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


Aspects of Health

This section provides some general information about the general health and wellbeing status and disabilities among Hull's population.

Information on life expectancy and mortality rates (from all causes) have been included in this section to give some overall context to the health status among the people of Hull, and to benchmark Hull’s overall health in relation to England, and compare health across the wards in Hull.

Some general information is also provided within this section on the use of healthcare services, secondary care and dental health.

Other information such as maternal health and vaccinations and immunisations are covered in the section on children and young people, screening is covered in the section on adults, sexual health is included in the section on adults, and palliative care is covered in the section on older and vulnerable people.

Information on learning disabilities, severe mental ill health and suicide and underdetermined injury are given in the section on vulnerable groups.

Information on specific diseases and medical conditions is given in the section on working-age adults, unless the condition is specific to children and young people such as accidents or relates to older people such as osteoporosis or hip fractures or relates to vulnerable groups such as learning disabilities or severe mental ill health.

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Life Expectancy

What’s the issue?

Life expectancy at birth is a commonly used method of assessing health, improvements in health over time, and differences in health between different groups (such as those defined on the basis of time, gender, geography and deprivation). A common misconception is that life expectancy at birth measures the expected duration of life for a newborn; it does not. It is a measure of life expectancy assuming that the current age-specific mortality rates continue throughout an entire lifetime. This is an unrealistic assumption and therefore life expectancy figures are an indication of current health status of a population rather than an expectation of the duration of life. However, it does not measure the quality of life. As a result, healthy life expectancy is the overarching indicator within the Public Health Outcomes Framework which is a statistically modelled measure of life expectancy based on living in ‘good health’. Disability adjusted life years (DALYs) measures the years of life adjusting for disability. Medical conditions with high DALYs are conditions which impact on quality of life substantially for a long period of time (see the JSNA Glossary for more information on DALYs).

What’s our situation?

For 2014-16, life expectancy at birth for Hull men is 76.3 years and for Hull women it is 80.1 years which is the fifth lowest for men and fourth lowest for women (out of 150) having decreased for the second successive year for men and the third successive year for women compared to small increases nationally. Life expectancy has not been this low in Hull since 2009-11 for men and since 2008-10 for women. Life expectancy in England is 79.5 years for men (3.2 years higher than Hull) and 83.1 years for women (3.0 years higher) [27, 98, 99]. For 2013-15, life expectancy estimates differ by a decade across the wards for both men (13.4 years) and women (9.9 years) [98, 100, 101]. As well as across the deprivation deciles being 10.7 years higher in men and 8.8 years higher in women in the least deprived tenth of areas of Hull compared to the most deprived tenth of areas of Hull [27, 98, 100]. This is compared to differences nationally of 9.2 years for men and 7.1 years for women [27]. Nevertheless, life expectancy has improved over the longer time in Hull as it was 73.7 years for men and 79.3 years for women in 2000-02 [100, 101].

For 2014-16, life expectancy at age 65 years is two years or more higher in England compared to Hull for both males (18.8 versus 16.6 years) and females (21.1 versus 18.9 years) [27, 98, 99, 100, 101]. Whilst there has been an increase since the beginning of the century (15.0 years for men and 18.4 years for women in 2000-02), life expectancy at age 65 years has fallen for the last two years for men and for the last three years for women. The national inequalities gap widened over the last decade as has the local inequalities gap (difference between most and least deprived fifths). For 2013-15, men and women who live in the least deprived fifths of areas of Hull who are aged 65 years can expect to live around 4.4 years and 4.8 years longer than those living in the most deprived fifths of areas of Hull. The difference in life expectancy at age 65 years varies across the wards between 13.7 years and 20.4 years for men (a difference of 6.7 years) and between 16.1 years and 23.8 years for women (a difference of 7.7 years) [98, 100, 101].

For 2014-16, healthy life expectancy at birth was 56.5 years for men and 56.0 years for women in Hull compared to 63.3 and 63.9 years respectively for England. Hull was ranked third and fifth lowest for men and women respectively (out of 150) [27, 100]. From this in Hull, it can be estimated that men and women in Hull spend only 74% and 70% respectively of their lives in good health (compared to a national average of 80% and 77% respectively) [100].Whilst healthy life expectancy in Hull increased by 0.20 years for men and by 0.60 years for women in the last year, it has decreased by 1.4 years for men and by 0.8 years for women since 2009-11.

Nationally, lower back and neck pain, coronary heart disease, stroke, chronic obstructive pulmonary disease, lung cancer, Alzheimer's disease, sense organ diseases, depressive disorders, falls and skin diseases are the top 10 causes of disability (highest DALYs) [102].

What are the strategic needs?

Whilst increasing life expectancy is important, this needs to be achieved in conjunction with improvements in the quality of life. This is particularly so with the ageing population and the increased demand on scarce resources.

The following reports are available to download:

This 2018 JSNA section on Life Expectancy (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Life Expectancy (108 pages)

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Mortality

What’s the issue?

Everybody must die, so it is common to examine and compare rates for premature mortality which is defined as mortality prior to the age of 75 years. It is also possible to examine mortality rates from deaths which are considered preventable such as deaths from suicide and accidents, liver disease from excessive alcohol, lung cancer deaths caused by smoking, etc. Mortality rates have generally been decreasing, but it is important to examine rates from specific causes and for specific groups to determine if rates are falling equally fast for all causes and different groups, and are falling to the same degree as England and comparator areas. However, in practice, it is necessary for the rate in Hull to fall at a faster rate than England to reduce the inequalities gap.

Years of life lost (YLL) measures the number of years of life lost for each person who dies prematurely (before the age of 75 years). It can be used to examine different causes in relation to the total YLL for all persons dying of that cause of death or the average YLL for each person who dies of that cause of death.

What’s our situation?

The infant (<1 year) mortality rate per 1,000 births is 3.8 per 1,000 live births (95% confidence interval 2.7 to 5.1) in Hull for 2014-16 which very similar to England (3.9). There were 40 infant deaths over the three year period [27, 103]. There were 7,468 deaths among Hull residents over the three year period 2014-16 (1,671 among men aged under 75 years, 2,035 among men aged 75+ years, 1,133 among women aged under 75 years and 2,629 among women aged 75+ years) [98, 104]. Overall, 1,747 deaths were from causes considered preventable (256 per 100,000 residents) which was higher than the rate for England (183), Yorkshire and the Humber (197) and 11 of 12 comparator areas [27, 103, 104]. Seven in ten Hull deaths are from cancer (2,053; 27.5%), cardiovascular disease (1,961; 26.3%) or respiratory disease (1,204; 16.1%) [98, 104]. For 2013-15, the all age all cause mortality rate for Hull was 1,437 deaths per 100,000 men and 1,098 deaths per 100,000 women [104], and 1,422 and 1,070 per 100,000 men and women respectively in 2012-14 compared with 1,138 per 100,000 men and 838 per 100,000 women in England [99, 104]. Across Hull, the highest all age all cause mortality rates were seen in St Andrews and Southcoates West for men (over 2,000 per 100,000) and in St Andrews and Newington for women (over 1,500 per 100,000) with the lowest rates in Boothferry for men (911 per 100,000) and in Beverley for women (730 per 100,000) [98, 104]. For 2012-2014, the under 75 standardised mortality ratio (SMR) for Hull was 138 for men and 135 for women, which means the mortality rate, after adjusting for the difference in age and gender structure, is 38% higher among men and 35% higher among women, in Hull than in England [99, 104]. There was a strong association with deprivation, with the SMR among residents living in the most deprived fifth of areas of Hull 195, while among those in the least deprived fifth of areas it was 88 (12% lower than England) [98, 104]. The excess winter mortality index (August 2013 to July 2016) was 18.9 in Hull and there was considerably variability over time [27, 103, 104].

Over the 15 year period 2001-15, coronary heart disease (CHD), lung cancer, suicide and undetermined injury, infant death, cirrhosis, other accidents, stroke, chronic obstructive pulmonary disease (COPD) and breast cancer were the top 10 causes of death with the highest total YLL in Hull, although there were differences between men and women.

For men, over the 15 year period, there were 3,329 CHD deaths (5.73 YLL per person) with a total annual average YLL of 1,271 years. Suicide and underdetermined injury had the second highest annual total of YLL at 729 years (340 deaths with 32.14 YLL per person) followed by lung cancer (1,756 deaths, 644 annual total YLL and 5.50 YLL per person). Cirrhosis (390 deaths, 537 annual total YLL and 20.26 YLL per person) and infant deaths (83 deaths, 415 annual total YLL and 74.99 YLL per person) were the next highest causes of YLL for men.

For women, over the 15 year period, the top five causes of death with the highest YLL were lung cancer (1,401 deaths, 196 annual total YLL and 5.31 YLL per person), breast cancer (687 deaths, 401 annual total YLL and 8.76 YLL per person), infant death (78 deaths, 390 annual total YLL and 74.99 YLL per person), CHD (2,547 deaths, 380 annual total YLL and 2.24 YLL per person) and stroke (1,809 deaths, 212 annual total YLL and 1.76 YLL per person).

What are the strategic needs?

There are focused approaches to prevention and early detection of ill health through the City Plan [2] and the local place-based work through the Humber, Coast and Vale Sustainability and Transformation Partnership [3] using assets approaches. Hull's Early Help and Priority Families Strategy (for more information see the JSNA Glossary) is in place to help achieve these aims for children, young people and families, with extra help for priority families with complex needs. The Early Help delivery model aims to identifies individuals or families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way, thus improving outcomes for families and reducing demand in the system on more costly, acute and specialist services. Children, young people and families getting early help to be able to make healthy lifestyle choices, be safe from harm and have the confidence to be ambitious and achieve their aspirations. There are four thresholds of need: (i) no additional needs which is the universal response to build resilience in children and young people; (ii) additional needs involving prevention and early help; (iii) complex needs involving a targeted response of early help and interventions; and (iv) risk of significant harm which includes child protection procedures and safeguarding services. Priority Families with more complex needs in Hull have been identified, and work in ongoing with individual families to improve their outlook. The aim is by addressing these needs earlier and in a more integrated holistic approach, risk factors for poor health around the wider determinants of health (poverty, unemployment, crime, educational attainment, resilience, etc) are improved resulting in improved health and wellbeing, and reducing premature mortality and increasing quality of life.

It is necessary to work together to ensure people understand the benefit of positive life choices and know how to access information and seek early support to change. In order to do this effectively, health care providers need to work together with different communities to use existing assets to realise the benefit of positive life changes. 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 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 physical or emotional difficulties, and getting more active.

A focus on preventing (or reducing) mortality prematurely from the main causes of death where years of life lost prior to the age of 75 years are the highest would increase life expectancy the most.

The following reports are available to download:

This 2018 JSNA section on Mortality (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Mortality (135 pages)

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General Health and Physical Disabilities

What’s the issue?

“Better health is central to human happiness and well-being. It also makes an important contribution to economic progress, as healthy populations live longer, are more productive, and save more” [105]. Health and physical abilities generally deteriorate with age, and this creates a “challenge for society to adapt in order to maximise the health and functional capacity of older people as well as their social participation and security” [106]. Poverty and deprivation and many associated factors such as poor housing, crime, lack of qualifications and unemployment also indirectly influence health. People living in poor areas may have lower health expectations which can delay treatments and influence poor health, and they may also be more likely to have unhealthily lifestyles and behaviours which further influence health. Further information relating to children with physical health problems who have special educational needs is given in the section on Schools and Educational Attainment.

What’s our situation?

From the local adult Prevalence Survey 2014 [86], just over one quarter (27.7%) of adults in Hull reported having only fair or poor health, including one third or more of respondents in Bransholme West, Longhill, Newington and St Andrew's wards. There was a clear association between deprivation and self-rated health status. From the 2011 Census [16, 17], 10% of people in Hull reported that their day to day activities were limited a lot by a long-term illness or disability (that had lasted or was expected to last longer than a year), with a further 9.6% having their activities affected a little which was higher than for England (8.3% and 9.3% respectively) but similar to comparator areas (10.2% and 10.0% respectively). For 2016/17, the gap in the employment rate for those with limiting long-term illnesses or disabilities and the overall employment rate was 22.7 percentage points which was lower than England (29.4) [27, 28], giving an employment rate of around 46.1% (as employment rate for general population is around 68.8% – see the section on Labour Market and Benefit Claimants). From the local Young People Health and Lifestyle Survey 2016 [107], 60% of boys and 49% of girls rated their health as 'excellent' or 'very good'. Slightly fewer boys (10.1%) than girls (13.1%) reported a long-term illness or disability that limited their activities. The local Health and Lifestyle Surveys conducted among Veterans in 2009 [108] and Gypsy and Travellers in 2007 [84] and 2011 [109] illustrated their health was worse than the general population. From PANSI [110] and POPPI [96], in 2017, it is estimated that the number of adults aged 18+ years in Hull with a moderate or severe hearing impairment is 21,908 (16,020 aged 65+ years), and 467 with a profound hearing impairment (416 aged 65+ years). They estimate that 107 people aged 18-64 years have a serious visual impairment and a further 3,365 people aged 65+ years have a moderate or severe visual impairment. POPPI estimate that 15,561 people in Hull aged 65+ years are unable to manage at least one domestic task on their own and 12,771 people are unable to manage at least one self-care activity on their own (some will fall into both categories). It is estimated that total numbers will increase by around 15% by 2025 due to the ageing population.

What are the strategic needs?

There are inequalities in relation to heath with people living in the more deprived areas having worse health earlier than those living in less deprived areas in Hull. It is necessary to target those living in the most deprived areas and other vulnerable groups, and work with them to help them improve their health and their lifestyle which may be affecting their health. People living in more deprived areas and those in vulnerable groups tend to have lower expectations in relation to their health, and may tend to be among the last to change behaviour to improve their health so encouraging people to come forward with their symptoms and seek medical help may be required, and informing people that they do not need to expect poor health and that changing their behaviours and lifestyle, such as quitting smoking, can have immediate effects on their health. The figures are also impacted by the fact that many people with disabilities or very poor health have impaired employment opportunities and are so more likely to live in relative poverty. Two of the six priorities across the Humber, Coast and Vale Sustainability and Transformation Partnership (STP) [3] are to help people stay well and supporting people with mental health problems (see the JSNA Glossary for more information on the STP). The Social Prescribing Service (Connect Well Hull – see the JSNA Glossary) aims to provide advice and support on a range of issues including physical or emotional difficulties.

The following reports are available to download:

This 2018 JSNA section on General Health and Physical Disabilities (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: General Health, Disabilities, Caring and Use of Healthcare Services (240 pages)

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Emotional Health and Wellbeing

What’s the issue?

Poor mental health can have a detrimental effect on all aspects of life undermining self-esteem, confidence and enthusiasm for life. "Social and emotional wellbeing in children creates the foundations for healthy behaviours and educational attainment. It also helps prevent behavioural problems (including substance misuse) and mental health problems. Social and emotional wellbeing provides personal competencies (such as emotional resilience, self-esteem and interpersonal skills) that help to protect against risks relating to social disadvantage, family disruption and other adversity in life. Such competencies provide building blocks for personal development which will enable children and young people to take advantage of life chances. Evidence shows that poor social and emotional wellbeing predicts a range of negative outcomes in adolescence and adulthood. Negative parenting and poor quality family or school relationships place children at risk of poor mental health. Early intervention in childhood can help reduce physical and mental health problems and prevent social dysfunction being passed from one generation to the next" [111] (also see the section on Maternity). Further information relating to children with emotional issues and behavioural problems who have special educational needs is given in th esection on Schools and Educational Attainment.

"A general low mood can include sadness, anxiety, worry, tiredness, low self-esteem, frustration and anger" [112]. People with poor mental health sometimes can deal with this by smoking more, eating excessively and unhealthy diets and not exercising. "Depression can involve continuous low mood, feelings of hopelessness and helplessness, low self-esteem, feeling tearful, feeling irritable and intolerant of others, having no motivation of interest in things, finding it difficult to make decisions, not getting any enjoyment out of life, having suicidal thoughts or thoughts of self-harming, and feeling anxious or worried" [112]. As a consequence, poor mental health influences all aspects of life, a person's physical health, their family, their workplace and employment, and their involvement in their community.

Nationally, depressive disorders have the eighth highest disability adjusted life years (DALY – see the JSNA Glossary) and thus has a substantial impact on the quality of people's lives [102]. Also see the section on Severe Mental Ill Health.

What’s our situation?

From local surveys [83, 86, 113], mental health is worse for women, younger age groups and those living in the more deprived areas of Hull. The local adult Black and Minority Ethnic Health and Lifestyle Survey 2007 [114] indicated worse mental health for failed asylum seekers, almost one-third of whom stated that they were ‘so unhappy that life is not worthwhile’ compared to 13% of those whose asylum had been granted and less than 4% for all other groups. For 2016/17 from the GP disease registers [115], the percentage of patients aged 18+ years “with a record of unresolved depression since April 2006 in their medical notes” was 8.2% with 20,045 patients on register in Hull compared to 9.1% nationally [116]. Numbers had increased by 55% (by over 7,000 patients) since 2013/14 which was higher than England's increase (44%) or that of comparator areas (39%), although some increase was expected as the register represents a cumulative count since April 2006 and Hull's rate in 2013/14 was substantially lower than other areas. The prevalence was statistically significantly different across the practices in relation to patient deprivation levels [116]. The eight practices serving the patients living in the most deprived areas had a prevalence of 8.2% compared to 7.2% among the nine practices serving the least deprived practices, although the highest prevalence estimates were for the middle three fifth groups (9.5%, 9.1% and 9.25 from second most to second least deprived practices).

For 2015/16, more people in Hull compared to England had a poor score (0-4 on a scale of 0-10) in relation to satisfaction with their life (6.7% versus 4.6%), feeling that the things they do in their life were worthwhile (6.3% versus 3.6%) and feeling happy yesterday (12.4% versus 8.8%), and had a high score (6-10 on a scale of 0-10) in relation to feeling anxious yesterday (22.9% versus 19.4%) [27, 117], although these percentages were even higher in the local adult Prevalence Survey 2014 [86] at 11.2%, 9.2%, 14.0% and 27.3% respectively.

From the local Young People Health and Lifestyle Survey 2016 [107], 80% of boys and 68% of girls reported being happy either all of the time or most of the time. Whilst there were differences between the school years, overall over half (61%) of girls felt sad at least some of the time (including 17% feeling sad all or most of the time), which was considerably higher than the boys with 37% feeling sad at least some of the time (including 10% feeling sad all or most of the time). Furthermore, girls were more likely to feel lonely or isolated from others with 35% feeling this at least some of the time (including 15% feeling lonely or isolated from others all or most of the time) compared to boys with 21% feeling lonely or isolated at least some of the time (including 9% feeling this all or most of the time). Fewer than one in four pupils (37%) had been bullied previously with 11% bullied within the last month. One in eight pupils (12.1%) had previously bullied someone else with 3.8% bullied someone else in the last month. The top five concerns of 1,377 children and young people participating in the Young People Health and Emotional Wellbeing Survey [118] were bullying including cyber bullying (49%), exam stress (38%), body image (37%), drugs and alcohol (29%) and self-esteem and confidence (25%). Young people were asked what support, if any, they needed, and the two responses with the highest responses were one-to-one support (533; 39%) and classroom sessions (298; 22%). Young people would like to find out about emotional health through websites (34%), school assembly (29%), videos or YouTube (29%), newspapers or magazines (25%) and/or mobile phone apps (25%).

What are the strategic needs?

People with general mental health issues need to be identified early and encouraged to seek help early so that the consequences in terms of the effects on family and employment are minimised, issues are not escalated so reduce the levels of need for crisis and/or medical interventions. It should be recognised that specific groups of people may be more likely to have mental health issues due to their circumstances, such as poverty, asylum seekers, social isolation. There is a need to improve and expand early help and targeted interventions to improve young people’s emotional health and wellbeing and build resilience to enable them to cope with challenging life events.

Hull’s Early Help and Priorities Family Strategy 2015-2020 (see the JSNA Glossary) aims to identify individuals and families with problems and brings together different services and agencies to collectively look at what support is needed and then work together to deliver the required support in an coordinated way [119]. The framework outlines the approach to ensure that collaboration and alignment of services, and that early help may be 'early in life or at the earliest opportunity' which is also part of the day job, helpful, non-stigmatising, preventative, targeted and tailored [119]. There are four thresholds of need: (i) no additional needs which is the universal response to build resilience in children and young people; (ii) additional needs involving prevention and early help; (iii) complex needs involving a targeted response of early help and interventions; and (iv) risk of significant harm which includes child protection procedures and safeguarding services.

Hull’s HeadStart programme, funded by the Big Lottery, aims to “Enable children and young people to have positive mental health and wellbeing, thrive in their communities and to bounce back from life's challenges”. There is an emphasis on prevention and early intervention including workforce development, Personal, Social and Health Education classes and whole organisation approaches as well as targeted interventions to identify and intervene early, reduce the need for clinical services and deliver sustained change to embed an asset based approach to emotional health and wellbeing.

In order to improve mental health, other non-medical approaches might be necessary such as talking therapies, helping solve practical problems that are causing stress and anxiety such as housing problems and debt, and improving social networks and support through community involvement, for example, befriending. Hull's Connect Well service aims to bridge a gap helping Hull's residents access support and guidance on a range of issues, helping people feel more linked in with their communities, helping with issues such as money, benefits and housing, helping with physical or emotional difficulties, and helping get active and feeling better.

One of the six priorities across the local Humber, Coast and Vale Sustainability and Transformation Partnership (STP)[3] is to support people with mental health problems, as well as helping people stay well (see the JSNA Glossary for more information on the STP).

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 physical or emotional difficulties.

The following reports are available to download:

This 2018 JSNA section on Emotional Health and Wellbeing (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Mental Health and Learning Disabilities (375 pages)

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Oral Health

What’s the issue?

Dental caries is the one of the most common health problems in the world, although the national adult survey conducted during 2009 showed that there has been a “continuation of improvement in younger age groups, first detected over 20 years ago, are now evident up to age 45. However, for those who do have decay or gum problems, disease can be extensive, whilst for many people in old age and older middle age, dental needs are very complex. Good health behaviours, such as regular brushing, are shown to be associated with better health and a greater proportion of dentate adults than ever before are engaging in these behaviours. The large majority of adults also indicate that they are attending the dentist at least once every two years, and do not have problems accessing the NHS dental service” [120]. Smoking increases the risk of gum disease, tooth loss and tooth discolouration [121].

“Poor oral health can affect confidence, diet and communication, and pain caused by dental caries can affect diet, sleep and lead to absence from work. Poor dental health does not just affect teeth, but is also linked to other serious problems with gum disease increasing the risk of stroke, diabetes, heart disease, and rheumatoid arthritis. It is thought the body over-reacts to the bacteria that is caused from plaque build-up, and that this enters the bloodstream and causes damage to blood vessels over a long time period” [122]. A dental check-up can also highlight other serious medical conditions and diseases such as oral cancer.

One factor that will make the biggest differences to people's oral health is using appropriate levels of fluoride as it can strengthen tooth enamel making it more resistant to tooth decay and reduces the amount of acid that the bacteria on teeth produce. Fluoride occurs naturally in many foods and is present in water supplies (and is sometimes added to drinking water). It is also added to toothpaste and can be applied to teeth as varnishes or gels. Adding fluoride to water has shown to reduce tooth decay by 40-60% [123].

Looked after children and people with learning disabilities tend to have worse dental health, although there is no specific data on these groups.

What’s our situation?

For 2016/17, Hull has a relatively high number of dentists (who undertook at least some NHS work during the financial year) with 56 dentists per 100,000 population, compared to 44 dentists per 100,000 population for England [124, 125]. It is not known how many residents of neighbouring East Riding of Yorkshire use dental services in Hull, but it is likely that a sizeable proportion do so.

Based on the local adult Health and Lifestyle Survey 2011-12 [83, 124], around 70% of men and 76% of women had seen a dentist within the last two years. Three-quarters of respondents reported their last dental visit was to an NHS dentist, 15% had seen a private dentist while 6% did not know whether their dentist was NHS or private, and 2.5% said they had never been to a dentist.

From the local Young People Health and Lifestyle Survey 2016 [107], over four fifths of pupils had visited the dentist in the last 6 months, with 92% having been at some time in the past year (and 96% in the last two years) [124]. From the GP patient survey (January to March 2016) [126], 93.8% of patients who had tried to get an NHS dental appointment within the last year had been successful (a further 2.8% could not remember). The majority were satisfied with their overall experience of NHS dental services with 54% rating the service as ‘very good’ and a further 36% as ‘fairly good’' although 2.5% rated their experience as 'fairly poor' and 1.0% as ‘very poor’. In the most recent dental survey among 5 year olds conducted during 2014/15 [127], Hull children have relatively high levels of tooth decay with 1.55 decayed, missing or filled teeth (0.84 for England and 1.01 for regional average) and 38% had at least one tooth that was decayed, missing or filled (England 25% and regional average 29%) [27, 103, 124].

Investment to improve oral health in Hull has increased in 2016/17, through the ‘Starting Well’ programme, which will provide funding to local dentists to provide preventative oral health interventions, targeting the most deprived wards.

What are the strategic needs?

Partnership working between the local authority, NHS England, Hull CCG, Public Health England, the local authority's recently established Oral Health Advisory Group, local dental providers and other key stakeholders should underpin development of dental commissioning and oral health improvement strategies to ensure that local people's oral health needs are met. This should be based upon national evidence-based guidance.

Ensure early years and the dental workforce have access to evidenced based oral health training and child oral health improvement information is communicated effectively. Parents and carers should ensure they start good oral hygiene routines with their children as soon as their infants get their first teeth, and that these routines continue throughout childhood and into adulthood with regular dental check-ups. Ensure that parents and carers know the effects of leaving a baby with a bottle of milk or fruit juice, and the effects of sugary foods and drinks on tooth decay. Ensure that people have appropriate levels of fluoride (whether this is through toothpaste, tooth varnishes or gels, or fluoridation of the water). Ensure that everyone who needs it has access to good NHS dental services, and that residents understand the value of having regular check-ups. There should be support for prevention-orientated NHS dental services. It is necessary to explore equity of access and barriers to NHS dental services particularly for people from more vulnerable groups.

The following reports are available to download:

This 2018 JSNA section on Oral Health (2 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: Dental Health (94 pages)

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Use of Healthcare Services and Secondary Care

What’s the issue?

It is important to examine and assess the use of healthcare services. It can help determine the current health needs of the population, predict future health care needs, and determine if specific groups are using health care inappropriately such as attending A&E when they should be seeing their GP.

It is also useful to examine usage by different groups to determine if there is an inequalities gap, for instance, if the prevalence of a disease is 50% higher among people living in the most deprived fifth of areas of Hull compared to people living in the least deprived fifth of areas of Hull, then one might expect that hospital admissions would similarly be approximately higher, but if admissions were only 20% higher it could signify health inequality and/or problems with access to healthcare.

Secondary care is specialist care typically provided in a hospital setting or following referral from a primary or community health professional.

Each health and wellbeing board must assess needs for pharmaceutical services in its area, and publish a statement of its first assessment and of any revised version.

What’s our situation?

The main local provider of NHS acute hospital care in Hull (and East Riding of Yorkshire) is Hull and East Yorkshire Hospitals NHS Trust (HEY), which provides specialist acute surgical, medical and trauma services through the delivery of elective and non-elective care from two main hospital sites: Hull Royal Infirmary and Castle Hill Hospital. There is also Hull and East Riding Women's and Children’s Hospital. Spire Healthcare is also used locally as they take patients through NHS e-Referrals as part of patient choice.

From the local Young Persons Health and Lifestyle Survey 2012 [95], two thirds of boys and almost three-quarters of girls had seen their GP in the past year; 38% of boys and 33% of girls had attended A&E in the past year; 12% of boys and 10% of girls had had an inpatient hospital stay over the past year.

Between 2008/09 and 2010/11 Hull residents had 224,410 hospital stays [128]. The average annual standardised admission rate exceeded 300 per 1,000 residents in four wards, with the highest rate seen in Orchard Park and Greenwood, St Andrew’s, Myton and Marfleet wards which was one-third higher than Avenue ward which had the lowest admission rate. The admission rate was 36% higher among those living in the most deprived fifth of areas of Hull compared to the least deprived fifth (312 versus 229 per 1,000 residents). Annual standardised non-elective admission rates varied from 75 in both Holderness and Bricknell to 148 in St Andrew's, and the percentage of non-elective admissions out of the total (excluding maternity admissions) ranged from 32% in Holderness to 48% in St Andrew's. These percentages varied from 28% to 46% across the General Practices (with two practices with special patient characteristics having higher rates at 51% and 70%) [128].

For 2011/12, the indirectly standardised emergency re-admission rate within 30 days of discharge was 12.1% in Hull which was similar to England (11.8%) and other comparator areas [87].

For 2013/14, the directly standardised emergency admissions rate for acute conditions that should not usually require hospital admission for Hull was 1,525 per 100,000 registered population, and this was considerably higher than England (1,181) [99].

The ‘friends and family test’ measures satisfaction (how likely the person would be to recommend the service), and is collected in a number of NHS care settings [129]. Satisfaction levels were higher in Hull compared to England with a higher percentage extremely likely or likely to recommend the service. In July 2017, 86.2% of the A&E survey responders were extremely likely or likely to recommend the service at HEY (85.9% in England), 97.4% of out-patient survey responders (93.7% in England), and 98.7% of inpatients survey responders (95.9% in England). It is not known how representative the survey responders are in relation to all service users as 12.1%, 3.6% and 22.5% of A&E, outpatient and inpatient users participated in the survey.

A pharmaceutical needs assessment (PNA) 2015-2018 was completed for Hull in 2015. The needs of the population were examined as well as the provision of services provided for Hull’s pharmacies with an analysis of potential gaps in services undertaken.

What are the strategic needs?

There is a need to work with partners to ensure that there is a shared understanding of people’s needs and that services are integrated, high quality and accessible in ways that offer people appropriate choices such as care organised around care hubs. There is a need to work together 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. The most vulnerable citizens should be identified so their specific needs are addressed in the way they wish. There is a need to work with individuals and communities to ensure they know where to go for medical help, and are not accessing A&E inappropriately. Tele-medicine and other technology can be used to provide monitoring and access to help and support when required, helping people improve their health and wellbeing.

During 2016/17 and 2017/18, good progress was made in delivering our plans to reduce system demand and develop place based services which meet local needs. Strategic integration of commissioning across the Clinical Commissioning Group (CCG) and Hull City Council progressed in year. There is a continuing focus as both organisations work together to start delivering the Hull City Plan including improving health and wellbeing. Joint working across the health and social care system, in both the commissioning and provision sectors, is becoming the norm but without more systemised and comprehensive levels of service and operational integration there is a substantial threat to both financial and operational delivery.

These challenges cannot be met with more of the same, or through incremental change around the edges of NHS services. In these commissioning intentions we seek to drive and facilitate widespread, transformational change across our health and social care system to deliver a step change in the quality of services and the experience of patients while enabling the system to become financially viable. There is an expectation that providers of the commissioning services and partner commissioning organisations will respond to these changes to jointly deliver the aspired health and care outcomes.

The aim of the Humber, Coast and Vale Sustainability and Transformation Partnership (STP) [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. Processes are being put in place which involve finance, governance, workforce, the local estate, communication and engagement, and technology (see the JSNA Glossary for more information on the STP).

The CCG’s focus is both inward; towards place where we seek to redesign and recommission health and social care to reflect the needs of discrete populations across the CCG area; but also outward with a clear move towards collaborative strategic planning and commissioning, both at a Hull and East Riding level and across the STP.

The landscape in primary care has moved on and Practices in the City are now working collaboratively in groupings to provide primary medical services at scale. These groupings, whilst formed, are still in their infancy and will need to be supported to provide integrated delivery of health services at a local level through the provision of appropriate intelligence and expertise to understand their populations and needs.

Hull’s Pharmaceutical Needs Assessment 2015-2018 found that there was sufficient pharmaceutical need across Hull and no gaps in necessary service provision were identified. The next Pharmaceutical Needs Assessment is being developed and will be published by April 2018.

The following reports are available to download:

This 2018 JSNA section on Use of Healthcare Services and Secondary Care (3 pages)
The full 2018 JSNA report (139 pages)
JSNA Toolkit: General Health, Disabilities, Caring and Use of Healthcare Services (240 pages)

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