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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-2015 population estimate, Medway's resident population is 276,492, an increase of 27,004 (10.8%) since 2001[1]. The population has increased naturally every year since 2001, with 3,609 live births in 2015[2]. However net out-migration since 2001 has reduced overall population growth over this period.

Approximately 2,300 Medway residents die each year (2,313 deaths in 2015)[3], with significantly higher mortality rates found in males than females. There is considerable variation in mortality rate by ward; mortality rates in the five wards with the highest rates are significantly higher than in the five wards with the lowest rates. Average life expectancy in Cuxton and Halling, Rainham Central, and Hempstead and Wigmore is significantly greater than in Chatham Central, Luton and Wayfield, and River wards. Life expectancy is highest in Cuxton and Halling at 85.6 years, and lowest in River at 78.1 years[4].

The majority of the population (85.9%) in Medway are classified as White British, with the next largest ethnic group being Asian or Asian British (5.0% - not including Chinese). The three wards with the most ethnically diverse school populations are Chatham Central, Gillingham South and River wards[5]. Within these wards 70% to 75% of pupils are White and at least 7% have mixed parents. There are increasing numbers of Slovak and Polish pupils in our schools[5].

Medway has a higher proportion of unemployment than the England average, but has achieved a decrease compared to last year. In June 2014 the number of people claiming job seekers allowance (JSA) in Medway was 4,631, a decrease of 1,554 (25.1%) compared to the previous 12 months[6]. However, this decrease is smaller than that seen nationally (30.5%) and regionally (33.6%) in the same period[6]. Unemployment is an important factor driving the health and well-being 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[1]. However, 2015 to 2025 projections suggest that the proportion of the population aged 65 years or over will increase from 15.4% (42,600) to 17.4% (53,000)[7]. The equivalent change in those aged 85 years and over is from 1.7% (4,800) to 2.3% (6,900)[7]. The number of people over 65 years with a limiting long-term illness is expected to increase by 48.3% from 2014 to 2030, which 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[8].

Our health and well-being

Between 2012 and 2014 Medway was ranked 87th out of 150 local authorities for overall rate of premature deaths with an age-adjusted rate of 371 per 100,000[9]. 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 occurring before the age of 75 (29% and 45% in 2012-2014 respectively). In both males and females the leading cause of premature deaths is cancer, accounting for almost half of deaths in women (46.7%) and two in five men (39.9%) of this age[10]. There has been a downward trend in mortality for all cancers in Medway since 1993 but cancer death rates have remained higher than in comparator groups, regional and national rates. Currently, there are an estimated 162 premature deaths per 100,000 resulting from cancer, equating to a ranking of 119th out of 150 local authorities[9].

The next largest cause of death in those under the age of 75 years is cardiovascular disease (for example heart attacks, stroke and heart failure), accounting for 10.5% of premature deaths in women and 24.0% in men[10].

A further 10.3% of premature deaths are due to respiratory diseases[4], notably chronic obstructive pulmonary disease (COPD), primarily caused by chronic tobacco smoking.

Premature mortality is strongly associated with deprivation; the Slope Index of Inequality (SII) for life expectancy by deprivation deciles is significantly above zero in both males and females[11].

A considerable proportion of the health and social care challenge relates to chronic conditions or situations. 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 standing health condition caused by a stroke will rise from 889 in 2012 to 1,657 in 2037 and those aged 65 and over predicted to have diabetes will rise from 4,870 to 8,687 in the same time frame[12]. Ageing of the population is likely to result in a substantial increase in costs to the health and social care system and primary and secondary prevention of conditions such as diabetes, COPD and heart disease, combined with improved care for people with conditions such as dementia, is essential to reduce or limit the numbers of high-intensity users of services and reduce the costs to the health and social care system.

Our community

Engagement with the community is an essential part of delivering services that are appropriate for the population. A recent engagement event to determine the needs and priorities of people in Medway found four main themes: continuity and availability of care, for example better continuity of care so there is a seamless transition between GPs and either community services or secondary care; “people power”, for example more support for self-management of long term conditions; education, e.g. increase public understanding of commissioning groups and processes; and communications and engagement, e.g. reassurance that public voice will be heard, including feedback when public consultation has been sought to show the opinions have been considered.

The Public Health White Paper released by the Department of Health in 2010 outlined a new approach to improving health through greater emphasis on well-being and prevention. This is done by transferring ownership to local communities to tackle the wider determinants of health such as social relationships. This approach, termed the 'asset based approach', identifies skills, strengths, capacity and knowledge of individuals within a community which are used to contribute towards sustainable development. In the JSNA we have begun to document the assets in Medway and in future will engage further with community groups to identify assets that are currently unrecognised.

Our programmes and services

Medway provides services and programmes in a number of domains. In primary care there are 231 GPs in 54 practices, 33 dental practices, 58 community pharmacies and 19 optometry practices [13][14]. Community care is provided by three providers and health improvement, covering smoking, healthy weight, infant feeding, sexual health, teenage pregnancy, and alcohol is provided jointly by NHS Medway and Medway Council.

Local acute care is provided mainly by Medway NHS Foundation Trust, while mental health care is provided by Kent and Medway NHS and Social Care Partnership Trust and other NHS providers and independent organisations offering provision from psychological therapies to secure accommodation.

Our health inequalities


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


• Within Medway the Slope Index of Inequality for life expectancy-the 'Life Expectancy Gap'-shows that in 2014 the difference in between the 10% most and least deprived in the population is 5.8 years for men and 4.8 years for women.


• The main disease contributors to the life expectancy gap are the same as the major killers, with cancer and respiratory disease contributing the most to the life expectancy gap.


• While in both men and women the gap in life expectancy due to circulatory disease is decreasing the gap in life expectancy due to cancer is static overall, with an increase in the inequality gap in men.


• 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 Job Seekers Allowance claimants are significantly worse than the national average. Medway is also in the worse quartile for use of outdoor space for leisure and exercise.

Appendices

The online appendices of the JSNA contain much detailed information including background papers on specific issues related to children, adults and life-style and wider determinants of health. There is also a data inventory containing key statistics on health and well-being, and links to a number of other additional resources.

Specific recommendations for commissioners can be found in the background papers on children, adults, lifestyle and wider determinants in the appendices.

The appendices, along with this narrative summary, are available online at www.medwayjsna.info


References

[1]   Office for National Statistics. Mid-2015 population estimate 2016;
[2]   Office for National Statistics. Birth summary tables in England and Wales: 2015 2016;
[3]   Office for National Statistics. Death registrations in England and Wales, summary tables: 2015 2016;
[4]   Medway Public Health Intelligence Team. Primary Care Mortality Database Analysis
[5]   Office for National Statistics. 2011 Census: Local Characteristics on Ethnic, Identity, Language and Religion for Output Area in England and Wales - links to tables on Nomis 2013;
[6]   Nomis office for labour market statistics. Labour Market Profile 2014;
[7]   Office for National Statistics. Mid-2014-based subnational population projections for England
[8]   Projecting Older People Population Information (POPPI). Population by age: Population aged 65 and over, projected to 2030 2014;
[9]   Public Health England. Mortality Rankings: Medway 2013-15
[10]   HSCIC Indicator Portal. Premature mortality from various causes
[11]   Public Health England, Association of Public Health Observatories. Slope Index of Inequality Data for LAs 2011;
[12]   Projecting Older People Population Information (POPPI). Long standing heath conditions
[13]   Primary Care Information System.
[14]   NHS England. NHS Organisation data