1. Health, Well-being and Care Version 1.2 of the Lewisham Joint Strategic Needs Assessment Dr Danny Ruta Joint Director of Public Health April 2010

2. What is the Joint Strategic Needs Assessment? A profile of health, well-being and care in Lewisham, in terms of outcomes, service delivery and the wider social determinants of health; A joint analysis of current and predicted health and social care needs. Evidence for an analysis of the needs of Lewisham’s citizens Reflects local and national health priorities Draws on and is supplemented by more detailed needs assessments

3. Developed using Partnership working –NHS, Local Authority, other key stakeholders Community engagement - community groups, public events, consultations Evidence of effectiveness - research Constantly developing work-in-progress

4. Lewisham’s health priorities Reduce health inequalities (making health and healthcare fairer) - Reduce gap in Life Expectancy - Reduce premature death from Cardiovascular Disease. - Reduce premature death from Cancer. - Improve the health of children and young people. - Reduce teenage conceptions. - Improve Mental Health. - Improve quality of care for people with Long-term Conditions. - Improve End of Life Care. Living longer Health & life chances for children & young people Quality of life

5. Content of the JSNA Demography : the growth, change and structure of the local population Social and Environmental Context : poverty, employment, housing, transport and the local environment Lifestyle and Risk Factors : e.g., smoking, alcohol consumption, eating habits and physical activity Burden of Ill-health : life expectancy, mortality, ill-health, disease, accidents and injury Social Care : the number of people receiving social care services now and projections on service use in the future Health Inequalities : key disparities in heath outcomes within Lewisham and in comparison with London and England Community Intelligence : what our local population has told us about their health and care needs

6. The JSNA informs… Lewisham Children and Young People’s Plan Lewisham’s Health Inequalities Strategy Lewisham Primary Care Trust’s Commissioning Strategy Plan Lewisham Council’s Corporate Strategy University Hospital Lewisham’s Annual Delivery Plan

7. Key Commissioning Themes 1) Improve children’s health and well being in Lewisham with a particular focus on prevention and education 2) Reduce childhood obesity 3) Support people in Lewisham to maintain healthier lifestyles through the delivery of health promoting strategies and programmes for sexual health, smoking and tobacco control, alcohol and drugs, healthy eating and physical activity 4) Improve take up of preventive health measures such as immunisation and screening 5) Improve access to mental health services in primary care 6) Improve the life expectancy for the residents of Lewisham, with a particular focus on premature mortality from circulatory diseases and cancers 7) Improve the quality of care for those with long term conditions 8) Support adults with social care needs to shape and control their services, empowering them to live independently within the community

8. Demography: Lewisham’s population Source: GLA Round 2008 PLP Low (Copyright) and ONS Mid 2008 England estimate

9. Demography: total population changes to 2015 Between 2009 and 2015 the population of Lewisham is expected to grow by 7.6%. The 5-14 year old age group is expected to grow by 14% Every ward is expected to experience some growth The large growth will be in Evelyn Ward, which will grow by abut 50%

10. Source: DCLG, IMD 2007 & ONS National quintiles No area in Lewisham is in the least deprived 20% of England Lewisham is the 39 th most deprived LA in England Social and Environmental Context – Deprivation

11. Key Theme 1: Improve children’s health(1) 1in 5 people in Lewisham are aged <15, 1 in 4 are <19. Varies across Lewisham from 14% <15 in Lewisham Central to 23% in Downham. Nationally, smoking rates in the 11-15 year old age group remains high. Preventing the uptake of smoking is a priority.

12. Key Theme 1: Improve children’s health(2) Uptake of childhood vaccinations is low. Levels are below those needed for herd immunity, and Lewisham has seen outbreaks of measles and mumps. Photo courtesy of Centers for Disease Control and Prevention

13. Key Theme 1: Improve children’s health(3) Nationally, smoking rates in the 11-15 year old age group remain high. Preventing the uptake of smoking is a priority. Photo © Roy Castle Lung Cancer Foundation

14. Key Theme 2: Reduce childhood obesity(1) Lewisham has high levels of childhood obesity in Year 6 children, 22.1% in 2008-9 compared with 18.3% for England. The equivalent figure for Lewisham in 2007/8 was 25.3%. Obesity is a major risk factor for cardiovascular disease, cancer and diabetes. Photo courtesy of fitness63.blogspot.com

15. Key Theme 2: Reduce childhood obesity(2) A local survey in Lewisham schools found that 12% of children rarely or never ate vegetables and 12% had not had any physical exercise in the previous week. Photo courtesy of fitness63.blogspot.com

16. Key Theme 3: Support healthy lifestyles Data show high rates of sexually transmitted infections and teenage conceptions among young people.

17. Key Theme 4: Preventive heath measures(1) During 2008/09, the percentage of 2 year olds immunised for Measles Mumps and Rubella was 74% compared to 85% in England. The WHO recommendation is 95%

18. Key Theme 4: Preventive heath measures(2) During 2008/09, the percentage of 1 year olds immunised for Diphtheria, Tetanus, Polio, Pertussis, Hib was 83% compared to 92% in England. The WHO recommendation is 95%

19. Demography: Ethnicity 60% of the population of Lewisham are in White ethnic groups. 30% are in Black ethnic groups. 7% are Asian. 3% are classified as “Other”. Over 60% of school pupils are in BME groups.

20. Demography: Births Births in Lewisham have increased by 30% since 2002, and are expected to continue to increase annually to 2015. 10% are to women 40. In 2008/9 60% were normal deliveries, 30% Caesarean, 10% were assisted. The majority gave birth at UHL, but those living nearer the borders of the borough tended to choose the nearest hospital. Photo courtesy of pregnancy.about.com

21. Lewisham has a higher proportion of secondary school pupils who are entitled to free school meals than England. The proportion of children living in income-deprived household varies across the borough from about 10% to about 75%. Over 30% of Lewisham children live in families on key benefits, in the top 10% in Great Britain. Social and Environmental Context – Children in poverty

22. Social and Environmental Context –Childcare and Tax Credit In March 2008, 29% of Lewisham’s families receiving Working Tax Credit had their children in formal child care and received Child Tax Credit, compared with the Borough’s statistical neighbours at 23%. The was an increase from 26.5% in March 2006, while the statistical neighbours’ rate was essentially unchanged.

23. Social and Environmental Context - Crime Reported crime in Lewisham fell by 3% in the year to July 2009. Lewisham has the highest rates of both offences and sanction detections for domestic violence in the Metropolitan Police Service. The proportion of young people supervised by the Youth Offending Service in full time education training and employment has risen from 69% in 2006-07 up to 85.5% in 2008-09.

24. Social and Environmental Context - Education and Attainment (1) Attainment at key stages 1, 2 and 3 is below the London average. 60% of Lewisham pupils achieved 5+ GCSEs at grade A-C, slightly below the England rate but comparing well with the Borough’s Statistical neighbours. White and Black Caribbean boys on free school meals have increased their GCSE attainment from 24% in 2003 to 40% in 2008. The gap between those receiving free school meals and those who do not has narrowed by 28% to 18%.

25. Social and Environmental Context - Education and Attainment (2) Lewisham has reduced the number of young people in vulnerable groups not in education, employment or training (NEET), between August 2007 and August 2009.

26. Drug Abuse by Young People There is evidence of widespread substance misuse by young people in Lewisham. Local treatment data suggest this is higher than the England average. Estimates suggest 6-7% of 11 year olds have taken drugs in the last year, rising to about 45% of 15 year olds. The main drug of choice used by young people in Lewisham is cannabis. The ethnic mix of young people in drug treatment varies from year to year. There has been an increase in the number of young people entering the treatment system but there is considerable unmet need.

27. Nutrition and Fruit and Vegetable Consumption For children and young people, there are a number of indicators which highlight concern in relation to eating habits. The Schools Health Education Unit survey data of Lewisham school children in 2008 found that: - 48% of primary pupils had eaten less than 3 portions of fruit or vegetables the previous day and 4% had nothing to eat or drink for breakfast that day - 19% of secondary pupils had nothing for breakfast the day of the survey Photo courtesy of University of California Davis Medical School

28. Physical Activity Among children, participation in sport is significantly higher (88.9%) that in England as a whole (85.7%). Of those surveyed, 57% of young people were satisfied with physical and sporting activities within the Borough. 16% were dissatisfied.

29. Teenage Pregnancy In 2007, there were 316 pregnancies in women aged 15-17. 21% of these involved girls under 16 years old. Lewisham’s rate of under-16 pregnancy (15/1000 females) is almost double that of England. 56% of pregnancies in the 15-17 age group were terminated. Under 18 Conception rates 1998-2007

30. Infant Mortality Infant mortality (children aged under 1 year old) in Lewisham fell steadily from 7.2/1000 births in1999-2001 to 4.6/1000 in 2005-7. Neonatal mortality (deaths under 7 days old) fell in the same period from 9/1000 to 2.6/1000. In 2006 stillbirths were 5.2/1000. For each of these figures Lewisham’s most recent data is slightly below the England rates, though not significantly different. Data for 2006-8, which became available after the JSNA was written, show rises in Infant and Neonatal mortality rates that take the borough above the England rate. This is not significantly different, but is currently under investigation.

31. Low Birth Weight – under 2,500 grams Low birth weight is a risk factor for infant mortality. Lewisham generally has significantly higher rates than England, but has usually not been statistically significantly different from the London Cosmopolitan benchmark group and London overall. Local provisional analysis for 2009 shows Lewisham’s rate reducing to 7.7%

32. Very Low Birth Weight – under 1,500 grams The most common reason for very low birth weight is extreme prematurity. Since 2005, Lewisham has had significantly higher rates of very low birth weight babies than London and England, though not statistically different from the benchmark London Cosmopolitan group.

33. Dental Health Children’s tooth decay at age 5 is much better in Lewisham than in London and England overall. The mean number of decayed missing and filled teeth is 0.9 compared to 1.7 for London and 1.5 for England. In 2006/07 on average, 70% of children were decay-free aged 5 although this varied between 62% and 77% across the Borough. In 2006/07 73% of 12-year-old children had no experience of dental disease although this varied between 71% and 81% across the Borough. At the end of 2007 67.5% of children were accessing dentistry services in Lewisham.

34. Disabilities and or Learning Difficulties Referrals for Autistic Spectrum Disorders increased from 26 referrals in 1994 to 265 referrals in 2008. Some children experience lengthy waits for assessment and treatment. The estimate prevalence of children with disabilities in Lewisham at 6.2% There are more male than female children with disabilities.

35. Looked after Children The health needs of looked after children and young people (LAC) are significantly greater than those within the general child population. Between March 2006 and July 2009, the proportion of LAC who had had health checks rose from 79% to 84%.