17. Updates on Progress from Last Year s JSNA

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1 17. Updates on Progress from Last Year s JSNA 3. The Health of People in Bromley NHS Health Checks The previous JSNA reported that 35 (0.5%) patients were identified through NHS Health Checks with non-diabetic hyperglycaemia. The numbers were lower than the expected prevalence of pre-diabetes. Further investigation led to the conclusion that there is variation in clinical coding in General Practice. For instance in 2013/14, 58 patients were coded with non-diabetic hyperglycaemia but 581(6.5%) had blood tests indicating they were at high risk of developing diabetes. There is further work to understand underlying issues and streamline practice. There is on-going targeted work to improve the identification and management of people at high risk of developing diabetes with the aim of preventing or delaying progression to diabetes. An in-depth audit is underway investigating follow on management of these patients. The results of the audit will inform further pathway development work. In addition, opportunities for interventions for those identified at risk have been expanded borough wide through the roll out of the successful pilot - Walking Away from Diabetes Sexual Health Given the increase in HIV prevalence rate, two pilot projects of HIV Rapid Point of Care Testing (POCT) in primary care and community settings were set up in 2012 and continued into The evaluation of these pilots found that: - both the use of POCT testing and the settings/venues in which HIV testing was offered (i.e. general practices, pharmacies and in community venues) were acceptable by all demographics. - success or failure of HIV testing in primary care depends on the support and enthusiasm of the clinical staff and education of GPs and practice nurses is needed to expand HIV testing Based on the findings and recommendations of the evaluation, HIV Rapid Testing was commissioned as part of the integrated sexual health services from approved general practices and pharmacies, targeting the demographics of MSM and Black Africans in high prevalence areas such as Crystal Palace and Penge & Anerley. 382

2 In addition, a training programme, SHIP (Sexual Health in Primary Care) was commissioned. It is tailored to develop primary care staff confidence and support them to promote HIV awareness and testing when appropriate. Health Protection A campaign to vaccinate pregnant mothers against Pertussis was implemented in 2012 to reduce the risks to the newborn in response to the national outbreak of pertussis declared following a marked increase in cases. In Bromley, the reported incidence rate of confirmed pertussis was 6.5 per 100,000 in 2012 compared to 0.3 in In 2013, there were 19 reported cases of pertussis (of which 14 were laboratory confirmed) Early indications suggest the programme has been successful in reducing the number of cases in young infants and, as such, immunisation of pregnant women will continue in England until further notice. Modifiable Risk Factors- Physical Activity 24.1% of Bromley residents are achieving less than 30 minutes of exercise per week compared with 27.5% London average and 28.5% England average. Getting this group active is likely to produce the greatest reduction in chronic disease. Work is being undertaken to target physically inactive adults: An independent Sport and Physical Activity Network (Pro-Active Bromley) has been set up to develop and progress physical activity in the borough. The Adult s and Older People subgroup refreshed their annual action plan and, in 2013/14, the network attracted over 244,000 in external funding with an additional in kind partnership contribution of 131,000 (total 375,000). The Children and Young People s subgroup has been re-established and is working on an annual action plan sharing resources and knowledge nationally and locally. A new Exercise Referral Hub was launched in May 2014 to accommodate walking, cycling and older adults activities for those residents with an existing medical condition to prescribe exercise depending on their medical condition and preference. Modifiable Risk Factors Smoking There continues to be a rising prevalence of smoking in Bromley, particularly within routine and manual worker groups where prevalence is 8% higher than the general population in Bromley and continues to increase (prevalence was 383

3 24.3% in , rising to 26.1% in ). A review of the Stop Smoking Service has taken place and a renewed action plan is now in place including a new outreach mobile clinic with a focus on routine and manual worker groups and wards with a high prevalence of smokers within Bromley. 2013/14 saw a focused programme to gain feedback on smoking status over time, recording the number of quitters recorded at 3, 6 and 12 months, measuring the long term effectiveness of Stop Smoking Services. In addition, work continues to be undertaken with the local acute trust with hospital staff being trained to deliver brief advice and make referrals to local stop smoking services. Modifiable Risk Factors Obesity A multifactorial and multiagency approach is needed to decrease the prevalence of obesity. Improvements are needed across prevention, identification and weight management interventions, involving a range of partners. Prevention: A Healthy Weight working group is due to be established to ensure a co-ordinated approach is used to tackle this increasing problem. Partners with the potential to impact on the obesogenic environment include; public health, environment, planning, transport, the food industry, the active environment, acute trusts and those that deliver weight management interventions. Identification: The aim is to improve the recording of BMI and identification of obesity to 70% of GP practice populations. In 2009, 29% of the practice population had a measured BMI. From , 55% of the practice population had a measured BMI. There is still a 15% improvement in recording required. Intervention: Increase the capacity of the weight management service to cover 3% of the obese population. In 2012/13, 2.6% of the population was covered. 6.Children and Young People Educational attainment Narrowed the gap from 2012 between the percentage of pupils who receive Free Schools Meals and those pupils who do not at Key Stage 2 and Key Stage 4 Improved the educational attainment of pupils with a Statement at Key Stage 2 and Key Stage 4 Reduced the average time between a child entering care and moving in with its adoptive family 384

4 Increased the percentage of young people aged 19 who were looked after aged 16 who were in education, employment or training, and those who were in suitable accommodation 7. Older People Increased the number of older people managing their own care through a Direct Payment Reduced the number of older people in placements supported by the London Borough of Bromley in care homes both residential and nursing Opened 2 new Extra Care Housing schemes as an alternative to residential care Undertook a survey of over 1,200 service users known to the London Borough of Bromley to better understand their needs and views 8&9. Learning Disabilities and People with Physical Disabilities & Sensory Impairment Increasing birth rates and advances in modern medicine have resulted in more children with disabilities and complex needs surviving at birth and into later life. Transitional arrangements were identified as an issue in last year s JSNA. Bromley was successful in being awarded pathfinder status for the Government s Special Educational Needs and Disabilities Green Paper in September In recognition of the work already being done on transition the Department of Education had agreed that Bromley s Pathfinder could be designated a Preparing for Adulthood (PfA) pathfinder. As a result, a Transition Workstream had been set up to take forward both the testing of the Green Paper proposals as well as the wider issues identified in the Transition. Therefore, no further work would be undertaken on the Transition Strategy pending further reforms by the government. 385

5 10. Mental Health There has been increased investment in Improving Access to Psychological Therapies (IAPT) to reach 15% of the Bromley population in recognition of the burden of mental health caused by moderate depression and anxiety disorders. A psychiatric liaison team has been set up at the PRUH to enable better assessment and care management of people with mental illness admitted to a general hospital. There has been increased funding and capacity development in the memory clinics in Bromley to assist in the earlier diagnosis of dementia. There has been continued implementation of the Mental Health Strategy for Bromley and a clinical redesign of the Care Pathway for Mental Health is now underway. 11. End of Life Care Bromley Care Partnership delivered by St Christopher s Bromley has been recently commissioned. This service should increase the number of palliative patients supported to die at home if that is their choice. Given the continued increase in the proportion of those dying in care homes, further work needs to be done to analyse how many patients in each nursing home in Bromley are identified as being on an end of life register using gold standard framework criteria- and therefore deliver adequate capacity of services for these homes as well as training for staff. Further work is planned, starting with data collation, to analyse the source of terminal admissions to hospital in order to attempt to understand some of the factors that contribute to high proportions of terminal hospital admissions that present as emergencies at Bromley. 12. Carers and Young Carers Published a revised Strategy for Carers for Undertook a survey of over 400 carers known to the London Borough of Bromley to better understand the needs and views of carers. 386

6 13. Substance Misuse A Drug Death Review Panel was established in 2012 critically looking at drug related deaths to generate understanding and learning towards preventing drug related deaths. In line with national guidance, a Drug and Alcohol Related Deaths review was carried out in 2012, looking at trends from This review is a baseline for driving drugs and alcohol mortality prevention in Bromley and will be produced annually. There has been an in-depth analysis of local data from Bromley Drugs and Alcohol Service to understand service use and needs within Bromley. The findings of the report have informed part of the Substance Misuse section. In order to improve service user access; Supervised Administration of Methadone (SAM) and Needle Exchange (NEX) services have been transferred to participating local pharmacies. Delivery points for NEX & SAM services for substance misuse safer injecting/harm minimisation have been increased from 14 to 34 This new approach will significantly improve access through wider coverage across the borough and also promote harm reduction in the community. In addition, there has been an increase in the number of GP Substance Misuse Shared Care partnership from 5 surgeries to 7. Shared Care partnership improves management of patients with a drug misuse problem. 14. Alcohol A Public Health Needs Assessment is underway to establish trends and possible preventative approaches in the future. Introduced Brief alcohol advice and measurement tool to the Accident and Emergency department at the Princess Royal University Hospital. Introduced Every Contact Counts Brief Advice in alcohol to health improvement services and the audit C brief advice and measurement tool has been introduced in the NHS Health Checks Programme for residents aged years. A social norms study on young people called R U different has taken place in four schools in Bromley. The findings will inform health promotion approaches for young people going forward. 387

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