Health Inequalities
CCG Governing Board
Presentation 14/11/2019
Dr Rashmi Sawhney
Clinical Director - Health
Inequalities
Index
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• Context – What are Health Inequalities • Buckinghamshire • Patient stories • Portfolio work • Gaps & Challenges • Results so far this year • Involvement of Patients • Next Steps
What are Health Inequalities?
Health inequalities are avoidable differences in health
across the population, and between different groups
within society.
Health inequalities arise because of the conditions in
which we are born, grow, live, work and age.
These conditions influence our opportunities for good
health, and how we think, feel and act, and this shapes
our mental health, physical health and wellbeing.
Action on health inequalities requires improving the lives
of those with the worst health outcomes, fastest.
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Dimensions Of Health Inequalities
Variables
Socio-economic/ Deprivation e.g., low income, unemployed/
deprived areas
Equality and diversity e.g.
age, sex, race
Inclusion health e.g. homeless
people; Gypsy, Roma and Travellers;
Sex Workers; vulnerable migrants
Geography e.g. urban,
rural.
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IMD 2019 for PCN, GP Practices and Bucks CCG
Variation in Life expectancy in Buckinghamshire Population
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Life Expectancy in Buckinghamshire Women 84.8 Men 81.8 Life Expectancy in England Women 83.1 Men 79.6
Babies born in poorer wards have a shorter
life span than those born in affluent wards
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Babies born in poorer wards have a shorter
life span than those born in affluent wards
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PCNs with significantly lower life expectancy at birth for persons are BMW, Maple, Dashwood and South Bucks
Gap for 5+ LTCs between DQ1 & DQ5
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People from most deprived areas have higher emergency admissions for all causes BMW, Dashwood, Maple
and South Bucks are significantly higher (compared to Bucks and England) for emergency all-cause admissions rates. Cygnet is similar to Bucks and England for emergency all-cause admissions rates. All other PCNs are lower than England and Bucks.
Inequalities in Mental Health
Mental health admissions – working age
Health Inequalities in Buckinghamshire
Inequalities in Mental Health
Mental health admissions – older age
Health Inequalities in Buckinghamshire
Key Facts for Buckinghamshire
• Most deprived have 60% higher prevalence of
long term conditions than the least deprived
• Multi-morbidity is more common & develops 10-
15 years earlier in deprived areas
• Key groups with poorer health are: Those with
mental illness, learning disabilities and those
from BAME ethnicity
In our most deprived areas: • Higher prevalence of low birthweight, infant
mortality
• Lower levels of children developing well
• Higher levels of children in need and children
looked after
• Higher prevalence of long term conditions and
multi-morbidity
• Lower uptake of screening
• Higher emergency admissions for all causes :
adult mental health, self harm alcohol misuse,
heart disease, stroke, respiratory , falls
• Higher early death rates
What’s fair?
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Long Term Plan Vision
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Maternity -continuity of midwifery care
-smoking cessation
SMI Physical health checks : Target: 60%;
LD & Autism -Strengthening health checks - accelerate LeDeR initiative
Rough
Sleepers
-Specialist mental health support
Carers -Carer friendly GP practices -Carers passports -Advanced care planning - Young Carers Top Tips to GPs adopted
Gambling Increased accessibility to specialist clinics for serious gamblers
Partnerships -
3rd Sector
Encourage innovation and new ways of working to address inequalities
Workforce -wellbeing: to include mental health support
Bucks CCG’s Priorities - the next 5 years
• Smoking: reduction overall, with a focus on the most
deprived populations
• Mental health for young people: increasing mental
health support teams in schools in deprived areas
• Care & support planning: improving the gap in patient
experience between the Black and minority ethnic
(BAME) & white communities
• Improving the detection of hypertension and it’s
management in our deprived and BAME communities
Patient stories
- Child with asthma living in a flat with lots of mould getting
recurrent exacerbations of asthma and attending A&E
Patient stories
- Homeless person with multiple issues: social, physical and
mental health, drug and alcohol issues, chaotic access to
services and poor outcomes: Pilots locally have been useful
for support
Patient stories
- Elderly couple living at home. Both frail . Wife the sole carer
of husband who has dementia. Lack of family support and
struggling to cope
Patient stories
- 80 year old Asian lady with memory problems: Case brought
up issues with diagnosis, cultural barriers to accepting a
diagnosis of dementia and a review of services available: this
led to the project : Raising awareness of dementia in BAME
communities
Examples of Portfolio Initiatives
Urgent Care
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• Falls and frailty – Elderly patients – paramedic to
continue- 5 days a week for 22 weeks based on demand
• Mental Health – SCAS and OHFT to get people to the
Whiteleaf Centre rather than A&E
Pregnancy, smoking and low birth weight
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% of low birth weight (<2500g), all births, by
deprivation quintile (DQ1 to DQ5*) in Bucks, 2014
Smoking and Health Inequalities
Live Well Stay Well provides universal support to all smokers but targets their work to groups with higher rates of smoking (for example: routine and manual workers, areas of higher deprivation and people with a mental health condition)
There is a smoking in pregnancy task and finish group, with BHT, working to ensure that pregnant women are encouraged to access stop smoking support and quit
Smoking is the single biggest cause of the difference in mortality rates between the least and most deprived populations. It accounts more than half of the difference in risk of premature death between social classes.
Children Hubs
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Gaps and Challenges
• Ethnicity recording
• Carer recording
• Closing the prevalence gaps
• Improving uptake of screening
• Cancer diagnosis
• Smoking
• Improving uptake of immunisation
• prevention, early diagnosis and management of long term
conditions
• Ownership of Gambling – PHE evidence based review
expected Dec 2019
• Development of key partners for the inequalities advisory
group meetings
• Workforce development of Mental Health support
• Resources to address the issues
Results so far this year
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84.21% 80.97% 80.58% 79.03% 76.37% 75.60% 75.48% 72.97% 70.35% 69.79% 62.90%
56.00%
89.21% 85.97% 85.58% 84.03% 81.37% 80.60% 80.48% 77.97% 75.35% 74.79% 67.90%
61.00%
0%
20%
40%
60%
80%
100%
% Patients with Ethnicity Coding Target: 5% Increase
Involvement of Patients
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• Review and presentation at the Patient Participation Groups event
• Working closely with Healthwatch Bucks in terms of achievement and the way forward
• Working with local community and voluntary organisations
• Presentation at Governing Body (held in public)
Next Steps
• Link with the PCNs:
-share the ICP priorities
-understand PCNs priorities
-develop joined up plans with the PCNs to address
inequalities
• Link with PPGs, and the voluntary sector to support the
PCNs to address inequalities
• Inequalities Steering Group: Partner organisations coming
together: agree ICP inequalities priorities
• Link with the BOB/ICS partners for shared understanding
and learning
• Support for the Rough Sleeper/Homeless – Expression of
Interest and follow on work
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How can we work together to close the inequalities gap?
Thanks to Public Health, Consultants Louise Hurst and Tiffany Burch for their contribution.