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Key themes for Medway

Summary :: Executive summary :: Key themes for Medway

The evidence in the JSNA points to five key themes for Medway:


• Giving every child a good start
• Enable our older population to live independently and well
• Prevent early death and increase years of healthy life
• Improve physical and mental health and well-being
• Reduce health inequalities

Giving every child a good start

There is increasing evidence that investment in the early years of life (0–5 years) is highly effective both in terms of the impact on future health and wellbeing and in being cost-effective. What happens during these early years, starting in the womb, has lifelong effects on many aspects of health and wellbeing, from obesity, heart disease and mental health, to educational achievement and economic status. It is important that mothers are supported to have good mental and physical health during pregnancy and early years. Smoking in pregnancy, which is a real challenge in Medway, impacts negatively on both maternal and child health. Parenting skills are important in improving outcomes and a particular focus is required on supporting the most vulnerable families to improve parenting and help very young children be school-ready.

The provision of good social care for children is important to ensure that children have a good start in life. In England the number of referrals to children's social care has increased in recent years and a similar pattern has been seen in Medway over the last two years, where the number of referrals has increased 63%, from 3,292 in 2009/10 to 5,364 in 2011/12. Of these, 383 children were subject to child protection plans in March 2012, higher than the national average but broadly in line with other similar unitary authorities of a similar size, for example Luton and Southend.

There has also been an increase in the number of children in care. In March 2011 Medway had 446 children in care, 19 more than in 2010/11. With 73 children in care per 10,000 children this is higher than the national average but again in line with other similar unitary authorities.

The number of children with special educational needs (SEN) is also expected to increase in the next five years. This may result in an additional 300 pupils with statements requiring specialist provision, over and above the number projected through normal population growth.

To respond to the care needs of children and young people, social workers play an important role in supporting children and young people to develop their emotional resilience and good physical and mental health. Medway is doing well at ensuring there are enough social workers with only 6.4% of social worker positions vacant in March 2012, the lowest level since at least 2006.

Enable our older population to live independently and well

The rapid increase that Medway will see in the number of people aged 65+ and 85+ over the next decade is something that should be celebrated. It is in part the result of steady improvements over many years in health care and public health. Many of these new older people will be healthy and strong and able to live independently; however, it is inevitable that there will also be an increase in the number of people who will need health and social care and support. In particular we can expect to see more people who have dementia, and others who become physically frail.

An increase in the number of older people is not a new phenomenon. In 1901 less than 5% of the UK population was over the age of 65 years. Since then there has been a steady increase and as a society we have made many changes during this period. As we go forward further changes are needed to ensure that we are able to provide affordable and high quality care for older people.

The government commissioned an independent body to review the funding system for care and support in England and national policy is awaited. Within this national context the options for how Medway chooses to care for and provide support for older people will also include the core themes of localism and personal responsibility noted above. Many home-owners will seek to stay in their existing homes for as long as they can and will need additional support to do so. There will also be increasing numbers of older people who will need specialist accommodation that mesh support, care and housing provision.

Older people are more likely to have multiple health and social needs which will require an integrated response from local services.

Prevent early death and increase years of healthy life

Over recent decades public health and improved health care have led to dramatic reductions in the number of deaths. For example the mortality rate from heart attacks in Medway fell 79% from 160 to 33 per 100,000 between 1995 and 2014[1]. About half of this reduction was due to improved health care and half was due to public health measures, such as reductions in smoking.

The current leading causes of early death and illness in Medway include cancer, cardiovascular disease (e.g heart attacks, stroke and heart failure) and respiratory disease, conditions that share many common causes. Prevention strategies are needed to reduce the numbers of people who will develop these conditions in the future. Early diagnosis can improve outcomes in some diseases and strategies are needed to promote early diagnosis through raised awareness and efficient diagnostic pathways.

Increasing years of healthy life will include improving care and treatment for those with mental health problems and long term health conditions such as diabetes and epilepsy. Most people with long-term conditions have a single condition and can be helped to manage their condition at relatively low cost. It is important that effective interventions are provided systematically and equitably across the population if health inequalities are to be reduced. However, as people age and if prevention and treatment are not optimal, more people begin to develop other conditions. As the number and severity of these conditions increases the complexity and cost of managing them becomes much greater. Addressing these conditions requires well-integrated health and social care systems to provide treatment and support for those who have the conditions.

Improve physical and mental health and well-being

Increasing attention is being paid not just to how long people live, but also how well they live. Quality of life is affected by many issues, including crime and the perception of crime, unemployment, the quality of employment for those who do have work, stress, the ability to live independently and autonomously and freedom from pain and ill-health. Quality of life is also very strongly affected by physical health and four main risk factors need to be reduced: tobacco use, harmful use of alcohol, physical inactivity and poor diet. While smoking prevalence has fallen nationally and in Medway in recent years, the prevalence in 2013 among those aged 18 years and over was 21.8%, which is 3.4% higher than the England average[2]. There is also considerable variation in the prevalence across Medway with 16.2% in Rainham Central and 39.8% in Chatham Central. There is much evidence to support the positive health effects of smoking cessation and continued efforts to reduce smoking must be supported.

The other major causes are more difficult to address than smoking, and recent trends have shown there have small increases in alcohol-related hospital admissions in Medway and increases in obesity. Each of these risk factors are aspects of “lifestyle”, a concept that superficially sounds quite simple, yet involves a complex interaction of personal choice and responses to the social and physical environment. People need to make the right choices as they have a personal responsibility for their own health, and this happens more readily in an environment in which these choices are the easy or are the default choices.

One particularly important aspect of well-being is mental well-being. According to estimates derived from the 2007 psychiatric morbidity survey for England, in Medway in 2014 there are 27,207 people at any one time living with common mental health problems and 668 with a psychotic disorder. In May 2015 the total number of people in Medway claiming employment and support allowance was 9,310. Of these, 4,140 (44%) were claiming incapacity benefit for mental health reasons[3].

Nationally a five step approach is being promoted to improve mental well-being. These steps are directed at individuals, however creating a supportive environment that makes it easy for people to take these steps is likely to lead to more people doing so. This may involve, for example, encouraging neighbours to work together on a local project or engage together in a celebration; ensuring that Medway is a pleasant and safe place to walk and cycle; providing courses or venues for others to run courses; and promoting volunteering.

Reduce health inequalities

Inequalities are a fundamental underlying feature of most health outcomes in Medway. Rates of death are higher in those who are more disadvantaged, as are emergency hospital admissions and rates of long-term illness. Health outcomes are not only worse in those who are the most disadvantaged; the inequalities follow a gradient and as such the response also needs to follow a gradient. This has been called “proportionate universalism” and simply means that health and social care provisions need to be made available to all, with increasing effort needed for those who are increasingly disadvantaged.

The Marmot Review identified six key areas for action, the first and highest priority area being to give every child the best start in life. This is because there is strong evidence that what happens in the early years has an effect on future employment prospects and health and well-being outcomes.

As well as the moral imperative to tackle inequalities there is a good business argument to do so. Emergency hospital admissions or more years spent with a long-term illness mean greater costs for health and social care systems. Taking action through prevention, education and improved health care to reduce inequalities by raising levels of health and well-being to reduce inequalities will result in reduced costs for the health and social care system caused by the major health and social care problems faced by Medway now and in the immediate future.


References

[1]   HSCIC Indicator Portal. Mortality from acute myocardial infarction: directly standardised rate, all ages, annual trend, MFP https://indicators.ic.nhs.uk/webview/
[2]   Public Health England. PHOF: 2.14 smoking prevalence 2013;
[3]   NOMIS. Benefit claimants - employment and support allowance 2015; ONS. https://www.nomisweb.co.uk/ .