A fascinating snapshot detailing the many different things that impact the health of people in Bucks has been published.
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Put together jointly by the County Council, the NHS and the district councils, the Joint Strategic Needs Assessment (JSNA) report doesn’t only look at health issues at all stages of life, but also at the wider economic and social factors that affect how people live and how they feel.
It also makes a number of rather general recommendations to improve health in Bucks, for example:
> Increase the number of people with healthy lifestyles, with a focus on physical activity, healthy eating, alcohol consumption and smoking at all ages
> Early detection of long term conditions and good care for those that have these conditions, including increased support for people to look after themselves
> Promotion of mental wellbeing and emotional resilience for all, including young people
Buckinghamshire County Council cabinet member for Health & Wellbeing Patricia Birchley said: “The Joint Strategic Needs Assessment shows that people in Buckinghamshire have better health and wellbeing compared to other parts of the country. But there’s still much that can be done to ensure that everyone enjoys excellent levels of health and wellbeing.
“Our joint Health and Wellbeing Strategy focuses on the key actions we can take together to achieve this goal. One important area is around healthy lifestyles.
“Increasing awareness of the things people can do to follow a healthy lifestyle, such as going for a daily walk, can help keep us well throughout life.”
Male life expectancy in Buckinghamshire is currently 80.5 years (compared to 78.6 years in England), and increased 2.5 years between 2001-03 and 2008-10.
Female life expectancy in Buckinghamshire is 84.0 years (compared to 82.6 years in England), and increased 2.1 years over the same period.
LIFESTYLE IMPACTS ON HEALTH:
The report says: ‘Increasing the numbers of people who have healthier lifestyles would have major impact on the health and wellbeing of people living in Buckinghamshire’.
> 80% of adults in Buckinghamshire are not sufficiently active to benefit their health. 27% of adults are also completely inactive.
> Less than a third of boys (32%) and under a quarter of girls (24%) meet recommended physical activity levels
> Physical inactivity costs the NHS in Buckinghamshire £6.4m per year.
> There are an estimated 65,000 adult smokers in Buckinghamshire (16% of adults). This is lower than the England average of 21%.
> Each year in Buckinghamshire smoking costs society an estimated £98.3 million.
> Around 90,000 Buckinghamshire adults drink alcohol at levels that are a risk to their health. Consumption levels are similar to national averages, with no significant differences (except for lower binge drinking levels in Wycombe).
> Alcohol related hospital admissions in Buckinghamshire are lower than the national average, but the rate has steadily increased in recent years. Total alcohol related admissions were estimated to cost the NHS in Buckinghamshire £25.8m in 2010/11. This is roughly £65 per adult.
> Alcohol consumption levels among young people in Buckinghamshire are similar to national levels. Alcohol related hospital admission levels in those aged under 18 are significantly lower.
> The alcohol attributable crime rate in Buckinghamshire was 5.1 per 1,000 population (compared to 6.7 per 1,000 regionally) and alcohol related violent crime levels were 3.5 per 1,000 (5.2 per 1,000 regionally); both rates were lower than national rates (2011/12).
> An estimated 31% of people eat five fruit and vegetables a day in Buckinghamshire. This is higher than the national average (29%), but considerably lower than the best levels for England (48%).
> The life expectancy of obese adults is on average nine years shorter. Life expectancy is reduced by three years for those who are overweight.
> The estimated annual cost for the NHS in Buckinghamshire from diseases related to obesity is £63.8m.
> 8.0% of children aged 4-5 years in Buckinghamshire were obese in 2010/11, compared to 9.4% nationally. Among those aged 10-11 years, 15.4% were obese compared to 19% nationally. 19% of those aged 10-11 years living in the most deprived quintile of Buckinghamshire were obese.
> 20.7% of adults in Buckinghamshire were estimated to be obese (2012), compared to 24.2% nationally.
> In 2011/12, 974 drug users over the age of 18 and 193 under 18 year olds accessed treatment in Buckinghamshire.
> It has been estimated that for every £1 spent on evidence based drug treatment in Buckinghamshire, there are £4.75 of health and crime related benefits
> Chlamydia is the commonest sexually transmitted infection in Buckinghamshire 772 young people aged 15-24 tested positive for Chlamydia in 2011 (7.2% of those tested). The proportion testing positive is in line with national levels.
> There are 366 people living with HIV in Buckinghamshire and numbers have tripled over the last ten years.
WIDER IMPACTS ON HEALTH
The report says ‘economic opportunity is fundamental to a broad range of life chances and therefore wellbeing’.
> From 2008 - June 2012 full time employment for those of working age in Buckinghamshire fell by 10,800, whereas part time employment rose by 4,600.
> Job Seeker’s Allowance claimants numbered 6,138 in September 2012 (2.0% of working age residents), compared to 3.8% nationally. The number has more than doubled in Buckinghamshire since 2007.
> The number of residents claiming all types of out of work benefits was 19,840 in February 2012 (6.3% of working age residents), compared to 12.5% nationally.
> The report says the ‘earnings of the lowest paid in Buckinghamshire have not kept up with the cost of living since the start of the economic downturn’.
> From 2011-2021 only a quarter of the total projected population increase will be in those of working age (more than 5,500 people, a 1.8% increase).
The report says Bucks is one of the most prosperous counties in England. But it adds: ‘People living in some areas of Buckinghamshire have less favourable socioeconomic circumstances. The longer people live in disadvantaged circumstances the less likely they are to have good health and wellbeing’.
> Buckinghamshire ranks 8th out of 149 in the index of multiple deprivation (where 1 is the least deprived upper tier local authority, 149 is the most deprived).
> More than a third of people aged 16+ (35%) had a higher education qualification in 2011, compared to 27% nationally.
> 18,800 people in Buckinghamshire live in areas that are within the 30% most deprived in England (2010); up from 4,700 in 2004 and 13,100 in 2007
> Almost a fifth of households in Buckinghamshire (18%) are categorised as ‘hard pressed’ or ‘moderate means’. The report says more than half of these households are in urban areas (57%), more than a third are in smaller market towns (35%), and 8% are in rural/isolated communities.
The report says the ‘communities in which people live and work have a profound impact on health and wellbeing’.
> The local population continues to increase, is becoming more multi-cultural and more diverse. Around 1,200 new households are created each year. Current resident turnover is about 6% annually, with more than 32,000 people moving into and out of the county in 2011.
> 85% of Buckinghamshire residents were satisfied with their local area as a place to live in 2010. 85% of residents also felt that people from different backgrounds got on well.
The report says ‘the quality of housing impacts on health’.
> An estimated 14,406 dwellings in the private sector in Aylesbury Vale, Chiltern and Wycombe districts contained category 1 hazards (serious risks from issues such as excess cold, falls, and fire) as at April 2012. This was an estimated 8% of all dwellings in the three districts.
> House prices in Buckinghamshire are on average over 50% higher than the national average.
> 513 applications were made for homelessness assistance in 2011/12. This rate of applications is below the national average, but showed an increase of 22% on the 2010/11 figures.
> 21,062 households (10.7%) were in fuel poverty in Buckinghamshire in 2010. This ranged from 9.7% of households in Aylesbury Vale to 11.5% in Wycombe, compared to 17.0% nationally.
The report says ‘transport is an enabler, both social and practical; facilitating access to work, leisure and crucial services.
> Improving access to services & work for those reliant on public transport is a priority. £3.8m is spent on concessionary travel for the disabled and elderly.
> Car use on the journey to school in Buckinghamshire fell from 45% to 30% in the 8 years to 2010. Cycle journeys were up 10% between 2007 and 2011.
> The number of people who were killed or seriously injured in Buckinghamshire reduced 40% in the 12 years to 2010, ahead of the target date for all England. > The rate is currently similar to the England average (2007-09), having been higher in previous years.
> There are currently four Air Quality Management Areas in Buckinghamshire where air quality standards are not met and where action plans are in place.
> Traffic is expected to grow by 50% within 25 years.
The report says ‘domestic Violence and abuse has a major impact on the health of victims. Women who experience domestic abuse present more frequently to health services and require wide-ranging physical and mental health interventions’.
> Over 6,070 cases of Domestic Violence and Abuse were reported to the police in 2011/12 and it is estimated that over 16,500 women and girls aged 16-59 in Buckinghamshire have been a victim in the last year.
> It is estimated that Domestic Violence and Abuse costs Buckinghamshire £53m a year, of which £13m is attributable to health service costs.
The report says: ‘Crime and the fear of crime can impact on both short and long term physical and mental health, and are often cited as influencing people’s quality of life’.
> Buckinghamshire is experiencing reductions in domestic burglary, theft of, and theft from motor vehicles, robbery, violence against the person and anti-social behaviour.
> However violent offences related to the night time economy have seen a 16% increase and gang related offending, including sexual exploitation are of significant concern.
> Crime related costs to the NHS nationally are estimated to be at least £1bn a year.
AGE RELATED HEALTH IMPACTS
The report says: ‘What happens to a child during their early years lays the foundation for the rest of their life. A child’s physical, social and cognitive development during the early years strongly influences their school readiness and educational attainment, the jobs they can do in the future and their health’.
> Buckinghamshire has a large proportion of women (28%) that give birth later in life (aged 35 years and over), compared with 20% of births in England to women of the same age.
> More than 6,000 women become pregnant every year in Buckinghamshire. In 2010 there were 183 births to women under the age of 18 years.
> 7.1% of births were low birth weight in Buckinghamshire, compared to 7.4% in England (2009/11). 8.9% of births were low birth weight in the most deprived
quintile of Buckinghamshire.
> In Buckinghamshire 79.4% of mothers started breastfeeding in 2011, but by the 6-8 week check-up this had dropped to 57.8% of babies.
> Uptake of immunisations in Buckinghamshire has been consistently high. 97.2% of children at the age of one received their primary immunisations, compared to 94.2% in England in 2010/11.
> 65% of all children in Buckinghamshire achieved a good level of development at the age of five in 2012, compared to 64% nationally and 66% in the South East.
> The number of children aged under five subject to Child Protection Plans is generally about half of the total number of children subject to Child Protection Plans. In July 2012, 130 children aged under five in Buckinghamshire had Child Protection Plans, out of a total of 254.
> 120 of the 254 Child Protection Plans in place in July 2012 across all ages were primarily for ‘neglect’, a term which includes failure to respond to a child’s emotional and psychological needs, as well as their physical wellbeing
> Nationally the population of Looked after Children of all ages has increased over the past 5 years by 9%. For children aged under 5 there has been a national increase of 34% over the last 5 years, and an increase in Buckinghamshire of 36% over the same period.
> The number of children of all ages entering care in Buckinghamshire has increased recently, from 100 children in 2007 to 165 children in 2011.
CHILDREN AGED 5-11:
The report says: ‘Improvements to mental health and emotional wellbeing in primary school aged children can make a big difference to a child’s future’.
> At Key Stage 2 in 2012, 391 pupils were known to be eligible for Free School Mealsin Buckinghamshire, which is 7.4% against a national average of 18.3%.
> In 2012 at Key Stage 2, 85% of children not eligible for Free School Meals achieved Level 4 in both English and maths compared with 60% of those children eligible for Free School Meals. This gap (25%) is one of the largest gaps in the country, and the gap was bigger for boys (27%) than for girls (24%).
> Nationally the population of all Looked after Children has increased over the past 5 years by 9%, and the numbers of Looked after Children aged between 5 and 9 increased by 8%. In Buckinghamshire the numbers of Looked after Children aged between 5 and 9 increased by 36% over the last 5 years.
CHILDREN AGED 11-18
The report says: ‘Half of those with lifetime mental health problems first experience symptoms by the age of 14, making adolescence a crucial time for intervention and prevention’.
> Teenage pregnancy rates have been consistently lower in Buckinghamshire compared with most other areas nationally. In Buckinghamshire. The teenage conception rate was 20.2 per 1000 young women aged 15-17 years in 2010, compared to 35.4 for England.
> Nationally the population of Looked after Children aged between 10 and 15 has decreased over the past 5 years by 5%. For children aged between 10 and 15 there has been a rise of 4% in Buckinghamshire over the same period.
> At the end of July 2012, there were 182 children aged between 11 and 18 in care.
> The national numbers of over 16s in care has increased by 17% over the past 5 years. Within Buckinghamshire the rise over 5 years has been 14%.
> In 2012 at Key Stage 4 (GCSE), 72.2% of pupils not eligible for Free School Meals achieved 5 A*-C grades including English and maths, compared with 29.6% of those pupils eligible for Free School Meals.
> 4% of young people aged 16-18 years were recorded as not in education employment or training (NEET) in July 2012, compared to the national average of 6.4%.
> There were 3271 statements of Special Educational Need (SEN) made in 2011/2012 which is an increase of 4.8% from the previous year.
> 284 disabled young people aged 16-18 accessed short breaks in 2011-2012.
The report says: ‘Accidental injury in children is a major cause of avoidable ill health, disability & death, and there is a greater impact on deprived communities. Tooth decay can lead to sleep deprivation, reduced growth, pain and low selfesteem’.
> Buckinghamshire’s emergency admission rate due to avoidable injuries in those aged 0-18 years was 14.0% lower than the rate for England in 2011/12. The admission rate in Buckinghamshire has remained stable since 2003/04. The rate was 55.8% higher in the most deprived quintile of Buckinghamshire compared to the least deprived quintile.
> Five year olds in Buckinghamshire had an average of 0.9 decayed teeth per child, compared to 1.1 in England (2007/08). But those with decayed teeth had between 3 and 4 decayed teeth each (average 3.4).
The report says: ‘Improvements in health mean that people are living longer than ever before. This is rightly a cause for celebration’.
> There were more than 84,000 people aged over 65 years in Buckinghamshire in 2011, of whom more than 11,000 were aged over 85 years. The 65+ population is projected to grow by more than a third (36%) by 2025, while the 85+ population is projected to increase by 84% over the same period.
> More than one in ten households (11.8%) were occupied by single pensioners in Buckinghamshire in 2011, ranging from 10.7% in Aylesbury Vale to 14.0% in South Bucks, compared to 12.4% in England.
> Half of those aged 80 and over in Buckinghamshire had three or more long term conditions in 2012
> Whilst only 2.2% of the total population (and 13% of all those aged 65+) are aged 85+, this age group accounts for 31% of all people aged 65+ with ‘moderate’ level and above social care needs in Buckinghamshire.
> A third (33%) of all adult social care clients in Buckinghamshire are aged 85+.
> 1,390 people aged 65+ had an emergency admission for an injury linked to a fall in Bucks in 2010/11. The admission rate was 21% lower in Buckinghamshire than the national average. The admission rate has also risen by 22% in Buckinghamshire between 2003/06 and 2009/12.
> In Buckinghamshire, it is estimated that in 2012 there were 6,549 people with dementia: 6,282 people aged over 65 with dementia and 267 people with early onset dementia. This number is predicted to rise to 8,454 by 2020.
> Many people in Buckinghamshire are living without a formal diagnosis or help in relation to their dementia. It is estimated that up to 39.7% of people with dementia in Buckinghamshire have been diagnosed.
> More than 2,400 people were recorded on GP registers in Buckinghamshire as having dementia, 0.47% of the total population, compared to 0.53% in England
> Just over half of deaths (51.2%) in Buckinghamshire were in hospital in 2008-10, compared to 54.5% in England and 42.2% in the area with the lowest proportion of deaths in hospital
> There are around 250 excess winter deaths every year in Buckinghamshire. Around 40% of excess winter deaths nationally are from heart disease and stroke, while around a third are caused by respiratory disease.
CONDITIONS AND ILLNESSES
LONG TERM CONDITIONS
The report says: ‘Having two or more long term conditions is linked to higher death rates, more hospital admissions, reduced quality of life, and higher levels of depression’.
> More than 90,000 people in Buckinghamshire in 2012 had two or more long term conditions, affecting more than half of those aged 65 and over.6
> More than 15,500 people in Buckinghamshire (3.0% of the population) are known to have coronary heart disease (heart attack or angina) compared to
3.4% nationally. 8,100 people (1.6% of the population) have had a stroke or transient ischaemic attack, compared to 1.7% nationally.
> The all age death rate from cardiovascular disease fell by 39% between 2001/03 and 2009/11. The premature death rate from cardiovascular disease fell 38% over the same period, and was more than three times higher in the most deprived quintile compared to the least in 2009-11.
> At least 21,000 people (4.0% of the population) have a diagnosis of diabetes, compared to 4.6% nationally. Around a quarter of diabetics in Buckinghamshire may as yet be undiagnosed. The NHS Health Checks programme should help to diagnose many of these people, as well as many people with pre-diabetes.
> More than a thousand extra people each year have been diagnosed with diabetes between 2008 and 2012. If obesity levels continue to rise, an estimated 10% of people aged 16+ will have diabetes by 2030.
> Almost 9,500 people have been diagnosed with cancer (1.9% of the population) compared to 1.8% nationally.7
> The all age death rate for all cancers fell by a tenth between 2001-03 and 2009-11, and was 12% lower than the national average. The premature death rate was 47% higher in the most deprived quintile compared to the least (2009-11).
> There were an estimated 14,000 – 17,000 people living with a long term neurological condition in Buckinghamshire in 2012.
> In Buckinghamshire, 2,717 adults (0.5% of the adult population) were recorded by their GPs in 2012 as receiving drug treatment for epilepsy, below the national average of 0.6%.
The report says: ‘The numbers of people with healthcare associated infections has fallen over the last five years, but further reductions are needed’.
> In 2011, 50 people were infected with Tuberculosis in Buckinghamshire. The majority of cases (33) were in High Wycombe.
> In 2011 the rate of hepatitis B infection in Buckinghamshire was 11 per 100,000 people (51 confirmed cases), a lower rate than for Thames Valley.
> 73% of people aged 65+ were immunised against flu in Buckinghamshire in 2011/12, compared to 74% nationally. Just under half (49%) of people in risk groups aged under 65 were immunised, similar to national levels, but well below the 60% target. Just over a quarter of pregnant women (28.7%) were immunised in 2011/12, similar to national levels; this proportion increased to 40.8% in 2012/13 (compared to 40.3% in England), well below the 70% target.
> There were 9 reported cases of MRSA infections in Buckinghamshire in 2011/12 (70% fewer cases than 2007/08) and 167 cases of clostridium difficile (42% fewer cases than 2007/08).
The report says: ‘People with a Learning Disability can and do lead happy and fulfilled lives. However, people with learning disabilities are often treated as “different” and as a consequence are subjected to discrimination, disadvantage, and have fewer lifefulfilling and economic opportunities. They also have significantly poorer health than the rest of the population, with an average life expectancy of just 55 years’.
> Across Buckinghamshire, there are an estimated 150 people aged 18-64 with profound and multiple learning disabilities, 1,130 with severe learning disabilities, and around 4,610 people aged 18-64 are expected to have moderate learning disability.
> The numbers of people with profound and multiple learning disabilities in Buckinghamshire are projected to increase to 2031 by 40%. This increase will lead to even greater demand and pressure on Adult Social Care budgets and resources to support these people appropriately.
> Based on prevalence rates, 2,880 adults living in Buckinghamshire will have Autistic Spectrum conditions and of these 1660 will also have a learning disability (aged 18-64).
> 1, 365 of the children with statements of Special Education Needs (SEN) are due to turn 18 in the next five years. Of these, 20 young people aged 14-17 have profound and multiple learning disabilities, 100 have severe learning disabilities, and 400 have moderate learning disabilities. It is these young people along with a smaller number of children with complex physical disabilities and those that access Child and Adolescent Mental Health Services who will require transition support as they move from child into adult social care services and systems.
> For people with a learning disability, Buckinghamshire County Council currently purchase 300 residential/ nursing placements, with half of these in Buckinghamshire and half in other areas across the country. Specialist Supported Living Accommodation is provided for an additional 233 clients, of which over a fifth are out of county. For young people with complex needs who are at college (63) over 40% are out of county.
The report says: A substantially higher proportion of individuals who live in families with disabled members live in poverty, compared to individuals who live in families where no one is disabled.
> Within Buckinghamshire an estimated 24,325 adults aged 18-64 have a moderate physical disability and an estimated 7,319 adults aged 18-64 have a serious physical disability. This figure is projected to rise by 3% by 2030.
> For adults aged 65 and over in Buckinghamshire it is estimated that in 2012 there were more than 16,259 adults who were unable to manage at least one mobility activityon their own. This figure is projected to rise by 65% in 2030 to a total of 26,792 people, with the biggest increases amongst those people aged over 85.
> In Buckinghamshire there are an estimated 9,973 adults, most of them aged over 65, who have a serious visual impairment, 51,218 adults who will have a moderate, severe or profound hearing impairment, and 2,892 people of all ages who have a dual sensory loss.
> There are an estimated 73,321 people who are deaf/hard of hearing in Buckinghamshire. The majority of people who are hard of hearing are aged over 60.
> Overall people from Black and Minority Ethnic groups who have a physical/sensory disability represent 6% of adult social care clients compared to comprising 11% of the 18+ population in Buckinghamshire.
The report says: ‘Buckinghamshire had one of the lowest mental health hospital admission rates in the country for people of all ages (2009-12)’.
> 79.3% of people in Buckinghamshire had high or very high life satisfaction, compared to 75.9% in the UK (2012). 82.7% felt that their lives were worthwhile, compared to 80% in the UK.
> The number of people in Buckinghamshire who have a severe mental illness recorded by their general practice was 3,305 (0.63% of the total population) in March 2012, compared to 0.82% nationally. Prevalence was higher in the mostdeprived quintile (0.86%) compared to the least deprived quintile (0.50%)
> In Buckinghamshire an estimated 40,530 people aged 16-64 had a common mental health problem at any one time in 2011 (12.7% of the 16-64 population), compared to an estimated 15.0% in the South East and 16.6% nationally.
> 9.3% of all people in Buckinghamshire have had depression (ever, as recorded by their GP), compared to 9.2% nationally (2011/12).
> The three year average suicide rate in Buckinghamshire in 2008/10 was 8.2/100,000 population, statistically similar to the rate for England (7.9/100,000).
CARING AND SAFEGUARDING
The report says: Those caring for 50 hours a week or more are twice as likely to be in poor health as those not caring (21% against 11%). This can be due to a range of factors including stress related illness and physical injury.
> More than 49,500 Buckinghamshire residents identified themselves as carers in the 2011 Census, 9.8% of the total population
> 13,694 carers in Buckinghamshire provide over 20 hours of care a week (28% of all carers). Of these 8426 (17% of all carers) provide over 50 hours of care a week (Census 2011).
> An estimated 23% of carers in Buckinghamshire are aged over 65 years; about a third of these carers are aged over 75 years and about 500 are over the age of 85.
> Nationally 29,000 adults with a learning disability live with parents aged 70 or over, many of whom are too frail to continue in their caring role.
> Whilst approximately 10,000 carers in Buckinghamshire receive support from the council directly or through funding given to Carers Bucks, this means that at least 80% of carers in Buckinghamshire are not accessing any formal care, support or information and advice services which could help them with their caring roles.
SAFEGUARDING OF VULNERABLE ADULTS
The report says: ‘Abuse is more common among women, people living alone, people in rented housing and people with declining health’.
> In 2011/2012 in England there were 320 alerts for alleged abuse per 100,000 population. Over a quarter of abuse alerts related to people aged 85+.24
> In Buckinghamshire during 2011/2012 there were 1491 safeguarding alerts (a rate of 380 per 100,000) which resulted in 789 safeguarding investigations. 63% of these alerts related to women and 37% to men. Over a third of alerts (34.3%) were for those aged 18-64.
> Over a third of alerts (34.1%) related to people aged 85+, which is higher than the England average.
> Whilst physical abuse is the single most frequent cause of alleged abuse in the past 2 years, within Buckinghamshire the numbers of people where neglect or institutional abuse is alleged or suspected have both increased significantly during 2011/2012.