Hull Public Health 

The Deep, Hull The Guildhall, Hull King William Statue, Market Place, Hull City Hall, Hull Spurn Lightship, The Marina, Hull

 

 

Joint Strategic Needs Assessment 2018

This 139-page summary document covers 69 topics. Further information on each of these topics are available in the Hull JSNA Toolkit reports, with the relevant JSNA Toolkit reports listed at the end of each topic below.

To view a topic click on one of the topic areas listed in the contents below or use the side bar drop down menu to the left.

Alternatively, to view or download the full report, or one of the previous iterations of the Hull JSNA, click here.

A further set of very brief summaries of Hull have also been produced. In some cases, people are interested in a paragraph or short summary of the health needs in Hull, perhaps for inclusion in another document. Please feel free to include the information in another document, but please acknowledge the source.


JSNA 2018 Contents

 

Introduction
Context of Need

Geographical Area
Population
Ethnicity
Population Projections
Deprivation and Poverty
Housing
Homelessness
Environment
Air Pollution
Climate Change
Crime
Domestic Abuse
Social Capital and Asset-Based Approach
Social Isolation and Safety
Social Care
Carers and Caring

Aspects of Health

Life Expectancy
Mortality
General Health and Physical Disabilities
Emotional Health and Wellbeing
Oral Health
Use of Healthcare Services and Secondary Care

Behaviour and Lifestyle Risk Factors

Smoking
Overweight and Obesity
Physical Activity
Diet
Alcohol Consumption
Drug and Substance Abuse
Multiple Behavioural and Lifestyle Risk Factors

Best Start in Life (Children and Young People)

Maternity
Breastfeeding
Best Start in Life and Transition into Adulthood
Accidents to Children and Young People
Vaccinations and Immunisations
Schools and Educational Attainment
Under 18 Conceptions

Healthier, Longer, Happy Lives (Working-Age Adults)

Labour Market and Benefit Claimants
Screening
All Cardiovascular Diseases
Coronary Heart Disease
Stroke
Heart Failure
Atrial Fibrillation
Hypertension (High Blood Pressure)
Abdominal Aortic Aneurysm
Peripheral Arterial Disease
All Cancers
Lung Cancer
Colorectal Cancer
Prostate Cancer
Breast Cancer
Diabetes
Chronic Kidney Disease
Respiratory Disease
Asthma
Chronic Obstructive Pulmonary Disease
Musculoskeletal Disorders
Epilepsy
Infectious Diseases
Liver Disease
Sexual Health
Sexually Transmitted Infections
Road Traffic Accidents

Safe and Independent Lives (Older People and Vunerable Groups)

Learning Disabilities
Severe Mental Ill Health
Suicide and Undetermined Injury
Dementia and Alzheimer's Disease
Osteoporosis, Falls and Hip Fractures
Palliative Care and End of Life Care

Further Information

Further Information Available From JSNA Toolkit
Abbreviations / Glossary
References

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Introduction

Hull is an amazing City.  We believe the citizens and communities in Hull are its greatest asset.  It is a place that has a history of welcoming and supporting the most vulnerable, including those seeking refuge from other countries.  It is a City of strong partnership working and a shared vision of what is required to improve the lives of our residents.  It is a great place to be born, live, learn, work, have a family and grow older.  Hull is a recovering City.  We have been devastated by the legacy of a World War 2 bombing campaign and the loss of the thriving port and fishing industry.  The City has survived major floods in 2007 and 2013. In recent times Hull has become used to bad press.  It has often been at the bottom of league tables due its high levels of deprivation.  Like many other cities, there are deprived areas in the city, but unlike most other cities its boundaries are so tight they exclude the ‘leafy suburbs’.  This also places major restrictions on our finances as our ability to generate income from the council tax and business rates from the suburbs and satellite developments is hugely limited.  However, a decade of major regeneration schemes and investment across the City is now having a huge beneficial impact on business start-ups, job creation and people’s aspirations.  Hull is a changing City.  Overall people are far healthier than they were in the past, but unfortunately health inequalities across population groups and localities still exist.  Poverty and deprivation have a huge impact on Hull’s population, which is mirrored in inequalities in health and wellbeing.  But overall, Hull is gradually changing for the better and 2017 has been a catalyst for that.  Being UK City of Culture has brought the city and its people out of our collective shell.  The lives of many of the 2,500 City of Culture volunteers have been transformed and this trained civic workforce is now capable of doing so much more after 2017, being change-makers within their communities.  It has been announced that the organisation set up to deliver Hull UK City of Culture is set to continue as a permanent national arts company based in the city, where it will develop a 20-year legacy plan.  The progress made by the city in so many spheres has been recognised in awards and plaudits that would not have been possible in recent times.  Hull is a proud City. The City has a sense of optimism for the future on the back our highly successful year as UK City of Culture 2017. The positive outside coverage of the city, and the inclusivity of the artistic programme, has helped to renew a real sense of pride in our history, our people and our culture.  Volunteers and residents have welcomed the chance to give praise to our heritage, strong family ties, historically significant buildings, and our free quality museums and galleries.  Visitor numbers to Hull have rocketed, and most visitors are pleasantly surprised by what Hull has to offer.  The continuing regeneration of the City centre and housing stock has added to the City’s renewed sense of satisfaction and confidence. Overall, the story of Hull is a story of a City that is proud and optimistic and wants to share its sense of freedom and place with the rest of the UK.

This JSNA summarises what the issues are, what the local situation is and what the strategic needs are in relation to almost 70 topic areas.  Quite a lot of these topics overlap or are associated, and information is not necessarily included in all these sections.  For example, there are topic areas for both screening and breast cancer, and for maternal health and breastfeeding, and deprivation and crime, etc.  So it might be necessary to look in more than one section for the information you require.  After general context, health, and lifestyle factors, the topics are broadly ordered around the three outcomes from the Health and Wellbeing Board Strategy [1]: the best start in life; healthier, longer, happy lives; and safe and independent lives

More detailed information is available in our detailed JSNA Toolkit reports, our JSNA Hull Atlas, Health and Lifestyle Survey reports, Social Capital Survey reports, and local analysis of the Public Health Outcomes Framework (all available at the Hull Public Health website).  Abbreviations, a glossary, details of local surveys and strategies, etc. are given here. A full set of references used within this report are given here.

This complements other overarching strategy documents for Hull such as the Health and Wellbeing Board Strategy [1], the City Plan [2] and the local Humber, Coast and Vale “Start Well, Live Well and Age Well” Sustainability and Transformation Partnership [3], and the Director of Public Health Annual reports [4, 5, 6, 7] as well as other strategies on very specific areas and topics (see here for more on these strategies).

The JSNA summary is a ‘living’ document, updated frequently, and any comments, corrections and additions would be welcome.

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Context of Need

Everything around us impacts on health and wellbeing, and our health and wellbeing impacts on everything we do.

Dahlgren and Whitehead illustrated the determinants of population health and wellbeing in the following diagram [7].

Determinants of population health and wellbeing

Determinants of health and wellbeing

This ‘context of need’ section of this report examines the geographical area, population and summarises some of these broader determinants of health and wellbeing such as information on deprivation, housing, the environment, crime, social capital, social isolation, social care, and caring and carers.

Information on schools including educational attainment is covered within the section on children and young people, information on the labour market and benefit claimants are covered in the section on working-age adults and behavioural and lifestyle factors are covered here.

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Geographical Area

What’s the issue?

In order to improve health and reduce inequalities, it is important to understand the make-up of the local population and geographical area.  Features within the geographical areas, such as rivers or the location of residential, commercial and industrial areas, or the way in which boundaries have been derived can influence health needs of the local population, and also their access to services.

What’s our situation?

The city and port of Hull lies on the banks of the river Humber and is positioned at the gateway to Europe.  It is linked to the national motorway networks from the west via the M62 and to the south across the Humber Bridge via the M180.  Hull is surrounded by the East Riding of Yorkshire a largely rural area containing a number of suburbs immediately adjacent to the city.

In November 2013, Hull was announced as the winner of the UK’s City of Culture 2017 [9] (see the JSNA Glossary for more information).

In relation to the characteristics of Hull, one problem relatively unique to Hull is its tight geographical boundaries.  Most cities such as Hull are relatively deprived, but most other local authority or NHS boundaries for that city cover some more affluent suburban areas.  Hull has very few affluent suburbs within its boundaries, and it is estimated that around 2,500 people in Hull move to the ‘leafy suburbs’ in East Riding of Yorkshire just outside Hull’s boundary each year.  The people that tend to move will often do so because of children and better schools, better quality and choice of housing, etc.  The more aspirational, successful and motivated people will tend, on average, to have increased mobility.  This also affects the employment and skills profile of Hull.  Furthermore, owing to Hull’s somewhat isolated location, people may be less likely to be influenced by positive health factors and changes occurring elsewhere in other geographical areas.  Due to Hull’s high levels of deprivation and tight boundaries, Hull is often at the bottom of national league tables and among the ‘worst’ for various indicators for both health and the wider determinants of health.  As a result, there are often negative comments made about Hull, which can influence attitudes, health and lifestyle.  Within local qualitative research projects, there were certainly some residents that had a “what’s the point?” attitude with regard to their health and lifestyle changes [10], however, others felt that this was just an excuse “You can lead a healthy lifestyle anywhere, it’s not the place – I staunchly defend Hull– it’s about choices” [11].

Hull currently has 23 wards, but with proposed ward boundary changes this is due to change, and none of the 23 existing wards will have the same boundary.

Other geographical areas have been defined on the basis of Clinical Commissioning Group (CCG) boundaries, and Sustainability and Transformational Partnerships (STPs) [12] have been established creating 44 STP areas in England.  Hull is included within the Humber, Coast and Vale (HCV) STP [3, 13], which includes five other local CCGs (see the JSNA Glossary for more information).

What are the strategic needs?

Most of the above factors are fixed and not amenable to change. However in the absence of altered boundaries, they reinforce the need for close and collaborative working with local geographic partners, particularly in the East Riding of Yorkshire, and areas included within the HCV STP.  The upside of Hull’s tight boundaries is that access to central services in Hull City Centre is relatively good for the majority of the public, with good transport links radiating to and from the City Centre.  Links such as bus routes are often less good between communities “around the edge” of Hull, which may be physically near to one another but not have easy access.

There has been significant recent investment in the city of Hull revealed within Hull’s City Plan as well as investment obtained prior to the start of 2017 linked with the UK City of Culture 2017  [9].  Further details about the City Plan, the City of Culture and its legacy, recent investment in the city and future investment plans for the city are given in the JSNA Glossary.

The aim of the HCV STP [3] is to work together to help communities “Start Well, Live Well and Age Well” through a priority to move towards place-based provision of services (the JSNA Glossary for more information).

The following reports are available to download:

This 2018 JSNA section on Geographical Area (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Geographical Area (64 pages)

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Population

What’s the issue?

In order to improve health and reduce inequalities, it is important to understand the make-up of the local population.  People at different ages and stages of their lives have different health needs.  Furthermore, people from different backgrounds defined on the basis of Black and Minority Ethnic (BME) group, socio-economic group, gender, age, sexuality, religion and other factors may seek professional medical help to a lesser or greater degree than the general population reflected by access to health care.  Certain geographical areas will have higher proportions of specific populations such as couples with young families, older people, students, and other groups and this will influence the health needs for different geographical areas.  Understanding the population is an essential tool in determining current and future health needs.

What’s our situation?

Population pyramid Hull 2016

Based on mid-year resident population estimates from the Office for National Statistics [14], the population of Hull was 260,240 in 2016, a increase of increase of 1,245 since 2015 and 2,530 since 2014.  To mid-year 2016, there were 3,552 births and 2,490 deaths in the year.  Each five year age band from 0-4 to 60-64 contains between 5% and 7% (between 12,900 and 17,900 people in each five age group) of the overall population with the exception of those aged 20-24 years (8.6%), 25-29 years (8.9%) and 30-34 years (7.4%) partly due to the student population.  Overall, there were 34,460 residents aged 0-9 years, 28,415 aged 10-19, 45,607 aged 20-29, 35,055 aged 30-39, 32,721 aged 40-49, 32,603 aged 50-59, 25,446 aged 60-69, 15,823 aged 70-79, 8,556 aged 80-89, and 1,554 aged 90+ years.  Around one-fifth of the population was aged 0-16 years, another fifth aged 17-28 years, another fifth aged 29-43 years, another fifth aged 44-59 years, and the final fifth aged 60+ years.

Based on the GP registration file for January 2017, the estimate of the resident population is slightly higher at 271,658 residents with 295,374 patients registered with General Practices in Hull [15].

What are the strategic needs?

At different life-stages, people have very different needs.  For instance, among areas with a high percentage of families, maternal health, breastfeeding, vaccinations and immunisations, and a good start in life are important issues.  Students and young people may need advice and support in relation to lifestyle and behavioural factors such as alcohol and smoking, mental health, and sexually transmitted infections.  People of working age may have needs in relation to employment, mental health, and lifestyle and behavioural risk factors, such as smoking and diet.  Older people will tend to have more long-term conditions, and needs in relation to falls and hip fractures, dementia, and mental health including social isolation.

Because of the 30,000 “extra” people registered with Hull GPs, but residing in East Riding of Yorkshire, if services are delivered through Primary Care, account needs to be taken of these non-Hull residents on the lists of Hull General Practices.

The following reports are available to download:

This 2018 JSNA section on Population (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Demography and Demographics (223 pages)

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Ethnicity

What’s the issue?

In order to improve health and reduce inequalities, it is important to understand the make-up of the local population.  People from different Black and Minority Ethnic (BME) groups have different health needs as they may have an increased risk of specific diseases due to different genetic risk factors or have different prevalence of lifestyle and behavioural risk factors and varying problems with access and cultural issues.

What’s our situation?

From the 2011 Census [16, 17], Hull remained 94.1% White, with 89.7% of Hull residents White British, 0.2% White Irish and 0.1% White Gypsy or Irish Traveller.  A further 1.3% of residents were from Mixed BME groups, 2.4% were Asian or Asian British (including 0.8% Chinese), 1.2% were Black or Black British, 0.4% were Arabs and 0.4% were from other ethnic groups.  Newland ward near the University and Myton ward in the city centre had the lowest proportion of White British residents at 66% and 69% respectively, while the largest percentage of White British residents were found in Sutton and Bransholme West wards (98% in each).  4.4% of Hull residents were Other White, largely Eastern Europeans, with the highest percentages in Newland and St Andrews wards (17% and 15% respectively).  The largest non-White ethnicity was Asian or Asian British, making up 2.5% of Hull’s population, with the largest percentages in Newland, Myton and Avenue wards (9.5%, 7.5% and 6.0% respectively).  Overall, 6.5% of the population spoke a language other than English as their main language in their home although this varied from 25.1% in Newland ward to 0.6% in Bransholme West ward.  Overall, 2.0% spoke Polish, 1.7% spoke other European Union languages and 0.6% spoke Chinese.  Hull’s BME population is diverse with relatively small numbers of people from a wide range of different BME groups.

In the 2001 Census [18], 97.7% classified themselves at White with 96.4% being White British.  So whilst the percentage of BME population is still relatively low compared to many parts of England for 2011, there has been a threefold increase (an increase of 6.7 percentage points) between 2001 and 2011.  There is anecdotal evidence that the numbers of Europeans has reduced following the vote to leave the European Union.
From the Child Health Profile 2017 [19], in 2016, 5,400 (17.3%) of school children in Hull were from minority ethnic groups (having increased from 9.1% in 2010 [20] and from 14.9% in 2014 [21]).  In January 2017, English was not their first language for 2,897 (11.4%) primary and 1,439 (10.9%) secondary pupils [22] which represents an overall reduction from January 2016 when it was 13.8% and 10.4% for primary and secondary school pupils respectively [23].

What are the strategic needs?

The relatively large increase over the last decade or so and wide diversity in Hull’s BME population requires changes to ensure that the health needs of the population are taken in to consideration, and that there are no barriers to access to healthcare.  There should also be work to identify the most vulnerable citizens and work with them to address their specific needs.

The following reports are available to download:

This 2018 JSNA section on Ethnicity (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Demography and Demographics (223 pages)

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Population Projections

What’s the issue?

In order to improve health and reduce inequalities, it is important to understand the make-up of the present and future local population.  People at different ages and stages of their lives have different health needs.  Those in the oldest age groups have the greatest health need and it is these age groups where it is projected that the largest relative increases will occur in the population due to advances in health care and people living longer.  Understanding the population is an essential tool in determining current and future health needs, and so planning to take account of changes.

What’s our situation?

Based on mid-2014 population projections, the Office for National Statistics (ONS) estimate the resident population of Hull was 257,600 in 2014 [24], and they project that this will increase to 263,000 by 2025 (an increase of 2.1%) and to 267,700 by 2035 (an increase of 3.9%) [25].

2014-based population projections for Hull to 2039

Over the shorter term to 2025, ONS project increases of 4.4% among the 0-19 year age group, decreases of 2.4% and 7.3% among those aged 20-39 years and 40-59 years respectively, and increases of 19.9% and 12.9% among those aged 60-79 years and 80+ years respectively.  These mask relatively large individual changes within five year age groups such as an increases of 17.6%, 15.3% and 33.7% among those aged 10-14 years, 55-59 years and 70-74 years respectively, and decreases of 12.6% and 12.0% among those aged 20-24 years and 40-44 years respectively [25].

Over the longer term to 2035, ONS project increases of 1.3% among those aged 0-19 years, decreases of 2.9% and 7.5% among those aged 20-39 year and 40-59 year respectively, and increases of 25.8% and 59.4% among those aged 60-79 years and 80+ years respectively [25].

Among those aged 65+ years, it is projected that Hull’s population will increase by 17.4% by 2025 (from 38,000 in 2014 to 44,600 in 2025) and by 40.8% by 2035 (to 53,500).  Among those aged 85+ years, it is projected that the population will increase by 21.3% from 4,700 in 2014 to 6,400 in 2025, and by 80.9% to 8,500 in 2035 [25].

What are the strategic needs?

Rising numbers of elderly and very elderly people will mean rising demand for a wide range of services which meet the needs of elderly people.  Not only are people living longer on average, but elderly people are living with an increasing number of chronic diseases which have implications for their health and care needs.  In the absence of other changes, the 40% increase in over 65s in Hull over the next 20 years will mean a similar 40% increase in service demand

The following reports are available to download:

This 2018 JSNA section on Population Projections (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Demography and Demographics (223 pages)

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Deprivation and Poverty

What’s the issue?

Poverty is not having enough money to get by on whereas deprivation refers to a more general lack of resources and opportunities.  Unemployment, poor housing, lack of qualifications, debt, low income, fuel poverty, crime and many other social and environmental factors all indirectly affect the health of the population.  Increased deprivation means that there is poorer health, but this is compounded as poor health also affects other measures such as employment and motivation to improve employment, education and the person’s environment such as housing.  People in more deprived areas also tend to have lower health expectations and potentially fewer GPs per population so there are more likely to be delays in diagnosis and treatment which will influence survival.  People living in more affluent areas tend to be among the first to initiate positive health changes whereas people living in more deprived areas find it more difficult to change due to the stress of poverty and increased pressures of life.  Consequently, those who live in the most deprived areas are more likely to have individual risk factors for ill health such as smoking, poor diet and lack of exercise.  There may also be more barriers in relation to access to health improvement services such as financial barriers, transport issues, access to local cheap good quality fresh fruit and vegetables, and safe access to parks.

What’s our situation?

Hull has high levels of both poverty and deprivation.  In general, in relation to national averages, Hull has a higher unemployment rate, more poor housing, residents qualified to a lower level and higher levels of crime.

Based on the Index of Multiple Deprivation 2015 score [26], Hull is the 3rd most deprived local authority in England (out of 326) with 17 of Hull’s 23 wards amongst the most deprived 20% nationally (fifth), two in the second most deprived fifth and four in the middle fifth nationally. Hull has the third highest percentage of lower layer super output areas within the most deprived 10% within England

Hull national quintiles of IMD 2015

Orchard Park and Greenwood is the most deprived ward in Hull (5th most deprived ward nationally out of 7,529) followed by St Andrew’s (16th ranked nationally), Myton (22nd), Bransholme East (37th) and Bransholme West (38th) with Marfleet (41st) and Southcoates East (65th) also in the bottom 1% of wards nationally in terms of deprivation.

Child poverty (children living in households where income is less than 60% the median household income before housing costs) is high in Hull.  For 2014, 31.0% of dependent children aged 0-19 years lived in relative poverty compared to 19.9% across England [27, 28].  Although unsurprisingly the percentages differed substantially across the wards in Hull from 8.9% in King’s Park to 48.8% in Orchard Park and Greenwood [28].  In total, it is estimate that there are 18,455 (out of 59,455) dependent children living in poverty in Hull.<

Hull is ranked as having the 6th highest ‘severe and multiple disadvantage’ of upper tier or ‘social services’ local authorities [29].  The statistical profile examined the problems faced by adults involved in the homelessness, substance misuse and criminal justice systems.  Mental ill-health was a common complicating factor and poverty was an almost universal complicating factor.

For 2015, it is estimated that 15,760 (13.8%) of households (out of total 114,079) spend 10% of more of their income on fuel (or would do so in order to achieve satisfactory heating requirements) [27, 28].  This is higher than England (11.0%) and has been increasing in Hull since 2011 when it was 10.6%.

What are the strategic needs?

Increasing secure employment is a key strategic need, strongly identified in  Hull’s City Plan [2], which aims to create 7,500 jobs for local people over the next 10 years sits at the heart of the developing 'energy estuary’, making Hull the UK hub for renewable energy industries and investment due to its location. It is necessary to ensure that local residents have the health, skills, education and training required to take up these employment opportunities.

It is necessary to support the ‘Fuel, Food and Finance’ anti-poverty initiatives that help people minimise the health impact of welfare reform and cost of living rises (e.g. initiatives that enable people to prevent, manage or recover from debt), and support the Living Wage.  Suitable affordable housing is also required.

Benefit can be obtained from projects in the community that raise resilience, confidence, self-worth and self-esteem to raise aspirations for life.  Children, young people and adults should have the best life opportunities in terms of education, training and employment so that they have financial stability.  This will improve health and wellbeing.

The most vulnerable citizens should be identified so that their specific needs can be addressed by working with them, and it needs to be acknowledgement that in order to help people improve their health and wellbeing, needs unrelated to health might need to be addressed prior to health needs as people generally need to be in a stable environment before they can change their lifestyle and behaviour and improve their health and wellbeing.

The Social Prescribing Service (Connect Well Hull – see the JSNA Glossary) aims to help people feel more linked in with their local communities and provide advice and support on a range of issues including money and benefits.

The following reports are available to download:

This 2018 JSNA section on Deprivation and Poverty (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Deprivation and Associated Measures (243 pages)

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Housing

What’s the issue?

“The relationship between poor housing and ill health is a complicated one involving many different factors.  Evidence suggests that living in poor housing can lead to an increased risk of cardiovascular and respiratory disease as well as to anxiety and depression.  Problems such as damp, mould, excess cold and structural defects which increase the risk of an accident also present hazards to health” [30].  Poverty also means that people in poor housing have less ability to move home.

What’s our situation?

From the 2011 Census [16, 17], there were 236 communal establishments such as children’s homes, mental health units, care homes and nursing homes where 3,658 residents lived.  There were 112,596 households across Hull (most in Drypool (8,687) and least in Pickering (3,383), and the type varied dramatically across the wards.  Overall, 7.1% were detached houses or bungalows, 26.9% were semi-detached, 49.2% were terraces, 0.1% were households in a caravan or other mobile or temporary structure and the remaining households were flats, maisonettes or apartments in purpose built blocks (12.6%), in converted or shared houses (3.0%) or in a commercial building (1.2%).  Almost half of households were owned outright (19.9%) or with a mortgage or loan (29.7%), with 0.4% shared ownership (part owned and part rented), 28.1% of households were socially rented (mainly from the Council; 21.2%), 20.4% were privately rented and 1.5% lived rent free.  Four in a hundred (3.9%) households had no central heating (highest in as Southcoates West ward at 7.5%).

On average, there were 2.28 Hull residents per household, and this was least in St Andrew’s ward (1.41) and most in Orchard Park and Greenwood ward (4.09) [16, 17].  Four percent of households needed one additional bedroom and a further 0.5% needed two or more bedrooms (based on the ages and relationship of household members to one another).  St Andrew’s (7.3%) and Newland (10.9%) had the highest levels of overcrowding with 7.3% and 10.9% of households requiring an extra bedroom (latter probably influenced by students sharing rooms to save costs).

Just over one-third of households were one person households (35.3%) and in one-third of these lived a person aged 65+ years (11.6%) [16, 17].  The majority were one family households (57.6%) with 5.9% all aged 65+ years, 26.3% married (10.3% no children, 10.9% dependent children and 5.1% non-dependent children), 12.5% cohabiting couples (5.7% no children, 6.1% dependent children and 0.7% non-dependent children), and 12.9% lone parent families (9.1% dependent children and 3.8% non-dependent children).  The remaining 7.1% of households were other types such as those with all full-time students.

What are the strategic needs?

There is a need to improve the quality and energy efficient status in homes across the city, promote the availability of affordable homes, ensure there is stability in the housing market so people are not forced to move frequently, and reduce overcrowding. Where appropriate, ensure provision of specialist and adapted housing that is fit for purpose.

The Neighbourhood and Housing Strategy [31] provides a framework for achieving the vision of housing which meets the needs and ambitions of current and future residents of the city. Whilst a key part of the Housing and Neighbourhood Renewal Strategy is to support the delivery of new and improved housing, there is always the need to prevent people becoming homeless and provide support and advice to meet individual needs. The five themes are: (i) housing need; (ii) access to housing; (iii) housing quality; (iv) neighbourhood quality; and (v) neighbourhood renewal and growth.

Hull's Tenancy Strategy [32] provides guidance to registered providers of social housing. It sets out what registered providers of social housing in its district should consider in preparing policies which relate to the kinds of tenancies they grant, the circumstances in which they will grant a tenancy of a particular kind, where they grant tenancies for a fixed term, the lengths or the term, and the circumstances in which they will grant a further tenancy when a tenancy is coming to an end.

Hull City Council also has a strategy for people who need care (older people and people with mental health, learning or physical disabilities) live a more independent life through extra care housing which provides self-contained housing with support and care and onsite social care services [33].

The Social Prescribing Service (Connect Well Hull – see JSNA Glossary) also provide advice and support on a range of issues which includes housing.

The following reports are available to download:

This 2018 JSNA section on Housing (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (181 pages)

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Homelessness

What’s the issue?

The Homeless Reduction Act 2017 amends the Housing Act 1996 Part VII extending the period when people are 'threatened with homelessness' so that help is available earlier, and giving a duty to assess every eligible applicant's case and agree a plan (rather than those who were possibly intentionally homeless or were in priority need, e.g. pregnant women, families, specific vulnerable groups). The Act also extends the duty to provide an advisory service and to 'help to secure' accommodation (although this only leads to a 'duty to accommodate' provided specific criteria are met), extends the 'prevention duty' and gives further information on when the duty ends and on the right to a review.

The physical health problems and mental health needs as well as the prevalence of behavioural and lifestyle risk factors such as smoking, poor diet, use of drugs and alcohol of people who are homeless is much worse and higher than the general population 34, 35, 36], and they attend A&E much more frequently [35, 36, 37] and use four times as many acute hospital services [35] than the general population, with a high cost to the NHS and public services [35, 36, 38].

What’s our situation?

During 2016/17, 625 housing decisions were made (in relation to Hull's 114,818 households). Six were eligible but not homeless, 38 were eligible, homeless and in priority need but intentionally homeless, 145 were eligible, homeless but not in priority need, and 436 were eligible, homeless and in priority need. Whilst the number in priority need was considerably lower than the 500-1000 households between 2004/05 and 2012/14, the current rate (3.80 per 1,000 households) is the highest it has been since 2013/14 (3.07), and higher than England (2.54) [39]. Between 2010/11 and 2012/13, the rate of statutory homeless households not in priority need was twice as high in Hull as England (4.4-4.7 for Hull compared to 2.0-2.4 for England per 1,000 households), but has decreased recently to 1.26 per 1,000 households in 2016/17. Despite the recent fall in Hull, the latest rate is still considerably higher than England at 0.84 per 1,000 households [27, 28]. Hull had a much higher rate of homelessness cases (43.4 per 1,000 households) that were prevented and relieved compared to England (9.3) for 2016/17 [40], and this might be why in Hull the rate of households in temporary accommodation is much lower than England (0.39 versus 3.33 per 1,000 total households for 2016/17) and this has consistently been the case since at least 2010/11 [27, 28].

It was estimated that there were 15 rough sleepers in Hull in Autumn 2016 [41] representing a rate of 0.13 per 1,000 households (between 7 and 15 since 2010 although 23 in 2015). However, this does not include 'hidden homeless' groups, such as those who are squatting or staying in places which are inaccessible to outreach workers, or people in hostels or shelters. Based on local information, there are 40-60 people with severe and multiple disadvantages who are at risk of being homeless but who are reluctant to engage with services and are not eligible for re-housing. In 2017, there were nine establishments offering accommodation to the homeless providing 499 places in total [42]. During 2016/17, the local Centre for Assessment and Emergency Accommodation had 249 different users of which 202 completed an assessment, and 76% were male, 23% female and 1% transgender, 19% were under 25, 44% aged 25-39, 27% aged 40-49, 8% aged 50-59 years and 2% aged 60-69 years. More than half (55%) were verified rough sleepers, 46% had no, 30% had limited and 21% had regular contact with services (3% unknown), 95% were White British, 64% had mental health needs (only 44% with a formal diagnosis) and 45% had physical health needs.

What are the strategic needs?

Hull's Preventing Homeless Strategy [43] has two key priorities improving access to housing and preventing homelessness, and relieving homelessness and preventing rough sleeping. The good work around prevention and relieving homelessness, resulting in fewer statutory homeless households in temporary accommodation should continue.

Hull City Council runs quarterly preventing homelessness focus group meetings which provide opportunities for discussions on how the local authority can work to prevent homelessness and develop appropriate services and support for people who are homeless. Organisations working with people who are homeless are invited to attend these quarterly meetings.

The following reports are available to download:

This 2018 JSNA section on Homelessness (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (184 pages)

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Environment

What’s the issue?

“Humans interact with the environment constantly. These interactions affect quality of life, years of healthy life lived, and health disparities. The World Health Organisation defines environment, as it relates to health, as "all the physical, chemical, and biological factors external to a person, and all the related behaviours” [44]. Environmental health consists of preventing or controlling disease, injury, and disability related to the interactions between people and their environment" [45].

We are currently experiencing the greatest change in the natural environment in human history [46]. The threat of climate change (see here) as a result of the increase of greenhouse gases by human activity is pushing known planetary boundaries in areas such as species loss, air quality (see here), natural resources and extreme weather events. The increasing global population expansion and dietary change is putting pressure on agriculture and land use.

What’s our situation?

Hull has some outstanding cultural and historic assets, many of national and international significance. Green space makes up around a third of land use (34.4%), followed by domestic gardens (20.6%), roads (13.0%), domestic buildings (8.6%), non-domestic buildings (6.4%), water (2.5%), paths (1.6%) and rail (0.6%), with the remaining 12.3% defined as other land uses [49]. In March 2010 [49], it was estimated that 7,090 dwellings could be built on land that was unused and suitable for housing or from developing existing buildings. Hull is a total of 7,154 hectares.

Between March 2015 and February 2016, from the national Natural England's Monitor of Engagement with the Natural Environment Survey, 18% of Hull's residents used outdoor spaces for health or exercise reasons over the previous seven days (the same as England) [27, 28].

What are the strategic needs?

The ambitions of the Hull's City Plan [2] are to make Hull the leading hub for renewable energy industries (UK Energy City), make Hull a world-class visitor destination (Destination Hull) by capitalising on Hull's role as UK City of Culture 2017 (see JSNA Glossary), the multi-million pound investment into the city's cultural and tourism infrastructure, and making Hull a place of opportunity for all, building strong and resilient communities by focusing on safeguarding the most vulnerable, prevention and early intervention, and making money go further (Community and Opportunity) [2]. Significant progress has already been made in these areas, and it is necessary to ensure that this momentum is built upon and developed within the wider context of the need to de-carbonise the economy to reduce the impact of climate change and ensure effective resilience to climate change.

It is necessary to work together to maintain and expand an environment that promotes physical activity and active lifestyle opportunities in everyday settings for all ages. There is also a need to work with partners to ensure the design of the built environment discourages crime and fear of crime.

It is necessary to work with partners to reduce the impact of extreme weather events and wider emergency events and seek assurance of preparedness, response and recovery when events happen. To create a natural and physical environment that is resilient to climate change.

We need to increase access to traditional environmental spaces including parks, nature areas, gardens, cycle paths, recreational paths and water courses to improve physical and mental well-being and ensure that these are maintained in a sustainable way.

There should be support for sustainable and seasonal approaches to food use within the City to support healthy eating within health and care environments through the Green Kitchen Standard and support residents in cooking and eating healthily.

The following reports are available to download:

This 2018 JSNA section on Environment (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (184 pages)

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Air Pollution

What’s the issue?

There are a number of different air pollutants such as ozone, sulphur dioxide (SO2), nitrogen dioxide (NO2), mono-nitrogen oxide (NO), and mono-nitrogen oxide and nitrogen dioxide combined (NOx). The summary measures of PM10 and PM2.5 provide a measure of the mass (in micrograms) per cubic metre of air of individual particles (particulate matter) with an aerodynamic diameter generally less than 10 and 2.5 micrometres respectively. The Air Pollution Index (API) is used to understand the daily air quality and if there are any health effects (within a few hours or days after breathing polluted air) that may concern the public [50, 51]. Bands 1-3 (low risk) is unlikely to be noted by individuals, bands 4-6 (moderate) may produce mild effects unlikely to require actions but may be noted amongst sensitive individuals, with band 7-9 (high) sensitive individuals may notice significant effects and may need to take action to avoid or reduce effects (e.g. people with respiratory or cardiovascular conditions avoiding exercise that day, asthmatics using their 'reliever' inhaler, etc.), and band 10 (very high) could affect sensitive individuals even worse.

NHS Choices [52] have summarised some research on lung cancer [53] and heart failure [54] in relation to air pollution. For the lung cancer study, each 10μg/m3 increase in PM10 led to a corresponding increase in the hazard ratio of lung cancer incidence of 1.22 (95% confidence interval 1.03 to 1.45) with no association found between lung cancer incidence and PM2.5, NOx or NO2. The heart failure study found an increased risk of heart failure hospitalisation or death for increases in carbon monoxide (3.52% increase in risk per increase of one part per million of pollutant), SO2 (2.36%), NO2 (1.70%), PM2.5 (2.12%) and PM10 (1.63%). In both studies, some potential confounders were included in the model, but it is possible important confounders were not included (see JSNA Glossary for more information on confounding).

What’s our situation?

Hull City Council measures air quality across the city, with results sent to the Department for Environment, Food and Rural Affairs' (DEFRA) [55]. Levels of NO2, NOx, NO, NO2, PM10 and PM2.5 are all measured.

The highest pollution concentrations are along the south edge of Hull (A63), near the train/bus station, and near the industrial areas (up the centre of Hull from South to North approximately route of river and the A1033) and around the Docks (in South-East corner (Marfleet ward) of Hull), although only an area around the A63 exceeds the National Air Quality Objectives.

The Committee on the Medical Effects of Air Pollutants (COMEAP) estimated that if all man-made particulate pollution were removed, this would lead to an increase in life expectancy of around 6 months although the effect could be as small as one month and as large as a year [56]. To put this into context, the effect on life expectancy of continued smoking is seven years on average. Nevertheless, mortality attributable to particulate air pollution has been modelled for Hull for 2015 from DEFRA's modelled pollution concentrations, the number of deaths to persons aged 30+ years and the relative risk of 6% increase in mortality per 10μg/m3 PM2.5 estimated by COMEAP. From this, it is estimated that 4.8% of deaths among those aged 30+ years are attributable to air pollution (compared to 4.7% for England) [27, 57].

What are the strategic needs?

There is a need to reduce levels of pollution across Hull and to raise awareness of the health and financial implications of poor air quality. This should encourage less polluting lifestyle choices. 58]. Hull City Council have committed to attaining the highest level 'Green'. Further information is given in the section on Climate Change.

The following reports are available to download:

This 2018 JSNA section on Air Pollution (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (181 pages)

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Climate Change

What’s the issue?

Climate Change is one of the greatest threats currently faced by humans. Climate change will affect the frequency and intensity of extreme weather events such as flooding, storms and heat waves. The warmest years since records began have all been in the period since 2000, and 2016 was the warmest in the UK. Current scientific evidence published by the United Nations Intergovernmental Panel on Climate Change [46] show that the climate impacts we are experiencing are a result of only a 1° Celsius rise in global temperatures and the Paris Agreement has set a target to restrict global warming to well below 2° Celsius with an ambition to restrict to 1.5° Celsius.

Nationally the Climate Change Act has set a target to reduce carbon emissions by 80% by 2050 (from a 1990 baseline). Further, in 2017 the Government published the national Climate Change Risk Assessment [59] identified six priority risk areas of which two concerned health (heatwaves and new diseases). Along with three of the other areas the assessment was that "more action was needed" in preparedness. There is therefore an imperative to reduce carbon emissions, and adaptation activity to prepare for the inevitable consequences of climate change. The National Adaptation Programme [60] is informed by the Risk Assessment and is currently being revised and a new programme will be published in 2018 with actions required by the health sector.

Work in 2014 by Joseph Rowntree Foundation and University of Manchester [61] has shown that residents that are already vulnerable due to age, long term life limiting illnesses and poverty are least able to be resilient to the impacts of climate change and are more adversely affected than the average resident.

What’s our situation?

The City of Hull has experienced several extreme weather events over the last ten years that have put increased pressure on public health services. The floods in 2007 affected significant parts of the City with some families not being able to return to their homes for up to two years. The tidal surge in December 2013 closed the A63 and the Transpennine rail line, and the snow and ice winters in 2010 and 2011 affected roads with some impassable for weeks and increased the number of people suffering falls. Hull has yet to experience a heat wave which is likely to become more of an issue as we move through the century.

The impacts of climate change will disproportionately affect the most vulnerable and therefore put increased pressure on public health and health services in Hull.

Since January 2013, Hull City Council has held the highest Green Accreditation for its environmental management system, Investors in the Environment and undertaken work to reduce its carbon emissions in line with its corporate targets. It has also undertaken climate adaptation risk assessment for Housing, Museums and Gallery, Waste Management, and Parks and Transport services.

The experience of the significant flooding events have shaped how we build homes, support vulnerable residents and business and undertake resilience work at the city and community level. We have a greater understanding of how we interact with our environment and the key role it plays in improving public health as well as how it can affect people's life chances. We also have a greater understanding and working relationship across service providers in how our actions impact each other and how through greater project integration we can build a whole system approach to the challenges.

What are the strategic needs?

There is a need to better understand the extent of climate risk to public health and the wider health services in the City. The development of effective climate adaptation for services and facilities would ensure that they are more resilient to extreme weather events and therefore reduce the emergency impact on public health services.

The cost of extreme weather events to public health services is not well understood and there is a need to better understand the financial impacts so that this can support timely and effective climate adaptation investment.

The following reports are available to download:

This 2018 JSNA section on Climate Change (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (184 pages)

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Crime

What’s the issue?

"The effect of local crime rates does affect the mental well-being of residents. Crime causes considerable mental distress of residents, and these effects are mainly driven by property crime. However, there is also an effect due to violent crime. Local crime creates more distress for females, and is mainly related to depression and anxiety." [62]. Individuals dependent on opioids and/or crack cocaine are responsible for an estimated 45% of acquisitive crime (shoplifting, burglary, vehicle crime and robbery), and around 40% of all violent crimes are alcohol-related [63].

What’s our situation?

Between the period February 2016 and January 2017, there were 31,102 reported crimes across Hull which has increased recently [64, 65]. The largest categories of crime were violent crimes (9,127), criminal damage and arson (4,969), shoplifting (3,600) and burglary (3,558). Some of these categories potentially overlapping as each crime could appear in more than one category. There were 8,051 incidents of anti-social behaviour.

From the Public Health Outcomes Framework (PHOF) [27, 28], for 2016, there were 101 first time entrants into the youth justice system (receiving their first reprimand, warning or conviction) aged 11-17 years in Hull which was slightly higher than England (471 versus 327 per 100,000 population, and fallen from 754 per 100,000 population for Hull for 2012). Across all ages, in 2016, there were 763 first time offenders in Hull giving a rate of 295 per 100,000 population (compared to 218 for England). For 2014, 1,201 re-offenders committed 4,338 re-offences out of the 3,833 offenders, and both the percentage re-offending (31.3% versus 25.4%) and the average number of offences committed per offender (1.13 versus 0.82) was higher in Hull compared to England, although both had decreased in Hull in the last year.

The trends in the rate of hospital admissions due to violence have formed a reverse U-shape since 2001/02-2003/04 increasing from 98 to a high of 158 per 100,000 population in 2005/06-2007/08 and then decreasing to 72 per 100,000 population for the most recent year 2012/13-2014/15 [27, 28].

Within the Joint Strategic Intelligence Assessment (JSIA) [66], levels of crime have increased including violent crime occurring within the city centre, and Hull has higher rates of offending and re-offending compared to nationally.

Priority Families in Hull have been identified which intended to change the repeating generational patterns of poor parenting, abuse, violence, drug use, anti-social behaviour and crime in the most troubled families. In phase 2 of the programme which commenced in April 2015, over 2,500 families have been identified in Hull and over 700 have achieved all outcomes (see the JSNA Glossary for more information on Priority Families Programme and on Early Help and Priority Families Strategy).

What are the strategic needs?

As stated in the local JSIA [66], there are four identified priorities: (i) reducing domestic abuse and violent behaviour; (ii) reducing offending and re-offending; (iii) reducing substance misuse; and (iv) supporting victims and vulnerable communities. There are a number of initiatives and multi-agency work happening around domestic abuse (see here). Hull's Alcohol Strategy 2016-2020 (see here) and The Government's 2017 Drug Strategy [67] (see here) link in with reducing violent crime, reducing offending and re-offending and reducing substance misuse. Targeting hotspots of crime in terms of both location and time could also be another approach which has been used previously as this has been shown to reduce crime rates more significantly than employing random methods. Partnership working is essential to reduce levels of crime, domestic abuse and anti-social behaviour, and to support victims. Work is ongoing with Hull's Priority Families to change repeating generational patterns of poor behaviours (see the JSNA Glossary). Social return on investment tools for drugs and alcohol make the case of investing in drug (see here) and alcohol (see here) treatment programs to reduce overall crime and anti-social behaviour to reduce costs incurred by drug and alcohol issues to society and the economy [63, 68].

The following reports are available to download:

This 2018 JSNA section on Crime (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Deprivation and Associated Measures (243 pages)

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Domestic Abuse

What’s the issue?

“The cross-government definition of domestic violence and abuse is: any incident or pattern of incidents of controlling, coercive, threatening behaviour, violence or abuse between those aged 16 or over who are, or have been, intimate partners or family members regardless of gender or sexuality. The abuse can encompass, but is not limited to: psychological; physical; sexual; financial; and emotional” [69].

“Domestic abuse can have a significant impact on your emotional wellbeing, as well as sometimes affecting other relationships and your ability to live your life as you'd want to” [70]. Safe Lives report that one in five high risk victims reported attending A&E as a result of their injuries in the year before getting effective help, and that two fifths of high risk victims reported mental health issues [71, 72]. Caada research found that 18% of children in domestic abuse households were injured as a result of the abuse [73]. Research in the US [74] found that there are domestic abuse has significant psychological consequences for victims, including anxiety, depression, suicidal behaviour, low self-esteem, inability to trust others, flashbacks, sleep disturbances and emotional detachment [75, 76, 77, 78, 79]. Domestic abuse victims are at risk of post-traumatic stress disorder (PTSD) [80], and between 30-60% of psychiatric inpatients had experienced severe domestic abuse [81].

It is difficult to collect good data on domestic abuse as data collection methods and definitions could differ [82]. Furthermore, eight in ten victims did not report the abuse to the police (Crime Survey for England and Wales 2014/15 [82]). With these provisos, around two million adults aged 16-59 years who said they were a victim of domestic abuse in the Crime Survey for England and Wales 2015/16. There were over one million domestic abuse-related incidents recorded by the police with a criminal offence committed in approximately four in every ten of these incidents. Domestic abuse-related crimes recorded by the police accounted for approximately 1 in 10 of all crimes. The majority of domestic abuse (78%) consisted of violence against the person offences [82].

What’s our situation?

From the Crime Survey across the Humberside Police area, between 2013/14 and 2015/16, there was an average of 39,100 victims of domestic abuse who were aged 16-59 years each year (15,100 men and 24,000 women). Overall, 7.6% of survey responders said that they had been a victim of domestic abuse more than once in the last year (5.8% of men and 9.3% of women) [82]. Hull's Domestic Abuse Partnership who support victims of domestic abuse have around 460 open cases each month throughout 2016/17 (90% female) [66]. There was an average of 50 men engaged with the perpetrators programme per month in 2016/17.

From the Public Health Outcomes Framework (PHOF), the rate of domestic abuse incidents recorded by the police was slightly higher than England (at 24.8 per 1,000 population in Hull compared to 22.1 per 1,000 population in England) for 2015/16 [27, 28].

What are the strategic needs?

Nationally over the last few years, there has been increased protection of victims of domestic abuse and a relatively new offence came into force in December 2015 around coercive and controlling behaviour [69].

The Humberside Criminal Justice Independent Review recommended education as a priority to target for prevention in particular relating to education: (i) for young people via new pedagogic approaches on domestic abuse (the discipline that deals with the theory and practice of education; it thus concerns the study and practice of how best to teach); and (ii) wider associated service including health, GPs and A&E need to be more aware of domestic abuse enabling them to ask the relevant questions at relevant times. This could be satisfied in part by the introduction of a local (Humberside) training and awareness standard or protocol aimed primarily at 'first responders' across a range of agencies such as police, social services, and health. There is a need to consider improving therapeutic support, particularly for young men and children. There is a need to agree a definition of what success looks like and to construct a common approach to evaluating service provision. The resultant framework should have a service user focus and enable the evaluation of services from a user perspective. There is a need to analyse how success is measured and defined in relation to services, with many interviewees suggesting they felt services were successful but there was little qualitative and quantitative evidence to support this. There is a need for regular evaluations of service provision and that the findings of these are communicated effectively to all involved in domestic abuse services. The near-universal prevalence of domestic abuse victimisation within neighbourhoods represents an opportunity to 'normalise' the recognition, acknowledgement and reporting of domestic violence through social marketing. It is essential that any campaign in this regard does not apportion blame to those who do not report victimisation but encourage them to recognise the wide prevalence of domestic abuse and the acceptability of seeking help. Policy makers and domestic abuse prevention services should recognise the disproportionate relationship between area deprivation and domestic abuse incidents.

Hull has various programmes and initiatives running relating to domestic abuse which gives support to victims and children in affected households and which provide early help and safeguarding, as well as running a programme for perpetrators to stop domestic violence and Hull's Priority Families Programme (see the JSNA Glossary).

The following reports are available to download:

This 2018 JSNA section on Domestic Abuse (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Deprivation and Associated Measures (243 pages)

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Social Capital

What’s the issue?

Social capital examines feelings of safety when walking in the community, civic engagement, neighbourliness, social networks and social support. It is argued that improved social capital can have a positive influence on the mental health and well-being of the people living in the community. However, it can sometimes be a negative effect with improved social capital such as social networks which, for example, lead to easier access to smuggled tobacco or drugs, peer-pressure to continue smoking or eating a poor diet. There are different types of social capital. Bonding social capital is narrow and more internal, and relates to immediate families, close friends and neighbours. Bridging social capital is wider and more external, and relates to looser ties, associated with more diverse relationships such as those with colleagues, acquaintances and other communities.

Traditional public health improvement has focused on providing services and dealing with ill-health and its consequences, and success has not been as good as it was hoped. A new approach increasingly used is based around an asset approach improving health of residents by making health and wellbeing everybody’s responsibility, and working together with communities to listen to their concerns and develop interventions. This approach is based on strengths, abilities and capacities of the community rather than weaknesses and disability, and ‘active participant in solution’ approach rather than a ‘passive victim of problems’ approach which involves collaboration rather than silo provision. Improving and maintaining high levels of positive social capital should help this approach.

What’s our situation?

From the local adult Health and Lifestyle Survey 2011-12 [83], the majority of people were ‘very satisfied’ (27%) or ‘fairly satisfied’ (49%) with their neighbourhood as a place to live. Fewer than half of survey responders (43%) said they were well informed about things affecting their area, but only 17% of men and 15% of women felt they could influence things that affect their area. Only one in twelve respondents had been involved in any local organisations over the past three years (but this might have changed due to City of Culture). Around one third of survey responders trusted most people in the neighbourhoods and an additional fifth trusted many people, and 61% of women and 56% of men felt that neighbours looked out for each other. The percentages who were informed about local decisions, ability to influence local decisions, who trusted and who felt neighbours looking out for each other increased with age and in areas with lower levels of deprivation.

It has been found in the local adult Health and Lifestyle Surveys that particular groups, such as Gypsy and Travellers and asylum seekers, can have high levels of bonding social capital, but have low bridging social capital [84]. This can make whole communities or groups feel isolated.

Local qualitative research work in Hull during 2014 [85] found successful community groups had a key central focus (based on either a geographical area or interest in particular topic), they were more likely to engage with ‘hard to reach’ groups, seen increasingly as filling ‘gaps’ as other (statutory) services became stretched, better able to understand community needs, and more offer affordable services at lower cost. The real value of groups is sometimes overlooked as savings are ‘hidden’ and it can take time for benefits to become apparent. There are many benefits from taking part in community groups. Volunteers are an absolutely central asset. Successful groups do not underestimate the associated demands of volunteering and have realistic expectations. Collaboration was often made with statutory services but not with other community groups (although there were exceptions). Professionals can play an important supporting role especially in the initial set-up and could help with official procedures and regulations. There was a recognition that there needs to be the provision for comprehensive local information with regards to priorities and plans, but also with regard to events, funding opportunities, other community organisations and initiatives, and training opportunities. Community groups also need more assistance with identifying appropriate sources of funding. Funding is often time-limited and insecure, and that successful groups and projects need time to both embed and develop to produce positive and substantive change.

What are the strategic needs?

The aim of the Humber, Coast and Vale Sustainability and Transformation Partnership [3] is to work together to help our communities "Start Well, Live Well and Age Well" through a priority to move towards place-based provision of services which are good quality and safe as well as operationally and financially sustainable. The vision is to support everyone to manage their own care better, reduce dependence on hospitals and use resources more efficiently. To achieve the aim of the STP, it is necessary that communities and public and voluntary sector organisations work together (see page 111 for more information).

An asset-based approach can help this process by focusing on the positive assets available to people within themselves as well as assets within their families and their communities, although people need to have the information and understanding of the benefit of positive life choices and know how to access information and seek early support to change. Supporting people to manage their own care, reduces dependence on hospitals and reduces resources in line with the STP's vision. Following financial restrictions and reductions in budgets, this approach represents a relatively recent shift from the provision of services to more integrated care using this asset-based approach to strengthen communities. This supports people to help themselves by providing more relevant solutions that are accessible to them, supporting them in this process with expert, relevant and timely help and advice. These types of approaches and initiatives aim to strengthen existing good work being undertaken in the community, and improve the social capital of the communities in a positive manner. Effective use of developing and maximising existing assets in our people, places and communities can build and improve self-esteem and resilience, reduce the prevalence of behavioural and lifestyle risk factors for poor health, improve health and reduce inequalities. Work is ongoing in Hull around the asset-based approach

The Social Prescribing Service (Connect Well Hull – see the JSNA Glossary) aims to help people feel more linked in with their local communities and provide advice and support on a range of issues such as money, benefits, housing, physical or emotional difficulties, and getting more active. A Social Prescribing funding panel is also being set up to enable the local authority, Clinical Commissioning Group (CCG) and Social Prescribing Service (Connect Well Hull) to work in partnership to providing grant funding to develop self-sustaining community initiatives to address unmet community-based need for the prevention provision of health and social care.

A community wide intensive approach to smoking and tobacco control working in an asset based way is being piloted across Hull from late 2017 until June 2018. Local authority area teams will work with local residents and stakeholders, utilising community assets to build a programme which better meets local needs. The programme developed will use existing networks and assets and importantly, work with the community, to provide solutions to problems. The proposal is being developed with Neighbourhoods and Housing to ensure that is aligned with new operating models. The key principles for the project are to: (i) Understand people's perception of their own smoking issues, to inform solutions; and (ii) Create a groundswell for change around smoking. The vision for the programme is to create a community driven programme for smoking which contributes to improved wellbeing and reduced health inequalities for residents.

The aim is also to harness the wider public health workforce to deliver very brief advice to those people with whom they have contact in their day-to-day work (“make every contact count”). It should be recognised that different approaches and support are required for different people, and any specific problems or changes that are required should not be dealt with in isolation, but by considering the needs of each individual separately. The asset-based approach also aims to address this by providing more individualised support focused around the individual rather than the provision of separate services for each of their specific needs.

However, in order to improve overall social capital in individual communities throughout Hull, it is necessary to provide the support and infrastructure throughout the city, such as supporting 'Fuel, Food and Finance' anti-poverty initiatives. These help people to minimise the health impact of welfare reform and cost of living rises, encouraging a culture across organisations that celebrates diversity, encourages respect and has a zero tolerance on hate crime. A key focus is to support families promoting positive parenting skills and to support initiatives that create and provide access to quality sustainable jobs as well as improving the housing stock across the city. There is a drive to build connections between generations to tackle loneliness and support the continued development of an 'age-friendly' city, etc. Work needs to continue with vulnerable groups such as Priority Families (see section on Crime), and young people at risk of becoming teenage parents (see section on Under 18 Conceptions) or not in education, employment or training (see section on Best Start in Life and Transition into Adulthood).

The following reports are available to download:

This 2018 JSNA section on Social Capital and Asset-Bassed Approach (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Mental Health and Learning Disabilities (375 pages)

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Social Isolation and Safety

What’s the issue?

Social isolation can influence anyone, but it perhaps affects the elderly more than younger age groups. People may feel isolated and not part of society for many reasons due to age, being a carer, poverty, unemployment, mobility problems, disability, ethnicity, religion, language barriers, poor literacy levels, etc. Certain groups, such as Gypsy and Travellers and asylum seekers, may have quite good social support within their group, but not outside their group so their whole community can feel isolated [84]. Social isolation and feelings of being unsafe in the community can have a large impact on wellbeing, but can also influence physical health.

What’s our situation?

From the local adult Prevalence Survey 2014 [86], a measure of social isolation was derived, and based on this, it was estimated that around 13.4% of Hull residents aged 65+ years might be socially isolated (but this ranges from 6% in University to 23% in Bricknell wards). If the 13.4% estimate is applied to Hull's overall population aged 65+ years, it is estimate that just over 5,000 people aged 65+ years across Hull could be socially isolated. From the Public Health Outcomes Framework [27, 28], at baseline 2010/11, 43.5% of adult social care users had sufficient social contact in Hull and this increased to 52.8% in 2016/17 with 282 out of 535 adult social care users surveyed feeling they had sufficient social contact. The percentage was higher than England (45.4%) and highest of 11 comparator areas. The rate among adult carers was lower with 32.0% (123 out of 385 surveyed) feeling they had sufficient social contact in Hull which was lower than England (35.5%).

From the local adult Health and Lifestyle Survey 2011-12 [83], one in six respondents had no close friends or family living within a 15-20 minute walk or 5-10 minute drive, increasing with age from 14% for those aged 16-24 years to 22% for those aged 75+ years. The majority (86%) had someone they could call upon for help if they were ill in bed, with the percentage slightly lower in the 75+ year age group (81% compared to 86%-88% for younger age groups). Around 5-6% stated they had no-one to ask except for women, those aged 16-24 years and those living in the least deprived areas where around 4% stated they had no-one to ask. Around 9% stated that "“don't know” or “it depends”, although the percentage was slightly higher among those aged 75+ years (13%) and people living in the most deprived fifth of areas of Hull (11%).

Feelings of safety among those aged 65+ years were considerably lower in Hull compared to England. For 2014/15, 97.6% of adults aged 65+ years felt ‘very safe’ or ‘fairly safe’ walking alone in their area during the daytime in England [87], compared to 89.1% for Hull from the local adult Prevalence Survey 2014 [86]. In England, 67.6% of people aged 65+ years felt safe when walking alone in their area after dark, and 94.3% felt safe when alone in their own home at night [87], but feelings of safety were considerably lower in Hull (46.8% and 87.2% respectively) [86].

What are the strategic needs?

One of the priorities of the local Humber, Coast and Vale Sustainability and Transformation Partnership [3] is to support everyone to manage their own care better through communities and public and voluntary sector organisations working together (see page 111 for more information). Work is ongoing in Hull around the asset-based approach which utilises assets within the community to support people and improve their health. Such approaches can be used to tackle the problems of isolation and loneliness (for more information see the section on Domestic Abuse).

A loneliness strategy for the City will be developed working closely with the voluntary sector. It will include the promotion of activities that seek to build connections between generations to tackle loneliness, and encouragement of a culture across organisations that celebrates diversity, encourages respect and has zero tolerance on hate crime. A focus is also to work with partners to ensure the design of the build environment discourages crime and fear of crime.

The Social Prescribing Service (Connect Well Hull – see the JSNA Glossary) aims to help people feel more linked in with their local communities, and provide advice and support on a range of issues.

The following reports are available to download:

This 2018 JSNA section on Social Isolation and Safety (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Mental Health and Learning Disabilities (375 pages)
JSNA Toolkit: Older People (201 pages)

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Social Care

What’s the issue?

“The Children Act 1989 places a general duty on all local authorities to ‘safeguard and promote the welfare of children within their area who are in need’. Local authorities are required to investigate the child’s circumstances and take any action to safeguard or promote the child's welfare. They also have some responsibilities for young people over 18 years, for example, those with disabilities or who have been ‘looked after’” [88].

“The Care Act 2014 provides the legislation regarding the provision of care and support services to older and disabled people, and their carers, plus safeguarding vulnerable adults from abuse and neglect” [89]. “The Act begins by defining the primary responsibility of local authorities as the promotion of individual wellbeing. There is a shift from the duty to provide a service to meeting needs. A key part of the Act is a focus on preventing or delaying the need for support. Carers are also given significant new entitlements under the Act” [90].

With the ageing population, the need for social care will increase. Furthermore, people are living longer with increasingly complex health needs which place additional needs on scarce resources.

What’s our situation?

From the Child Health Profiles [19], there were 645 children aged under 18 years in care in Hull at the end of 2015/16 which gives a rate of 116 per 10,000 population which is almost twice as high as England (60).

In 2016/17, 4,725 children were referred for services a rate of 842 per 10,000 population which was higher than England (548), and 19% of referrals were repeat referrals within 12 months and the police referred 29% of all referrals. There were 3,899 single assessments completed in 2016/17 a rate per 10,000 of 695. Alcohol abuse (202), drug misuse (289), domestic abuse (616), mental health (429), neglect (289), emotional abuse (287) and other factors (1,722) were factors identified during the assessment with multiple factors recorded in some cases. As at 31st March 2017, there were 3,507 children with an open episode of need with Children's Social Care, giving a rate of 625 per 10,000 population. Over half were open because the child was at risk of abuse or neglect (55%) and 15% were recorded as having a disability. Children's Social Care conducted 1,961 (rate of 350) S47 enquiries where a child was at risk of serious harm or neglect. The outcomes of these enquiries led to 551 Initial child protection conferences. During 2016/17, 504 new Child Protection Plans were started (with physical abuse and emotional abuse the prevalent categories). Overall, 881 children were subject to a Child Protection Plan at any time during 2016/17 with 412 children with open child protection plans as at 31st March 2017.

As at 31st March 2017, there were 695 children aged under 18 years in care in Hull, which gives a rate of 124 per 10,000 population, which is twice as high as England (62). Three-quarters of these children were placed with foster carers, and 88% were placed within 20 miles of their home. Overall, 74% of all placements were provided by the local authority. At any time during 2016/17, there were 950 children in care (42% of 310 admissions were aged 0-4 years). During 2016/17, 270 children left care (48 per 10,000 population) with 44% returning home to live with parents or relatives.

From the Adult Social Care Survey 2016/17 [91, 92, 93], the quality of life of service users in Hull (average score 19.7 out of 24) was higher than for England and the Yorkshire and Humber region (both 19.1). Eight in ten service users in Hull (79.0%) reported that they had control over their daily life, again higher than for England (77.7%) and the region (77.4%).

Virtually all of service users accessing long-term support in Hull received self-directed support (99%), higher than England (89%) and the region (88%). Around one-third of Hull's service users accessing long-term support received direct payments (33%) higher than England (28%) and the region (26%).

For 2015/16, hardly any of the service users aged 18-64 years with a learning disability were in paid employment in Hull (0.9%) which was lower than England (5.7%) and the region (6.7%). Around three-quarters lived in their own home or with their family (74.8%) which was slightly lower than England (76.2%) and the region (79.4%). Among adults in contact with secondary mental health services, 9.0% were in paid employment in Hull which was the same as the region (9%) and slightly higher than England (7%). Just over three-quarters were living independently with or without support (77%) which was higher than England (54%) and the region (71%). Among all service users surveyed, 53% had as much social contact as they would like which was higher than England (45%) and the region (46%).

Long-term support needs were met by admission to residential and nursing care homes for 16.9 per 100,000 younger adults aged 18-64 years which was higher than England (12.8) and the region (13.8), and for 919 per 100,000 older adults aged 65+ years which was considerably higher than England (610) and the region (658). Nine in ten of the older people discharged were still living at home 91 days after discharge from hospital which was higher than England (82.5%) and the region (83.4%). There were 13.4 delayed transfers of care from hospital per 100,000 population which was lower than England (14.9) but higher than the regional average (12.3), and 6.1% of delays were attributable to social care (similar to England at 6.3% but slightly higher than the regional average at 4.8%).

At 70.7%, the proportion of service users satisfied with the care and support they receive was statistically significantly higher than both England (64.4%) and the region (63.8%), and higher than all 11 comparator local authorities. Three-quarters (76.0%) of service users find it easy to find information about support which was higher than England (73.5%), the region (75.3%) and nine of 11 comparator areas. Seven in ten (69.5%) of services users felt safe which was similar to England and the region, and nine in ten (90.7%) of people who use services said that those services have made them feel safe and secure which was slightly higher than England (85.4%) and the region (85.9%).

What are the strategic needs?

There is a need to work with partners to ensure that services are integrated, high quality and accessible in ways that offer people appropriate choices. Collaboration with partners to promote self-care, reablement or mutual support in community settings so this is viewed as the norm and reduce reliance on residential or home care will be a key feature. Another focus is to ensure, where appropriate, that the provision of specialist and adapted housing is fit for purpose. The new Care Act 2014 focuses around meeting needs and promoting wellbeing rather than simply the provision of services and on preventing, reducing or delaying the development of need. Therefore, individual needs should be assessed holistically within the context of their support network and each individual's circumstances considered in order to provide the most appropriate care, help and support for that individual.

The Priority Families programme in Hull aims to change these repeating generational patterns of poor parenting, abuse, violence, drug use, anti-social behaviour and crime in the most troubled families in Hull (see the JSNA glossary) which should influence safeguarding and the number of children in care.

One of the priorities of the local Humber, Coast and Vale Sustainability and Transformation Partnership (STP) [3] is to support everyone to manage their own care better through communities and public and voluntary sector organisations working together which includes those providing social care (see the JSNA glossary for more information). Work is ongoing in Hull around the asset-based approach which utilises assets within the community to support people and improve their health. Such approaches can be used to tackle the challenges within social care and to help people feel better through the ability to help themselves and to be not so reliant on services. Furthermore, the asset-based approach focuses on the holistic approach rather than previous reliance of solving health and care needs through the provision of multiple different services for different conditions or problems (see the JSNA section on Domestic Abuse for more information). Within the STP, there are processes being put in place around technology which can be used to transform health and care services, as well as developing a single electronic care record that can be shared and accessed by health and care professionals, meaning that people will tell their story only once.

The aim is to identify our most vulnerable citizens and work with them to address their specific needs, and support ‘Fuel, Food and Finance’ anti-poverty initiatives that help people minimise the health impact of welfare reform and cost of living rises (e.g. initiatives that enable people to prevent, manage or recover from debt).

The following reports are available to download:

This 2018 JSNA section on Social Care (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Housing, Environment and Social Care (184 pages)

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Carers and Caring

What’s the issue?

“Whilst caring for an ill, elderly or disabled relative or friend can be rewarding, it can be a difficult experience without the right support” [94]. Some carers sacrifice their own way of life, lifestyles, and careers to become carers and the needs of other family and friends for the loved ones, and it can affect the carer’s physical and emotional health if the care needs are high or the carer does not have sufficient support. With the ageing population, it is often the case that elderly couples are caring for the other, with the carer also having significant health needs. The Care Act gives specific rights to all carers and places a responsibility on the local authority to assess and meet their needs.

What’s our situation?

From the local adult Health and Lifestyle Survey 2011-12 [83], 16% of respondents reported that they were responsible for the long-term care of someone, with the highest percentage caring for a sick or disabled partner (5.1%). From the local Young People Health and Lifestyle Survey 2012 [95], one-third of pupils stated they helped look after someone (disabled or ill mother / father / brother / sister, elderly grandparents or someone else). The predicted future numbers of people in Hull providing unpaid care to a partner, family member or other person among those aged 65+ years has been estimated [96]. For 2015, it was estimated that 5,118 carers are aged 65+ years (including 333 aged 85+ years) in Hull but that this will increase to 6,000 by 2025 (including 435 aged 85+ years). It is further estimated that 2,727 of these carers aged 65+ years are providing 50+ hours of care per week in 2015, increasing to 3,232 by 2025.

From the Adult Social Care Survey 2016/17 [91, 92, 93], 32.0% of carers had as much social contact as they would like which was slightly lower than England (35.5%).

What are the strategic needs?

One of the aims of the local Humber, Coast and Vale “Start Well, Live Well and Age Well” Sustainability and Transformation Plans (STP) [3] is to support everyone to manage their own care better through communities and public and voluntary sector organisations working together which includes those providing care (see the JSNA Glossary for for more information on the STP). Work is ongoing in Hull around the asset-based approach which utilises assets within the community to support people and improve their health. This approach can be used to for carers as well as the people they care for (for more information see the section on Domestic Abuse).

There is a need to work with partners to ensure that services are integrated, high quality and accessible in ways that offer people appropriate choices. Also working with partners to promote self-care, reablement or mutual support in community settings so this is viewed as the norm and reduce reliance on residential or home care. Where appropriate, ensure provision of specialist and adapted housing that is fit for purpose. The new Care Act 2014 gives carers the right to receive services in their own right and focuses around promoting wellbeing and meeting needs rather than simple provision of services and on preventing, reducing or delaying the development of need, so individual needs should be assessed holistically within the context of the person’s support network and each individual’s circumstances considered, in order to provide the most appropriate care, help and support for that individual.

The vision from the National Carers Strategy [97] is that by 2018, carers will be universally recognised and valued as being fundamental to strong families and stable communities. Support will be tailored to meet individuals needs enabling carers to maintain a balance between their caring responsibilities and a life outside of caring, whilst enabling the person they support to be a full and equal citizen. This includes supporting carers at an early stage, recognising the value of their contribution and involving them from the outset both in designing local care provision and in planning individual care packages. It is also important to enable those with caring responsibilities to fulfil their educational and employment potential, and having personalised support, and that they remain mentally and physical well. It is important to give them a ‘voice’ in decisions about service development, promoting knowledge about carers’ rights, offering training, breaks and respite, and increasing the number of annual carers’ assessments as well as increasing access to information.

The local council and the Clinical Commissioning Group (CCG) are keen to ensure that carers support is of a high standard and provided locally in local communities and facilities in which carers already spend much of their time. The new Carers Support Service must be personalised to carers' individual needs and circumstances and services must be provided to a wide range of carers, particularly those with complex caring responsibilities and those who are not currently receiving any services, or are not familiar with support available.

The local Carers Service is delivered on behalf of Hull City Council and NHS Hull CCG aims to improve the quality of life for carers in Hull, helping them sustain their caring role, and enhancing their ability to enjoy a life of their own through the provision of a range of person, coordinated and outcome focused services. The key priorities for the carers journey and to improve the quality of life for carers are: (1) Think Carer, Think Family; Make Every Contact Count; (2) Support what works for carers, share and learn from others; (3) Right care, right time, right place for carers; (4) Measure what matters to carers; (5) Support for carers depends on partnership working; (6) Leadership for carers at all levels; (7) Train staff to identify and support carers; (8) Prioritise carers health and wellbeing; (9) Invest in carers to sustain and save; and (10) Support carers to access local resources.

There is work locally to identify, learn and report to local commissioners cases where 'hidden carers' are apparent locally and provide these carers with access to appropriate support with to continue their caring role. The service provides regular episodes of outreach support work within GP surgeries, hospitals, and with healthcare professionals, faith organisations, places of further education and leisure centre's to identify carers and ensure they are signposted to appropriate support and in doing so ensure that carers are provided with the necessary information to manage their own health and wellbeing. It will also ensure an intensive support service is provided to carers who are in crisis or near breakdown for a maximum duration of six weeks, following an assessment of their need. The provider is to record the type of support provided, the impact of the support provided, and report on the outcomes achieved for the carer. It will also provide support and information to carers to access education and training.

The following reports are available to download:

This 2018 JSNA section on Carers and Caring (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: General Health, Disabilities and Caring (240 pages)
JSNA Toolkit: Older People (203 pages)

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