1. Cllr Mark Hawthorne Dr Helen Miller Let’s Talk Health

2. FIT FOR THE FUTURE A 20 year H&WB Strategy for Gloucestershire Reviewed every three years – refresh annually A 5 year Strategy for Care and Services - ‘Your Health, Your Care’ Clear links between the 2 strategies We want to talk with people about: –priorities for improving health and well-being –how support and services could change in the next 5 years

3. LET’S TALK ABOUT HEALTH 12 week period of engagement Booklet 1 – health and well-being in Gloucestershire Booklet 2 – Your Health, Your Care (care and services)

4. Supporting communities to take an active role in improving health Encouraging people to adopt healthy lifestyles to stop problems from developing Taking early action to tackle symptoms or risks Helping people to take more responsibility for their health Helping people to recover more quickly from illness and return home Supporting individuals or communities where life expectancy is lower than average of where quality of life is poor OUR PRINCIPLES

5. A great place to live, but picture is not perfect H&WB of some not improving at the same rate as others Challenging times Shared responsibility – building vibrant and healthy communities When services needed – efficient and joined up HEALTH AND WELLBEING

6. The LifeCourse Section for each stage of the ‘life course’ – birth to old age Starting Well (0-4 yrs) Developing Well (5-18 yrs) Living and Working Well (19+ yrs) Ageing Well (65+ yrs)

7. what’s going well… Successes for each stage of the life course Lots to be proud of Supported by key facts and figures

8. what could be better… Highlights areas where we need to improve for each life stage Let’s not settle for average Backed up by facts and figures

9. what do you think… What can individuals or communities do to improve health and wellbeing... At each life stage... And what can we do to help? Feedback will help us shape our priorities

10. Your Health, Your Care. Care and Services LET’S TALK CARE, SUPPORT AND SERVICES

11. Links closely with our vision for H&WB Takes into account many of the same challenges Proposals for how health and social care services could change in the next 5 years YOUR HEALTH, YOUR CARE

12. Improving a person’s experience in 4 key areas: Self Care and wider support Supporting people in their communities Community access to specialist help Maintaining high quality, specialist services WHAT ARE WE PLANNING TO DO?

13. Reducing variation Developing community teams Single point of contact for advice Speeding up diagnosis Care Coordinator Monitor and treating people in their own homes Higher level of care for a short time when needed SUPPORTING PEOPLE IN THEIR COMMUNITIES

14. Links to named consultants Does the person need more specialist care? Correct specialist first time Right support in place when they leave hospital COMMUNITY ACCESS TO SPECIALIST HELP

15. MAINTAINING HIGH QUALITY, SPECIALIST SERVICES Maintain, or even extend, access to specialist services Medical benefits and safety CGH and GRH continue to play a key role Distribution of services

16. People with LTCs – independent for longer Less people admitted to hospital due to a LTC More older people return home faster after a hospital stay Equal access to information, advice and support in the community Culture of recovery for mental health service users IF SUCCESSFUL

17. Director of Public Health Report 2011/12 Supports the JHWBS and provides supplementary data and information on the priorities identified in it Stand alone reports have been written for each of the life course stages The priorities in the strategy have been identified using the data available in the Joint Strategic Needs Assessment (JSNA) Where available data has been provided at a national, district and deprivation level

18. The key areas for improvement in Gloucestershire?

19. Key areas for improvement for Starting Well (0-4) Reduce the numbers of pregnant women who smoke Increase the numbers of young children who: – eat well – maintain a healthy weight Reduce the numbers of children living in poverty

20. Data for Gloucestershire 16.8% of mothers smoked at the time of booking (2009-2010) 28.5% of mothers in the most deprived quintile are smoking at time of booking compared to only 6.9% in the least deprived (2006-2010) Around 550 (9%) reception age children (5 yrs old) are obese (2010-2011) 16.1% of children live in poverty (2009) – 19% in Cheltenham

21. Percentage of children under 16 years living in families in Gloucestershire receiving means tested benefits, 2009 Sources: iJSNA (APHO, DCLG) Starting Well

22. Key areas for improvement for Developing Well (5-18) Increase the numbers of young people who lead positive lifestyles: – eat well – are physically active – maintain a healthy weight – do not smoke – do not drink alcohol or drink within safe limits – do not use drugs Increase the numbers of young people that are in education, employment or training in some parts of the county

23. Data for Gloucestershire The 2012 OPS data show that for year 12 (16-17yrs) children: – 13.8% do less than 1 hour of physical activity a week - only 36.7% do more than 6 hours – 15% eat 5 or more portions of fruit & vegetables – 12.2% smoke on most days – Only 12% never drink – 29% had tried illegal drugs The OPS data show that as children get older their lifestyle behaviours get worse! 17.6 % of children in year six (age 10-11 years) were obese (2010-2011) 5.1% of 16-18 year olds in Gloucestershire were classified as NEET –ranging from 2.9% in Cotswold to 6.1% in Cheltenham

24. Developing Well Source: iJSNA (LAPE) Percentage of 16-18 year old NEETS Gloucestershire, December 2011 Sources: iJSNA (Inform Bulletin, NCISS) Under 18s admitted to hospital in Gloucestershire with alcohol specific conditions, per 100,000, 2008-2011

25. Key areas for improvement for Living & Working Well (19+) Increase the numbers of adults who lead positive lifestyles: – eat well – are physically active – maintain a healthy weight – do not smoke – do not drink alcohol or drink within safe limits – do not use drugs

26. Living &Working Well cont... Reduce the difference in life expectancy between the least deprived and most deprived populations caused by: – cancers (including the skin cancer malignant melanoma) – coronary heart disease (CHD) – stroke – chronic obstructive pulmonary disease (COPD) – diabetes – liver disease Reduce the number of people who self-harm or die by suicide Improve the sexual health of young people (15+) and adults, including reducing the numbers of people with Chlamydia

27. Data for Gloucestershire Causes of premature deaths over the last 10 yrs: – 42% by Cancer – 15% by CHD – 5% by Stroke – 4.3% by COPD Mortality rates for all of these are highest in Gloucester and among our most deprived neighbourhoods Diabetes and liver disease show similar patterns with the most deprived neighbourhoods having the highest prevalence

28. Projected growth in Gloucestershire of diabetes, stroke and CHD

29. Living & Working Well Cancer mortality, all people under 75 per 100,000, 2008-2010 Smoking related deaths per 100,000 population (people aged 35+) 2008-2010 Source: iJSNA (ONS)Source: iJSNA (NHS IC)

30. Living & Working Well Cancer deaths and deprivation, standard mortality rates, 2002-2011 by local quintiles of deprivation Source: GPHIU (PHMF & DCLG) St Paul's Oakley Hester’s Way St Mark‘s Warden Hill, Charlton Kings Names of ‘hotpsot’ wards for Cancer under 75 mortality, 2002- 2011 in Cheltenham

31. Data for Gloucestershire cont... Lifestyle factors are important contributors to most preventable disease, four lifestyle factors cause 42% of premature deaths nationally: – Poor diet – annually overweight and obesity costs the PCT £149.1 million – Physical inactivity – annual cost to the PCT is £7.5 million – Smoking - estimated that smoking costs the PCT over £144 million. – Excessive alcohol – estimated that each dependant drinker costs the NHS £2,300 per year In Gloucestershire these lifestyle factors are associated with deprivation with the most deprived neighbourhoods being less likely to make positive lifestyle choices

32. Data for Gloucestershire cont... Mortality rate from suicide and undetermined injury is 10.2 per 100,000 (63 deaths) - England rate is 7.9 per 100,000 (2008-10) Rate of emergency hospital admissions due to intentional self- harm is 236 per 100,000 (1328 admissions) - England rate is 212 per 100,000 (2008-10) In 2011-2012, 12,352 young people (15-24) were screened in the county, of these 6.3% were found to have Chlamydia

33. Ageing Well Source: iJSNA (Health and Social Care Information Centre) Suicide and injury undetermined mortality: All people all ages per 100,000, 2008-2010 Suicide rates and deprivation, 2001-2011 Sources: GPHIU (PHMF, DCLG)

34. Key areas for improvement for Ageing Well (65+) Continue to improve identification and management of dementia, including the support given to carers Reduce the number of hip fractures among people aged 65 and over Reduce the numbers of excess winter deaths among people aged 75 and over

35. Data for Gloucestershire 8,500 over 65’s have some form of dementia - by 2030 it is projected that this will be 14,700 – a 70% increase Almost 32,000 people over 65 years of age will have a fall this year - 5-10% of all falls result in serious injuries Average number of excess winter deaths each year for Gloucestershire is 300 - EWD are higher than England in Gloucester, Tewkesbury, Cheltenham and the Cotswolds

36. Living & Working Well Admissions to hospital following a fall with fractured neck of femur, age 75 and over, district rate per 1000 population, 2006-2011 Sources: GPHIU (SUS, Exeter)

37. Further information and data is in the DPH report 2011/12 and is available on the NHS Gloucestershire Website at: http://www.nhsglos.nhs.uk/your-local-nhs/about-nhs-gloucestershire/corporate- publications-and-strategies/director-of-public-health-annual-reports/