Agenda item

To receive a presentation by Dr Pat Riordan, Director of Public Health, on the key health inequalities and other issues for Berkshire East, and an update on the plans for producing the updated Joint Strategic Needs Assessment.

Dr. Riordon, the Director of Public Health, NHS Berkshire East gave a presentation on key health inequalities and other issues for Berkshire east, and an update on the plans for producing the updated Joint Strategic Needs Assessment.

NHS Berkshire East modelling had shown that over the next 5-10 years there would be a significant increase in older people in the population, particularly in Bracknell Forest, which would result in increased pressure on health and social care services and carers. There would be an increase in long term health conditions, mental health problems and a significant rise in dementia.

A new national measure ‘all age all cause mortality’ had been introduced to show how PCTs and LAs were tackling inequalities. Evidence had shown that the most effective way to achieve a 1 year increase in life expectancy and to narrow the gap between the worst and best wards was by targeting male cardiovascular disease and female Chronic Obstructive Pulmonary Disease (COPD). Health inequalities indicators such as mortality rate, life expectancy and preventable years of life lost needed to be looked at to narrow the gap between wards.

In comparison to the national average the health profiles for Berkshire east could be summarised as:

• Bracknell Forest – young but most rapidly ageing population within five years, increase in long term conditions such as stroke, COPD, heart failure, cancers, dementia, hip fractures.
• Royal Borough of Windsor and Maidenhead – ageing population, long term conditions, cancers, hip fractures, dementia, violent crime
• Slough – early deaths from heart disease and stroke, children in poverty, violent crime, drug misuse, physically inactive children and adults, tooth decay, new cases of diabetes, tuberculosis

The Committee noted that only 1.5% of residents in Slough were classed as in the best quintile for deprivation. The majority of residents, 55.7%, were in the bottom 2 deprivation quintiles, this did not reflect the average for South Central SHA or England, and would be addressed by NHS Berkshire East. Surprisingly, the average life expectancy for females in Slough’s most deprived areas was higher than elsewhere.

Professor Sir Michael Marmott chaired an independent review to propose the most effective evidence based strategies for reducing health inequalities and to address the social derminants of health inequalities. The review concluded that people with a higher socio economic position had greater life chances and opportunities to live a full and flourishing life, they also had better health. The report resulted in 6 policy objectives to reduce health inequalities:

• Give every child the best start in life
• Enable all ages to maximise their capabilities and have control over their lives
• Fair employment and good work for all
• A healthy standard of living for all.  Create healthy and sustainable places and communities
• Strengthen the role and impact of ill health prevention.

The focus of the Berkshire East Joint Strategic Needs Assessment for 2010/11 was health inequalities, with methodology developed around the 6 strategic policy objectives of the Marmott report. The JSNA was due to be finalised in October 2010. The JSNA would look at life opportunities across the board and not just focus on health.

Arising from the subsequent Committee discussion and questions the following points were noted:

• The data used to model the health profile for the next 5- 10 years was as accurate as the PCT could possibly gauge it to be.
• The results of the Marmott report were not likely to be of great surprise to the majority of people, with the concept of deprived areas being home to less healthy residents having been raised in the past.
• If health inequalities were the result of socio economic problems then the problem was not for the health service to resolve by itself, but would involve cultural change across the country. NHS Money alone would not solve the problem.
• Violent crime was not confined to the lowest socio-economic groups
• The NHS would not be able to deliver change by itself but would need cross cutting support as it would be a partnership agenda addressing all aspects of life opportunities.
• Resources to address the socio economic problems raised by the report were likely to be difficult to raise by partners due to the current economic climate.
• The involvement of partners with the JSNA would be to provide a central database about the society across East Berkshire which could be used by agencies to decide which actions to tackle.