Public Health Annual Report 2008-9 by Alex Hawley

Sandwell Primary Care Trust

Public Health Annual Report 2008/09

NHS

Contents Contents Foreword – by Dr John Middleton, Sandwell’s Director of Public Health

Overview of the Year

Improving Health and Reducing Inequality

Vital Signs

How We Spend Our Money

Director’s Recommendations

Our Achievements in 2008/09

Town Profiles

Acknowledgements

Contents of the CD

Foreword Still crunch time Welcome to the 20th Public Health Annual Report for Sandwell at a time of growing concern for the economic and health futures of those who live and work in Sandwell. This report gives an overview of the Borough’s health in 2008/09 and all of the work being carried out to help and improve the lives and prospects of our communities. 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.

deepening financial restrictions and belt-tightening on our part – as well as everyone else’s. Our job in the coming years will involve careful planning and decision-making about how we spend the resources we have, to reap the greatest benefits for those who live and work in Sandwell. And whilst we must ensure that we target those with health problems effectively – and improve the health of our Borough compared to other more affluent areas – we must not forget those who are healthy.

My last public health annual report, Crunch Time for Health, was written in October 2008 at the very peak of the international credit crunch crisis. The potential collapse of the world banking system led to government interventions in many nations, to stave off the collapse of business and industry and the threat of prolonged depression, unemployment and poverty. In Sandwell the credit crunch resulted in a catastrophic rise in unemployment and dependence on benefits – to a much greater extent than in the rest of the West Midlands. The West Midlands in turn has been the most affected region in the country. This report reflects the effect this has had on the health of our Borough and on our work to address this, at a time of

This report, therefore, goes into some detail about Programme Budgeting – or how to plan what we spend for the best health outcomes. It also considers how we can invest more in healthy people by redirecting a higher percentage of what we spend into prevention and making Sandwell people more knowledgeable about their own health. We are calling this ‘5% for Health’ and I believe this will prove to be a crucial part in improving Sandwell’s overall health in the years to come – when we must ensure that the effects of this economic recession do not echo those of the 1980s. We should be in no doubt: Unemployment kills. It is becoming clear from our current situation, and that of the 1980s, that there is a direct link between economic recession and health. Evidence for the prolonged effect of the previous recession can be seen in the

health of a generation who were young adults at the time. They have not experienced the improvements in health that we would expect and local statistics for the rate of men dying before 65 appeared to increase from 2003 to 2006 and can at best be described as remaining static. Death rates for adults aged 45 to 65 are included on the CD at the back of this document. We need to ensure this doesn’t happen again. My Public Health colleagues and I, working with partners such as Sandwell Council, are committed to doing what we can to improve the Borough’s health and prospects to make sure that we all eventually emerge from the economic recession with better prospects for our health and wellbeing. Dr John Middleton Director of Public Health

Overview Times are tough. Finances are restricted and prospects for the Borough’s economy and health are not in good shape. Given this, it is vital that we target our work appropriately, spend our money wisely – and look at ways of helping healthy people to avoid illness. In this overview, I discuss what we have been doing in some of the areas of work that I feel can have the biggest impact on the challenges we are currently facing. At the back of this report (see page 43) are my recommendations for the future. Other sections of this report summarise specific programmes of work and more detail is available on the CD at the back of this document.

5% for Health How much of Sandwell PCT’s budget should be spent on protecting health and preventing ill health? This was the question posed by the director of commissioning for the Strategic Health Authority at an assessment of World Class Commissioning – an NHS programme to transform the way health and services are commissioned, or bought. In the USA, American health maintenance organisations commit 5% of their total budgets for health improvement and protection. In Sandwell we spent less than 1% on keeping people healthy in 2007/08. An additional 4%, to bring it up to 5%, would make a real difference to maintaining people’s health.

‘5% for Health’ will require the PCT to invest £25 million in healthy people. This is an extremely large amount of money – roughly the amount put into extra funding for hospital services this year. To do this immediately in one year would not be possible. So a planned programme for investment in health improvement and prevention of ill health should be put in place over the next three years – even while health service budgets are being cut. The section on Programme Budgeting explains more about how our money is currently spent and how we can achieve a £25.5 million ‘5% for Health’ investment fund.

It would also represent a clear statement that we value health more and don’t just concentrate our time and money on services when people are sick.

Examples of ways we could invest include:

● Housing and health

● Smoking prevention and tobacco control

● Investing for health (see below) ● Healthy lifestyles

● Cardiovascular risk reduction and the healthy communities collaborative

The Proportion of NHS Spend in West Midlands on Treatment and Prevention

Treatment and management of ill health 98.1%

Prevention 1.9%

Hospital admission

● The proportion of the health service budget spent on prevention in the West Midlands is only 1.9%. In Sandwell, it was less than 1%

Investing for Health People who live in Sandwell have poorer health and shorter lives than people in many other parts of the country. The ‘Improving Health’ section of this report goes into more detail about the health of the Borough and the work we are currently doing to improve it. Investing more in healthy people through a Programme for Health – funded by ‘5% for Health’ and changes in how we actually spend our money – could help us to improve the health and wellbeing prospects for those who live and work in the Borough. 6

With local people ‘fully engaged’ – with greater knowledge about health and how to prevent illness – we could begin to develop a programme of investment for healthy people. The ‘Programme Budgeting’ approach (outlined on page 37) explains how we plan what we spend according to different health problems, how we compare to other similar PCTs and how much we spend on these different conditions.

This way of managing our finances suggests that we should be reducing the amount of money spent in some areas and investing in more efficient and effective services, particularly on preventative services where we can help people stay healthier for longer. Our future health investments should take into consideration some sobering facts: ● Our death rates for all cancers, all circulatory diseases (heart disease and strokes) diabetes and respiratory deaths are higher than the national average ● Compared to similar PCTs, we only spend an average amount for circulatory diseases and for respiratory diseases – so we clearly need to spend much more if we are to make an impact on these preventable and controllable conditions ● Compared to similar PCTs, we only spend an average amount on maternity and infancy. We should continue to invest in preventative health improvement programmes and early life, including breastfeeding and smoking prevention

● We spend more than similar PCTs on diabetes, reflecting the level of need in Sandwell ● We spend less on cancer, compared to similar PCTs and relative to patients’ outcomes ● We are a low spender for mental health in comparison to similar PCTs and need to invest in this area given the likely impact of the recession ● For smoking cessation services, we only spend about the same amount as others when our need is much greater The Programme Budgeting section explains more about how we are spending our money but Sandwell PCT cannot fund all of these things alone. It must work with its partners on the joint investment needed from everyone to improve health in all fields. In some areas there is a clear health service responsibility. For others the health service should be seen as the lead agency and should encourage pooled funding to achieve a bigger benefit than it can do on its own. The health service should also support the work of others to create benefits to health, such as in housing or town planning.

Who pays for what? An overall programme for health would need to include investment in the following areas Health service investment ● Healthy public nutrition ● Increase in physical activity programmes ● Tobacco control ● Control of alcohol-related harm and ill health ● CVD risk programme/healthy communities collaborative ● Chronic disease identification and treatment ● Public information ● Community development ● Expert patients/self-help ● Mental health promotion and resilience ● Sexual health programmes Partnership contributions ● Children’s Centres and a Sure Start Sandwell, through community outreach ● Anti-poverty and welfare rights ● Measures to create healthier environments ● Reducing teenage pregnancy ● Improve skills and job opportunities for young people ● Measures to improve housing for health benefit ● Reducing violence and crime Helping people live healthier lifestyles and tackling health problems earlier – before they become severe illnesses – makes sense financially. There is substantial evidence that this kind of work helps us get better health results for the money

we spend – which adds up to the ‘best buys’ for health services, particularly for things like smoking and alcohol-related work. A detailed ‘league table’ for ‘best buys’ is included on the CD.

Improving Sandwell’s health: our plans People in Sandwell don’t live as long as those in better-off areas of the country – and the reasons for this are referred to as ‘health inequalities’. There’s a whole section of this report that deals with this really important issue and how we are tackling it (See Page 19). We have in place a plan of action to improve the situation called a Floor Target Action Plan. This, along with my evidence, the National Support Team (NST) action plan and its recommendations, are on the attached CD. Alongside the Floor Target Action Plan, we have worked together with Heart of Birmingham Teaching PCT (HoB) to produce a Strategic Model Of Care (SMOC) – another plan – for staying healthy. This outlines the reasons why people die younger in Sandwell and what we will do to change things. The big five causes for premature deaths up to the age of 75 are the same for Sandwell and for HoB patients. They are: ● Cancer ● Heart disease and stroke ● Infant deaths ● Smoking ● Alcohol

The SMOC, which overlaps with many of our other plans, sets out how the whole health system can be involved in helping to prevent illness and maintain and improve health. Major actions include: ● Preventing all the major causes of premature deaths ● Encouraging all parts of the health system to refer people to stop smoking services ● Increasing emphasis on identifying and tackling alcohol problems ● Screening for, and managing, patients at risk of heart disease and stroke, kidney disease, chronic bronchitis and diabetes in the community ● Better and bigger health information in the community ● Creation of health-promoting environments in all health service facilities ● Improving the health of health service staff and being health-promoting organisations

Setting our priorities In my last annual report I recommended a massive shift in spending towards preventative and community health measures to stop people developing the same illnesses as their parents before them.

It backs up the priorities set by the Government-led World Class Commissioning (WCC) programme – which is aimed at dramatically improving the way health services are commissioned, or bought.

I also recommended that the health services should aim to behave as a good corporate citizen – by doing everything in their power as a member of the Sandwell community to provide better jobs, education and healthier environments and maintain a safer secure community.

These WCC priorities are: ● Reducing infant deaths, with a specific initiative to improve breastfeeding rates ● Reducing teenage pregnancy ● Reducing alcohol problems ● Preventing and treating diabetes better ● Providing better support for people with neurological conditions ● Improving access to psychological therapies for people with common mental health problems ● Reducing cancer deaths by reducing smoking ● Reducing deaths from heart disease and strokes ● Improving end of life care

A five-year strategy, ‘Invest Well’, has now been produced and it aims to reduce the gap in life expectancy between Sandwell and the rest of the country by 15% by 2015. This would prevent 154 deaths per year in 2015. The full five-year ‘Invest Well’ strategy is included on the CD.

The WCC priorities and our Invest Well strategy run alongside the aims of our Local Area Agreement (explained in the Improving Health section) and those of the Right Care Right Here programme. Right Care Right Here, formerly the ‘Towards 2010’ programme, agreed a Charter for Health Improvement clearly stating its top 20 aims. A summary is below and full details are on the CD.

Right Care Right Here 20 things we will do to improve the public’s health 1. Reduce health inequalities by reducing income inequalities 2. Reduce the difference in inequality in life expectancy by 10% by 2010, and by 25% by 2020 3. Support basic skills development in adult education – especially black and ethnic minority groups, young people, people with learning disabilities and white, unemployed men over 50 4. Promote and contribute to a network of early years support: Sure Start 2010 5. Develop services for and with young people to give them the best chance of achieving good health and a satisfying role in their communities 6. Ensure people over 65 enjoy their full health potential and play an active social role 7. Ensure that people’s psychosocial wellbeing improves and that comprehensive services are available and accessible to people with mental health problems 8. Reinforce our immunisation programmes to re-establish 90%-plus rates for childhood immunisations to prevent the threat of measles, rubella, whooping cough, diphtheria, polio, tetanus, haemophilus, meningitis and mumps 9. Reduce non-communicable disease, such as heart disease, diabetes and cancer 10. Reduce injury from violence and accidents 11. Promote a healthy and safe physical environment 12. Promote and contribute to housing improvement which benefits health (safe and secure, accessible and supportive and affordably warm) 13. Encourage regular exercise and making active lifestyles, like walking and cycling, easier, safer and attractive 14. Create smoke free public places and workplaces, inside and outside the NHS 15. Support development of healthier food access – making good food easier to buy locally 16. Support the development of alcohol problem services in the community to treat alcohol problems earlier and reduce the harm caused by alcohol 17. Provide better, more efficient, more accessible services for people with sexually transmitted disease 18. Expand primary care services to adopt a ‘whole population’ approach identifying ill health early, using register-based care and developing expertise in maintaining the health of people with chronic illness 19. Remodel services for patients with long-term conditions 20. Make communities’ voices heard by encouraging user-led and user-owned services

Rationing and Efficiency The credit crunch has had a massive effect on everyone and, as the country’s finances are brought back into line, the NHS faces a future of reduced public funding from 2011/12. Those of us working to keep people healthy now have to deliver the same, or more care, but at less cost: something which means expert management on our part. The scale of savings needed by the NHS cannot be achieved by budget cuts alone. We must use practical actions to improve efficiency and get more done for the same amount of money or less to use healthcare more efficiently and to ensure that the involvement of our partners to improve health is supported through pooled funding. All of the directors of public health in the West Midlands met in the summer of 2009 to discuss the best ways of cutting costs and spending money most effectively. The whole discussion paper is included on the CD but, in summary, they suggested five top areas for health investment: 1. Same or better care, at lower price 2. Better care, same price 3. Reduce volume of services 4. Stop completely 5. Maintain or increase in order to save in the future There are tough choices ahead. Not all of them will be palatable or possible but the NHS faces massive reductions in finances which have not been seen since the 1980s. If crude budget cuts don’t happen, other choices will have to be made to increase efficiency and ensure the vast majority get the care they need. 12

Against this backdrop, preventing ill health is becoming really important because it can save lives – and money. If we can do more to help people avoid becoming ill, it will mean fewer people will need treatment or hospital care and will help them live longer. We can do this through better screening and information services at people’s GP practices and public policy changes can also make a difference. For example, the national smoking ban has seen a drop in the number of people having heart attacks. Savings from prevention of home accidents and alcohol intervention are also possible. There are a number of ways in which the NHS can reduce its costs but also continue to increase treatments and services. Some of these, such as staff redundancies, cutting back on expensive treatments and reducing training, are among the least desirable. Top of the list for action is prevention of illness and keeping people healthy. We also need to improve the way we plan our spending and look at ways of saving money or spending it in different, more effective, ways by using Programme Budgeting effectively. Peter Spilsbury, Executive Director of Performance and Regulation for the Strategic Health Authority, has looked at these and put together an ‘economic resilience programme’ – a way of strengthening financial planning. This can be found on the CD.

Payment by results? A new national tariff, or ‘price list’, was introduced this year to ensure every healthcare provider across the land is paid the same for the work they do. Sounds fair? In reality, it meant Sandwell PCT instantly had to pay out £10 million to hospitals for no extra treatments and no improvement in quality. A further £9 million has been paid out to hospitals at the time of writing. So what are we paying extra for? We have been required to pay more for technical things like coding and definition changes – work we have not seen as priority in our published spending plans – and for work which we have had no evidence of benefit to Sandwell people. This has meant that vital schemes to reduce ill health have not gone ahead.

This scheme, called Payment by Results, has encouraged more hospital activity throughout the year, particularly at Dudley hospitals, and has meant that the health system has been working in the same way as the banking system. Just as banking should create wealth, not just more activity in the money markets, health services should create health, not more activity for the health services. It is a cliché that the National Health Service is a ‘national sickness service’ but what few people realise is that the way in which we pay hospitals gives them the same income if all their patients come out of hospital alive or dead.

Saving lives through spotting illness early Going to the doctor’s is something everyone does and is many people’s only contact with the NHS and health services. It is therefore right that we should use primary care – GPs’ practices – as a way of addressing the health inequalities in Sandwell. The NST recommended we actively search out patients at high risk of dying prematurely and provide treatments we know will work to reduce that risk and save lives. We have done this to great effect through our cardiovascular (CVD) risk management programme in primary care which is explained in the Vital Signs section (see page 27). The key to its success, which has seen more than 6,000 people screened for CVD, has been in the way GP practices have their performance managed to make sure they reach certain targets in their treatment and care of patients. We have created the Clinical Dashboard – which will tighten up targets to meet the best practice guidelines, give a fuller

picture of the management of conditions and allow practices to compare themselves with others in Sandwell. We have started with CVD, and all of the different conditions included under this name, because of the large number of people who suffer from it and the lives that could be saved. The ‘Dashboard’ includes markers or targets for each CVD condition and the average performance by the GP practice – enabling comparisons to be made across the Borough and any issues to be picked up early by the CVD prevention team. It gives us a more reliable means of determining the true levels of ill health in the community for the first time. The next stage is to expand the system for other big killers and causes of chronic disease, such as COPD, diabetes, high blood pressure (hypertension) and stroke. These have been picked because of the number of people affected.

Facts and Figures ● ● ● ●

4.8% of people in Sandwell – that’s 16,188 people – have diabetes 1.7% - or 5,806 people – have chronic bronchitis 3.6% - or 12,077 people – have heart disease 14.6% - or 49,413 people – have high blood pressure

Healthy communities and healthy hearts Working closely with people to help them improve their own health is showing signs of real success – and is something we should consider investing more in. The healthy communities collaborative was set up in the Soho and Victoria ward in Smethwick – the ward with the highest, and increasing, rate of cardiovascular deaths in 2006. The programme has combined primary care (GPs’ surgeries), public health and community development and community and voluntary organisations to improve health and reduce heart disease. It is made up of: ● A nurse-led programme of cardiovascular risk reduction for those people with a 20% risk of having a heart attack in the next ten years ● A health trainer programme for those at lesser risk (15%) (see page 16 for case studies showing how effective they are) ● A programme for everyone of ‘buddying’ support for healthy lifestyles, using volunteers from established community organisations New evidence from hospital statistics suggests that there has been a substantial reduction in admissions due to coronary heart disease to all of the hospitals receiving Sandwell residents: from 512 in the first quarter of 2006 to 393 in the second quarter of 2008 – that’s nearly 500 per year.

reducing heart disease and we need to review how we invest in treatment, prevention and care for heart problems. We should consider how much the healthy communities collaborative costs us and what it could save us if it were expanded. Nurse and health trainers break down to £100,000 and the healthy communities programme was also about £100,000. If this were expanded across all the electoral wards of Sandwell, it would cost around £4.2 million each year. If we targeted highest risk areas first – such as Great Bridge, Glebefields and Friar Park – this would come to between £500,000 and £2.1 million, including recruitment and training. This could mean savings of around £200,000 by the prevention of hospital admissions for heart patients.

Some of this may also be due to the national smoking ban in public places and our cardiovascular risk reduction programme. Whatever the reasons, it does suggest major improvements in 15

The Benefits of Health Trainers (HTs) Case Studies Example 1: A 73 year-old man ● Referred within practice for weight management support ● BMI 28 Outcome after 4 months ● Weight loss 18lbs ● BMI 25 Example 2: 58 year-old man ● Manic depressive ● CVD risk 20% - Cholesterol 8 ● Treatment Simvistatin and referral to HT ● Anticipated outcome reduction of cholesterol to 6 Outcome after three months of combined drug and lifestyle change ● CVD risk 11% ● Cholesterol 4.6 Example 3: 18 year-old Pakistani woman ● Referred within practice for lifestyle advice ● Initial assessment identified blood pressure and pulse irregularities. Referred to GP ● Two-week review with HT saw the same results. HT spoke to GP who saw patient next day Outcome ● The patient was hospitalised with an abdominal growth ● The GP personally thanked the HT for highlighting the abnormality and good communication skills ● Referrals in this practice have increased as a result

Smoking: getting to the nub of things We now know roughly how many people smoke in Sandwell after analysing 150,000 of those who live here. This is the largest sample size we have ever had and it gives us the potential for smoking status information for the whole population of 287, 494. When it comes down to actual numbers, we estimate that 27% of people in the Borough are smokers – that’s more than 62,000 people and is 6% above the national target of 21%.

It costs us a lot to support people who want to quit smoking so it would clearly be much better if they didn’t start in the first place – so programmes to prevent children taking up the habit are really important. The cost for helping smokers to quit needs to be supported by major investment in tobacco control, education, enforcement and social marketing.

We were planning on reaching that target by 2010 but we are likely to miss it. However, we will continue to aim for that reduction with a more realistic target date of 2013 to 2014. If we reached this, it would mean around 13,912 fewer smokers in Sandwell.

Housing and health Cold kills and the houses people live in play a big part in how healthy they are. By working with others, such as the council, we can find those who are most at risk and do things to prevent them becoming ill or dying. We believe that carrying out action in 450 high-risk homes a year could contribute to preventing 153 deaths, 108 other hospital admissions and 189 GP consultations. A special Housing Health and Safety Rating System is used to identify the main risks to people’s health based on how cold their homes are. The different outcomes to their health are put together in a table, called the Class of Health Outcomes for Excess Cold. More details about this are on the CD. Sharing our resources will have the biggest impact. By using PCT money in support of much larger housing improvements by the housing agencies –

Sandwell Homes, Sandwell strategic housing and Urban Living – we could shape more housing investment towards health improvement goals. If the NHS agreed to invest £1 million in a pooled budget for which housing agencies agreed to invest £4 million, the £5 million total could be spent on alleviating winter deaths – preventing 765 deaths and 540 hospital admissions. This would enable the closure of 10 hospital beds and, more importantly, it would save the PCT £1,188,000 which could be reinvested for health improvement. It could agree to reinvest the money in housing-related health improvement. The case study shows how, if all agencies worked effectively together, we could have a real impact – not just on our finances but on the health prospects for some of our most vulnerable citizens.

Housing and Health: A Case Study Mr and Mrs X both have serious health problems. She is in hospital recovering from pneumonia and he is in respite care with Parkinson’s Disease. Mrs X should go home – but when her house was assessed by occupational therapists it was found to be too cold, with just one electric fire, so she couldn’t leave hospital. The council’s Sandwell Warm Zone was asked to help them get central heating but, as they were all electric, a gas supply would take eight weeks. Storage heaters would cost a fortune to run so were not the best solution. Better co-ordination between all of the different agencies would have made a real difference not just to their health – but the cost to the NHS. The average household fuel bill is around £1,250 a year. The cost of one hospital admission is £2,200. If their home had been assessed before Mrs X went in to hospital, the heating would have been sorted by the time she was better and she could have left hospital quickly to a warm home. It’s also possible that the cold house caused, or contributed to, her illness in the first place. So if her home had been assessed earlier something might have been done to help prevent her illness and hospital admission – and her husband’s need for respite care. 18

Improving health and reducing inequality We want people who live in Sandwell to be healthier, safer and live more active and fulfilling lives. At the moment, those who live in the Borough aren’t as healthy and die younger than people in other areas of the country, for all kinds of different reasons. Our job is to identify these ‘health inequalities’ and take action to reduce them. We cannot do this on our own and so we work with other organisations like Sandwell Council and Sandwell Partnership who can have an effect on improving people’s lives in many different ways.

The work that we do is delivered through the Sandwell Health Inequalities Strategy and the Local Area Agreement – a plan of action agreed with the Government. This plan has nine ‘top priorities’ which are: ● More and better homes ● Improved health ● Supporting independence ● Less high volume crime ● Giving children a good start in life ● Successful young people ● Cleaner, safer, active communities ● More people in employment ● Better educational attainment This section explains more about the current health of Sandwell people, what we have been doing over the last year to improve things and what we will be doing in the future.

Health inequalities Health inequalities are the differences in health that are found across different geographical areas, between genders, people of different ethnic origin and between different social and economic groups.

● Reducing seasonal excess deaths

By collecting information from evidence across the country and from experts, we can see which things affect health inequality and where we should target our work to improve things. These are:

● Tackling poverty

● Spotting cancer and respiratory disease early

● Improving information and intelligence

● Preventing cardiovascular disease through primary care (at GP practices) ● Managing cardiovascular disease in hospital ● Reducing chronic obstructive pulmonary disease (COPD)

● Smoking cessation and tobacco control ● Services to support alcohol and drug dependency ● Infant deaths ● Other contributing factors (diabetes, mental health, children and young people) ● Addressing quality and poor performance in primary care ● Communication: making tackling health inequalities everybody’s business Our target is to reduce health inequalities by 10% by 2010, as measured by infant mortality and life expectancy at birth.

The health of the Borough People who live in Sandwell have a shorter life expectancy than those in more affluent parts of the country and because of some of the lifestyle choices they make – like smoking, lack of exercise and drinking too much.

The areas in Sandwell with lowest life expectancy for women (page 23) are:

In Sandwell, male life expectancy has been rising since 1997 but fell last year slightly to 74.4 years compared to the national average of 77.7 years. Life expectancy for women has continued to rise and has gone from 78.6 in 1997 to 80 years now. The national average is 81.8.

● Hateley Heath

Both are below the national average, but now there is a significant gap in Sandwell between men and women. The difference between the wards with the lowest to highest life expectancy is between seven and nine years, showing inequality across the Borough, regardless of gender. Life expectancy is not the same across the Borough. Using averages over three years, a man living in Abbey ward is expected to live nine years longer than someone in Soho and Victoria wards (79.7 years compared to 70.7). Similarly for women, life expectancy in Old Warley ward is 84.2 compared to Tipton Green and Great Bridge wards, which is 77.4 years – a difference of nearly seven years. The areas in Sandwell with lowest life expectancy for men (page 22) are:

● Soho and Victoria ● Tipton Green ● Great Bridge ● Wednesbury North According to the Department of Health, the main reasons for the gap in life expectancy between Sandwell and other areas in the country are: ● Circulatory diseases, such as heart attacks and stroke ● Cancer ● Respiratory disease ● Digestive diseases ● Infant deaths (aged under one year) Figures show the main causes of death in the Borough are circulatory disease, mainly strokes and heart disease, and cancers – in particular lung (page 24). Infant mortality remains high in Sandwell. Across England deaths have declined over the last 10 years from 5.7 to 5.0 but in Sandwell the rate has not changed dramatically and latest figures for 2005-07 show 7.2 per 1,000 live births – which is higher than the West Midlands and national averages (page 25).

● St Paul’s ● Smethwick ● Soho and Victoria ● West Bromwich Central and Tipton Green

Life Expectancy at birth across Sandwell Wards Males, 2006-2008

Life Expectancy at birth across Sandwell Wards Females, 2006-2008

Major causes of death by sex for all ages, Sandwell in the last five years (2002-2006)1 Heart failure

2.8 1.5

Dementia

3.1 1.3

Other diseases of digestive tract

3.3 2.2

Other respiratory disease

3.5 3.2

Other circulatory disease

3.8 2.9

Females Males

COPD

4.6 5.5

Pneumonia

6.0 4.4 4.0

Lung cancer

7.8 13.1

Cerebrovascular disease

9.6 16.0

Ischaemic heart disease

20.8

0 1

5 10 15 20 Percentage of deaths (%)

Pubic Health, Joint Strategic Needs Assessment 2008

How Sandwell compares to others Sandwell is one of 70 council areas and 62 PCTs across the country that make up the Spearhead Group: a group identified as needing drastic action to improve health inequalities. All of those included are in the bottom fifth nationally for three or more of the five things that have a big effect on health inequality. These are: ● Male and female life expectancy at birth ● Cancer death rate in under 75s ● Cardiovascular disease death rate in under 75s 24

● Average score in the Index of Multiple Deprivation 2004 This group also contains more than a quarter of the population of England (28%) and 44% of the black and minority ethnic (BME) population. The Department of Health has reported on progress being made by the Spearhead areas to improve health inequalities. Sandwell is not doing too well but we are not alone in under-performing, with 37 of the 70 areas also ‘off track’ for both male and female life expectancy.

Infant death rates - 3 year moving average Sandwell PCT 1997-2007 10 9 8 7

Rate /000

6 5 4 England and Wales 3 West Midlands 2 Sandwell 1 0

97-99

98-00

99-01

00-02

01-03

02-04

03-05

04-06

05-07

What have we been doing to improve things In the last year we have been working hard to tackle the things that affect people’s life expectancy and close the gap in the things that create health inequalities here in Sandwell. The main things are: circulatory diseases, which include heart-related problems; chronic obstructive pulmonary disease (COPD); seasonal excess deaths; smoking cessation; alcohol and drug dependency; infant mortality; poverty; information and intelligence; quality and performance in primary care and communication. Information on the work we have been doing to improve the health of people’s heart, childhood obesity and teenage pregnancy can be found in the Vital Signs

section (see page 27). Full details of our work in all areas can be found on the CD at the back of this report. Highlights include: ● Redesigning the COPD services and identifying ‘hot spots’ ● Carrying out a winter warmth campaign for seasonal excess deaths ● Promoting annual ‘flu jabs’ ● Increasing access to smoking cessation support by exploring the use of social marketing ● Working with the fire service, customs and others to promote the ‘quit smoking’ message 25

● Establishing the Alcohol Brief Interventions Scheme

● Auditing the risk factors for infant deaths

● Working with police, shops and licensing body to reduce anti-social behaviour

● Improving the nutrition of pregnant women

● Appointing an anti-poverty lead ● Establishing programmes to help with skills and unemployment, such as Routeways to Health, apprenticeships, Workwell and Job Link ● Improving sex and relationships education

● Appointing breastfeeding co-ordinators to increase breastfeeding and signing up to the UNICEF Baby Friendly initiative ● Exploring social marketing techniques for cancer, smoking and alcohol ● Producing a GP information pack promoting lifestyle services

● Using new software to audit GPs’ performance against clinical standards

What are we planning to do? We have plans for the coming year in all of the main areas that contribute to health inequality in Sandwell. These include: ● Extending the healthy communities collaborative and communities for health programmes ● Increasing diagnostic services within primary care (GP practices) ● Increasing prompt referral for a range of treatments for heart patients ● Adding COPD screening to cardiovascular disease (CVD) risk screening ● Setting up a list of people most vulnerable in colder weather and offering a range of services to help ● Using social marketing to target smoking cessation information to priority groups such as manual workers and pregnant women

● Promoting health growth and healthy weight for children ● Improving information, intelligence and communication with the public, stakeholders and partners to get the message across that tackling health inequalities is ‘everyone’s business’ More details can be found on the attached CD.

Vital signs It is vital that the performance of PCTs across the country is monitored to see how they well they are doing at keeping people healthy. This is complicated because every area has different needs – so the Department of Health set up the performance framework for the NHS (Vital Signs) to analyse all of the things that affect the performance of PCTs. This includes their effort and how they prioritise their work as well as things that are out of their control such as: crime; social deprivation; social class; the size of the ethnic minority population; poor education; population density; low earnings and unemployment.

Each area of health that is analysed is called a ‘marker’ and the PCT is given a predicted score or ‘outcome’ for each – which can then be compared to the actual outcome to show how well the PCT is doing. Here in Sandwell, we have been put into a group of similar PCTs by the Healthcare Commission so that our performance can be compared to see if we are doing better or worse in each of the health ‘markers’. The information we have put together compares us directly with local PCTs such as Wolverhampton, Dudley, Heart of Birmingham and Birmingham East North PCTs.

Our Performance: At-a-glance We have done well in: ● Better than predicted outcomes in teenage pregnancy rates, female death rates, cancer and suicide death rates ● Ensuring uptake of the diphtheria, tetanus, pertussis and polio (DTP&P) vaccine ● Getting lower than predicted childhood obesity rates for four to five year-olds We haven’t done so well in: ● Preventing male deaths and deaths from cardiovascular disease ● Uptake rates for the measles, mumps and rubella (MMR) vaccine ● Lowering childhood obesity rates for children aged 10 to 11 years

Our Performance: In Detail Our performance is measured by looking at information about our work in the following areas:

● Cancer deaths ● Suicide deaths The information was put into graphs for each and these show how we were predicted to perform, how we actually performed and how we compare to similar PCTs.

● Childhood vaccinations ● Childhood obesity ● Teenage pregnancies ● Deaths

Here, we explain the results and what we are doing in each type of health issue.

● Cardiovascular deaths

Childhood vaccinations: DTP&P (diphtheria, tetanus, pertussis and polio) In 2007/08, the uptake rate of this vaccine was better than predicted in Sandwell, with 82.9% of under-fives receiving it (including the booster). Compared to similar PCTs we were average at this, but we have done better than some of our neighbours such as Heart of Birmingham and Wolverhampton. Graph 1: The differences between actual and predicted uptake of the DTP&P vaccine by age five years in 2007/08.

Islington

Nottingham

Newham

Wolverhampton

Blackburn

Knowsley

Sandwell

Dudley

Tower Hamlets

Middlesbrough

Manchester

Birmingham East & North

-10

Blackpool

-5

Salford

Liverpool

Walsall

% difference

Hull

Heart of Birmingham

better than predicted

PCT

worse than predicted PCT

MMR (measles, mumps and rubella) We aren’t doing so well in reaching our predicted result for the MMR vaccine with only 77.2% of under-fives receiving both doses in 2007/08. This was worse than predicted and worse compared to similar PCTs.

September 2008 and our GPs worked hard to increase the number of children up to the age of 18 having the MMR jabs. We also ran publicity campaigns about the importance of receiving both doses of the vaccine and those carrying out the immunisations also received updates on their importance.

Graph 2: The differences between actual and predicted uptake of the MMR vaccine by age five years in 2007/08 10

-10

Blackburn

Knowsley

Tower Hamlets

Manchester

Salford

Heart of Birmingham

-8

Birmingham East & North

-6

Blackpool

-4

Middlesbrough

Islington

Newham

Hull

Liverpool

Dudley

2 Walsall

% difference

Sandwell

Wolverhampton

PCT

-2

better than predicted

Nottingham

To address this, we took part in a national ‘catch-up’ programme launched in

worse than predicted

PCT

Childhood obesity Obesity is a real problem in Sandwell for both young and old alike and only radical action on top of individual behaviour change will make any difference. In 2007/08 there were actually fewer obese four and five year-olds and we compared well with other similar PCTs. However, the figures were misleading because the information against which they were measured was not detailed enough.

As the proportion of children measured in the year group increased, the obesity level has gone up. In 2008/09 we expect the figure will be higher but will be more accurate. For ten to 11 year-olds, there was more obesity than predicted in Sandwell in 2007/08. This was worse compared to similar PCTs and worse compared to all our local PCTs (except Wolverhampton). The prediction for obesity in this age group was set at a time when measurement coverage was low. 29

Since a team of school health nurses began collecting the data, coverage has increased and the figure for the prevalence of obesity has therefore become more accurate. The results show there were around 7,687 obese and overweight children in Sandwell primary schools in 2007/08. To tackle the issue, a plan of action has been put together, combining goals for obese adults and children. ‘Wellfit’, a food and physical activity weight management programme, is now being developed alongside ‘Fab Tots’ – a health promotion and obesity prevention programme for young children. This will be carried out in children’s centres in 2010 following staff training. Tackling obesity does not come cheap. The average cost of providing a family-based child weight management

programme is approximately £500 per family (one child, one adult). To 'treat' all overweight and obese children currently in primary schools would therefore cost more than £3.8million. To provide programmes for 10% of the obese and overweight child population would still cost £384,500 and would involve providing 64 programmes, each with 12 children, across the Borough. This is unlikely to be a real solution, especially when combined with what we know about children’s eating habits. Children know about healthy eating but they successfully separate this knowledge from their own eating practices – and many live in households where parents are also obese which in itself is a risk factor for childhood obesity. School meals have improved, but the take up is very low.

Teenage pregnancies Sandwell has a bad reputation for teenage pregnancy rates – but our hard work is having a positive effect. We are doing better than expected for teenage conception rates, which includes 15 to 17 year-olds. Figures from 2006 show there were fewer teenage pregnancies than Vital Signs indicators predicted – but the rate was still high at 62.7 per 1,000 teenage girls. To address the issue, we are continuing to deliver our teenage pregnancy strategy. This aims to: ● Improve sex and relationships education ● Improve access to contraception and sexual health ● Target work with young people most at risk 30

● Provide services to pregnant teenagers and teenage mothers and fathers The way services are delivered needs to change to make a difference and we are tendering to provide these where we think they are most needed, based on a review of our work and consultation with young people themselves. Our tenders include: ● A new service to provide sex and relationships education to black and ethnic minority and dual heritage young people. This followed a review of our work which showed these are most at risk of teenage conception ● A new Borough-wide service for contraception and sexual health services. This would replace the current system where different providers offer different services in different places

We donâ&#x20AC;&#x2122;t just work alone in tackling this issue. In the last year we have worked with sexual health commissioners to develop a new contraception and sexual health service at Sandwell College called the Condom Project. It was so successful it will run again in the coming year.

Young people themselves are also crucial partners. They get involved in our work in all kinds of ways, including the peer education programme and we have secured support from the Working Neighbourhoods Fund for a new programme to be delivered.

We are also working closely with colleagues at the council to develop plans for targeted and integrated Youth Support which provides a fantastic opportunity for strengthening work with vulnerable young people to prevent unwanted pregnancies.

A number of young people also took part in a Mystery Shopper Project this year, visiting local pharmacies that offer free emergency contraception to under 18s and providing feedback on their services.

Blackpool

Manchester

Tower Hamlets

Walsall

Blackburn

Salford

Sandwell

Dudley

Heart of Birmingham

City and Hackney

Islington

Middlesbrough

-10

Newham

-5

Knowsley

Nottingham

better than predicted

PCT Wolverhampton

Liverpool

Difference in pregnancy rate

Hull

Birmingham East & North

Graph 3: The differences in conception rate in girls aged 15-17 years, per 1000 girls, in 2006

worse than predicted PCT

Deaths More people are dying in Sandwell than expected, according to the Vital Signs project. Twenty more people died in the Borough during 2005 to 2007 than was predicted. This was an average finding when compared to similar PCTs, but we were the worst when compared with our local PCTs.

Men in particular fared badly. In 2005/07 in Sandwell 38 more men died than predicted â&#x20AC;&#x201C; a number that was worse than other PCTs in our group as well as our neighbouring PCTs. This was not the case for women, with 15 fewer dying in the Borough during 2005 to 2007 than was predicted. Compared with other PCTs, we were in the top half of results.

Graph 4: The differences in actual and predicted death rates in 2005 to 2007

-100

Blackpool

Liverpool

Blackburn

Manchester

Newham

Islington

Hull

Salford

Nottingham

Knowsley

Wolverhampton

Middlesbrough

-80

Heart of Birmingham

-60

Birmingham East & North

-40

Dudley

-20

City and Hackney

Sandwell

Tower Hamlets

Walsall

Death rate difference

better than predicted

PCT

worse than predicted

Cardiovascular (CVD) deaths Sandwell has the highest rate of deaths from heart-related illness in the whole of the West Midlands – and is among the highest 12% across the whole country. The figures that we have for 2005/07 show more people died from heart disease than expected and our performance against other similar PCTs put us in the bottom half of the group – but more recent figures suggest that things are now improving (graph 5). Action is being taken to get Sandwell’s hearts in better shape and help prevent deaths from cardiovascular disease (CVD) – the overall name for a group of conditions such as heart disease and stroke. One of our main developments has been setting up a CVD Primary Prevention Programme made up of a team of dedicated nurses. These have been visiting GP surgeries to identify and screen people who might be at risk of heart problems. All of Sandwell’s GP practices support this work and by the end of 2009 screening will be taking place, or will have taken place, in every practice in the Borough. Since it began, 6,623 people have been screened with 1,532 of them identified and treated for CVD. A further 435 have been referred into diet and activity programmes and 347 people have been referred for help to quit smoking. Other developments this year include: ● Investing in a cardiologist and cardiac technicians based in the community ● Expanding the community-based nursing team

● Making paperwork electronic to improve the way different teams work together such as physiotherapy and the physical activity, which improves rehabilitation for patients ● The appointment of 22 Health Trainers at GP surgeries. They give intensive support close to home, to help people make changes to their lifestyles to improve the health of their hearts ● Setting up a Clinical Dashboard – a way of checking and comparing the performance of all GP practices in the Borough to make sure they reach certain targets in their treatment and care of CVD patients We have also been tailoring our work to ensure we target those at highest risk of CVD. This has included: ● Mental health patients, screened in the community and through Sandwell Mental Health Trust ● Those with learning difficulties checked for CVD signs as part of their physical health annual review ● Screening close relatives of patients with early acute coronary syndrome. Of those screened through this programme, 82% received at least one follow-up referral ● Working with local people through the Healthy Communities Collaborative to carry out ‘mid-life MOTs’. Those at high risk of CVD are told where they can get help or are referred to us ● Using our trained health development workers to improve awareness and education about CVD and diabetes and help with screening 33

-15 -20

Newham

Manchester

Blackpool

Knowsley

Islington

Sandwell

Liverpool

Blackburn

Hull

Wolverhampton

Birmingham East & North

Middlesbrough

-10

Tower Hamlets

-5

Walsall

City and Hackney

Dudley

Death rate difference

better than predicted

PCT

Nottingham

Salford

Heart of Birmingham

Graph 5: The differences in actual and predicted cardiovascular death rates in 2005-2007

PCT

worse than predicted

Cancer deaths Our performance for cancer deaths has been really good compared to PCTs locally and nationally.

signs of cancer. They also revealed there was low awareness of certain risk factors for cancer, such as:

Fewer people died from cancer here in 2005/07 than was predicted by Vital Signs and, compared with similar PCTs, we were in the top five. We performed better than Walsall, Wolverhampton and Heart of Birmingham and, when we compared to all other PCTs in the country, we were in the top third (graph 6).

● Eating less than five portions of fruit and vegetables a day

Despite our good performance, there is plenty of room for improvement and we should not be complacent.

● Being over 70 years old

In the last year, we carried out a Cancer Awareness Measure (CAM) survey to find out people’s attitudes and knowledge about cancer. The results were quite revealing. They showed that almost a third of people were unable to name any warning 34

● Eating red or processed meat once a day or more ● Doing less than 30 minutes of moderate physical activity five times a week. Another survey which asked people about their beliefs and attitudes towards cancer found some people saying: “Apart from lung cancer and smoking, there is nothing you can do to stop yourself getting cancer.” “It’s just the luck of the draw.”

To address this gap in awareness and improve treatment, management and prevention, we are developing a cancer strategy for Sandwell. It will help to improve awareness of cancer symptoms and screening, therefore providing better care.

have employed a cancer screening nurse to boost the number of those in specific groups who are reluctant to get screened. In the last year we carried out five cancer awareness road shows across Sandwell to find out about peopleâ&#x20AC;&#x2122;s lifestyles and to promote awareness of ways they can reduce the risk of cancer. We plan to carry out four of these every year.

We are also increasing the number of people who are screened so cancer can be picked up at an earlier stage and we

Graph 6: The differences in actual and predicted cancer death rates in 2005-2007

Blackpool

Liverpool

Newham

Tower Hamlets

Salford

Blackburn

Wolverhampton

Islington

Hull Knowsley

Walsall

Sandwell

Nottingham

PCT

Heart of Birmingham

-15

Birmingham East & North

-10

Dudley

-5

City and Hackney

Death rate difference

Middlesbrough

PCT

better than predicted

Manchester

worse than predicted

Suicide deaths The death rate from suicide in Sandwell was less than predicted between 2005 and 2007 and we are in the top five of similar PCTs for having better than predicted rates (graph 7). For more information about the data, methodology and indicators used in this section, see the relevant documents on the CD.

Graph 7: The differences in actual and predicted suicide death rates in 2005-2007

3 4

Hull

Wolverhampton

Islington

Nottingham

Blackburn

Newham

Middlesbrough

Liverpool Manchester

City and Hackney

Salford

Sandwell

PCT

Heart of Birmingham

Walsall

Knowsley

Dudley

Birmingham East & North

Suicide mortality difference

Tower Hamlets

PCT

Blackpool

better than predicted

worse than predicted

How our money is spent Planning how we spend our money is vitally important because we need to make sure that we meet the health needs of everyone in Sandwell. All of the different health problems we spend money on are referred to as ‘programmes’ and each has a different amount of money, or budget, according to people’s needs. Programme Budgeting is a way of assessing investment in health programmes rather than services – in other words, it is a way of addressing the health problems of Sandwell people. There are 23 programme budget categories used to describe how the NHS spends its money across the whole of the country. Here in Sandwell our spending is compared to similar PCTs, according to the amount we have spent on each health problem.

5% for Health Creating an extra 5% in our total budget to be invested in health in Sandwell will not be easy – and will involve changing the way we spend our money to stop healthy people becoming ill. In order to create that 5%, a total of £20.44million needs to be made available from each health programme area across the board. An 8% reduction in all the programme areas with a budget of more than £20 million could generate a total investment fund for health of £25.5million. This money could be spent to help prevent people becoming ill by reinvesting in the health programme area itself, improving the quality of patient information or in other areas.

We hope to demonstrate how Programme Budgeting can be used for planning better health improvement and health care for the future.

What have we spent the money on Using the information collected for 2007/08 we can see that, compared to similar PCTs, this is how Sandwell PCT currently spends its money:

These areas accounted for 35% of the money Sandwell PCT spent in 2007/08.

We are in the top fifth for spending on these health problems:

● Infectious diseases

● Dental ● Learning disability ● Adverse effects and poisoning ● Vision

We are in the bottom fifth for spending on these health problems: ● Cancers and tumours ● Trauma and injuries ● Healthy individuals ● Mental health disorders

● Endocrine, nutritional and metabolic ● Neurological ● Skin and blood disorders

Where we spent most ● Mental health disorders - £133 per head, per year ● Problems of circulation - £127 per head per year ● Dental problems - £87 per head per year ● Cancers ● Neurological ● Gastrointestinal problems ● Respiratory problems ● Musculoskeletal problems ● Learning disability ● Genitourinary system ● Maternity and reproductive health Each of these areas spent more than £20m in total for Sandwell patients in 2007/08

Where we spent least ● Conditions affecting newborn babies ● Healthy individuals ● Hearing problems ● Infectious disease ● Social care needs Each of these areas spent less than £7.5 million in total for Sandwell in 2007/08 From the detailed information collected, we can work out how much is actually spent here on different health problems for people who live in Sandwell – which has a population of around 287,700 people. We can then compare this with the average amount spent by other PCTs and can work out the difference between them.

As an example, we can see that Sandwell PCT is spending £2,256,981 more than the average for dental problems and £4,349,948 less than the average for mental health. The box below shows where we spent the most and the least and what percentage each budget is of all the money we spent.

Money spent as a percentage of the total Dental problems

£8,668,700

-1.61%

Neurological

£7,523,871

-0.66%

Learning disability

£6,432,282

-0.96%

Endocrine, nutritional and metabolic

£4,942,113

-0.71%

Vision problems

£4,194,992

-0.90%

Skin problems

£3,760,335

-0.57%

Adverse effects and poisoning

£3,091,766

-0.90%

Disorders of blood

£2,198,596

-0.41%

Mental health disorders

£13,260,527

3.11%

Cancers and tumours

£7,893,358

0.71%

Trauma and injuries

£4,074,545

0.71%

Infectious diseases

£1,233,855

0.33%

Healthy individuals

£955,431

1.28% 39

Sandwell PCT spending compared to similar PCTs (centres with industry) £133

Mental Health

£127

Circulation £79

Cancers & £70

Musculoskeletal

£74

GI System £62

Genito Urinary Respiratory System

£73

Neurological

£75 £87

Dental £41

Trauma & Injuries Maternity

£62

Learning

£64 £49

Endocrine £18

Social Care Needs Healthy Individuals

£10 £42

Vision

£38

Skin £12

Infectious Diseases

£22

Disorders of the Blood

£31

Poisoning Neonates Hearing

£7 £10 £143

GMS/PMS £70

Miscellaneous

Expenditure in £millions Sandwell PCT

● Full details of spending for each of the programme areas can be found on the attached CD

Centres with industry (similar PCTs)

What these figures tell us Breaking down what we spend is important because we don’t have as much money as we should, according to calculations based on the health needs of people who live in Sandwell. Our total budget target is worked out using a formula based on our health needs, weighted according to our population age, illness and deprivation. According to this, we are receiving about £30 million less than we should – or than we need. In the areas where we spend the most and the least, the information we have tells us much about the health of our population, how decisions we have made affect what we spend and also suggests that there may be ways that we can improve things. High spending in dental services has to be carefully interpreted. On one hand we now have some of the best dental health for children in the country and the best access for dental care for adults and children in the West Midlands. We also offer excellent service to those who may not otherwise receive dental care, such as patients with learning disabilities and limiting long term conditions. But poor adult dental health is still a big problem from the days before water fluoridation.

which is common in Asian populations. If this were the case, other PCTs with a similarly high proportion of Asian residents would be expected to spend a lot on diabetes as well. We need to examine what we spend to confirm it is all diabetes-related – or whether other endocrine conditions are causing us to spend more. The apparent high spending on learning disabilities reflects Sandwell’s commitment to these patients following the closure of St Margaret’s hospital in the early 1990s. A substantial programme of community care was put together between the health service and Sandwell Council and it is right that this should continue. However, managers should look critically at what they spend and ensure they get value for money. Spending on cancer and mental health is consistently lower than that in other PCTs with centres of industry and the money spent on healthy people was also very low in 2007/08. Managers need to scrutinise their budgets to find out why and consider whether spending really reflects the level of need in the Sandwell community.

Sandwell appears to be a high spender on endocrine conditions which may reflect the high number of people with diabetes,

-£5

Mental Health Disorders

Healthy Individuals

Social Care Needs

Problems due to Trauma and Injuries

Cancers and Tumours

Other

Conditions of Neonates

Infectious Diseases

£2

Problems of Genito Urinary System

Problems of Gastro Intestinal System

Maternity and Reproductive Health

Problems of the Musculo Skeletal System

Problems of the Respiratory System

Problems of Hearing

Problems of Circulation

Disorders of the blood

Problems of the Skin

Neurological

Endocrine, Nutritional and Metabolic

Problems of Vision

Adverse effects of poisoning

Problems of Learning Disability

Conditions of Neonates

Healthy Individuals

Problems of Hearing

Infectious Diseases

Social Care Needs

Disorders of the blood

Adverse effects of poisoning

Problems of the Skin

Problems due to Trauma and Injuries

Problems of Vision

Endocrine, Nutritional and Metabolic

Maternity and Reproductive Health

Problems of Genito Urinary System

Problems of Learning Disability

Problems of the Musculo Skeletal System

Problems of the Respiratory System

Problems of Gastro Intestinal System

Neurological

Cancers and Tumours

Dental Problems

Problems of Circulation

Mental Health Disorders

Other

£0

Dental Problems

£million £million

Programme Budgeting category spend per 100,000 Sandwell Population £25 Programme budgeting category

£20

£15

£10

£5

Difference in Programme Budgeting category spend per 100,000 Population £3

Programme budgeting category

£1

£0

-£1

-£2

-£3

-£4

Director’s recommendations I recommend: ● Sandwell PCT makes plans to invest 5% of its total income in health maintenance, health improvement and health information. This would be a first step towards helping Sandwell people become more knowledgeable about their own health and be able to protect, maintain and improve it ● Over the next three years, a planned programme for investment in health improvement and prevention of ill health should be put in place, even in the context of a reducing health service budget. This should be planned into the PCT’s activity and finance model ● Managers redirect some of the money spent on certain health programmes towards preventing ill health within that programme ● Hospitals and other health service providers earn some of their income by hitting health improvement targets, such as getting people to stop smoking ● The PCT should not adopt any new priorities – my recommendations for action are the same as last year’s. But there are new methods for interpreting financial information about our investment: the Programme Budgeting approach. We also know we can reduce health inequalities by more systematic use of data and better programmes of care ● We should stick to the World Class Commissioning priorities and invest more in them. This investment can be financial but can also be through management effort, information analysis, public information and training. Specifically, we need to invest more into: ●

Teenage pregnancy. We have not adequately supported the peer education component of the school sex and relationship programme APAUSE. The children and young people’s partnership collectively needs to invest in this programme

●

Smoking cessation and tobacco control. A programme spend of £5 million average per year for three years is needed to generate the level of quitters required to reduce our prevalence down to 21% of the adult population

●

Alcohol. We plan to achieve our local target for doubling alcohol brief interventions in three years - we need to double it again by 2013/14

●

Cardiovascular disease risk reduction, diabetes and chronic disease management. This area is particularly one which needs management effort, information analysis and redesign of services.

● We need to recognise the PCT’s role and relationship with other partners and pursue strategies to support our health objectives across all the targets we are seeking to achieve - like better housing, welfare rights, income support, environmental improvement, safety and freedom from violence, community development and engagement and better public information. We also need to recognise our undelivered role as statutory partner in reducing crime and disorder, in healthy and town planning and as good corporate citizens, particularly with a responsibility in relation to tackling and reducing carbon emissions, environmental and climate change issues ● More openness and accountability in the use of public funds and willingness to pool funding to achieve shared priorities ● The Sandwell strategic partnership (Sandwell Partnership) needs to explore new ways to develop joint services and eliminate waste. For example, the council should undertake a full assessment of its corporate buildings to see what can be shared, what can be released, what can work more effectively with other facilities and what should be demolished ● The council should pursue an active policy of enabling asset transfer to community organisations with proven track records in governance, financial management and service delivery ● Partners should revisit budgets for services by smaller geographical areas so that local people can gain an understanding of how local services are paid for and give back accountability to local people ● Sandwell Partnership should review its community development resources and seek to enhance local community resources which have been shown to be highly cost effective in service delivery. High quality public information should also be developed more vigorously by the Partnership 44

● The Partnership and the council should look at their use of the power of wellbeing to develop services for young people into employment, for lifestyle services for health, for independent living services including telecare, streetlighting, delivery of shared healthy town planning and public realm and for delivery of the community agriculture strategy ● The personalisation agenda should be implemented vigorously and speedily through adult social care but with a view to health services and other services applying it as well ● The Partnership should also look to implement shared schemes of ‘spend to save’ initiatives, particularly capital schemes which would reduce energy consumption and other use of natural resources to contribute to reducing environmental and climate change issues

A Final Word The economy has changed dramatically in a very short space of time – and the way that public health is funded now needs to change dramatically, too. For many years, the work we do has competed for funding with all of the other health services provided in Sandwell. I now believe this is simply not possible because of the reduction in the budgets planned for the forthcoming years and the perverse system of funding by which hospitals are rewarded. Preventing ill health is seen as an afterthought and we cannot compete for the limited funds available in this new financial situation. I therefore believe that a specific ring-fenced budget for preventing ill health is needed, even in the context of a reducing health service budget. There must be specific funding dedicated to preventing ill health. Existing services should also be required to demonstrate that they are redirecting their own budgets towards preventing illness and making sure Sandwell people are ‘fully engaged’ – knowledgeable, informed and aware of health issues. It would be necessary for these funds to be administered through a proper governance arrangement – an enhanced Health and Wellbeing Board. It would also be expected that such funding would be matched by lead partners in programmes such as housing and education to achieve additional health related goals. To begin with, our target for this - within three years - we should be allocating:

5% for health 45

Our Achievements in 2008/09 Although times are tough at the moment, there have been real achievements over the last year that we should be really proud of. Our work in identifying illness early and saving lives has already been mentioned but here is a summary of some of our other ‘headlines’. In many

cases, details are available on the CD at the back of this report. This section also notes achievements by individuals, including notable awards, presentations, publications and conferences organised.

Service achievements In health protection, headlines include: ● Reducing cases of tuberculosis to below the 40/100,000 ‘danger mark’ ● Healthcare-acquired infections have been massively reduced through a combination of measures such as better hospital control of infection, better antibiotic prescribing and reviews of all cases of MRSA ● Reduction in Clostridium difficile ● Immunisation rates for common childhood infections have been excellent ● MMR rates have climbed almost to the 90% target ● The cervical cancer prevention vaccine has proved to be very popular with children and parents alike and we have had rates of uptake of more than 90% ● Improvements in environmental standards for minor surgery ● Infection prevention included in new contracts ● Local decontamination discontinued in all services apart from dentistry ● Established and running a Swine Flu Incident Response Team 7 days a week ● Established and operating an anti-viral collection point at Oldbury Health Centre which processed thousands of contacts ● Successfully managing extensive TB prevention programme in schools ● Managing the public health impact of two major fires involving asbestos containing materials preventing any serious public exposure In food and fitness, headlines include: ● Raising the profile of the impact of town planning and urban design on health, through the Sandwell Healthy Urban Development Unit – a partnership between health and town planning 46

● Agreeing a new community agriculture strategy between Sandwell council and the Health and Wellbeing Board – and launching a new scheme at Barlow’s Road, Wednesbury ● Agreeing and implementing new physical activity and sports strategy ● Substantial progress towards increasing adult participation in sport ● Childhood obesity not getting worse ● 20 Slimwell programmes running across Sandwell with 40 facilitators trained and 12 Cookwell facilitators trained ● 35 Children’s Centre staff and Early Years workers trained to run FAB Tots obesity prevention programme ● 200 workers from 120 early years settings trained to deliver the ‘Busy Feet’ programme – a food and physical activity-based programme for children aged three to five years ● Shopwell supermarket tours developed in collaboration with Bristol University. Six supermarkets in Sandwell participating and 30 people trained to deliver ● More than 700 primary school-aged children have taken part in Ready Steady Grow programme at Salop Drive Market Garden ● Launching Active Lifestyle format in Friar Park ● Developing the Early Years Physical Activity Programme ● Walk to Beijing: More than 2,000 people registered with the programme in the 1st two quarters of 09/10 ● Active Sandwell: 120% increase in new participants on the programme over the last 3 years ● The only PCT to secure Bikeability status for delivery of cycle training In employment and skills, headlines include: ● Setting up a Health and Worklessness programme to help people keep healthy and avoid long-term unemployment, as well as offering innovative ways to improve skills, find work and support our population through our own ways of working. We are doing this by: ●

Promoting employment opportunities for people in Sandwell by using our role as an employer and purchaser of goods and services

●

Supporting projects that help people to become more active, acquire new skills and get ready for work.

Promoting change in local health services to reduce the risks of ill health leading to worklessness ● Training people and finding jobs through Routeways to NHS Health and Social Care. The scheme is continuing with Working Neighbourhoods funding and is being rolled out as a regional hub for the public sector with £2 million of European Social Care Funding in 2009/10 with a potential for £4 million ●

● Setting up learning and physical disability social enterprises in creative and performing arts plus a volunteer bureau ● Apprenticeships – development work to introduce 38 health and social care apprenticeships in 2009/10 ● Ready, Steady, Work – 22 men from Smethwick took part and completed a skills programme with ourselves and West Bromwich Albion FC ● Workwell – provided on-going occupational health advice and support to Sandwell business community to ensure work is a healthy place to be ● A ‘survival guide’ – Jobless not Hopeless – produced and widely supported ● Cycling courses for community groups and Accord Housing going well with further courses across Sandwell’s Children’s Centre’s planned More information is on the health and worklessness annual report on the CD. In housing and health, headlines include: ● Carrying out a lot of work towards a housing and health strategy. The report is included on the CD and will be published as part of next year’s annual public health report In tobacco control, headlines include: ● Producing a new tobacco control strategy ● Introducing the ‘stop before your op’ programme, together with Sandwell and West Birmingham Hospitals NHS Trust, to help people stop smoking before they go for an operation. The scheme is now being expanded to include all hospital attendances ● Substantial progress on tariff payments for those who stop smoking – to be implemented in 2010 implementation ● Social marketing research helping us to establish next steps in the control of tobacco and support for smoking quitters ● Partnership seminar on tobacco control driving a new strategy ● Achieving 92% of our target for smoking quitters – more than 2,000 people stopping smoking In drugs, headlines include: ● A new facility for drug and alcohol treatment and prevention opened in December 2008. Metro Court, West Bromwich, is home to Sandwell Anchor project and for the Sandwell Drug and Alcohol Action Team and is widely hailed as a much better facility for drug users and service professionals ● Keeping clients in treatment and getting more into treatment (the ‘recovery plan’) has been accompanied by continuing falls in the level of domestic burglary – as research evidence predicts

In alcohol, headlines include: ● A partnership review supported by the National Support Team, with a new strategy produced ● We are on course to achieve our target to double the numbers of people receiving brief counselling for their alcohol problems – a measure that research evidence suggests will help reduce alcohol problems In maternal and infant health, headlines include: ● A substantial series of reviews of maternal care at Sandwell and City hospitals leading to : ●

A massive reduction in the number of Caesarian sections

●

Indications that obstetric and newborn care is improving

●

A proposal for interim changes to maternity services, pending the new facility at the Smethwick hospital in 2015 (currently at public consultation)

● Substantial progress on breastfeeding ● Breastfeeding strategy agreed and clinical guidelines produced ● First stage UNICEF baby friendly standard achieved In community development, headlines include: ● Agreeing the community development framework (on CD) ● Continuing acknowledgement of the REWIND project as a national and international exemplar of best practice in anti-racist training and preventing violent extremism. It continues to be supported by the PCT, the Working Neighbourhoods Fund and the Home Office PREVENT agenda ● Producing the first Community Development annual report and action plan (on CD) ● Profiling six Black and Minority Ethnic (BME) communities and developing action plans ● Continuing to grow Sandwell Time Bank – Time to Trade ● Implementing targeted health improvement interventions in all communities and developing key community development health programmes in Communities for Health ● Raising approximately £0.5 million extra funding working with voluntary and community sector ● Organising three Community Development Sandwell conferences In public information, headlines include: ● A new, single contact number for all healthy lifestyle service referrals by GPs and by the general public themselves: 0800 0114656 ● The Sandwell Public Information Network (SPIN) continued to develop website and other information systems, working with Sandwell College 49

In information and intelligence, headlines include: ● Introducing Iplato text messaging system into 13 practices ● Implementing Risk Stratification 4D into practices ● Launching social marketing website www.overthegardenfence.org ● More than 50 people attended training on social marketing ● Nationally recognised as exemplar Joint Strategic Needs Assessment In other public health research and teaching, headlines include: ● Two major pieces of social marketing research on smoking and alcohol completed (on CD) ● Sandwell PCT taking part in the Cancer Awareness Mapping research (on CD) ● The PCT successfully setting up its programme for housing and health research under the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) ● The PCT leading the work of the West Midlands Teaching Public Health Network (annual report on CD) ● The PCT has championed innovation over the last three years (Chief Executive’s summary on CD) In Older People’s Team, headlines include: ● New Deal for Carers (Government directive) ● Launch of Carers Emergency Card Scheme (Sandwell Homes) ● Winter Warm Programme ● Distribution of 3,500 bags with information on Keeping Warm & Keeping Well to vulnerable adults In Choosing Health Programme, headlines include: ● CVD screening – rolling out our successful CVD risk programme to 100% of GP practices and have aligned the health trainer service to this model ● Undertaking a piece of qualitative research examining the underlying reasons behind the low levels of uptake of school meals in a small sample of Sandwell primary schools In the Health and Wellbeing Unit, headlines include: ● Established Sandwell Health Urban Development Unit ● Anti-poverty strategy approved resulting in £22 million in benefits via the Welfare Rights Team ● Completing a review of the Health and Wellbeing Unit ● Increasing understanding of health inequalities across all partnerships ● Establishing the Health and Wellbeing Board and holding a successful stakeholder event 50

In Mental Health, headlines include: ● Establishing confidence and wellbeing team as part of Primary Care Mental Health Model ● Developing a new mental health advocacy model following comprehensive consultation ● Producing a revised Adult Mental Health Joint Commissioning Strategy ● Producing service specifications for all statutory adult mental health services ● Implementing CORENET screening tool for GPs to enable assessment of mental ill health in patients In Public Health Workforce Development, headlines include: ● New wider public health workforce recruited from our local communities in the form of health trainers, now working in 31 GP practices across the Borough ● A new confidence and wellbeing team is in place with life coaches working in the community ● Pandemic training and response to ‘flu outbreak included electronic, written and face-to-face training and awareness-raising with our communities ● Health and wellbeing unit has been accredited by the Open College Network to deliver training and this year has delivered blood pressure training for wider public health workers. The Slimwell programme will be accredited shortly Other service achievements included: ● 4th best PCT in the country on World Class Commissioning ● Improved outcomes in relation to the World Class Commissioning targets (on CD) ● Primary Care Trust of the Year for 2008, awarded by the Health Service Journal

Awards Dr John Middleton ● Collaboration for Leadership in Applied Health Research and Care (CLAHRCs). Awarded £10m over five years for leading on the housing and health theme, £1m over five years ● Member of the successful submission and presentation team for the Health Service Journal awards, September 2008 Anna Pronyszyn ● Awarded MSc in Infection Control from the University of Highlands and Islands, Inverness Michelle Lawrence ● Awarded Masters in Public Health degree from University of Wolverhampton ● Completed Breaking Through Leadership programme Lynne Thompson ● Awarded MSc in Health Development. Research for dissertation was carried out in Sandwell. Entitled: “Can a family approach that encourages parents/carers to get involved with a healthy eating school project influence the food children eat at home?” Portway Lifestyle Centre ● Liftco Award for innovative design Friar Park Children’s Centre ● Winner: Children’s Centre Team of the Year Award 2009 No Smoking Day Awards ● Organiser of the Year award for Best Use of Big Cig campaign ● Runner-up in Best Use of Local MPs and Celebrities category Older People Team ● Carers Emergency Card Scheme – Shortlisted finalist in National ALMOs Awards ● Salvation Army Volunteers Shining Star Award – Winter Warm Programme Food Policy Team ● Regional finalist, Health and Social Care Award 2009 for Slimwell, in the Transforming Service Category ● Slimwell shortlisted for National Obesity Forum Awards 2009 ● Secured ESRC CASE PhD Studentship to research ‘Environmental determinants of diet: exploring the mediating role of culture’ in partnership with Queen Mary University, London.

Publications Ali S, O’Callaghan V, Middleton JD. A Case Study of the Towards 2010 Programme – Health Impact Assessment. Journal of Environmental Assessment Policy and Management (2008). Vol. 10, No. 4, pp 403-430. Ali S, O’Callaghan V, Middleton JD, Little R. The challenges of evaluating a health impact assessment. Critical Public Health (2009). Vol. 10, No. 2, pp 171-180. Marshall T, Westerby P, Chen J, Fairfield M, Harding J, Westerby R, Ahmad R, Middleton J. A controlled evaluation of a programme of targeted screening of cardiovascular disease in primary care. BMC Public Health 2008; 8:73. Middleton J, ed. Crunchtime for Health in Sandwell – The 19th Annual Public Health Report for Sandwell. West Bromwich: Sandwell PCT/MBC, 2008. Pitches D. Middleton J. Teenage pregnancy: the influence of the school calender. Submitted. Wilson R. Chapter in Recession and Health, Key Heath Data 2009, University of Birmingham Grayland A, Wilson R. Improving male life expectancy in Birmingham. Public Health 123 (2009) e50-e56 Better Business, Healthier Food report published August 2009. Work jointly commissioned by PCT and SMBC Economic Regeneration and Skills Division

Presentations Laura Brodrick Solihull NHS Care Trust Primary Care Strategy – Sandwell’s Model for Supporting Carers Michelle Lawrence Health Protection Agency Conference - ‘What factors inhibit the uptake of Hepatitis B vaccine in babies born to mothers who are Hepatitis B positive?’ The views of health visitors in Sandwell PCT towards Hepatitis B infection and vaccination. 14th September 2009

Dr John Middleton Community Development Sandwell. Drugs and Alcohol in Sandwell, West Bromwich Albion Conference UKPHA Conference, Liverpool, April 2008 ● Poster paper: ‘Doctor write me a prescription for the blues’ ● Poster paper presentation: ‘Casino gambling with the nation’s health’ ● Poster paper presentation: ‘Teaching Public Health Networks West Midlands’ Lecture: ‘Crime and health evidence based policy making in the Safer Sandwell Partnership’ Teaching Public Health Network West Midlands – presentation for Staffordshire Public Health Network, April 2008 CDC Atlanta – Sustainable Management Development Programme. Cavtat, Croatia Conference, May 2008 Keele University Public Health Research Network, with the Staffordshire and Cheshire Public Health Network evidence based public health practice, June 2008. Sandwell Health’s Other Economic Summit (SHOES) – The pUBLIC, West Bromwich; organiser, chair and presenter. Featuring: T Lang, P Lincoln, K Macpherson, E Kuhn, et al. SHOES / Black Country PH training consortium, July 2008. Chair. Paper presentations on lay involvement in research and worked example papers including osteoporosis NICE TAG 87. Drugs policy for Sandwell – presentation to the senior police officers of Sandwell WHO EURO Healthy Cities Conference, presentation: Environmental resilience, climate chaos and healthy city planning, October 2008, Zagreb, Croatia Collaboration for Leadership in Applied Health Research and Care – Inaugural conference presentation on housing and health, October 2008 Caritas DE, Germany. Meeting to discuss partnership for health and social care in Europe. Presented as part of a round table international forum, Brussels, NordRhein Westfallen Brussels office. November 2nd and 3rd 2008 Inequalities in health in Sandwell – Presentation for the National Support Team (Health Inequalities) Sandwell, February 27th 2009 IDEA and Local Authorities of Greater Manchester. Partnerships for health improvement, Rochdale, March 3rd 2009 West Midlands Regional Public Health Observatory. Recession and Health: the need for pubic health information March 10th 2009, Birmingham UK Food policy initiatives in Sandwell. Presentation to the Council of food policy advisers, to the Department of Environment, Food and Rural Affairs, London, March 24th 2009 54

Dr Richard Wilson Recession and Health, Key Health Data for West Midlands 2009, Birmingham, 7 Sept 2009 Joint Strategic Needs Assessment and Tackling Inequalities 3, UKPHA 2009 Brighton Profiling Migration, data and analysis, at Migration Matters, Mainstreaming Migration in the West Midlands, 23 February 2009, Birmingham Chamber of Commerce Identifying local population concentrations Population Change Seminar 16 September 2008 West Midlands Regional Observatory Chair. Sharing Information Digitally, 7th October 2009, West Midlands Regional Observatory Chair. Population Change Seminar, 16th September 2008, West Midlands Regional Observatory The NHS Carbon Footprint: Estimating the CO2 Emissions of Patient Journeys. UKPHA Brighton, 2008 Eileen Kibbler Tackling Inequalities through Employment – Locality Stakeholder Board Regional Forum, February 2009 Routeways to NHS Health and Social Care Careers – Regional Workforce Planners network, August 9th 2009 Dr Rosemary Kyle and Angela Blair Warwick University Horticultural Research Institute: Presentation on Sandwell Food Policy at Food Security Seminar, July 6th Workshops and a presentation on Eatwell as a whole system approach to obesity prevention/treatment Improvement Foundation Conference, Manchester, October 17th Presentation on Food Policy and Community Agriculture Strategy at AGM of Garden Organic, Ryton, September 5th Slimwell presentation at Improvement Foundation Conference (Anna Skeats and Helen Waters), July 14th, Manchester and August 20th, Barnsley Lynne Thompson ‘Can a family approach that encourages parents/carers to get involved with a healthy eating school project influence the food children eat at home?’ Birmingham City University Research conference 20th November 2009

Conferences organised Joanna Luxmore Tobacco Control ‘Making it everyone’s business’. 17th September 2009 Dr John Middleton Sandwell Health’s Other Economic Summit 2008. ‘Fat chances for food and health’. Speakers included Tim Lang, Klim Macpherson, Paul Lincoln, Eric Kuhne, Laura Davis, Angela Blair, Rosemary Kyle ‘Community governance and third sector health activites’. Presentations for the visit of Hubei Province China government officials, Sandwell PCT, Ideal for All and Birmingham University Applied Social Studies International division, March 6th 2009 Dr Richard Wilson Chaired and organised in partnership with Clinical Audit Department. The Road to Excellence – Audit and Research Conference, Hawthorns, 28th January 2009 Older People’s Team Sandwell Carers Conference – June 2008 Full of Life Festival to celebrate International Day of Older People, 1st October 2009

Town profiles Oldbury Rowley Regis Smethwick Tipton Wednesbury West Bromwich

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% 3% 5.3%

106.3 112.2

All causes 0

5.4% 4.9% 5.2% 0

152.5

Cancers

4.6% 5.7% 5.2%

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

10 15 20 25 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

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 0

6.9% 5.3% 6% 5

144.8

Cancers

4.4% 6.2% 5.4%

130.9

Endocrine, nutritional and metabolic diseases

9.5% 4.2% 6.6%

COPD

144.6

Respiratory disease

20.9%

Ischaemic heart disease

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

25 15 20 10 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

Circulatory diseases

8.5% 12.2% 10.4%

Cerebrovascular disease Malignant neoplasms of trachea, bronchus and lung

Pneumonia

COPD

5.5% 5.4% 5.5% 0

135.6

Endocrine, nutritional and metabolic diseases

8.4% 4.7% 6.4% 3.8% 5.7% 4.8%

141.9

Respiratory disease

21.3% 17.4% 19.2%

Ischaemic heart disease

213.4 121.6

Cancers

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%

15 20 25 10 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

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%

Ischaemic heart disease

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

10 15 20 25 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

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 Dr Victor Aiyedun Shaukat Ali Enderjit Aujla Dr Kate Bosworth Dr Jenny Chen Dr Chris Chiswell Alan Dean Dr Carl Griffin Nicola Howe Wafia Hussain Eileen Kibbler Dr Alexis Macherianakis Dr John Middleton Vicky O’Callaghan Dr Pardip Phull Dr Deborah Saleh Dr Patrick Saunders Ralph Smith Paul Westerby 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 2008/09 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

Public Health Annual Report 2008/09 This CD contains PDF files in high and low resolution of the 20th Public Health Annual Report for Sandwell 2008/09 and further support documents.

Contents of the CD ● Towards 2010 Charter ● Breastfeeding ● Young people’s needs profile ● Child Protection Plan analysis ● Children and Young People Partnership update ● Clinical dashboard ● Community Development Annual Report ● Sandwell Community Development Framework ● African Caribbean Community Health Profile ● Bangladeshi Community Drugs Needs Analysis ● Bangladeshi Community Mental Health Needs Analysis ● Pakistani Community Health Profile ● Sikh Community Health Profile ● Yemeni Community Health Profile ● Directors of Public Health QIPP presentation ● Top ‘best buys’ cost per QALY league table ● The financial challenge – Directors of Public Health discussion paper ● Health and Worklessness Annual Report 2009 ● Addressing Health Inequalities summary ● Addressing Health and Health Inequalities analysis ● Improving Health and Health Inequalities ● Housing and Health Strategy

● Housing and Health Strategy - case for investment ● Infectious Diseases Annual Report 2009 ● Investwell Strategy ● Joint Strategic Needs Analysis ● Local Area Agreement (LAA) ● LSP shared priorities ● Mortality 45-64 year-olds ● MSDi ● NST inequalities Report ● Perinatal mortality summary ● Sandwell Place Survey ● Potential Years of Life Lost ● Programme Budgeting ● Public Health Archive ● QMAS ● Sandwell Sexual Health Needs Assessment ● SHOES 2008 and 2009 ● Strategic Models of Care presentation ● Preoperative Smoking Cessation ● Social Marketing – Alcohol and Smoking ● Spearhead PCTs ● West Midlands Teaching Public Health Network Annual Report ● Wellbeing Power ● An Approach to encouraging innovation presentation ● Sandwell’s forgotten children ● The journey of a child

ISBN 978-1-900471-30-5 Designed and produced by Hyland Freeman Ltd hylandfreeman@btconnect.com Content: Red Cat Communications info@redcatcomms.co.uk