F   HEALTH

Health Improvement and Modernisation Plans and Primary Care Trusts

Organisational changes to the NHS will result in the establishment of five Primary Care Trusts (PCTs) to cover all of Suffolk from April 2002. The current countywide Health Authority will be disestablished and, subject to consultation, will be replaced by a Strategic Health Authority covering Suffolk, Cambridgeshire and Norfolk.

Each PCT will lead the development of a Health Improvement and Modernisation Plan (HIMP) for its area, which will bring together the planning for health improvement, including health inequalities, with the delivery of NHS modernisation agenda set out in the NHS Plan.

In practice, HIMPs will build on the work already being done in Suffolk to develop local Health Improvement Programmes (HImPs). It is expected that HIMPs will be closely aligned with the Community Strategies being developed by Local Strategic Partnerships (LSPs) which will also look at improving the wellbeing of local communities. This will help to rationalise partnerships, and the processes and mechanisms for engaging with local people.

Contact: Terry Ward, Suffolk HImP Co-ordinator.

1   Accident and Emergency Statistics

Road Traffic Accidents in Suffolk

1.1   Road Traffic Accidents and Casualties

Information contained is for those accidents occurring within Suffolk, and therefore they do not necessarily involve residents of Suffolk.
Source: Environment & Transport, Suffolk County Council (SCC)

Numbers of reported road accidents in Suffolk involving personal injury have fallen by 13.6% between 1990 and 1999. It can be seen from Table 1.1 that after a continuous decline since 1990 to their all time low of 2,012 in 1995, accident levels have risen slightly in each of the four years from 1996-1999. Accident and casualty levels in 1999 have both increased by 14.2% from their respective lows in 1995.

The level of traffic flow on Suffolk‘s roads has increased continuously since 1989 on average by 1.7% per annum. With this measure of accident risk exposure increasing and levels of fatal or serious accidents either declining or static, the suggestion is that the risk of sustaining a fatal or serious injury on Suffolk’s roads has declined in the last ten years.

• Most accidents occur between two cars with 3,795 occurring in the 5 year period between 1994-1998.

• Most accidents occur on single carriageway. This is not surprising considering 72% of the Suffolk road network is comprised of this road type.

• Young Adults are over-represented in road accidents. Per capita those aged between 17-24 are twice as likely to be road casualties than those in the next most susceptible group 25-39.

• Speed related accidents account for around a third of the total number of accidents.

Source: Suffolk Road Accident & Casualty Trends 1998. Environment & Transport, SCC.

1.2   Age-specific A&E attendance rates. Residents of Suffok attending Suffolk hospitals. Injuries resulting from incidents in all locations. Financial years 1996/97 - 2000/01

Source: Suffolk Health, 2001

Using attendances per 1000 residents allows comparison of the districts. Ipswich may have a much higher figure due to the proximity of the hospital to the majority of the local population. Those in Forest Heath and Suffolk Coastal may consider other alternatives before travelling to Bury St Edmunds and Ipswich/Lowestoft respectively.

This information is also available as accidents at home, at work, in public places, in educational establishments - all by district and by the age brackets included above.

Source: Suffolk Health (Dr Brian Keeble)

Dwelling Fires

1.3   Dwelling Fires by Station Jan - Nov 2001

Both Ipswich and Lowestoft include two fire stations that cover both the town and the immediate surrounding areas partly reflected in the larger numbers, as well as population density.

Death Rates from Accidents

The Government’s action plan for health improvement, ‘Saving Lives: Our Healthier Nation’, was published in July 1999. The Government’s target is “to reduce the death rate from accidents by at least a fifth and the rate of serious injury by at least a tenth” by the year 2000.

Some 601 Suffolk people died from accidents in the five year period 1995 to 1999 giving an overall death rate of 9.2 deaths per 10,000 Suffolk residents during that time and an average of 120 deaths per annum. The annual figure would need to be cut by about 25 deaths in order to achieve the Government’s target.

Accidents and their prevention are important for a number of reasons. Firstly, as indicated above, accidents and accidental deaths are by and large preventable - if they were not they would not be classified as accidents. Secondly, they take a considerable number of young lives and thirdly, accidents cause considerable disability - often lifelong.

Accident information is collected differently by different organisations. Suffolk County Council collates information collected by the Police on accidents that happen within the Suffolk boundary, irrespective of where the people involved in the accident live. Suffolk Health collect information on accidents with regard to residents, irrespective of where the accidents happen. The HImP Accident programme group is currently looking at all sources of accident data covering accidents in the home, at work, at leisure and on the roads.

Contact David Osborne, telephone: 01284 757050, email: env.health@burybo.stedsbc.gov.uk.

1.4   Number of Deaths for All Accidents by District

Source: Director of Public Health Report 2000. http://www.suffolkhealth.nhs.uk/PublicHealth/2000.
[Standardised mortality ratios are a way of comparing death rates for different populations on an equal basis. For example they take account of the fact that one population might have a higher proportion of elderly people than another, which would otherwise distort comparisons as elderly people are more likely to die in any one year than younger people. The SMR for England and Wales is set at 100.]

The above figures are for all deaths. The Annual Report from the Director of Public Health 2000 looks in more detail at accidents, specifically for falls and motor vehicle accidents by different age groups.

2   Disability

The World Health Organisation introduced new classifications of disability in 1999. Disablement is said to cover three dimensions: 1. Body structures or functions, 2. Personal activities, and 3. Participation in society.

• Impairment – is a loss or abnormality of body structures or of a physiological or psychological function.

• Activity – is the nature and extent of functioning at the level of the person. Activities may be limited in nature, duration or quality.

• Participation – is the nature and extent of a person’s involvement in life situations in relationship to impairments, activities and contextual factors. Participation may be restricted in nature, duration and quality.

The Office of Population Censuses and Surveys (OPCS) Survey of Disability researched the levels of disability in both adults and children.

Many disabilities are caused by impairments that arise as a consequence of ageing, so the rate of disability rises with age. The survey found that nationwide, 60-70% of disabled adults were aged 60 or over and nearly 50% were 70 or over. There were also more disabled women than men, because women live longer and predominate in older age groups. Also in higher age groups, women are more likely to be disabled than men of the same age. In the survey, East Anglia had lower than average rates of disability.

2.1   Disability and their prevalence (Nationwide)

Source: ‘Definitions and Levels of Disability’, Suffolk Health Authority

Estimated figures of Suffolk residents suffering from disabling health conditions are available, but actual figures are difficult to collect. Larger surveys such as the 1991 Census ask people to report any problems they have with their health and restrictions to their activities. The General Household Survey is carried out annually and covers different topic areas each time. These create self-reported figures, rather than those officially diagnosed by the medical profession.

Through the knowledge of the incidence of certain health problems by 100,000 people, it is possible to estimate the numbers of Suffolk residents suffering from a number of conditions which may lead to disability.

• Multiple Sclerosis – between 660 and 1,187 people affected.

• Parkinsons Disease – 120 people affected, with 40% having severe disability.

• Motor Neurone Disease – 39 people in Suffolk at any one time.

• Musculoskeletal problems – 866 people in Suffolk severely disabled with rheumatoid arthritis and 2,000 severely disabled with osteoarthritis.

• Amputees – 200 with a lower limb amputated, 33 with an upper limb amputated.

Source: ‘Definitions and Levels of Disability’, Suffolk Health Authority

2.2   Claimants of Incapacity Benefit and severe disablement allowance - Suffolk

As an indication of the number of people who might possibly benefit from the Joint Investment Plan, Welfare to Work for disabled people, the following figures are for Suffolk, by District/Borough Council area, of those claiming incapacity Benefit and Severe Disablement Allowance at 31st May 2000. These statistics have been published by the Employment Service in documents relative to the “New Deal for Disabled People” initiative:-

NB. If a claimant has paid enough National Insurance contributions prior to the illness/disability which made them incapable of work they receive Incapacity Benefit, if however, under the same circumstances of being incapable of work but they have not paid sufficient National Insurance contributions, they receive Severe Disablement Allowance.

These figures may give a representative picture of need by geographical area and are displayed on the following bar chart.

Percentage figures displayed are the fraction of the total number of claimants within the county.

Source: Welfare to Work Joint Investment Plan for Disabled People, March 2001.

3   Drug and Alcohol Misuse

Drug misuse is one of the most important challenges facing society today. The harm it causes affects us all. It destroys families and young lives, fuels crime and undermines neighbourhoods. It is estimated that a third of all property crime is drug related. In some parts of the county, a quarter of all offenders tested positive for heroin and around one in five for crack cocaine. The consequences of drug misuse costs our nation up to £4 billion a year in crime and related costs, including injuries as a result of road accidents and unemployment.

“Tackling Drugs to Build a Better Britain” aims to shift the emphasis away from dealing only with the consequences of drug misuse. Instead it invests in ways to tackle misuse and prevent it happening in the first place. The strategy has set targets and is focusing efforts on prevention and education, treatment for drug misusers and active disruption of the illegal drug trade. It focuses particularly on Class ‘A’ drugs, especially heroin and crack cocaine because they cause the greatest harm. Another important focus is evidence based interventions. The new National Treatment Agency will take the lead in relation to treatment services.

The Suffolk Drug Action Team Plan focuses on four key areas –

• Young People

• Communities

• Treatment

• Availability

It also sets out both short term and long term targets:

• By 2008, to halve the number of young people using Class A drugs

• To halve the level of re-offending by drug misuse offenders

• To double the number of drug misusers in treatment

• To halve the availability of Class A drugs

We are still awaiting publication of the National Alcohol Strategy. According to Alcohol Concern, alcohol misuse costs Britain £3.3 billion a year. Of the total bill, some £2.8 billion has been lost by British industry in terms of sickness, absenteeism, unemployment and premature deaths. The cost to the National Health Service is in the region of £200 million. Alcohol related road accidents account for a further £189 million and criminal activity £68 million.

Alcohol misuse contributes significantly to crime levels, and it is estimated that people commit 40% of violent crime, 78% of assaults and 88% of criminal damage while under the influence of alcohol. In Suffolk, there is a worrying trend of young people binge drinking, which is also linked to town centre disorder.

Suffolk Community Arrest Referral Service (SCARS)

The Suffolk Community Arrest Referral Service currently operates from Ipswich police station custody suite. Individuals are interviewed by a SCARS worker, and given an opportunity to discuss any substance misuse confidentially, then, if necessary, a referral is made for treatment or support.

The service is a unique source of information about the full range of substance misuse, as the majority of detainees are interviewed. The numbers are small, the locality confined and the population range limited, therefore the data cannot be held to be typical of all those taking drugs or alcohol.

From April 2000 to March 2001, SCARS made contact with 1456 individuals passing through custody suites. Of all SCARS face to face contacts, 43% stated that they had a substance misuse problem. 533 people were referred for treatment and support agencies by SCARS. Of those referred, 341 (64%) made contact with the service.

3.1   Assessment Results

Source: Suffolk Community Arrest Referral Service Annual Report 2001

Suffolk Drug Action Team (DAT) Report 2000/01

The Regional Drug Misuse Databases (RDMDs) collects specialised data, in that it is anonymous and is from individuals presenting themselves to drug services for new episodes of care. This leads to a bias towards more significant drug use such as heroin.

As the unit only collects data on new episodes of care, this does not include all users receiving treatment.

The number of drug users in Suffolk has increased from 463 in 1999/00 to 701 in 2000/01. Heroin is the main drug of use, however, the majority of recorded drug users are poly drug users. The RDMDs can record up to five drugs on the database for each individual.

3.2   Main drug

Source: Suffolk DAT Report 2000/01

The proportion of women as drug users has increased slightly upon recent years, with 38% of drug users being female and 62% male.

Those aged 25 and over were the largest group of drug users, with 498 receiving treatment.

3.3   Recorded Drug Users by District

Source: Suffolk DAT Report 2000/01

4   Healthy Lifestyles

Suffolk Health Authority’s Health Improvement Programme (HImP), sets targets in order to improve the general health of residents within the county. How healthy a person is depends on many factors, some cannot be controlled by the individual as they are outside factors e.g. environment, but others can be controlled, such as our lifestyles.

Positive lifestyle changes can help you look and feel better, live longer and reduce your chances of falling ill. While lifestyle decisions such as diet, exercise and quitting smoking have an important effect on health, other factors are outside the individual’s control e.g. poverty, social exclusion, employment, housing, education, and the environment. The National Health Website – NHS Direct has a considerable amount of information on how to improve your health by improving your lifestyle. It can be found at http://www.nhsdirect.nhs.uk.

4.1   Indoor recreation facilities by district council

This indicator measures the exisiting provision of indoor recreation facilities, against the objectives of maintaining and enhancing the range of facilities for recreation and promoting and enabling the provision of social and community facilities to meet local needs.

St. Edmundsbury and Forest Heath recorded no change, whilst information was not available from Mid Suffolk District Council. Of particular note is the increase in Leisure Centres in Babergh, Ipswich and Suffolk Coastal. Whilst new leisure centres can account for two of these additional facilities throughout the county, it is pleasing to note the other four facilities, two in Ipswich and two in Suffolk Coastal are through dual use arrangements with schools. Such arrangements are a valuable means of increasing accessibility to such facilities. However, it is not known how frequent such facilities are used by members of the public and, in this respect, it is vital such arrangements are publicised locally. Dual use arrangements are dependent upon the schools’ governing body, rather than the Education Authority.

Other indicators in the “Suffolk’s Environment” report include provision of outdoor playing space (youth and adult use), children’s playspace, allotments and facilities for golf.

Source; “Suffolk Environment...towards sustainable development” Third Monitoring Report April 2001 (p133)

5   Maternal, Infant and Early Child Health

Composite indicator of stillbirths and infant mortality.

“This indicator has two components, stillbirth rates and infant mortality rates. Access to a full range of services before and after giving birth will help to reduce stillbirth and infant mortality rates. In addition, services aimed at improving general health, education and nutrition along with reducing the prevalence of risk factors, such as smoking and drinking in pregnancy, are of importance”. Quality and performance in the NHS

In the NHS Performance Indicators certain indicators are pooled to give an overall indicator where “an individual indicator on its own might only pick up limited aspects of performance and where pooling indicator data will give a more rounded assessment of performance.” NHS Performance Indicators: July 2000. Composite methodology.

A composite indicator may be interpreted in a similar way to a standardised ration. The composite indicators for Suffolk as a whole and the Suffolk district councils have been standardised to England and Wales. The difference between the composite indicator for one of these areas and the index value of 100 indicates how well that area is performing in relation to the standard population. Values below 100 indicate better than average performance, and vice versa.

5.1   Composite indicator of stillbirth rate and infant mortality rate 1996-98

Source: Suffolk Health Authority, 2000

The composite indicator for stillbirths and infant mortality in Suffolk as a whole in 1996-98 has 85.2. Among the Suffolk district councils in 1996-98 only Waveney had a composite indicator value for these variables of over 100 (100.2). However, it should be noted that the indicator covers a relatively short period during which stillbirth and infant mortality rates at a local level were subject to considerable variability due to chance. This is indicated by the wide 95% confidence intervals shown on the diagram as vertical lines. (A 95% confidence interval means that there is a possibility of less than 1 in 20 that the true rate in the population falls outside the confidence internal).

6   Mortality

Suffolk generally has a favourable mortality rate in relation to the standard population of England and Wales. This is seen to reflect the generally favourable socio-economic circumstances of Suffolk, in comparison to the country as a whole.

Source: Suffolk HA

The highest standardised death rates occurred in the more urban areas of Bury, Ipswich and Lowestoft, this indicates a more favourable mortality experience in the more rural districts of the county.

6.1   Direct Age Standardisation Rate For All Deaths 95/96 - 97/98

Source: Suffolk Health Authority

Suicide Rates

Currently in England, on average, more than one person every two hours dies as a result of suicide. If the target below was met, up to 4,000 lives in the UK would be saved.

Standardised Mortality Ratios (standardised to Suffolk as a whole)

Deaths from all causes among persons aged under 75 years during 1995-98. Electoral wards with SMRs which are significantly high or low at 5% level of siginificance.

Source: Suffolk Health Authority
Click map for larger image.

© Crown Copyright. All rights reserved. Suffolk County Council Licence No. LA076864 2000

Suffolk Health are working towards the 7 key standards of the National Service Framework for Mental Health available on the internet at http://www.doh.gov.uk/nsf/mentalhealth.htm.

6.2   Number and Rate of Suicides 1996-98

Source: Suffolk Health Authority

Coronary Heart Disease (CHD)

CHD is a major cause of death in England. In 1998, CHD accounted for over 110,000 deaths. 41,522 deaths were among those less than 75 years of age, so called premature deaths. About 300,000 people have a heart attack each year. Also, some 35 million working days a year are lost through illness directly attributable to heart disease.

Source: Annual Report, Director of Public Health for Suffolk 2000

6.3   CHD in Suffolk – under 75’s 1995-2000

In Suffolk only one ward had a significantly high standardised mortality ratio (SMR) which was Kirkley in Lowestoft, i.e. Kirkley’s lower confidence interval was greater than the Suffolk Upper confidence interval.

Source: Public Health, Suffolk Health

Cancer

Over the twelve year period 1987-1998 some 34,408 cases of cancer (excluding non-melanoma skin cancer) were registered, at the East Anglian Cancer Registry, amongst the people of Suffolk. Slightly over half of these (17,278) were amongst males, and just under half (17,130) amongst females.

Source: Annual Report, Director of Public Health for Suffolk 2000

6.4   Cancer deaths - under 75’s 1995-99

No wards in Suffolk had significantly high or low SMR’s for cancer deaths. However Bridge (Ipswich) and Woodbridge Riverside were at the opposing ends of the scale for cancer deaths with both close to being significant.

Source: Public Health, Suffolk Health

Cancer registrations

Female breast cancer was the most common cancer registered during this period, closely followed by colorectal cancer (cancer of the large bowel). Lung cancer (the commonest cause of cancer death) was the third most common followed by prostate cancer. Between them, these four cancers accounted for over half of all registrations.

Source: Annual Report, Director of Public Health for Suffolk 2000

6.5   Cancer registrations – under 75’s 1987-98

Great Cornard North was the only ward with a significantly high SRR and Leavenheath was the only ward with a significantly low SRR. Interestingly both wards are in Babergh district and only about 5 miles apart.

Source: Public Health, Suffolk Health

7   Teenage Pregnancies

Improved health and sex education programmes, and improved contraceptive services should reduce the number of teenage conceptions. Health Authorities need to ensure that the provision of family planning services through GP’s, clinics and hospitals is appropriate, accessible and comprehensive. There is some evidence to suggest that rates of teenage conceptions are correlated with levels of deprivation.

During the period 1995 – 1997 (the most recent period for which data is available), there were 1173 conceptions among girls aged under 18 in Suffolk.

• 695 conceptions leading to births

• 478 conceptions leading to abortions

The Social Exclusion Unit have produced a national report Teenage Pregnancy (Published June 1999). http://www.cabinet-office.gov.uk/seu/1999/teenpreg.pdf.

7.1   Teenage conception rates (TCR) among girls aged under 18 by district

TCR: conceptions among girls aged under 18 years per 1000 girls aged 15-17 years

Source: Public Health, Suffolk Health

7.2   Wards with significantly high under 18 teenage pregnancy rates 1995-98

Source: Director of Public Health, Suffolk Health
NB: The calculation of confidence intervals allows us to estimate the likelihood of a particular ward’s pregnancy rate as being as high as it is simply because of chance rather than because there were real differences in the rate of pregnancy in its teenage population.

Therefore any ward which has a lower 95% confidence interval (TCRLL) greater than the upper limit for Suffolk as a whole (TCRLL=31.4) had during 1995-98 a teenage pregnancy rate which at the 95% level was significantly higher than the rate for Suffolk as a whole. I.e. There was a probability of less than 1 in 20 that the difference between the ward rate and the Suffolk rate was due to chance. Out of the 21 wards with significantly high teenage conception rate, 10 of these were in Ipswich. Harbour and Kirkley (both in Lowestoft) and Brandon West have a teenage conception rate over 3 times the Suffolk rate.

8   Poverty and Health

Health outcomes are not evenly distributed across Suffolk and the main cause of this health inequality is the effect on peoples’ health caused by living in poverty. The variations in health closely reflect the patterns of poverty and income inequality across the county.

In order to make significant reductions in ill health it is necessary to address the underlying socio-economic causes.

Examples of the links between poverty and ill health nationally are:

• As poverty increased in the 1980s, so health outcomes worsened for the very poorest-for example, a 39% increase in deaths from fire in social class V and a 2% rise in mortality rates for men in class V when those for class I fell 36%

• Among the bottom 31% of the population, half of the deaths which occur are attributable to socio-economic position. This is equivalent to 17,000 premature deaths each year just among men aged 20-65.

• People living in the poorest areas have death rates four times above people living in the richest areas.

• The average gap in life expectancy between the poorest and the most affluent neighbourhoods is eight years.

• The rate of limiting long term illness or disability among those classed as “unskilled manual” (48%) is over twice the rate of those classed as “professional” (17%).

• Among people in their sixties, people in social class IV and V are twice as likely to suffer from moderate anxiety and depression than those in social class I.

• 27% of unemployed people report having moderate anxiety and depression compared to 14% in a salaried job.

• The death rate from fires among boys under 14 is fifteen times greater in social class V then social class I.

• Death rates among children of parents with unskilled or semi-skilled occupations are nearly twice as high as among children of parents with professional, managerial or skilled backgrounds.

• The incidence of babies with low birthweight is 25% greater for social classes IV and V than for classes I to III.

• Over a third of people in social class V are regular smokers compared to one in ten in social class I.

• Among homeless people aged 45-64, mortality rates are 25 times higher than the national average, suicide rates are 35 times more likely and Tuberculosis rates three times the national average.

Source: Independent Inquiry into Inequalities in Health Report, Chairman: Sir Donald Acheson. Available on the Department of Health website at http://www.official-documents.co.uk

For information with regard to Suffolk please refer to Director of Public Health’s Annual report Inequalities in Health - Time for Action, 1997.

CONTACTS - HEALTH