Commentary for based on JSNA Scorecards, January 2013 This commentary is to be read alongside the JSNA scorecards. Scorecards and commentaries are available at both local authority and NHS geographies and can be downloaded from www.eastsussexjsna.org.uk. Scorecards contain data down to ward and GP practice level, and commentaries are available for districts and boroughs, and NHS localities and CCGs. Here the term significance refers to statistical significance at the 95% or 99.8% confidence level. Glossary IMD Index of Multiple Deprivation, 2010 CCG Clinical Commissioning Group HWLH CCG High Weald Lewes Havens Clinical Commissioning Group EHS CCG Eastbourne, Hailsham and Seaford Clinical Commissioning Group H&R CCG Hastings and Rother Clinical Commissioning Group County consists of 2 boroughs (Eastbourne and Hastings) and 3 districts (Lewes, Rother and Wealden). There are 3 CCGs in (HWLH CCG, EHS CGG and H&R CCG). Map of local authority and CCG boundaries in 1
Map of Districts and Boroughs Map of CCGs POPULATION Age There are an estimated 518,599 residents in (i.e. with an postcode) and 531,602 persons registered with East Sussex GP practices (irrespective of whether an resident or not). Wealden is the largest district/borough (144,125 persons) and Hastings is the smallest (87,582 persons). From an NHS perspective, EHS CCG is the largest CCG in (184,290 patients) and HWLH CCG is the smallest (164,024 patients). wards vary in size from 2,013 residents in Kingston to 12,657 in Devonshire. GP practice size ranges from 1,132 for Hastings Medical Practice & Walk In (as at 01/10/2011) to 17,058 for Seaford Medical Practice. About 1 in 4 (24%) persons in are aged 65 years and over and 4% are aged 85 years and over. Within the county the oldest age profiles are generally in the Bexhill, Seaford and Polegate areas. For every working age person in there are 0.70 dependents (known as the dependency ratio: number of dependents [persons aged under 16 years and aged 65 years and over] to working age people [persons aged 16-64 years]). The dependency ratio ranges from 0.48 in Devonshire to 1.35 in Polegate South. The population of is estimated to increase by 3% by 2015 and 5% by 2017. By 2017 there are estimated to be 21,000 more persons aged 65 years and over. Ethnicity It is estimated that 6.4% of the population of are of non- White ethnicity. In 11% of pupils are of non-white British ethnicity. Within the county Eastbourne (16%) has the highest percentage. Most of the highest rates of pupils with English as an additional language are found in areas of Eastbourne. 2
Births There are 66 live births per 1,000 women aged 15-44 years (5,483 births in 2011/12). The rates of live births for women aged 15-19 years are highest in West Hastings and St Leonards areas. WIDER DETERMINANTS OF HEALTH AND WELLBEING Indices of deprivation Hastings is the most deprived district/borough in with an IMD score of 34.49. Wealden is the least deprived and has an IMD score of 11.81. The majority of the 10% most deprived wards are in Hastings, with Central St Leonards (58.14) the most deprived ward in. From an NHS perspective, H&R CCG is the most deprived CCG in and HWLH CCG is the least. Economy and income Within the most income deprived and employment deprived areas are in Hastings. In 14% of older people are affected by income deprivation. The percentage is highest in West Hastings and St Leonards areas. In 32% of households are on low income (less than 60% of national median income). At ward level percentages range from 15% for Uckfield Ridgewood and Crowborough St. Johns, to 46% in Hailsham East. The more rural areas of Rother are estimated to have some of the highest percentages of households living in fuel poverty in East Sussex. Hastings (30%) has the highest percentage of children living in poverty of all the districts/boroughs in. Almost half (47%) of children in Central St Leonards live in poverty, the highest percentage of all wards. H&R CCG has 26% of children living in poverty, EHS CCG 19% and HWLH CCG 12%. In 15% of pupils are eligible for free school meals. Rates are highest in Hastings and lowest in Wealden. About 1 in 10 (12%) of working age people are claiming out-of-work benefits. In H&R CCG it is 16%, EHS CCG 12% and HWLH CCG 7%. Hastings has the highest percentages of working age persons claiming income support, incapacity benefit or severe disablement allowance, and working age lone parents claiming income support, of all districts/boroughs in. 3
Transport In 35% of primary school children and 15% of secondary school children travel to school by car/van or taxi. Education 57% of pupils score at least 78 points overall, with at least 6 in the core areas, in Early Years Foundation Stage. At ward level, there is a 53 percentage point gap between the ward with the lowest percentage of pupils at Key Stage 4 achieving 5 or more GCSE passes at A*-C including Maths and English, and the ward with the highest (Castle [35%] and Alfriston [88%]). In there is a 31 percentage point gap between pupils eligible for free school meals and their peers achieving at least 5 A*-C grades or equivalent including English and Maths at Key Stage 4. Crime and disorder The rate of total recorded crimes is 53 per 1,000 population. Castle ward (289 per 1,000) has the highest rate of all wards in. Eastbourne and Hastings have significantly higher rates than East Sussex for recorded violent crimes and recorded drug offences, and Rother, Lewes and Wealden have significantly lower rates. The rate of A&E attendances between 8pm and 4am due to assault for persons aged 15-59 years is highest for EHS CCG (31 per 10,000 population). H&R CCG has a rate of 29 per 10,000 and HWLH CCG has a rate of 17 per 10,000 population. At a small area level, the highest rates tend to be found in the most deprived areas. LIFESTYLES AND HEALTH IMPROVEMENT Child and maternal health 80% of mothers initiate breastfeeding. All districts/boroughs have wards where the percentage is significantly lower than for. In 50% of babies were breastfed at 6-8 weeks. The percentage is significantly lower than this in West Hastings (39%), Bexhill (39%) and the Havens areas (40%). Obesity About 1 in 5 (21%) reception year children are overweight or obese and 1 in 3 (31%) year 6 children are overweight or obese. In Rother 23% of adults are estimated to be obese (lowest district/borough value) and in Hastings 27% of adults are estimated to be obese (highest district/borough value). Smoking The estimated prevalence of smoking for persons aged 18 years and over ranges from 14% in Rother to 27% in Hastings. 4
West Hastings (27%) and East Hastings (22%) have a significantly higher percentage of mothers smoking at the time of delivery than East Sussex (16%). At ward level Hailsham East has the highest percentage, with around half of mothers (52%) smoking at the time of delivery. In 16% of mothers and 28% of fathers are current smokers at the time of their baby s 6-8 week check. All districts/boroughs except Lewes have wards with a significantly higher percentage than. Hailsham East has the highest percentage of all wards for both mothers (44%) and fathers (56%) being current smokers at the time of their baby s 6-8 week check. The age-standardised rate of smoking related deaths amongst people aged 35 years and over ranges from 154 per 100,000 population in Lewes to 284 per 100,000 population in Hastings. Alcohol and drugs Around 26% of adults are estimated to be engaging in increasing or higher risk drinking (of those who drink alcohol). About 1 in 5 (21%) adults in Hastings are estimated to binge drink. The age-standardised rate of alcohol-related hospital admissions ranges from 1,416 per 100,000 population in Wealden to 2,190 per 100,000 in Hastings. In there are, on average, 31 alcohol-specific deaths per year for males and 14 alcohol-specific deaths per year for females. The highest rates of young people aged 0-18 years in drug or alcohol treatment are found in the West Hastings, St Leonards and Bexhill areas. The rates of adults in drug or alcohol treatment are highest in the most deprived areas and lowest in the least deprived areas. Screening and vaccination 95% of children are receiving childhood immunisations by age 1 (DTaP/IPV/Hib). Uptake is significantly lower than this in the Lewes area (92%). 85% of children in are immunised for MMR by age 5. GP practices with significantly lower uptake than are found in Lewes, the rural areas of Rother and the northern part of Wealden. 72% of persons aged 65 years and over were vaccinated against seasonal flu, and 71% have ever received a pneumococcal vaccination. 81% of eligible women aged 25-49 years and 77% of eligible women aged 50-64 years were screened through the NHS cervical screening programme. 76% of eligible women are screened through the NHS breast screening programme. St Leonards (70%) has a significantly lower uptake than and Lewes (83%) has a significantly higher uptake. 5
HEALTH AND WELLBEING STATUS Life expectancy and mortality There is a gap in life expectancy at birth of 12.9 years at ward level and 12.7 years at GP practice level. The lowest life expectancies at birth are for Baird ward (74.9) and Shankill Surgery (76.7). The highest life expectancies at birth are for Plumpton, Streat et al ward (87.8) and Woodhill Surgery (89.4). Life expectancy at age 65 is an additional 20.7 years. It is lowest in the St Leonards area and highest in the Lewes area. Compared to, all-age all-cause mortality is highest, and significantly higher than expected, in the Bexhill and Seaford areas. H&R CCG has significantly (15%) higher premature mortality than expected compared to. EHS CCG has similar to expected premature mortality and HWLH CCG has significantly lower premature mortality than expected compared to. Mortality from causes considered preventable (age-standardised) is 17% higher than expected compared to in the St Leonards area. Mental health The GP reported incidence of depression for persons aged 18 years and over is highest in Newhaven and Polegate areas. Emergency hospital admissions due to mental and behavioural disorders are significantly higher than expected compared to East Sussex in the West Hastings, St Leonards, Bexhill and the Havens areas. These areas, as well as East Hastings, also have significantly higher than expected emergency hospital admissions for persons with psychosis when compared to. The Havens area, West Hastings and St Leonards have significantly higher than expected emergency admissions (age-standardised) relating to self-harm compared to. There are 4,085 patients on dementia registers in (in H&R CCG there are 1,547, in EHS CCG there are 1,637 and in HWLH CCG there are 901). Age-standardised emergency hospital admission ratios for persons with dementia are highest in Bexhill and Seaford. The Child and Adolescent Mental Health Services (CAMHS) caseload rate is 18 per 1,000 population aged under 18 years. The rates of working age people claiming employment and support allowance due to mental health problems and claiming incapacity benefits due to mental health problems are highest in the more deprived areas. Cardiovascular health, cancers and respiratory health The highest GP reported prevalences of circulatory diseases tend to be in those areas with the oldest age profiles (Bexhill and Seaford). There are 21,331 patients on CHD registers in. This is 66% of the expected number. 6
Compared to, H&R CCG has significantly higher than expected elective admissions for CHD. EHS CCG has significantly higher than expected emergency admissions for CHD and HWLH CCG has significantly lower than expected emergency and elective CHD admissions (all age-standardised). Bexhill has significantly higher than expected emergency hospital admissions and mortality from stroke compared to. Seaford has significantly higher than expected mortality from stroke compared to. Hastings has significantly (36%) higher premature mortality from circulatory diseases than expected compared to. The 3 wards with the highest premature mortality (age-standardised) due to cancer are all in Hastings (Hollington, West St Leonards and Central St Leonards). The highest GP reported prevalences of asthma are in the Hailsham and Polegate areas. The practice with the highest age-standardised emergency hospital admissions ratio due to asthma is in West Hastings and the two with the next highest ratios are in Hailsham. There are 10,287 patients on COPD registers in. This is 64% of the expected number. Emergency admissions (age-standardised) due to COPD are significantly higher than expected compared to for H&R CCG. HWLH CCG has significantly fewer emergency COPD admissions than expected. Mortality from COPD (age-standardised) is significantly higher than expected compared to in the Bexhill and Hailsham areas. All district/boroughs have wards with significantly higher than expected emergency hospital admissions (age-standardised) due to pneumonia compared to. Almost half of the wards in Hastings have significantly higher admission ratios. Compared to, Eastbourne and Hastings have significantly higher than expected premature mortality due to respiratory diseases. Other key health issues There are 24,620 patients aged 17 years and over on diabetes registers. The rates of GP reported diabetes for persons aged 17 years and over are highest in Peacehaven followed by the Polegate area. Compared to, premature mortality from chronic liver disease is significantly (74%) higher than expected in Hastings and significantly (40%) lower than expected in Wealden. Sexual Health The rate of teenage conceptions for district/boroughs ranges from 24 per 1,000 females aged 15-17 years in Wealden to 51 per 1,000 for Hastings. 7
The incidence of Chlamydia for persons aged 15-24 years, and the incidence of acute STIs for all ages, are highest in Eastbourne and Hastings. Accidents and injuries Hastings and St Leonards areas have the highest rates of emergency hospital admissions due to unintentional and deliberate injuries for children and young people. The areas in the county with the highest rates of emergency hospital admissions (age standardised) for persons aged 65 years and over due to a fractured femur or due to a fall are Bexhill, Seaford, Hailsham and some areas in Eastbourne. Wealden (83 per 100,000 population) has a significantly higher rate than (62 per 100,000) of people killed or seriously injured on roads SERVICE UTILISATION Social care adults There are 31 referrals to adult social care per 1,000 population aged 18 years and over with significantly higher rates in Bexhill. There are 28 per 1,000 population aged 18 years and over currently supported to live independently through social services. The majority of wards with the highest rates of adults with mental health needs supported to live independently through social services are in Hastings. The rate of carers known to social care is 11 per 1,000 population. Bexhill and St Leonards areas have the highest rates of persons aged 18 years and over supported to live in permanent council-supported residential or nursing care. Social care children There are 149 referrals to children s social care per 1,000 population aged under 18 years. Referral rates are highest in the more deprived areas. Rates of looked after children and children on a child protection plan are highest in the West Hastings and St Leonards areas. Health care 46% of patients responded to the GP Satisfaction Survey. 91% of patients say their experience of their GP surgery was fairly or very good. 74% of patients are generally able to see or speak to their preferred doctor. 68% of residents aged 0-18 years access NHS general dental services. For persons aged 18-64 years it is 52% and for persons aged 65 years and over it is 47%. 8
In 2011/12 there were 225,375 first outpatient attendances for East Sussex residents. Compared to, age-standardised first outpatient attendances are significantly (5%) higher than expected for HWLH CCG, are similar to expected for EHS CCG and are significantly (4%) lower than expected for H&R CCG. patients did not attend 7% of outpatient appointments. At a small area level the percentages of patients not attending outpatient appointments tend to be highest in the most deprived areas. In 2011/12 there were 128,835 A&E attendances for residents. The rate of A&E attendances for persons aged 0-4 years is highest in the Havens areas; for persons aged 5-19 years the attendance rates are highest in West Hastings and St Leonards and for persons aged 65 years and over and 85 years and over rates are highest in the Havens areas. There are around 79,000 elective and 51,000 emergency hospital admissions per year for residents. 9