“Improving Health Together”: Public Health Annual Report 2006 Dr Andrew Clark, Rachel Johns, Dr Phil Kirby, Dr Jeffrie Strang North Yorkshire and York PCT North Yorkshire Overview and Scrutiny Committee 6 th July 2007

Content of Report 1.Introduction 2.National Public Health Targets 3.Health Profile (by LA area) 4.The Healthcare Agenda 5.Health Protection Update: TB 6.Celebrating Success Appendices I - IV

Chapter 2: National Public Health Targets - local progress towards national targets…..

Life expectancy at birth: & Source: NCHOD

Smoking during pregnancy 2004/05: % mothers known to smoke at delivery

Breastfeeding initiation rate 2004/05

Progress to 2010 target: cancer mortality under 75 years in North Yorkshire and York Source: Compendium of Clinical and Health Indicators

Progress to 2010 target: circulatory mortality under 75 years in North Yorkshire and York Source: Compendium of Clinical and Health Indicators

Smoking prevalence (16+)

Teenage conceptions under 18 years in North Yorkshire and York

Rates of newly diagnosed chlamydia cases in former NEYNL Strategic Health Authority area Source: Health Protection Agency 2007

Recommendations - 1 Commission services that reduce inequalities. Deliver high impact actions to reduce smoking before, during and after pregnancy. Increase breastfeeding initiation and duration through commissioning and provision. Refine cancer pathways, with a particular focus on diagnostics and direct referral. Improve systems to identify, advise and treat those with or at risk of hypertension, high cholesterol and diabetes.

Recommendations - 2 Commission an effective range of providers of smoking cessation services. Work with partners to deliver a comprehensive tobacco control approach. Support teenage pregnancy action with a focus on York. Continue to develop the commissioning of sexual health services to achieve 48 hour access. Fully roll-out chlamydia screening. Ensure effective signposting and training for frontline staff and to support self-care.

Chapter 3: Health Profile Based on Health Profiles by LA area (see Appendix II)….

Proportion of adults aged 16 and over who are obese (BMI over 30),

Scarborough CD Harrogate CD Richmondshire CD York UA Hambleton CD Craven CD Ryedale CD Selby CD ENGLAND YORKSHIRE AND THE HUMBER Rate per 100,000 Source: Health Episode Statistics Number of alcohol-related admissions per 100,000 (directly age standardised rate),

Number of resident persons aged in contact with drug treatment services 2004/05

People killed or seriously injured per 100 million vehicle kilometres, 2003/04 (ONS “Coastal and Countryside” LAs)

People killed or seriously injured per 100 million vehicle kilometres, 2003/04 (ONS “Prospering Smaller Towns” LAs)

Recommendations Deliver health related LAA targets. Commission a tiered model for preventing, managing and treating overweight and obesity. Improve data collection for childhood obesity. Work with partners to increase physical activity. Review current provision for screening, brief interventions and alcohol treatment services. Continue to increase numbers in drug treatment services. Work with partners to reduce road injuries. Work with partners to support older people living at home.

Chapter 4: The Health Care Agenda Commissioning for health improvement and a balanced health economy in North Yorkshire and York….

Average of last 4 quarters Trend in outpatient attendances (first appointment, after GP referral) Quarter 4 of 2003/04 - Quarter 2 of 2006/07 Source: Nationwide Clearing Service Outpatient Minimum Dataset

PCT GP referral rates, all specialities, 2005

Trend in consultant to consultant referrals in the North Yorkshire and York PCT population, Quarter 4 of 2003/04 – Quarter 2 of 2006/07 Average of last 4 quarters Source: Nationwide Clearing Service Outpatient Referrals

Trend in follow-up out-patient attendances in the North Yorkshire and York PCT population, Quarter 4 of 2003/04 – Quarter 2 of 2006/07 Average of last 4 quarters Source: Nationwide Clearing Service Outpatient Minimum Dataset

Trend in North Yorkshire and York PCT statin prescribing: costs and items prescribed, December 2001 – November 2006 Source: Electronic Prescribing Analysis and CosT (ePACT)

Numbers of people registered with common conditions in North Yorkshire and York Asthma46,237 CHD32,680 COPD10,911 Diabetes24,346 Hypertension100,253 Stroke15,486

Recommendations - 1 Commissioning for health improvement should initially give most attention to the following: conditions that are the biggest causes of emergency admissions. These are coronary heart disease and stroke, respiratory disease and falls conditions that are the biggest causes for out-patient referral and/or follow up. These are musculo-skeletal problems, dermatology, ophthalmology and ENT highest risk populations should be targeted for local care pathway development. This encompasses the population aged 60 plus years, and/or those communities with the largest prevalence of poor health, highest rates of emergency admissions and out-patient referrals/follow-ups

Recommendations - 2 the same highest risk populations should be targeted for lifestyle interventions to reduce smoking prevalence, increase physical activity and reduce the prevalence of obesity subsequently, such work should be undertaken in populations at lower risk of poor health commissioning strategies should be explicitly based on needs analysis and evidence-based practice.

Chapter 5: Health Protection Unit Update Tuberculosis – trends, recent developments and future challenges…

North Yorkshire: “Mycobacterium Tuberculosis Complex”: rates Source: North Yorkshire HPU TB database

Mycobacterium Tuberculosis Complex: cases in North Yorkshire, by country of birth Source: North Yorkshire HPU TB database

New Entrants into North Yorkshire: by month and year of notification Source: North Yorkshire HPU New Entrant screening database

Recommendations North Yorkshire and York PCT should: develop a strategy for TB control develop existing TB services work to achieve the performance criteria identified in CMO’s TB Action Plan explore the option of discrete commissioning of TB services.

“Improving Health Together”: Public Health Annual Report 2006 Dr Andrew Clark, Rachel Johns, Dr Phil Kirby, Dr Jeffrie Strang North Yorkshire and York PCT North Yorkshire Overview and Scrutiny Committee 6th July 2007