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Health Profile Haringey Clinical Commissioning Group (CCG) West Collaborative September 2012 (For more information please see Haringey’s Joint Strategic Needs Assessment 2012). West Collaborative Health Profile 2012, Public Health Directorate 1 Contents 1. 2. 3. 4. 5. 6. 7. Summary Haringey at a glance The west collaborative area: demography and deprivation Children and young people 3.1. Early access to maternity services 3.2. Teenage pregnancy 3.3. Childhood immunisation Mortality and morbidity 4.1. Life expectancy 4.2. Lifestyle risk factors: smoking, physical activity, diet and nutrition, obesity 4.3. Lifestyle risk factors: drug and alcohol misuse 4.4. Long term conditions 4.5. Cardiovascular disease 4.6. Cancer 4.7. Diabetes 4.8. Chronic obstructive pulmonary disease Mental health Sexual health Infectious diseases West Collaborative Health Profile 2012, Public Health Directorate 2 Summary West Collaborative Health Profile aim is to provide the overall needs assessment specific to this collaborative and to inform the implementation of the Primary Care Strategy. It supplements Haringey’s Joint Strategic Needs Assessment (JSNA) 2012. The west collaborative covers a vibrant area of an older population that is geographically most varied, encompassing some of the wealthiest areas in the country and some areas which are amongst 20% most deprived in the country. It is the biggest of the four collaboratives with the highest number of population registered with GPs (88,405). It has a resident population of 74,940 that is older than the Haringey average. One fifth of the population is under 20 years of age. 64.2% of the population describe themselves as White British and only 7.8% as Black. Key issues in the west collaborative area are: • Children and young people o The west collaborative has the lowest birth rates in comparison to other collaboratives. Women in Muswell Hill book late for antenatal appointments. Stroud Green has the highest under 18 conception rate in the west collaborative. Stroud Green has increased childhood obesity for year 6 students. • Mortality and morbidity o There is a wide range in male life expectancy from 74.7 in Hornsey to 81.5 in Fortis Green. Female life expectancy is lower in Muswell Hill and Crouch End. In 2011 in comparison to other collaboratives, west collaborative had the highest proportion of patients with cancer on the GP registers. There are issues of low uptake of breast screening. Majority of service users in drug treatment in the west collaborative reside in Muswell Hill and Hornsey. • Mental health o There are more people with dementia here due to the greater proportion of older people. • Haringey’s Health and Wellbeing Strategy, North Central London Primary Care Strategy and the latest Haringey’s Clinical Commissioning Group Plans are addressing key issues identified in this profile. West Collaborative Health Profile 2012, Public Health Directorate 3 1. Haringey at a glance • Haringey stretches from the prosperous neighbourhood of Highgate in the west to Tottenham in the east, one of the most deprived areas in the country. • It has a relatively young population with almost a quarter of the population under the age of 20, and 90.5% of the population aged under 65. • It is the 4th most deprived borough in London and the 13th most deprived in the country. • Figure 1 shows how the health of people in Haringey compares to the rest of England. Haringey has significantly poor health behaviours and outcomes, including childhood obesity, teenage pregnancy, alcohol related harm, drug misuse, tuberculosis, acute sexually transmitted infections, life expectancy for men and early deaths from heart disease and stroke. • The borough has a particularly high level of severe mental illness concentrated in the east of the borough; it is ranked third in London. • Haringey’s residents experience challenging circumstances that impact negatively on their health including deprivation, proportion of children in poverty, statutory homelessness, violent crime and long term unemployment. Figure 1: Health summary for Haringey. Source: Association of Public Health Observatories (APHO). West Collaborative Health Profile 2012, Public Health Directorate 4 2. The west collaborative area: demography and deprivation • There are 74,940 residents in the area covered by the west collaborative practices, 33% of the borough’s population. • This is an older population with a small proportion (19.8%) of children and young people under-20 years compared to 23.8% in Haringey overall. The under-5 population (6.8%) is also lower than the average for Haringey (8%). • The proportion of the population describing themselves as White British (64.2%) is significantly higher than the average for Haringey. A further 13.4% describe themselves as Other White, 3.8% Black Caribbean and 3.3% Black African. • The west collaborative has the lowest birth rates in comparison to other Haringey’s collaboratives. • The population covered by the west collaborative is predicted to increase by 4.3% in 10 years from 2012 to 2022 whereas the predicted increase for Haringey is 7% for the same time period. • The predicted population growth in ten years from 2012 to 2022 across age groups is uneven with most growth in the 65+ age group. • It is most varied socio economically encompassing some of the wealthiest (Highgate, Crouch End) and some areas which are amongst 20% most deprived in the country (Stroud Green and Hornsey). Figure 2: Map of Haringey by ward showing demarcation by collaboratives. Source: Directorate of Public Health. West Haringey comprises of Alexandra, Fortis Green, Muswell Hill, Hornsey, Highgate, Crouch End and Stroud Green wards West Collaborative Health Profile 2012, Public Health Directorate 5 There are 14 GP surgeries in west collaborative (Fig. 3), seven of whom are singlehanded and 8 have PMS contracts. Figure 3: List of GP practices, by collaborative. Source: NCL Primary Care Contracting Code Practice type (No. Principals) GMS Y03035 5 Highgate Group Practice PMS F85014 7 Highgate Park Road Surgery GMS F85026 2 Fortis Green Queens Ave Surgery GMS F85045 3 Fortis Green Christchurch Hall Surgery GMS F85061 1 Crouch End Dukes Avenue Practice PMS F85063 5 Fortis Green The 157 Practice (Ramnani) PMS F85067 1 Stroud Green Crouch Hall Rd Surgery PMS F85069 2 Crouch End Grosvenor Road Surgery PMS F85658 1 Alexandra Alexandra Surgery PMS F85675 1 Alexandra Allenson House Medical Centre GMS F85679 1 The 157 Practice (Nubi) PMS F85680 1 Stroud Green Rutland House Surgery PMS F85688 1 Fortis Green The Vale Practice GMS Y01655 2 Muswell Hill Practice Contract Queenswood Medical Practice West Collaborative Health Profile 2012, Public Health Directorate Location (ward) Muswell Hill Crouch End 6 3. Children and young people 3.1 Early access to maternity services • • • The Department of Health target is for 90% of women to receive an antenatal assessment by 12 weeks and 6 days of pregnancy. Latest figures for Haringey show that only 62.7% of women accessed maternity services by this time. Those aged under 20, Black African women, and women living in the east of the borough (Fig. 4) are most likely to book late. Figure 4: Access to maternity services by ward of residence 2011. Source: Whittington and North Middlesex Hospitals. Women in Muswell Hill booked late for antenatal appointments 90% 80% 70% Percentage (%) 60% 50% 40% 30% 20% 10% Fo r ti s Cr Gre ou e c n Al h En e Se xan d ve d n ra Si Hi ster gh s ga B o Ho t e un rn d se M s Gr y us ee w n W ell es H t G il l W N ree h i oe n te l P Ha ar B r rt L k To uc an e t e T o t en G r o tt ha ve en m ha H m ale G W r ee No rt Str ood n hu ou si m d de be Gr rla ee nd n P St ark A Ha n n rr 's Al inga lw y om en 0% Early Late Very late Early: under 13 weeks ; Late: 13-22 weeks ; Very late: over 22 weeks Partnership plans include: • • • • Hold a knowledge exchange event with faith leaders and health professionals to share ideas on promoting early access with African communities. Promote the importance of early access with a range of professionals including GPs, particularly those providing services for vulnerable families. Undertake a health promotion campaign with pharmacists to promote early booking. In partnership with the Family Nurse Partnership and acute trusts develop an information card for first time mothers under 20 to promote early booking for subsequent pregnancies. West Collaborative Health Profile 2012, Public Health Directorate 7 3.2 Teenage pregnancy • Following three years of going down, the teenage pregnancy rate increased in Haringey in 2010 and at 64.7 per 1000 women aged 15-17 was the highest rate in England (England and Wales rate is 35.5 per 1000); 203 teenagers became pregnant. Given the small numbers involved, there can be large year on year fluctuations in the rate, and the overall trend (3-year ‘rolling average’) remains a decreasing one. • Positively, Haringey’s under-16 conception rate decreased to its lowest rate. • Teenage pregnancy rates in west Haringey remain low in five wards. Stroud Green and Hornsey have rates higher than England and Wales (Fig. 5). Figure 5: Teenage pregnancy rates by ward in Haringey. Source: ONS. Stroud Green has the highest rate in west Haringey Partnership plans include: • • • • • Continue to increase access to the C-Card scheme (accessible, free condoms for teenagers). Ensure young women under 25 have access to free Emergency Hormonal Contraception. Promote sex and relationship education (SRE) through the Healthy Schools programme. Continue the Family Nurse Partnership programme, which provides intensive support to young first time mothers. Continue the 4YP service (a young people-friendly sexual health service) in a range of school-based and non-healthcare settings for young people under 25. West Collaborative Health Profile 2012, Public Health Directorate 8 3.3 • • • Childhood immunisations In Haringey there has been a steady increase in the coverage of childhood vaccinations since 2008 and a significant improvement in 2011/12. Uptake of all the childhood immunisation in the west collaborative is lower than in central collaborative but higher than north east and south east collaborative (Fig. 6). It is important to note that there are significant variations within the collaborative with some practices meeting the national target of 95% while others are underperforming. Figure 6: Childhood immunisations coverage in 2011-12 in Haringey – comparison of 4 collaboratives. Source: Data extracted from GP computer systems. Uptake of pre-school booster and MMR is low in west collaborative 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% 3 doses Hib/MenC DTaP/IPV + (booster) Hib West 1st MMR Central PCV (Booster) North east Pre School Booster 2nd MMR South east Partnership plans include: • • • • Work and liaise with the Whittington Health Child Health Records Department (CHRD) to improve the process for data flow from practice systems to the Child Health Information System, to enable us to be able to report on uptake across Haringey, by practice and at a population level. Support practices in conjunction with the CHRD to scrutinise individual defaulter lists and practice coverage: • Make sure all immunisations are coded correctly and picked up on reports. • Target those practices that need extra support by working alongside the primary care strategy. Continue to support the implementation of the local ‘Best Practice Guidance’ and ‘Call and Recall’, DNA process and make sure this is updated as appropriate. Promote and support the availability of appropriate training and advice for front line staff. West Collaborative Health Profile 2012, Public Health Directorate 9 • • • 4. Mortality and morbidity 4.1 Life expectancy Overall life expectancy in the west collaborative ranges from 74.7 to 81.5 (Fig. 7). Female life expectancy in Haringey overall is better than the national. Female life expectancy in the west collaborative ranges from 81.4 in Muswell Hill to 89.9 in Stroud Green. Haringey has a 10% higher than expected premature (under 75) death rate (SMR: 110); whereas the west collaborative has a 18% lower than expected premature death rate (SMR: 82). Figure 7: Life expectancy in west collaborative (2005-2009). Source: Directorate of public health, 2012. West collaborative Haringey London England Females 84.7 83.3 83.6 82.0 Males 78.2 76.2 78.1 77.9 Figure 8: Male life expectancy by ward- 2005-09 (wards of west Haringey are shaded in purple) Fortis Green Life expectancy (years) 84 82 80 78 76 th u No r To t te nh am Gr e m be St en r la A n nd ns W W Pa hit oo rk e ds Bo Ha r ide un t L a ds ne Gr Ho een No rnse Br e l y uc Pa e r W Gr k To es ov t te t G e nh re St am en ro H u M d G ale us re w Se el en ve l H n ill Cr Sist ou er c s Ha h E n rr d Al inga ex y an Hi dra Fo gh rt i ga s G te Ha reen r in g Lo ey nd En on gla nd 74 72 70 68 66 has the highest male life expectancy in Haringey, significantly higher than the London and England Partnership plans include: • Allocate resources and implementing programmes that prevent ill health and detect and manage key diseases early. • Take forward Health and Wellbeing Strategy to deliver Outcome 2, “ A reduced gap in life expectancy”: • Reduce smoking e.g. through tobacco control measures and the smoking cessation service. • Increase physical activity e.g. by scaling up brief interventions to encourage take up and by making Haringey more cycle friendly. • Reduce alcohol misuse (see 4.3). • Reduce early death from CVD and cancer e.g. by increasing uptake of the NHS Health Checks programme and developing community champions. • Support people with LTC to live a healthier life e.g. by implementing evidence based care pathways and integrated care systems. West Collaborative Health Profile 2012, Public Health Directorate 10