Health and Social Care Constituency Profiles 2011

Health and Social Care profiles for each constituency in Birmingham have recently been released by the Public Health Information Team.

These reports form part of Birmingham’s Joint Strategic Needs Assessment and provide an overview of the key health and social care issues within each constituency. They complement other profiles released by the team and more general profiles from Be Birmingham.

The profiles provide a breakdown of demographics within each area and identify the key social determinants that impact upon health. They include a breakdown of the key indicators identified across health and social care, including a breakdown of the diseases causing preventable deaths in each area.

For further information on any of the profiles, please contact the Public Health Information Team at phit@bhwp.nhs.uk or 0121 465 2966

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The Health and Social Care Bill: progress update

It has been over 12 Months since the Public Health White Paper, Healthy Lives: Healthy People was published, and almost a year since the Health and Social Care Bill was introduced into Parliament in January 2011, as the vehicle to take forward the proposals for the future of public health in England.

Progression of the Bill through the legislative process since then continues to be far from smooth. .The July/August Edition of BHM contained overview articles of both the White paper and the recommendations for changes to the Bill following the Governments acceptance of the Core Recommendations of the NHS Future Forum. This article aims to provide an update of progress as we head into 2012.

Following successful passage through Commons in September, Lord Rea’s amendment ‘to decline to give the bill a second reading’ fell by 134 votes (220 for and 354 against). This would have stopped the Bill in its tracks and proposals for further scrutiny were also later rejected by the House of Lords in October.

In early November, following a complaint under FOI, the Information Commissioner has ordered the Department of Health to publish its analysis of the impact of the proposed modernisation. Release of the Risk Register (due by early December) potentially poses a further threat to the progress and passage of the Bill, but the ICO report deems release to be in the public interest on the basis that “Disclosure would significantly aid public understanding of risks related to the proposed reforms and it would also inform participation in the debate about the reforms.”

Changes due to come into effect in 2013 are of course all subject to the Bills passage, but preparations towards transition to the new model have been in progress for some time. For example, the timescale for Health & Wellbeing Boards to assume statutory duties has been set as April 2013, and 90% of local authority areas signed up to be Early Implementer sites, including Birmingham, and Shadow Boards are now in operation. However, with a period of debate and amendment through the report Stage and Each House’s Consideration of Amendments still to come before Royal Assent there is still some way to go before the proposals become statutory.

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NHS Commissioning Board Authority goes live

The NHS Commissioning Board Authority, a special health authority and the shadow form of the NHS Commissioning Board (the Board), is now in operation.

Subject to the successful passage of the Health and Social Care Bill 2011 through Parliament, over the next 12 months the Board Authority will focus on designing an innovative business model for the Board, which puts patients and clinical leadership at its heart.

It will also work in partnership with clinical commissioning group leaders, GPs and the Department of Health to agree the method for establishing, authorising and running clinical commissioning groups (CCGs).

In addition, the Board Authority will create the infrastructure and organise the resources to allow the NHS Commissioning Board to operate successfully as an independent body from October 2012 (subject to the successful passage of the Health and Social Care Bill 2011 through Parliament).

Sir David Nicholson, NHS Chief Executive said: ‘Building this new system over the next two years, while delivering for our patients, increasing productivity and improving the quality of care, is a major challenge. But I firmly believe that what we are trying to achieve – a stronger, more innovative and more coherent commissioning system – will be critical to sustaining the NHS in years to come.’

The central role of the new Board will be to improve patient outcomes, by supporting, developing and performance managing an effective system of clinical commissioning groups. The Board will also take responsibility for commissioning services that can only be provided efficiently and effectively at a national or a regional level. Sir David Nicholson summarised this purpose as: ‘Using the £80 billion commissioning budget to secure the best possible outcomes for NHS patients.’

He continued: ‘Putting patients at the heart of all we do means we must be obsessed with improving quality outcomes, obsessed with involving patients at every stage of organisation and service development and obsessed with the availability of clear and accessible information. Only then can we create a system that offers real choice and control to patients.’

Subject to successful passage of the Health and Social Care Bill 2011 through Parliament, it is anticipated the NHS Commissioning Board will become fully operational on 1 April 2013, when it takes on its complete legal responsibilities for managing the NHS Commissioning system.

Find out more and watch Sir David Nicholson speaking about the NHS Commissioning Board on the NHS Commissioning Board Authority website: http://www.commissioningboard.nhs.uk

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6 out of 10 people with dementia go undiagnosed

Six out of ten people with dementia in England go undiagnosed. This means almost 400,000 people could be going without the vital support the NHS and social care services can offer.

The National Audit Office estimates that, nationally, dementia costs health and social care services £8.2 billion per year. Alzheimer’s Research UK have estimated that the overall cost of dementia to society as a whole is £23 billion per annum. It is estimated that savings of £80 million could be made every year by improving hospital care for people with dementia.

In a survey carried out for the Department of Health, only around a third of adults aged over 40 agreed that they understand the differences between normal signs of ageing and signs of dementia, and close to a third of adults aged over 40 thought there was no support available for people with dementia.

A Coalition Government campaign to raise awareness of the early signs and symptoms of dementia was launched on 7 November by Care Services Minister Paul Burstow.

Care Services Minister Paul Burstow said: “People are afraid of dementia and rather than face the possibility someone we love has the condition, we can wrongly put memory problems down to ‘senior moments’.

“But if we are worried, the sooner we discuss it and help the person seek support the better. Don’t wait until a crisis. Being diagnosed with dementia won’t make the condition worse but leaving it untreated will.

“We can’t cure dementia, but we can help keep the person we love for longer.”

Aimed at encouraging more people to seek an early diagnosis of dementia, the campaign targets the family and friends of people at risk of dementia who are likely to be the first to see the signs and can encourage their loved one to see their GP.

With many people seeing relatives at Christmas, the timing of the campaign is particularly poignant. The Alzheimer’s Society had 43 per cent more calls to its helpline in January this year than in December 2010.

It is estimated that every general hospital has excess costs of £6 million because of dementia, due to the worse outcomes for length of stay, mortality and institutionalisation. In hip fracture alone, better management of patients who also have dementia could save between £64 million and £102 million in England every year.

National Clinical Director for Dementia, Professor Alistair Burns said: “Getting a timely diagnosis of dementia is vital and we know that those who do receive one don’t regret it. On the contrary, knowing about their condition helps them gain control and allows them and their families to seek the services and support they need.

“Timely early diagnosis and supportive interventions allow people to plan for the future while they still can. They have been shown to reduce care home admissions and improve the quality, not only of the life of the person with dementia, but also their family, carers and friends.”

This new campaign follows the successful national campaign, ‘I have dementia – I also have a life’, which ran last year. That campaign aimed to raise awareness of the condition and challenge the belief that people with dementia are not able to still enjoy life.

Dementia is a progressive and eventually terminal condition, but with early intervention and the right support people with dementia can continue to live well for many years.

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Get ready for Winter

A new plan to keep people warm and healthy throughout the cold winter months has been launched by Health Secretary Andrew Lansley – in conjunction with Age UK and the Met Office.

The cross Government initiative reminds all local communities and the NHS how best to prepare to keep people healthy and warm in their homes this winter. The schemes focus on helping the most vulnerable people by:

  • making an extra £10 million available to support existing Government schemes for those at risk of fuel poverty – for example grants for insulation or heating improvements provided through the Warm Front scheme;
  • creating a new £20 million fund – supported by Age UK – for local authorities and charities to address cold housing. Bids will be invited for innovative new ways to help vulnerable older people, people with disabilities or families with young children – reaching those falling through the gaps of existing schemes.
  • launching a Cold Weather Plan – which will be jointly run with the Met Office and Health Protection Agency – to advise people how to stay healthy thus relieving the pressures on the NHS which winter always brings; and providing information on all aspects of keeping safe and well in winter via the “Getting Ready for Winter” website (http://www.direct.gov.uk/getreadyforwinter).

If the £10 million were used to support Warm Front it would be expected that around 5000 low income households would get improvement to heating and insulation worth up to £3,500 (£6,000 where oil central heating and other alternative technologies are recommended).

The new £20 million scheme for energy efficiency insulation and heating improvement could help around 10,000 households.

Severe cold weather can be dangerous for vulnerable groups such as older people and those with serious illnesses. It’s important for people to look after their health as the winter months can mean:

an increase in heart attacks and stroke – accounting for 40 per cent of excess winter deaths;
pressure on GPs – GP visits for respiratory illnesses increase by up to 19 per cent for every 1°C drop below 5°C of the mean temperature;
more pressure on the NHS – in 2009/10, the cost of emergency admissions due to falls on snow and ice was estimated at £42million; and
it is estimated that over £850 million is spent by the NHS each year as a result of the impact of cold housing on people’s health.

Met Office figures show that December 2010 was the coldest December in the UK since 1910 and the winter before was the coldest since 1978. While many associate cold weather with hypothermia, deaths directly caused by this represent only a small proportion.

Andrew Lansley said: “We want everyone to get ready for winter and be prepared before temperatures drop.

“Being cold in your own home can be miserable and impacts on your health. We cannot look at health in isolation. We must look at the bigger picture, which is why I am making £30 million available to help keep homes warm.

“Older people and those with long term illnesses are particularly vulnerable to the cold and we need to be aware – within families, in communities and across the NHS – of how we can help others when the winter temperatures drop.

“Every year, there is a 20 per cent increase in deaths in the winter in England. By working together, this coordinated plan will help protect those most in need, we are determined to do all we can to achieve this.”

Michelle Mitchell, Charity Director at Age UK says: “We warmly welcome the fact that the Department of Health now recognises that cold weather and fuel poverty cause avoidable illness which leads to distress for older people affected as well as adding to the workload of all healthcare providers. Ministers have long acknowledged the fact that every winter brings thousands of avoidable deaths.

“The Coalition Government has set a new emphasis on public health as one of its key objectives, and this Cold Weather Plan is a very important step in the right direction. Age UK will be building on this with its own winter campaign to help vulnerable older people live well through the cold months of the year.”

The Cold Weather Plan is supported by a Met Office cold weather alert service that will run from 1 November 2011 to 31 March 2012.

The Cold Weather alert service has four levels that depend on the severity of conditions. Together the plan and alerts aim to prepare, alert and prevent the effects of winter weather on people’s health by helping keep people well.

The four levels are:

  • Level 1 winter preparedness – long term planning
  • Level 2 severe winter weather is forecast – 60 per cent risk of extreme cold lasting more than 48 hours
  • Level 3 response to severe winter weather – we are experiencing severe weather which is expected to have an impact on peoples health and health services
  • Level 4 major incident – exceptional widespread winter weather causing disruptions

The ‘big freeze’ at the end of last year would have been classified as level 3 .

Further details of the action needed at each level can be found on the Met Office website. (http://www.metoffice.gov.uk/health/public/coldweatherwarnings).

Chief Medical Officer Professor Dame Sally Davies said:
“Keeping warm in the winter is important to avoid serious or life-threatening illnesses.

“Healthcare staff and care home managers need to make sure that patients and residents are able to keep warm during cold weather spells.

“Keeping our homes warm is important – but it’s not necessary to heat the whole house. We just need to keep the main rooms we occupy – such as the living room and bedroom – warm. Warm clothing and hot drinks should help prevent our most vulnerable people falling ill this winter.”

John Hirst, Chief Executive of the Met Office, said: “The Met Office is proud to be able to support the Department of Health, the Health Protection Agency and Age UK with their winter preparedness.

“These alerts will put everyone in a better position to respond to forecasts of severe weather, inform those who are most at risk from winter weather and what they can do to keep well.”

Professor Virginia Murray of the Health Protection Agency said: “Many of the deaths and injuries due to cold weather are preventable. People most at risk should make sure they have their flu jabs, and everyone should wear sufficient layers of clothing and shoes or boots with non-slip soles while outside. They should also have enough of their medication in the event of severe weather.

“People should have their fossil fuel and wood burning appliances such as boilers, heaters and cookers, regularly checked by an appropriately registered engineer. Poorly maintained appliances may release carbon monoxide, a gas which can kill at high levels and cause health problems at lower levels.”

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Seasonal Flu vaccinations

Figures released by the Department of Health at the beginning of November showed that only one in three people in at-risk groups have come forward for a flu vaccination this Autumn.

The new data shows that although more than half (55%) of people over 65 have had the jab, which protects against several strains of flu including swine flu, only 32% of those under 65 in at-risk groups – such as with diabetes, liver disease, asthma or chest problems and neurological conditions – have come forward.

Data suggests diabetics are six times more likely to die if they get flu than a healthy person, while those with chronic heart disease are 11 times more likely to die. People with chronic liver disease are 48 times more likely to die and those undergoing medical treatment who may have a compromised immune system are 47 times more likely.

As was the case in 2010, the Department of Health has chosen not to run a seasonal flu advertising campaign for this year. Currently Birmingham has the second highest influenza rate per 100,000 population in England (8 cases per 100,000 people with London being at 12 per 100,000) and the numbers are rising rapidly. While this is about right for the season, the risk of this plus other winter illnesses exacerbating winter pressures is significant. In the absence of national awareness campaign, The Public Health Service is leading an awareness drive – focused on users of social care, older people, and vulnerable children and young people, service providers, staff and Direct Payment recipients ( both in their role as employers as well as those in at-risk groups). The aim is to actively promote uptake by reminding those in clinical at-risk groups that they are eligible for the vaccine free of charge, and as well as encouraging those outside this group to play their own role in helping to minimise the spread of the virus, through vaccination.

Steps include:

  1. Sending letters and information packs to all managers and care staff, both independent and Council owned residential and day centre establishments, providing information on eligibility for the flu vaccine and promoting its uptake among service users and care providers. Libraries, post offices, community centres and day centres in Birmingham will also receive a package of posters, leaflets and information on flu vaccine
  2. Cascading information on flu uptake through Birmingham Care Development Agency
  3. Asking GPs with relationships with specific establishments to offer all residents vaccination quickly, along with eligible staff
  4. Reminding establishments of the importance of practicing good infection and prevention control procedures and the risk of D & V or other gastroenteric bugs during this period.
  5. Writing to everyone receiving direct payments of any kind to remind them of their eligibility for vaccination.

The Health Protection Agency Website contains detailed information on Seasonal Flu: http://bit.ly/uu5lp0

For any queries from care establishments, those involved in the provision of care, or service users, please contact Mo Phillips on 0121 303 3623, or mo.phillips@birmingham.gov.uk

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Editorial: Taking Prevention Seriously

Like me, you’ve probably lost count of the number of times someone has said something along the lines of “prevention is the best approach” or “we must invest in prevention”. And then we go back to business as usual. We’ve probably even said it to each other.

Leaving aside for a minute the whole debate about what exactly constitutes evidence which should compel us to action; looking around the system I think we can say several things about prevention:

  • There is enough evidence that prevention can work and bring benefits to citizens and the public purse. Our falls prevention pilot in Birmingham saved money for the public purse and reduced misery for the older people it reached. The “double dividend” of prevention – taxpayers and citizens at risk getting benefit – is real. What we need to do is get serious about achieving it.
  • Even where evidence is silent, there have been enough advances in methods of assessing and decision-making to let us work out reasonably promising candidates for preventive activity.
  • Other countries do it, and do it a lot better than we do. Australia, Canada, Germany all have some fantastic examples.
  • All prevention is not the same. The theory and evidence tells us that you do very different things for preventing breast cancer than you do for preventing a fall.
  • We often resort to talking twaddle about behaviour change. Giving people information rarely leads to behaviour change by itself.
  • Prevention is as much a system issue as an individual issue. There’s little point doing diet education if the bulk of available food near you is stuffed with fat, sugar and salt unless you tackle that. The World Health Organization Ottawa Charter on Health Promotion in 1986 recognised that improving health is as much a matter of healthy public policy and systems and right access to services as it is behaviour change. We know this.
  • We rely too heavily on methods informed by social-cognitive theory like “reasoned action” which assume Eurocentric styles of thought and behaviour and ignore the interpersonal and system blocks to behaviour change, as well as the intrapersonal dynamics going on within the individual. I read recently a paper which suggested there were 28 different typologies of behaviour change which have evidence of effectiveness…no wonder we’re bewildered.
  • Good implementation is key – a lot of prevention would be enhanced considerably in its impact if we implemented it more consistently with what evidence and theory suggests. This has been the Dutch experience.

So, now I’ve had a moan, what do I suggest we do? Well, let’s nudge Nudge out of the picture for a while and go back to first principles. I think a prevention approach for Birmingham looks like this:

  1. We work out the priorities for preventive activity across our system from various sources of decision-making (evidence, economics, etc.). And I think there are a variety:
    1. Preventing the big killers and causes of preventable ill-health (heart disease etc.) by long and short term measures.
    2. Preventing people losing independence and functional ability and ending up with care packages (home, residential, hospital) we could have stopped them needing through system and pathway redesign
    3. Preventing small problems (complex family problems) becoming worse by integrating systems and responses across agencies
    4. Take a lifespan approach, start preventing ill health in later life by redesigning the services and socialisation of our youngest from conception
  2. Each of those needs a systems approach – whether you take the Ottawa Charter or another approach doesn’t matter as long as it identifies the components of the system. Most prevention is three parts system redesign, three parts culture change where peoples’ social norms change around an issue and one part individual behaviour. Take smoking as an example. I went to see Tinker, Tailor, Soldier, Spy three times (sad, I know). Each time just one topic of comment in the audience was that the sheer amount of smoking portrayed was squalid, off-putting and unacceptable. Cultural norms are changing around smoking, but not overnight. But those norms did not originate by themselves. Prevention is as much slow burn as quick win. The trick is working out which.

My argument is this: redesigning the system to achieve behaviour change is more effective for some changes, while motivating the individual is more effective than others. Redesigning pathways so people get put into preventive pathways rather than go from GP appointment to GP appointment, or assessment into care package straight away, are more likely to achieve change than posters telling people not to go to A and E. Our behaviour patterns and norms around accessing care services are so ingrained that system redesign needs to be the priority for service access. For eating behaviour, it’s probably a mix of individual skill and motivation combined with systems which make healthy eating easier.

So, we’re back to needing a multi-faceted approach. That’s not old hat, that’s the perennial challenge of health improvement.

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Council invests in helping vulnerable adults stay independent

A service that helps vulnerable people improve their independence and stay safe is being rolled out across the city.

Birmingham City Council has invested in a £14 million contract with Tunstall to provide a city-wide telecare service. The contract, which should benefit up to 25,000 people over three years, includes a new Birmingham-based call centre.

Telecare combines a response service and a range of technology and equipment for elderly people and those with disabilities, such as movement detectors, temperature sensors and push-button alarms.

Councillor Sue Anderson, cabinet member for adults and communities, said: “We are proud to provide services that mean vulnerable adults across the city can continue to live independently but with the additional reassurance that they are being monitored for emergencies 24 hours a day.

“The contract marks a significant milestone in how we are improving the lives of adults we support throughout the city. It will mean more adults can remain in their own homes, helping to prevent the need for hands-on home care or a move into residential care.”

Carol Jarvis from Sheldon in Birmingham has MS and epilepsy and has a telecare package to support her in managing these conditions. She said: “I feel a lot safer now I have this service. I am more relaxed and it’s given my family more freedom as they can do more things without having to worry about me all the time.”

Previous use of telecare in the city has involved separate provision, installation and management; under the new contract Tunstall will provide all aspects of the service. It is now expected that there will be far greater use as the system will be an integral part of adult social care provision, maximising people’s skills and supporting them safely within community. A citizens’ assurance panel will support the monitoring and effectiveness of the telecare service.

Tunstall UK managing director Simon Arnold said: “This contract is truly innovative in terms of its partnership approach, involving parties from the public, private and voluntary sectors, to deliver services that will benefit citizens by being cared for in the environment of their choice for longer, through combined services being available 24 hours a day.”

Letters will be sent soon to all service users who currently have telecare equipment provided under the old Telecare Direct service to explain that there will be no change to the service they get, apart from new contact details to report any faults, compliments or complaints, or changes in personal circumstances.

Under the previous telecare service there were a number of different organisations providing separate parts of the service, one provided equipment, one installed and managed equipment, and one managed the response centre. The contracts with existing suppliers are due to end on 11th November 2011.

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Winter Chills

As winter approaches attention is turning to reducing Excess Winter Deaths (EWDs) attributed to seasonal risks to the elderly and vulnerable, the flu virus and falling temperatures. The seriousness of both factors is often underestimated, and campaigns to raise awareness among staff and the public are underway.

At the beginning of October, health bosses started vaccinating the most at-risk against the flu virus. According to a recent statement from the DoH, three-quarters of older people get their flu vaccine each year, but only around half of younger people in at risk groups get vaccinated Last year, 602 people with flu died in the UK. About 70% of deaths were in young and middle aged people aged 15 to 64 years.

People who can get the flu jab free of charge on the NHS include:

  • anyone aged 65 or over
  • anyone with a long-term condition including diabetes, asthma, liver disease, kidney disease or heart or chest problems and neurological conditions
  • people undergoing medical treatment who may have a compromised immune system
  • frontline health or social care staff
  • people living in a residential or nursing home
  • Carers
  • Pregnant women

Further information is available from http://bit.ly/nC1blL

There is always much discussion about using less energy, and with rising fuel costs this is a concern to many, especially the elderly. For the most part there is widespread awareness of the relationship exposure to extreme cold and increased deaths .The impact is exacerbated for vulnerable individuals and the colder the temperature the greater the risk of harm: Temperatures that are lower than 16 degrees can impair respiratory functions and below 12 degrees place strain on the cardiovascular system, increasing the risks of Stroke and Heart Attacks. Temperatures below 6 degrees place people at risk of hypothermia.

However, the impact of cold temperatures on health is wider than at the extreme end of the spectrum. Exposure to cold temperatures reduces mobility which increases the risk of falls and injuries in the home for example. Living in a damp cold home also increases mental health problems. Keeping warm is crucial, yet despite initiatives such as the Winter Fuel Allowance, many households, especially the elderly are deemed to be in fuel poverty, and will attempt to cut their fuel bills by reducing the amount of energy they use.

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Falls Prevention Service

Elderly people are more prone than younger people to unpredictable and unexpected falls and these can have serious consequences beyond physical injury, effecting individuals’ mobility, confidence, social interaction, mental health and care needs.

The falls prevention service, run by Birmingham City Council, Adults and Communities, offers free advice and support for people who live in Birmingham and are aged 50 and over. The service works with people who have fallen in the past and also those who are at risk of falling or are afraid of falling.

Most of the services that the team’s falls coordinators can arrange are aimed at helping to prevent people from falling and many of these are provided through partner organisations.

The types of services the team can access can help vulnerable people with jobs around the home, equipment to help with daily living activities, provide information on how to reduce the risks of falling, give advice on welfare and benefits and help the person to become more involved in physical and social leisure activities

The service is easy to access. People who would like help preventing falls complete a form called a “toolkit” which identifies an individual’s falls risk factors (both health and social risks). The person can select from a range of information and services that help prevent falls or reduce the impact of falls. Most of these services are free, although a few may incur a charge (this depends on an individual’s financial circumstances).The completed toolkit is sent to our falls coordinators who will arrange the services selected.

At a later stage, the falls coordinators will re-contact the person to discuss the impact of the range of information and services provided on the individual’s level of confidence about preventing falls and to check if they have fallen since.

Toolkits can be obtained by contacting the Falls Prevention Team on:

Tel.: 0121 6755171
Email: fallsprevention@birmingham.gov.uk
Web: www.birmingham.gov.uk/fallsprevention

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