Havering Health and Social Care Needs



LONDON BOROUGH OF HAVERINGHavering Health and Social Care Needs2017An overviewJoint Strategic Needs AssessmentBy LBH Public Health Service(with contributions from: Learning and Achievement; Children Social Care; Adult Social Care; and Business & Performance Services)Contents TOC \o "1-3" \h \z \u List of Figures PAGEREF _Toc443572139 \h 2List of Tables PAGEREF _Toc443572140 \h 3Executive Summary PAGEREF _Toc443572141 \h 4Introduction PAGEREF _Toc443572142 \h 4What will happen to the population of Havering? PAGEREF _Toc443572143 \h 4What are the risk factors affecting ill health in Havering? PAGEREF _Toc443572144 \h 4What is the current status of health in Havering? PAGEREF _Toc443572145 \h 5How do local people use health and social care services? PAGEREF _Toc443572146 \h 6Introduction PAGEREF _Toc443572147 \h 9What is Health? PAGEREF _Toc443572148 \h 9What are health inequalities? PAGEREF _Toc443572149 \h 10What is the purpose of this report? PAGEREF _Toc443572150 \h 10What will happen to the population of Havering? PAGEREF _Toc443572151 \h 11What are the risk factors for ill health in Havering? PAGEREF _Toc443572152 \h 12Obesity and overweight PAGEREF _Toc443572153 \h 12Physical Inactivity PAGEREF _Toc443572154 \h 13Smoking PAGEREF _Toc443572155 \h 14Alcohol Misuse PAGEREF _Toc443572156 \h 16Other factors PAGEREF _Toc443572157 \h 17Teenage pregnancies PAGEREF _Toc443572158 \h 17Maternal mental health PAGEREF _Toc443572159 \h 18Breastfeeding PAGEREF _Toc443572160 \h 18Early Years PAGEREF _Toc443572161 \h 18Oral Health PAGEREF _Toc443572162 \h 19What is the current status of health in Havering? PAGEREF _Toc443572163 \h 20Mortality PAGEREF _Toc443572164 \h 20Long-Term Conditions PAGEREF _Toc443572165 \h 23Mental Illness PAGEREF _Toc443572166 \h 24Diabetes PAGEREF _Toc443572167 \h 25Dementia PAGEREF _Toc443572168 \h 26Disability PAGEREF _Toc443572169 \h 27Specific Groups PAGEREF _Toc443572170 \h 29How do local people use health and social care services? PAGEREF _Toc443572171 \h 31Children Social Care PAGEREF _Toc443572172 \h 31Adult Social Care PAGEREF _Toc443572173 \h 33Health Services PAGEREF _Toc443572174 \h 35Key documents for further information PAGEREF _Toc443572175 \h 39List of Figures TOC \h \z \c "Figure" Figure 1: Dahlgren and Whitehead’s model of the determinants of health. PAGEREF _Toc479591041 \h 10Figure 2: Proportion of reception children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16 PAGEREF _Toc479591042 \h 14Figure 3: Proportion of reception year 6 children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16 PAGEREF _Toc479591043 \h 14Figure 4: Distribution of Havering CCG registered adult (18+) population, by BMI category, as at December 2016 PAGEREF _Toc479591044 \h 15Figure 5: Sports participation at least once a week 2005/06-2015/16, Havering, London, England, statistical comparator Bexley PAGEREF _Toc479591045 \h 16Figure 6: Smoking Prevalence (% of adult population) across Havering Wards by Quintile (where Quintiles 1 and 5 refer to the lowest and highest prevalence wards respectively) PAGEREF _Toc479591046 \h 17Figure 7: Smoking status at the time of delivery, Havering compared to Bexley, London and England, 2010/11 to 2015/16 PAGEREF _Toc479591047 \h 18Figure 8: Trend in under 18-conception rate per 1,000 women aged 15-17, Havering, Bexley, London and England, 1998-2014 PAGEREF _Toc479591048 \h 19Figure 9: Percentage of children achieving a good level of development at the end of reception, 2015/16 PAGEREF _Toc479591049 \h 21Figure 10: Distribution of number of deaths amongst Havering residents of all ages by broad underlying causes (with four biggest broken down further), in 2012-2016 PAGEREF _Toc479591050 \h 22Figure 11: Distribution of number of deaths amongst Havering residents of those aged under 75 by broad underlying causes, in 2012-2016 PAGEREF _Toc479591051 \h 23Figure 12: Premature mortality, Havering compared to all local authorities (LAs) in England and similar LAs average, 2013-15 PAGEREF _Toc479591052 \h 24Figure 13: Breakdown of life expectancy gap between the most deprived quintile and the least deprived quintile in Havering by cause of death and gender PAGEREF _Toc479591053 \h 25Figure 14: Number and proportion of registered population by LTC count, Havering CCG, 2015/16 PAGEREF _Toc479591054 \h 26Figure 15: Ratio of patients with long-term conditions (LTCs) compared to patients with no long-term conditions (LTCs) for A&E attendances, Emergency Admissions and Inpatient Bed Days PAGEREF _Toc479591055 \h 26Figure 16: Prevalence of depression in patients registered with GP in Havering CCG and resident in the London Borough of Havering, per 1,000 persons aged 17 years and over, Census wards, as of February 2017 PAGEREF _Toc479591056 \h 27Figure 17: Prevalence of dementia in registered patient, all ages, London boroughs and England 2015/16 PAGEREF _Toc479591057 \h 28Figure 18: Prevalence of diabetes in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 17 and over, Census wards, as of February 2017 PAGEREF _Toc479591058 \h 29Figure 19: Prevalence of Cancer in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017 PAGEREF _Toc479591059 \h 30Figure 20: Prevalence of Chronic Obstructive Pulmonary Disease (COPD) in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017 PAGEREF _Toc479591060 \h 31Figure 21: Prevalence of Hypertension in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017 PAGEREF _Toc479591061 \h 32Figure 22: Prevalence of Coronary Heart Disease in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017 PAGEREF _Toc479591062 \h 33Figure 23: Projected numbers of children with statements of special educational needs by type and school in Havering, 2013/14 to 2023/24 PAGEREF _Toc479591063 \h 35Figure 24: Count of children’s social care referrals and assessments in Havering, 2013/14 to 2015/16 PAGEREF _Toc479591064 \h 38Figure 25: Distribution of plans across Children and Young people, 2014-2016 PAGEREF _Toc479591065 \h 38Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016 PAGEREF _Toc479591066 \h 39Figure 27: Population Pyramid of children in need activity, Havering, 2014-2016 PAGEREF _Toc479591067 \h 40Figure 25: Population Pyramid of child protection activity, Havering, 2014-2016 PAGEREF _Toc479591068 \h 41Figure 24: Rate per 1000 children aged under 18 for Child in need plans, child protection plans and looked after children in Havering, 2014 to 2017 PAGEREF _Toc479591069 \h 43Figure 25: Carers - Primary support reason of 'Cared For' person 2014-15 PAGEREF _Toc479591070 \h 46Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016 PAGEREF _Toc479591071 \h 47Figure 27: Rate of A&E attendances per 1,000 population registered with Havering CCG GP and resident in Havering, by LSOA, 2013/14 PAGEREF _Toc479591072 \h 48Figure 28: Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, 2015/16 PAGEREF _Toc479591073 \h 50List of Tables TOC \h \z \c "Table" Table 1: Projected percentage population change by age group, from 2015 to 2020, 2025 and 2030 PAGEREF _Toc443572417 \h 11Table 2: Prevalence of mental health amongst maternal population in Havering PAGEREF _Toc443572418 \h 18Table 3: Number of adults with learning disability in Havering, 2015 PAGEREF _Toc443572419 \h 27Document Version ControlVersionDescription1.0Original document in 2015/16 financial yearPublished in February 20162.0Annual update in 2016/17 financial yearPublished in March 2017Population figures updated using Mid-2015 population estimatePopulation projections updated from 2017 to 2032Life Expectancy figures addedDifference in Life Expectancy figures updated from 2011-12 to 2012-2014Childhood Obesity figures updated from 2014/15 to 2015/16Adult Obesity updated from December 2015 to December 2016Physical Activity updated from 2014 to 2015/16Smoking prevalence updated from 2014 to 2015Alcohol harm figures updated from 2013/14 to 2014/15Maternal mental health figures updated using Mid-2015 Population estimatesBreastfeeding figures updated from 2014/15 to 2015/16Child development figures updated with from 2014/15 to 2015/16The top 5 (underlying) causes of death figures updated (2012 to 2016)Long Term Conditions counts and ratios updated from 2014/15 to 2015/16Prevalence of Mental Health, Diabetes, COPD, Cancer, CHD and Hypertension (accessed via health analytics) have all been updated from January 2016 to February 2017Prevalence of Dementia updated from 2014/15 to 2015/16 Learning disability figures updated from 2015 to 2016Figure added showing distribution of plans across Children and Young people, 2014-2016Figures added on rate of children’s social care activity by type of plan and gender, per 1000 children aged under-18 years in Havering, 2016New figures added on Looked After Children activityCount and population pyramid added reflecting Children in Need activityCount and population pyramid added reflecting Child Protection activityCount and population pyramid added reflecting Looked After Children activityRate per 1000 children aged under 18 for Child in need plans, child protection plans and looked after children in Havering updated (2014 to 2017)Added Number of registered patients per GP, Havering Clinical Commissioning Group (HCCG) GP practices, Havering CCG, London average, England Average 2016Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, updated from 2013/14 to 2015/16 Executive SummaryIntroductionThis report, developed as part of the Joint Strategic Needs Assessment (JSNA), is an overview of Havering’s health and social care needs. It provides a high-level description of population growth, prevalence and pattern of risk factors for ill health, status of health and wellbeing and the patterns of demand for health and social care services in Havering. From this understanding, all local stakeholders will understand the following changes that need to be made:Prevention needs to be prioritised in order to reduce the prevalence of risk factors in the population particularly in the more deprived parts of the borough.A reduction in risk factors will mean a reduction in the number of people who develop long term conditions; less people with multiple co-morbidities; reduced demand for more expensive and complex packages of care; and longer lives free of disability.Targeting high-risk population groups will ensure efficient use of limited resources and in the longer term reduce health inequalities.What will happen to the population of Havering?Based on the Greater London Authority (GLA) population projection, the population of Havering is projected to increase from 255,407 in 2017 to 297,369 in 2032 – 13% increase. The population aged 25-64 will remain the largest age group up to 2032 but from 2017 to 2032, the largest increases will be seen in children (5-10 year olds: 13%; 11-17 year olds: 36%), and older people (65-84 year olds: 24%; 85+ year olds: 45%).What are the risk factors affecting ill health in Havering?Women in the least deprived parts of the borough are likely to live 5.7 years longer than those in the most deprived parts. Similarly, there is a difference in life expectancy of 6.5 years in men.In 2015/16, a quarter of children (23.2%) in Reception Year were either overweight or obese. This figure increased to a third (37.3%) of children in Year 6 - this is significantly higher than the England average. Regarding adults, around one in two (54%) persons aged over 18 years registered with a General Practice (GP) in the Havering Clinical Commissioning Group (CCG) is either overweight or obese.Estimates show that one in three adults (36.2%) in Havering are inactive compared to London (37.8%) and England (36.1%). The general trend in participation in sports lags behind that of Bexley (Havering comparator) and London but in the last couple of years has performed better than EnglandIn Havering, approximately 17.3% of persons aged 18 years and above smoked in 2015. This is similar to both London and England.The number of deaths attributable to smoking is on the decline, but based on the most recent data (2012-2014) this is still higher than England and significantly higher than London.Smoking in pregnancy, although on the decline, is highest in Havering (7.7%) compared to other London boroughs (significantly higher in Havering compared to 5.0% in London but significantly better than England, 10.6%) for 2015/16..The majority of drinkers (73%) in Havering do not drink above the recommended limits.Although Havering had significantly lower alcohol related admissions to hospital (430 per 100,000 hospital admissions for alcohol-related conditions in comparison to London and England in 2014/15 , alcohol is implicated in 4% of ambulance call outs; 16% of road fatalities and over 70% of cases of domestic violence. Other FactorsHavering’s teenage (under-18) conception rate has almost halved from the rate in 1998. However, Havering’s rate (26 per 1000 women under the age of 18) in 2013 is higher than London (21.5 per 1000) but similar to England (22.8 per 1000). For the conception rate under 16, Havering’s rate (6.1 per 1000) is higher than England (4.4 per 1,000) and significantly higher than London (3.9 per 1,000)Maternal depression and stress related disorders are the most common maternal mental health conditions in Havering.In 2015/16, about three quarters of Havering mothers’ breastfed at birth (73.3%) - this is statistically similar to London (86.1%) but lower than England (74.3%). However, a significant proportion do not continue to breastfeed – at 6-8 weeks, only 43% continue to do so compared with 48.9% in London and 43.2% in England.Havering is currently ranked 16th highest of 32 boroughs in London for the proportion of children achieving a good level of development at the early years foundation stage for 2015/16.For 2014/15, Iin Havering, proportion of five year olds free from dental decay is 80.0%one in five 5-year olds (19.8%) have decay experience ., This is better than England (75.2%) and significantly better than London (72.6%). Dental decay can resulting in pain, sleep loss, time off school and, in some cases, treatment under general anaesthetic.What is the current status of health in Havering?The top 5 (underlying) causes of death in Havering (from 2012 to 2016) are: cancers, circulatory diseases, respiratory diseases, dementia & Parkinson’s disease, and diseases of digestive system.Unspecified dementia comprises the biggest single underlying cause of death. Lung cancers comprise the largest proportion of deaths from Cancer.About 620 (28%) deaths each year occur prematurely (deaths that occur before a person reaches the age of 75 years). Cancer, heart disease and stroke are the main causes of premature deaths.Long Term ConditionsThere is an increasing number of Havering residents living with long term conditions (LTCs) – this has a significant impact on daily lives including the use of urgent and emergency health and social care services.Havering CCG patients with five or more LTCs are 3 times more likely to attend A&E, 13 times more likely to be admitted for an emergency, and the average number of inpatient bed days will be 23 times greater compared to patients with no LTC.The prevalence of mental health problems in Havering (0.65%) is generally lower than both London (1.07%) and England (0.88%) but there is variation in how common it is across the wards in the borough.The prevalence of depression ranges from 56.6 per 1000 persons aged 17 and over in Upminster to 113.0 per 1000 persons aged 17 and over in Gooshays (i.e. more generally more common with increasing deprivation).Dementia is more common in Havering than London but similar to England; and it will be an increasing problem for Havering because of its ageing population.In Havering, the number of people living with diabetes is on the increase. The prevalence of diabetes is lowest in Upminster (47.3 per 1000 persons aged 17 and over) and highest in South Hornchurch (70.1 persons aged 17 and over).DisabilityChildren and adults with a learning disability are at increased risk of having or developing physical and mental health problems. In addition, they are 10 times more likely to have serious sight problems.Havering was estimated to have 906 adults with moderate or severe learning disability in 2016, of which about 300 are estimated to be living with a parent. Additionally, about 1681 people were estimated to have autistic spectrum disorders. Havering has a lower rate of people registered blind (205 per 100,000) compared to London and England.The number of children with special educational needs and disabilities is growing year on year, averaging increases of between 40 to 60%in all groups between 2012 and 2015.There is increasing demand for specialist help and schooling for children with autism (ASD) and for those with behavioural, emotional and social difficulties (BESD), including those with mental health issues.Specific GroupsOverweight and obesity is an issue for children in Havering. They are likely to develop Type 2 Diabetes requiring long term medical care.Havering has the lowest number of children going into care. Looked after children generally have greater mental and physical health care needs.Older people are at increased risk of living with multiple long-term conditions; dementia; and experiencing falls.Working age adults comprise the largest age group in Havering and are more likely to experience serious mental health issues such as depression, schizophrenia and psychoses. Certain health problems are more common in BAME groups because of various reasons including diet and other lifestyle factors e.g. diabetes in South Asians; and sickle cell disease in black Africans.How do local people use health and social care services?Children Social CareHavering’s children centres saw a 7.5% increase in the number of individual attendances between 2013/14 and 2014/15 (12,236 to 13,148).Projected figures for 2015/16 indicate a 23% increase in children centre numbers to 16,148.There were 2,129 contacts received by the service in 2014/15 with 2015/16 projections set to exceed 3,000 indicating an over 40% increase in activity.In 2013/14 Havering’s Children Social Care received 1,106 referrals to the service. In 2014/15 this had increased by 60 to 1,774.The number of Child Protection Plans in Havering increased by 50% from 2013/14 (143) to 2014/15 (214). The projected number for 2015/16 is 329, which would be a further 56% increase on the previous year.The number of looked after children between 2013/14 and 2014/15 had increased from 207 to 240 (15.9%). Projected figures for 2015/16 are 227 which would indicate a 5.4% reduction. Adult Social careIn 2013/14, 7,096 clients received adult social care support in Havering of which two thirds were aged 75.The majority of the demand (98%) is driven by the following: physical disability (78%), learning disability (12%) and mental health (8%).In Havering, the rate of adults aged 18-64 years admitted to residential and nursing homes was 9.5 per 100,000 in 2014/15. This is lower compared to both London (11.1 per 100,000) and England (14.2 per 100,000).Over a 1,000 adults receive support in their homes; equating to about 11.3 hours per person per week; an increase from 10.7 in 13/14.In 2014/15, 266 clients used respite services totalling 638 separate episodes.The use of day care services in Havering decreased from 447 per 1000 people in 2008/09 to 101 per 1000 population in 2013/14. This is lower when compared to London (260 per 1000 population) and England (324 per 1000 population) and our statistical neighbours.The majority of the demand for reablement, 80%, arises from the Joint Assessment and Discharge (JAD) team at the local acute trust; the remaining 20% from the community.According to the 2011 Census, 25,214 people, 11% of Havering’s residents identified themselves as carers, an increase from 23,253 (8.4% increase) in 2001. Twenty-three per cent (5,835) said they provided more than 50 hours of care per week.Health ServicesThe average number of patients registered with a Havering CCG practice per GP (Full Time Equivalent, FTE) is 2,073, which is lower than both the London average (6825 patients per GP-FTE) and the England average (5252 patients per GP-FTE)79% of patients stated their overall experience with their GP was good, similar to London (80%) - higher compared to London (60.3%) and lower compared to England (85%).People living in the more deprived parts of the borough are more likely to use A&E services than those from least deprived areas in Havering.There were approximately 31,003 elective admissions to hospital by patients registered with a General Practice (GP) in Havering in 2014/15. This is a 1.5% increase since last year which is lower than the increase seen across both London and England, 6.0% and 2.8% respectively. Estimates suggest that about 3,275 children aged 0-16 years and resident in Havering have a mental health disorder sufficient to cause distress to the child or have a considerable impact on the child’s day-to-day pared to both our statistical neighbour Bexley, and to England, Havering has a lower rate of admission for children with mental health disorders aged 0-17 years.IntroductionThis document forms part of the Joint Strategic Needs Assessment (JSNA). The JSNA is a systematic method for reviewing the issues facing a population, leading to agreed priorities and resource allocation that will improve health and wellbeing of the population and reduce inequalities within the population.What is Health?In 1948, the World Health Organisation (WHO) defined health as a state of complete physical and mental wellbeing and not merely the absence of disease and infirmity. This enduring definition has not been changed by the WHO since then, though there are many other definitions of health and wellbeing in existence.The factors that determine the health of a population are, broadly speaking, divided as follows:Socio-economic factors e.g. employment, income, education, housing, environment, etc.Lifestyle choices e.g. smoking, diet, exercise, alcohol, uptake of preventive services, etc.Health service provision (the contribution of health services to health differs by population subgroup).Genetics (although a relatively small contribution, its importance is increasing).Dahlgren and Whitehead have mapped the complex relationship between the factors that impact on the health of individuals and communities (see REF _Ref440612039 \h \* MERGEFORMAT Figure 1). Figure 1: Dahlgren and Whitehead’s model of the determinants of health. Source: Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Copenhagen: World Health Organization, 1992.Individually and collectively, we can influence some of these factors in Havering and in so doing improve the quality of our lives. What are health inequalities?Health inequalities (sometimes called health inequities) are differences in health status between social groups. They exist in all countries – whether low, middle or high income. The lower an individual's socio-economic position, the higher their risk of poor?health.?Such disparities in health are considered avoidable and modifiable and, therefore, unjust. There are health inequalities within Havering and between Havering and other local authorities.Reducing health inequalities has been a longstanding national and local priority. There has been an increasing realisation (articulated in many Government documents over the past 30 years), that more effort needs to be put into preventing individuals and families from getting into situations where they require health or social care interventions. This would help to reduce health inequalities. There is also amble evidence that it is possible to prevent such situations from occurring. Therefore, there has been a strong national and local policy drive to shift more resources into prevention and early intervention and away from more expensive services that are required once problems have occurred.This understanding informs the selection of our prevention priorities and shapes the things we can do in Havering to deliver these priorities. It allows us to engage all the resources at our collective disposal to create a more resilient economic and social environment in which individuals can make fully informed decisions about how to live their lives. It guides us to develop the circumstances in which it is easier for individuals to make healthier choices and to make best use of the services that are available to them to promote and protect their health and that of their family.What is the purpose of this report?This document is one of a suite of reports, developed as part of the Joint Strategic Needs Assessment (JSNA), which aims to give readers a high level understanding of the population of Havering. This report is an overview of Havering’s health and social care needs. Using routinely collected data, it describes the pattern of risk factors for ill health, the status of health and wellbeing and how people use local services. From this understanding (of population growth, prevalence of risk factors for ill health across Havering, and the patterns of demand for health and social care services), all local stakeholders will understand the following changes that need to be made:Prevention needs to be prioritised in order to reduce the prevalence of risk factors in the population particularly in the more deprived parts of the borough.A reduction in risk factors will mean a reduction in the number of people who develop long term conditions; less people with multiple co-morbidities; reduced demand for more expensive and complex packages of care; and longer lives free of disability.Targeting high-risk population groups will ensure efficient use of limited resources and in the longer term reduce health inequalities.What will happen to the population of Havering?Based on the Office for National Statistics (ONS) 2015 mid-year population estimates, the London Borough of Havering has a population of 249,085 - an increase of 11% from 223,641 in 1998. Havering has the oldest population in London and is also one of the most ethnically homogenous boroughs with 83% of its residents recorded as White British in the 2011 census (London 43%, and England 80%).Based on the Greater London Authority (GLA) population projections, the population of Havering is projected to increase from 255,407 in 2017 to: 270,232 in 2022 – a 6% increase from 2017 281,590 in 2027 – a 10% increase from 2017 287,369 in 2032 – a 13% increase from 2017 The population aged 25-64 will remain the largest age group up to 2032 but the largest increases will be seen in children (5-10 year olds: 13%; 11-17 year olds: 36%), and older people (65-84 year olds: 24%; 85+ year olds: 45%) from 2017 to 2032 (see REF _Ref434847478 \h \* MERGEFORMAT Table 1). Therefore, if the population continues to be affected by ill health at the current rate then the demand for health and social care services will grow (particularly services for frailty and dementia; long term conditions and child & adolescent mental health). However, as the population aged 25-64 will remain the largest age group up to 2032, access to affordable housing and good quality local employment opportunities will be important. Table 1: Projected percentage population change by age group, from 2017 to 2022, 2027 and 2032Data source: GLA 2015-based Demographic Projections – Local Authority population projection Housing-led Model; Greater London Authority (GLA); Produced by Public Health IntelligenceFor more information on the key geographic, demographic and socio-economic facts and figures for the London Borough of Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at the following website: . What are the risk factors for ill health in Havering?Havering is a relatively healthy borough - the life expectancy for people living in Havering is 80.2 years (for males) and 84.1 years (for females) from birth from 2013-2015. Life expectancy in Havering has been mostly higher than the England average and has been on the increase over the last decade.However, some people experience better health than others and the reasons vary across the local population. During 2012-2014, women in the least deprived parts of the borough are likely to live 5.7 years longer than those in the most deprived parts. Similarly, there is a difference in life expectancy of 6.5 years in men. The key risk factors are obesity, insufficient physical activity, smoking, and alcohol misuse.Obesity and overweight The main health risks associated with being overweight or obese are diabetes, heart disease and cancer.On average, one in four children (23.2%) in Reception Year ( REF _Ref434847625 \h \* MERGEFORMAT Figure 2) and one in three children in Year 6 ( REF _Ref434923528 \h \* MERGEFORMAT Figure 3) in Havering schools are overweight or obese. In addition, REF _Ref434923528 \h \* MERGEFORMAT Figure 3 shows that (in 2015/16) the proportion of Year 6 children in Havering that are overweight or obese (37.3%) continues for the third year in a row to be significantly higher than the England average (34.2%). With respect to adults, around one in two adults (54%) over the age of 18 years registered with a General Practice (GP) in the Havering Clinical Commissioning Group (CCG) is overweight or obese ( REF _Ref424174480 \h \* MERGEFORMAT Figure 4).Figure 2: Proportion of reception children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16Data source: National Child Measurement Programme (published November 2015), Health and Social Care Information Centre; Produced by Public Health IntelligenceFigure 3: Proportion of reception year 6 children within academic year with recorded BMI overweight or obese, Havering compared to London and England, 2006/07 to 2015/16Data source: National Child Measurement Programme (published November 2015), Health and Social Care Information Centre; Produced by Public Health IntelligenceFigure 4: Distribution of Havering CCG registered adult (18+) population, by BMI category, as at December 2016Data source: Health Analytics, (accessed December 2016); Produced by Public Health IntelligencePhysical InactivityPhysical inactivity increases the risk of being overweight and obese and developing diabetes, heart disease, cancers and mental ill health.Estimates show that one in three adults (36.2%) in Havering is inactive compared to London (37.8%) and England (36.1%). The general trend in participation in sports lags behind that of Bexley (Havering comparator) and London but in the last couple of years has performed better than England ( REF _Ref434924231 \h \* MERGEFORMAT Figure 5).Figure SEQ Figure \* ARABIC 5: Sports participation at least once a week 2005/06-2015/16, Havering, London, England, statistical comparator BexleyData source: Active People Survey (APS) Interactive Tool, Sports England (accessed February 2017); Produced by Public Health IntelligenceSmokingSmoking increases the risk of lung and other cancers, heart disease, chronic obstructive lung disease (COPD). Since the 80s there has been a fall in deaths from heart disease thought to be due mainly to a reduction in smoking. This trend has continued along with a fall in other respiratory conditions following the introduction of the smoking ban in 2007. In Havering, approximately 17.3% of persons aged 18 years and above smoked in 2015. This is similar to both London and England. Smoking prevalence was highest in Gooshays (20.3%) and Heaton (19.6%), two of the most deprived wards in Havering; and lowest in Emerson Park (17.2%) and Upminster (16.6%) – see REF _Ref442278252 \h \* MERGEFORMAT Figure 6. The number of deaths attributable to smoking is on the decline, but based on the most recent data (2012-2014) this is still higher than England and significantly higher than London.Figure 6: Smoking Prevalence (% of adult population) across Havering Wards by Quintile (where Quintiles 1 and 5 refer to the lowest and highest prevalence wards respectively)Data source: Action on Smoking and Health (ASH) Ready Reckoner Tool (published December 2015); Produced by Public Health IntelligenceSmoking in pregnancy, although on the decline ( REF _Ref435000041 \h \* MERGEFORMAT Figure 7) is highest in Havering (7.7%) compared to other London boroughs (significantly higher in Havering compared to 5.0% in London but significantly better than England, 10.6%) for 2015/16. Figure 7: Smoking status at the time of delivery, Havering compared to Bexley, London and England, 2010/11 to 2015/16Data source: Local Tobacco Control Profile (accessed March 2017); Produced by Public Health IntelligenceAlcohol MisuseDrinking alcohol above recommended limits (14 units per week for women and 21 units per week for men) increases the risk of cancers, liver and heart diseases. This is also associated with anti-social behaviour, domestic violence and other criminal offences. However, the majority of drinkers (73%) in Havering do so safely. Although Havering had significantly lower alcohol related admissions to hospital (430 per 100,000 hospital admissions for alcohol-related conditions in comparison to London and England in 2014/15, alcohol is implicated in 4% of ambulance call outs; 16% of road fatalities and over 70% of cases of domestic violence. Other factors There are other risk factors that influence health and wellbeing, particularly for children. Some of these include teenage pregnancies, maternal mental health, breastfeeding, early years and oral health. Teenage pregnanciesEvidence shows that children born to teenage mothers are more likely to experience a range of negative outcomes in later life and are more likely, in time, to become teenage parents themselves – perpetuating the disadvantage that young parenthood brings from one generation to the next.Teenage pregnancy is both a contributory factor as well as an outcome of child poverty. However, with the right level of support, the life chances of young parents can be significantly improved.Havering’s teenage (under-18) conception rate has almost halved from the rate in 1998. However, Havering’s rate (26 per 1000 women under the age of 18) in 2014 is higher than London (21.5 per 1000) but similar to England (22.8 per 1000). For the conception rate under 16, Havering’s rate (6.1 per 1000) is higher than England (4.4 per 1,000) and significantly higher than London (3.9 per 1,000) . Figure 8: Trend in under 18-conception rate per 1,000 women aged 15-17, Havering, Bexley, London and England, 1998-2014Data source: Conception Statistics 2014 (published February 2015), Office for National Statistics; Produced by Public Health IntelligenceMaternal mental health Women are at increased risk of suffering from mental health problems following childbirth, but women with pre-existing psychiatric disorders may also face a relapse or recurrence of their condition following childbirth. Mental illness occurring at this time may have an adverse effect on the woman herself, and also on her marriage, family and, in particular, on the future development of her infant. Maternal depression and stress related disorders are the most common maternal mental health conditions in Havering (see REF _Ref434926249 \h \* MERGEFORMAT Table 2).Table 2: Prevalence of mental health amongst maternal population in HaveringMENTAL HEALTH CONDITIONNUMBERSPREVALENCE (per thousand maternities)All Maternities3,138Postpartum psychosis62 in 1000Chronic serious mental illness62 in 1000Severe depressive illness9430 in 1000Mild-moderate depressive illness and anxiety states314-471100-150 in 1000Post-traumatic stress disorder9430 in 1000Adjustment disorders and stress471-941150-300 in 1000Data source: Guidance for commissioners of perinatal mental health services, Joint Commissioning Panel for Mental Health 2012 (Births based on ONS Mid-Year Population Estimates 2015); Produced by Public Health IntelligenceBreastfeedingBreastfeeding is good for babies. Breastfeeding rates in the UK are among the lowest in Western Europe, with young mothers, women of lower socioeconomic status or those who left full-time education at an early age being least likely either to start breastfeeding or to continue breastfeeding beyond six to eight weeks. In 2015/16, about three quarters of Havering mothers breastfed at birth (73.3%) and this is statistically similar to London (86.1%) but lower than England (74.3%). However, a significant proportion do not continue to breastfeed – at 6-8 weeks, only 43% continue to do so compared with 48.9% in London and 43.2% in England. Early YearsAchieving the very best outcomes in the early years is fundamental to shifting the long-term health and wellbeing of the residents of?Havering. ?Evidence-based interventions that have been shown to be highly cost effective include preschool early childhood education for 2, 3 and 4 year olds in families with low incomes.The proportion of children achieving a good level of development during early years remained relatively static over 2010-2013 at 59-60%. Havering is currently ranked 16th highest of 32 boroughs in London for the proportion of children achieving a good level of development at the early years foundation stage from 2013 to 2015 (see REF _Ref440368930 \h \* MERGEFORMAT Figure 9). Figure 9: Percentage of children achieving a good level of development at the end of reception, 2015/16Data source: Public Health Outcomes Framework 1.02i 2015/16; Produced by Public Health IntelligenceOral HealthDental health in children is a good indicator of diet and overall health.? Tooth decay is predominantly preventable. For 2014/15, in Havering, proportion of five year olds free from dental decay is 80.0%. This is better than England (75.2%) and significantly better than London (72.6%). Dental decay can result in pain, sleep loss, time off school and, in some cases, treatment under general anaesthetic. What is the current status of health in Havering?Mortality rates are routinely used to describe health status in England. Therefore, this section describes the status of health as mainly measured by mortality rates, and by specific conditions that are the main contributors to mortality in Havering. In the main, those living in the more deprived wards of the borough experience worse health and higher death rates, based on current access to and the quality of health and wellbeing services. MortalityApproximately 1% of the population of Havering die each year (on average 2,234 people). The top 5 (underlying) causes of death in Havering (from 2012 to 2016) are: cancers, circulatory diseases, respiratory diseases, dementia & Parkinson’s disease, and diseases of the digestive system. Unspecified dementia comprises the biggest single underlying cause of death. Lung cancers comprise the largest proportion of deaths from Cancer (see REF _Ref440370412 \h \* MERGEFORMAT Figure 10).Figure 10: Distribution of number of deaths amongst Havering residents of all ages by broad underlying causes (with four biggest broken down further), in 2012-2016Data source: Primary Care Mortality Database (Office for National Statistics); Produced by Public Health IntelligenceIn Havering, about 620 deaths (28%) each year occur prematurely (deaths that occur before a person reaches the age of 75 years). Cancer, heart disease and stroke are the main causes of premature deaths (see REF _Ref440370745 \h \* MERGEFORMAT Figure 11). This reflects the national picture.Figure 11: Distribution of number of deaths amongst Havering residents of those aged under 75 by broad underlying causes, in 2012-2016 Data source: Primary Care Mortality Database (Office for National Statistics); Produced by Public Health IntelligenceHavering generally ranks well in comparison to 150 local authorities (LAs) in England for premature mortality, except breast cancer (though not significantly different from the average). Compared to local authorities with similar deprivation scores, Havering scores statistically better for premature deaths from injuries, better than average (though not statistically significant) for colorectal cancer, stroke, breast cancer, heart disease and stroke. In addition, Havering ranks worse than average (but not significantly) for lung cancer, overall cancer, lung disease, heart disease, lung disease and liver disease related premature mortality (see REF _Ref440371179 \h \* MERGEFORMAT Figure 12).Figure 12: Premature mortality, Havering compared to all local authorities (LAs) in England and similar LAs average, 2013-15Data source: Longer Lives tool (accessed March 2017), Public Health England; Produced by Public Health IntelligencePeople living in the most deprived parts of the borough are more likely to die early compared to those living in the least deprived parts of the borough (See REF _Ref440371534 \h \* MERGEFORMAT Figure 13). For the main causes of death: Cancer: The main causes are lung, bowel, breast and prostate. The single most important risk factor for cancers is smoking. Men from the most deprived parts of the borough are more likely to die early from cancer.Heart disease and Stroke: Women from the most deprived parts of the borough are more likely to die early from heart disease.Lung disease: The main type of lung disease responsible for deaths is Chronic Obstructive Pulmonary Disease (COPD); the single most important risk factor is smoking. Men from the most deprived parts of the borough are more likely to die early from lung problems.Figure 13: Breakdown of life expectancy gap between the most deprived quintile and the least deprived quintile in Havering by cause of death and gender“<28 days” means neonatal deaths (i.e. deaths under 28 days).Data source: Life Expectancy Segment Tool 2012-2014 (Published May 2016), Public Health England; Produced by Public Health Intelligence Long-Term ConditionsThere is an increasing number of Havering residents living with long-term conditions (LTCs). LTCs have a significant impact on daily lives including the use of urgent and emergency health and social care services. The current distribution of Havering CCG registered population by LTC count is presented in REF _Ref435026274 \h \* MERGEFORMAT Figure 14 and the impact the LTCs have on hospital usage (compared to those with no LTC) is shown in REF _Ref440498429 \h \* MERGEFORMAT Figure 15.Figure 14: Number and proportion of registered population by LTC count, Havering CCG, 2015/16Data source: Health Analytics; Produced by Public Health IntelligenceHavering CCG patients with five or more LTCs are 3 times more likely to attend A&E, 13 times more likely to be admitted for an emergency, and the average number of inpatient bed days will be 23 times greater compared to patients with no LTC. Figure 15: Ratio of patients with long-term conditions (LTCs) compared to patients with no long-term conditions (LTCs) for A&E attendances, Emergency Admissions and Inpatient Bed DaysData source: Health Analytics; Produced by Public Health IntelligenceMental IllnessMental illness encompasses a range of conditions such as depression, anxiety, psychoses and schizophrenia. Risk factors for the development of mental illness are multifactorial. However, physical illness, stress and alcohol and substance misuse are important risk factors. Mental illness is the third most important cause affecting the health of people in Havering, (cancers being the first, and heart disease & stroke the second). Up to a third of people with problems such as diabetes, heart disease and COPD are also affected by mental health problems.The prevalence of mental health problems in Havering (0.65%) is generally lower than both London (1.07%) and England (0.88%) but there is variation in how common it is across the wards in the borough. For example, the prevalence of depression ranges from 56.6 per 1000 persons aged 17 and over in Upminster to 113.0 per 1000 persons aged 17 and over in Gooshays (i.e. more generally more common with increasing deprivation) – see REF _Ref440540424 \h \* MERGEFORMAT Figure 16.Figure 16: Prevalence of depression in patients registered with GP in Havering CCG and resident in the London Borough of Havering, per 1,000 persons aged 17 years and over, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceFor more information on mental health in Havering, see the mental health JSNA at Dementia is more common in Havering than London and England ( REF _Ref478557581 \h \* MERGEFORMAT Figure 17) and it will be an increasing problem for Havering because of its ageing population. The care that people need is quite complex and expensive. Many people with dementia will also be living with other long-term conditions, as the risk factors for the main types of dementia are similar to those that result in conditions such as cardiovascular diseases (CVD) and diabetes. Figure 17: Prevalence of dementia in registered patient, all ages, London boroughs and England 2015/16Data source: Quality Outcomes Framework 2015/16 (published October 2016), Health and Social Care Information centre; Produced by Public Health IntelligenceDiabetesAbout 10% of the NHS budget is spent on patients with diabetes, 90% of whom have Type 2 or adult onset diabetes. The main risk factors are a diet rich in unrefined sugars, physical inactivity and being overweight or obese. The risk is increased in people from certain Black, Asian, and minority ethnic?(BAME) groups – South Asian and Afro-Caribbean backgrounds. In Havering, the number of people living with diabetes is on the increase. The prevalence of diabetes is lowest in Upminster (47.3 per 1000 persons aged 17 and over) and highest in South Hornchurch (70.1 persons aged 17 and over) – see REF _Ref400975848 \h \* MERGEFORMAT Figure 17.Figure 18: Prevalence of diabetes in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 17 and over, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceCancerIn Havering there are 30.8 people per 1000 persons living with Cancer. The prevalence of Cancer is lowest in Gooshays (19.1 per 1000 persons) and highest in Cranham (45.2 per 1000 persons) – see REF _Ref478574166 \h \* MERGEFORMAT Figure 19Figure 19: Prevalence of Cancer in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceCOPDIn Havering there are 17.3 people per 1000 persons living with Chronic Obstructive Pulmonary Disease (COPD). The prevalence of COPD is lowest in Squirrel’s Heath (12.1 per 1000 persons) and highest in Heaton (25 per 1000 persons) – see REF _Ref478574748 \h \* MERGEFORMAT Figure 20Figure 20: Prevalence of Chronic Obstructive Pulmonary Disease (COPD) in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons of all ages, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceHypertensionIn Havering there are 198.5 people per 1000 persons aged 30 and over living with Hypertension. The prevalence of Hypertension is lowest in Romford Town (158.7 per 1000 persons aged 30 and over) and highest in Heaton (221.1 per 1000 persons aged 30 and over) – see REF _Ref478576120 \h \* MERGEFORMAT Figure 21Figure 21: Prevalence of Hypertension in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceCHDIn Havering there are 41 people per 1000 persons aged 30 and over living with Coronary Heart Disease (CHD). The prevalence of CHD is lowest in Romford Town (32.7 per 1000 persons aged 30 and over) and highest in Heaton (46.8 per 1000 persons aged 30 and over) – see REF _Ref440459956 \h \* MERGEFORMAT Figure 22Figure 22: Prevalence of Coronary Heart Disease in patients registered with GP in Havering CCG and resident in London Borough of Havering per 1000 persons aged 30 and over, Census wards, as of February 2017Data source: Health Analytics (accessed February 2017); Produced by Public Health IntelligenceDisabilityChildren and adults with a learning disability are at increased risk of having or developing physical and mental health problems. In addition, they are 10 times more likely to have serious sight problems.Havering was estimated to have 906 adults with moderate or severe learning disability in 2016, of which about 300 are estimated to be living with a parent (see REF _Ref440369580 \h \* MERGEFORMAT Table 3). Additionally, about 1,681 people were estimated to have autistic spectrum disorders. Havering has a lower rate of people registered blind (205 per 100,000) compared to London and England.Table 3: Number of adults with learning disability in Havering, 20162016Age groups (years)18-2425-3435-4445-5455-6465-7475+TotalPeople predicted to have a moderate or severe learning disability1241781911841458445906People predicted to have a severe learning disability4150524134Not calculatedNot Calculated218People predicted to have autistic spectrum disorders2003243003392892291881,681People with learning disability predicted to be living with a parent8292744214Not calculatedNot Calculated304Data source: Projecting Adult Needs and Service Information (PANSI) and Projecting Older People Population Information (POPPI), 2016; Produced by Public Health IntelligenceFor more information on the key facts and figures on adult disabilities in Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at . The number of children with special educational needs and disabilities is growing year on year, averaging increases of between 40% and 60% in all groups between 2012 and 2015. These are particularly marked in respect of children with the most severe and complex needs where there are disproportionate growths, leading to pressures and shortfalls in relation to both mainstream and special school places. There is increasing demand for specialist help and schooling for children with autism (ASD) and for those with behavioural, emotional and social difficulties (BESD), including those with mental health issues. Whilst respective increases of 40% and 62% were seen in these two groups between 2012 and 2015, numbers for ASD in the primary school population are expected to double over a 5-year period (from 2015 to 2020). Numbers for the BESD primary school group are also expected to treble during this period, and these will add to the increases already in secondary schools. There are also increases in children with moderate learning difficulties and those with speech, language and communication needs. However, mainstream schools are increasingly making successful provision for these two categories. Autism and behaviour difficulties remain major issues, requiring significant help and resources for schools to meet these needs. REF _Ref479694874 \h \* MERGEFORMAT Figure 23: shows predicted growths in ASD and BESD growths by type of need and school over a 10 year period. For more information, see the “Strategy for Children and Young People with Special Educational Needs and Disabilities 2015-20”Figure 23: Projected numbers of children with statements of special educational needs by type and school in Havering, 2013/14 to 2023/24Data source: Strategy for Children and Young People with Special Educational Needs and Disabilities 2015-20; Produced by Public Health IntelligenceSpecific GroupsChildrenOverweight and obesity is an issue for children in Havering. They are likely to develop Type 2 Diabetes requiring long-term medical care. There are also mental health issues associated with being overweight and obese and living from an early age with a chronic medical condition. Havering has the lowest number of children going into care. Looked after children generally have greater mental and physical health care needs. In 2012/2013, screening test results for 95 children in care aged 5 to 16 showed that (56%) were at a high or borderline risk of clinically significant mental health problems.For more information, see the Children and Young People JSNA at PeopleOlder people are at increased risk of living with multiple long-term conditions; dementia; and experiencing falls.About 32% (13,449) of the population aged 65 years and above are living in one-person households. Almost half (48%) of all one person households in Havering are occupied by persons aged 65 years and over, which is the highest proportion in London. Older people living alone can be an indicator of social isolation and may require more support from health and social care services.Havering has one of the largest proportions of the population in the country with dementia and it is estimated that around half of people living with dementia are as yet undiagnosed. Refractive error and cataracts cause two thirds of sight loss in older people. However diabetes, smoking and hypertension increase the risk of developing sight loss due to macular degeneration. Working Age AdultsThis is the largest age group in Havering. This age group is more likely to experience serious mental health problems such as depression, schizophrenia and psychoses.The majority of people who misuse drugs and alcohol also fall into this age group.Ethnic Minority groupsA small proportion of the Havering population is from a BAME group (17% compared to 55% of London and 20% of England). Certain health problems are more common in BAME groups because of various reasons including diet and other lifestyle factors e.g. diabetes in South Asians; and sickle cell disease in Black Africans.For more information on the key facts and figures on ethnic minorities in Havering, see the JSNA products prefixed “This is Havering: a demographic and socioeconomic profile” at . How do local people use health and social care services?This section provides information on the use of health and care services by Havering residents. Children Social CareAs discussed in the “ REF _Ref443570016 \h \* MERGEFORMAT What will happen to the population of Havering?” section of this document (and “This is Havering: a demographic and socioeconomic profile”), the population of those aged 0-17 years in Havering is set to see huge increases in the coming years. Demand pressures have already been noticed across the Children Social Care Service, from Early Help and the front door – Multi Agency Safeguarding Hub (MASH) – through to the numbers of looked after children. Using data as at December 2015, the end of 2015/16 financial year activity figures for the service have been projected to show increased demand across board.Havering’s children centres saw a 7.5% increase in the number of individual people that attended them between 2013/14 and 2014/15 (12,236 to 13,148). Projected figures for 2015/16 indicate a 23% increase in children centre numbers to 16,148. There were 2,129 contacts received by the service in 2014/15 with 2015/16 projections set to exceed 3,000 indicating an over 40% increase in activity. This is continued throughout the service when looking at the number of Contacts progressing to an Early Help assessment which is also set to increase by 22% by the end of 2015/16 financial year (from 396 to 483).Referrals and AssessmentsIn 2013/14, Havering’s Children Social Care received 1,106 referrals to the service. In 2014/15, this had increased by 60% to 1,774. Projections for 2015/16 are in the region of 2,246 which would indicate a further 27% increase from the previous year. Linked to the increase seen in Referrals to the service, the number of assessments completed has also seen an increase. Between the years 2013/14 and 2014/15, a 6% (1,101 to 1,165) increase was seen with projections for 2015/16 set at 75% more than the previous year (2,039) – see REF _Ref440541876 \h \* MERGEFORMAT Figure 20.Figure 24: Count of children’s social care referrals and assessments in Havering, 2013/14 to 2015/16Data source: Children’s Social Care Case Management SystemChild and Young People on PlansBetween 2014 and 2016, there were 1952 plans in total across Children in Need, Child Protection Plan, Looked After Children. The spread of activity is shown in Figure 25.Figure 25: Distribution of plans across Children and Young people, 2014-2016Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceTable 4: Rate of children’s social care activity by type of plan per 1000 children aged under-18 years in Havering, 2016Children in NeedChild Protection PlanLooked After ChildRate per 1000 children6.96.04.6Count 344298231Figure 26: Rate of children’s social care activity by type of plan and Gender per 1000 children aged under 18 years, Havering 2014-2016Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceChildren In NeedThere were 344 children in need care plans as end of December 2016. This is a rate of 6.9 per 1000 children aged under-18. This has been on the increase from 2014 to 2016. Table 5: Count of children in need activity, Havering, 2014-2016AGEBANDGENDERMF2014-2016329337Under 1162001-04758305-099410210-14977115-184761Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceFigure 27: Population Pyramid of children in need activity, Havering, 2014-2016Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceChild ProtectionThere were 269 plans for Section 47’s (S47’s) – Child Protection Investigations as end of December 2016. This is a rate of 5.0 per 1000 children aged under-18. This has been an increase since 2014 (3.1 per 1000 children aged under 18) but a drop from the previous year (5.2 per 1000 children aged under-18). This is projected to reach 342 by 2017 – a rate of 5 per 1000 children aged under-18.Table SEQ Table \* ARABIC 5: Count of child protection activity, Havering, 2014-2016AgebandCountMF2014-2016335371Under 1343901-04808305-0910010210-14909915-183148Figure SEQ Figure \* ARABIC 25: Population Pyramid of child protection activity, Havering, 2014-2016Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceLooked After ChildrenThere were 196 plans for Looked After Children as end of December 2016. This is a rate of 3.6 per 1000 children aged under-18. The rate of activity for Looked After Children (LAC) has remained fairly consistent between 2014 and 2016. The consistency indicates that cases are being dealt with at an earlier stage (before crisis) which is better for families. (see REF _Ref440541901 \h \* MERGEFORMAT Figure 24). Table of count of looked after children activity, Havering, 2014-2016AgebandCountMFTotal298314Under 1222201-04435505-09644910-14939615-187692Population Pyramid of looked after children activity, Havering, 2014-2016Data source: Children’s Social Care Case Management System; Produced by Public Health IntelligenceFigure 24: Rate per 1000 children aged under 18 for Child in need plans, child protection plans and looked after children in Havering, 2014 to 2017Count201420152016Projected 2017Children In Need143202321400Child Protection163276269342Looked After Children187195196202Data source: Children’s Social Care Case Management System Adult Social Care People need care and support?for many reasons. This can be because of their?age, disability, health?or the personal situation they find themselves in. The introduction of the Care Act 2014, which puts people and their carers in control of their care and support, will change the pattern of use.As end of 2016, 7224 clients received adult social care support in Havering.Three quarters of cases were those aged 65 and over.The majority of the demand (98%) is driven by the following: physical disability (78%), learning disability (12%) and mental health (8%).Residential and Nursing Care In Havering, the rate of adults aged 18-64 years admitted to residential and nursing homes was 9.5 per 100,000 in 2014/15. This is lower compared to both London (11.1 per 100,000) and England (14.2 per 100,000). The rate of adults aged 65 and over admitted to residential and nursing homes (596.7 per 100,000 adults aged 65 and over) in Havering is higher compared to London (491.7) and lower compared to England (668.8). There are 39 care homes (21 residential and 18 nursing) in Havering with a total of 1,611 beds. Of these, Havering currently place a third of clients, the rest being self-funders, health placements, out of borough placements and vacancies. On average, adults with care needs were able to self-fund for 25 months before presenting to social care. Between April 2014 and March 2015, there were a total of 286 (including self-funders) new admissions into care homes with around 88% being over the age of 75. Over a third of these new admissions came directly from the local acute hospitals (Queens and King George’s), the remainder admitted from the community. Analysis last done in 2013-14 indicated that around 45% of care homes admissions from hospital were admitted as a result of a fall.From April 2014 to March 2015 there were, on average, 602 adults over the age of 65 (known to Adult Social Care) in a long stay placement at the end of each month, with a general increase in the number of adults with dementia, rather than physical frailty. The majority of clients that have physical and sensory disabilities (PSD) are unable to access local placements with the right level of specialist support; and as a result are placed outside of the borough.Home Care Over a 1,101 adults receive support in their homes; equating to about 11.3 hours per person per week; an increase from 10.7 in 13/14.Respite CareFor 2014/15, 266 clients used respite services totalling 638 separate episodes. There were:600 respite placements:452 as planned respite (for 155 clients)148 as emergency placements (for 105 clients)38 short stays (for 14 clients) which can sometimes be respite with no fixed end dates.Day Care ServicesThe use of day care services in Havering decreased from 232 per 100,000 people aged 18 and over in 2010/11 to 203 per 100,00 people aged 18 and over in 2013/14. This is lower when compared to London (268 per 100,000 population) and England (301 per 100,000 population). In 2014/15, there were on average 140 clients over the age of 65, using day services each week.ReablementThe aim of reablement is to support people after they have had a crisis, in order for them to remain as independent as possible. The majority of the demand for reablement, 80%, arises from the Joint Assessment and Discharge (JAD) team at the local acute trust; the remaining 20% from the community. Carers and Carers AllowanceAccording to the 2011 Census, 25,214 people, 11% of Havering’s residents identified themselves as carers, an increase by 8% from 23,253 in 2001. Twenty-three per cent (5,835) said they provided more than 50 hours of care per week.There are 2,330 claimants of Carers Allowance in the borough and in the past year, 1,936 carers had an assessment of their needs carried out by Adult Social Care. This represents 9% and 8%, respectively, of the number of carers identified in the 2011 census. REF _Ref440540929 \h \* MERGEFORMAT Figure 25 shows that in 2014-15 the majority of Havering carers supported a loved one with a physical or learning disability (see REF _Ref440540929 \h \* MERGEFORMAT Figure 22).Figure 25: Carers - Primary support reason of 'Cared For' person 2014-15Source: ASC Market Position Statement 2016; Produced by Public Health IntelligenceFor more information on adult social care in Havering, see the Adult Social Care Market Position Statement 2016.Health ServicesPrimary CareThe average number of patients registered with a Havering CCG practice per GP (Full Time Equivalent) is 2,073, which is lower than both London and England ( REF _Ref435006118 \h \* MERGEFORMAT Figure 23). The workload per GP will vary not only because of the number of registered patients but also the level of ill health amongst registered patients. GPs based in areas with higher levels of deprivation are also more likely to have increased demand for services.79% of patients stated their overall experience with their GP was good, similar to London (80%) - higher compared to London (60.3%) and lower compared to England (85%). Figure 26: Number of registered patients per GP, Havering Clinical Commissioning Group (HCCG) GP practices, Havering CCG, London average, England Average 2016Data source: NHS Digital (Numerator: number of patients registered at a GP Practice as at December 2016; and denominator: number of GPs (FTE) linked to a GP practice as at January 2017); Produced by Public Health IntelligenceAccident and Emergency (A&E) AttendancesIn 2013/14, there were 160,544 A&E attendances by people registered with a Havering CCG and resident in Havering. This equates to a rate of about 664 A&E attendances per 1,000 people. A breakdown of the rate of A&E attendances per 1,000 people (presented in REF _Ref435024102 \h \* MERGEFORMAT Figure 24) suggests that people living in the more deprived parts of the borough are more likely to use A&E services than those from least deprived areas in Havering.Figure 27: Rate of A&E attendances per 1,000 population registered with Havering CCG GP and resident in Havering, by LSOA, 2013/14Data source: Secondary Uses Services (SUS)Hospital AdmissionsThere were approximately 31,003 elective admissions to hospital by patients registered with a General Practice (GP) in Havering in 2014/15. This is a 1.5% increase since the previous year which is lower than the increase seen across both London and England, 6.0% and 2.8% respectively. In 2013/14, there were 34,993 elective and 20,906 emergency hospital admissions (spells) for Havering CCG-registered patients. The top 10 causes of admissions of elective and emergency admissions are displayed in REF _Ref435006169 \h \* MERGEFORMAT Figure 25. Only the top 5 causes of Elective Admissions and Emergency Admissions account for 63% and 64% respectively. Figure 28: Top 10 causes of admissions, by primary ICD-10 chapter, Havering CCG registered population, 2015/16Data source: Secondary Uses Services (SUS)Mental HealthEstimates suggest that about 3,275 children aged 0-16 years and resident in Havering have a mental health disorder sufficient to cause distress to the child or have a considerable impact on the child’s day-to-day life. Children and Mental Health Services (CAMHS) in Havering are provided by North East London Foundation Trust (NELFT). Over 2000 children received care in 2012/13 - the majority of whom had emotional problems. Of these children over 64% were between 11 and 17 years of age. Compared to both our statistical neighbour Bexley, and to England, Havering has a lower rate of admission for children with mental health disorders aged 0-17 years.See the mental health JSNA (at ) for information on service use by adults.Key documents for further informationBelow is a list of useful documents and resources for further information. Except otherwise stated, these are locally produced documents which can provide more detailed information on various sections of this document. Any of the documents noted as being in draft will be available online when published.This is Havering: a Demographic and Socioeconomic Profile (updated quarterly)Health and Wellbeing Strategy 2015-2018 Obesity JSNA 2016 (currently in draft)Obesity Strategy 2016 (currently in draft)Adult Social Care Market Position Statement 2016 (currently in draft)Strategy for Children and Young people with Special Educational Needs and Disabilities, 2015-2020 (currently in draft)Public Health Outcomes Framework – Havering profile (nationally produced)Adult Social Care Outcomes for Havering (nationally produced)NHS England and PHE’s Commissioning for Value document for NHS Havering CCG (nationally produced)Pharmaceutical Needs Assessment 2015Mental Health JSNA 2015Sexual Health JSNA 2015Drug and Alcohol JSNA 2014Children and Young People JSNA 2014 ................
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