Health Inequalities

CCG Governing Board

Presentation 14/11/2019

Dr Rashmi Sawhney

Clinical Director - Health

Inequalities

Index

2

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

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 e.g., low income, unemployed/

deprived areas

Equality and diversity e.g.

age, sex, race

Inclusion health e.g. homeless

people; Gypsy, Roma and Travellers;

Sex Workers; vulnerable migrants

Geography e.g. urban,

rural.

5

6

7

8

9

10

IMD 2019 for PCN, GP Practices and Bucks CCG

Variation in Life expectancy in Buckinghamshire Population

13

Life Expectancy in Buckinghamshire Women 84.8 Men 81.8 Life Expectancy in England Women 83.1 Men 79.6

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

15

PCNs with significantly lower life expectancy at birth for persons are BMW, Maple, Dashwood and South Bucks

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?

22

Long Term Plan Vision

23

Maternity -continuity of midwifery care

-smoking cessation

SMI Physical health checks : Target: 60%;

LD & Autism -Strengthening health checks - accelerate LeDeR initiative

Rough

Sleepers

-Specialist mental health support

Carers -Carer friendly GP practices -Carers passports -Advanced care planning - Young Carers Top Tips to GPs adopted

Gambling Increased accessibility to specialist clinics for serious gamblers

Partnerships -

3rd Sector

Encourage innovation and new ways of working to address inequalities

Workforce -wellbeing: to include mental health support

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

30

• Falls and frailty – Elderly patients – paramedic to

continue- 5 days a week for 22 weeks based on demand

• Mental Health – SCAS and OHFT to get people to the

Whiteleaf Centre rather than A&E

Pregnancy, smoking and low birth weight

31

% of low birth weight (<2500g), all births, by

deprivation quintile (DQ1 to DQ5*) in Bucks, 2014

Smoking and Health Inequalities

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

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.

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

35

84.21% 80.97% 80.58% 79.03% 76.37% 75.60% 75.48% 72.97% 70.35% 69.79% 62.90%

56.00%

89.21% 85.97% 85.58% 84.03% 81.37% 80.60% 80.48% 77.97% 75.35% 74.79% 67.90%

61.00%

0%

20%

40%

60%

80%

100%

% Patients with Ethnicity Coding Target: 5% Increase

Involvement of Patients

36

• 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)

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.