Havering Health and Social Care Web viewBased on the Greater London Authority (GLA) population projection, ... Copenhagen: World Health Organization, 1992. Individually and collectively,

LONDON BOROUGH OF HAVERING

Havering Health and Social Care Needs

2017

An overviewJoint Strategic Needs Assessment

By LBH Public Health Service(with contributions from:

Learning and Achievement;Children Social Care;

Adult Social Care; andBusiness & Performance Services)

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ContentsList of Figures........................................................................................................2List of Tables.........................................................................................................3Executive Summary...............................................................................................4

Introduction........................................................................................................4What will happen to the population of Havering?...............................................4What are the risk factors affecting ill health in Havering?..................................4What is the current status of health in Havering?..............................................5How do local people use health and social care services?..................................6

Introduction...........................................................................................................9What is Health?..................................................................................................9What are health inequalities?...........................................................................10What is the purpose of this report?..................................................................10

What will happen to the population of Havering?................................................11What are the risk factors for ill health in Havering?.............................................12

Obesity and overweight....................................................................................12Physical Inactivity.............................................................................................13Smoking...........................................................................................................14Alcohol Misuse..................................................................................................16Other factors....................................................................................................17

Teenage pregnancies....................................................................................17Maternal mental health.................................................................................18Breastfeeding................................................................................................18Early Years....................................................................................................18Oral Health....................................................................................................19

What is the current status of health in Havering?...............................................20Mortality...........................................................................................................20Long-Term Conditions.......................................................................................23

Mental Illness................................................................................................24Diabetes........................................................................................................25Dementia.......................................................................................................26

Disability...........................................................................................................27Specific Groups.................................................................................................29

How do local people use health and social care services?...................................31Children Social Care.........................................................................................31Adult Social Care..............................................................................................33Health Services.................................................................................................35

Key documents for further information................................................................39

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List of FiguresFigure 1: Dahlgren and Whitehead’s model of the determinants of health.........10Figure 2: Proportion of reception children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16...............................................................................................................14Figure 3: Proportion of reception year 6 children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16.............................................................................................14Figure 4: Distribution of Havering CCG registered adult (18+) population, by BMI category, as at December 2016..........................................................................15Figure 5: Sports participation at least once a week 2005/06-2015/16, Havering, London, England, statistical comparator Bexley..................................................16Figure 6: Smoking Prevalence (% of adult population) across Havering Wards by Quintile (where Quintiles 1 and 5 refer to the lowest and highest prevalence wards respectively)..............................................................................................17Figure 7: Smoking status at the time of delivery, Havering compared to Bexley, London and England, 2010/11 to 2015/16...........................................................18Figure 8: Trend in under 18-conception rate per 1,000 women aged 15-17, Havering, Bexley, London and England, 1998-2014............................................19Figure 9: Percentage of children achieving a good level of development at the end of reception, 2015/16...................................................................................21Figure 10: Distribution of number of deaths amongst Havering residents of all ages by broad underlying causes (with four biggest broken down further), in 2012-2016...........................................................................................................22Figure 11: Distribution of number of deaths amongst Havering residents of those aged under 75 by broad underlying causes, in 2012-2016..................................23Figure 12: Premature mortality, Havering compared to all local authorities (LAs) in England and similar LAs average, 2013-15......................................................24Figure 13: Breakdown of life expectancy gap between the most deprived quintile and the least deprived quintile in Havering by cause of death and gender.........25Figure 14: Number and proportion of registered population by LTC count, Havering CCG, 2015/16.......................................................................................26Figure 15: Ratio of patients with long-term conditions (LTCs) compared to patients with no long-term conditions (LTCs) for A&E attendances, Emergency Admissions and Inpatient Bed Days.....................................................................26Figure 16: Prevalence of depression in patients registered with GP in Havering CCG and resident in the London Borough of Havering, per 1,000 persons aged 17 years and over, Census wards, as of February 2017...........................................27Figure 17: Prevalence of dementia in registered patient, all ages, London boroughs and England 2015/16...........................................................................28Figure 18: Prevalence of diabetes in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 17 and over, Census wards, as of February 2017.....................................................................29

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Figure 19: Prevalence of Cancer in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017.....................................................................30Figure 20: Prevalence of Chronic Obstructive Pulmonary Disease (COPD) in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017.......31Figure 21: Prevalence of Hypertension in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017............................................................32Figure 22: Prevalence of Coronary Heart Disease in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017.......................................33Figure 23: Projected numbers of children with statements of special educational needs by type and school in Havering, 2013/14 to 2023/24................................35Figure 24: Count of children’s social care referrals and assessments in Havering, 2013/14 to 2015/16.............................................................................................38Figure 25: Distribution of plans across Children and Young people, 2014-2016..38Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016...................................39Figure 27: Population Pyramid of children in need activity, Havering, 2014-2016............................................................................................................................ 40Figure 25: Population Pyramid of child protection activity, Havering, 2014-2016............................................................................................................................ 41Figure 24: Rate per 1000 children aged under 18 for Child in need plans, child protection plans and looked after children in Havering, 2014 to 2017................43Figure 25: Carers - Primary support reason of 'Cared For' person 2014-15.........46Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016...................................47Figure 27: Rate of A&E attendances per 1,000 population registered with Havering CCG GP and resident in Havering, by LSOA, 2013/14...........................48Figure 28: Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, 2015/16....................................................................50

List of TablesTable 1: Projected percentage population change by age group, from 2015 to 2020, 2025 and 2030..........................................................................................11Table 2: Prevalence of mental health amongst maternal population in Havering18Table 3: Number of adults with learning disability in Havering, 2015.................27

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Document Version ControlVersion

Description

1.0 Original document in 2015/16 financial year Published in February 2016

2.0 Annual update in 2016/17 financial year Published in March 2017 Population figures updated using Mid-2015 population estimate Population projections updated from 2017 to 2032 Life Expectancy figures added Difference in Life Expectancy figures updated from 2011-12 to

2012-2014 Childhood Obesity figures updated from 2014/15 to 2015/16 Adult Obesity updated from December 2015 to December 2016 Physical Activity updated from 2014 to 2015/16 Smoking prevalence updated from 2014 to 2015 Alcohol harm figures updated from 2013/14 to 2014/15 Maternal mental health figures updated using Mid-2015 Population

estimates Breastfeeding figures updated from 2014/15 to 2015/16 Child development figures updated with from 2014/15 to 2015/16 The top 5 (underlying) causes of death figures updated (2012 to

2016) Long Term Conditions counts and ratios updated from 2014/15 to

2015/16 Prevalence of Mental Health, Diabetes, COPD, Cancer, CHD and

Hypertension (accessed via health analytics) have all been updated from January 2016 to February 2017

Prevalence of Dementia updated from 2014/15 to 2015/16 Learning disability figures updated from 2015 to 2016 Figure added showing distribution of plans across Children and

Young people, 2014-2016 Figures added on rate of children’s social care activity by type of

plan and gender, per 1000 children aged under-18 years in Havering, 2016

New figures added on Looked After Children activity Count and population pyramid added reflecting Children in Need

activity Count and population pyramid added reflecting Child Protection

activity Count and population pyramid added reflecting Looked After

Children activity Rate per 1000 children aged under 18 for Child in need plans, child

protection plans and looked after children in Havering updated (2014 to 2017)

Added Number of registered patients per GP, Havering Clinical Commissioning Group (HCCG) GP practices, Havering CCG, London average, England Average 2016

Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, updated from 2013/14 to 2015/16

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Executive Summary

Introduction This report, developed as part of the Joint Strategic Needs Assessment

(JSNA), is an overview of Havering’s health and social care needs. It provides a high-level description of population growth, prevalence and

pattern of risk factors for ill health, status of health and wellbeing and the patterns of demand for health and social care services in Havering.

From this understanding, all local stakeholders will understand the following changes that need to be made:o Prevention needs to be prioritised in order to reduce the prevalence of

risk factors in the population particularly in the more deprived parts of the borough.

o A reduction in risk factors will mean a reduction in the number of people who develop long term conditions; less people with multiple co-morbidities; reduced demand for more expensive and complex packages of care; and longer lives free of disability.

o Targeting high-risk population groups will ensure efficient use of limited resources and in the longer term reduce health inequalities.

What will happen to the population of Havering? Based on the Greater London Authority (GLA) population projection, the

population of Havering is projected to increase from 255,407 in 2017 to 297,369 in 2032 – 13% increase.

The population aged 25-64 will remain the largest age group up to 2032 but from 2017 to 2032, the largest increases will be seen in children (5-10 year olds: 13%; 11-17 year olds: 36%), and older people (65-84 year olds: 24%; 85+ year olds: 45%).

What are the risk factors affecting ill health in Havering? Women in the least deprived parts of the borough are likely to live 5.7 years

longer than those in the most deprived parts. Similarly, there is a difference in life expectancy of 6.5 years in men.

In 2015/16, a quarter of children (23.2%) in Reception Year were either overweight or obese. This figure increased to a third (37.3%) of children in Year 6 - this is significantly higher than the England average.

Regarding adults, around one in two (54%) persons aged over 18 years registered with a General Practice (GP) in the Havering Clinical Commissioning Group (CCG) is either overweight or obese.

Estimates show that one in three adults (36.2%) in Havering are inactive compared to London (37.8%) and England (36.1%). The general trend in participation in sports lags behind that of Bexley (Havering comparator) and London but in the last couple of years has performed better than England

In Havering, approximately 17.3% of persons aged 18 years and above smoked in 2015. This is similar to both London and England.

The number of deaths attributable to smoking is on the decline, but based on the most recent data (2012-2014) this is still higher than England and significantly higher than London.

Smoking in pregnancy, although on the decline, is highest in Havering (7.7%) compared to other London boroughs (significantly higher in Havering

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compared to 5.0% in London but significantly better than England, 10.6%) for 2015/16..

The majority of drinkers (73%) in Havering do not drink above the recommended limits.Although Havering had significantly lower alcohol related admissions to hospital (430 per 100,000 hospital admissions for alcohol-related conditions in comparison to London and England in 2014/15 , alcohol is implicated in 4% of ambulance call outs; 16% of road fatalities and over 70% of cases of domestic violence.

Other Factors Havering’s teenage (under-18) conception rate has almost halved from the

rate in 1998. However, Havering’s rate (26 per 1000 women under the age of 18) in 2013 is higher than London (21.5 per 1000) but similar to England (22.8 per 1000). For the conception rate under 16, Havering’s rate (6.1 per 1000) is higher than England (4.4 per 1,000) and significantly higher than London (3.9 per 1,000)

Maternal depression and stress related disorders are the most common maternal mental health conditions in Havering.

In 2015/16, about three quarters of Havering mothers’ breastfed at birth (73.3%) - this is statistically similar to London (86.1%) but lower than England (74.3%). However, a significant proportion do not continue to breastfeed – at 6-8 weeks, only 43% continue to do so compared with 48.9% in London and 43.2% in England.

Havering is currently ranked 16th highest of 32 boroughs in London for the proportion of children achieving a good level of development at the early years foundation stage for 2015/16.For 2014/15, Iin Havering, proportion of five year olds free from dental decay is 80.0%one in five 5-year olds (19.8%) have decay experience ., This is better than England (75.2%) and significantly better than London (72.6%). Dental decay can resulting in pain, sleep loss, time off school and, in some cases, treatment under general anaesthetic.

What is the current status of health in Havering? The top 5 (underlying) causes of death in Havering (from 2012 to 2016) are:

cancers, circulatory diseases, respiratory diseases, dementia & Parkinson’s disease, and diseases of digestive system.

Unspecified dementia comprises the biggest single underlying cause of death. Lung cancers comprise the largest proportion of deaths from Cancer.

About 620 (28%) deaths each year occur prematurely (deaths that occur before a person reaches the age of 75 years). Cancer, heart disease and stroke are the main causes of premature deaths.

Long Term Conditions There is an increasing number of Havering residents living with long term

conditions (LTCs) – this has a significant impact on daily lives including the use of urgent and emergency health and social care services.

Havering CCG patients with five or more LTCs are 3 times more likely to attend A&E, 13 times more likely to be admitted for an emergency, and the

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average number of inpatient bed days will be 23 times greater compared to patients with no LTC.

The prevalence of mental health problems in Havering (0.65%) is generally lower than both London (1.07%) and England (0.88%) but there is variation in how common it is across the wards in the borough.

The prevalence of depression ranges from 56.6 per 1000 persons aged 17 and over in Upminster to 113.0 per 1000 persons aged 17 and over in Gooshays (i.e. more generally more common with increasing deprivation).

Dementia is more common in Havering than London but similar to England; and it will be an increasing problem for Havering because of its ageing population.

In Havering, the number of people living with diabetes is on the increase. The prevalence of diabetes is lowest in Upminster (47.3 per 1000 persons aged 17 and over) and highest in South Hornchurch (70.1 persons aged 17 and over).

Disability Children and adults with a learning disability are at increased risk of having

or developing physical and mental health problems. In addition, they are 10 times more likely to have serious sight problems.

Havering was estimated to have 906 adults with moderate or severe learning disability in 2016, of which about 300 are estimated to be living with a parent. Additionally, about 1681 people were estimated to have autistic spectrum disorders.

Havering has a lower rate of people registered blind (205 per 100,000) compared to London and England.

The number of children with special educational needs and disabilities is growing year on year, averaging increases of between 40 to 60%in all groups between 2012 and 2015.

There is increasing demand for specialist help and schooling for children with autism (ASD) and for those with behavioural, emotional and social difficulties (BESD), including those with mental health issues.

Specific Groups Overweight and obesity is an issue for children in Havering. They are likely to

develop Type 2 Diabetes requiring long term medical care. Havering has the lowest number of children going into care. Looked after

children generally have greater mental and physical health care needs. Older people are at increased risk of living with multiple long-term

conditions; dementia; and experiencing falls. Working age adults comprise the largest age group in Havering and are more

likely to experience serious mental health issues such as depression, schizophrenia and psychoses.

Certain health problems are more common in BAME groups because of various reasons including diet and other lifestyle factors e.g. diabetes in South Asians; and sickle cell disease in black Africans.

How do local people use health and social care services?Children Social Care Havering’s children centres saw a 7.5% increase in the number of individual

attendances between 2013/14 and 2014/15 (12,236 to 13,148).

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Projected figures for 2015/16 indicate a 23% increase in children centre numbers to 16,148.

There were 2,129 contacts received by the service in 2014/15 with 2015/16 projections set to exceed 3,000 indicating an over 40% increase in activity.

In 2013/14 Havering’s Children Social Care received 1,106 referrals to the service. In 2014/15 this had increased by 60 to 1,774.

The number of Child Protection Plans in Havering increased by 50% from 2013/14 (143) to 2014/15 (214). The projected number for 2015/16 is 329, which would be a further 56% increase on the previous year.

The number of looked after children between 2013/14 and 2014/15 had increased from 207 to 240 (15.9%). Projected figures for 2015/16 are 227 which would indicate a 5.4% reduction.

Adult Social care In 2013/14, 7,096 clients received adult social care support in Havering of

which two thirds were aged 75. The majority of the demand (98%) is driven by the following: physical

disability (78%), learning disability (12%) and mental health (8%). In Havering, the rate of adults aged 18-64 years admitted to residential and

nursing homes was 9.5 per 100,000 in 2014/15. This is lower compared to both London (11.1 per 100,000) and England (14.2 per 100,000).

Over a 1,000 adults receive support in their homes; equating to about 11.3 hours per person per week; an increase from 10.7 in 13/14.

In 2014/15, 266 clients used respite services totalling 638 separate episodes. The use of day care services in Havering decreased from 447 per 1000

people in 2008/09 to 101 per 1000 population in 2013/14. This is lower when compared to London (260 per 1000 population) and England (324 per 1000 population) and our statistical neighbours.

The majority of the demand for reablement, 80%, arises from the Joint Assessment and Discharge (JAD) team at the local acute trust; the remaining 20% from the community.

According to the 2011 Census, 25,214 people, 11% of Havering’s residents identified themselves as carers, an increase from 23,253 (8.4% increase) in 2001. Twenty-three per cent (5,835) said they provided more than 50 hours of care per week.

Health Services The average number of patients registered with a Havering CCG practice per

GP (Full Time Equivalent, FTE) is 2,073, which is lower than both the London average (6825 patients per GP-FTE) and the England average (5252 patients per GP-FTE)

79% of patients stated their overall experience with their GP was good, similar to London (80%) - higher compared to London (60.3%) and lower compared to England (85%).

People living in the more deprived parts of the borough are more likely to use A&E services than those from least deprived areas in Havering.

There were approximately 31,003 elective admissions to hospital by patients registered with a General Practice (GP) in Havering in 2014/15. This is a 1.5% increase since last year which is lower than the increase seen across both London and England, 6.0% and 2.8% respectively.

Estimates suggest that about 3,275 children aged 0-16 years and resident in Havering have a mental health disorder sufficient to cause distress to the child or have a considerable impact on the child’s day-to-day life.

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Compared to both our statistical neighbour Bexley, and to England, Havering has a lower rate of admission for children with mental health disorders aged 0-17 years.

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IntroductionThis document forms part of the Joint Strategic Needs Assessment (JSNA). The JSNA is a systematic method for reviewing the issues facing a population, leading to agreed priorities and resource allocation that will improve health and wellbeing of the population and reduce inequalities within the population.

What is Health?In 1948, the World Health Organisation (WHO) defined health as a state of complete physical and mental wellbeing and not merely the absence of disease and infirmity. This enduring definition has not been changed by the WHO since then, though there are many other definitions of health and wellbeing in existence.

The factors that determine the health of a population are, broadly speaking, divided as follows: Socio-economic factors e.g. employment, income, education, housing,

environment, etc. Lifestyle choices e.g. smoking, diet, exercise, alcohol, uptake of preventive

services, etc. Health service provision (the contribution of health services to health differs

by population subgroup). Genetics (although a relatively small contribution, its importance is

increasing).

Dahlgren and Whitehead1 have mapped the complex relationship between the factors that impact on the health of individuals and communities (see Figure 1).

Figure 1: Dahlgren and Whitehead’s model of the determinants of health.

Source: Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Copenhagen: World Health Organization, 1992.

1 Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Copenhagen: World Health Organization, 1992.

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Individually and collectively, we can influence some of these factors in Havering and in so doing improve the quality of our lives.

What are health inequalities?Health inequalities (sometimes called health inequities) are differences in health status between social groups. They exist in all countries – whether low, middle or high income. The lower an individual's socio-economic position, the higher their risk of poor health. Such disparities in health are considered avoidable and modifiable and, therefore, unjust. There are health inequalities within Havering and between Havering and other local authorities.

Reducing health inequalities has been a longstanding national and local priority. There has been an increasing realisation (articulated in many Government documents over the past 30 years), that more effort needs to be put into preventing individuals and families from getting into situations where they require health or social care interventions. This would help to reduce health inequalities. There is also amble evidence that it is possible to prevent such situations from occurring. Therefore, there has been a strong national and local policy drive to shift more resources into prevention and early intervention and away from more expensive services that are required once problems have occurred.

This understanding informs the selection of our prevention priorities and shapes the things we can do in Havering to deliver these priorities. It allows us to engage all the resources at our collective disposal to create a more resilient economic and social environment in which individuals can make fully informed decisions about how to live their lives. It guides us to develop the circumstances in which it is easier for individuals to make healthier choices and to make best use of the services that are available to them to promote and protect their health and that of their family.

What is the purpose of this report?This document is one of a suite of reports, developed as part of the Joint Strategic Needs Assessment (JSNA), which aims to give readers a high level understanding of the population of Havering. This report is an overview of Havering’s health and social care needs. Using routinely collected data, it describes the pattern of risk factors for ill health, the status of health and wellbeing and how people use local services.

From this understanding (of population growth, prevalence of risk factors for ill health across Havering, and the patterns of demand for health and social care services), all local stakeholders will understand the following changes that need to be made: Prevention needs to be prioritised in order to reduce the prevalence of risk

factors in the population particularly in the more deprived parts of the borough.

A reduction in risk factors will mean a reduction in the number of people who develop long term conditions; less people with multiple co-morbidities; reduced demand for more expensive and complex packages of care; and longer lives free of disability.

Targeting high-risk population groups will ensure efficient use of limited resources and in the longer term reduce health inequalities.

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What will happen to the population of Havering?Based on the Office for National Statistics (ONS) 2015 mid-year population estimates, the London Borough of Havering has a population of 249,0852 - an increase of 11% from 223,641 in 19983. Havering has the oldest population in London and is also one of the most ethnically homogenous boroughs with 83% of its residents recorded as White British in the 2011 census (London 43%, and England 80%).

Based on the Greater London Authority (GLA) population projections, the population of Havering is projected to increase from 255,407 in 2017 to: 270,232 in 2022 – a 6% increase from 2017 281,590 in 2027 – a 10% increase from 2017 287,369 in 2032 – a 13% increase from 2017

The population aged 25-64 will remain the largest age group up to 2032 but the largest increases will be seen in children (5-10 year olds: 13%; 11-17 year olds: 36%), and older people (65-84 year olds: 24%; 85+ year olds: 45%) from 2017 to 2032 (see Table 1). Therefore, if the population continues to be affected by ill health at the current rate then the demand for health and social care services will grow (particularly services for frailty and dementia; long term conditions and child & adolescent mental health). However, as the population aged 25-64 will remain the largest age group up to 2032, access to affordable housing and good quality local employment opportunities will be important. Table 1: Projected percentage population change by age group, from 2017 to 2022, 2027 and 20324

Age group 2022 2027 20320-4 6% 4% 1%

05-10 12% 16% 13%11-17 18% 32% 36%18-24 -4% 4% 13%25-64 4% 6% 5%65-84 5% 16% 24%85+ 9% 18% 45%

Percentage change from 2017 to:

Data source: GLA 2015-based Demographic Projections – Local Authority population projection Housing-led Model; Greater London Authority (GLA); Produced by Public Health Intelligence

For more information on the key geographic, demographic and socio-economic facts and figures for the London Borough of Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at the following website: http://www.haveringdata.net/research/jsna.htm.

2 Mid-Year Population Estimates 2015 (published June 2016), Office for National Statistics 3 Mid-Year Population Estimates 1998, Office for National Statistics4 2015 Round Strategic Housing Land Availability Assessment (SHLAA)-Based Projections (October 2016), Greater London Authority

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http://www.haveringdata.net/research/jsna.htm

http://data.london.gov.uk/dataset/2014-round-population-projections

http://data.london.gov.uk/dataset/2014-round-population-projections

What are the risk factors for ill health in Havering?Havering is a relatively healthy borough - the life expectancy5 for people living in Havering is 80.2 years (for males) and 84.1 years (for females) from birth from 2013-2015. Life expectancy in Havering has been mostly higher than the England average and has been on the increase over the last decade.

However, some people experience better health than others and the reasons vary across the local population. During 2012-2014, women in the least deprived parts of the borough are likely to live 5.7 years longer than those in the most deprived parts. Similarly, there is a difference in life expectancy of 6.5 years in men.6 The key risk factors are obesity, insufficient physical activity, smoking, and alcohol misuse.

Obesity and overweight The main health risks associated with being overweight or obese are diabetes, heart disease and cancer.7

On average, one in four children (23.2%) in Reception Year (Figure 2) and one in three children in Year 6 (Figure 3) in Havering schools are overweight or obese. In addition, Figure 3 shows that (in 2015/16) the proportion of Year 6 children in Havering that are overweight or obese (37.3%) continues for the third year in a row to be significantly higher than the England average (34.2%).8 With respect to adults, around one in two adults (54%) over the age of 18 years registered with a General Practice (GP) in the Havering Clinical Commissioning Group (CCG) is overweight or obese (Figure 4).

5 Life expectancy is a frequently used indicator of the overall health of a population: a longer life expectancy is generally a reflection of better health. Reducing the differences in life expectancy is a key part of reducing health inequalities. Life expectancy at birth for an area is an estimate of how long, on average, babies born today may live if she or he experienced that area’s age-specific mortality rates for that time period throughout her or his life.6 Public Health Outcomes Framework (PHOF - 0.1ii. Life expectancy at birth), Public Health England7 National Obesity Observatory8 National child Measurement programme, Health and Social Care Information Centre

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http://www.noo.org.uk/

http://www.phoutcomes.info/

Figure 2: Proportion of reception children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16

Data source: National Child Measurement Programme (published November 2015), Health and Social Care Information Centre; Produced by Public Health IntelligenceFigure 3: Proportion of reception year 6 children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16

Data source: National Child Measurement Programme (published November 2015), Health and Social Care Information Centre; Produced by Public Health Intelligence

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Figure 4: Distribution of Havering CCG registered adult (18+) population, by BMI category, as at December 2016

Data source: Health Analytics, (accessed December 2016); Produced by Public Health Intelligence

Physical InactivityPhysical inactivity increases the risk of being overweight and obese and developing diabetes, heart disease, cancers and mental ill health.

Estimates show that one in three adults (36.2%) in Havering is inactive compared to London (37.8%) and England (36.1%).9 The general trend in participation in sports lags behind that of Bexley (Havering comparator) and London but in the last couple of years has performed better than England (Figure5).

Figure 5: Sports participation at least once a week 2005/06-2015/16, Havering, London, England, statistical comparator Bexley

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Data source: Active People Survey (APS) Interactive Tool, Sports England (accessed February 2017); Produced by Public Health Intelligence

SmokingSmoking increases the risk of lung and other cancers, heart disease, chronic obstructive lung disease (COPD). Since the 80s there has been a fall in deaths from heart disease thought to be due mainly to a reduction in smoking. This trend has continued along with a fall in other respiratory conditions following the introduction of the smoking ban in 2007.10

In Havering, approximately 17.3% of persons aged 18 years and above smoked in 2015.11 This is similar to both London and England. Smoking prevalence was highest in Gooshays (20.3%) and Heaton (19.6%), two of the most deprived wards in Havering; and lowest in Emerson Park (17.2%) and Upminster (16.6%) – see Figure 6.12 The number of deaths attributable to smoking is on the decline, but based on the most recent data (2012-2014) this is still higher than England and significantly higher than London.13

Figure 6: Smoking Prevalence (% of adult population) across Havering Wards by Quintile14 (where Quintiles 1 and 5 refer to the lowest and highest prevalence wards respectively)

Data source: Action on Smoking and Health (ASH) Ready Reckoner Tool (published December 2015); Produced by Public Health Intelligence

10 Smoke Free England 11 Local Tobacco Control Profiles, Public Health England 12 Action on Smoking and Health Ready Reckoner (Published December 2015)13 Local Tobacco Control Profile (accessed November 2015) latest available data 2011-2013, Public Health England14 Quintile is a statistical term to divide a sample or population into fifths

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Map key Ward

Smoking prevalence(% of population aged 16+) Quintile

1 Brooklands 19.1 52 Cranham 17.1 13 Elm Park 18.8 44 Emerson Park 17.2 15 Gooshays 20.3 56 Hacton 18.1 27 Harold Wood 18.3 38 Havering Park 19 49 Heaton 19.6 5

10 Hylands 18.3 311 Mawneys 18.6 312 Pettits 17.6 213 Rainham and Wennington 19 414 Romford Town 18.3 315 St Andrew's 18 216 South Hornchurch 19.4 517 Squirrel's Heath 17.6 218 Upminster 16.6 1

18

2

7

5

9

8

12

17

4

11

114

10 15

63

16

13

LegendQuintile Low(>=) (<)High Occurrences

1 16.6 17.6 32 17.6 18.3 43 18.3 18.8 44 18.8 19.1 35 19.1 20.5 4

http://www.smokefreeengland.co.uk/

Smoking in pregnancy, although on the decline (Figure 7) is highest in Havering (7.7%) compared to other London boroughs (significantly higher in Havering compared to 5.0% in London but significantly better than England, 10.6%)15 for 2015/16.

Figure 7: Smoking status at the time of delivery, Havering compared to Bexley, London and England, 2010/11 to 2015/16

Data source: Local Tobacco Control Profile (accessed March 2017); Produced by Public Health Intelligence

Alcohol MisuseDrinking alcohol above recommended limits (14 units per week for women and 21 units per week for men) increases the risk of cancers, liver and heart diseases. This is also associated with anti-social behaviour, domestic violence and other criminal offences. However, the majority of drinkers (73%) in Havering do so safely16.

Although Havering had significantly lower alcohol related admissions to hospital (430 per 100,000 hospital admissions for alcohol-related conditions in comparison to London and England in 2014/1517, alcohol is implicated in 4% of

15 Smoking Status at Time of Delivery Returns, Health and Social Care Information Centre via Local Tobacco Control Profiles for England, Public Health England (accessed March 2017)16 Alcohol Harm Map by Alcohol Concern accessed Jan 201617 Indicator 10.01: Admission episodes for alcohol-related conditions (Narrow) Local Alcohol Profile for England (accessed December 2015), Public Health England

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ambulance call outs18; 16% of road fatalities19 and over 70% of cases of domestic violence20.

Other factors There are other risk factors that influence health and wellbeing, particularly for children. Some of these include teenage pregnancies, maternal mental health, breastfeeding, early years and oral health.

Teenage pregnanciesEvidence shows that children born to teenage mothers are more likely to experience a range of negative outcomes in later life and are more likely, in time, to become teenage parents themselves – perpetuating the disadvantage that young parenthood brings from one generation to the next.Teenage pregnancy is both a contributory factor as well as an outcome of child poverty. However, with the right level of support, the life chances of young parents can be significantly improved. Havering’s teenage (under-18) conception rate has almost halved from the

rate in 1998. However, Havering’s rate (26 per 1000 women under the age of 18) in 2014 is higher than London (21.5 per 1000) but similar to England (22.8 per 1000). For the conception rate under 16, Havering’s rate (6.1 per 1000) is higher than England (4.4 per 1,000) and significantly higher than London (3.9 per 1,000) 21.

18 Drug and Alcohol Misuse in Havering JSNA (p78) via SafeStats, 2012-1319 Drug and Alcohol Misuse in Havering JSNA (p78) via Reported Road Casualties in Great Britain: 2012 Annual Report by Department of Transport20 Gilchrist, E., Johnson, R., Takriti, R., Weston, S., Beech, A. and Kebbell, M. (2003) Domestic violence offenders: characteristics and offending related needs, Findings, 217, London, Home Office21 Conception Statistics 2013 (Published 24 February 2015), Office for National Statistics, Under 16 conceptions (numbers and rates) and outcome, three year aggregates

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Figure 8: Trend in under 18-conception rate per 1,000 women aged 15-17, Havering, Bexley, London and England, 1998-2014

Data source: Conception Statistics 2014 (published February 2015), Office for National Statistics; Produced by Public Health Intelligence

Maternal mental health Women are at increased risk of suffering from mental health problems following childbirth, but women with pre-existing psychiatric disorders may also face a relapse or recurrence of their condition following childbirth.

Mental illness occurring at this time may have an adverse effect on the woman herself, and also on her marriage, family and, in particular, on the future development of her infant. Maternal depression and stress related disorders are the most common maternal mental health conditions in Havering (see Table 2).

Table 2: Prevalence of mental health amongst maternal population in HaveringMENTAL HEALTH CONDITION NUMBER

SPREVALENCE (per thousand maternities)

All Maternities 3,138Postpartum psychosis 6 2 in 1000Chronic serious mental illness

6 2 in 1000

Severe depressive illness 94 30 in 1000Mild-moderate depressiveillness and anxiety states

314-471 100-150 in 1000

Post-traumatic stress disorder

94 30 in 1000

Adjustment disorders and stress

471-941 150-300 in 1000

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Data source: Guidance for commissioners of perinatal mental health services, Joint Commissioning Panel for Mental Health 2012 (Births based on ONS Mid-Year Population Estimates 2015); Produced by Public Health Intelligence

BreastfeedingBreastfeeding is good for babies. Breastfeeding rates in the UK are among the lowest in Western Europe, with young mothers, women of lower socioeconomic status or those who left full-time education at an early age being least likely either to start breastfeeding or to continue breastfeeding beyond six to eight weeks.

In 2015/16, about three quarters of Havering mothers breastfed at birth (73.3%) and this is statistically similar to London (86.1%) but lower than England (74.3%). However, a significant proportion do not continue to breastfeed – at 6-8 weeks, only 43% continue to do so compared with 48.9% in London and 43.2% in England22.

Early YearsAchieving the very best outcomes in the early years is fundamental to shifting the long-term health and wellbeing of the residents of Havering. Evidence-based interventions23 that have been shown to be highly cost effective include preschool early childhood education for 2, 3 and 4 year olds in families with low incomes.The proportion of children achieving a good level of development during early years remained relatively static over 2010-2013 at 59-60%. Havering is currently ranked 16th highest of 32 boroughs in London for the proportion of children achieving a good level of development at the early years foundation stage from 2013 to 2015 (see Figure 9).

22 Public Health Outcomes Framework 2.02i (2014/15) Breastfeeding InitiationPublic Health Outcomes Framework 2.02ii (2015/16) Breastfeeding Prevalence 6-8 weeks 23 Healthy child programme: rapid review to update evidence 2015

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Figure 9: Percentage of children achieving a good level of development at the end of reception, 2015/16

Data source: Public Health Outcomes Framework 1.02i 2015/16; Produced by Public Health Intelligence

Oral HealthDental health in children is a good indicator of diet and overall health. Tooth decay is predominantly preventable. For 2014/15, in Havering, proportion of five year olds free from dental decay is 80.0%24. This is better than England (75.2%) and significantly better than London (72.6%). Dental decay can result in pain, sleep loss, time off school and, in some cases, treatment under general anaesthetic.

24 Dental Health Profile, Public Health England published October 2014 v2 % decay experience refers to the proportion of children affected by dental decay (source: Local authority dental profiles 5yr 2012)

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What is the current status of health in Havering?Mortality rates are routinely used to describe health status in England. Therefore, this section describes the status of health as mainly measured by mortality rates, and by specific conditions that are the main contributors to mortality in Havering. In the main, those living in the more deprived wards of the borough experience worse health and higher death rates, based on current access to and the quality of health and wellbeing services. MortalityApproximately 1% of the population of Havering die each year (on average 2,234 people)25. The top 5 (underlying) causes of death in Havering (from 2012 to 2016) are: cancers, circulatory diseases, respiratory diseases, dementia & Parkinson’s disease, and diseases of the digestive system. Unspecified dementia comprises the biggest single underlying cause of death. Lung cancers comprise the largest proportion of deaths from Cancer (see Figure 10).

Figure 10: Distribution of number of deaths amongst Havering residents of all ages by broad underlying causes (with four biggest broken down further), in 2012-2016

Data source: Primary Care Mortality Database (Office for National Statistics); Produced by Public Health IntelligenceIn Havering, about 620 deaths (28%) each year26 occur prematurely (deaths that occur before a person reaches the age of 75 years). Cancer, heart disease and

25 Based on the number of deaths over 5-year period (2012-2016) – 11,172 (Data source: ONS PCMD)

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stroke are the main causes of premature deaths (see Figure 11). This reflects the national picture.

Figure 11: Distribution of number of deaths amongst Havering residents of those aged under 75 by broad underlying causes, in 2012-2016

Data source: Primary Care Mortality Database (Office for National Statistics); Produced by Public Health Intelligence

Havering generally ranks well in comparison to 150 local authorities (LAs) in England for premature mortality, except breast cancer (though not significantly different from the average). Compared to local authorities with similar deprivation scores, Havering scores statistically better for premature deaths from injuries, better than average (though not statistically significant) for colorectal cancer, stroke, breast cancer, heart disease and stroke. In addition, Havering ranks worse than average (but not significantly) for lung cancer, overall cancer, lung disease, heart disease, lung disease and liver disease related premature mortality (see Figure 12).

26 Based on the number of premature deaths over 5-year period (2012-2016) – 3,094 (Data source: ONS PCMD)

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Figure 12: Premature mortality, Havering compared to all local authorities (LAs) in England and similar LAs average, 2013-15

Data source: Longer Lives tool (accessed March 2017), Public Health England; Produced by Public Health Intelligence

People living in the most deprived parts of the borough are more likely to die early compared to those living in the least deprived parts of the borough (See Figure 13).

For the main causes of death: Cancer: The main causes are lung, bowel, breast and prostate. The single

most important risk factor for cancers is smoking. Men from the most deprived parts of the borough are more likely to die early from cancer.

Heart disease and Stroke: Women from the most deprived parts of the borough are more likely to die early from heart disease.

Lung disease: The main type of lung disease responsible for deaths is Chronic Obstructive Pulmonary Disease (COPD); the single most important risk factor is smoking. Men from the most deprived parts of the borough are more likely to die early from lung problems.

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Figure 13: Breakdown of life expectancy gap between the most deprived quintile and the least deprived quintile in Havering by cause of death and gender

“<28 days” means neonatal deaths (i.e. deaths under 28 days).Data source: Life Expectancy Segment Tool 2012-2014 (Published May 2016), Public Health England; Produced by Public Health Intelligence

Long-Term ConditionsThere is an increasing number of Havering residents living with long-term conditions (LTCs). LTCs have a significant impact on daily lives including the use of urgent and emergency health and social care services. The current distribution of Havering CCG registered population by LTC count is presented in Figure 14 and the impact the LTCs have on hospital usage (compared to those with no LTC) is shown in Figure 15.

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Figure 14: Number and proportion of registered population by LTC count, Havering CCG, 2015/16

Data source: Health Analytics; Produced by Public Health Intelligence

Havering CCG patients with five or more LTCs are 3 times more likely to attend A&E, 13 times more likely to be admitted for an emergency, and the average number of inpatient bed days will be 23 times greater compared to patients with no LTC.

Figure 15: Ratio of patients with long-term conditions (LTCs) compared to patients with no long-term conditions (LTCs) for A&E attendances, Emergency Admissions and Inpatient Bed Days

Data source: Health Analytics; Produced by Public Health Intelligence

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Mental IllnessMental illness encompasses a range of conditions such as depression, anxiety, psychoses and schizophrenia. Risk factors for the development of mental illness are multifactorial. However, physical illness, stress and alcohol and substance misuse are important risk factors.

Mental illness is the third most important cause affecting the health of people in Havering, (cancers being the first, and heart disease & stroke the second). Up to a third of people with problems such as diabetes, heart disease and COPD are also affected by mental health problems.

The prevalence of mental health problems in Havering (0.65%) is generally lower than both London (1.07%) and England (0.88%)27 but there is variation in how common it is across the wards in the borough. For example, the prevalence of depression ranges from 56.6 per 1000 persons aged 17 and over in Upminster to 113.0 per 1000 persons aged 17 and over in Gooshays (i.e. more generally more common with increasing deprivation) – see Figure 16.

Figure 16: Prevalence of depression in patients registered with GP in Havering CCG and resident in the London Borough of Havering, per 1,000 persons aged 17 years and over, Census wards, as of February 2017

56.6

62.2

69.5

70.3

74.2

75.2

77.4

81.0

82.5

84.5

85.5

88.4

88.7

93.5

93.8

95.9

106.

1

113.

0

83.7

0

20

40

60

80

100

120

140

Rate

per

100

0 pe

rson

s age

d 1

7 an

d ov

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Compared to HAVERING

Significantly Lower

Not Significant

Significantly Higher

Data source: Health Analytics (accessed February 2017); Produced by Public Health Intelligence

For more information on mental health in Havering, see the mental health JSNA at http://www.haveringdata.net/research/jsna.htm.

27 Quality outcomes Framework 2014/15 published October 2015P a g e | 28

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Dementia Dementia is more common in Havering than London and England (Figure 17) and it will be an increasing problem for Havering because of its ageing population. The care that people need is quite complex and expensive.

Many people with dementia will also be living with other long-term conditions, as the risk factors for the main types of dementia are similar to those that result in conditions such as cardiovascular diseases (CVD) and diabetes. Figure 17: Prevalence of dementia in registered patient, all ages, London boroughs and England 2015/16

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DiabetesAbout 10% of the NHS budget is spent on patients with diabetes, 90% of whom have Type 2 or adult onset diabetes.28 The main risk factors are a diet rich in unrefined sugars, physical inactivity and being overweight or obese. The risk is increased in people from certain Black, Asian, and minority ethnic (BAME) groups – South Asian and Afro-Caribbean backgrounds.

In Havering, the number of people living with diabetes is on the increase. The prevalence of diabetes is lowest in Upminster (47.3 per 1000 persons aged 17 and over) and highest in South Hornchurch (70.1 persons aged 17 and over) – see Figure 18.

28 Diabetes UK – Diabetes Facts and Stats; Version 4. Revised: May 2015P a g e | 29

HAVERING J S N A

Figure 18: Prevalence of diabetes in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 17 and over, Census wards, as of February 2017

47.3

48.2

51.4

53.3

55.6

55.9

56.3

58.6

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59.3

59.7

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64.9

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66.4

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58.6

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CancerIn Havering there are 30.8 people per 1000 persons living with Cancer. The prevalence of Cancer is lowest in Gooshays (19.1 per 1000 persons) and highest in Cranham (45.2 per 1000 persons) – see Figure 19

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Figure 19: Prevalence of Cancer in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017

19.1

21.6

22.6

23.3

24.9

29.3

29.3

29.9

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31.4

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COPDIn Havering there are 17.3 people per 1000 persons living with Chronic Obstructive Pulmonary Disease (COPD). The prevalence of COPD is lowest in

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HAVERING J S N A

Squirrel’s Heath (12.1 per 1000 persons) and highest in Heaton (25 per 1000 persons) – see Figure 20

Figure 20: Prevalence of Chronic Obstructive Pulmonary Disease (COPD) in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017

12.1

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23.3

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Rate

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Significantly LowerNot Significant



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HAVERING J S N A

HypertensionIn Havering there are 198.5 people per 1000 persons aged 30 and over living with Hypertension. The prevalence of Hypertension is lowest in Romford Town (158.7 per 1000 persons aged 30 and over) and highest in Heaton (221.1 per 1000 persons aged 30 and over) – see Figure 21

Figure 21: Prevalence of Hypertension in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017

158.

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162.

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168.

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CHDIn Havering there are 41 people per 1000 persons aged 30 and over living with Coronary Heart Disease (CHD). The prevalence of CHD is lowest in Romford Town

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(32.7 per 1000 persons aged 30 and over) and highest in Heaton (46.8 per 1000 persons aged 30 and over) – see Error: Reference source not found

Figure 22: Prevalence of Coronary Heart Disease in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017

32.7

33.1

34.0

34.7

38.2

40.8

41.5

42.2

42.5

43.2

43.2

43.4

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41.0

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20

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Significantly Lower

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DisabilityChildren and adults with a learning disability are at increased risk of having or developing physical and mental health problems. In addition, they are 10 times more likely to have serious sight problems.

Havering was estimated to have 906 adults with moderate or severe learning disability in 2016, of which about 300 are estimated to be living with a parent (see Table 3). Additionally, about 1,681 people were estimated to have autistic spectrum disorders. Havering has a lower rate of people registered blind (205 per 100,000) compared to London and England29.

29 Data source: Registered Blind and Partially Sighted People - Year Ending 31 March 2014 (published September 2014), Health and Social Care Information Centre

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Table 3: Number of adults with learning disability in Havering, 2016

2016Age groups (years)

18-24

25-34

35-44

45-54

55-64

65-74

75+ Total

People predicted to have a moderate or severe learning disability

124 178 191 184 145 84 45 906

People predicted to have a severe learning disability 41 50 52 41 34

Not calculate

d

Not Calculate

d218

People predicted to have autistic spectrum disorders 200 324 300 339 289 229 188 1,68

1People with learning disability predicted to be living with a parent 82 92 74 42 14

Not calculate

d

Not Calculate

d304

Data source: Projecting Adult Needs and Service Information (PANSI) and Projecting Older People Population Information (POPPI), 2016; Produced by Public Health Intelligence

For more information on the key facts and figures on adult disabilities in Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at http://www.haveringdata.net/research/jsna.htm.

The number of children with special educational needs and disabilities is growing year on year, averaging increases of between 40% and 60% in all groups between 2012 and 2015. These are particularly marked in respect of children with the most severe and complex needs where there are disproportionate growths, leading to pressures and shortfalls in relation to both mainstream and special school places30.

There is increasing demand for specialist help and schooling for children with autism (ASD) and for those with behavioural, emotional and social difficulties (BESD), including those with mental health issues. Whilst respective increases of 40% and 62% were seen in these two groups between 2012 and 2015, numbers for ASD in the primary school population are expected to double over a 5-year period (from 2015 to 2020). Numbers for the BESD primary school group are also expected to treble during this period, and these will add to the increases already in secondary schools. There are also increases in children with moderate learning difficulties and those with speech, language and communication needs. However, mainstream schools are increasingly making successful provision for these two categories. Autism and behaviour difficulties remain major issues, requiring significant help and resources for schools to meet these needs.

Figure 23: shows predicted growths in ASD and BESD growths by type of need and school over a 10 year period. For more information, see the “Strategy for Children and Young People with Special Educational Needs and Disabilities 2015-20”

30 Strategy for Children and Young People with Special Educational Needs and Disabilities 2015-20 (published September 2015)

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Figure 23: Projected numbers of children with statements of special educational needs by type and school in Havering, 2013/14 to 2023/24

44

7582 85 87 90 92 94 95 97 98 99

6475

77 77 79 80 83 85 87 89 91 92

14

3338 39 40 42 43 43 44 45 46 46

42

54 57 57 58 59 62 63 65 66 68 68

0

20

40

60

80

100

120

Num

ber o

f sta

tem

ente

d pu

pils

Financial Year

Primary School ASD Secondary School ASD Primary School BESD Secondary School BESD

Data source: Strategy for Children and Young People with Special Educational Needs and Disabilities 2015-20; Produced by Public Health Intelligence

Specific GroupsChildren Overweight and obesity is an issue for children in Havering. They are likely to

develop Type 2 Diabetes requiring long-term medical care. There are also mental health issues associated with being overweight and obese and living from an early age with a chronic medical condition.

Havering has the lowest number of children going into care. Looked after children generally have greater mental and physical health care needs. In 2012/2013, screening test results for 95 children in care aged 5 to 16 showed that (56%) were at a high or borderline risk of clinically significant mental health problems.

For more information, see the Children and Young People JSNA at http://www.haveringdata.net/research/jsna.htm.

Older People Older people are at increased risk of living with multiple long-term conditions;

dementia; and experiencing falls. About 32% (13,449) of the population aged 65 years and above are living in

one-person households. Almost half (48%) of all one person households in Havering are occupied by persons aged 65 years and over, which is the highest proportion in London31. Older people living alone can be an indicator of social isolation and may require more support from health and social care services.

31 Census 2011 (Household Composition by Age), Office for National Statistics (ONS)P a g e | 36

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Havering has one of the largest proportions of the population in the country with dementia and it is estimated that around half of people living with dementia are as yet undiagnosed32.

Refractive error and cataracts cause two thirds of sight loss in older people33. However diabetes, smoking and hypertension increase the risk of developing sight loss due to macular degeneration.

Working Age Adults This is the largest age group in Havering. This age group is more likely to

experience serious mental health problems such as depression, schizophrenia and psychoses.

The majority of people who misuse drugs and alcohol also fall into this age group.

Ethnic Minority groups A small proportion of the Havering population is from a BAME group (17%

compared to 55% of London and 20% of England). Certain health problems are more common in BAME groups because of various reasons including diet and other lifestyle factors e.g. diabetes in South Asians; and sickle cell disease in Black Africans.

For more information on the key facts and figures on ethnic minorities in Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at http://www.haveringdata.net/research/jsna.htm.

32 Primary Care Web Tool https:// www.primarycare.nhs.uk/default.aspx 33 Royal National Institute of Blind People (accessed January 2016)

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http://www.rnib.org.uk/knowledge-and-research-hub/key-information-and-statistics

https://www.primarycare.nhs.uk/default.aspx

https://www.primarycare.nhs.uk/default.aspx

How do local people use health and social care services?This section provides information on the use of health and care services by Havering residents.

Children Social CareAs discussed in the “What will happen to the population of Havering?” section of this document (and “This is Havering: a demographic and socioeconomic profile”34), the population of those aged 0-17 years in Havering is set to see huge increases in the coming years. Demand pressures have already been noticed across the Children Social Care Service, from Early Help and the front door – Multi Agency Safeguarding Hub (MASH) – through to the numbers of looked after children. Using data as at December 2015, the end of 2015/16 financial year activity figures for the service have been projected to show increased demand across board.Havering’s children centres saw a 7.5% increase in the number of individual people that attended them between 2013/14 and 2014/15 (12,236 to 13,148). Projected figures for 2015/16 indicate a 23% increase in children centre numbers to 16,148. There were 2,129 contacts received by the service in 2014/15 with 2015/16 projections set to exceed 3,000 indicating an over 40% increase in activity. This is continued throughout the service when looking at the number of Contacts progressing to an Early Help assessment which is also set to increase by 22% by the end of 2015/16 financial year (from 396 to 483).

Referrals and AssessmentsIn 2013/14, Havering’s Children Social Care received 1,106 referrals to the service. In 2014/15, this had increased by 60% to 1,774. Projections for 2015/16 are in the region of 2,246 which would indicate a further 27% increase from the previous year. Linked to the increase seen in Referrals to the service, the number of assessments completed has also seen an increase. Between the years 2013/14 and 2014/15, a 6% (1,101 to 1,165) increase was seen with projections for 2015/16 set at 75% more than the previous year (2,039) – see Figure 24.

34 Can be found at the following website: http://www.haveringdata.net/research/jsna.htm.P a g e | 38

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Figure 24: Count of children’s social care referrals and assessments in Havering, 2013/14 to 2015/16

1,106

1,774

2,246

1,101 1,165

2,039

0

500

1,000

1,500

2,000

2,500

2013/14 2014/15 Projections for 2015/16

Coun

t

Children's Social Care Referrals Children's Social Care Assessments

Data source: Children’s Social Care Case Management System

Child and Young People on Plans

Between 2014 and 2016, there were 1952 plans in total across Children in Need, Child Protection Plan, Looked After Children. The spread of activity is shown in Figure 25.

Figure 25: Distribution of plans across Children and Young people, 2014-2016

Data source: Children’s Social Care Case Management System; Produced by Public Health Intelligence

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Table 4: Rate of children’s social care activity by type of plan per 1000 children aged under-18 years in Havering, 2016

Children in Need Child Protection Plan Looked After Child

Rate per 1000 children 6.9 6.0 4.6

Count 344 298 231

Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016

Child In Need Child Protection Plan Looked After Child

2014 2015 2016 2014 2015 2016 2014 2015 2016

Female

Male

0

2

4

6

8

10

Rate per 1000 children aged 00-17

0

2

4

6

8

10

Rate per 1000 children aged 00-17

3.76(100)

2.97(79)

5.94(158) 5.11

(136) 5.53(147)

3.35(89)

3.53(94) 3.65

(97)3.35(89)

3.69(102)

2.32(64)

5.90(163)

4.42(122)

5.07(140)

2.64(73)

3.59(99)

3.59(99)

3.66(101)

GenderFemaleMale


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Children In NeedThere were 344 children in need care plans as end of December 2016. This is a rate of 6.9 per 1000 children aged under-18. This has been on the increase from 2014 to 2016.

Table 5: Count of children in need activity, Havering, 2014-2016AGEBAND

GENDERM F

2014-2016 329 337Under 1 16 20

01-04 75 8305-09 94 10210-14 97 7115-18 47 61


Figure 27: Population Pyramid of children in need activity, Havering, 2014-2016


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Child Protection

There were 269 plans for Section 47’s (S47’s) – Child Protection Investigations as end of December 2016. This is a rate of 5.0 per 1000 children aged under-18. This has been an increase since 2014 (3.1 per 1000 children aged under 18) but a drop from the previous year (5.2 per 1000 children aged under-18). This is projected to reach 342 by 2017 – a rate of 5 per 1000 children aged under-18.

Table 6: Count of child protection activity, Havering, 2014-2016

AgebandCount

M F2014-2016 335 371

Under 1 34 3901-04 80 8305-09 100 10210-14 90 9915-18 31 48

Figure 28: Population Pyramid of child protection activity, Havering, 2014-2016


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Looked After Children

There were 196 plans for Looked After Children as end of December 2016. This is a rate of 3.6 per 1000 children aged under-18. The rate of activity for Looked After Children (LAC) has remained fairly consistent between 2014 and 2016. The consistency indicates that cases are being dealt with at an earlier stage (before crisis) which is better for families. (see Figure 29).

Table of count of looked after children activity, Havering, 2014-2016

AgebandCount

M FTotal 298 314

Under 1 22 2201-04 43 5505-09 64 4910-14 93 9615-18 76 92

Population Pyramid of looked after children activity, Havering, 2014-2016


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Figure 29: Rate per 1000 children aged under 18 for Child in need plans, child protection plans and looked after children in Havering, 2014 to 2017

Count 2014 2015 2016 Projected 2017

Children In Need 143 202 321 400

Child Protection

163 276 269 342

Looked After Children

187 195 196 202

Data source: Children’s Social Care Case Management System

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Adult Social Care People need care and support for many reasons. This can be because of their age, disability, health or the personal situation they find themselves in. The introduction of the Care Act 2014, which puts people and their carers in control of their care and support, will change the pattern of use.

As end of 2016, 7224 clients received adult social care support in Havering. Three quarters of cases were those aged 65 and over. The majority of the demand (98%) is driven by the following: physical

disability (78%), learning disability (12%) and mental health (8%).

Residential and Nursing Care In Havering, the rate of adults aged 18-64 years admitted to residential and nursing homes was 9.5 per 100,000 in 2014/15. This is lower compared to both London (11.1 per 100,000) and England (14.2 per 100,000). The rate of adults aged 65 and over admitted to residential and nursing homes (596.7 per 100,000 adults aged 65 and over) in Havering is higher compared to London (491.7) and lower compared to England (668.8)35.

There are 39 care homes (21 residential and 18 nursing) in Havering with a total of 1,611 beds. Of these, Havering currently place a third of clients, the rest being self-funders, health placements, out of borough placements and vacancies. On average, adults with care needs were able to self-fund for 25 months before presenting to social care. 36

Between April 2014 and March 2015, there were a total of 286 (including self-funders) new admissions into care homes with around 88% being over the age of 75. Over a third of these new admissions came directly from the local acute hospitals (Queens and King George’s), the remainder admitted from the community. Analysis last done in 2013-14 indicated that around 45% of care homes admissions from hospital were admitted as a result of a fall.

From April 2014 to March 2015 there were, on average, 602 adults over the age of 65 (known to Adult Social Care) in a long stay placement at the end of each month, with a general increase in the number of adults with dementia, rather than physical frailty.

The majority of clients that have physical and sensory disabilities (PSD) are unable to access local placements with the right level of specialist support; and as a result are placed outside of the borough.Home Care Over a 1,101 adults receive support in their homes37; equating to about 11.3 hours per person per week; an increase from 10.7 in 13/14.

Respite Care

35 Adult Social Care Outcomes Framework (ASCOF) 2014/15 published October 2015, Health and Social Care Information Centre36 Adult Social Care Market Position Statement 201637 Ibid

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For 2014/15, 266 clients used respite services totalling 638 separate episodes38. There were: 600 respite placements:

o 452 as planned respite (for 155 clients)o 148 as emergency placements (for 105 clients)

38 short stays (for 14 clients) which can sometimes be respite with no fixed end dates.

Day Care ServicesThe use of day care services in Havering decreased from 232 per 100,000 people aged 18 and over in 2010/11 to 203 per 100,00 people aged 18 and over in 2013/14. This is lower when compared to London (268 per 100,000 population) and England (301 per 100,000 population). 39

In 2014/15, there were on average 140 clients over the age of 65, using day services each week40.

ReablementThe aim of reablement is to support people after they have had a crisis, in order for them to remain as independent as possible. The majority of the demand for reablement, 80%, arises from the Joint Assessment and Discharge (JAD) team at the local acute trust; the remaining 20% from the community41.

Carers and Carers AllowanceAccording to the 2011 Census, 25,214 people, 11% of Havering’s residents identified themselves as carers, an increase by 8% from 23,253 in 2001. Twenty-three per cent (5,835) said they provided more than 50 hours of care per week.

There are 2,330 claimants of Carers Allowance in the borough and in the past year, 1,936 carers had an assessment of their needs carried out by Adult Social Care. This represents 9% and 8%, respectively, of the number of carers identified in the 2011 census.

Figure 30 shows that in 2014-15 the majority of Havering carers supported a loved one with a physical or learning disability (see Figure 30).

38 Ibid39 Adult Health Profiles, Public Health England: Adults who attended day care during the year per 100,000 population aged 18+ (RAP P2F)40 Adult Social Care Market Position Statement 201641 Ibid

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Figure 30: Carers - Primary support reason of 'Cared For' person 2014-15

Sensory Disability78%

Learning Disability15%

Memory & Cognition3%

Mental Health2%

Social Support2%

Source: ASC Market Position Statement 2016; Produced by Public Health Intelligence

For more information on adult social care in Havering, see the Adult Social Care Market Position Statement 2016.

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Health ServicesPrimary CareThe average number of patients registered with a Havering CCG practice per GP (Full Time Equivalent) is 2,073, which is lower than both London and England (Figure 31).

The workload per GP will vary not only because of the number of registered patients but also the level of ill health amongst registered patients. GPs based in areas with higher levels of deprivation are also more likely to have increased demand for services.

79% of patients stated their overall experience with their GP was good, similar to London (80%) - higher compared to London (60.3%) and lower compared to England (85%).42

Figure 31:

Number of registered patients per GP, Havering Clinical Commissioning Group (HCCG) GP practices, Havering CCG, London average, England Average 2016

Data source: NHS Digital (Numerator: number of patients registered at a GP Practice as at December 2016; and denominator: number of GPs (FTE) linked to a GP practice as at January 2017); Produced by Public Health Intelligence

Accident and Emergency (A&E) Attendances

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In 2013/14, there were 160,544 A&E attendances by people registered with a Havering CCG and resident in Havering43. This equates to a rate of about 664 A&E attendances per 1,000 people44.

A breakdown of the rate of A&E attendances per 1,000 people (presented in Figure 32) suggests that people living in the more deprived parts of the borough are more likely to use A&E services than those from least deprived areas in Havering.

Figure 32: Rate of A&E attendances per 1,000 population registered with Havering CCG GP and resident in Havering, by LSOA, 2013/14

Data source: Secondary Uses Services (SUS)

Hospital AdmissionsThere were approximately 31,003 elective admissions to hospital by patients registered with a General Practice (GP) in Havering in 2014/15. This is a 1.5%

43 Secondary Uses Services (SUS)44 The denominator used is 241,883. Data source: Health Analytics

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Attendances per 1,000 persons382 - 557 per 1,000 persons558 - 613 per 1,000 persons617 - 676 per 1,000 persons683 - 779 per 1,000 persons785 - 1,042 per 1,000 persons

increase since the previous year which is lower than the increase seen across both London and England, 6.0% and 2.8% respectively.45

In 2013/14, there were 34,993 elective and 20,906 emergency hospital admissions (spells) for Havering CCG-registered patients46. The top 10 causes of admissions of elective and emergency admissions are displayed in Figure 33. Only the top 5 causes of Elective Admissions and Emergency Admissions account for 63% and 64% respectively.

45 Quarterly Hospital Activity Data 2013/14 to 2014/15, NHS England46 Secondary Uses Services (SUS)

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Figure 33: Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, 2015/16

Data source: Secondary Uses Services (SUS)

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Mental HealthEstimates suggest that about 3,275 children aged 0-16 years and resident in Havering have a mental health disorder sufficient to cause distress to the child or have a considerable impact on the child’s day-to-day life. Children and Mental Health Services (CAMHS) in Havering are provided by North East London Foundation Trust (NELFT). Over 2000 children received care in 2012/13 - the majority of whom had emotional problems. Of these children over 64% were between 11 and 17 years of age. Compared to both our statistical neighbour Bexley, and to England, Havering has a lower rate of admission for children with mental health disorders aged 0-17 years.47

See the mental health JSNA (at http://www.haveringdata.net/research/jsna.htm) for information on service use by adults.

Key documents for further informationBelow is a list of useful documents and resources for further information. Except otherwise stated, these are locally produced documents which can provide more detailed information on various sections of this document. Any of the documents noted as being in draft will be available online when published.

This is Havering: a Demographic and Socioeconomic Profile (updated quarterly)

Health and Wellbeing Strategy 2015-2018 Obesity JSNA 2016 (currently in draft) Obesity Strategy 2016 (currently in draft) Adult Social Care Market Position Statement 2016 (currently in draft) Strategy for Children and Young people with Special Educational Needs and

Disabilities, 2015-2020 (currently in draft) Public Health Outcomes Framework – Havering profile (nationally produced) Adult Social Care Outcomes for Havering (nationally produced) NHS England and PHE’s Commissioning for Value document for NHS Havering

CCG (nationally produced) Pharmaceutical Needs Assessment 2015 Mental Health JSNA 2015 Sexual Health JSNA 2015 Drug and Alcohol JSNA 2014 Children and Young People JSNA 2014

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https://www.england.nhs.uk/wp-content/uploads/2016/01/havering-ccg-16.pdf

https://www.england.nhs.uk/wp-content/uploads/2016/01/havering-ccg-16.pdf

http://ascof.hscic.gov.uk/Outcome/726/

http://www.nepho.org.uk/pdfs/public-health-outcomes-framework/E09000016.pdf

http://democracy.havering.gov.uk/documents/s16474/Item%206b%20-%20Appendix%201%20-%20Outline%20Proposals.pdf

http://democracy.havering.gov.uk/documents/s16474/Item%206b%20-%20Appendix%201%20-%20Outline%20Proposals.pdf





Havering Health and Social Care Web viewBased on the Greater London Authority (GLA) population projection, ... Copenhagen: World Health Organization, 1992. Individually and collectively,

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