Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...

 
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Hampshire and Isle of Wight ICS
 Population Health Summary.
          April 2021
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Contents
 •    Key Points
 •    Demographics and Life Events
 •    Long Term Conditions, Morbidity and Risk Factors
 •    Wider Determinants and Inequalities
 •    Picture of COVID-19
 •    Priorities and Local JSNA Work Programmes

     Early data and evidence around the impact of COVID have been highlighted in red text,
      these are not of course all inclusive and are for discussion and consideration as the
                       evidence of the short and long term impacts grows.
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Key Points
• The 10th largest ICS in the country, but estimates forecast slower resident population
  growth than that Nationally.
• Ageing demographic – increasing frailty and multimorbidity, continue to be a big driver
  in health and social care needs. This is particularly expected in West Hampshire and
  Isle of Wight. During the first wave of the pandemic, age ≥ 70 years and male sex,
  increased vulnerability to COVID-19.
• The population is ethnically less diverse than England but diversity is increasing.
  Individuals from Black and Asian ethnicities had a higher risk of COVID-19 infection
  compared to White individuals.
• Addressing behavioural risk factors, such as smoking, unhealthy weight and physical
  inactivity, are important for the prevention and treatment of long term conditions. Body
  mass index (BMI) and specific health conditions increase the risk of a person catching
  coronavirus and becoming seriously unwell.
• COVID-19 has exposed, exacerbated, and created health and social care needs and
  new inequalities.
• JSNA work programme - understand how the effects of COVID have disproportionally
  affected different population groups across HIOW and resultant population health and
  social care vulnerabilities and needs.
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Population & changes
                                                                       • With a registered population of 1,902,230, the HIOW ICS
                                                                         is the 10th largest of the 42 ICSs in the country.
                                                                       • Ageing demographic – increasing frailty and
                                                                         multimorbidity, this will be a big driver in health and social
                                                                         care needs. This is particularly expected in West
                                                                         Hampshire and Isle of Wight
                                                                       • Young population structure’s in Southampton and
                                                                         Portsmouth - driven by the student residents health and
                                                                         social care needs would be different to that of an ageing
                                                                         demographic.

                                                                       Ethnicity
                                                                       • 93.8% white population – Census shows population
                                                                         becoming more diverse
                                                                       • Diversity is greatest in the cities and north east
                                                                         Hampshire

                                                                       Life expectancy
                                                                       • Inequalities exist within the ICS with males in the most
                                                                          deprived areas living 3 yrs. less and females living 2.8
                                                                          yrs. less than the most affluent areas of the ICS.

  For the first time in the history of ‘patients registered at a GP’   Vital statistics - births and deaths
 publication, the ICS had a decrease in the number of patient          • Birth data show a steady decrease in the number of live
    registrations in May 2020, and over the next 5 months till            births and general fertility rate.
September 2020 (1,897,555 to 1,894,963). From October 2020,            • Cancer and circulatory disease account for over half of
the number of patient registrations started to rise again, although       the deaths (55%) across the ICS in 2019
 there was another decrease in February 2021 (1,899,425). The
  decrease in registered patients seen in these periods is likely
  due to an increase in deaths, a decrease in immigration, and
  potentially increased list cleansing activities brought about by
        additional activities to contact vulnerable patients.                                                                             Data source: NHS Digital interactive dashboard
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Resident Population Projections, 2021 to 2026
(Hampshire, Southampton, Portsmouth and IOW combined)
                                                        IMPACT OF COVID-19 ON
                                                        POPULATION AGE GROUPS

                                                        Older population/care home
                                                        residents - decreased social
                                                        connectiveness through
                                                        restricted visiting, staff/visitors
                                                        wearing PPE.

                                                        Clinically vulnerable ‘conditioned
                                                        population’ social isolation -
                                                        deliveries of medication,
                                                        shopping – fears of returning to
                                                        ‘normal’ following over 12 months
                                                        of isolating.

                                                        Working population ‘decreased
                                                        social connectiveness’ – remote
                                                        working from home, furloughed
                                                        staff.

                                                        Health and social care staff –
                                                        mental impact/trauma.

                                                        Young working population –
                                                        economic impact - decrease in
                                                        job opportunities

                                                        Children and Young People- ‘lost
                                                        learning generation’, missing out
                                                        on key social events. Vulnerable
                                                        children became a ‘hidden
                                                        population’ – reduced contact
                                                        with educational and health
                                                        professionals.
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
HIOW Population by age, sex and ethnic group
                                                             Ethnicity data are poorly recorded across health care records
                                                             and still heavily reliant on Census 2011 data.

                                                             The population is less diverse than England as a whole with
                                                             93.4% describing themselves as belonging to White ethnic
                                                             groups compared to the national average of 86.7%. The
                                                             diversity of the population is increasing, 6.2% of the
                                                             population described themselves as of an ethnic background
                                                             other than White in 2011, up from 3.1% in the previous
                                                             Census conducted in 2001.

                                                             Overall, the white population of Hampshire and Isle of Wight
                                                             has higher proportions of people in the older age groups.
                                                             Southampton and Portsmouth both have peaks in younger
                                                             age groups in their White ethnic population.

                                                             The Asian and Asian British population is younger than the
                Individuals from Black and Asian
                                                             white population. The same pattern is seen in the Black and
                  ethnicities had a higher risk of
                COVID-19 infection compared to               Black British population.
                        White individuals.
                                                             When compared with the White population, residents
                HIOW Ethnic Minority Groups and              identifying as of Mixed Ethnicity are far younger in age, with
               Covid-19, Rapid Needs Assessment              peaks in residents aged between 0 and 4 years of age.
                (Feb 2021) has been undertaken,
                      soon to be published
                                                     Data source: HIOW Ethnic Minority Groups and Covid-19, Rapid Needs Assessment (Feb 2021)
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Life Expectancy (LE) at birth and inequality                                              Life expectancy at birth is an estimate of the
                                                                                          average number of years a newborn baby would
MALE & FEMALE LE: 2017 to 2019 data   MALE & FEMALE INEQUALITY IN LE: 2017 to 2019 data   survive if he or she experienced the age-specific
                                                                                          mortality rates for that area and time period
                                                                                          throughout his or her life.

                                                                                          Across the ICS local authorities there is:
                                                                                          • 3 years variation in the male LE
                                                                                          • 2.8 years variation in the female LE
                                                                                          • Life expectancy for Portsmouth and
                                                                                             Southampton is significantly lower than the
                                                                                             England average

                                                                                          Inequality in life expectancy at birth is an
                                                                                          estimate of how much life expectancy varies with
                                                                                          deprivation and represents the range in years of life
                                                                                          expectancy across the social gradient from most to
                                                                                          least deprived

                                                                                          A male or female born in the most deprived areas
                                                                                          have lower life expectancy and live in poor health
                                                                                          for longer.

                                                                                          Across the ICS local authorities:
                                                                                          • A boy born today in the most deprived areas will
                                                                                             live on average between 6.3 years to 8.8 years
MALE: LE trend data 2010 to 2019       FEMALE: LE trend data 2010 to 2019                    less compared to a boy born in a least deprived
                                                                                             area.
                                                                                          • A girl born today in the most deprived areas will
                                                                                             live on average between 3.0 years to 6.5 years
                                                                                             less compared to a boy born in a least deprived
                                                                                             area.
                                                                                          • The social gradient is greatest in Southampton.

                                                                                          Trends in LE
                                                                                          LE fluctuates vary slightly over time. Hampshire
                                                                                          has seen a slight increase in both male and female
                                                                                          LE between the recent two time periods, by 0.3
                                                                                          and 0.2 years respectively. Southampton males
                                                                                          LE has also increased by 0.3 years.

                                                                                          The other areas in the ICS have experienced very
                                                                                          small decreases between the recent time periods.
                                                                                          The largest decrease in LE was observed in
                                                                                          Southampton and Portsmouth both decreased by
                                                                                          0.1 years.
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Healthy Life Expectancy (HLE) at birth
MALE: HLE 2016 to 2018 data         FEMALE: HLE 2016 to 2018 data
                                                                          Healthy life expectancy (HLE)
                                                                          is the proportion of life spent in
                                                                          good health. On average
                                                                          females live longer than males
                                                                          however they live in poor health
                                                                          for longer.

                                                                          Isle of Wight residents live
                                                                          longer in poor health than other
                                                                          authorities across HIOW.

                                                                          A male or female born in the
                                                                          most deprived areas has lower
                                                                          life expectancy and lives in poor
                                                                          health for longer.

MALE: HLE trend data 2010 to 2018   FEMALE: HLE trend data 2010 to 2018
                                                                          Trends in HLE
                                                                          The average years males and
                                                                          females spend in good health
                                                                          has fluctuated over time and
                                                                          the trends vary across the
                                                                          areas.

                                                                          Isle of Wight data suggest that
                                                                          since 2012-14 for males, and
                                                                          2014-16 for females, the time
                                                                          spent in good health has
                                                                          decreased and is significantly
                                                                          worse than England. This is
                                                                          also evident for Southampton
                                                                          females who spend the least
                                                                          time in good health compared
                                                                          to the other areas
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Births
 In 2019 there were 19,569
  live births across the ICS

Trend data from 2013 show
 a steady decrease in the
 number of live births and
    general fertility rate*.
  In line with these trends
   there have been fewer
    births in 2020 so far,
 compared with the same
        stage in 2019.

   All areas have a lower
  general fertility rate than
    England and show a
      decline over time

                                                  *General Fertility Rate (GFR) is the number of live births per 1,000 15-44yrs female population

In response to the COVID-19 pandemic, birth registration services in England and Wales were suspended in March 2020. Since June 2020, birth
registrations have restarted where it was safe to do so but the 2020 birth registration data the Office for National Statistics (ONS) has access to is
currently incomplete. However, NHS birth notification data have not been impacted by the coronavirus pandemic unlike birth registrations. The
pandemic will affect birth rates and types of care (home/hospital) and these characteristics are yet to fully manifest.
Hampshire and Isle of Wight ICS Population Health Summary. April 2021 - Hampshire, Southampton and Isle of Wight ...
Deaths
 In 2019 across the four authorities
 there were there were 18,160 deaths
 the main causes of deaths were:

 •   Cancer – 29% of deaths

 •   Diseases of the circulatory
     system - 26% of deaths

 •   Diseases of the respiratory
     system - 12% of deaths
 •   –9% of deaths

 •   Diseases of the nervous system -
     8% of deaths
COVID-19 will impact on the causes of death
data for 2020 and 2021 death registrations.

• In February 2021 COVID-19 was the
  leading cause of death in February 2021 in
  England and Wales

• England recorded the highest excess
  deaths in the spring 2020.

• The number of deaths involving COVID-19
  were higher among men than women

• Caring, leisure and other service
  occupations saw high COVID-19 death
  rates
Data source: NHS Digital interactive dashboard

                                                                                                                                               Optimal management of long
                                                                                                                                              term conditions is essential for
                                                                                                                                              not only the patients own health
                                                                                                                                              and wellbeing but also reduces
                                                                                                                                                the risk of severe COVID-19
                                                                                                                                                           illness.

                                                                                                                                                              ICS Prevalence is higher than national

Risks
•     Smoking remains the biggest preventable killer. But recording of smoking status in medical conditions across the ICS is low. It needs to be more strongly committed to tackling smoking by
      improving identification, offering help and support to quit, especially for smokers admitted to hospital and in specialist mental health services
•     Obesity is a priority for the ICS, - it accounts for the second highest QOF recorded prevalence rate. Targeted weight management support is key especially in obese people with Type 2
      diabetes or hypertension and the challenge of keeping people active and eating healthily is a concern.
Both these risks increase the likelihood of getting severely ill from COVID-19. Obesity prevalence may have increased over the pandemic due to increasing sedentary lifestyles.
Ill health
•     Across the ICS, cancer, cardiovascular disease, diabetes, respiratory disease, mental health and musculoskeletal conditions are increasing and are likely to continue to rise as they are
      linked to lifestyle-related risks and an ageing demographic. The burden of multimorbidity also needs to be better managed, as does palliative care.
•     Pressures are increasing, but there are significant opportunities to focus on - reducing the risk of people becoming ill or having increasing need; making use of the ICS’s assets, focusing on
      prevention particularly working with the middle ages (40-64 years) adult population to promote healthy ageing, to reduce future risk of disease or to support active management of health
      conditions that improve outcomes and help people retain independence for longer.
This is important because conditions such as cardiovascular disease, respiratory disease, metabolic (diabetes), renal and liver conditions, neurological and psychiatric conditions, immune and
haematological conditions and immunosuppressants, cancer conditions and treatments are known to increase the risk of becoming severely ill from COVID-19. And a number of these patients
would have been risk assessed as being clinically extremely vulnerable (CEV) and added to the Shielded Patient List (SPL).
Long Term Conditions – Multi-morbidity (Southampton)

                                                                      By age 80-84 over
                                                                      a third (34%) have
                                                                      at least 6 LTCs

                           By 40-44 over half
                           have at least 1 LTC   By age 60-64 over
                                                 a third (38%) have
                                                 at least 3 LTCs

         89.0% have no
         LTCs at age 0-4
Leading causes and risk factors of disability
Deprivation
                                                                          Large variation of place based deprivation across the ICS

                                                                          Hart ranked least deprived local authority in England. Southampton is the
                                                                          most deprived local authority across the ICS ranked 55th nationally out of
                                                                          317 local authorities (where 1 = most deprived), Portsmouth is ranked 57th.

                                                                          11% (approx. 203,500 residents) of the population live in one of the 20%
                                                                          most deprived areas nationally

                                                                          Across the four authorities;

                                                                          •   a boy born today in the most deprived areas will live on average
                                                                              between 6.3 years to 8.8 years less compared to a boy born in a least
                                                                              deprived area.

                                                                          •   a girl born today in the most deprived areas will live on average
                                                                              between 3.0 years to 6.5 years less compared to a boy born in a least
                                                                              deprived area.

                                                                          The inequality in life expectancy is greatest in Southampton for both males
                                                                          and females

National analysis of wave one found that people who live in deprived areas have higher COVID-19 diagnosis rates and death rates
than those living in less deprived areas. The mortality rates from COVID-19 in the most deprived areas were more than double the
least deprived areas, for both males and females. This is greater than the inequality seen in mortality rates in previous years,
indicating greater inequality in death rates from COVID-19.                            Source: PHE: Disparities in the risk and outcomes from COVID-19
Deprivation - Southampton
                            Focussing in on Southampton, the
                            city has a large variation in
                            deprivation between it’s
                            neighbourhoods

                            Whilst 12% of Southampton’s
                            population live in the 10% most
                            deprived areas nationally, this rises
                            to 18% for under 18s….suggesting
                            deprivation has a disproportionate
                            impact on young people in the city
Deprivation and inequalities among wider determinants
Covid cases and Covid-related mortality

Cases                                             Deaths
These figures are likely to be an underestimate   These figures include deaths where
as1 in 3 cases are asymptomatic and may not       coronavirus (COVID-19) was mentioned on the
be tested for                                     death certificate.
Hampshire and Isle of Wight Priorities
Cardiovascular Disease
• Addressing behavioural risk factors, such as smoking, unhealthy weight and physical inactivity, are important for the prevention
  and treatment of CVD. Providing advice on management of behavioural risk factors is typically recommended before, or
  alongside, any medical interventions.
• During the pandemic there have been excess deaths recorded due to CVD. Several behavioural risk factors have also been
  found to be important in relation to CVD outcomes. Some population groups experience worse outcomes; these can relate to
  socio-economic, behavioural and clinical risk factors. Action on modifiable risk factors provides an opportunity to address the
  health inequalities that may have been exacerbated as a result of the pandemic.
                                                                        Need to ensure better recording of lifestyle and risk factors – potential to link in with
                                                                                    the Health and Wellbeing coaches being recruited by PCN’s

                                                                         Health and Wellbeing Coaches holistically support patients’ wider health and well-
                                                                            being, public health, and contribute to the reduction of health inequalities.

                                                                        CASE STUDY : Expansion of the Hampshire Healthy Hearts Programme

                                                                        Programme vision
                                                                        To develop an operational model for CVD prevention and to support the practical
                                                                        implementation of opportunities in an equitable way.

                                                                        Programme outcomes:
                                                                        •   Support behaviour change and promote CV health by MECC
                                                                        •   Optimise medication
                                                                        •   Extend work on cholesterol across HIOW and adapt risk review model
                                                                        •   Initiate work on blood pressure
                                                                        •   Increase technology use for diagnosis and monitoring
                                                                        •   Adapt programme when PCN CVD DES is published, assisting ‘struggling’
                                                                            practices
Hampshire and Isle of Wight ICS Priorities
•   Diabetes
      o Estimated 123,251 (8.1%) people with diabetes across the STP
      o Significantly higher proportion of minor and major diabetic lower-limb amputation procedures across the ICS compared to England
      o Higher median and adjusted length of stays for diabetic foot disease compared to England
      o Risk of severe COVID-19 and complications

•   Mental health
     o 12.6% recorded with depression, 1.7% new diagnosis. Prevalence has increased significantly year on year since 2012/13
     o 0.89% with serious mental Illness. Prevalence has remained stable over previous 3 reporting years.
     o More than two-thirds of adults in the UK (69%) report feeling somewhat or very worried about the effect COVID-19 is having on their life.
        The most common issues affecting wellbeing are worry about the future (63%), feeling stressed or anxious (56%) and feeling bored (49%).
     o UCL report found symptoms were highest among young people, those with lower household income, people with a diagnosed mental
        illness, people living with children, and people living in urban areas suggesting a possible widening of pre-existing inequalities in mental
        health.

•   Long Term Condition management
      o Multimorbidity is often associated with reduced quality of life, higher mortality, polypharmacy and high treatment burden, higher rates of
        adverse drug events, and much greater health services use (NICE Guidance QS153)
      o Approximately 150,000 residents across the ICS have moderate or severe frailty and are at higher risk of adverse outcomes such as falls,
        disability, admission to hospital, or the need for long-term care.
      o Long COVID care and management will disproportionately fall on Primary Care, including Rehab.

•   Elective/Planned Care activity
      o Pandemic’s full impact on access to elective care still emerging - Recovery, backlog clearance, 18-week waiting times (waiting lists),
          specialities affected Trauma & Orthopaedics, Ophthalmology, Oral surgery, Cancer. Need more radical options as services resume that are
          not derailed by further waves of COVID-19.
Hampshire CC and IOW JSNA Proposed Work Programme
JSNA Core Documents: Late spring to summer 2021
Demographics including protective characteristics, deprivation and life expectancy/health life expectancy
Vital Statistics – mortality and birth data
Hampshire and Isle of Wight COVID-19 Health Impact Assessment: Summer 2021
On the 11th March 2021 the World Health Organisation declared COVID-19 a pandemic, 18 months on this
report aims to look at the impact COVID-19 has had on the residents of Hampshire & IOW.

COVID-19 has exposed, exacerbated, and created new inequalities. People across the UK, and indeed the
world, have been harmed by the virus in very different ways. What has COVID-19 meant for our local
population groups and their future population health and social care needs.
                                                 JSNA Main Chapters: Autumn /Winter 2021 linked to the social
                                                                  determinants of health model
    Detailed JSNA Topic
  reports informed by HIA                                    Healthy People                                       Healthy Living                                              Healthy Places
Children and Young people - the impact           •Mortality: healthy life expectancy, avoidable         •Physiological risk factors: diabetes, overweight and      •Access to green space: public green space,
COVID-19 has had on this generation.             deaths                                                 obesity in adults, hypertension                            private outdoor space
Obesity, smoking, physical activity, substance   •Physical health conditions: dementia,                 •Behavioural risk factors: alcohol misuse, drug            •Local environment: air pollution, transport
misuse, mental health, learning disabilities,    musculoskeletal conditions, respiratory                misuse, smoking, physical activity, healthy eating         noise, neighbourhood noise, road safety, road
diabetes, cancer, heart/cardiac,                 conditions, cardiovascular conditions, cancer,         •Unemployment                                              traffic volume
lung/respiratory, heart, kidney/renal,           kidney disease                                         •Working conditions: job-related training, low pay,        •Access to housing: household overcrowding,
neurological), musculoskeletal,                  •Difficulties in daily life: disability that impacts   workplace safety                                           rough sleeping, housing affordability
gastrointestinal, long-COVID, rehabilitation,    daily activities, difficulty completing activities     •Risk factors for children: infant mortality, children’s   •Access to services: distance to GP services,
maternity/pregnancy, screening &                 of daily living (ADLs), frailty                        social, emotional and mental health, overweight            distance to pharmacies, distance to sports or
immunisation, end of life, air quality &         •Personal well-being: life satisfaction, life          and obesity in children, low birth weight, teenage         leisure facilities
climate change, medicines                        worthwhileness, happiness, anxiety                     pregnancy, child poverty, children in state care           •Crime: personal crime, Mental well-being
management(steroids).                            •Mental health: suicides, depression, self-harm        •CYP education: young people’s education,                  tool, Social isolation
                                                                                                        employment and training, pupil absence, early years
                                                                                                        development, GCSE achievement
            Demography                                                                                  •Protective measures: cancer screening, vaccination
        including protective                                                                            coverage, sexual health

           characteristics
                                                                                 Inequalities: age, ethnicity, religion, learning or physical disability, sex, sexual orientation,
Hampshire and Isle of Wight Priorities: HIA
COVID-19 has exposed, exacerbated, and created health                                      There are a range of actions that are needed if we
and social care needs and new inequalities. People across                                  are to robustly address the inequalities observed
                                                                                           during COVID-19. There is an absolute need to do
the UK, and indeed the world, have been harmed by the                                      more, and focus on the specifics of the pandemic
virus in very different ways. We need to understand how                                   response, but we must also use this opportunity to
the effects of COVID-19 have disproportionally affected                                     have a robust conversation about how we tackle
                                                                                          these inequalities longer term. We cannot continue
different population groups across HIOW (age, gender,                                         to accept these inequalities as inevitable*.
ethnicity, occupations, co-morbidities, deprivation).

To date;
• Over 63,200 residents of Hampshire and 6,700 Isle of             Just as COVID-19 has
                                                                   exacerbated existing
   Wight residents have tested positive for COVID-19.
                                                                    inequalities in other
    o Using ONS estimates this equates to approximately            parts of life, access to
      7,000 people across the Hampshire and IOW with Long            elective treatment
      COVID symptoms.                                                 fell further in the
• Across the 4 trusts 12,249 patients have been admitted           most deprived areas
                                                                      of England during
  to hospital for COVID-19.
                                                                      2020 than in less
    o National analysis suggest patients in hospital with           deprived areas. Far
      COVID-19 experienced elevated rates of metabolic,            more people are now
      cardiovascular, kidney and liver disease compared with         waiting longer for
      patients of similar demographic and clinical profiles over         treatment*.
      the same period
    o The rates of diabetes and cardiovascular disease were
      particularly pronounced among patients.                       *ADPH Guidance: Living Safely with Covid: Moving toward a Strategy for Sustainable Exit from the Pandemic – ADPH
                                                                    Longer waits, missing patients and catching up | The Health Foundation
Further resources

•   HIOW STP JSNA (2019) can be accessed here
•   Southampton Data Observatory can be accessed here
•   Hampshire PCN data packs can be accessed here
•   Hampshire JSNA pages can be accessed here
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