Rainham Central, Lordswood and Capstone, and Rainham North is significantly greater than 10 wards including Chatham Central, Watling, and Gillingham South wards. Life expectancy is highest in Cuxton and Halling at 85.1 years, and lowest in Chatham Central at 78 years (2013 to 2017).[4]

The majority of the population in Medway are classified as White British (85.5%), with the next largest ethnic group being Asian or Asian British (4.8% - not including Chinese).[5] The three wards with the most ethnically diverse school populations are Chatham Central, Rochester East, and Gillingham North. Within these wards 53.8% to 62.9% of pupils are White British and at least 36.6% of pupils are of minority ethnic origins.[6]

Medway has a higher proportion of unemployment than the England average, but has achieved a decrease compared to last year. In January 2017 the number of people claiming Jobseeker's Allowance (JSA) in Medway was 2,487, a decrease of 717 (22.4%) compared to the previous 12 months. This decrease is larger than that seen nationally (21.6%) and regionally (18%) in the same period.[7] Unemployment is an important factor driving the health and wellbeing of a population and this is likely to be playing a key role in the health inequalities seen in Medway.

The population of Medway is slightly younger than the national average, with a larger proportion aged 0 to 24 years. However, the 2016 to 2026 projections suggest that the proportion of the population aged 65 years or over will increase from 15.6% (43,600) to 17.7% (54,500). During the same time period, the proportion of the population aged 85 years and over is also expected to increase from 1.7% (5,000) to 2.3% (7,100). [8] The number of people aged 65 and over with a limiting long-term illness in Medway is projected to rise by 23% between 2017 and 2025[9]. This would have a significant impact on the demand for health services for the management of long-term conditions, such as dementia, heart disease and diabetes, as the incidence of these conditions increases with age.

Our health and well-being

Between 2014 and 2016 Medway was ranked 98th out of 150 local authorities for overall rate of premature deaths with an age-adjusted rate of 378 per 100,000.[10] Of the roughly 2,200 deaths that occur in Medway each year, almost a third of deaths in females and almost half of deaths in males occur before the age of 75 (30.5% and 44.7% respectively; 2014-2016). [4]

In both males and females the leading cause of premature death is cancer, accounting for almost half of deaths in females (47.5%) and over a third of deaths in males (36.9%) under 75 years (2014-2016). [4] There has been a downward trend in the premature mortality rates from cancer in Medway since 2005-07, however these rates have remained consistently higher than both the South East region and England. Currently, there are an estimated 158 premature deaths per 100,000 resulting from cancer, equating to a ranking of 120th out of 150 local authorities.[10]

The next largest cause of death in those under the age of 75 years is circulatory disease (including coronary heart disease and stroke), accounting for 23.5% of premature deaths in males and 16.7% in females (2014-2016).[4] A further 10% of premature deaths are due to respiratory disease, [4] notably chronic obstructive pulmonary disease (COPD), which is primarily caused by smoking.

Premature mortality is strongly associated with deprivation. The Slope Index of Inequality (SII) is a measure of the social gradient in life expectancy at birth. In 2013-15, the SII in Medway was 8.2 years for males and 5.8 years for females; these values have increased since 2012-14 for both males (6.6 years) and females (5.2 years).[11]

A considerable proportion of the health and social care challenge relates to the impact of chronic long-term health conditions. Increasing numbers of older people means that there will be increasing numbers of people developing chronic conditions who will become intensive users of services. For example, the number of people aged 65 and over predicted to have a long-term condition caused by a stroke will rise from 1,018 in 2017 to 1,595 by 2035 and those aged 65 and over predicted to have diabetes will rise from 5,560 to 8,414 in the same time frame.[9]

Ageing of the population is likely to result in a substantial increase in costs to the health and social care system, as well as the primary and secondary prevention of conditions, such as diabetes, COPD and heart disease. Combined with improved care for people with conditions such as dementia. It is therefore essential to reduce or limit the number of high-intensity users of services and reduce the costs to the health and social care system.

Our community

Community involvement is an essential part of the planning, and increasingly the delivery, of health and wellbeing services. In Medway, DERiC (Developing and Empowering of Resources in Communities) works with WALT (Walderslade Together) and wHoo Cares (Hoo Peninsula Carers) to help build resilient communities in Walderslade and the Hoo Peninsula. These community interest companies aim to reduce social isolation by identifying additional support that could improve a person's life and helping people access local services. This may be, for example, a chat and a cup of tea once a week, help getting to the local coffee morning or support getting to GP or hospital appointments.

Further to this, a new initiative, called Involving Medway, is designed to encourage people to get involved with and help make decisions about health provision in the area. Red Zebra leads this project and works in partnership with six other community organisations. Grants are available to Medway community groups looking to engage local residents in leading healthier and more active lifestyles. Involving Medway are looking to support community-focused projects that need help to, for example, hire a hall for a coffee morning or organise a day out for a carers group. Understanding the needs of the community, is also an essential part of delivering efficient, effective and responsive services. As part of the development of the Kent and Medway STP process, a specific workstream focused on the development of a 'Local Care Model' across Kent and Medway has been established. The aim of the local care workstream is to transform the way in which services are provided and develop preventative and innovative approaches to address some of the entrenched issues impacting on the health and wellbeing of the population.

Within Medway, the aspirations of the local care workstream are being taken forward in the guise of the 'Medway Model'. The Medway Model brings together a range of key stakeholders to build on and further develop local community assets. The Medway Model segments Medway into 6 distinct areas formed around natural units of care (General Practices). The JSNA highlights the key health and wellbeing issues within these communities, providing invaluable insight to inform action to address the problems identified.

Through the work of the local care workstream, Medway should see an increase in proportion of vulnerable people able to actively 'self-manage' and take action to manage the impact of long-term chronic health conditions. People will also be able to access a range of services in community locations that were previously only available in an acute hospital setting. There will be a focus on developing new ways of working, and building capacity and resilience in the Medway community. This 'asset based approach' will identify the skills, strengths, capacity and knowledge of individuals within a community, which will be used to contribute towards sustainable development.

Our health inequalities

Overall both male and female life expectancy in Medway is significantly worse than the England average. Compared with other local authorities of a similar deprivation status it has one of the lower life expectancies.[14]

Within Medway, the Slope Index of Inequality (SII) shows that the difference in life expectancy at birth between the 10% most and least deprived in the population is 8.2 years for men and 5.8 years for women (2013-2015).[11]

The main disease contributors to the life expectancy gap are the same as the major killers, with circulatory disease and respiratory disease contributing the most to the life expectancy gap in Medway.[4]

The causes of health inequalities are complex, but there appears to be three main areas that contribute to the differences in health between different socio-economic groups: 1) variation in quality and uptake of health care; 2) differences in lifestyle factors; 3) wider determinants of health.

There is significant variation in access to and uptake of primary and secondary health care within Medway.

Smoking, obesity, alcohol and poor mental health are all key lifestyle issues which impact on health inequalities.

Social determinants of health have been recognised to be key determinants of health inequalities. With respect to Medway's position relative to England, the Marmot indicators show that the number of unemployed people and long-term Jobseekers Allowance claimants are significantly worse than the national average.[15]

Appendices

The online appendices of the JSNA contain much detailed information, including over 30 topic-specific chapters related to lifestyle and wider determinants of health, children, and adults. Each chapter contains local and national data, evidence of what works, local views, and proposed recommendations for commissioners.

There are also profiles that provide an overview of the variation in health and social care outcomes within Medway across a wide range of indicators. Data is presented in the form of charts, maps and infographics, and is available for specific wards, sub-hubs (groups of extended practices in the Medway Model), and early help hubs.


References

[1]   Office for National Statistics. Mid-2017 population estimate
[2]   Office for National Statistics. Birth summary tables in England and Wales: 2016 2017;
[3]   Office for National Statistics. Death registrations in England and Wales, summary tables: 2017 2018;
[4]   Medway Public Health Intelligence Team. Primary Care Mortality Database Analysis
[5]   Office for National Statistics. Table KS201EW: 2011 Census: Ethnic group, local authorities in England and Wales.
[6]   Department for Education. Schools, pupils and their characteristics
[7]   NOMIS official labour market statistics. Jobseeker's Allowance with rates and proportions.
[8]   Office for National Statistics. Mid-2014-based subnational population projections for England
[9]   Projecting Older People Population Information System. People aged 65 and over with a limiting long-term illness, by age, projected to 2035. 2017;
[10]   Public Health England. Mortality Rankings: Medway 2014-16
[11]   Public Health England. Slope index of inequality in life expectancy at birth 2013-2015;
[12]   NHS Digital. GP and GP practice related data 2017;
[13]   NHS England. NHS Organisation data
[14]   Public Health England. Life expectancy at birth 2013-2015;
[15]   Public Health England. Public Health Outcomes Framework data tool