Public Health Annual Report 2007-8 by Alex Hawley

Sandwell Primary Care Trust

NHS

Crunch Time for Health in Sandwell Public Health Annual Report 2007/08

Crunch time for health in Sandwell

Contents Foreword

Crunch Time for Health in Sandwell

60 Years of the NHS

Healthy People and Towns

Working Towards Better Health and Wellbeing

Town Profiles

Achievements and Awards

Acknowledgements

Support CD

Foreword Welcome to the 19th Public Health Annual Report for Sandwell. This gives an overview of the state of Sandwell’s public health in 2007/08 and the work that is being carried out to improve the health and wellbeing of those who live and work in the Borough. A more detailed version of the different sections that have informed this Annual Report is contained on a CD at the back of this document and includes a full set of the Public Health Archive data sets for reference. This year has seen a real milestone in healthcare with the 60th anniversary of the NHS. This has given me an opportunity to look back on how things have changed in that time for the health of all who live in the six towns that make up Sandwell. There have been some dramatic changes over six decades, noticeably in the way we are now protected against diseases and illnesses that once killed us. Although things have improved, some things remain the same. Sandwell’s biggest killer today – heart disease and stroke – is the same as it was 60 years ago. There are areas of real deprivation which have a major impact upon people’s ability to be healthy and live healthier lifestyles. That is the challenge that my colleagues and I face every day. But it is the global ‘credit crunch’ that is really affecting us all right now. My Introduction to this Annual Report considers Crunch Time for Health in Sandwell and addresses the effects of this economic downturn on our own health, wealth and wellbeing – and what we can do about it. Health-wise, just like economically, we are all living beyond our means: stacking up a burden of health ‘debt’ in obesity, inactivity, unhappiness and dependence. The health service itself has been funded at record levels on the back of the economic boom of recent years and has seen much improvement in care standards, waiting times, access and so on. But with the economy sinking, the ‘banker’ for our health that we rely on for our care and cures – the NHS – cannot bail us out for long. It cannot offer cures for everything and can barely cope with the burden of care. The years of boom are about to be replaced with years of tightened belts in health service spending as well as everywhere else – and we have to learn to adapt our own lifestyles to contribute to aid our own recovery. We must learn to live within our health means by: ● Consuming what we need to live, not what supports our lifestyles. ● Growing as much of our own food as we can locally, to reduce our reliance on transported food and world harvests and world markets. ● Walking and cycling where we can, to reduce our reliance on petrol and to keep our bodies and minds fitter, leaner, and more alert. ● Equipping ourselves with health knowledge, so we can be self-reliant and independent and not at the mercy of health professionals and the health market. ● Developing our local alternative economy for health and self-reliance by building social enterprises, co-ops and community economic systems – such as the Credit Union and Time Banks – to prevent us being at the mercy of speculators and world finance markets. My Public Health colleagues and I, together with our partners, are committed to helping and supporting the people of Sandwell achieve all these things. By working together, and by reducing our debt burden of unhealthy lifestyles, ill health, dependency and over reliance on expensive and ineffective medical treatments, we can all help to contribute towards a more cost effective, affordable health service through maintaining and protecting health.

Dr John Middleton Director of Public Health

Crunch time for health in Sandwell

Crunch Time for Health in Sandwell Following the theme of Crunch Time For Health, it is appropriate and timely that we look at work, skills and economic development – and the contribution that health and health services can make to improve economic security and independence as well as the health and wellbeing of Sandwell people. In this Introduction I have outlined the major challenges and areas of work being carried out in Sandwell – and my recommendations for what we should be doing to improve the lives of everyone who lives and works in the Borough. More detail is available on the CD at the back of this report and this document highlights specific areas of work from the last year that are worthy of note in their own sections.

Working in Partnership Sandwell Partnership – the body that pulls together all of the organisations that want to see Sandwell thrive and flourish – has had a successful year. It has consulted widely on proposals for the revised Sandwell Plan – a 20-year plan for transforming the Borough – and the new Local Area Agreement (LAA). This is a kind of flexible ‘contract’ between the Council, its partners and the national Government which agrees how it will deliver national targets to meet local priorities in eight different ways. These are: ● Improving Health ● Supporting Independence ● A Better Start To Life ● Successful Young People ● Reducing High Volume Crime ● Stronger Safer Communities ● Improving Housing ● Improving Skills and Jobs Sandwell PCT has played a full part in the development of these plans. It leads on two of these eight LAA priorities – Improving Health and A Better Start to Life – and is a major player in most of the others. Improving Health is perhaps the most obvious lead for the PCT and requires us to make substantial improvements in identifying people at risk from coronary heart disease and strokes and preventing them from becoming ill. We cannot do this alone. It is a partnership activity which requires others to send us referrals to the stop smoking service, to provide better occupational health screening and create workplace conditions for better health.

A Better Start to Life remains a major concern in the area – but substantial plans are in the pipeline for better services and better prevention of ill health in pregnancy for mother and baby. The PCT plays a strong role in Reducing High Volume Crime through its role in domestic violence prevention and management, alcohol and drug prevention programmes. In the Improving Housing objective, the PCT plays a role developing better aids and adaptations, home care services, SMART housing and assistive technology and in tackling fuel poverty – a major cause of premature death and extra deaths in winter. A new Housing and Health Strategy will be brought forward early in 2009. The LAA priorities are reflected in an exercise the PCT has been going through on World Class Commissioning, which has been heavily influenced by public health priorities, but also cross references with other partners’ priorities and initiatives. It has been a substantial year for consolidating organisational policies – next year must be a year for implementation.

Two Major Milestones This year has seen two great milestones in healthcare and wellbeing. It is the 60th birthday of the NHS – you can read more about that in the next section – and it is also 60 years since the Universal Declaration of Human Rights. Health is a basic human right but there is still much to be done to reduce the inequalities – or differences – in health within Sandwell itself and between Sandwell and the rest of England. The priorities set within the LAA and the World Class Commissioning priorities are designed to address some of those differences and we have work to do to improve the standard of healthcare for people with learning disabilities, in particular. The Universal Declaration of Human Rights seeks to secure the right to freedom from danger and violence for all people and we have much more to do in the field of safeguarding vulnerable adults and children. The PCT is the third accountable body for crime reduction in the LAA’s eight priorities. With the Local Authority (Council) and the Police, the PCT must fulfil its responsibilities by investing in the prevention and management of domestic violence, tackling alcoholrelated violence, drug-related harm and improving community safety. Freedom from poverty and the right to a satisfying role in society is also a human right. The draft Anti-Poverty Strategy for the Borough can be found in the CD at the back of this document. In brief, Sandwell PCT: ● Must contribute to efforts to alleviate the ill health caused by poverty and to support partnership efforts to improve welfare rights and tackle fuel poverty. ● Should review its commitment to welfare rights advice in General Practice and consider improving the specialist services managed through the Local Authority service within the Joint Policy Unit. ● Increase efforts to reduce poverty and to tackle the ill health caused by fuel poverty, including the excess of winter deaths seen in Sandwell principally because of cold, stress and poor heating in our housing.

Work Is Good

Crunch time for health in Sandwell

Work is important to keep healthy and well and our health services offer many chances for people to find meaningful work. Skills shortages and poor working opportunities for Sandwell people are long-term local problems which health and care services can contribute towards improving. The section of this report called Working Towards Better Health and Wellbeing explains more about what we are doing to help people back into work – and it is important that we do this. Returning to work is an intrinsic part of any worker’s recovery plan and the environment they return to should support this. The employment rate in Sandwell is below the regional and national average and those out of work and claiming benefits account for 17% of the Borough’s population of just over 287,000 people. In the worst neighbourhoods, this rises to a rate of 30%. Fewer professional people work in Sandwell compared to other places in the country with almost a third of those employed working in process, plant, machinery and elementary occupations. Skills and qualifications in the Borough are low: one in four working people hold no qualifications at all, which is twice the national average. Work is more than just a source of cash. Work gives a structure to people’s days, fills time, offers creative possibilities and gives people the possibility to make things much bigger than themselves. All of these psychological and social benefits of work are lost to people who are unemployed. Some of these benefits are also lost to people who are carers and to people who are disabled or long-term sick – who are seen as dependants and not given enough chance to show what they can offer. There are very few occupations where being in work is more unhealthy than being unemployed. The health of people who become unemployed deteriorates and the life expectancy of unemployed people is reduced. So we need to see work as important – but it has to be as rewarding and fulfilling as possible. We should strive for more than just ‘machine minding’. As well as unemployment benefit claimants, Sandwell has a very high proportion of its population receiving Incapacity Benefit: 18.3% in 2007/08. This reflects, to some degree, the high levels of ill health in the Borough but it also reflects poor work opportunities and inflexible working practices that are disability-unfriendly. The health service is guilty of being among those employers who have not done very much to help disabled people into jobs. New Deal for Welfare: Empowering People to Work began in 2007 to help disabled people and those receiving Incapacity Benefit to get into work. Seetec is the local company contracted to deliver Pathways to Work – the support programme helping to make this happen. The principle of the initiative is welcome: that all people of varying abilities should be able to participate in work in order to have the benefits that employment brings. There is also the political and economic desire to reduce the financial cost of Incapacity Benefit and this is quite a proper objective. Looking at Sandwell’s figures, it should be quite unacceptable that nearly one in five of our citizens claim Incapacity Benefit.

I recommend Sandwell PCT to: ● Further develop its occupational health service for employers in Sandwell. ● Implement the draft service model, Sandwell Works (see the tiered diagram in the Working Towards Better Health and Wellbeing section).

Skills Development Sandwell is still more involved in manufacturing than other parts of the country but, as with the rest of the country, more of our jobs are now in the service sector. There is inequality in the distribution of unemployment and Sandwell’s Neighbourhood Employment and Skills Plans (NESPs) are intended to address these problems in the 13 areas with the highest unemployment. Sandwell’s Learning To Care Project was very effective in getting people from some of these high unemployment areas into work in social care, with the added benefit of providing a better diversity profile – a mix of people from all kinds of backgrounds more in keeping with the communities they serve. This work is now being taken forward to enable people to get jobs in healthcare and social care through the Routeways to Health and Social Care Careers project. The aim is to provide entry-level job opportunities from the age of 18 years, leading to progression and development opportunities through improving individuals’ skills. The health service can make a major contribution towards skills development in lots of different ways: ● For its own staff. There are high levels of poor literacy and numeracy in the health service and we need to take part in the Skills For Life staff programme and other adult education to support our staff in acquiring skills that support their development and personal growth. ● For our patients, clients and carers. We should point people in the right direction for adult education and basic skills when needed. ● For potential new employees. We should offer encouragement and a first step on the ‘skills escalator’ to higher levels of health service work. We can do this by our support for schemes such as placements, volunteering opportunities, apprenticeships, supporting the new diplomas and developing a consortium to ensure that the current gaps are filled. There are many opportunities for health and health service training in schools through health education, personal skills, food technology and physical education. We are proud to be a partner in Holly Lodge School’s Smethwick Health Education and Wellbeing (SHEW) Foundation School project. Through this, the school majors on all aspects of health service work in science and in health and social care.

I recommend Sandwell PCT to: ● Play a full part in the development of Holly Lodge SHEW project. ● Work with other schools, such as Willingsworth and the Priory Family Centre, to develop their community agriculture proposals and with Alexandra High School with their health and citizenship work. ● Continue to develop our participation in the National Healthy Schools Programme. Currently 117 (97%) of Sandwell's 121 schools are participating. 82 (68%) schools have achieved National Healthy School Status and 51 (42%) schools have Sandwell's Platinum Healthy Schools Award . This scheme has been successful in helping young people to healthier lifestyles but has also helped to develop whole school health policies which have contributed to improved academic results. Parents should ask schools what level of the Healthy Schools Programme they are at when they come to choose for their children. ● Fully support appropriate diplomas, in areas such as healthcare and public services, by developing a consortium with partners and provide good quality placements.

Unpaid Work ‘Work’ doesn’t just include paid employment. The work of unpaid workers in the home, carers and voluntary work should not be ignored. The full Carers’ Strategy is included on the CD.

Crunch time for health in Sandwell

I recommend that Sandwell PCT: ● Identifies and recognises carers as equal partners in providing care, such as: the development of care pathways; health improvement programmes; GP practice registers; annual health checks and hospital discharge planning. ● Works more closely with the Local Authority and the voluntary sector to promote and support the right of carers to a life outside caring, by safeguarding their employment and training opportunities. ● Develops support services for carers, including short breaks. ● Supports people after bereavement – often an overlooked issue. ● Develops a full portfolio of voluntary sector contracts that is publicly available. ● Considers voluntary sector options for the provision of services in all the PCT’s commissioning decisions. ● Recognises the need to develop the voluntary and community sectors to enable them to compete more equally in the developing ‘market’ for healthcare and lifestyle services. ● Agrees a Community Development Strategy by March 2009. This document will outline the contrasts and similarities between community development and public and patient involvement in health and describe the role of community development in raising the aspirations of local communities for better health – and support local communities to secure their rights and entitlements to better health and care. (The current draft Community Development Strategy and the agreed PCT Patient and Public Involvement Strategy can be found on the CD)

Citizen Wage In this time of economic hardship and insecurity, it is time to resurrect and debate the concept of the ‘citizen wage’. This is a level of income provided to all citizens by the state. It differs from the minimum wage because it is not paid by employers but the state and recognises and rewards unpaid house working, caring, being cared for, voluntary work and other activities not covered by the conventional economic system. It may appear inflationary – the state simply paying everybody some minimum subsistence level. However some of it is covered by existing state handouts – the minimum rate tax band and existing benefits payments, for example. It is not means tested and it is not discriminatory. There are advantages to employers and to industry in that the first level of wage payment to their employers is paid by the state meaning the chance to employ more people is generated.

I recommend Sandwell PCT will: ● Initiate a debate on the ‘citizen wage’ at the 2009 Sandwell Health Other Economic Summit.

Time Bank In this time of credit crunch – wouldn’t it be great to have a secure income that is inflation-proof so it will be worth the same in ten years’ time and that no-one can steal from you? Welcome to the Time Bank. This is a system through which people trade in time instead of cash – offering their skills and services and making requests for things they want in return. It is not bartering because you do not have to trade one-to-one with another person and no money is exchanged. ‘Earnings’ – calculated in hours – go into the bank and you can draw on them to get things you want from anyone else in it. Everyone’s time is valued the same so no-one can cheat, steal or market their talents as being more valuable than yours. Your time is not vulnerable to speculators, hedge fund highrollers or computer viruses and will be worth the same in ten years as it is now. People trade simple everyday skills and offer to do things for other people that may not be bought in the conventional job market. Need someone to hang your clean curtains up? Walk the dog? Do a small shop? This kind of community support is just what Time Bank is all about and it gives people with time on their hands, but very little income, the chance to do something to help. Those who take part could build up credits now, whilst in good health, so they can be traded in a few years if they are not so fit and able and need some help. The ‘credit crunch’ is the ideal opportunity to reinvigorate this scheme.

As such, I recommend: ● Sandwell PCT and Sandwell Partnership should seriously expand investment and support to Sandwell Time Bank. ● The PCT should re-establish its volunteering scheme, enabling all members of the PCT staff to do one day’s volunteering work in a community organisation of their choice in Sandwell. ● Major employers should also join the Time Bank and use their corporate volunteering scheme to massively stimulate the local ‘time market’. ● Major employers and Sandwell Partnership should reward patients and members of the public who take part in consultations with time credits cashable through the Sandwell Time Bank. Other recipients should include: volunteer walk leaders; Dr Bike; those involved in the Green Gym and the enormous body of volunteer public health workforce providing public service every day of the week so the initiative can grow to an industrial scale.

Working in the NHS

Crunch time for health in Sandwell

The ‘Towards 2010’ programme for reconfigured health services in Sandwell and west Birmingham will require new skills and, potentially, new workers in local GP and healthcare practices, redesigned clinical services and in the public health protection and health promotion services. Over recent years, there has been less on-the-job training and, with planned changes to the education system, it is perhaps the right time to change this to meet the future demands. In General Practice and in hospitals, nurses’ roles are changing and evolving, and they are taking on duties and responsibilities previously held by doctors. All this gives Sandwell PCT the opportunity to increase the ‘diversity profile’ of its workforce. In other words, to increase the numbers of people with disabilities, from minority ethnic groups, and those from the local population who need to improve their skills to get back into work. To do this, we will work with projects such as Pathways to Work and Routeways to Health and Social CareCareers to prepare and support local people through the public sector recruitment processes. We will also develop placement schemes for young people and adults in ‘sector tasters’, work experience and training support. We will also increase the capacity and capability of the new public health workforce to include new roles including Health Trainers and will equip support staff with skills to support health improvement (see the Healthy People and Towns section).

In our existing workforce: ● The largest proportion of our staff are classified as White British at 73.21% which equates largely to the make-up of the local population. ● The next largest ethnic group is Asian or Asian British (Indian) at 9.47% - which mirrors the local health economies and the local population. ● Black or Black British (Caribbean) account for 6.44% of the workforce – which is larger compared to the percentage living in the local community. ● Staff of Asian or Asian British (Bangladeshi) and Asian or Asian British (Pakistani) origin are under-represented within Sandwell PCT compared to the local Sandwell population. This is not true of the other local health economies and we will be taking action to address this. ● Women comprise the largest gender breakdown of Sandwell PCT which is not unusual in a healthcare setting. In all directorates, women are the largest gender group, but the most significant difference is within the Operations Directorate with 86% of staff being women compared to 14% men. ● The majority of the workforce falls between ages 26 to 55 years with the largest group of staff aged between 46 and 50 years, followed by ages 41 to 45 and 36 to 40 years. The number of staff aged 55 and over drops significantly. As the general population moves to an ageing population the PCT should aim to reflect this in its workforce.

Investment in skills and training in the health service, in healthcare and in lifestyle and health promotion services is one of the best investments public bodies can make if they want to secure more jobs. Only transport and education provide better returns in jobs created per investment. There is clearly much for the NHS to do in this difficult economic time to try to secure the rights to health for local people and to find opportunities for them to work in health-promoting and health-protecting services.

I recommend that the PCT should: ● Write a Workforce Development Strategy to include ideas for on-the-job training and also to look at the mix of skills of staff in community care and General Practice to see if new ways of working can offer greater opportunities for nonqualified workers. ● Develop with partners a health and social care apprenticeship scheme. ● A substantial proportion of the next year’s Working Neighbourhoods Fund is used to support the full implementation of health-related job creation and skills development. This will enable other health service resources and European funds to be secured in matching funding to greatly boost the number of jobs created. ● The PCT should review its existing training budgets and on-the-job training opportunities, together with its partners, to ensure maximum synergy with developments being taken forward through the Working Neighbourhoods Fund and European Regional Development Fund money.

Crunch time for health in Sandwell

Public Health The Sandwell Community Agriculture Strategy has been produced this year and has had a period of consultation. It offers Sandwell a massive chance to improve local knowledge about healthy food, to give people healthy activity and the chance for more local jobs. At the same time the UK Research Partnership has produced for us a report on the state of the Sandwell food industry. Nourishing The Local Economy shows that Sandwell is still massively under-represented by jobs in the food industry, so there is a massive opportunity for local job creation in growing, supplying, processing and distributing. Both the strategy and the report can be found on the CD. The CD also includes a short report on the Sandwell Health Other Economic Summit conference, held in July 2008, called Fat Chances for Food and Health. This report highlights the insecurity of the global food production system, the problems of climate change, crop failure, food commodity speculation, genetic engineering and intellectual property theft for food substances which all contribute to price rises and food shortages.

On the back of these reports, I recommend that: ● Sandwell needs to make itself as food aware and as food secure as it possibly can. ● Sandwell Partnership gives its strong support to the implementation of the Community Agriculture Strategy. ● The Council, economic agencies and the PCT support the further development of the local food industry research and support the Find It In Sandwell initiative, working with local food industry representatives. In addition, people need more information so they can be healthy and well and community projects like Murray Hall Community Trust and the Sandwell Public Information Network (SPIN) should receive more investment, development and promotion. Local people are already playing their part in improving the health of their own communities through the innovative new Health Trainers programme. Through this, the PCT is looking at a different way of identifying and supporting those at risk of heart disease by bringing together screening programmes, health professionals, community support and trained local people – Health Trainers – to offer a package of support. There is more about this in the Healthy People and Towns section. This initiative is complemented by the Communities for Health pilot programme in Soho Victoria. This is a cardio vascular disease (CVD) project aimed at offering community health information and support for people not identified as being at current risk of CVD, as part of general health promotion activity in areas at high risk of premature death and disease. In addition, there is enormous potential for job creation in public health including: ● Promoting cycling through: cycle maintenance; cycle training for all ages and abilities; cycle clubs for leisure or transport and town planning developments.

● Public health nutrition: community food growing; supply; distribution; cooking skills and healthy eating educational developments such as Growwell, Eatwell, Shopwell and Slimwell.

Arts and Health The PCT will shortly receive an Arts and Health Strategy to consider adopting. The involvement of the arts in health and health service development has historically been seen as something of a luxury and a low priority – but there is a substantial role for the arts in health and health services. Use of the arts can help us improve: ● Our understanding and our communications. ● How our healthcare settings look and the appearance of aids and adaptations for everyday living. ● Improve the quality and content of health promotion products. ● Our mass media communication. ● Non-competitive, highly socially acceptable, life-long physical activity through dance. Working with artists is a low cost way to improve the effectiveness of health services and health promotion campaigns. It is also a useful means to create jobs locally. There are new opportunities in Sandwell with the opening of THE PUBLIC building in West Bromwich and it is essential that we capitalise on this excellent resource and develop Sandwell as a centre of excellence for the arts and health.

I recommend: ● The PCT adopts an Arts and Health Strategy early in 2009. ● There is specific investment in dedicated arts and health projects – some of which will attract external funding from arts bodies, the National Lottery and trusts. ● All service commissions from the PCT should incorporate 1% for an art element to enable the improvement of the aesthetics of care delivery, communications and public information.

Applied Health Research

Crunch time for health in Sandwell

Sandwell PCT is a partner with Birmingham University, which together made a successful funding bid earlier this year to become a centre of excellence for health research – earning CLAHRC status (Collaboration for Leadership in Applied Health Research and Care). CLAHRC is a departure from previous research funding regimes in that it matches an amount of research funding to an existing health service development. This means that new services can be subjected to proper evaluation using the best available research methods from the start. Sandwell PCT leads the housing and health research strand of the LAA which will evaluate the implementation of telephone care and assistive technology in Sandwell and develop a data warehouse for housing and health. This will help us to track the health improvements associated with major housing improvement over five years. Sandwell PCT is participating in two other strands of CLAHRC. Firstly, the coronary risk programme, together with Heart of Birmingham Teaching PCT and Solihull PCT. Secondly, the health service reconfiguration evaluation, covering the ‘Towards 2010’ programme in Sandwell and west Birmingham and service re-design in Walsall. This renewed interest in high quality research throws up some exciting opportunities in Sandwell, including jobs through additional research work and the prospect of a new university campus in the Borough.

I recommend: ● The PCT should play a key role in developing potential training and research content with the candidate university when agreed. ● The PCT supports the development in principle of a Sandwell public health research and practice teaching base, which will be allied to the proposed developments of CLAHRC, the University of Sandwell and the Towards 2010 programme. The full CLAHRC bid can be found on the CD.

Social Marketing ‘Social marketing’ is a buzz phrase at the moment and there is considerable interest. It is a way of analysing people’s behaviours, attitudes and beliefs so that advertising works more effectively. For health organisations like ourselves, this means targeting health campaigns, promotions and information about redesigned health and care services more appropriately – to suit different audiences. Now is the time to take a step into social marketing to assist with better-targeted preventive care programmes as well as service redesigns, such as diabetes and eye services. To do this, Sandwell PCT should adopt the draft Social Marketing Strategy and invest in a rolling programme of social marketing studies.

I recommend: ● The PCT seeks to develop local capacity to undertake social marketing using expert external resources to undertake dedicated surveys and help staff to understand the value and power of social marketing. Just ‘buying in’ external studies is not going to give us the intelligence we need to properly redesign services on the basis of what the surveys tell us. ● All service planners and commissioners consider a percentage addition to planning costs to be used for social marketing purposes. They should also include a research component in their investments. A working assumption for the combined social marketing and research evaluation should be around 10% extra. ● The PCT, through the Director of Public Health and the Head of Public Health Information and Intelligence, should develop a Health Research Strategy for Sandwell by July 2009.

Picture supplied by the National Social Marketing Centre

A Bid for a Healthier Town Following publication of the National Obesity Strategy published in late 2007, the Department of Health’s Department for Children and Families invited expressions of interest in a Healthy Communities Challenge Fund.

Crunch time for health in Sandwell

Sandwell PCT put together a bid for a share of this national fund and has been shortlisted. The national strategy recognised that obesity is not simply the result of eating too much and not exercising but is also a product of unhealthy – or ‘obesogenic’ – environments. This includes the increased reliance on cars which has created unfriendly, inhospitable environments in which people are afraid to walk to shops and services, leading to inactivity, obesity and then more car reliance… The PCT’s bid is for developments in food and fitness programmes and there is more about this in the Healthy People and Towns section. In brief, the central part of the plan is to set up Sandwell Healthy Urban Development Unit (SHUDU) which will bring together health and planning expertise to improve health and the environments that contribute to obesity. The PCT is the body that is accountable for this proposal but it is jointly submitted with the Council. If successful, it will initially cover West Bromwich and Wednesbury and could be rolled out across the Borough in the future. Whatever happens in the bidding round, we believe the work done so far is essential if we are to have any chance of hitting obesity reduction targets and creating healthier, safer and more attractive environments for our children to grow up in.

I recommend: ● That all those involved seek to implement everything that has been learned from the bid submission through the Challenge Fund if successful – but through local resources if we are not.

Personalised Care Agenda for Social Care The Government has set a new agenda for health and social care – with the aim of giving people choice and independence through care packages devised by themselves, for themselves. That has to be a good thing to aim for – after all, who wants to go to a day centre every day and why shouldn’t people choose to spend time in the community garden or a day on a self-build project instead? In reality there are likely to be difficulties in the short term, getting services changed to deliver to the new models. The Learning To Care project in Sandwell has been successful over many years in training people for jobs in the residential and nursing care sector. Now training needs to be geared towards personal care provision for clients, supporting them in their homes and in their everyday activity.

I recommend: ● That social care workforce needs are taken forward through strong consultation with support agencies, client groups and voluntary organisations such as Ideal for All, which has a strong track record in supporting clients and client-centred activity.

Corporate Citizenship Corporate citizenship is the name given to the role organisations play in their local community. Sandwell PCT’s ‘value statement’ says it will be environmentally and socially responsible and it can be a good corporate citizen by: ● Buying goods and services from local sources. ● Using its land and buildings wisely. ● Setting a good example to others by providing high quality occupational health services and improving the working lives of its staff. ● Protecting its innovations – or intellectual property – so they may be developed for local job creation and patent royalty returns to the NHS. Sandwell PCT has recently secured two patents for products developed by our designer and ergonomist and the PCT has demonstrated its commitment to developing new aids, adaptations and products for health and care use through its role in the i-Health project. ● Reducing its carbon footprint, conserving physical resources such as heat and water and reducing pollution and waste. Preventive services and services which can be locally delivered are likely to have a lower carbon impact. Health promotion schemes such as food and fitness promotion, cycling and walking are ‘greener’ as well and an Exercise On Prescription regime for obesity or peripheral vascular disease might be better for the local economy and environment than buying expensive imported drugs or surgery requiring imported equipment. The PCT has responded to the NHS Carbon Reduction Draft Strategy and will be expected to develop its awareness and responsiveness to the climate change agenda.

I recommend the PCT: ● Gives greater attention to the environmental impacts of the decisions it takes. ● Allocates a reserve for investment towards its carbon reduction initiatives to be implemented in 2009/10. ● Includes a carbon reduction impact statement and a corporate citizen impact statement in its policy reports to the PCT Board. ● Gives strong support, together with Sandwell Partnership and other housing partners, to the development of the i-Health project in Sandwell, with intensive use of assistive technology in new and adapted housing. ● Considers extending the role of design in our health service development processes, recruiting an additional designer/ergonomist to assist health and care strategies and design new aids and adaptations for the commercial market. ● Invests more in occupational health services for its own staff. In the light of Dame Carol Black’s recommendations for an NHS lead on occupational health for small business, the PCT should increase its investment in our local Workwell service. ● Reviews corporate citizenship responsibilities, along with all Sandwell partners, and considers its contributions to the local economy and local community resilience.

Dr John Middleton Director of Public Health

60 Years of the National Health Service

60 Years of The National Health Service This year sees the 60th anniversary of the founding of the NHS and this is an opportunity to review how things have changed – and yet how some things have remained the same. During this time, the health of Sandwell has seen some dramatic improvements, as you will see below. However, many of the issues that concerned the Medical Officers of the six towns in 1948 remain a challenge to my Public Health colleagues and I today. Boundaries have changed and the way conditions are recorded are different, so comparisons between ‘then and now’ are not exact but give a flavour of how things have changed. There have been some incredible advances in health and healthcare over this period, especially in the control of infectious diseases and the development of medications for heart disease and cancer. People are living longer and have better healthcare – but with progress comes a different set of challenges for us to face.

Mothers and Babies Child and maternal health has been one of the great success stories for health improvement since 1948. The development of vaccination programmes has almost eradicated infant deaths from infectious diseases. Until recently measles was on the decline due to a successful immunisation programme. However due to scare stories around the measles, mumps and rubella (MMR) vaccination, measles is on the comeback and the number of cases rose to 20 in 2007. This echoes a situation from 60 years ago when Mr F Acker, the Medical Officer of Rowley Regis, despaired about the unnecessary suffering and deaths caused by the failure of parents to take up the effective vaccination against diphtheria. In 1948, births outside of marriage were seen as a stigma with the challenge of reducing figures and caring for mothers being overseen by Birmingham and Lichfield Diocesans. Back then, teenage conceptions were so rare as not to warrant mention. Social changes have brought big changes. The stigma has disappeared from births outside marriage but the flipside of this is that teenage pregnancy has dramatically increased.

Mothers & Babies: Facts and Figures Sandwell 60 Years Ago… ● A child born in 1948 was five times less likely to make their first birthday than one born today. ● 272 babies did not get to their first birthday and there was an infant mortality rate of 40.5 per 1,000 live births. ● A mother giving birth was at 16 times greater risk of dying than a mother today. In 1948, four mothers died as a result of child birth (one in every 1,000 births). ● 15 infants died from diarrhoea and enteritis aged under two, one from diphtheria and three from measles. There were over 3,097 cases of measles 1948. ● One in 330 babies were born out of marriage in 1948.

Sandwell Today… ● The infant mortality rate is 7.8 per 1,000 population (based on figures from 2004 to 2006). This is still 50% higher than the average for England (five per 1,000). ● Just one mother died as a result of childbirth in the last four years (one in 16,000 births). ● 43.5% babies are born outside of marriage. ● Latest figures (2006) show 62.7 per 1,000 women aged 15 to 17 are pregnant.

Causes of Death Although many things have changed, some have remained the same. Today’s biggest killers for adults are the same as they were in 1948. Circulatory disease – which includes heart disease and stroke – was responsible for 37% deaths in 1948 and 36% in 2007. However, there are significant differences. The percentage of people dying from cancer has gone up from 17% in 1948 to 26% in 2007. Many of the causes of death have changed, with the large numbers of deaths from respiratory and infectious diseases being dramatically reduced. The introduction of antibiotics had a huge effect on this and has seen tuberculosis change from being a major cause of death to a curable condition in all but a few cases: but the challenge is still with us in Sandwell. Seven people died from the condition last year and we have a higher prevalence rate than the rest of England. Changes in the way we work and live has also played a major part in causes of death. In 1948 respiratory disease was linked to industrial exposure to pollutants, in particular smoke, with large numbers of deaths from bronchitis and pneumonia. In 2008, deaths from industrial pollution have been largely replaced with personal pollution from tobacco. In 1948 lung cancer was rare, making up only 8% of cancers compared with 22% today.

40% 35%

Major causes of death: 1948 compared to 2007 37%

36%

Key

30%

1948

26% 25%

2007

20%

17%

15%

4% 5%

Pneumonia

Bronchitis

Cancers

1% 0%

1% 1%

0% 0% Diarrhoea

1% 1%

Diabetes

6% 6%

Road traffic

Suicides

10%

Circulatory disease

Percentage of all deaths

60 Years of the National Health Service

Perhaps surprisingly the number of people dying from road traffic incidents has declined very significantly over six decades. Much of this is down to improvements in road layouts and driver training. Those who are dying are different now to then: it is largely pedestrians and cyclists who lose their lives and not car occupants. Drivers are rarely exposed to life-threatening situations due to safety devices such as safety belts and airbags.

The Future: Now and Then In 1948 the Medical Officers were facing the same demographic challenges we face today with “the number of pensioners continuing to increase and, proportionally more important, placing a gradually increasing burden on the social services”. (Staffordshire CMO, 1948 quoting Office of National Statistics) In this year’s Joint Strategic Needs Assessment, produced by Sandwell PCT’s Public Health Department, there is a very similar conclusion about our population. We now know that the prediction of 1948 did not come true as the ‘baby boomer’ generation of the post-war period filled the employment gap. It will be interesting to see if the same will happen again and whether the gap will be filled by newcomers from the European Union. As far as Sandwell’s future is concerned, it has a number of major challenges to ensure the next 60 years see an improvement in local people’s health and wellbeing and the key challenges are: ● To address obesity, physical activity and smoking. ● To strive to maintain the gains made in child health through immunisation. ● To continue to reduce infant mortality.

The Environment Sustainability and pollution were as much issues for the Medical Officers of 1948 as they are to us today, although their concerns were about smoke rather than carbon emissions and climate change. Sixty years ago, the Medical Officers recognised a role to inform and educate the public to change their behaviours. Mr Eugene, Medical Officer of Oldbury, used his Annual Report to encourage people to adopt less polluting smokeless fuels in the home as part of the need to reduce overall smoke levels. Improving people’s health by getting them to make changes doesn’t happen overnight. It can take years to reap the benefits and requires everyone to be involved, from the individual themselves to those who have an effect on the services they access or the environment in which they live. Many of the interventions identified in 1948 to improve health and social issues are largely the same today, albeit using different technologies. The need for improved social conditions, housing and better maternity services are now, as well as then, crucial to health and wellbeing. For example, the recommendations in 1948 to reduce accidents in the home were to improve lighting, reduce slip risks in the home and to provide handrails – much the same as today.

Healthy People and Towns Health Trainers: A Force for Change Helping people to help themselves to a better way of life: that is the key to a healthier Sandwell. Improved physical, emotional and mental health can only happen if people play their part in choosing healthier lifestyles – but they need proper support, in their own communities, to help them achieve this.

Healthy People and Towns

That is where our innovative Health Trainers come in. These are local people trained to offer personal health advice to people and give them the support they need to adopt healthier lifestyles. The aim is for Health Trainers to be integrated with the cardiovascular risk stratification screening process within General Practice. These combined services will provide a targeted approach to identifying those at risk and improving the health and wellbeing of people in disadvantaged wards and within their GP practice. This will be rolled out across all Sandwell GP populations in 2009/10. High-risk people will see nurses and medium-risk will see Health Trainers. At a population level we currently estimate 15,000 high-risk patients and 9,300 medium-risk patients between 35 and 74 years of age are currently not on any treatment or identified as being at risk. It is hoped this new approach will prevent 1,020 heart attacks or strokes over the next ten years in the high-risk category, saving an estimated 306 lives and sparing many more from incapacity. Health Trainers will play a crucial part with the medium-risk group, working intensively to change lifestyles and help prevent patients becoming high-risk. By doing this we believe that, over ten years, Health Trainers can help prevent 465 heart attacks or strokes and save 155 lives. In the last two years: ● 3,075 people have been invited for screening. ● 1,699 people have been screened with an estimated 80 heart attacks and strokes prevented and 26 lives saved. ● Of the 1,699 people screened, 802 needed drugs. ● 48 new diabetics have been diagnosed. ● Five patients were referred to a rapid access chest pain clinic. ● 482 referrals were made to lifestyle services (194 smoking and 288 activity and diet).

Why We Need a New Approach People living in Sandwell have a shorter life expectancy than those in more affluent areas and some of the lifestyle choices they make – such as smoking, lack of exercise, unhealthy food and alcohol consumption – are contributing to ill health. According to the Public Health Observatory, people living in 17 out of 24 wards in Sandwell have significantly worse life expectancy than the national average. These wards broadly match areas of material deprivation. The difference in life expectancy between the lowest and highest wards in the Borough is five years. The wards of highest need are: ● Soho and Victoria ● Great Bridge ● Wednesbury North ● Friar Park ● Hateley Heath An analysis of lifestyle trends show: ● 19 of the 24 wards have smoking rates of between 28% and 48% ● 20 of the 24 wards have obesity rates of between 23% and 35% and coronary heart disease prevalence of 3.6% to 5% Changing the way people behave to improve their health and wellbeing is complex but we believe that a community-based approach is the right way. This is supported by two Government White Papers: Choosing Health (2004) and Our Health Our Care Our Say (2006) alongside the Commissioning a Patient-Led NHS strategy (2004). More locally, the West Midlands Regional Assembly has recently completed a consultation exercise on a Regional Health and Wellbeing Strategy which emphasises that good health and wellbeing relies on people living in strong communities. Health Trainers can help support this approach.

What Health Trainers Do Health Trainers are a friendly face who can offer something in addition to the services of a health professional. They work one-to-one with patients with a focus on health improvement and prevention. They work in local communities, specifically those that are most disadvantaged, and help: ● Individuals make lifestyle changes to improve their health. ● Target people from deprived communities. ● Bring people into better contact with mainstream health improvement services.

Healthy People and Towns

● Recruit local people into these NHS roles. ● Maintain and develop excellent links to wider community and voluntary sector services. This new workforce is already developing and, over time, will help us to meet the Borough-wide targets we share with our partners, as laid out in the Local Area Agreement, mentioned in the Introduction. Our health and wellbeing priorities include: ● Reducing number of people who smoke. ● Encouraging and supporting sensible drinking. ● Reducing obesity and improving diet and nutrition. ● Increasing exercise. ● Improving sexual health. ● Improving wellbeing and mental health. By linking in Health Trainers to health screening projects and lifestyle services, we hope to make a real impact on the health and wellbeing of those people who are most at risk from problems such as cardiovascular disease (CVD).

What Real People are Saying About Health Trainers

Keda, 58 and John, 59:

Irene, 70: “I feel much better since losing weight. I no longer get breathless and feel much healthier.”

“Very happy with the advice, assurance and support in losing weight.”

Monmohan, 41: Rita, 63: “My diet is much better. I feel ten times better since starting a better way of living and cholesterol is lower.”

Janet, 51: “Very helpful. My health has improved, I’ve stopped smoking and started to eat more healthily.”

“A big improvement in my health. My cholesterol and blood pressure are lower and I’ve lost weight.”

Rohina, 38 and Paul, 42: “Health Trainers gave us the motivation to lose weight we needed to, to get us started. We were pleased with the detailed dietary information we received compared to previously.”

A ‘Healthy Town’ Health Trainers are helping individuals who want to help themselves – but what can we do to create a whole town that can encourage, support and offer opportunities to make life better for those who live there? Creating a ‘healthy town’ doesn’t happen by chance – so we are going to try and make it happen through an innovative two-year pilot project involving all kinds of different people and organisations. We want to bring together local people, town planners, highway engineers, food and physical activity experts, police, the fire service, social enterprises, businesses, community groups and charities to create the right environment to improve health and wellbeing. To do this, we are hoping to create the Sandwell Healthy Urban Development Unit (SHUDU) in West Bromwich. West Bromwich, Wednesbury and Great Bridge are the proposed areas for the pilot, largely because they contain two of the wards with the highest levels of childhood obesity in Sandwell. In addition, there is a lot of redevelopment happening here and there are many existing facilities and environments that could be utilised, such as Sandwell Valley Country Park and Sheepwash Local Nature Reserve in Great Bridge, Tipton. The vision for the project is to create a sustainable ‘healthy town’ by raising awareness of obesity, encouraging people to make healthy lifestyle changes and supporting them to succeed in a fun and practical way. The overall aim is to enable people to get more active and eat well by creating positive experiences in a healthy, safe and accessible environment.

How Will It Work? The idea is to explore new ways of delivering food and fitness programmes by pulling together all of the different agencies and getting local communities involved. We are looking to secure investment – potentially up to £4.2m over the two years – and will carry out high-quality research, plus additional research funding. Local people will be able to access information about where to get information or attend fun sessions near to where they live and local Champions will work together with Role Models and public and business sponsors to help it succeed. The project will co-ordinate existing food policy activities – such as Eatwell, Slimwell, Shopwell and Growwell – with physical activity programmes, such as the Get Active in Sandwell campaign. In addition, SHUDU will help to create the infrastructure and environment which will make it easier for people to get involved safely. This will include: ● Street improvements. ● Extended and upgraded cycle network. ● Improved town centre open space. ● Safer routes to school. ● Improvements in catering establishments. ● ‘Fitter for Walking’ scheme. ● Improved canal towpaths. ● A policy framework for all this to happen.

Target Town: Facts and Figures In the pilot areas of West Bromwich, Wednesbury and Great Bridge the total population is 116,376 of which: ● 21.1% are under 16 years old. ● 22.8% are over 60 years old. ● 18.6% of the population is black and minority ethnic.

Healthy People and Towns

● The 2006 Health Survey for England shows that 29% of adults are obese. ● The National Child Measurements for Year 6 children showed that an average of 21.4% were obese. ● The Active People Survey for 2005/06 shows that 16.67% of adults take part in moderate activity three times a week. ● Disease prevalence is higher and life expectancy in these wards is lower.

What We Hope To Achieve Our targets are to: ● Raise obesity as an issue. ● Create a desire to do something about it. ● Create demand for, and be able to supply, more healthy food choices and activity opportunities. ● Create neighbourhoods that encourage healthier lifestyles. ● Visible improvements to the environment. ● Deliver a model that influences the policies of others. ● Embed health in a sustainability policy. ● Contribute to reducing health inequalities and improve health.

Working Towards Better Health and Wellbeing Improved diet and increased activity will make a difference to health – but working is good for you, too. Evidence shows that having a job is generally good for physical health and mental wellbeing. The flipside is that worklessness – or not having a job – has a strong association with poor physical health and mental health wellbeing. Research has demonstrated that once someone has been off work for two years they are more likely to die or retire than return to work and will have shorter lives than the Sandwell average, so it is important that we do what we can to get people back into the workplace as soon as possible. Here in Sandwell, worklessness is a real issue. Almost a third of working-age people in the Borough do not have a job because of health reasons, which is more than the national average. The employment rate in Sandwell is 65% - which is 7% below the regional average and 9% below the national average. This breaks down further to an employment rate among the white population of around 69%, compared with 54% for ethnic minorities. Those out of work and claiming benefits account for 17% of the Borough’s population of just over 287,000 people. In the worst neighbourhoods, this rises to a rate of 30%. Fewer professional people work in Sandwell compared to other places in the country. Just under a third – 29% of the workforce – are professionals or associate professionals compared to 43% in England. Process, plant, machinery and elementary occupations account for 29% of the working population – which is 11% higher than the national average. Skills and qualifications in the Borough are low with just 45% of residents having NVQ qualifications at Level 2 or above – compared to 64% across England – and one in four working people hold no qualifications at all, which is twice the national average. Increasing employment and supporting people into work are linked to improving people’s health and wellbeing and are a key part of the Government’s public health and welfare reform programmes. Sandwell Metropolitan Borough Council (SMBC) has undertaken detailed analysis at ward level of 13 hotspots for employment and worklessness in Sandwell. These closely correlate with deprivation and poor health indicators and back up the theory that worklessness is linked to poor health and reduced life expectancy. Full details of the Neighbourhood Education and Skills Plans (NESPs) to improve things are included in the CD but here is an overview of the top priorities and challenges for our ‘hotspots’:

Working Towards Better Health and Wellbeing

Tipton and Rowley Regis ● Princes End: lone parents; benefit dependency; people with low qualifications; over 50s; access to transport links;16-24 age group high % benefit claimants. ● Tipton Green: black and minority ethnic (BME) community; lone parents; people with low qualifications; benefit dependency. ● Great Bridge: lone parents; benefit dependency; people with low qualifications; over 50s; access to transport links; claims for all benefits in 16-24 age range.

Smethwick and Oldbury ● St Paul’s: lone parents; residents with low qualifications; BME groups; more female benefit claimants than men; 3rd highest number of jobs in the Borough after West Bromwich and Oldbury; high levels of long-term benefit claimants. ● Smethwick: lone parents; BME groups; high % of Job Seekers Allowance claimants of 6-12 months – low number in 12-month category; high proportion of people with higher level qualifications. ● Soho & Victoria: lone parents; BME groups; life expectancy lowest in Borough; high % of people with no qualifications; high % of females claiming benefit than Borough average. ● Oldbury: BME groups; Incapacity Benefit claim rate increased; high proportion of residents claiming Job Seekers Allowance; unemployment rate has increased compared to Borough average. ● Bristnall: low number of males in employment; high % with no qualifications; high % of Incapacity Benefit; worklessness high in over 50s.

Wednesbury and West Bromwich ● Friar Park: residents with low qualifications; lone parents; highest proportion of people with no qualifications; lowest proportion of people with higher level qualifications. ● Greets Green and Lyng: BME groups; people with low qualifications; high manufacturing employment rate – double the Borough; high % of long-term claimants of Job Seekers Allowance. ● Hateley Heath: residents with low qualifications; high number of unemployment benefit claimants; high % of Incapacity Benefit claimants. ● Wednesbury South: over 50s; the older population; high % with no qualifications. ● West Bromwich Central: BME groups; Incapacity Benefit claimants; over 50s; high % of long-term unemployed.

Worklessness: Facts and Figures ● The number of people in Sandwell who have a disability or limiting illness is higher than the national average at 12.7%: that’s 33,800 people. ● Of those who work, 10.62% have a disability – which is 3% below the national average. ● Of all of those who are unemployed in Sandwell almost a quarter – 24.67% (1,900 people) – have health-related issues, which is 10% higher than the national average. ● A total of 26,400 (28.32%) people of working age in Sandwell have a health issue and are economically inactive. This is 6% higher than the national average. ● 8.93% of the working age population in Sandwell receive Incapacity Benefit which is higher than the national average. ● According to the Population Survey 2006, there are around 2,900 people on long-term sick leave from work, and possibly claiming Incapacity Benefit, who actively wish to work.

What We Are Planning To Do The Department for Work and Pensions (DWP) has recently introduced a new programme called Pathways to Work, which enables people on Incapacity Benefit to return to work. First-time claimants, or those renewing claims, will be automatically referred to this new scheme. Anyone on the benefit can refer themselves for support back into employment. The scheme has a keen focus on those who aren’t working because of mental health problems, muscular-skeletal issues and coronary heart disease. We want to build on this by identifying and supporting those people who may have disabilities or health-related issues – but do not qualify for the Pathways to Work programme. We want to help them access employment and work closely with Seetec, the organisation that provides the Pathways to Work programme in Sandwell. Sandwell already has a dedicated mental health employment service for people with severe and enduring mental health issues. However, no such provision exists for others with learning difficulties, physical disabilities or a chronic disease outside of the Workstep-supported employment programme. This is run by Sandwell MBC through Working Link at Beeches Road and Ideal for All in Smethwick.

Working Towards Better Health and Wellbeing 30

This existing structure gives us a starting point to help those people with health issues who would either risk losing their jobs due to their ill health or who would like to return to or start work. We want to use this, together with input from GPs, consultants and other health professionals, to create a ‘tiered’ package of services that start once a sick note is requested. These would offer the patient an assessment, rehabilitation, occupational therapy or even a ‘prescription’ for voluntary or therapeutic work that could help them back into paid employment. It is envisaged that a tiered approach is taken to identify service provision, which can encompass the work already done in the Borough and the possibilities for future work. Primary care – such as GP practices – would be able to concentrate on tiers 1 and 2 with separate funding or scope for further work with partners for tier 4.

A tiered approach 1st long-term sick note >6 weeks

Tier 2

Rehabilitation Incapacity Benefit claimant mild / moderate Severe disability or health issue

Tier 1

Tier 3

Tier 4

Each of these tiers will have a slightly different approach to dealing with clients but within these patient and GP discussions it is likely that a return to work plan will be negotiated to include such items as: ● Agreeing realistic goals and expectations of healthcare. ● Encouraging a gradual increase in activity levels. ● Agreeing clear goals and a timeline for return to work. ● Discussing what the patient can do rather than telling them what they can’t. ● Discussing how to overcome any obstacles to return to work and thinking about communication with the employer. ● Talking about possible sources of support to help cope with the condition. If these guidelines are implemented within Sandwell it is predicted that the number of sickness certificates issued will decrease, along with the number of benefit claims. Our plans for the coming year will see us develop these services to help tackle worklessness in Sandwell. The aims are to: ● Enable people with health and/or long-term unemployment issues to successfully enter employment or training. ● Provide volunteering and placement opportunities in a range of different settings – including charities and community groups. ● Keep people in work who have had a period of ill health. ● Provide support to employers. ● Enable people with learning and/or physical disabilities opportunities for paid or unpaid work. ● Have a healthy workforce.

Oldbury town profile

oldbury

Who lives here?

Wednesbury West Bromwich

Population 2005

Tipton 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Oldbury Rowley Regis

2.5

1.5

0.5

1.5

Quantity in 1000s

Males

2.5

Smethwick

Females

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

81.0% 2.2% 9.0% 2.9% 0.2% 3.5% 1.3%

Source: ONS, Census 2001

People living with a long-term condition Coronary heart disease Stroke

Percentage shown is percentage of Oldbury population

1775 3.7% 855 1.8% 6985 14.7%

Hypertension Diabetes COPD

2127 4.5% 822 1.7%

Obesity 0 Source: QOF 2006/07

4371 9.2% 2000

4000 6000 Number of people in Oldbury

8000

Deaths Top five causes of death Source: ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

21.6% 16.7% 19.1%

Ischaemic heart disease

8.4% 12% 10.2%

Cerebrovascular disease Malignant neoplasms of trachea, bronchus and lung

Respiratory disease

99.7

Circulatory diseases

103.3

Endocrine, nutritional and metabolic diseases

8.3% 3.6% 5.9%

99.4

All causes 0

4.8% 4.5% 4.7%

COPD

101.8

Cancers

5.2% 5.4% 5.3%

Pneumonia

120.1

10 15 Percentage

100

150 SMR

200

250

Percentage of working age population on benefits

Source: DWP date 2008

Alcohol deaths

25%

Source: ONS Mortality 20%

Males 24.5

2.4% 2.5%

Sandwell Males 27.5 15%

Females 6.6 Sandwell Females 10.3 0

1.7%

2.7%

3.2%

8.5%

9.3%

3.9%

4.2%

Oldbury Town

Sandwell

10%

10 15 20 25 5 year average rate per 100,000

35 5%

Deaths from smoking Source: ONS Mortality / HAD 1995

Males 209.7 Sandwell Males 230.9

Key Other

Females 113.5

Care

Sandwell Females 122.2 0

100 150 200 Rate per 100,000 residents

Lone parent 250

300

Incapacity Job seeker

Rowley Regis town profile

rowley regis

Who lives here?

Wednesbury

Population 2005

West Bromwich

80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Tipton

Oldbury Rowley Regis

2.5

1.5

0.5

1.5

Quantity in 1000s

Males

2.5

Smethwick

Females

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

92% 1.6% 1.8% 2.1% 0.3% 1.4% 0.8%

Source ONS: Census 2001

People living with a long-term condition Coronary heart disease Stroke

792 1.9% 6100 14.4%

Hypertension Diabetes COPD

1864 4.4% 834 2.0%

Obesity 0 Source: QOF 2006/07

Percentage shown is percentage of Rowley Regis population

1610 3.8%

4736 11.2% 2000

4000 6000 Number of people in Rowley Regis

8000

Deaths Top five causes of death Source: ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

20.4%

Ischaemic heart disease

15.4% 17.7% 10.6% 14.8% 12.9%

Cerebrovascular disease Malignant neoplasms of trachea, bronchus and lung

119.2

Circulatory diseases

118.4

Endocrine, nutritional and metabolic diseases

7.9%

112.2 0

5.4% 4.9% 5.2% 5

106.3

All causes

4.6% 5.7% 5.2%

152.5

Cancers

3% 5.3%

Pneumonia

COPD

Respiratory disease

100

150 SMR

200

250

Percentage of working age population on benefits 10 15 Percentage

25 Source: DWP date 2008 25%

Alcohol deaths Source: ONS Mortality

20%

2.7%

Males 22.2 1.7%

Sandwell Males 27.5

15%

3.6%

2.4% 1.7% 3.2%

Females 10.5 10%

Sandwell Females 10.3 0

10 15 20 25 5 year average rate per 100,000

9.3%

35 5% 4.3%

4.2%

Deaths from smoking 0% Source: ONS Mortality / HAD 1995

Rowley Regis

Sandwell

Males 239.9

Key

Sandwell Males 230.9

Other

Females 128.2

Care Lone parent

Sandwell Females 122.2 0

100 150 200 Rate per 100,000 residents

250

300

Incapacity Job seeker

Smethwick town profile

smethwick

Who lives here?

Wednesbury

Population 2005

West Bromwich

80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Tipton

Oldbury Rowley Regis

2.5

1.5

0.5

1.5

Quantity in 1000s

Males

2.5

Smethwick

Females

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

55.8% 3.7% 18.7% 8.6% 2.9% 6.9% 3.4%

Source: ONS, Census 2001

People living with a long-term condition Coronary heart disease Stroke

Percentage shown is percentage of Smethwick population

1822 3.3% 815 1.5% 7534 13.8%

Hypertension Diabetes COPD

2495 4.6% 687 1.3%

Obesity 0 Source: QOF 2006/07

4310 7.9% 2000

4000 6000 Number of people in Smethwick

8000

Deaths Top five causes of death Source: ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

19.7% 17.7% 18.7%

Ischaemic heart disease

9.2% 12.7% 10.9%

Cerebrovascular disease Malignant neoplasms of trachea, brochus and lung

128.6

Circulatory diseases

127.0

Endocrine, nutritional and metabolic diseases

7.2% 4.5% 5.9%

108.1 121.2

All causes 0

5.9% 3.8% 4.8% 0

234.6

Cancers

4.8% 7% 5.9%

Pneumonia

COPD

Respiratory disease

100

150 SMR

200

250

Percentage of working age population on benefits 10 15 Percentage

25 Source: DWP date 2008 25%

Alcohol deaths Source: ONS Mortality

20% 2.4%

Males 27.2

2.1%

Sandwell Males 27.5

15%

1.7%

1.3% 3.1%

3.2%

Females 7.1 10%

Sandwell Females 10.3

7.6% 0

20 25 15 10 5 year average rate per 100,000

5% 4.2%

Deaths from smoking

0% Smethwick

Source: ONS Mortality / HAD 1995

9.3%

4.2% Sandwell

Males 190.7

Key

Sandwell Males 230.9

Other

Females 100.1

Care Lone parent

Sandwell Females 122.2

Incapacity 0

100 150 200 Rate per 100,000 residents

250

300

Job seeker

Tipton town profile

tipton

Who lives here? Population 2005

Wednesbury West Bromwich

80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Tipton

Oldbury Rowley Regis 3

2.5

1.5

0.5

1.5

Quantity in 1000s

Males

2.5

Smethwick

Females

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

85.5% 1.5% 6.0% 2.6% 1.0% 2.3% 1.0%

Source: ONS, Census 2001

People living with a long-term condition Coronary heart disease Stroke

650 1.8% 5064 13.8%

Hypertension Diabetes COPD

1513 4.1% 787 2.1%

Obesity 0 Source: QOF 2006/07

Percentage shown is percentage of Tipton population

1486 4.1%

3456 9.4% 2000

4000 6000 Number of people in Tipton

8000

Deaths Top five causes of death Source: ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

Ischaemic heart disease

13.7% 17%

Malignant neoplasms of trachea, bronchus and lung

Pneumonia

Circulatory diseases

10.4% 14.1% 12.4%

Cerebrovascular disease

123.5 129.7

All causes

4.4% 6.2% 5.4%

6.9% 5.3% 6% 5

144.8

Cancers

4.2% 6.6%

130.9

Endocrine, nutritional and metabolic diseases

9.5%

COPD

144.6

Respiratory disease

20.9%

100

150 SMR

200

250

Percentage of working age population on benefits 10 15 Percentage

25 Source: DWP date 2008 30%

Alcohol deaths

2.9% 25%

Source: ONS Mortality

2.3%

Males 31.9 20%

4.8%

Sandwell Males 27.5

2.4% 1.7%

Females 16.2

15% 12.2%

Sandwell Females 10.3 0

10 15 20 25 5 year average rate per 100,000

10% 9.3% 5%

Deaths from smoking

5.3%

4.2%

Tipton

Sandwell

Source: ONS Mortality / HAD 1995 0%

Males 264.1 Sandwell Males 230.9

Key Other

Females 140.3

Care

Sandwell Females 122.2 0

3.2%

100 150 200 Rate per 100,000 residents

Lone parent 250

300

Incapacity Job seeker

Wednesbury town profile

wednesbury

Who lives here?

Wednesbury West Bromwich

Population 2005 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Tipton

Oldbury Rowley Regis

2.5

1.5

0.5

1.5

Quantity in 1000s

Males

2.5

Smethwick

Females

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

88.3% 1.6% 5.8% 0.4% 1.7% 1.5% 0.7%

Source: ONS, Census 2001

People living with a long-term condition

Stroke

598 1.6% 5468 15.1%

Hypertension Diabetes COPD Obesity 0 Source: QOF 2006/07

Percentage shown is percentage of Wednesbury population

1528 4.2%

Coronary heart disease

1459 4.0% 624 1.7% 2698 7.4% 2000 4000 6000 Figure is number of people in Wednesbury

8000

Deaths Top five causes of death Source: ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

Ischaemic heart disease

Circulatory diseases

8.5% 12.2% 10.4%

Cerebrovascular disease Malignant neoplasms of trachea, bronchus and lung

COPD

5.5% 5.4% 5.5% 0

213.4 121.6

Cancers

4.7% 6.4% 3.8% 5.7% 4.8%

135.6

Endocrine, nutritional and metabolic diseases

8.4%

Pneumonia

141.9

Respiratory disease

21.3% 17.4% 19.2%

129.6

All causes 0

100

150 SMR

200

250

Percentage of working age population on benefits 10 15 Percentage

25 Source: DWP date 2008 25%

Alcohol deaths Source: ONS Mortality

20%

Males 38.3 Sandwell Males 27.5

2.6% 2.0%

2.4%

3.5%

1.7%

15% 3.2%

Females 13.2 10%

Sandwell Females 10.3

10.6% 9.3%

20 25 10 15 5 year average rate per 100,000

40 5%

Deaths from smoking

3.9%

4.2%

Wednesbury

Sandwell

0% Source: ONS Mortality / HAD 1995

Males 274

Key

Sandwell Males 230.9

Other

Females 149.8

Care Lone parent

Sandwell Females 122.2

Incapacity 0

100 150 200 Rate per 100,000 residents

250

300

Job seeker

West Bromwich town profile

west bromwich

Who lives here?

Wednesbury West Bromwich

Population 2005 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4

Tipton

Oldbury Rowley Regis

2.5

1.5

Males

0.5

1.5

2.5

Smethwick

Females

Quantity in 1000s

Ethnic Group

White Mixed Indian Pakistani Bangladeshi Black Caribbean Other

76.3% 2.1% 12.5% 1.7% 1.4% 4.1% 1.9%

Source: ONS, Census 2001

People living with a long-term condition Percentage shown is percentage of West Bromwich population

2572 3.8%

Coronary heart disease Stroke

1071 1.6% 10577 15.5%

Hypertension

3080 4.5%

Diabetes

965 1.4%

COPD Obesity

5977 8.8% 0

Source: QOF 2006/07

2000

4000 6000 8000 Number of people in West Bromwich

10000

12000

Deaths Top five causes of death Source ONS Mortality as a percentage of all causes of death

Standardised Mortality Ratio (SMR), all ages, 2004-06 Compared to England

Key Males

Females

Sandwell

Ischaemic heart disease

15.7% 18.3%

Malignant neoplasms of trachea, bronchus and lung

Pneumonia

COPD

Circulatory diseases

10.1% 12.6% 11.3%

Cerebrovascular disease

110.4

Endocrine, nutritional and metabolic diseases

6.7% 4.1% 5.4% 3.9% 6.1% 5%

170.0

Cancers

101.1

All causes

107.4 0

5.3% 3.8% 4.5% 0

111.3

Respiratory disease

21%

100

150 SMR

200

250

Percentage of working age population on benefits 5

10 15 Percentage

25 Source: DWP date 2008 25%

Alcohol deaths Source: ONS Mortality

20% 2.2%

Males 26.0

2.4%

1.7%

2.5%

3.2%

9.0%

9.3%

3.9%

4.2%

West Bromwich

Sandwell

15%

Sandwell Males 27.5

Females 10.6 10% Sandwell Females 10.3 0

20 25 10 15 5 year average rate per 100,000

Deaths from smoking

Source: ONS Mortality / HAD 1995

Males 230

Key

Sandwell Males 230.9

Other

Females 116.3

Care Lone parent

Sandwell Females 122.2

Incapacity 0

100 150 200 Rate per 100,000 residents

250

300

Job seeker

Achievements 2007/08 Awards Ralph Smith Appointed Honorary Research Fellow with the University of Leicester Geography Department. Health Service Journal (HSJ) Award CVD Project, ‘Highly Commended’ in computer-based decision making category, November 2007. CVD Project, ‘top 5’ in chronic disease management category, November 2007.

Achievements 2007/08

Publications Ali S, O’Callaghan V, Middleton J, Little R. The challenges of evaluating a health impact assessment, Journal of Critical Public Health (in press). Ali S, O’Callaghan V, Middleton J. A case study of the ‘Towards 2010’ Programme Health Impact Assessment. Journal of Environmental Assessment Policy and Management (JEAPM) (in press). Middleton J, Sidel V. Terrorism and public health. In Douglas J et al eds. Open University. Reader in Public Health. London: Sage books, 2007. Dean A, Parkes M, Middleton J. Seamless delivery: the work of the Sandwell Joint Policy Unit. Environmental Health News, 9th February 2007, p9. Middleton J, Latif F. Gambling with the nation’s health. BMJ 2007: 334: 828-829. Middleton J. Oceans of work: arms conversion revisited. Book review. Medicine Conflict and Global Survival 2007; 23: 325-327. Middleton J, ed. Cares well? The 18th annual public health report for Sandwell, for 2006. West Bromwich: Sandwell Primary Care Trust, 2007. Middleton J. Environmental health, climate chaos and resilience. Medicine Conflict and Survival, Medicine Conflict and Survival, Volume 24, Supplement 1, S62-S79, April-June 2008. Arif N, Middleton J. Towards an inclusive local economy: the work of Sandwell Ideal for all. Medicine Conflict and Survival, Volume 24, Supplement 1, S114-S117, April-June 2008. Middleton J. Health and human rights in Sandwell and abroad, editorial. Medicine Conflict and Survival, Volume 24, Supplement 1, S2-S7, April-June 2008. Commentary on: Goldberger J, Waring CH, Tanner WF (1923). Pellagra prevention by diet among institutional inmates. Public Health Reports 38:2361-68. cite as: Middleton J (2008). Pellagra and the blues song ‘Cornbread, meat and black molasses’. James Lind Library (www.jameslindlibrary.org). Accessed Friday 21 March 2008 Marshall T, Westerby P, Fairfield M, Chen J, Fairfield M, Harding J, Westerby R, Ahmad R, Middleton J. Evaluation of a pilot project for primary care based prevention, BMC Public Health 2008, 8: 73. Pitches D, Middleton J. Teenage pregnancy: the influence of the school calender. (submitted).

Presentations Shaukat Ali and Ralph Smith Geographical Information Systems (GIS) as a tool for aiding health impact assessments. 8th International Health Impact Assessment Conference, Dublin, 2007. Marie Carroll A collaborative approach to delivering a workplace health programme. Royal College of Nursing Occupational Health Conference, Cardiff. A collaborative approach to preparing local businesses for smoke-free legislation and reducing prevalence in routine and manual workers. A Call to Action! Successful Tobacco Control for the Future. Wales Dr John Middleton Doctor write me a prescription for the blues. Birmingham University, School of Public Health and Music Faculty, January 17th 2007. Commissioning for health and wellbeing, the West Midlands meeting of the Association of Directors of Social Services March 9th 2007. Teaching Public Health Networks. Welcome to the West Midlands Network. Opening presentation, Holly Lodge School, Smethwick, June 7th 2007. Faculty of Public Health Conference Eastbourne. Organised seminar on floor target action plans for spearhead PCTs; presented teenage pregnancy work. June 2007. Environmental health, climate chaos and resilience Birmingham University International Applied social science students conference. Organised by Sandwell PCT, JPU in Sandwell Independent living Centre on Diversity and Health. July 2007. Motovun Istria Croatia, international Summer School in Health Lectures x 2 on mental health policy and alcohol and young people. July 2007. School nursing: from nit nurse to eco warrior? Presentation and participation in school nurses conference. Sandwell, September 2007. Twenty years of Sandwell Health; PCT AGM, September 2007. Black Country Public Health Teaching Network presentation: Casinos, gambling and public health (not registered in FPH submission. 14/12/07) Ralph Smith Mapwell â&#x20AC;&#x201C; 3 decades of Health GIS and joint working in Sandwell. Mapping the way to health: AGI Health Special Interest Group seminar, November 2007 Dr Jenny Chen, Paul Westerby, Mary Fairfield and Dr Tom Marshall The Sandwell Programme: Piloting Cardiovascular Disease Prevention in Primary Care. Faculty of Public Health Annual conference 2007

Conferences organised Dr John Middleton Sandwell Healthâ&#x20AC;&#x2122;s Other Economic Summit, Sandwell PCT, Sandwell Council, Sandwell Independent Living Centre, June 8th 2007 Diversity and health seminar Sandwell PCT, Sandwell MBC, Sandwell Independent Living Centre, Birmingham University Applied Social Studies International Division. July 13th 2007

Acknowledgements This report has been produced by the joint efforts of the following people who either contributed to the writing or provided data and information:

Individuals in the Public Health Team Shaukat Ali Marie Carroll Dr Jenny Chen Dr Chris Chiswell Alan Dean Sam Hay Kath Hosskinson

Acknowledgements

Wafia Hussain Eileen Kibbler Dr Adam Low Dr John Middleton Hope Ojukwu Vicky O’Callaghan Ralph Smith Katie Spence Mary Tooley Dr Kate Warren Dr Richard Wilson Responsibility for the opinions expressed in this report rest with the Editor, Dr John Middleton, Director of Public Health. Any errors or points of clarification that need to be further addressed should be forwarded to him at john.middleton@sandwell-pct.nhs.uk

Additional Information Detailed reports that make up Sandwell’s Public Health Annual Report for 2007/08 are contained on the enclosed CD. It features a full set of the Public Health Archive data sets for reference. ● If the CD is not attached, you can request a copy by telephoning: 0845 155 0500 This document is also available for download on Sandwell PCT’s website. Go to: www.sandwell-pct.nhs.uk and click on ‘Publications’.

Sandwell Primary Care Trust

NHS

Crunch Time for Health in Sandwell Public Health Annual Report 2007/08

This CD contains PDF files in high and low resolution of the Sandwell PCT 2007/08 Public Health Annual Report and further support documents for the annual report

Contents of the CD ● Arts in Health Strategy

● Parenting Needs Assessment

● Arts in Health Strategy Plan

● PCT Patient Public Involvement Strategy

● Bowel Cancer Screening

● Public Health Archive

● Cancer Awareness Case Study ● Carers Strategy

● Report on Sandwell Health Other Economic Summit: Fat Chances for Food and Health

● Draft Anti-Poverty Strategy

● Respiratory Health

● Draft Community Development Strategy

● Review of Children & Young People With Special Education Needs and/or Disabilities

● Draft Personalisation Strategy ● Draft response to the Communities in Control consultation ● Full CLAHRC bid ● Growing Healthy Communities: A Draft Community Agriculture Strategy ● Health Protection Report ● Health Trainers Strategy ● Joint Strategic Needs Assessment (JSNA) ● Leeds University Sandwell Carers Report ● Neighbourhood Employment and Skills Plans (NESPs) for Sandwell Towns

● Sandwell Local Area Agreement (LAA) Implementation Plan ● Sandwell Works ● Scrutiny briefing paper on the Communities in Control White Paper ● UK Research Partnership's report: Nourishing the Local Economy ● Urban Living – older people living in larger properties ● Valuing People: A Review of Learning Disabilities in Sandwell ● Workwell

ISBN 978-1-900471-09-1 Designed and produced by Hyland Freeman Ltd hylandfreeman@btconnect.com Content: Red Cat Communications info@redcatcomms.co.uk