Central to this vision is that decisions about services should be full text of “Your Shepway, Issue 7, October 24, 2007” as locally as possible, involving people who use them and communities to the maximum degree. The JSNA is a continuous process involving engagement and review and will therefore be updated regularly. As part of this process the Local Government Group has published guidance on the kinds of data that might be useful in a JSNA.
In addition to the guidance on the JSNA, the current health and social care environment also includes new Outcomes Frameworks that focus on a number of key domains of health and social care. The narrative section of the JSNA presents the big picture, while more detailed background papers and a data inventory can be found in the appendices. A new version will be released every three months, ensuring that the data are up-to-date and that issues can be developed further and refined based on feedback from those who read the JSNA. Health has generally been improving over many years and with it peoples’ expectations have increased.
The constraints imposed by the economic crisis mean that it is more important than ever to deliver health and social care as efficiently and effectively as possible. The JSNA is an objective assessment of local needs and is intended to address all current and future health and social care needs. It is an extensive document that will evolve over time as new evidence and intelligence about the needs in Medway are developed. However net out-migration since 2001 has reduced overall population growth over this period. Average life expectancy in Cuxton and Halling, Rainham Central, and Hempstead and Wigmore is significantly greater than in Chatham Central, Luton and Wayfield, and River wards. Life expectancy is highest in Cuxton and Halling at 85. Medway has a higher proportion of unemployment than the England average, but has achieved a decrease compared to last year.
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Unemployment is an important factor driving the health and well-being of a population and this is likely to be playing a key role in the health inequalities seen in Medway. However, 2015 to 2025 projections suggest that the proportion of the population aged 65 years or over will increase from 15. The equivalent change in those aged 85 years and over is from 1. The number of people over 65 years with a limiting long-term illness is expected to increase by 48. There has been a downward trend in mortality for all cancers in Medway since 1993 but cancer death rates have remained higher than in comparator groups, regional and national rates. A considerable proportion of the health and social care challenge relates to chronic conditions or situations.
Increasing numbers of older people means that there will be increasing numbers of people developing chronic conditions who will become intensive users of services. Ageing of the population is likely to result in a substantial increase in costs to the health and social care system and primary and secondary prevention of conditions such as diabetes, COPD and heart disease, combined with improved care for people with conditions such as dementia, is essential to reduce or limit the numbers of high-intensity users of services and reduce the costs to the health and social care system. Our community Engagement with the community is an essential part of delivering services that are appropriate for the population. The Public Health White Paper released by the Department of Health in 2010 outlined a new approach to improving health through greater emphasis on well-being and prevention. This is done by transferring ownership to local communities to tackle the wider determinants of health such as social relationships. Our programmes and services Medway provides services and programmes in a number of domains. Community care is provided by three providers and health improvement, covering smoking, healthy weight, infant feeding, sexual health, teenage pregnancy, and alcohol is provided jointly by NHS Medway and Medway Council.
Local acute care is provided mainly by Medway NHS Foundation Trust, while mental health care is provided by Kent and Medway NHS and Social Care Partnership Trust and other NHS providers and independent organisations offering provision from psychological therapies to secure accommodation. Overall both male and female life expectancy in Medway is significantly worse than the England average. Compared with other LAs of a similar deprivation status it has one of the lower life expectancies. 8 years for men and 4. The main disease contributors to the life expectancy gap are the same as the major killers, with cancer and respiratory disease contributing the most to the life expectancy gap.
While in both men and women the gap in life expectancy due to circulatory disease is decreasing the gap in life expectancy due to cancer is static overall, with an increase in the inequality gap in men. There is significant variation in access to and uptake of primary and secondary health care within Medway. Smoking, obesity, alcohol and poor mental health are all key lifestyle issues which impact on health inequalities. Social determinants of health have been recognised to be key determinants of health inequalities.
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With respect to Medway’s position relative to England the Marmot indicators show that the number of unemployed people and long-term Job Seekers Allowance claimants are significantly worse than the national average. Medway is also in the worse quartile for use of outdoor space for leisure and exercise. Appendices The online appendices of the JSNA contain much detailed information including background papers on specific issues related to children, adults and life-style and wider determinants of health. There is also a data inventory containing key statistics on health and well-being, and links to a number of other additional resources.
Specific recommendations for commissioners can be found in the background papers on children, adults, lifestyle and wider determinants in the appendices. The appendices, along with this narrative summary, are available online at www. Nomis office for labour market statistics. Public Health England, Association of Public Health Observatories.
Of the roughly 2,000 deaths that occur in Medway each year, almost a third of deaths in females and almost half of deaths in males are premature . Both male and female life expectancy in Medway is significantly worse than the England average. Smoking, obesity and alcohol and poor mental health are all key lifestyle issues which impact on health inequalities and need to be addressed. What happens during these early years, starting in the womb, has lifelong effects on many aspects of health and wellbeing, from obesity, heart disease and mental health, to educational achievement and economic status.
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The provision of good social care for children is important to ensure that children have a good start in life. There has also been an increase in the number of children in care. With 73 children in care per 10,000 children this is higher than the national average but again in line with other similar unitary authorities. This may result in an additional 300 pupils with statements requiring specialist provision, over and above the number projected through normal population growth.
To respond to the care needs of children and young people, social workers play an important role in supporting children and young people to develop their emotional resilience and good physical and mental health. Medway is doing well at ensuring there are enough social workers with only 6. March 2012, the lowest level since at least 2006. It is in part the result of steady improvements over many years in health care and public health.
An increase in the number of older people is not a new phenomenon. UK population was over the age of 65 years. Since then there has been a steady increase and as a society we have made many changes during this period. As we go forward further changes are needed to ensure that we are able to provide affordable and high quality care for older people. The government commissioned an independent body to review the funding system for care and support in England and national policy is awaited. Within this national context the options for how Medway chooses to care for and provide support for older people will also include the core themes of localism and personal responsibility noted above.
Many home-owners will seek to stay in their existing homes for as long as they can and will need additional support to do so. Older people are more likely to have multiple health and social needs which will require an integrated response from local services. Prevent early death and increase years of healthy life Over recent decades public health and improved health care have led to dramatic reductions in the number of deaths. About half of this reduction was due to improved health care and half was due to public health measures, such as reductions in smoking.
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Prevention strategies are needed to reduce the numbers of people who will develop these conditions in the future. Early diagnosis can improve outcomes in some diseases and strategies are needed to promote early diagnosis through raised awareness and efficient diagnostic pathways. Increasing years of healthy life will include improving care and treatment for those with mental health problems and long term health conditions such as diabetes and epilepsy. Most people with long-term conditions have a single condition and can be helped to manage their condition at relatively low cost. It is important that effective interventions are provided systematically and equitably across the population if health inequalities are to be reduced. Improve physical and mental health and well-being Increasing attention is being paid not just to how long people live, but also how well they live.
Quality of life is affected by many issues, including crime and the perception of crime, unemployment, the quality of employment for those who do have work, stress, the ability to live independently and autonomously and freedom from pain and ill-health. There is also considerable variation in the prevalence across Medway with 16. There is much evidence to support the positive health effects of smoking cessation and continued efforts to reduce smoking must be supported. The other major causes are more difficult to address than smoking, and recent trends have shown there have small increases in alcohol-related hospital admissions in Medway and increases in obesity. One particularly important aspect of well-being is mental well-being. According to estimates derived from the 2007 psychiatric morbidity survey for England, in Medway in 2014 there are 27,207 people at any one time living with common mental health problems and 668 with a psychotic disorder. In May 2015 the total number of people in Medway claiming employment and support allowance was 9,310.
Nationally a five step approach is being promoted to improve mental well-being. These steps are directed at individuals, however creating a supportive environment that makes it easy for people to take these steps is likely to lead to more people doing so. Reduce health inequalities Inequalities are a fundamental underlying feature of most health outcomes in Medway. Rates of death are higher in those who are more disadvantaged, as are emergency hospital admissions and rates of long-term illness. The Marmot Review identified six key areas for action, the first and highest priority area being to give every child the best start in life. This is because there is strong evidence that what happens in the early years has an effect on future employment prospects and health and well-being outcomes.
As well as the moral imperative to tackle inequalities there is a good business argument to do so. Emergency hospital admissions or more years spent with a long-term illness mean greater costs for health and social care systems. There is much variation between the Medway wards in terms of population density, deprivation, and death rates. The all-age, all-cause mortality rate is significantly higher in Medway than in both England and the South East.
Life expectancy at birth is highest in Cuxton and Halling at 85. 2 years, and lowest in Chatham Central at 77. In every ward life expectancy is greater in females than it is in males. There were 3,657 live births in Medway in 2016. In 2016 the rate of live births to women aged 15-44 was higher than South East region and England averages. The general fertility rate varies considerably between wards, ranging from 52 in Watling to 78 in Luton and Wayfield. Areas with higher GFR will need more children services and interventions to ensure that children have a healthy start in life.
18 and under 16 year olds. C grades, including English and Maths GCSEs, in Medway increased from 57. Medway remains above the national average of 53. Some of the most income deprived neighbourhoods in Medway are in Gillingham North, and Luton and Wayfield. 6th highest out of the 67 local authorities in the South East.
The built areas of the main towns have expanded over time and in places there is little demarcation between the end of one town and the beginning of another. The distance from the centre of one of these main towns to the next is between one and two miles. While the towns are densely populated there are larger, much more sparsely populated rural areas in the Hoo Peninsula to the north of Medway, and the ward of Cuxton and Halling in the west. Medway NHS Foundation Trust, located about halfway between Chatham and Gillingham railway stations. The population of Medway is therefore younger than the population of England overall.
Figure 1: The population structure of Medway and England in 2016. Population within Medway At first glance Medway may appear to be largely homogenous, but this belies considerable variation. The largest ward is Gillingham North, with 19,039 people, and the smallest ward is Cuxton and Halling, with 5,843 people. There is considerable variation in population density, ranging from 1. 8 people per hectare in Peninsula to 85. 3 people per hectare in Gillingham South in 2011. The median density is 37 per hectare, and Rainham Central, Watling, and Strood South have approximately this density.
The least densely populated wards are Peninsula, Cuxton and Halling and Strood Rural, and the most densely populated wards are Rochester East, Chatham Central and Gillingham South. There are also differences in the age distributions of the ward populations as described below. Wards with a population greater than 12,000: Gillingham North, Chatham Central, Gillingham South, Strood South, and Luton and Wayfield are the most populated wards in Medway and have a high proportion of younger people, particularly children aged under 5. Rainham Central, Peninsula, Rochester South and Horsted, and Twydall have older populations. Strood Rural, Strood North, and Rainham South are large wards with a mix of young and older populations.
Wards with a population smaller than 12,000: Princes Park, Rochester East, and Lordswood and Capstone have a younger age profile. Conversely Hempstead and Wigmore, Rainham North, Cuxton and Halling, Watling, Walderslade, and Rochester West have an older population. River ward is slightly unusual in terms of having a very high proportion of its population between 18 and 64 and also an above average proportion aged under 5. There are also differences in life expectancy between the wards.