Cambridgeshire and Peterborough Joint Strategic Needs Assessment 2018 – what does it tell us? Dr Liz Robin Director of Public Health February 2018

Cambridgeshire and Peterborough © Crown copyright and database rights 2017 Ordnance Survey 100023205 (JSNA CDS Figure 1)

Population growth

Overall, we have a growing resident population Cambridgeshire and Peterborough retrospective population growth mid-2011 to mid-2015 (absolute numbers) – NOTE: axis does not start at 0 Source: Cambridgeshire County Council Research Group

Growth is occurring in both Cambridgeshire and Peterborough Retrospective population growth in absolute numbers mid-2011 to mid-2015 NOTE: axis starts at 0 Slides 4 and 5 are 2 ways of showing C&P *which would you like? Source: Cambridgeshire County Council Research Group mid-2015 based population estimates (JSNA CDS figure 3)

The CCG’s GP registered population is also growing Cambridgeshire and Peterborough CCG registered population, 2011-2017* NOTE: axis does not start at 0 *Data from April each year Source: Serco and NHS Digital (JSNA CDS figure 5)

With different drivers at different times and in different areas Cambridgeshire and Peterborough– ONS mid-2015 to ONS mid-2016 population estimates – absolute and proportional contribution of each component of population change Source: Office for National Statistics population estimates mid-2016 (JSNA CDS figure 16)

People come here from many parts of the world but this varies by area National insurance registrations to adult overseas nationals entering Cambridgeshire and Peterborough - registration's year to March 2017 Note1*: Cells in this table have been randomly adjusted by DWP to avoid the release of confidential data and may not aggregate to the total registrations. Note2: EU15 member countries = EU members prior to the accession of 10 candidate countries on 1/5/2004; EU8 = the 10 accession countries; EU2 = those countries joining from 2007 (Bulgaria and Romania) Source: Department for Work and Pensions (DWP) (JSNA CDS table 14)

We have several new development sites Source: Cambridgeshire County Council Business Intelligence – Research Group (JSNA CDS figure 13)

We expect continued growth but forecasts from different sources vary Cambridgeshire and Peterborough - absolute long term (20 year) population change, 2016 to 2036 (all ages) Source: ONS 2014-based Subnational population projections and CCCRG mid-2015 based population forecasts (JSNA CDS figure 8)

The rise in the older population is clear Comparison of proportional change in CCC Research Group mid-2015 based population forecasts and ONS 2014 based population projections to 2026 by age group for Cambridgeshire and Peterborough to 2026 Source: ONS 2014-based Subnational population projections and Cambridgeshire County Council Research Group mid-2015 based population forecasts (JSNA CDS figure 11)

Determinants of health

Several wider ‘determinants’ affect our health

Healthy life expectancy is closely linked with socio-economic deprivation (e.g. England, males) Source: Public Health England

Healthy life expectancy varies between our two areas Healthy life expectancy at birth, Cambridgeshire and Peterborough, 2013-15 Note: Data for Cambridgeshire and Peterborough combined is not available Source: Public Health England Public Health Outcomes Framework indicator 0.1i (JSNA CDS Table 74)

Socio-economic deprivation varies across the area Indices of Multiple Deprivation, 2015 (IMD2015) - percentage of lower super outputs areas (LSOAs) in national IMD2015 deciles in Cambridgeshire and Peterborough and Cambridgeshire Districts Source: Index of Multiple Deprivation 2015, Department for Communities & Local Government (DCLG) (JSNA CDS figure 20)

Cambridgeshire – deprivation by national groupings Source: DCLG from PHE Cambridgeshire Health Profile 2017 (Crown Copyright 2017) (JSNA CDS figure 21)

Peterborough – deprivation by national groupings Source: DCLG from PHE Cambridgeshire Health Profile 2017 (Crown Copyright 2017) (JSNA CDS fig 22)

Education, skills and training are a particular concern Indices of Multiple Deprivation, 2015 – education, skills and training domain - percentage of lower super output areas (LSOAs) in national IMD deciles by district in Cambridgeshire and Peterborough and Cambridgeshire Districts Source: Index of Multiple Deprivation 2015, Department for Communities & Local Government (DCLG) (JSNA CDS figure 30)

..and are closely linked to health Standardised limiting illness rates in 2001 at ages 16-71, by education level recorded in 2001 Source: ONS Longitudinal Study

Educational inequalities occur from an early age - Cambridgeshire Cambridgeshire compared to similar local authorities (CIPFA neighbours) Source: Public Health England, Fingertips (PHOF) Tool

Educational inequalities occur from an early age - Peterborough Peterborough compared to similar local authorities (CIPFA neighbours) Source: Public Health England, Fingertips (PHOF) Tool

..and continue throughout education Cambridgeshire compared to similar local authorities (CIPFA neighbours) Source: Public Health England, Fingertips (PHOF) Tool

..and continue throughout education Peterborough compared to similar local authorities (CIPFA neighbours) Source: Public Health England, Fingertips (PHOF) Tool

Overall employment rates are good but the rate of ESA claimants for mental and behavioural problems is rising Trends in employment Support Allowance (ESA) claimants for mental and behavioural disorders: rate per 1,000 working age population (people aged 16-64 years), 2012-2016 Source: NOMIS, from PHE Mental Health and Wellbeing JSNA (JSNA CDS figure 34)

Health inequalities

Public Health England (PHE): health profile summary for Peterborough, Cambridgeshire and the districts - selected indicators, 2017 Source: Public Health England Health Profiles at November 2017 (JSNA CDS table 1)

Risk behaviours

Behavioural risk factors Source:

Trends in childhood obesity locally are fairly stable Source: Public Health England Public Health Outcomes Framework Indicator 2.06 (National Child Measurement Programme, NHS Digital)

Physical inactivity among young people in secondary school is rising Physical activity and sedentary behaviour in 15 year olds, 2014/15 1. Percentage of 15 year olds physically active for at least one hour per day seven days a week 2. Percentage of 15 year olds with a mean daily sedentary time in the last week over 7 hours per day Cambridgeshire and Peterborough data not available Source: Public Health England, What About You (WAY) Survey (JSNA CDS Table 28)

Smoking and drinking among secondary school children are falling Smoking prevalence in 15 year olds, 2014/15 1. Regular smokers (>1 cigarette per week) and occasional smokers (smoke cigarettes sometimes) 2. Regular smokers (>1 cigarette per week) Drinking behaviours in 15 year olds, 2014/15 Source: Public Health England, What About YOUth (WAY) Survey (JSNA CDS Tables 31 and 35)

Trends in mental health are of concern DASR – Directly age-standardised rate Source: Public Health England, Child Health Profiles (Fingertips Tool)

Trends in adult obesity and physical activity are unclear - obesity Prevalence of obesity in adults (18+) by area of general practice location, 2015/16 Obesity prevalence is showing a slight downward trend for the area (getting better) in recent years – Quality and Outcomes Framework 2012-2015 The percentage of adults classified as overweight or obese in C&P, Cambridgeshire, and Peterborough are statistically similar to England – Public Health England, based on 2015/16 Active Lives Survey. Source: NHS Digital, Quality and Outcomes Framework, Cambridgeshire County Council Public Health Intelligence (JSNA CDS Table 26)

Trends in adult obesity and physical activity are unclear – physical activity Percentage of adults physically active1, 2015/16 1 Percentage of adults (aged 19+) that meet CMO recommendations for physical activity (150+ moderate intensity equivalent minutes per week). *Value aggregated from all known lower geography values Sources: Public Health England Public Health Outcomes Framework Indicator 2.13 (Active People Survey, Sport England), Office for National Statistics mid-2016 population estimates (JSNA CDS Table 29)

Adult smoking rates are falling but alcohol related hospital admissions are rising Trends in smoking prevalence in adults, Cambridgeshire and Peterborough, 2012-2016 (survey data) Admission episodes for alcohol-related conditions (narrow definition) Cambridgeshire and Peterborough Sources: Public Health England National General Practice Profiles (Quality and Outcomes Framework); Public Health England Local Alcohol Profiles for England (Health Survey for England)

Drug related deaths are ‘higher’ in Cambridge, Fenland and Peterborough Directly age-standardised drug-related1 mortality, 2012-16  1Any drug controlled under the Misuse of Drugs Act 1971 Sources: NHS Digital Primary Care Mortality Database (Office for National Statistics (ONS) death registrations), ONS mid-year population estimates (JSNA CDS Table 41)

Disease prevalence

Disease prevalence Source:

Long term health issues vary by area … Directly age-standardised percentage of the population with a long-term activity-limiting illness, Cambridgeshire, Peterborough and Cambridgeshire Districts, 2011 Usual residents in households only (i.e. excluding communal establishments such as hospitals and care homes)   Source: Office for National Statistics Census 2011, Cambridgeshire County Council Public Health Intelligence (JSNA CDS figure 49)

Rates of cardiovascular disease vary around the area, are highest in Fenland Prevalence of cardiovascular conditions by area of general practice location, Cambridgeshire and Peterborough, 2015/16 Sources: NHS Digital, Quality and Outcomes Framework, Cambridgeshire County Council Public Health (JSNA CDS table 50)

..and coronary heart disease is following a slight downwards trend Prevalence of coronary heart disease, based on GP practice location, Cambridgeshire and Peterborough Rates in Cambridgeshire and Peterborough are statistically significantly lower than England from 2008/2009 to 2016/17 Source: NHS Digital, Quality and Outcomes Framework

Asthma rates appear high across the area, and chronic lung disease is highest in Fenland Prevalence of respiratory conditions by district of general practice location, Cambridgeshire and Peterborough, 2015/16   Sources: NHS Digital, Quality and Outcomes Framework, Cambridgeshire County Council Public Health Intelligence (JSNA CDS table 55)

..prevalence of chronic lung disease is on a rising trend Prevalence of COPD, based on GP practice location, Cambridgeshire and Peterborough Rates in Cambridgeshire and Peterborough are statistically significantly lower than England from 2008/2009 to 2016/17 Sources: NHS Digital, Quality and Outcomes Framework

Cancer and diabetes are two important high dependency conditions Prevalence of long-term and high dependency conditions by district of general practice location, Cambridgeshire and Peterborough, 2015/16 * Patients diagnosed with cancer (excluding non-melanotic skin cancer) on or after 01/04/2003 Sources: NHS Digital, Quality and Outcomes Framework, Cambridgeshire County Council Public Health Intelligence (JSNA CDS table 58)

..and prevalence of diabetes has been rising Prevalence of diabetes, based on GP practice location, Cambridgeshire and Peterborough Rates in Cambridgeshire and Peterborough are statistically significantly lower than England from 2008/2009 to 2016/17 Source: NHS Digital, Quality and Outcomes Framework

Falls and hip fracture admission rates are high in some areas, but are generally stable Falls in people aged 65 and over - emergency hospital admissions (for age/sex groups where Cambridgeshire, Peterborough or one or more districts have worse rates than England), 2015/16 Cambridgeshire and Peterborough rates not available 1 age standardised rate per 100,000 population *value aggregated from all known lower geography Source: Public Health England, Public Health Outcomes Framework (JSNA CDS table 45)

Prevalences of different mental health conditions vary across the area Prevalence of mental health conditions by district of general practice location, Cambridgeshire and Peterborough, 2015/16   * Patients with a record of unresolved depression since April 2006 Sources: NHS Digital, Quality and Outcomes Framework, Cambridgeshire County Council Public Health Intelligence (JSNA CDS table 61)

While hospital admissions for self harm seem high in most areas Emergency hospital admission episodes for intentional self-harm, Cambridgeshire and Peterborough, 2015/16 DASR – Directly age-standardised rate “-“ Data not available Source: Public Health England Public Health Outcomes Framework indicator 2.10ii (JSNA CDS table 66)

Recorded dementia has been rising, this may be partly affected by national targets Prevalence of dementia, based on GP practice location, Cambridgeshire and Peterborough Rates in Cambridgeshire and Peterborough are statistically significantly lower than England from 2008/2009 to 2016/17 Source: NHS Digital, Quality and Outcomes Framework

Use of health and care services

Hospital admission rates vary around the area Hospital inpatient admission episodes by local authority of residence - all admissions, Cambridgeshire and Peterborough, 2016/17 DASR – Directly age-standardised rate Sources: NHS Digital Hospital Episode Statistics, Office for National Statistics mid-year population estimates (JSNA CDS table 68)

.. overall, the absolute number of admissions has been increasing Hospital inpatient admission episodes by local authority of residence - all admissions: numbers, Cambridgeshire and Peterborough, 2011/12 to 2016/17 Source: NHS Digital Hospital Episode Statistics (JSNA CDS figure 35)

The trend in admission rates per 1,000 is steepest in Fenland and Huntingdonshire Rates of hospital inpatient admission episodes by local authority of residence - all admissions: directly age-standardised rates, Cambridgeshire and Peterborough, 2011/12 to 2016/17 Sources: NHS Digital Hospital Episode Statistics, Office for National Statistics mid-year population estimates (JSNA CDS figure 36)

Planned (elective) hospital admission rates vary across the area Rates of hospital inpatient admission episodes by local authority of residence - elective admissions: directly age-standardised rates, Cambridgeshire and Peterborough, 2011/12 to 2016/17 Sources: NHS Digital Hospital Episode Statistics, Office for National Statistics mid-year population estimates (JSNA CDS figure 38)

Emergency admission rates have risen - particularly for Fenland and Peterborough Rates of hospital inpatient admission episodes by local authority of residence – emergency admissions: directly age-standardised rates, Cambridgeshire and Peterborough, 2011/12 to 2016/17 Sources: NHS Digital Hospital Episode Statistics, Office for National Statistics mid-year population estimates (JSNA CDS figure 40)

The Adult Social Care Outcomes Framework provides a broad overview of key indicators for Cambridgeshire and Peterborough 1 Source: Public Health England - Fingertips Adult Social Care 2 Source: Measures from the Adult Social Care Outcomes Framework, England - 2015-16, NHS Digital (JSNA CDS table 72)

Key health outcomes

Life expectancy in the area has improved since 2001/3 but improvement has stalled recently Life expectancy at birth, 2001-03 to 2014-16 Source: Public Health England Public Health Outcomes Framework indicator 0.1ii (JSNA CDS figure 44)

The main causes of death are cancer, cardiovascular disease, respiratory disease and dementia/Alzheimers Major causes of death, Cambridgeshire and Peterborough, 2014-16 Source: Cambridgeshire County Council Public Health Intelligence (NHS Digital Primary Care Mortality Database, Office for National Statistics mid-year population estimates) – (JSNA CDS table 78)

Generally, death rates from cardiovascular disease have fallen, but remain significantly high in some areas Mortality from cardiovascular disease, Cambridgeshire and Peterborough, 2014-16 DASR - Directly age-standardised rate Source: Cambridgeshire County Council Public Health Intelligence (NHS Digital Primary Care Mortality Database, Office for National Statistics mid-year population estimates). (JSNA CDS table 79)

Death rates from cancer are falling overall, but by less in more deprived areas Mortality from cancer, Cambridgeshire and Peterborough, 2014-16 DASR - Directly age-standardised rate Source: Cambridgeshire County Council Public Health Intelligence (NHS Digital Primary Care Mortality Database, Office for National Statistics mid-year population estimates) (JSNA CDS table 82)

Suicide rates are improving for Cambridgeshire and Peterborough Suicide and injury of undetermined intent for persons, Cambridgeshire and Peterborough, 2014 to 2016 Cambridgeshire and Peterborough have a recent downward trend in suicide rates (getting better) DASR - Directly age-standardised rate Source: Public Health England Public Health Outcomes Framework indicator 4.10 (JSNA CDS Figure 67)

There are other important contextual factors not covered in the JSNA Significant financial pressures in the local public sector, including NHS deficits and local authority savings requirements Increasing challenges in recruiting the local workforce to deliver health and social care services Potential new ways of working - building on the shared footprint of the Sustainable Transformation Plan and the new Combined Authority

Where should the HWB Board focus? Improving the wider determinants of health? Addressing health inequalities? Alternatives to the doctors surgery? Helping people change their risk behaviours? Health in new housing developments? Helping people to be discharged promptly from hospital? Emotional and mental wellbeing? Healthy Weight?