TEES JSNA WEBSITE


Date: 15/12/2017

Tees JSNA

Welcome to the website for Joint Strategic Needs Assessment (JSNA) in the Tees area.  The website contains a JSNA for each of the four Tees areas: Hartlepool, Middlesbrough, Redcar & Cleveland and Stockton-on-Tees.

Content for each of the JSNAs is arranged into five themes, with detailed topic contented available within each theme, as follows:

People
  • Children
  • Transition years
  • Adults
  • Older people
Vulnerable Groups
  • Learning disabilities
  • Autism (content in learning disabilities topic for Middlesbrough and Stockton)
  • Physical disabilities
  • Sensory disabilities
  • Sexual violence victims
  • Domestic violence victims
  • Carers
  • End of life care
  • Ex-forces personnel
  • Migrants
  • Travellers
  • Offenders
Wider Determinants
  • Crime
  • Education
  • Employment
  • Environment
  • Housing
  • Poverty
  • Transport
Behaviour and Lifestyle
  • Alcohol misuse
  • Illicit drug use
  • Smoking
  • Diet and nutrition
  • Physical inactivity
  • Obesity
  • Sexual health
Illness and Death
  • Cancer
  • Circulatory diseases
  • Diabetes mellitus
  • Injuries
  • Mental health and behavioural disorders
  • Oral health
  • Respiratory diseases
  • Self-harm and suicide

Core data has also been uploaded for population age and sex structure, ethnicity, births, deaths, life expectancy and some ward-level population data.  There are some details regarding Mosaic in the Segmentation section.

Previous JSNAs for each partnership area can be found at www.teespublichealth.nhs.uk.



Hartlepool

This web site is important to you if you live or work in Hartlepool and care about health, quality of life and health and social care services for you, your family, friends and community. It will help to shape how we work with local people to secure a healthier future for us all. This is not about visiting your doctor or the local hospital or the services they provide for you. This website is about other factors which affect your health and well-being.

This Joint Strategic Needs Assessment (JSNA) summarises the efforts of many people through a range of different mechanisms to identify, define, and address the wider health and wellbeing needs of the people of Hartlepool. The work we do in partnership is guided by plans, strategies, and policies that have been developed after needs assessment, data analysis and research, and through consultation with professionals and residents across the area.

The purpose of this Joint Strategic Needs Assessment is to bring together in one place the information that this rich resource provides, backed up by a technical compilation of statistics, data, and analysis. This will enable the widest spectrum of partners to have the intelligence they need to ensure commissioning strategies work together for better provision of services for those areas of greatest need.

I hope you will find this resource useful.

Louise Wallace

Director of Public Health

Hartlepool Borough Council



Submenu Links


Executive Summary

Unmet needs and commissioning intentions arising from Hartlepool JSNA 2012-15

 



Steering Group


Core Strategies

Hartlepool Health and Wellbeing Strategy 2013-2018

NHS Hartlepool & Stockton-on-Tees Clinical Commissioning Group A Clear and Credible Plan for Commissioning Health Services 2012-2017

Director of Public Health Report 2013: Public health then & now 1973-2013

 



Population


Intelligence


Inequalities
Segmenting life expectancy by cause of death

Public Health England has developed a resource which provides information on the causes of death that are driving inequalities in life expectancy at local area level. Targeting the causes of death which contribute most to the life expectancy gap should have the biggest impact on reducing inequalities.

For males and females, the tool provides data tables and charts showing the breakdown of the life expectancy gap in 2012-14 for two comparisons:

  • The gap between the Local Authority as a whole and England as a whole.
  • The gap between the most deprived quintile and the least deprived quintile within the Local Authority.

 

The gap between Hartlepool and England
For men , about one-third of the gap between Hartlepool and England is caused by higher rates of cancer mortality, whereas for women, cancer mortality accounts for half of the gap.  Within the cancer category, lung cancer is the main contributor to the gap for men and women.  Circulatory and digestive diseases have a larger contribution to the gap for men than women, with respiratory diseases contributing similarly for both sexes.

Hartlepool inequality gaps with England cause of death scarf chart 2012-14

 

The gap within Hartlepool

For women, cancer forms the largest part of the gap between the most and least deprived communities in Hartlepool, whereas for men, circulatory diseases have the greatest contribution to the gap.  For males, external causes of death (such as suicide and accidents) have a much greater contribution to the gap between deprived and affluent communities in Hartlepool compared with females.

Hartlepool gap in cause of death most and least deprived, 2012-14

 

Full details, including number of deaths and numbers of excess deaths can be found in The Segment Tool: Key results for Hartlepool.

 

Premature mortality

Premature mortality, that is to say deaths before age 75 years, is a symptom of high disease burden as well as underlying health inequalities.  Know your numbers: premature mortality provides an analysis of the main causes of premature mortality in Tees Valley, and estimates how many premature deaths would need to be prevented to achieve rates similar to the North East and England.  In Hartlepool the greatest burden of premature mortality is due to cancer, followed by circulatory disease.

Hartlepool premature mortality rates and numbers

 



A to Z


People

Summary of Children, Transition Years, Adults and Older People topics in Hartlepool.

Content under development, see individual topic pages for details.



Children

Sir Michael Marmot’s review of health inequalities recommends that action in the early years is crucial to giving every child the best start in life to reduce health inequalities across the life course.  The foundations of many aspects of human development (including physical, intellectual and emotional) are laid in utero and in early childhood.

The importance of the health and wellbeing of children is well documented.  There is national recognition of the importance of health/behaviour during pregnancy and the early years of life, with significant emerging evidence related to neo-natal science.  In particular, the importance of early experiences, responsive parenting and secure attachment.

The following JSNA topics are the most significant factors that increase a child’s risk of poor life chances:

Wider determinants of health

Education

Children who achieve low educational attainment are likely to suffer from lower life chances.

Poverty

Growing up in poverty can affect every area of a child’s development and future life chances.  Children from low income households are less likely to achieve their academic potential, less likely to secure employment as adults, more likely to suffer from poor health, more likely to live in poor quality housing and they are more likely to reside in unsafe environments.

Behaviour and lifestyle

Alcohol misuse

Alcohol misuse during pregnancy poses a significant health risk to the unborn child.

Children living with parents who are dependent on alcohol are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse are at a higher risk of becoming alcohol abusers themselves.

Illicit drug use

Children living with parents who abuse drugs are more likely to suffer from emotional and educational neglect.

Children living in homes with adults who abuse drugs are at a higher risk of becoming drug abusers themselves.

Smoking

Smoking during pregnancy poses a significant health risk to both the mother and unborn child.

Parents who smoke around their children are significantly increasing their child’s risk of disease and ill-health.

Diet and nutrition

Breastfeeding gives a child the best start in life and is beneficial for the health of the mother.

Nutrition has a key role in the prevention and management of diet-related diseases (such as cardiovascular disease, cancer, diabetes and obesity).

Obesity

Obesity is one of the biggest risks to the health of the population. 

Obesity in children can lead to poor physical health (including increased risks for elevated blood pressure and Type 2 diabetes) and poor mental health (including low self-esteem, anxiety and depression).

Illness and death

Injuries

Injuries are a leading cause of death and illness of children and one of the most common reason for hospital admissions. 

Mental health

One-in-ten 5 to 15-year-olds has a mental health problem. Many continue to have mental health problems as adults.



What are the key issues?

Wider determinants of health

Education

A slightly lower proportion of children in Hartlepool (56%) achieve 5 A*-C GCSEs (including English and Maths) compared to the England average (58%).

Poverty

A higher proportion of children in Hartlepool (30%) are living in poverty compared to the England average (22%).

Behaviour and lifestyle

Alcohol misuse

A slightly lower proportion of adults receiving alcohol treatment in Hartlepool (30%) are in contact with their children compared with the England average (32%).

A higher proportion of dependent drinkers in Hartlepool (32%) are in treatment compared to the England average (13%).

Illicit drug use

Almost one-third (30%) of adults in treatment for substance misuse in Hartlepool have (or are living with) children.

Smoking

A higher proportion of adults in Hartlepool (22%) smoke regularly compared to the England average (21%).

A higher proportion of pregnant women in Hartlepool (23%) are smoking at the time of delivery compared to the England average (14%).

Diet and nutrition

A lower proportion of mothers in Hartlepool (46%) initiate breastfeeding compared to the England average (75%).

Obesity

A slightly higher proportion of reception age children (5-year-olds) in Hartlepool (9.9%) are obese compared to the England average (9.5%).

A higher proportion of children in year 6 (11-year-olds) in Hartlepool (24%) are obese compared to the England average (19%).

Illness and death

Injuries

A higher proportion of children (under 18-year-olds) in Hartlepool (152 per 10,000) are admitted to hospital due to injury than the England average (123 per 10,000).

Mental health

It is estimated that one-in-ten children have a mental health condition. Local data is not sufficient enough to provide evidence of the scale of the mental health problems among children in Hartlepool.

A higher proportion of adults in Hartlepool have certain mental health conditions than the England average.



What commissioning priorities are recommended?

Wider determinants of health

Education

Offer schools a more coherent package of school improvement measures. This can be done through a targeted, flexible and bespoke school improvement service level agreement (designed to meet the specific needs of individual schools).

Poverty

Tackle issues relating to employability and worklessness.

Behaviour & lifestyle

Alcohol misuse

Promote sensible drinking to reduce the harm caused by alcohol misuse.

Deliver a co-ordinated, stepped programme of treatment services that are effective, appropriate and accessible. The programme requires adequate capacity to meet demand and should be evidence based.

Illicit drug use

Improve the integrated substance misuse assessment, screening and core co-ordination.

Smoking

Develop service level agreements which require all health professionals (including staff from primary and secondary care, midwifery and mental health) to raise the issue of smoking through a brief intervention and refer to Stop Smoking Services for support.

Diet and nutrition

Implement evidence-based best practice to maximise breastfeeding initiation and continuation.  Ensure appropriate support services are in place and health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods.

Increase the promotion and uptake of the national ‘Healthy Start’ initiative (particularly vitamin supplements) to both professionals and the target group.

Obesity

Invest in the development and delivery of a children & young people’s weight management pathway/service.

Illness and death

Injuries

Ensure adequate resources are available for local partnerships and prevention strategies.

Mental health

Undertake a needs analysis of the emotional health and wellbeing of children and young people.



Who is at risk and why?

Wider determinants of health

Education

Children are at greater risk of low educational attainment if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses substances;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a poor school attendance record;
  • Suffer from poor mental health; and
  • Have a learning disability.

Poverty

Children are at greater risk of being subjected to the effects of poverty if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Live in a single parent family; and
  • Are a looked after child.

Behaviour and lifestyle

Alcohol misuse

Children are at greater risk of being subjected to alcohol misuse if they:

  • Live in a deprived area;
  • Have a family member who misuses alcohol;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family; and
  • Are a looked after child.

Illicit drug use

Children are at greater risk of being subjected to illicit drug use if they:

  • Live in a deprived area;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child (they are four times more likely to use illegal substances than children raised in a household); and
  • Are in contact with the criminal justice system.

Smoking

Children are at greater risk of being subjected to passive smoking if they:

  • Live in a deprived area;
  • Have a family member who is a smoker;
  • Have a family member who misuses alcohol;
  • Have a family member who uses illicit drugs;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment.
  • Live in a single parent family; and
  • Are a looked after child.

Diet and nutrition

Children are at greater risk of having a poor diet and poor nutrition if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth;
  • Have a learning disability; and
  • Are from a black or minority ethnic group.

Obesity

Children are at greater risk of being obese if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Are not breastfed at birth; and
  • Have a learning disability.

Illness and death

Injuries

Children are at greater risk of being injured if they:

  • Live in a deprived area;
  • Are under-5 years old (under 5-year-olds are more vulnerable to unintentional injuries in the home);
  • Are over-11 years old (11 to 18-year-olds are more vulnerable to unintentional injuries on the road);
  • Have a disability or impairment (physical or learning);
  • Are from a black or minority ethnic group;
  • Live in accommodation which potentially puts them more at risk (including multiple-occupied housing and social and privately rented housing); and
  • Are a 1 to 14-year-old boy (twice as likely to die of injuries than girls).

Mental health

Children are at greater risk of having poor mental health if they:

  • Live in a deprived area;
  • Face three or more stressful life events (three times more likely than other children to develop emotional and behavioural disorders);
  • Have stressful family situations;
  • Have a family member with poor mental health;
  • Live in rented accommodation;
  • Are in local authority or residential care;
  • Have a family member who has low educational attainment;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a learning disability;
  • Have a  physical disability; and
  • Have a serious or chronic illness.


What is the level of need in the population?

Summary of child health and well-being in Hartlepool.

Source: Child and Maternal Health Observatory - ChiMat

Wider determinants of health

Education

It is clear from the scatter chart below that the electoral wards in Tees with the least proportion of children who have five or more GCSEs graded A* to C, are those with higher proportions of children living in a workless household.

Children in workless households v GCSE results, Tees electoral wards, 2010

The chart below shows that in Hartlepool, the proportion of 5-year-olds described as “good” (in the early years foundation stage profile) compared with those who receive 5 or more GCSEs graded A* to C has been decreasing over the last six years, there has however been an increase in the last year.

Poverty

The bar chart below shows that Hartlepool has a higher percentage of children living in poverty than the England average.

The map below shows the percentage of children living in poverty for the electoral wards in Tees.

The wards with the highest proportion of children living in poverty in Hartlepool are Dyke House, Owton and Stranton.

Tees map to % Children living in poverty, borough rank, by ward, Tees, 2010

Behaviour and lifestyle

Alcohol misuse

Content under development

Illicit drug use

The bar chart below shows that Hartlepool is estimated to have a higher rate of opiate and/or crack cocaine users than the North East and England average.

Smoking

The chart below shows that the proportion of pregnant women in Hartlepool who are recorded as smoking at the time of delivery is reducing each year. However, the proportion still remains higher than the North East average and significantly higher than the England average.

Diet and nutrition

The chart below shows that the proportion of women in Hartlepool who are breastfeeding at 6-8 weeks has remained static each year. Moreover, the proportion still remains lower than the North East average and significantly lower than the England average.

Obesity

The chart below shows that the prevalence of obesity of reception (5-year-olds) children in Hartlepool is reducing each year for both males and females. In 2009/10, the prevalence of obesity for males was lower than the national average.

The chart below shows that the prevalence of obesity of year 6 (11-year-olds) children in Hartlepool is reducing each year both males and females. However, the proportion still remains higher than the England average.

Illness and death

Injuries

The chart below shows that Hartlepool is estimated to have a higher rate of hospital admissions due to falls (under 5-year-olds only) than the England average.

The chart below shows that the rate of hospital admissions due to injury (under 18-year-olds only) in Hartlepool is increasing each year. This rate remains much higher than the England average.

Mental health

The chart below shows that Hartlepool is estimated to have a lower rate of adults with depression than the England average. This information must be treated with caution as the awareness of people with depression is estimated to be greatly under-recorded.



What services are currently provided?

The local Family Information Service (FIS) provides a range of information on all services available to parents and also hold up-to-date details of local childcare and early years provision:

http://www.stockton.gov.uk/citizenservices/learning/fis/

Please refer to individual JSNA sections for topic specific services.



What is the projected level of need?

Wider determinants of health

Education

As a result of the updated OFSTED schedule of inspection, it is likely that there will be an increased number of Hartlepool schools judged to be ‘satisfactory - requires improvement’. These schools will require co-ordinated support packages in order to bring about strong and sustainable improvement within the 24 months stipulated by OFSTED.

Poverty

Behaviour and lifestyle

Alcohol misuse

Unable to identify the local projected levels of need.

Illicit drug use

It is difficult to project the level of need due to the complex nature of illicit drug use.

Smoking

Content under development.

Diet and nutrition

Obesity

Obesity prevalence is forecast to rise for both adults and children.  The trend has been upward for decades, and suggests that by 2030 41-48% of men and 35-43% of women could be obese. The most recent data suggests that the rise in obesity is levelling off.  However, more than one-quarter of adults are already obese and there is a serious and growing burden of obesity-related ill-health.

The Foresight report suggests an increase in the prevalence of obesity among people aged under 20 to around 15% by 2025.  The proportion of boys having a healthy BMI will be 45% while for girls only 30% will be in the healthy weight category (Government Office for Science , 2007).

Percentage of children predicted to be obese by age and sex, England, 2004 and 2025

Gender

Age

2004

2025

Boys

6-10

10%

21%

11-15

5%

11%

All under 20

8%

15%

Girls

6-10

10%

14%

11-15

11%

22%

All under 20

10%

15%

Source: Foresight report

 

For children, there is evidence from the last three to four years of HSE data that the increase in child obesity is slowing. This is also evident from the local NCMP data. Forecasts to 2020 show encouraging signs that the rising trend may be levelling out, suggesting that there will be considerably lower proportions of overweight and obese children and young people than previously estimated McPherson et al, 2011). While it is encouraging that the trend in child obesity is levelling off, and may reduce in the future, the forecast prevalence of obesity and overweight remains high.

Forecasts for overweight and obesity in children and young people in 2020, England

Gender

Age

Overweight

Obese

‘Foresight’ forecast 2007

McPherson forecast 2011

‘Foresight’ forecast 2007

McPherson forecast 2011

Boys

2-11

22%

17%

20%

13%

12-19

25%

18%

19%

6%

Girls

2-11

34%

17%

14%

10%

12-19

35%

29%

30%

9%

 

Illness and death

Injuries

Mental health

Unable to identify the local projected levels of need.



What needs might be unmet?

Wider determinants of health

Education

School-to-school improvement work is still in is infancy and will require careful strategic managing by a range of partners (including the LA, head teachers and the Hartlepool Teaching School Alliance), to ensure that it is able to successfully address issues detailed in the JSNA.

Not enough children are progressing as they should be in Maths and English.

Poverty

Content under development.

Behaviour and lifestyle

Alcohol misuse

More robust data is required in order to identify the number of children affected by parental alcohol misuse.

Illicit drug use

Further consultation is needed to understand service users’/provider’s needs in order to know what needs are unmet.

Smoking

Many women continue to smoke during pregnancy, thus failing to give their child the best start in life.

Diet and nutrition

There in a need to increase the capacity and training of health professionals who are able to support women with breastfeeding in the first two weeks after delivery (as Hartlepool has its greatest ‘drop off’ in the numbers of women breastfeeding).

Obesity

There is a need for a children’s weight management service in Hartlepool. As the number of obese children in Hartlepool increase the demand for this service will grow.

Illness and death

Injuries

Not all schools take up the offer of pedestrian and cycle training.  If all schools did respond to the offer, it is unlikely that the local authority would be able to have the capacity to deliver in all schools.

Mental health

Due to the lack of a robust mental health needs assessment for children and young people, it is difficult to assess what needs are unmet.



What evidence is there for effective intervention?

Wider determinants of health

Education

Fair Society Healthy Lives a review of health inequalities (2010); Sir Michael Marmot http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

Poverty

The foundation years: preventing poor children becoming poor adults (2010); Frank Field http://www.nfm.org.uk/news/77-family-policy/486-frank-field-final-indpendent-report-on-poverty-and-life-chances

Behaviour and lifestyle

Alcohol misuse

Preventing harmful drinking (PH 24) (2010) www.nice.org

Alcohol-use disorders (CG 100) (2010) www.nice.org

Illicit drugs

Drug Misuse: psychosocial interventions (CG 51) (2007) www.nice.org

Smoking

Quitting smoking in pregnancy and following childbirth (PH1) (2006) www.nice.org

School-based interventions to prevent smoking (PH23) (2010) www.nice.org

Preventing the uptake of smoking by children and young people (PH14) (2008) www.nice.org

Diet and nutrition

Breastfeeding:

Promotion of breastfeeding initiation and duration: evidence into practice briefing (2006) (NICE) www.nice.org

Maternal and child nutrition (PH 11) (2008) www.nice.org

Obesity

Weight management before, during and after pregnancy (PH 27) (2010) www.nice.org

Behaviour change at population, community and individual levels (PH6) (2007) www.nice.org

Obesity (PH 42) (2012) www.nice.org

Health Development Agency (2003) The management of Obesity and Overweight.  Evidence Briefing http://www.nice.org.uk/niceMedia/documents/obesity_evidence_briefing.pdf

Illness and death

Injuries

Strategies to prevent unintentional injuries (PH 29)  (2010) www.nice.org

Preventing unintentional injuries among under-15’s in the home (PH 30) (2010) www.nice.org

Preventing unintentional injuries among under-15’s: road design (PH31) (2010) www.nice.org

Mental health

Social and emotional wellbeing in primary education (PH 12) (2008) www.nice.org

Depression in children and young people (CG 28) (2005) www.nice.org



What do people say?

Wider determinants of health

Education

Approximately 50% of the children and young people surveyed said they worried about school work and exams (this was more common among girls than boys and more common among children in Year 10). Most young people were positive about school and the help and feedback they received (although this declined with age). (TellUs4 survey, 2010)

Poverty

A regional (North East) consultation with children (on poverty) identified a number of priorities highlighted in the JSNA poverty topic.

Behaviour and lifestyle

Alcohol misuse

More than half (51%) of children and young people said that they have never had an alcoholic drink. About two-fifths (42%) said that they had consumed an alcoholic drink and 7% did not wish to say. The majority of all children and young people surveyed had not been drunk in the previous four weeks (68%). (TellUs4 survey, 2010)

Viewpoint (2011) recorded that 63% of the people surveyed stated that better education and raising awareness of the dangers of alcohol misuse would help tackle alcohol-related problems in Hartlepool.

Illicit drug use

Content under development.

Smoking

Most children and young people said that they had never smoked (77%). The minority of children (10%) said that they had only tried smoking once and fewer children (4%) indicated that they had stopped smoking. (TellUs4 survey, 2010)

Diet and nutrition

Most children and young people had eaten fruit and vegetables the previous day (most commonly three or four pieces). (TellUs4 survey, 2010)

Health visitors in Hartlepool collected feedback from 844 women. Of those surveyed, 41% (348) initiated breastfeeding at birth and 14% (117) ceased breastfeeding before the health visitor’s primary visit.

Obesity

There has been some consultation work to develop the children’s weight management service. The results of this are not yet available.

Illness and death

Injuries

Content under development.

Mental health

  • The majority of children and young people said that they have one or more good friends;
  • The majority of children feel happy with life and have someone they can talk to;
  • Boys are more likely than girls to feel happy about life while girls are more likely to talk to their friends when worried than boys are;
  • Young people who said they were disabled are less likely to say they are happy;
  • The most common worries for children and young people are about education and their future;
  • Year 10 (11-year-olds) pupils are more likely to worry about exams than younger people;
  • Girls are more likely to worry about exams than boys. (TellUs4 survey, 2010)


What additional needs assessment is required?

Wider determinants of health

Education

No additional needs assessment is needed at present.

Poverty

Behaviour and lifestyle

Alcohol misuse

The Hartlepool Alcohol Action Plan ended in April 2013. An updated Plan for 2013/14 will be developed which will identify further needs assessment.

Illicit drug use

Undertake an in-depth analysis and review to determine best practice in prevention/treatment services.

Smoking

No further needs assessment required at this stage

Diet and nutrition

An analysis of the results of the CQUIN ‘maternity and health visiting antenatal contact pilot’ is required.

Obesity

Further work is needed to identify the views of children and families who will, potentially, use the new children’s weight management service.

Local data collection is needed to identify the prevalence of maternal obesity in Hartlepool.

Illness and death

Injuries

Detailed analysis of the reasons for admissions to hospital for injuries is required (particularly for those in the young age range and those admissions under 24 hours).

Mental health

A needs analysis of the emotional health and wellbeing of children and young people is required.



Key Contact

Name: Rachael Smith/Sally Robinson/Deborah Clark

Job Title:

e-mail: deborah.clark@hartlepool.gov.uk

phone: 01429 523397



Transition Years

The transition period for a young person is a time of continuous change as they grow, develop and mature.  Teenagers naturally grow in independence and need to try new things, take on responsibility, and be allowed to learn from their mistakes.  Through this process young people often question and test the assumptions, rules and boundaries that shape their lives at home, in education and in their communities.

The following issues are the most significant factors affect life changes of young people:

Wider determinants of health

Education

Young people with low educational attainment are likely to have fewer opportunities in life (e.g. employment).

Employment

Unemployed young people are more likely to suffer from poor health than those who are employed.

Behaviour and lifestyle

Alcohol misuse

Adolescence is a time that young people experiment and may become involved in risk-taking behaviours.  Alcohol misuse can lead to poor health. 

Illicit drug use

Adolescence is a time that young people experiment and may become involved in risk-taking behaviours.  Illicit drug use can lead to poor health. 

Smoking

Smoking is the leading cause of preventable death; almost all (90%) smokers start smoking during their teenage years.

Sexual health

The early onset of sexual activity can have a major impact on young people’s lives and can lead to teenage pregnancy and sexually transmitted infections.

Illness and death

Self-harm and suicide

Deliberate self-harm and suicide have disproportionately high rates among young people.

Mental health

One-in-ten young people have a diagnosable mental health problem. Many continue to have poor mental health as adults.



What are the key issues?

Wider determinants of health

Education and employment

A higher proportion of 16 to 18-year-olds in Hartlepool (7.7%) are not in education, employment or training (NEET) compared to the England average (5.8%).

Behaviour and lifestyle

Alcohol misuse

A higher proportion of under 18-year-olds in Hartlepool (76.9 per 100,000) are admitted to hospital due to alcohol-specific conditions than the England average (42.7 per 100,000).

Illicit drug use

A higher proportion of 15 to 24-year-olds in Hartlepool (120.5 per 100,000) are admitted to hospital due to substance misuse than the England average (75.2 per 100,000).

Smoking

In Hartlepool, almost 1-in-4 (24.7%) adults smoke regularly (approximately 18,000 people).

Sexual health

The teenage (15 to 17-year-olds) conception rate in Hartlepool (37.7 per 1,000) is higher than the England average (30.7 per 1,000).

A higher proportion of 15 to 24-year-olds in Hartlepool (47.5 per 1,000) have been diagnosed with a sexually transmitted infection (including chlamydia) than the England average (34.4 per 1,000).

Illness and death

Self-harm and suicide

A higher proportion of under 18-year-olds in Hartlepool (681 per 100,000) are admitted to hospital as a result of self-harm than the England average (346.3 per 100,000).

Mental health

A lower proportion of under 18-year-olds in Hartlepool (29.6 per 100,000) are admitted to hospital as a result of self-harm than the England average (87.6 per 100,000).



What commissioning priorities are recommended?

Behaviour and lifestyle

Smoking

Ensure that any stop smoking service developments take into account young people’s views and needs

Sexual health

Reduce teenage conceptions by targeting areas where there are high levels of teenage pregnancy.

Illness and death

Self-harm and suicide

Develop a comprehensive understanding of self-harm and suicide and further identify levels of unmet need (building on existing local research and evidence).

Mental health

Undertake a needs analysis of the emotional health and wellbeing of children and young people



Who is at risk and why?

Wider determinants of health

Education

Young people are at greater risk of low educational attainment if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a family member who has low educational attainment;
  • Have a poor attendance record;
  • Have a family member who misuses substances;
  • Suffer from a mental health condition;
  • Have a learning disability;
  • Misuse alcohol;
  • Use illicit drugs;
  • Smoke.

Employment

Young people are at greater risk of not gaining employment if they:

  • Live in a deprived area;
  • Have a family member who is unemployed;
  • Live in a single parent family;
  • Are a looked after child;
  • Have a family member who has low educational attainment;
  • Have a poor attendance record;
  • Have a family member who misuses substances;
  • Suffer from a mental health condition;
  • Have a learning disability;
  • Misuse alcohol;
  • Use illicit drugs;
  • Are homeless;
  • Are not in education, employment or training (NEET).

Behaviour and lifestyle

Alcohol misuse

Young people are at greater risk of misusing alcohol if they:

  • Live in a deprived area;
  • Have a family member who misuses alcohol;
  • Have friends that misuse alcohol;
  • Have a family member who is unemployed;
  • Live in a single parent family;
  • Are a looked after child;
  • Have low educational attainment;
  • Have a poor attendance record;
  • Have a family member who has low educational attainment;
  • Are homeless;
  • Are involved in prostitution;
  • Are a teenage mother;
  • Use illicit drugs;
  • Are not in education, employment or training (NEET).

Illicit drug use

Young people are at greater risk of using illicit drugs if they:

  • Live in a deprived area;
  • Have a family member who use illicit drugs;
  • Have friends that use illicit drugs;
  • Have a family member who is unemployed;
  • Live in a single parent family;
  • Are a looked after child;
  • Have low educational attainment;
  • Have a poor attendance record;
  • Have a family member who has low educational attainment;
  • Are homeless;
  • Are involved in prostitution;
  • Are a teenage mother;
  • Misuse alcohol;
  • Are not in education, employment or training (NEET).

Smoking

Young people are at greater risk of smoking if they:

  • Live in a deprived area;
  • Have a family member who smoke;
  • Have friends that smoke;
  • Have a family member who use illicit drugs;
  • Have a family member who is unemployed;
  • Live in a single parent family;
  • Are a looked after child;
  • Have low educational attainment;
  • Have a poor attendance record;
  • Have a family member who has low educational attainment;
  • Are homeless;
  • Are involved in prostitution;
  • Are a teenage mother;
  • Misuse alcohol;
  • Are not in education, employment or training (NEET).

Sexual health

Young people are at greater risk of a sexually transmitted infection (STI) if they:

  • Live in a deprived area;
  • Are of black or minority ethnicity (HIV);
  • Are aged between 16 to 24-years-old (STI);
  • Are a man who has sex with another man (HIV);
  • Have low educational attainment;
  • Have a poor attendance record;
  • Are not in education, employment or training (NEET);
  • Are sexually active at an early age;
  • Misuse alcohol;
  • Use illicit drugs;

Young people are at greater risk of a teenage conception if they:

  • Live in a deprived area;
  • Have low educational attainment;
  • Have a poor attendance record;
  • Are a looked after child;
  • Are not in education, employment or training (NEET);
  • Are sexually active at an early age;
  • Misuse alcohol;
  • Use illicit drugs;

Illness and death

Self-harm and suicide

Young people are at greater risk of self-harm and suicide if they:

  • Live in a deprived area;
  • Have a mental health condition;
  • Have a family member with a mental health condition;
  • Use illicit drugs;
  • Smoke;
  • Misuse alcohol;
  • Have stressful family situations;
  • Are a teenage parent;
  • Are a looked after child;
  • Are involved in the youth justice system;
  • Have a learning disability;
  • Have a  physical disabilities;
  • Have a serious or chronic illness.

Mental health

Young people are at greater risk of having a mental health condition if they:

  • Live in a deprived area;
  • Have stressful family situations;
  • Have a family member with a mental health condition;
  • Are in a single parent family;
  • Are a looked after child;
  • Have low educational attainment;
  • Have a family member who has low educational attainment;
  • Have a learning disability;
  • Have a  physical disabilities;
  • Have a serious or chronic illness;
  • Use illicit drugs;
  • Smoke;
  • Misuse alcohol;
  • Are a teenage mother;
  • Are involved in the youth justice system.


What is the level of need in the population?

Wider determinants of health

Education

Hartlepool has a higher rate of young people not in education, employment or training (NEET) than the England average (chart below).

Source: ChiMat - Child Health Profiles

Behaviour and lifestyle

Alcohol misuse

In Hartlepool, the proportion of under 18-year-olds admitted to hospital for an alcohol-specific has decreased over the last seven years but there has however been a year on year increase since 2008/09 (chart below).

Source: LAPE (http://www.lape.org.uk/atlas/index.html)

Illicit drug use

Hartlepool has a higher rate of substance use among young people than the England average (chart below).

Source: ChiMat - Child Health Profiles

Sexual health

In Hartlepool, the conception rate of under 18-year-olds decreased over the last ten years but the rate still remains significantly higher than the North East and England average.

Source: www.swpho.nhs.uk

Illness and death

Self-harm and suicide

Hartlepool has a higher rate of hospital admissions as a result of self-harm than the England average (chart below).

Source: ChiMat - Child Health Profiles

Mental health                  

Hartlepool has a lower rate of hospital admissions for a mental health condition than the North East and England average (chart below).

Source: ChiMat - Child Health Profiles



What services are currently provided?

Family Information & Support: 

http://hartlepool.fsd.org.uk/kb5/hartlepool/fsd/home.page



What is the projected level of need?

Wider determinants of health

Education

Behaviour and lifestyle

Alcohol misuse

Sexual health

Illness and death

Self-harm and suicide



What needs might be unmet?

Wider determinants of health

Smoking

As young people continue to take up smoking there is a continuing need to educate them about the harms of cigarettes and the benefits of not smoking.

Sexual health

Dedicated sexual health services for young people are required to meet their needs.

Illness and death

Self-harm and suicide

There is a need for a ‘service pathway’ for those in transition between child and adult services.

Mental health

Due to the lack of a robust mental health needs assessment for children and young people it is difficult to assess what needs are unmet.



What evidence is there for effective intervention?

Wider determinants of health

Education

Fair Society Healthy Lives a review of health inequalities (2010); Sir Michael Marmot http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review

The foundation years: preventing poor children becoming poor adults (2010); Frank Field http://www.nfm.org.uk/news/77-family-policy/486-frank-field-final-indpendent-report-on-poverty-and-life-chances

Employment

Neilson & O’Donnell (2012) approaches to supporting young people  not in education, employment or training a review http://www.nfer.ac.uk/nfer/publications/RSRN01/RSRN01.pdf

Behaviour and lifestyle

Alcohol misuse

Preventing harmful drinking (PH 24) (2010) www.nice.org

Alcohol-use disorders (CG 100) (2010) www.nice.org

School-based interventions on alcohol (PH7) (2007) www.nice.org

Illicit drug use

Drug Misuse: psychosocial interventions (CG 51) (2007) www.nice.org

Interventions to reduce substance misuse among vulnerable young people (PH4) (2007) www.nice.org

Smoking

School-based interventions to prevent smoking (PH23) (2010) www.nice.org

Preventing the uptake of smoking by children and young people (PH14) (2008) www.nice.org

Brief interventions and referral for smoking cessation (PH1) (2006) www.nice.org

Sexual health

Prevention of sexually transmitted infections and under 18 conceptions (PH7) (2007) www.nice.org

Long-acting reversible contraception (CG 30) (2005) www.nice.org

Illness and death

Self-harm and suicide

Self harm long term management (CG133) (2011) www.nice.org

Self harm (CG16) (2004) www.nice.org

Mental health

Depression in children and young people (CG28) (2005) www.nice.org

Social and emotional wellbeing in primary education (PH 20) (2009) www.nice.org



What do people say?

Wider determinants of health

Education

Most children and young people intend to embark on further study after Year 11 and to attend higher education. A notable minority are thinking about pursuing a work-based route (including apprenticeships).

Behaviour and lifestyle

Alcohol misuse

More than half (51%) of children and young people said that they have never had an alcoholic drink. About two-fifths (42%) said that they had consumed an alcoholic drink and 7% did not wish to say. The majority of all children and young people surveyed had not been drunk in the previous four weeks (68%).

Smoking

Most children and young people said that they had never smoked (77%). The minority of children (10%) said that they had only tried smoking once and fewer children (4%) indicated that they had stopped smoking.

Sexual health

The Added Power and Understanding in Sex education (APAUSE) questionnaire for children in year 11 (2010/11) showed that:

  • Boys answered 78% of questions correctly;
  • Girls answered 83% of questions correctly; 
  • 65% of girls viewed their sex and relationship education as ‘ok’; and
  • 75% of boys viewed their sex and relationship education as ‘ok’..

Illness and death

Self-harm and suicide

A study by Youthhealthtalks found that some young people felt that professionals (including hospital staff) were unsure how to handle self-harming or how to best help young people.



What additional needs assessment is required?

Behaviour and lifestyle

Alcohol misuse

More robust data is required to understand young people’s use of alcohol.

Illicit drugs

More robust data is required to understand young people’s access to illicit drugs.

Sexual health

Act on the results of the recently undertaken sexual health needs assessment.

Illness and death

Self-harm and suicide

There are hidden vulnerable groups where additional information is required.  These may include young carers and looked after children.

Mental health

Undertake a needs analysis of the emotional health and wellbeing of children and young people.



Key contact

Name: Ian Merritt/Neil Harrison

Job title:

e-mail: Ian.Merritt@hartlepool.gov.uk

Phone number:

 

References

Local strategies and plans

 

National strategies and plans

 

Other references

 



Older People

There is no one commonly accepted definition of ‘old age’ or older people. The National Service Framework for Older People (Department of Health, 2001) defined three groups of older people:

  • Those entering old age on completing paid employment and child-rearing (50-60 years);
  • Those in the transitional stage between healthy active life and frailty (70-80 years); and
  • Frail older people who are vulnerable because of health or social care needs.

In 2011, the average age at which the public defined the start of ‘old age’ was 59 (Age UK, 2011).

The Department of Work and Pensions (DWP) refers to people aged 60 and over as older people, but also includes people in their 50s as a period when many people take early retirement or prepare for retirement (DWP, 2005).
 



What are the key issues?

The number of older people in Hartlepool is estimated currently estimated at 15,700 but is expect to rise to 22,300 by 2030 (POPPI, 2013). The sharpest rise will be in people aged over 85 years where the numbers are expected to increase from 1,900 in 2012 to 5,300 in 2030. It is this age group that is the heaviest users of care and support services.

A growing number of older home-owners on low incomes live in poor and unsuitable housing and struggle to meet the cost of repairing and adapting their homes and manage energy costs and household finances. This is particularly true in the North East (Housing Association Charitable Trust, 2012).

 
 



What commissioning priorities are recommended?

2012/01
Promote and develop accessible information for older people
that is available in the right place at the right time.

2012/02
Ensure that the public transport needs of older people are taken into account
when planning all services.

2012/03
Provide clear information about housing options
.

2012/04
Develop and promote early intervention, reablement and preventative services
to maximise people’s opportunity to remain fit and well and living independently within the community for as long as they wish and are able to do so.

2012/05
Improve access to services for all individuals who have cognitive impairment, impaired mental health or dementia
.

2012/06
Improve efforts to inform older people of the local changes to public transport to hospital
and how to access them.

2012/07
Continue to promote help for carers
so they can continue in their caring role; be acknowledged as ‘expert’ partners in caring; and be acknowledged as individuals in their own right  with their own needs.

2012/08
Ensure that all planning and commissioning reflects a personalised approach
.

2012/09
Maximise the use of new technology
so that people can summon or receive help at home.

2012/10
Promote and commission training that reflects the changing ways that services are delivered
. The workforce needs to be fully aware and confident when working with new systems and be aware of different ways of working. This needs to include personal assistants who are directly employed by people to provide their care.

2012/11
Ensure that planned urgent care support services are able to respond flexibly
to needs that occur outside ‘traditional’ care and support plans.

 

 



Who is at risk and why?

Age
The prevalence of many conditions increases with age.  In the UK, 34% of people aged 65-74 and 48% of those aged 75+ have a limiting longstanding illness.  More than two-thirds (69%) of people aged 85 and over in the UK have a disability or limiting longstanding illness.

Particular health risks within this age group include:

About half of people aged 75 and over live alone.  Older people are more likely to live in residential and care homes than the general population.


Gender
In older populations the proportion of women increases markedly.

Socioeconomic status
In the UK, about one in seven pensioners lives in poverty.  About half of these live in severe poverty, with incomes less than half of the median.

Ethnicity
The proportion of older people from black and minority ethnic communities is smaller than the general population but growing.

There is a greater prevalence of some illnesses among specific groups of people. For example, there are increased rates of hypertension and stroke among African-Caribbeans and of diabetes among South Asians.

 



What is the level of need in the population?

An estimated 15,700 older people live in Hartlepool.

Older people, who make up 20% of the population, are users of a larger proportion of some key resources, such as up to 65% of hospital beds. Of those people, approximately one third may have some symptoms of dementia.

In Hartlepool, there are about 5,800 older people living alone, of whom 1,800 are men and 4,000 are women.

Hartlepool Council currently supports 18% of the older people.

In 2011 it was estimated that 8,500 people aged 65 years and over+ had a limiting long term illness (LLTI), 5,000 were estimated to need help with self-care and 6,000 were estimated to need help with domestic care.

However, only 2,650 were supported to live at home by the local authority and 500 older people were permanently living in residential or nursing care (Hartlepool Borough Council, 2013). This number can be broken down as:

  • 60 were in nursing care  for Older people with mental Illness / dementia
  • 150 were in residential care for Older people with mental Illness / dementia
  • 40 were in nursing care for frail older people
  • 250 were in residential care for frail Older People


Within Hartlepool, it was estimated in 2011 that:

  • more than half of the older people population (8,500) had life limiting long term illnesses.
  • 980 older people were estimated to have a dementia.
  • There were 1,310 older people with depression, with twice as many women as men having this condition.  Of these, 400 are predicted to have severe depression.
  • About 4,000 will have falls resulting in over 300 requiring hospital admission.
  • The prevalence of falls is higher for women in 65-79 age groups, but evens out as people reach 80 and 85+.
  • About 350 will have a long lasting health condition caused by stroke.  Men are disproportionately represented (62%).
  • About 750 will have a long standing health condition due to a heart attack.  Again men are disproportionately represented (55%) but the proportion is much higher for men aged 65-74 (70%).
  • About 5,000 older people are unable to carry out at least 1 self-care task.  Women disproportionately represented 3,550 or 72%.
  • 6,100 older people are unable to manage at least one domestic task on their own. Again women are disproportionately represented; 5085 or 69%.
  • 2,700 older people unable to manage at least 1 or more mobility activity on their own. Women are disproportionately represented 1,850 or 69%.

 

 

A comprehensive set of data is available through the Older People's Health and Wellbeing Atlas.
 



What services are currently provided?
Social care

Person-centred social care assessment: “personalisation” is well established, with 92% of people eligible for support having a ‘personal budget’.

Assistive technology /telecare: now considered part of mainstream services to maintain people’s independence in the community by use of simple but effective remote sensing and contact technology.

Domiciliary  care: in-house direct care and support team offering short-term rapid response home care and supporting telecare, carers emergency respite care; contracted area-based registered domiciliary providers and specialist niche providers.

Housing with Extra care: 5 schemes run by 2 organisations offering in excess of 500 potential accommodation units.

Day services: for older people, people with disabilities and people with mental health problems, both in traditional day centres and activity specific facilities.

Community support: for older people, people with disabilities and people with mental health problems to assist them to use community resources and avoid social isolation.

Intermediate care working closely with health colleagues to avoid unnecessary hospital admissions and enable rapid hospital discharge including home-based support and step-up/ step-down rehabilitation and transition care beds.

Reablement: the service assists people with poor physical or mental health to accommodate their illness (or condition) by learning or re-learning the skills necessary for daily living and increase their confidence. This is done by:

  • helping people ‘to do’ rather than ‘doing to or for’ people;
  • being outcome-focused with defined maximum duration;
  • recognising that assessment for ongoing care packages cannot be defined by a one-off assessment but requires observation over a defined period;
  • providing aids, equipment and adaptation to assist activities of daily living; and
  • using personal budgets including the use of ‘Direct Payments’ to enable people to manage their own care needs; often employing their own personal assistant.
Health

Primary care / GP interventions, including walk-in and out of hours support.

Community nursing: including ‘rapid response’ nursing service to assist hospital discharge and avoid hospital admissions; and ‘out of hours’ service.

Intermediate care working closely with social care colleagues to avoid unnecessary hospital admissions and enable rapid hospital discharge including home-based support and step-up/ step-down rehabilitation and transition care beds.

In-patient acute services: most support to older people in Hartlepool is provided by North Tees and Hartlepool Hospitals and South Tees Hospitals offering a full range of general hospital and sub-regional specialist services.

Community older people mental health services provided by Tees, Esk and Wear Valley NHS Foundation Trust, including support to primary care and nursing homes, memory clinic, secondary out-patient and in-patient services.

In-reach by mental health staff into acute hospitals to assist colleagues identify and adapt treatment for people with dementia and delirium.

Inpatient older people mental health services.

Falls service: multi-factorial assessment addresses risks with a high correlation of falls (Indicated in NICE 2004 guidance); appropriate intervention to modify risk and reduce incidence of further fall and consequential injury.  Core service includes physiotherapy, occupational therapy and preventative activity including supporting falls prevention activity, organised by the voluntary sector.

 
 



What is the projected level of need?

The number of older people in the borough is expected to rise from 15,700 to 22,300 by 2030 (POPPI, 2013). The sharpest rise will be in older people aged over 85 years where the numbers are expected to double to 2,900 by 2030. Increased age does not automatically mean that a person has a disability or illness but, proportionately, this age group has traditionally been the heaviest users of care, support and health services.

There are high levels of deprivation and ill health in Hartlepool. This is in part due to factors such as its heavy industrial past, historic and current high level of unemployment and a disproportionate impact of low income for older people. This means that a local health and lifestyle improvements gap remains.

It is predicted that by 2030 the number of people with life-limiting long-term illnesses will increase to 12,500 people, of whom 7,400 will need help with self-care, and 9,000 will need help with domestic tasks.  Using current levels of uptake, only a projected 3,800 will be supported by the local authority.

Levels of disability are high and are likely to remain so for the foreseeable future.  Within the population of Hartlepool it is estimated that by 2030:

  • 12,500 older people will have life limiting long term illnesses (more than half of the older people population).
  • 1,600 older people will have a dementia  an increase of 60% from 2011.
  • 1,900 older people with depression, with twice as many women as men having this condition.  Of these, 600 will have severe depression.
  • 5,900 will have falls resulting in 470 requiring hospital admission.
  • 540 will have a long-lasting health condition caused by stroke.  Men are disproportionately represented (62%).
  • 1,100 will have a long-standing health condition due to a heart attack.  Again men are disproportionately represented (58%) but the proportion is higher for men aged 65-74 (70%).
  • 2,750 will have diabetes.
  • 5,000 older people will be unable to carry out at least 1 self-care task.  Women disproportionately represented 3550 (72%).
  • 6,100 older people will be unable to manage at least one domestic task on their own.  Women are disproportionately represented 5,100 (83%).
  • 2,700 older people will be unable to manage at least 1 or more mobility activity on their own. Women are disproportionately represented 1,850 (69%).

The number of people with dementia in Hartlepool is set to increase from about 1,000 to 1,600 by 2030. This 60% increase in the number of people who suffer from dementia should be seen as a key priority for commissioning services and support.

At a time of increasing need it is likely that the number of people who are in a position to offer support as carers both professionally and  informally carers will not increase at the same rate.

Forecast growth in the number of  older people, Hartlepool, 2012 to 2030

 

2012

2015

2020

2025

2030

People aged 65-69

4,600

5,200

5,000

5,500

6,400

People aged 70-74

3,700

3,700

4,800

4,600

5,100

People aged 75-79

3,300

3,400

3,200

4,200

4,100

People aged 80-84

2,200

2,500

2,600

2,600

3,400

People aged 85-89

1,300

1,300

1,700

1,900

1,900

People aged 90 and over

600

600

800

1,100

1,400

Total population 65 & over

15,700

16,700

18,100

19,900

22,300

Population aged 65 and over

(as a proportion of the total population)

17.10%

18.00%

19.17%

20.82%

23.08%

Population aged 85 and over

(as a proportion of the total population)

2.07%

2.05%

2.65%

3.14%

3.42%

Total females 75 and over

27.39%

27.54%

26.52%

27.64%

27.36%

Total males 75 and over

63.05%

63.47%

62.99%

63.32%

63.23%

total aged 75 and over

46.50%

46.70%

45.30%

48.75%

48.44%

Source: POPPI

 

 



What needs might be unmet?

The number of people who fund their own care and support and who do not make contact with the local authority is difficult to ascertain.

If current funding arrangements continue there is a risk that people who fund their own care may in the future require local authority support. However, until government plans for reforms of support of personal care are clarified estimating the impact is problematic.

In 2011, it was estimated that 8,550 people aged 65 years and over were predicted to have a limiting long-term illness; 5,000 were estimated to need help with self-care and 6,100 were estimated to need help with domestic care. However, only 2,900 are supported by the local authority. Lack of access to appropriate information can have a considerable impact.

The level of unreported falls in older people is not clear.

There is likely to be a largely unknown group of older house owners with low income who do not have access to support to enable them to repair or adapt their homes to meet their changes needs as they age or become frailer.

The age profile of the social care workforce shows a greater proportion of older workers. Measures to attract new entrants, supported by flexible and modern working opportunities, are an important element in bringing more staff into the sector. It will also be crucial to ensure flexible working practices are fully utilised to maintain workforce capacity.

 



What evidence is there for effective intervention?

National Service Framework for Older People (Department of Health, 2001).

Under Pressure: Tackling the financial challenge for councils of an ageing population (Audit Commission, 2011).
The report outlines if care service costs simply increase in line with population change, they could nearly double by 2026.  Carers aged over 60 provide care worth twice public spending on care services for older people. The biggest single financial impact will be on social care spending.  There are big differences in care costs – some council spend three times more than the average per person on some services.  Small investments in services such as housing and leisure can reduce or delay care costs and improve wellbeing.

Preventive Social Care. Is it cost-effective? (King’s Fund, 2006).
There is little quantified information of the effectiveness of preventive services.  Available cost-effectiveness analyses are often small scale and not comparable with other studies.    It is often not clear quantitatively or qualitatively what element(s) of a reportedly successful service elsewhere have contributed to its success and could be potentially replicated.  “Measuring the effectiveness of community services (e.g. improved public transport) has seemingly proved too complex”.  Although the benefits are difficult to quantify, low level interventions provided informally, and by all sectors, are highly valued.

‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes (University of Birmingham, 2010).
This paper draws on Interlinks, an EU review of prevention and long term care in older people’s services across 14 European countries and ‘The case of adult social care reform - the wider social and economic benefits’ and finds evidence to invest in: Healthy life styles; Vaccination; Screening; Falls prevention; Adaptations/practical support; Telecare; Intermediate care; Re-ablement; Partnership working; and Personalisation.

Confident Communities, Brighter Futures - framework for developing wellbeing (Department of Health, 2010).
Age-related decline in mental wellbeing should not be viewed as an inevitable part of ageing.  The factors affecting mental health and wellbeing for older people are the same as in the general population.  To promote the wellbeing of older people: psychosocial interventions, high social support before and during adversity, prevention of social isolation, multi-agency response to prevent elder abuse, walking and physical activity programmes, learning, volunteering. To reduce prevalence of depression: early intervention, target prevention in high risk groups.  For dementia: exercise and anti-hypertensive treatment.

 



What do people say?
Findings from consultation with older people

There has been a succession of consultation events stemming back to the original Older person’s strategy in 2004 , the older people’s housing care and support strategy in 2007 and several town wide events to update the older people’s strategy action plan the latest of which was in 2011 and the draft town wide Housing Care and support strategy.

Several common themes occur throughout this work:

Information - often information existed but it was not easily accessible or appropriate, “signposting” was inadequate and individuals felt they often needed to chase the information, sometimes being referred to several organisations.

Transport - this can be problematic as public services have been cut and taxi rates are often varied, a dial-a-ride service has been discontinued; the recent the closure of the local hospital accident and emergency unit means people have to travel out of town and service transferring to other hospitals, coupled with a marked reduction in bus services.

Hospital - issues were:

  • hospital changes that required travel to North Tees or James Cook Hospitals or use the One Life Centre Minor Injuries Unit whose usage, purpose and function remains unclear to many of the public at large
  • lack of a clear, consistent and easy to understand discharge process which was felt to be necessary to ensures patients and carers are clear about the next steps including intermediate care, reablement, care at home and self-care.

Housing options - there is often not enough information provided or available for the various options. There remains no extra care housing for people with mild to moderate dementia. Also many older people live in large or unsuitable accommodation that no longer meet their requirements or needs.

Low level support - it was important to have assistance with jobs that they couldn’t manage by themselves. Many felt that without assistance they would either leave the job, wait until family or friends could help, if this was not an option they would attempt the job themselves (even if this was unsafe). The SAILS service that attempts to begin to address this is still only in its infancy and is not universally known.

Social isolation - addressing the needs of older lone adults and carers who may face social and family isolation which in turn affects health and wellbeing.

Engagement - widening engagement of older people in service planning, decision making and consultation.

 



What additional needs assessment is required?

Social isolation has been identified as an increasing factor in the lives of older people. Even where help is available, older people have been at best “living in two worlds” – a ‘service world’ and ‘ordinary life’. Most of their contact is with people who are either paid for providing a particular role or who have a formal volunteering relationship.  It is often their ‘ordinary life’ and their ordinary social networks that shrink – and their ‘care life’ or ‘support life’ with its ‘formal’ network that now dominates. Particular problems can arise for older people and their families when the service world starts to dominate and not support - or allow for – an ‘ordinary life’ to continue or restart.” (Bowers et al, 2007).  Personal budgets in social care are now established and personal health budgets are being piloted. If used creatively, these can attempt to link the two worlds but more work is needed to establish meaningful best practice that puts the older person in control.

Groups of older, vulnerable, home-owners have been identified who are in need and require appropriate forms of funding to maintain, repair or adapt their property. Hitherto, they have largely not been ‘on the radar’ in terms of policy development or identification of appropriate forms of funding. These vulnerable older home-owners are likely to need trusted sources of information, advice and support that are accessible. The suggested mechanism is for joined up delivery through Home Improvement Partnerships. This requires leadership, effective support infrastructures and the need for development or scaling up of available innovative affordable finance (Bowers et al, 2007). At present these structures and resources are not available locally.

Access by people with dementia or cognitive impairment to mainstream physical support and therapy remains problematic. The true size of the issue has been difficult to quantify. However, recent local developments such as those for dementia in acute hospital settings and the North Tees Dementia collaborative and North Tees and Hartlepool dementia strategy group will  be major players in addressing this.

 



Key Contacts

Name: To be advised

Job title:

e-mail: 

Phone number: 

References

Local strategies and plans

Hartlepool strategy for assistive technology 2010-2015; The way forward for Telecare and Tele-health, including Tele-monitoring and Telemedicine.

Hartlepool Older People Strategy 2004

Hartlepool Housing Care and Support Strategy 2012

 

National strategies and plans

Department of Health (2001). National Service Framework for Older people.

Department of Health (2009). Living well with dementia: A national dementia strategy.

Quality Indicators for Dementia (Quality Outcomes Framework (QOF))

Department of Health (2011) No Health without Mental Health: A cross-government mental health outcomes strategy for people of all ages.

 

Other references

Age UK (2011). A Snapshot of Ageism in the UK and across Europe.

Audit Commission (2011). Under Pressure: Tackling the financial challenge for councils of an ageing population .

Bowers, H; Bailey, G; Sanderson, H et al (2007). Person Centred Thinking with Older People: Practicalities and Possibilities.

Department of Health (2010). Confident Communities, Brighter Futures - framework for developing wellbeing.

Department of Work and Pensions (2005). Opportunity Age – Opportunity and security throughout life.

Housing Association Charitable Trust (2012).  Living well in retirement: An investment and delivery framework to enable low income older home-owners to repair, improve and adapt their homes.

King’s Fund (2006). Preventive Social Care. Is it cost effective?

POPPI (2013). Projecting Older People Population Information System.

Public Health England (2013). Older People's Health and Wellbeing Atlas.

University of Birmingham (2010). ‘The billion dollar question’: embedding prevention in older people’s services – 10 ‘high impact’ changes.

 



Vulnerable Groups
Introduction

Some people are more vulnerable to poor health than others.  This poor health may arise for a variety of reasons, including the effects of deprivation and difficulty accessing services.  The health needs of vulnerable groups are often complex and require a co-ordinated and flexible response from services. It is easy for clients to fall into the gaps between different services leading to unplanned care and the risk of clients revolving through the system.

This theme summary groups together the complex health needs of many vulnerable groups, some of which may overlap and others that are highly specific.


Learning disabilities and Autism

  • Ensure the availability of choice and cost-effective provision which meets needs locally.
  • Promote personalised systems which place the person at the heart of any process, provide information and advice, and stimulate universal access to all services.
  • Provide carers with the support required.

 

Physical disabilities and Sensory disabilities

  • Demand for community-based services is increasing, with increased requirement for supported living and reduced reliance upon residential care.
  • Promote personalised systems which place the person at the heart of any process, provide information and advice and stimulate universal access to all services.
  • The number of older people with a limiting long-term illness is expected to increase from about 9,500 in 2015 to 10,200 in 2020 and 11,300 in 2025.
  • The number of older people with moderate or severe visual impairment is expected to increase from about 1,500 in 2015 to 1,800 in 2025, a 22% increase.  There will be a similar increase in those with moderate or severe hearing impairment, from 7,000 to 8,600 between 2015 and 2025.

Domestic violence victims and Sexual violence victims

  • It is believed that many cases of both domestic and sexual violence are unreported.
  • The majority of known sexual violence victims are female and aged under 25 years.  Women are more likely to suffer domestic violence, particularly those aged under 30 years.
  • People from vulnerable groups (those with a physical disability, learning impairment and mental illness) are more likely to experience sexual violence, but may have difficulty verbalising their abuse.
  • There is a need for better data collection to enable improved analysis.

Carers and End of life care

  • There is a high number of carers who are unknown to carer support services.
  • Provide carers with the support required to enable them to continue their caring roles.
  • Remove the stigma surrounding death and dying.  Encourage healthcare professionals and people with end of life care needs, their families and carers to engage in open conversations.
  • Increase choice and personalisation within integrated, high quality services that meet the needs of people approaching the end of life.


Migrants and Travellers

  • Ensure migrants and travellers are aware of local health, care and education services and that these services are responsive to individual needs.

Ex-forces personnel

  • Provide adequate signposting to health and care services for armed service leavers.
  • Former forces personnel are more likely to need mental health care and rates of alcohol misuse are higher than for the general population.  This is particularly so for younger, male veterans who held lower ranks and were exposed to combat.
  • A small but significant proportion of veterans experience homelessness.

Offenders

  • Prisoners have high rates of: poor mental health; alcohol and substance misuse; smoking; suicide and attempted suicide; and learning disabilities.
  • There are high levels of educational need.  About half of male, sentenced prisoners were previously excluded from school compared with 2% in the general population.
  • Offenders have increased difficulty in accessing employment and housing, and tend to be socially isolated.
  • Re-offending rates are higher than average in Hartlepool.
Recommendations

The recommendations below relate to the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term (1-2 years)
1. Continue to develop personalised services and further improve access to universal services for vulnerable groups.
2. Improve data collection, in particular, identification of vulnerable members of society who are unknown to local services.

Medium-term (3-5 years)
1.  Increase the supply of housing which meets the needs of vulnerable groups.

Long-term (over 5 years)
1. Ensure that service capacity is sufficient for the anticipated increase in some of these vulnerable groups, particularly those with physical and sensory disabilities.

 

Summary author

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service

 



Learning disabilities

A learning disability affects the way a person learns new things in any area of life.  It affects the way they understand information and how they communicate.  Learning disability can be defined as:

  • the presence of a significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence, often defined as an IQ level of 70 or less), with;
  • a reduced ability to cope independently (impaired social functioning);
  • which started before adulthood, with a lasting effect on development.

People with a learning disability can have difficulty understanding new or complex information, learning new skills and coping independently.  A learning disability can be mild, moderate or severe. Some people with a mild learning disability can talk easily and look after themselves, but take a bit longer than usual to learn new skills. Others may not be able to communicate at all and may have more than one disability.

Adults with learning disabilities are one of the most vulnerable groups in society, experiencing health inequalities, social exclusion and stigmatisation.  In general, adults with learning disabilities have greater and more complex health needs than the general population, and often these needs are not identified or treated.  Life expectancy of this group is shorter than the general population.  Adults with learning disabilities often experience barriers to accessing healthcare services, and poor levels of care.  They are more likely to die from a preventable cause than the general population.  Health needs amongst adults with a learning disability are different to the general population.

There are about 1.5 million people in the UK with learning disabilities.

This topic is linked with:

 



What are the key issues?

‘Valuing People Now’ (DH, 2009a) aims to ensure that those groups who are least often heard and most often excluded have the same opportunities and responsibilities as other citizens and are treated with the same dignity and respect. These groups include:

  • people with more complex needs;
  • people from black and minority ethnic groups and newly arrived communities;
  • people with autistic spectrum conditions; and
  • offenders in custody and in the community.

The Hartlepool Learning Disability Partnership Board has the following priorities:

Health
Better health for people with learning disabilities is a key priority. There is clear evidence that most people with learning disabilities have poorer health than the rest of the population and are more likely to die at a younger age. Their access to the NHS is often poor and characterised by problems that undermine personalisation, dignity and safety.

Key issues for the NHS are to achieve full inclusion of people with learning disabilities in mainstream work to reduce health inequalities and to ensure high quality specialist health services, where these are needed.


Employment
This is seen as both a strength and challenge in Hartlepool. There are many organisations employing people with learning disabilities through supported employment, job coaching, tailoring a job so that it is suitable for a particular worker (also known as job carving) and more accessible job recruitment processes.  Employment, both paid and unpaid, should be seen as the default rather than attending traditional day services.

Housing
Many people with learning disabilities have no choice over where they live or with whom. More than half live with their families, and most of the remainder live in residential care.  People with a learning disability and their families should have choice about where and with whom they live, and have access to mainstream housing (DH, 2009a).  For this vision to become a reality, a choice of housing options needs to be available to all people with a learning disability. This should include properties in the private-rented sector and social housing, as well as giving people the option to buy their own home. Choice about housing for an individual should be based on good, person-centred planning to ensure it will suit their individual needs.

Carers
Carers are important to many people with learning disabilities.  About 11% of the population of the Hartlepool describe themselves as carers.  Hartlepool carers’ strategy (Hartlepool Borough Council, Carers Strategy 2011-2016) outlines the vision for carers in Hartlepool and the priority actions needed to support carers. Some of the priorities that the strategy will deliver include information and communication, access to health services, training and support to care and what is called ‘flexibility for a life of your own’.

Other matters include:

Advocacy – recognise the importance of ensuring the right level of support, information and advice and advocacy is available to people with learning disabilities.

Transport – knowing that people with learning disabilities are less likely to make journeys than non-disabled people because of transport difficulties.

Being safe in the community and at home – support the development and implementation of a Disability Hate Crime Strategy for Hartlepool, making sure the specific issues for people with learning disabilities are addressed. This recognises that the lives of people with learning disabilities are still constrained by experience of abuse and neglect. Many people do not feel safe in their local communities and have been victims of hate crime.

Personalisation – the commitment to give people more independence, choice and control through high quality and personalised services. This can be achieved by better  person-centred planning, advocacy and direct payments empowering people to shape their own lives and the support they receive by allowing them to use resources more flexibly.

 



What commissioning priorities are recommended?

2012/01 - remains a priority
Provide good quality healthcare that meets the needs of people with learning disabilities by:

  • Ensuring people with learning disabilities have a health action plan.
  • Providing annual health checks.
  • Training healthcare staff to understand the needs of people with learning disabilities.
  • Improving access to mainstream health services and mental health services.
  • Providing health improvement courses for people with learning disabilities.

2012/02 - remains a priority
Create employment opportunities for people with learning disabilities by:

  • Increasing employment options for people with a learning disability, including education, training and apprenticeships.
  • Working in partnership with key organisations.
  • Exploring new ways of creating employment opportunities for people with a learning disability.

2012/03 - remains a priority
Ensure the housing requirements of people with learning disabilities are identified and catered for by:

  • Increasing the range and types of housing available for people with learning disabilities.
  • Planning for the future needs of people with a learning disability – ensuring information on future need is captured.
  • Increasing the number of people with a learning disability in settled accommodation.

2012/04 - replaced by 2015/01
Provide carers with the integrated and personalised services they need to support them in their caring role.

2012/05 - replaced by 2015/02
Ensure advocacy is available to all people with learning disabilities.

2012/06 - replaced by 2015/03
Support people to maximise their independence and travel independently by increasing awareness of the “Safe on the move in Hartlepool” scheme.


2015/01
Provide carers with the integrated and personalised services they need to support them in their caring role
by:

  • Ensuring carers are aware of their rights in relation to changes in entitlements under the Care Act 2012.

2015/02
Ensure advocacy is available to all people with learning disabilities
by:

  • Supporting the development of a service that will be Care Act compliant.

2015/03
Support people to maximise their independence and travel independently
by:

  • Increasing awareness of the “Safe on the move in Hartlepool” scheme.

  



Who is at risk and why?

A learning disability happens when a person’s brain development is affected, either before they are born, during their birth or in early childhood. Several factors can affect brain development, including:

  • the mother becoming ill in pregnancy 
  • problems during the birth that stop enough oxygen getting to the brain
  • the unborn baby developing certain genes
  • the parents passing certain genes to the unborn baby that make having a learning disability more likely (known as inherited learning disability) 
  • illness, such as meningitis, or injury in early childhood.

Sometimes there is no known cause for a learning disability. (NHS Choices, 2011)

Age
In older age groups there tends to be more women than men with learning disability due to higher female life expectancy.

Children and young people with learning disabilities are six times more likely to have mental health problems than other young people.

Gender
Males are more likely than females to have a mild learning disability (ratio 1.2:1) and severe leaning disability (1.6:1) (Emerson et al, 2001)

Men with a learning disability are more likely to work for more than 30 hours per week than women.

Socioeconomic status
Mild learning disabilities are associated with parental social class and family instability, but no such relationship is reported for severe learning disabilities (Emerson et al, 2001).

Ethnicity
Prevalence rates for severe learning disabilities are higher in South Asian groups in the UK, with rates approximately three times higher among 5-34 year olds compared to non-Asian communities (Emerson et al 1997).

Consanguineous marriages (usually defined as being related as second cousins or closer) increase the risk of having a child with learning disabilities.  In the Pakistani community in Britain it is estimated that 50-60% of marriages are consanguineous.

Other risks
Compared with the general population, people with learning disabilities:

  • have a lower life expectancy;
  • are more likely to die from respiratory disease;
  • are less likely to receive regular health checks from their general practitioner;
  • are more likely to be admitted to hospital as an emergency (50% compared to 31% of admissions);
  • have higher rates of epilepsy, gastro-oesophageal reflux disorder, sensory impairments, osteoporosis, schizophrenia, dementia, dysphagia, dental disease, musculoskeletal problems and accidents;
  • find it more difficult to access health services;
  • are more likely to suffer abuse and neglect;
  • have lower rates of smoking and harmful alcohol consumption;
  • have higher levels of obesity, lower rates of physical activity and worse diets.

Less than 2% of the general population has a learning disability, but 7% of prisoners and 23% of young offenders have an IQ below 70.  About one-quarter of offenders have learning disabilities or difficulties that interfere with their ability to cope with the criminal justice system (Prison Reform Trust, 2012).

 



What is the level of need in the population?

In January 2011 there were nearly 350 children with learning disabilities known to schools in Hartlepool.  This rate is similar to the rate seen in England and lower than the North East average.

Children with learning disabilities known to schools, Tees, 2011

The number of clients (aged over 18 years) receiving services has increased from 300 in 2005/06 to 335 in 2011/12, a 12% increase over 7 years.  The rate of service provision in Hartlepool is above both England and the North East and is increasing more than national and regional rates (Source: NASCIS; RAP P1).

Clients with learning disabilities receiving services, Hartlepool, 2005/06 to 2011/12

The data on service provision provides an indication of what types of services have been provided.  In Hartlepool, a higher than average proportion of services are community-based.  The number of people receiving residential care services has tended to fall whereas nursing care and community-based services have increased (numbers are rounded to the nearest 5).

Clients with learning disabilities by service type, Hartlepool, 2008/09 to 2011/12

Estimates of the expected number of people with learning disabilities (Projecting Adult Needs and Service Information, PANSI) can be compared with numbers on general practice registers and those receiving services known to the local authority.  In Hartlepool, the number receiving services is similar to the expected number with moderate or severe learning disabilities.  It is likely that not all people identified will require services, but three-quarters of those estimated to have learning disabilities currently don’t receive services in Hartlepool.

Estimated and know rates of learning disability, Tees, 2010/11 and 2012

In Hartlepool, just under two-thirds of adults known to the local authority are in settled accommodation.  The accommodation status of one-quarter is unknown.

Accommodation and learning disabilities, Tees, 2010/11

The proportion of adults with learning disabilities who are in employment in Hartlepool is almost three times the rate seen nationally, and nearly twice the rate seen in Middlesbrough.  Only one-in-five adults with learning disabilities in Hartlepool are in paid employment.

Employment and learning disabilities, Tees, 2010/11

In Hartlepool, about 20 people with learning disabilities (rounded to nearest 5) were referred to safeguarding teams in 2010/11.  The rate of referral for abuse of people with learning disabilities in Hartlepool is significantly below the England rate.

Safeguarding and learning disabilities, Tees, 2010/11

A comprehensive profile of learning disabilities is available from the Learning Disabilities Observatory.  The following chart summarises the data available.

Learning disabilities profile, Hartlepool, 2012

 



What services are currently provided?

Hartlepool Job Centre Plus offers a service for disabled workers by putting them in touch with a Disability Employment Advisor (DEA) who will help people to find work or to gain new skills for a job. The DEA can help with work preparation, advocacy, recruitment, and confidence building. DEAs offer an employment assessment to find out what kind of work would best suit individuals.

Hartlepool Now provides information on services provided by Hartlepool Borough Council.  If age or disability makes it difficult for people to manage at home, they can learn about the wide range of equipment and adaptations which are available to help them carry out daily tasks. There is a wide range of equipment designed to help people stay living as independently as possible in their own home, supporting activities such as climbing the stairs, taking a bath, getting dressed or preparing meals.

Hartlepool Advocacy Service promotes social inclusion and equality by enabling people to express their personal views and needs to achieve their rights and entitlements through advocacy. They assist people in finding information and knowledge to enable them to make informed choices about the services they receive, promoting self-advocacy throughout their work.  The service works throughout Hartlepool with people aged over 18 who:

  • Have a physical, sensory or learning disability; or
  • Need support for their mental health; or
  • Are considered an ‘older person’; or
  • Have a caring responsibility.

Hartlepool Learning Disability Partnership Board reports to the Health and Wellbeing Partnership.  It meets on alternate months and aims to improve the lives of people with learning disabilities, their families and carers.  It is envisaged they will report to the Health & Wellbeing Board.

Hartlepool Centre for Independent Living is home to voluntary and community sector organisations offering advice, information, advocacy and practical help for those living with a disability.  It includes:

  • Hartlepool day services which incorporates two day services and is provided at a number of locations in Hartlepool. These services are currently provided from Monday to Friday.  The vision for day services is based on the four key principles identified in Valuing People (DH, 2001): Rights, Independence, Choice and Inclusion.  The day service aims to include people in all aspects of community life, developing skills, building social networks and gaining experiences which lead to fulfilling and rewarding lives (employment, education, leisure, arts and drama).
  • For people with more complex and physical health care needs, therapy-based services are available, including physiotherapy, speech therapy and other sensory programmes. The service can be accessed following a community care assessment of need by a social worker or community nursing health professional in learning disability services. Increasingly, service users are choosing to use an individualised budget to purchase their own support to meet their needs.

 



What is the projected level of need?

The number of adults forecast to have a learning disability is set to increase from 2012 by 2.5% in 2020 and by 5.5% in 2030.  The number of working age adults with a moderate or severe learning disability is forecast to remain stable.  However, there is likely to be a rapid increase in people aged over 65 with moderate or severe learning disabilities.

Forecast change in the number of people with learning disabilities, Hartlepool, 2012 to 2030

Forecast number of people with learning disabilities, Hartlepool, 2012 to 2030

 



What needs might be unmet?

Mental health of people with learning disabilities
People with learning disabilities and their families tell us that they do not get support to think or talk about mental health problems in the same way that they get increasingly with physical health. If a mental health problem occurs, for whatever reason, it is more likely to be attributed to their learning disability (diagnostic overshadowing) or classed as challenging behaviour.

Autism

  • Many people with autism also have a learning disability. 
  • People with autism spectrum condition (ASC) falling between LD/MH services.
  • Problems in transition planning for young people with autism.
  • A lack of community acceptance for people with ASC.

Service uptake within specific ethnic groups
The 2005 Equality Impact Assessment identified lower levels of service uptake within certain Black and Minority Ethnic communities. This needs to be investigated further to clarify whether adequate care is being provided from alternative sources and/or whether the development of additional council services is justified.

Enablement
Research carried out by the Care Services Efficiency Delivery team (CSED) highlighted a gap in the current provision of ‘enablement services' for people aged under 65. The specific client groups affected include learning disabilities, physical impairment, and social inclusion care management. Further investigation will be undertaken to see how this can be solved.

Transport
An issue raised frequently by people attending local consultation groups is transport.  It was noted that “many service users find regular transport to be a problem due their disabilities or deteriorating conditions”. Taxis were seen as very expensive and often unable to provide wheelchair access.

 



What evidence is there for effective intervention?

NICE guidance

Autism in children and young people (CG128)

Autism in adults (CG142)

 

Valuing People (DH, 2001) set out the Government’s commitment to improving the life chances of people with learning disabilities, through close partnership working to enable people with learning disabilities to live full and active lives.

Valuing People Now (DH, 2009a) retained the principle outlined in Valuing People that people with learning disabilities are people first, and re-emphasised the need for agencies to work together to achieve the best outcomes for people with learning disabilities.

Death by Indifference (MENCAP, 2007) detailed six cases believed to demonstrate institutional discrimination towards people with learning disabilities within the NHS, leading to shortcomings in care received that ultimately resulted in the death of the patients.

Healthcare for all (DH, 2008), the report of the Independent Inquiry into ‘Death by Indifference’ (MENCAP, 2007) concluded that people with learning disabilities appear to receive less effective care than they are entitled to, with evidence of a significant level of avoidable suffering and a high likelihood that deaths are occurring that could be avoided.  A total of 10 recommendations were made, all of which were accepted by the Department of Health in Valuing People Now (DH, 2009a).

Six Lives (Parliamentary and Health Service Ombudsman, 2009), considered the cases in ‘Death by Indifference’ highlighted some significant and distressing failures in health and social care services, leading to situations where people with learning disabilities experienced prolonged suffering and inappropriate care.  The report required all NHS and social care organisations to review:

  1. the effectiveness of local systems to enable understanding and planning to meet the needs of people with learning disabilities 
  2. the capacity and capability of services to meet the complex needs of people with learning disabilities. 

 

The Six Lives progress report (DH, 2010a) looks at the progress made by NHS and social care organisations in implementing the recommendations of the ‘Six Lives’ report.

The Mansell Report (DH, 2010b) highlights the most important parts of planning and delivering support for people with the most complex needs.

Valuing Employment Now (DH, 2009b) sets out the government’s strategy to improve employment opportunities for people with learning disabilities.

Equal access? A practical guide for the NHS: creating a Single Equality Scheme that includes improving access for people with learning disabilities (DH, 2009c) is a guide that supports the NHS to include people with learning disabilities in their equality schemes, with practical examples of reasonable adjustments to achieve equality of access.

World Class Commissioning for the health and wellbeing of people with learning disabilities (DH, 2009d) supports commissioners to meet the needs of people with learning disabilities, and ensure they are fulfilling their duty to promote equality.

Raising our sights: services for adults with profound intellectual and multiple disabilities (DH, 2010b) highlights the most important parts of planning and delivering support for people with the most complex needs.

The Learning Disability Observatory was established in 2010 and aims to provide better, easier to understand information on the health and wellbeing of people with learning disabilities.  By collecting information across England, it will help health and social care commissioners and providers to understand better the needs of people with learning disabilities, and their families and carers. The Observatory examines the data of the national learning disability self-assessment framework (LDSAF).

 



What do people say?

The Learning Disability Partnership Board consults using various methods and engages with people with learning disabilities, their families and carers. These include:

  • Adult Social Care Survey (PSS).
  • Service User Experience Surveys.
  • Service User Focus Group.
  • Voice for You Group -Self Advocacy group.
  • Making it Happen Hartlepool – Partners in Policy Making.
  • Working Together for Change – Person Centred review methodology.

These consultations have found that:

  • 65% of service users are extremely or very satisfied with the care and support services they receive (PSS).
  • 51% of people with learning difficulties said that their life was really great, 35% said that life was mostly good, 13% said that their life was OK (PSS).
  • 13% of service users wanted more control over their daily life (PSS).
  • 33% of service users said that they do some of the things they value and enjoy with their time but not enough (PSS).
  • However, there is more and more evidence that people want more choice over what they do with their personal budgets.
  • The Learning Disability Partnership Board said that the priorities should be housing, health, employment and the needs of carers. Appropriate Advocacy support was also highlighted as an integral part of these themes.
  • Hartlepool Council reviewed day opportunities.  They engaged with a number of people and organisations and had the support of external consultants in using a process called ‘Working together for change’ (WTfC) is an approach used to engage with people using services to review their experiences and determine priorities for change.  The second step of the WTfC process is about collecting the person-centred data from individual support plans or person-centred reviews that will drive the process. The key information needed is person-centred statements in people’s own words about what is working in their life, what is not working so well and what is most important to them for the future. People are then asked to prioritise the two most important things to them in each category, i.e. the top two things that are working, the  top two that are not working and the top two most important things to change for the future.

 



What additional needs assessment is required?

Whilst there is evidence to suggest that the number of people with a Learning Disability and individual budget is rising, it is not known what services are being purchased and whether such services are improving the lives of disabled people. 

The provision of such data would improve the identification of significant trends and variation in service usage by ethnic group.

 



Key Contacts

Name: Neil Harrison

Job Title: Head of Service – Hartlepool Borough Council

e-mail: neil.harrison_1@hartlepool.gov.uk

phone:01429 523913

 

Name: Donna Owens

Job Title:

e-mail: donna.owens@nhs.net

Phone: 0191-374-4168

 

References

National strategies and plans

Department of Health (2001). Valuing People: a new strategy for learning disability for the 21st century.

Department of Health (2009a). Valuing people now: a new three-year strategy for people with learning disabilities.

 

Local strategies and plans

Hartlepool Borough Council (2011). Who cares for carers? A multi-agency strategy for carers in Hartlepool 2011-2016.

 

Other references

Brugha T, Cooper SA, McManus S et al (2012). Estimating the Prevalence of Autism Spectrum Conditions in Adults.

Department of Health (2008). Healthcare for all: report of the independent inquiry into access to healthcare for people with learning disabilities.

Department of Health (2009b). Valuing employment now - real jobs for people with learning disabilities.

Department of Health (2009c). Equal access? A practical guide for the NHS: creating a Single Equality Scheme that includes improving access for people with learning disabilities.

Department of Health (2009d). World class commissioning for the health and wellbeing of people with learning disabilities.

Department of Health (2010a). ‘Six lives’ progress report.

Department of Health (2010b). Raising our sights: services for adults with profound intellectual and multiple disabilities.

Emerson, E and Hatton, C (2004). Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England.

Health and Social Care Information Centre (2009). Autism Spectrum Disorders in adults living in households throughout England: The Report from the Adult Psychiatric Morbidity Survey 2007

Learning Disabilities Observatory. http://www.improvinghealthandlives.org.uk/

MENCAP (2007). Death by indifference.

MENCAP (2012). Death by indifference: 74 deaths and counting.

NHS Choices (2011). What is a learning disability?

NHS Information Centre (2010). Access to healthcare for people with learning disabilities.

NICE (2011). Autism in children and young people.

NICE (2012). Autism in adults.

Parliamentary and Health Service Ombudsman (2009). Six Lives: the provision of public services to people with learning disabilities.

Prison Reform Trust (2012). Bromley Briefings Prison Factfile: November 2012.

Public Health England (2015). The determinants of health inequities experienced by children with learning disabilities.

 



Autism

Autism is a lifelong development disability that affects how a person communicates with, and relates to other people.  It also affects how they make sense of the world around them.

Autism is a spectrum condition which means that, while all people with autism share certain difficulties their condition will affect them in different ways.  Some people with autism are able to live relatively independent lives but others may have accompanying learning disabilities and need a lifetime of specialist support.

Types of autistic spectrum disorders (ASD)
There are three different types of ASDs:

1. Autistic disorder (also called "classic" autism)
This is what most people think of when hearing the word ‘autism’.  People with autistic disorder usually have significant language delays, social and communication challenges, and unusual behaviours and interests.  Many people with autistic disorder also have intellectual disability.

2. Asperger syndrome
People with Asperger syndrome usually have some milder symptoms of autistic disorder. They might have social challenges and unusual behaviours and interests. However, they typically do not have problems with language or intellectual disability.

3. Pervasive developmental disorder – not otherwise specified (PDD-NOS – also called "atypical autism")
People who meet some of the criteria for autistic disorder or Asperger syndrome, but not all, may be diagnosed with PDD-NOS. People with PDD-NOS usually have fewer and milder symptoms than those with autistic disorder. The symptoms might cause only social and communication challenges.

Signs and symptoms
ASDs begin before the age of 3 and last throughout a person's life, although symptoms may improve over time.  Some children with an ASD show hints of future problems within the first few months of life. In others, symptoms might not show up until 24 months or later.  Some children with an ASD seem to develop normally until around 18 to 24 months of age and then they stop gaining new skills, or they lose the skills they once had.

A person with an ASD might:
not respond to their name by 12 months
not point at objects to show interest (‘point at an airplane flying over’) by 14 months
not play "pretend" games (pretend to ‘feed’ a doll) by 18 months
avoid eye contact and want to be alone
have trouble understanding other people's feelings or talking about their own feelings
have delayed speech and language skills
repeat words or phrases over and over (echolalia)
give unrelated answers to questions
get upset by minor changes
have obsessive interests
flap their hands, rock their body, or spin in circles
have unusual reactions to the way things sound, smell, taste, look, or feel.

This topic is most closely associated with

 



What are the key issues?

The Autism Act 2009  places two key duties on the Government:
1. To produce a strategy for adults with autism; and
2. To publish statutory guidance by December 2010

The Strategy focuses on five things:
1. Making sure that more people understand about autism
2. Making it easier for adults to get a diagnosis of autism
3. Ensuring adults with autism can choose how they live, and get the help they need to do this.
4. Helping adults with autism to find jobs
5. Helping local councils and health services to write plans so that adults with autism who live in their area get the help they need.

The legislation and initial strategic planning in Teesside has identified the following priorities that have been incorporated into local action plans:
1. Training for front line staff in health & social care;
2. Identification of people with autism;
3. Provision of diagnostic and assessment services for people who may be autistic;
4. Planning for adult services;
5. Engaging parents and carers in the development of services for people with autism; and
6. Engaging people with autism in the development of services.

The outcome of the project to develop a Tees Autism Strategy will give clearer definition to the local needs.


Think Autism: updating the 2010 adult autism strategy

Identified 15 things to make things better for people with Autism:

An equal part of my local community
1. I want to be accepted and people to understand my condition
2. I want to be able to change things that matter to me
3. I want to know what is going on locally
4. If I need a service I would like people to make some adjustments
5. I want to feel safe in my community
6. I want to be seen as me

The right support at the right time during my lifetime
7. I don’t want to have to wait a long time for people to diagnose me
8. I want autism to be included in local strategic needs assessments
9. I want staff in health and social care services to understand that I have autism
10. I want to be supported through big life changes
11. I want somewhere my family can go to get help if they need it 
12. I want people to recognise my autism and adapt the support they give
13. If I break the law, I want the criminal justice system to think about autism

Developing my skills and independence and working to the best of my ability
14. I want the same opportunities as everyone else
15. I want support to get a job and support to help me keep it.


Think Autism – innovation fund

There are three key areas in this update and a focus to deliver change:

  • People with autism to really be included as part of the community.
  • Promote innovative local ideas, models which will support early intervention or crisis prevention
  • A focus on how advice and information can be joined up better for people

The government has made available £4.5 million to support the delivery of some of the key themes through a time limited Autism Innovation Fund to help drive creative and cost effective solutions.  There are four areas, aligned with the priority challenges in the report, where proposals will beinvited:

  • Advice and information;
  • Gaining and growing skills for independence;
  • Early intervention and crisis prevention; and
  • Employment, particularly involving the use of apprenticeships.

Proposals need to demonstrate the following core characteristics:

  • Involvement of people with autism;
  • Innovation, including either technology or innovative service design or provision;
  • Partnership: an integrated approach to local services and/or partnership with local businesses, employers or other services.

 



What commissioning priorities are recommended?

2012/01 - remains a priority
Improve access to good housing by developing schemes for people with autistic spectrum disorders.

2012/02 - remains a priority
Provide specialist employer support services to improve access to employment for people with autistic spectrum disorders.

2012/03 - replaced by 2015/01
Implement a specialist advocacy service for people with autistic spectrum disorders, and explore NAS accreditation.

2012/04 - replaced by 2015/02
Implement guidance contained within the Autism Act 2009 to meet the needs of people with autistic spectrum disorders.


2015/01
Implement a specialist advocacy service for people with autistic spectrum disorders
, and explore NAS accreditation.

2015/02
Implement guidance contained within the Autism Act 2009, and Think Family
to meet the needs of people with autistic spectrum disorders.

 



Who is at risk and why?

Approximately 1% of the population are estimated to be on the Autistic Spectrum.

Age
Autistic spectrum disorders (ASDs) are lifelong conditions commonly diagnosed in early childhood.  There is no change in risk with age.

Gender
Five times as many males as females are diagnosed with autism.  The proportion of males as opposed to females diagnosed with autism varies across studies, but always shows a greater proportion of males. Fombonne at al (2011) found a mean of 5.5 males to 1 female.


Socioeconomic status
ASDs occur in all socioeconomic groups.

Ethnicity
ASDs occur in all ethnic groups.

Genetic and familial predisposition
Most scientists agree that genes are one of the risk factors that can make a person more likely to develop an ASD.   Children who have a sibling or parent with an ASD are at a higher risk of also having an ASD.   ASDs tend to occur more often in people who have certain genetic or chromosomal conditions. About 10% of children with ASDs also have been identified as having Down syndrome, fragile X syndrome or other genetic and chromosomal disorders.

Autism and learning disability
Between 44% and 52% of people with autism may have a learning disability.  Research findings on the proportion of people with autism spectrum disorders who also have learning disabilities (IQ less than 70) vary considerably as they are affected by the method of case finding and the sample size.

Around one-third of people with a learning disability may also have autism.

 



What is the level of need in the population?

By applying the 1% national prevalence estimate to Hartlepool’s population, one would expect to find about 920 people with an autistic spectrum disorder.  This might include approximately 220 children and 700 adults.

Hartlepool’s Autism self-assessment 2011 identified 134 Adults with autism (including Asperger syndrome).

The Department for Education’s analysis of children with special educational needs (2015) found 64 primary school children and 50 secondary school children in Hartlepool with ASDs attending state-funded schools with a statement of special educational needs or at ‘school action plus’.  An additional 31 children with ASDs attended special schools.

 



What services are currently provided?

Diagnosis and treatment
Diagnosing ASDs can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Clinicians look at the child’s behaviour and development to make a diagnosis.  ASDs can sometimes be detected at 18 months or younger. However, many children do not receive a final diagnosis until much older.  This delay means that children with an ASD might not get the help they need.

There is currently no cure for ASDs. However, research shows that early intervention treatment services can greatly improve a child’s development.  Services can include therapy to help the child talk, walk, and interact with others.  Therefore, it is important to involve clinicians as soon as possible if a child has an ASD or other developmental problem.  In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis.

Local authority services
Hartlepool Borough Council currently provides housing, care and support to about 140 adults with autism.

A review of autism services across Teesside was undertaken during 2011/12 with a view to informing commissioners on further service provision.

All people who are eligible for community care services will undertake a self-directed assessment questionnaire linked to a resource allocation.  The resource allocation will be linked to their assessed need via a support plan.

Specialist care and support
Where specialist care and support is required a Tees-wide autism framework agreement is in place.  This is a collaboration between four Tees local authorities and identifies eight providers of care deemed to have the skills, competencies and knowledge to work with adults with autism.

Support groups
Two active support groups exist within Hartlepool:

  • Hartlepool Autism Self-Help Group
  • Autism Rights Group Hartlepool

Autism partnership board
The board is a multi-agency forum that brings together commissioners and the autism community to identify local priorities and enable a more strategic approach to developing better outcomes for people with autism.  This is carried out through the Teesside Autism Strategy Development Group (TASDG), a sub-regional network of organisations interested in improving service provision in Teesside.

The group provides support and tracks progress on the Department of Health's 'fulfilling and rewarding lives' guidance 2010.  The sub-regional network monitors the Hartlepool Local Autism Action Plan and reports progress to the North East Autism Consortium.

Employment
Hartlepool Borough Council provides a supported employment team.  The Learning Disability & Mental Health employment link team is accredited through the National Autistic Society (NAS).  This service helps employers, educational providers and welfare agencies to increase opportunities for people wishing to return to work.

Day care provision
Warren Road day service and the 'sunflower lounge' are accredited by the National Autistic Service (NAS) and operate a range of day care provision for adults with autism. The service can be accessed by referral from a care manager.


 



What is the projected level of need?

Current estimate show that about 20% of adults and 35% of children with ASDs are known to the local authority in Hartlepool.  There is no forecast increase in the number of people with ASDs, but identification of people currently unknown to services is likely to lead to an increased need for those services.

The number of adults with autistic spectrum disorders is forecast to remain similar (550 in 2012 to 546 in 2020) (PANSI, 2012).  There is no forecast available for children or adults aged over 65.

Hartlepool estimated autistic spectrum disorder age 18-64, 2012 to 2020

 



What needs might be unmet?

Hartlepool Borough Council has engaged with people with autism with a view to identifying what is working, what is not working and what needs to change.  This process, known as Working Together for Change (WTfC) is a tried and tested approach to coproducing change with local people and harnessing the energy and intelligence from that process to drive commissioning and service development activity.

WTfC can help to make better use of scarce resources, improve productivity and lead to better outcomes for people by ensuring services provide the things people want and need in the way that makes most sense to them.

It goes significantly beyond consultation, towards empowering people to play a leading role in determining the changes and improvements they want to see. It has been recognised as national best practice and is being used across the country in a wide variety of settings as a tool for delivering inclusive change.

It is estimated that approximately 1 in 100 people has Autism, for Hartlepool this could be as many as 920 people based on local estimates.  Over 140 people are currently in receipt of services, so as many as 760 people could be living in Hartlepool with an autistic spectrum disorder without any support.

 



What evidence is there for effective intervention?

Autism national strategy

Fulfilling and rewarding lives: The strategy for adults with autism in England (Department of Health 2010).

 

NICE guidelines

Autism: the management and support of children and young people on the autism spectrum.  (clinical guideline 170, 2013)

Autism: recognition, referral, diagnosis and management of adults on the autism spectrum.  (clinical guideline 142, 2012)

Autism: recognition, referral and diagnosis of children and young people on the autism spectrum. (clinical guideline 128, 2011)

Autism (Quality standard 51, 2014)

Antisocial behaviour and conduct disorders in children and young people (Quality standard in development, expected April 2014)

 

NICE pathway

This guidance has been incorporated into a NICE Pathway, along with other related guidance and products.

 

Additional evidence

Improving access to social care for adults with autism. (Social Care Institute for Excellence, 2011)

 



What do people say?

In February 2012 information provided by 100 people from Teesside was used in the Working Together for Change process. This was completed to inform and support strategic planning and develop local service provision.

The main messages are that people with autism:

  • want to be understood;
  • want a job;
  • want to choose where I live; and
  • need more local support and provision.

There is a recognised gap in the involvement of people with autism, their families and carers in the development of local services. The Working Together for Change process was an initial step to address this but further work is required.

Further engagement of local people with autism, their families and carers in the identification of issues and development of new services is fundamental to establishing local communities that are accessible.

Over 60% of adults with Asperger syndrome or high functioning autism who responded to an NAS survey in 2007 said that they have experienced difficulties in accessing services.  About half of these (52%) were told that they do not fit easily into mental health or learning disability services.

 



What additional needs assessment is required?

None identified at present.

 



Key Contacts

Name: Neil Harrison

Job Title: Head of Service – Hartlepool Borough Council

e-mail: neil.harrison_1@hartlepool.gov.uk

phone:01429 523913

 

Name: Donna Owens

Job Title:

e-mail: donna.owens@nhs.net

Phone: 0191-374-4168

 

References

 

National Strategies and Plans

Department of Health (2010) “Fulfilling and rewarding lives”. The strategy for adults with autism in England.

 

Local Strategies and plans

Hartlepool Borough Council (2014) Hartlepool Local Autism Action Plan

 

Other references

National Autistic Society (2014). Autism strategy: fulfilling and rewarding lives

Autism and Developmental Disabilities Monitoring Network Surveillance Year 2008 Principal Investigators (2012) Prevalence of autism spectrum disorders - autism and developmental disabilities monitoring network, 14 sites, United States, 2008. Morbidity and Mortality Weekly Report. Surveillance summaries, 61(3), pp. 1-19.

Baird, G. et al. (2006) Prevalence of disorders of the autism spectrum in a population cohort of
children in South Thames: the Special Needs and Autism Project (SNAP). The Lancet, 368 (9531), pp. 210-215.

Blumberg, S. J. et al (2013) Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011–2012. National Health Statistics Reports, No 65.

Brugha, T. et al (2009) Autism spectrum disorders in adults living in households throughout England: report from the Adult Psychiatric Morbidity Survey, 2007. Leeds: NHS Information Centre for Health and Social Care.

Department for Education (2015). Special educational needs in England: January 2015.

Ehlers, S. & Gillberg, C. (1993). The epidemiology of Asperger syndrome: a total population study. Journal of Child Psychology and Psychiatry, 34(8), pp. 1327-1350.

Emerson, E. and Baines, S. (2010) The estimated prevalence of autism among adults with learning disabilities in England. Stockton-on-Tees: Improving Health and Lives.

Elsabbagh, M. et al (2012) Global prevalence of autism and other pervasive developmental disorders.  Autism Research, 5 (3), pp.160-179.

Fombonne, E., Quirke, S. and Hagen, A. (2011). Epidemiology of pervasive developmental disorders. In Amaral D.G., Dawson G. and Geschwind D.H. eds. (2011) Autism spectrum disorders. New York: Oxford University Press, pp. 90 – 111.   Available from the NAS Information Centre.

Gillberg, C., Grufman, M., Persson, E. & Themner, U. (1986). Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects. British Journal of Psychiatry, 149, pp. 68-74.

Gould, J. and Ashton-Smith, J. (2011) Missed diagnosis or misdiagnosis? Girls and women on the autism spectrum. Good Autism Practice, 12 (1), pp. 34-41.
Available from the NAS Information Centre.

Green, H. et al (2005) Mental health of children and young people in Great Britain, 2004. Basingstoke: Palgrave Macmillan.

Idring, S. et al. (2012) Autism spectrum disorders in the Stockholm Youth Cohort: design, prevalence and validity. PLoS One, 7(7): e41280

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, pp. 217-250.

Kim, Y.S. et al (2011) Prevalence of autism spectrum disorders in a total population sample. American Journal of Psychiatry, 168 (9), pp. 904-12.

Lotter, V. (1966). Epidemiology of autistic conditions in young children, I. Prevalence. Social Psychiatry, 1, pp. 124-137.

The NHS Information Centre, Community and Mental Health Team, Brugha, T. et al. (2012) Estimating the prevalence of autism spectrum conditions in adults: extending the 2007 Adult Psychiatric Morbidity Survey. Leeds: NHS Information Centre for Health and Social Care.

The Westminster Commission on Autism (2016). A spectrum of obstacles: an enquiry into access to healthcare for autistic people.

Wing, L. (1981). Asperger's syndrome: a clinical account. Psychological Medicine, 11, pp. 115-129.
Available from the NAS Information Centre

Wing, L. (1991). Asperger's syndrome and Kanner's autism. In: Frith, U., ed. Autism and Asperger Syndrome.  Cambridge: Cambridge University Press.
Available from the NAS Information Centre

Wing, L. & Gould, J. (1979). Severe impairments of social interaction and  associated abnormalities in children: epidemiology and classification. Journal of Autism & Developmental Disorders, 9, pp. 11-29.
Available from the NAS Information Centre

Wing, L. & Potter, D. (2002). The epidemiology of autistic spectrum disorders: is the prevalence rising? Mental Retardation and Developmental Disabilities Research Reviews, 8(3), pp. 151-161.
Available from the NAS Information Centre

Wolff, S. (1995). Loners: the life path of unusual children. London: Routledge.

World Health Organisation.  (1992). International Classification of Diseases. 10th ed. Geneva: WHO.

 

Principal diagnostic ‘labels’ for autism (from National Autistic Society)

 

Autistic spectrum disorders
Commonly used to cover the whole range of conditions that have in common the triad of impairment of social interaction, social communication and social imagination. This triad is associated with a repetitive pattern of behaviour. The social interaction impairment is the most important part of the triad so people who have this on its own can be included in the spectrum. This is particularly relevant for people coming for a diagnosis later in childhood or adult life. They may have learned to compensate for their disabilities in communication and imagination, but the social interaction impairment is still evident even though it may be shown in subtle ways.

Pervasive developmental disorders
This term is used in the International Classification of Diseases, 10th edition (ICD-10) to cover more or less the same range as autistic spectrum disorders.

Childhood autism (ICD-10)
Used when the person's behaviour fits the full picture of typical autism.

Atypical autism (ICD-10)
Used when the person's behaviour pattern fits most but not all the criteria for typical autism.

Pervasive developmental disorder not otherwise specified (PDD-NOS)
This is more or less the same as atypical autism.

Asperger syndrome (ICD-10)
Briefly, this is used for more able people who have good grammatical language but use it mainly to talk about their special interests.

Other labels that are sometimes used for particular patterns of disabilities and/or behaviour that can be found among people with autistic spectrum disorders

Some professionals in the field have picked out particular patterns of disabilities and/or behaviour that can be seen in some people with autistic spectrum disorders, and have named them as separate syndromes. There is disagreement as to whether these so-called syndromes can ever occur on their own without the social communication and imagination impairments that are diagnostic of an autistic spectrum disorder.

 

Non-verbal learning disorder (NVLD)
Study of the criteria for this condition shows that it covers people with the social behaviour pattern of Asperger syndrome, who also have problems with the non-verbal skills of arithmetic and some visuo-spatial skills. Dr Asperger included such people in his descriptions but also included people with social problems who were very good with numbers and visuo-spatial skills.

Right hemisphere learning disorder
The same as non-verbal learning disorder. The non-verbal learning problems mentioned above are mainly located in the right hemisphere of the brain.

Semantic-pragmatic disorder
Good grammatical language but lack of ability to use language in a socially appropriate manner. This pattern is characteristic of the people Asperger described.

Pathological demand avoidance (PDA)
Briefly, avoidance of everyday tasks and manipulative, socially inappropriate, in some cases aggressive behaviour.

 

There is also a list of developmental disorders that are not in the autistic spectrum but often occur together with an autistic spectrum disorder.  These can be found here:

http://www.autism.org.uk/About-autism/All-about-diagnosis/The-use-and-misuse-of-diagnostic-labels.aspx

 

 



Physical disabilities

The Equality Act 2010 defines disability as an impairment that has a substantial and long-term adverse effect on a person’s ability to perform normal day-to-day activities. Such impairments can vary considerably and include both congenital and acquired disabilities.

In England it is estimated that there are 3.3 million people aged 16-64 with a moderate or severe physical disability (PANSI, 2012).  In addition there are 4.3 million people aged 65 and over with a limiting long-term illness (POPPI, 2012).  Furthermore an estimated 0.8 million children in the UK have a disability (DWP, 2012), approximately 670,000 in England.  Combining these shows about 8.3 million people in England have a physical disability.

People with physical impairments face many barriers to living a fulfilling and independent life. Not only do they have the practical problems of everyday life to struggle with that a physical disability brings but they have to face the negative public perceptions of disabled people and problems gaining access to everyday facilities and services. The support required for people with physical impairment may be multi-dimensional and therefore needs to be tailored to address their specific individual needs.

People with physical impairment also face prejudice.  Prejudice is not always hostile; benevolent prejudice results from the belief that a disabled person needs looking after.  Benevolent prejudice can be just as consequential as hostile prejudice, making it likely disabled people will be treated less favourably in respect of the opportunity for advancement because they are seen as less capable.

This topic is most closely linked with:

 



What are the key issues?

In the next 20 years there are likely to be many more older people who need help with day-to-day activities.  The number of people aged over 65 with a limiting long-term illness is forecast to increase by 8% in 2016 and 27% by 2025.

Current services may not be accessible to people from all ethnic groups.

There is a gap in the current provision of enablement services to people aged under 65.

Many service users find regular transport to be a problem due to their disabilities.

 



What commissioning priorities are recommended?

2012/01 - remains a priority
Develop services and responses that will prevent people from developing a long-term condition – promote health and wellbeing and identify and support people at risk of developing a long-term condition.

2012/02 - remains a priority
Make self-care the norm – encourage people to maintain their own health and lead independent lives.

2012/03 - remains a priority
Deliver more services close to home – provide personalised community-based integrated care.

2012/04 - remains a priority
Reduce the number of admissions and the length of hospital stay for those with long-term conditions.

2012/05 - remains a priority
Develop a workforce which has the skills to deliver care in the right place at the right time – invest in professional education and skills development.

2012/06 - remains a priority
Harness technology to support those who care for and those who live with long-term conditions – take advantage of the possibilities opened up by new technologies.

2012/07 - remains a priority
Reduce inequalities in local health and experience and access for those managing long-term conditions – deliver convenient, quality services.

2012/08 - remains a priority
Commission services and measure outcomes that matter to those living with a long-term condition – find out what people want from services working with a range of providers to commission effective, holistic responsive packages of care.

2012/09
Commission services and measure outcomes that matter to those supporting and caring for people with a long-term condition – create an environment that allows carers to take greater control over their own health and the health of others in their care.

2012/10 - remains a priority
Provide a systematic, person-centred approach to the management of long-term conditions.

No additional priorities identified in 2015.



Who is at risk and why?

Age
The chances of suffering physical disability increase with age.  About 5% of people aged 18-25 have a moderate or severe physical disability.  At age 55-64 it is almost 21% (PANSI, 2012).

About 47% of people aged over 65 have a limiting, long-term illness, rising to 57% of people aged over 85 (POPPI, 2012).

Young disabled people (aged 16-34) are at greater risk of being a victim of crime than their non-disabled counterparts (Office for Disability Issues, 2012).

Gender
As women age they are more likely to suffer mobility problems than men.  At age 65-69 about 8% of men and 9% of women have a mobility problem, but at age 85+ it is 35% of men and 50% women.

Socioeconomic status
Disabled people are less likely to be employed (49%) than non-disabled people (78%).  Of those who are employed, about one-third of disabled people are in part-time employment compared with one-quarter of non-disabled people (Office for Disability Issues, 2012).

Disabled people tend to earn at a lower hourly rate (£11.78) than non-disabled people (£12.88) (Office for Disability Issues, 2012).
Disabled people are more than twice as likely to have no qualification and half as likely to have a degree level qualification as non-disabled people (Office for Disability Issues, 2012).

In families where no one is disabled, 18% of children live in poverty, but in families where there is at least one disabled person, 22% live in poverty (Office for Disability Issues, 2012).

Nearly one-quarter (23.6%) of households with a disabled person are in fuel poverty compared with 16.3% of households where no disabled people live (Office for Disability Issues, 2012).

Ethnicity
None identified.

Other risks
Stroke victims are at risk of developing a physical disability.

People with progressive degenerative diseases (for example, arthritis; muscular dystrophy; multiple sclerosis) are at increased risk of developing a physical disability.

People sustaining a brain injury are at increased risk of physical disability.  Brain injury is the fastest growing cause of disability in young people in the UK.


Compared with non-disabled people, disabled people are:

  • More likely to live in poverty – the income of disabled people is, on average, less than half of that earned by non-disabled people.
  • less likely to have educational qualifications – disabled people are more likely to have no educational qualifications.
  • more likely to be economically inactive – only one in two disabled people of working age are currently in employment, compared with four out of five non-disabled people.
  • more likely to experience problems with hate crime or harassment – a quarter of all disabled people say that they have experienced hate crime or harassment.
  • more likely to experience problems with housing – nine out of ten families with disabled children have problems with their housing.
  • more likely to experience problems with transport – the issue given most often by disabled people as their biggest challenge.
  • more likely to experience problems with access to information & guidance relating to their condition and care.

(Source: Department of Health, 2005).
 



What is the level of need in the population?

The number of clients receiving services has increased from 3,400 in 2005/06 to 4,200 in 2011/12, a 24% increase over 7 years.  The rate of service provision in Hartlepool is above both England and the North East and is increasing where national and regional rates are decreasing (Source: NASCIS; RAP P1).

Hartlepool adults with physical disability receiving services

 

The data on service provision provides an indication of what types of services have been provided.  In Hartlepool, a higher than average proportion of services are community-based.  The number of people receiving residential care services has tended to fall whereas nursing care and community-based services have increased (numbers are rounded to the nearest 5).

Hartlepool adult physical disability services by type

 

Using data from the Projecting Adult Needs and Service Information (PANSI) for people aged 18-64 and Projecting Older People Population Information (POPPI) for people aged 65 and over it is possible to estimate the number of people with physical disabilities.  In Hartlepool, 41% of those with severe physical disability (age 18-64) or with a limiting long-term illness (age 65+) receive services, compared with 29% in England.  It is likely that not all people identified will require services, but nearly 6 in 10 of those with physical disabilities currently don’t receive services in Hartlepool.

Tees predicted number of adults with physical disability

 



What services are currently provided?

Hartlepool Centre for Independent Living (CIL)
The centre is home to voluntary and community sector organisations offering advice, information, advocacy and practical help for those living with a disability. The service offers the opportunity to try a range of daily living aids such as bath-lifts and hoists, as well as smaller pieces of equipment. An occupational therapist provides advice on the equipment available and how to use it safely.

Hartlepool Borough Council Child & Adult Social Care teams
The disability service is made up of several teams providing specific services to adolescents and adults with disabilities.  The sensory loss service provides specialist support and assistance across all age ranges.

 



What is the projected level of need?

The number of people with a moderate or serious physical disability aged 18-64 is expected to peek within the next 8-10 years and then begin to fall slowly.  In contrast the number of people aged over 65 with a limiting long-term illness is forecast to increase by 8% by 2016, and in 2025 the number will be 27% higher than in 2012 and continuing to increase further by 2030.

Hartlepool people predicted to have physical disability

 



What needs might be unmet?

Service uptake within specific ethnic groups
The 2005 Equality Impact Assessment identified lowered levels of service uptake within certain black and ethnic minority communities. This needs to be investigated further to clarify whether adequate care is being provided from alternative sources and/or whether the development of additional council services is justified.

Enablement
Research carried out by the Care Services Efficiency Delivery team (CSED) has highlighted a gap in the current provision of ‘enablement services' to under 65s. The specific client groups affected include learning disabilities, physical impairment, and social inclusion care management. Further investigation will be undertaken to see how this can be developed.
 
Transport
An issue that is raised regularly by people attending local consultation groups is transport. It was noted that “many service users find regular transport to be a problem due to their disabilities or deteriorating conditions”. The taxis were seen as very expensive and often unable to provide wheelchair access.

 



What evidence is there for effective intervention?

National Institute for Health and Clinical Excellence (NICE)

Active for life: Promoting physical activity with people with disabilities (guidelines)

Multiple sclerosis: Management of multiple sclerosis in primary and secondary care (CG8)

Osteoarthritis: The care and management of osteoarthritis in adults (CG59)

Rehabilitation after critical illness (CG83)

Depression in adults with a chronic physical health problem: Treatment and management (CG91)

Spasticity in children and young people with non-progressive brain disorders: Management of spasticity and co-existing motor disorders and their early musculoskeletal complications (CG145)

Osteoporosis: assessing the risk of fragility fracture (CG146)

 

The IBSEN project - National evaluation of the Individual Budgets Pilot Projects

The National evaluation of the Individual Budget pilots notes that -
“(younger physically disabled people) were significantly more likely to report higher quality of care (having taken up an Individual Budget), and were more satisfied with the help they received. The choice and control afforded by an Individual Budget has apparently given them the opportunity to build better quality support networks”.


The Care Services Efficiency Delivery (CSED) guidance addresses issues of enablement / inclusion for a number of client groups including those with physical impairment.   This service has been co-designed with health organisations and begins at the stage when they require community care assessments for care packages.  The aim is to have intensive periods of reablement and assessment (6-8 weeks) to enable people to gain confidence in independent living skills prior to having independent care providers carry out these tasks.  It is hoped that through this mechanism people will have tailor-made care packages which will be specific to their needs.

Raising Expectations and Increasing Support (DWP, 2008) announced the government’s intention to introduce legislation to give disabled people the right to control certain public funds spent on their support.

National Service Framework (NSF) for Long Term Conditions (DH, 2005a) aims to transform the way health and social care services support people with long-term neurological conditions to live as independently as possible. It puts the people who have these conditions, along with their family and carers, at the centre of care by setting evidence-based quality requirements from diagnosis to end of life care.  Although the NSF is focused on people with long-term neurological conditions, the principles enshrined in the framework apply to all people with a physical disability.

Independence, Well-being and Choice (DH, 2005c) offers a vision for the future of social care for adults in England. Person-centred, proactive and seamless services are promoted so that people who use social care services will have more control, more choice, and the chance to do things that other people take for granted.

Our Health, Our Care, Our Say (DH, 2006) set the Government’s vision for health and social care services.  It is underpinned by achieving four main goals:

  • better prevention and early intervention for improved health, independence and well-being;
  • more choice and a stronger voice for local individuals and communities;
  • tackling inequalities and access to services;
  • more support for people with long-term needs.

 

Putting People First (DH, 2007) is a ministerial concordat establishing a shared vision and commitment across Government. It sets out the shared aims and values, which will guide the transformation of adult social care.

Improving the Life Chances of Disabled People (DH, 2005b) is a cross-government policy. The vision is for disabled people in Britain to be respected as members of society by 2025.

Disabled People's User-led organisations - organisations led and controlled by the users, are a vital part of the new approach which supports independent living.

 



What do people say?

Information from the Life Chances Partnership Board identified five key themes important to improving the lives of Disabled People.  These are:

  • Access - members of the life chances group suggested that a one-stop shop for disability-related information and services was needed.
  • Transport - difficult to access public transport in the evening and there had been a reduction in the number of accessible taxis.
  • Housing - a broad range of housing, care and support services is needed to enable vulnerable people and their carers to improve the quality of their lives and maximise their own resources, including financial resources.
  • Health - members of the Life Chances group supported recommendations to ensure equality of access to health care for people with disabilities was considered for all primary, secondary and tertiary health care provision.
  • Employment - people wanted more support from Job Centre Plus and specialist employment agencies to reduce levels of unemployment for people with a disability.

 



What additional needs assessment is required?

There is a need for improved service user feedback:

Current commissioning needs assessment efforts are impeded by the limited availability of accurate service delivery monitoring information. Such efforts would be directly informed by better data regarding current user satisfaction levels and patterns of service take up.

Whilst there is evidence to suggest that the number of people with a sensory impairment and individual budget is rising, it is not know what services are being purchased and whether such services are improving the lives of disabled people.

The provision of such data would also greatly facilitate the improved identification of significant trends such as variations in service usage by ethnic group.

 



Key Contact

Name: Neil Harrison

Job Title:Head of Service

e-mail: neil.harrison_1@hartlepool.gov.uk

phone:01429 523913

 

References

Local strategies and plans

 

 

 

 

National strategies and plans

Department of Health (2005a). The National Service Framework for long term conditions

Department of Health (2005b). Improving the life chances of disabled people

Department of Health (2005c). Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England.

Department of Health (2006). Our health, our care, our say: a new direction for community services: A brief guide

Home Office (2010). Equality Act.

 

Other references

Bakejal et al., (2004). Review of Disability Estimates and Definitions

Department for Work and Pensions (2012). Family Resources Survey 2010/11.

Department for Work and Pensions (2008). Raising expectations and increasing support: reforming welfare for the future.

Department of Health (2007). Putting people first: a shared vision and commitment to the transformation of adult social care.

Department of Health (2005). Improving the life chances of disabled people.

HM Governnment: Office for disability issues.

National Adult Social Care Intelligence Service (NASCIS). http://nascis.ic.nhs.uk

Office for Disability Issues (2012). Disability Equality Indicators.

Office for Disability Issues (2011). Strengthening Disabled People's User-Led Organisations Programme.

Office for Disability Issues (2010). Public Perceptions of Disabled People: Evidence from the British Social Attitudes Survey 2009

Projecting Adult Needs and Service Information (PANSI). www.pansi.org.uk

Projecting Older People Population Information (POPPI). www.poppi.org.uk

 



Sensory disabilities

Sensory disabilities refer to visual and hearing impairment.

Visual impairment (blind or partially sighted)

There are two main areas that are looked at when measuring a person’s vision:

  • Visual acuity: This is the central vision used to look at objects in detail, such as reading a book or watching television;
  • Visual field: This is the ability to see around the edge of your vision while looking straight ahead.

Hearing impairment (hard of hearing or deafness)

There are three main types of hearing loss:

  • Conductive hearing loss: Sounds are unable to pass from the outer ear to the inner ear, often as the result of a blockage such as earwaxglue ear or a build-up of fluid due to an ear infection, a perforated ear drum or a disorder of the hearing bones;
  • Sensorineural hearing loss: Sensitive hair cells either inside the cochlea or the auditory nerve are damaged, either naturally through ageing, or as a result of injury;
  • Mixed hearing loss: It is possible to get both types of hearing loss at the same time.

Dual sensory impairment

Dual sensory impairment is the combined loss of hearing and vision.

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Evidence indicates that the prevalence of visual and hearing impairments increases with age. With an ageing population, this means there will be more people acquiring these conditions.

Most sensory impairments develop gradually and are often secondary to other disabilities.

The impact of sensory loss and other health determinants can dramatically increase risk and demand on health and social care services. 

People with sensory loss are at greater risk of social isolation.

It is estimated there are more than ten million people in the UK with some form of hearing loss.

There are around 360,000 people who are registered as visually impaired in England. As many as 2 million people in the UK may be living with some degree of visual impairment.

It is estimated that around 1 in 5 people over the age of 75-years-old have some degree of visual impairment.

Age-related macular degeneration leading cause of blindness in adults. Other significant causes of sight loss are glaucoma, cataracts and diabetic retinopathy.

For adults with sight loss there is a correlated loss of independence and an increased   risk of poverty.

Sensory disabilities is linked with the following JSNA topics:

Carers

Employment

Housing

Transport

Education

Diabetes

Mental and behavioural disorders



What are the key issues?

Hearing loss affects more than 16% of the population of Hartlepool, equating to more than 14,700 people. 

A focal point at Cafe 177 for people with hearing loss in Hartlepool was established for people to meet and obtain information and support, but some people do not use this.

Improvements are required to the commissioning of communication and translation services.

Better engagement with people who have a sensory impairment is required. This will enable them to be involved in decisions and changes in services affecting them.

 



What commissioning priorities are recommended?

2015/01
Continue to monitor the scope of the North Regional Association for Sensory Support (NRASS) contract
in consultation with the deaf community using the community group meetings to improve engagement.

2015/02
Further develop the focal point in Hartlepool
for people with sensory loss to meet, obtain information and gain support.

2015/03
Refresh the communication and translation service
(in consultation with members of the deaf community) corporate priority.

2015/04
Support the development of Digital Inclusion
for people with Sensory Disabilities

2015/05
Update and improve access to information, advice and guidance
for people with sensory impairments.


2015/06
Seek the views of local community groups
to explore possible solutions to improve access to sensory support services.

2015/07
Review the health needs of the deaf community
to inform the ‘Focus on Health’ project aimed at improving the physical and emotional wellbeing of Hartlepool’s deaf community.

2015/08
Work with partners to ensure that British Sign Language (BSL) interpreting services are commissioned to a consistently high standard
across organisations to improve continuity of service where possible across the pathway, and where appropriate checks and feedback is sought on the provision of that service.

2015/09
Continue to promote and provide deaf awareness training
across all sectors, making it a mandatory part of induction for staff.
 


2012/01

Review the ‘Self-Directed Assessment Questionnaire’ (V5.5) to establish its effectiveness for those people with sensory impairment.

2012/02

Review the process for the transfer of information between Care-first and Innovative Communication Services (ICS) to ensure children are included on the deaf and hard of hearing register.

2012/03 - replaced by 2015/01

Review the scope of the North Regional Association for Sensory Support (NRASS) contract in consultation with the deaf community and consider using the community group meetings to improve engagement.

2012/04 - replaced by 2015/02

Develop a central focal point in Hartlepool for people with sensory loss to meet, obtain information and gain support.

2012/05 - replaced by 2015/03

Review the commissioning of communication and translation services (in consultation with other partners in Teesside and members of the deaf community).

2012/06

Consider the benefits of a ‘virtual’ assessment team for adults to improve cover and reduce backlogs.

2012/07 - replaced by 2015/05

Update and improve access to information, advice and guidance for people with sensory impairments (both hard copy and web-based).

2012/08

Explore the value of offering patients greater choice with ‘In the Ear’ hearing aids in their commissioning plans for hearing aid provision. 

2012/09

Develop a strategic approach to engaging people with sensory impairments, enabling them to be fully involved in decisions and changes in services affecting them.

2012/10 - replaced by 2015/06

Seek the views of local community groups to explore possible solutions to improve access to sensory support services.

2012/11

Work with ‘Durham Deafened Support’ to determine how best to address the needs of Hartlepool’s hard of hearing and deafened people.

2012/12

Survey the hard of hearing community on their needs for social and communication support, including lip-reading provision and the availability of a support group.

2012/13 - replaced by 2015/07

Review the health needs of the deaf community to inform the ‘Focus on Health’ project aimed at improving the physical and emotional wellbeing of Hartlepool’s deaf community.

2012/14

Review the peripatetic and paediatric support pathways for children with sensory disabilities in order to provide appropriate support and information to them and their families.

2012/15

Review the current provision of mental health services available to children and young people, working with partners to achieve economies of scale and considering the development of links between local CAMHS services and the National Deaf Service for Children.

2012/16 - replaced by 2015/08

Work with partners to ensure that British Sign Language (BSL) interpreting services are commissioned to a consistently high standard across organisations to improve continuity of service where possible across the pathway, and where appropriate checks and feedback is sought on the provision of that service.

2012/17 - replaced by 2015/09

Continue to promote and provide deaf awareness training across all sectors, making it a mandatory part of induction for staff.

 



Who is at risk and why?

Visual impairment

Age

The vast majority of people with sight loss are elderly. Visual impairment prevalence increases with age.

Socioeconomic status

People from deprived areas are less likely to seek eye health checks and therefore are at higher risk of undiagnosed eye conditions.

Ethnicity

People from African/African-Caribbean populations are four times more likely to develop glaucoma and have higher risk of age-related macular degeneration (AMD). People from Asian populations are at higher risk of cataracts. Both groups are at higher risk of diabetic eye disease.

Lifestyle

Smokers double their risk of developing AMD; they also tend to develop it earlier than non-smokers do. 

Smoking can make diabetes-related sight problems worse, and has been linked to the development of cataracts.

Obesity has been linked to several eye conditions including cataracts and AMD.  Obesity also has a strong link with diabetes and an exacerbation of sight deterioration in diabetic retinopathy.

Illness

An estimated 60% of stroke survivors have some sort of visual dysfunction following a stroke. The most common condition is some loss of visual field which occurs in 30% of all stroke survivors.

Uncontrolled high blood pressure can cause retinal damage by constriction of the retinal blood vessels.

Diabetic retinopathy can lead to sight loss.

Dementia sufferers may have eye conditions such as cataracts or AMD; others will have a type of dementia that impairs their vision by affecting perception of depth, colour and detail. It is estimated that around 2.5% of people over the age of 75 will have dementia and significant sight loss.

Depression

Older people with sight loss are also almost three times more likely to experience depression than people with good vision. 

Stress from living with visual impairment places a strain on relationships, as people become less able to live independently and are compelled to rely on family and friends to meet their needs.

Learning disabilities

Adults with learning disabilities are ten times more likely to be visually impaired than the general population. In the past people with learning disabilities have been less likely to have eye examinations.

Falls

People with visual loss are 1.7 times more likely to have a fall and 1.9 times more likely to have multiple falls.

Of the total cost of treating all accidental falls in the UK, 21% was spent on the population with visual impairment.

Hearing impairment

Age

The vast majority of people with hearing loss are elderly. Prevalence increases with age. It is estimated that there are 3.7m aged between 16 and 64-years-old with a hearing loss and 6.4m aged 65-years-old and above.

Babies will be at risk of failing to develop language skills and of low educational attainment if their hearing impairment goes undetected.

Ethnicity

It is believed that prevalence of hearing impairment is higher in BME communities, particularly in more recent immigrants from countries with low levels of immunisation against conditions such as rubella.

Illness

People receiving ototoxic drugs are at greater risk of a hearing impairment.

People with hearing loss may also have other additional disabilities or long-term health conditions that limit their daily activities such as arthritis and mobility problems. This often means that barriers to inclusion and feelings of isolation are worsened.

Environment

People regularly subjected to loud noise are at greater risk of a hearing impairment.

Injuries

Direct head trauma can cause hearing loss.

People with hearing loss are also highly likely to have problems such as tinnitus and balance disorders which contribute as risk factors for falls and other accidental injuries.

Those who become suddenly deafened through trauma or infection are likely to experience acute emotional distress and find it difficult to cope.



What is the level of need in the population?

Hartlepool

National prevalence data estimates that 16.1% of the population have a hearing loss and that this is predominantly age-related.  For example, only 2% of 17 to 30-year-olds will have a hearing loss compared to 60% of those over the age of 70-years-old. 

Applying prevalence estimates to the population of Hartlepool gives a total of 15,900 people in the population with hearing loss:

Age group

Pop of Hartlepool

(Mid-2014)

% with hearing loss

Number with hearing loss

under 17

18,762

0.11

21

17-30

16,422

1.8

296

31-40

10,181

2.8

282

41-50

13,090

8.2

1,073

51-60

12,648

18.9

2,390

61-70

10,510

36.8

3,868

71-80

6,904

60.2

4,156

81+

4,073

93.4

3,804

Total

92,590

 

15,890

 

 



What services are currently provided?

National

Newborn Hearing Screening Programme (NHSP)

The Newborn Hearing Screening Programme (NHSP) aims to identify moderate, severe and profound hearing impairment in newborn babies. The programme automatically offers all parents the opportunity to have their baby's hearing tested shortly after birth.

National Deaf Children's Society 

The National Deaf Children's Society  is a telephone helpline for children with a hearing impairment.

Jobcentre Plus

Jobcentre Plus offers a service for disabled workers by putting them in touch with a disability employment advisor (DEA). A DEA will help clients to find work or to gain new skills for a job. They can help with work preparation, advocacy, recruitment, and even confidence building. DEAs offer an employment assessment to find out what types of work would suit the individual best.

Staying Put

The Staying Put Agency assists older, vulnerable and disabled people to remain independent and in their home by offering a range of financial and practical support services including disabled facilities grants, equipment repairs and minor adaptations.

Tees-wide

North Tees and Hartlepool Audiology

The North Tees & Hartlepool Audiology department provides a complete diagnostic and hearing aid rehabilitation service making special provision for deaf and hearing impaired patients and offering guidance and support to patients and their families.

South Tees ENT and Audiology

The South Tees ENT and Audiology department provide the regional cochlear implant service as well as NHS treatment for patients with more complex hearing disorders.

Peripatetic services

The peripatetic service based in Middlesbrough is for teachers of the deaf who provide support for children and young people throughout their education. 

Teesside Society for the Blind

Teesside Society for the Blind is contracted to provide a visiting service for people with visual impairments. The visitors are volunteers who assist people with a range of tasks such as reading of mail, writing letters, escorting to appointments, shopping trips or social engagements.

Hartlepool

Hartlepool Family First Centre

Focus on Health Project includes classes in healthy eating, cookery, Yoga as well as providing access to British Sign Language (BSL) DVDs on a range of topics including general health, depression, breast cancer, stress and relaxation.

The North Regional Association for Sensory Support (NRASS)

The NRASS provide a drop-in advocacy and welfare rights service from the Hartlepool Central Library

Durham Deafened Support

Hartlepool residents receive services provided by Durham Deafened Support.  This organisation promotes the relief, integration, rehabilitation, welfare and education of people who have become isolated because of hearing loss, enabling them to cope with their disability through advocacy, support, education, information, the teaching of lip-reading skills and other ways of helping them to understand and meet their communication needs.

Hartlepool Now

Hartlepool Now provides information on services provided by Hartlepool Borough Council.

Hartlepool Blind Welfare Association

The Hartlepool Blind Welfare Association is a registered charity concerned with the welfare of visually impaired people of all ages living in Hartlepool. They give support and information on all aspects of living with a visual impairment. There is also a home visitor who offers practical information and help.

 



What is the projected level of need?

Visual impairment

The chart below estimates the people aged over 65-years-old predicted to have a moderate or severe visual impairment.

Forecast people with visual impairment, hartlepool, 2012-2030

Predicted number of people with moderate or severe visual impairment aged 65+

2012

2013

2014

2015

2016

2020

2025

2030

1,383

1,424

1,442

1,465

1,490

1,578

1,781

1,983

 

Hearing impairment

The chart below estimates the people aged 18 to 64-years-old predicted to have a moderate or severe hearing impairment.

People with hearing impairment, age18-64, Hartlepool, 2012-2030

Predicted number of people with moderate or severe hearing impairment aged 18-64

Year

2012

2013

2014

2015

2016

2020

2025

2030

Number

2,278

2,286

2,284

2,286

2,323

2,361

2,327

2,181

 

The chart below estimates the people aged over 65-years-old predicted to have a moderate or severe hearing impairment.

People with hearing impairment, age 65+, hartlepool, 2012-2030

Predicted number of people with moderate or severe hearing impairment aged 65+

Year

2012

2013

2014

2015

2016

2020

2025

2030

Number

6,529

6,840

6,879

7,025

7,085

7,518

8,639

9,659

 

The chart below estimates the people aged over 65-years-old predicted to have a profound hearing impairment.

People with profound hearing impairment, age 65+, Hartlepool, 2012-2020

Predicted number of people with profound hearing impairment aged 65+

Year

2012

2013

2014

2015

2016

2020

2025

2030

Number

163

170

172

178

182

199

231

256

 

 



What needs might be unmet?

Lip-reading skills

There is evidence of a demand for lip-reading classes in Hartlepool (classes currently being carried out by Durham Deafened Support). 

Hearing tests

It is estimated that only 55% of people with a hearing loss are referred by their GP for a hearing test.  Therefore, it is possible that several thousand people in Hartlepool are trying to cope unaided with their hearing loss.

Service uptake within specific ethnic groups

The 2005 Equality Impact Assessment identified lowered levels of service uptake within certain black and ethnic minority communities. This needs to be investigated further to clarify whether adequate care is being provided from alternative sources and/or whether the development of additional council services is justified.

Enablement

Research carried out by the Care Services Efficiency Delivery (CSED) team has highlighted a gap in the current provision of ‘enablement services' for under 65s. The specific client groups affected include learning disabilities, physical impairment, and social inclusion care management.

Local intelligence and statistical information

Due to inconsistencies between children and adults information systems, data available for people with sensory impairment may not be robust.

Transport

Many service users find regular transport to be a problem due their disabilities or deteriorating conditions. Taxis were seen as very expensive and often unable to provide wheelchair access.

 



What evidence is there for effective intervention?

Improving the Life Chances of Disabled People (Jan 2005)

A cross-government policy. The vision is for disabled people in Britain to be respected as members of society by 2025. 

Our Health, Our Care, Our Say

White paper, the Government’s Vision for Health and Social care services is underpinned by achieving four main goals:

  • Better prevention and early intervention for improved health, independence and well-being;
  • More choice and a stronger voice for local individuals and communities;
  • Tackling inequalities and access to services;
  • More support for people with long-term needs.

Independence, Well-being and Choice (DH 2005)

This offers a vision for the future of social care for adults in England. Person centred, proactive and seamless services are promoted so that people who use social care services will have more control, more choice, and the chance to do things that other people take for granted.

UK Vision Strategy

The strategy aims to:

  • Improve the eye health of the people of the UK;
  • Eliminate avoidable sight loss and deliver excellent support to those with a visual impairment;
  • Enhance the inclusion, participation and independence of blind and partially sighted people.

 



What do people say?

NRASS Consultation with members of the former Hartlepool Deaf Centre:

“Hartlepool people want information and interpretation services that are provided by qualified interpreters who are fully experienced in signing and voice over skills, with total understanding of deaf culture and the condition of deafness.”

 



What additional needs assessment is required?

The need for improved service user feedback.

Current commissioning needs assessment efforts are impeded by the limited availability of accurate service information. Such efforts would be directly informed by better data regarding current user satisfaction levels and patterns of service uptake.

Whilst there is evidence to suggest that the number of people with a sensory impairment and individual budget is rising, it is not known what services are being purchased and whether such services are improving the lives of disabled people.

The provision of such data would also greatly facilitate the improved identification of significant trends such as variations in service usage by ethnic group.

Further work is also needed to look at the support offered to children and parents and also transition into employment. This is already under review by the council children’s team in collaboration with other local authorities in Teesside.

 



Key Contact

Name: Neil Harrison

Job Title: Head of Service – Hartlepool Borough Council

e-mail: neil.harrison_1@hartlepool.gov.uk

phone:01429 523913

 

Name: Donna Owens

Job Title:

e-mail: donna.owens@nhs.net

Phone: 0191-374-4168

 

References

 

Local strategies and plans

 

National strategies and plans

 

Other references

 



Sexual violence victims

Introduction

Sexual violence is any unwanted behaviour perceived to be of a sexual nature or sexual contact that takes place without consent or mutual understanding.

The World Health Organisation defines sexual violence as:    

“Any sexual act, attempt to obtain a sexual act, unwanted sexual comments or advances, or acts to traffic, directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting, including the home” (World Health Organisation Report on Violence and Health, 2002)

There are two sub-categories of sexual offences depending on the seriousness of the crime:

  • Serious sexual crime including rapes, sexual assaults, and sexual activity with children;
  • Other sexual offences (including soliciting, exploitation of prostitution, and other unlawful sexual activity between consenting adults).

The effects of sexual violence on victims can include depression, anxiety, post-traumatic stress disorder, drug and substance misuse, self-harm and suicide. However, when victims receive the support they need when they need it, they are more likely to take positive steps to recovery. It is therefore important that victims of sexual violence have good access to effective services, whether or not they wish to report incidents to the police. 

It is estimated that in England & Wales, up to 9 in 10 cases of rape go unreported and 38 per cent of serious sexual assault victims tell no one about their experience. Each adult rape is estimated to cost over £76,000 in its emotional and physical impact on the victim, lost economic output due to convalescence, early treatment costs to the health service and costs incurred in the criminal justice system. The overall cost to society of sexual offences in 2003-04 was estimated at £8.5 billion.

Addressing the needs of victims of sexual violence through the provision of accessible specialist services can deliver benefits in terms of better health and well-being and quality of life. There are also long-term productivity savings in services and costs to society when the immediate effects of sexual assault are managed effectively.

This topic links with the following JSNA topics:

Sexual health

Sensory disabilities

Physical disabilities



What are the key issues?

It is generally accepted that there is no entirely accurate way of measuring the true extent of sexual violence. 

There is a national and local increase in the number of sexual violence incidents being reported to the police.  Even after taking this increase into account estimates through the Crime Survey of England and Wales indicate that there are still significant levels of under reporting.  

In 2013/14, the overall increase of sexual offences reported to Cleveland Police was 4.3%, with rape offences increasing by 17.2%.  

There is no shared vision across Teesside, it is unclear who is responsible for commissioning what service and there are risks of duplication and double funding. 

Many clients have to travel to other areas for services that are not available in the area where they live.

There has been a significant annual shortfall in SARC funding that has been met on an ad-hoc basis by the commissioners.  

There has not been a review of SARC funding since the initial financial agreements of partners in 2006.

SARC services are in place, but there is a lack of clarity on who holds responsibility to ensure that appropriate ‘follow-on’ services are in place.  

Due to inconsistencies between the Tees specialist sexual violence services, it is difficult for professionals and members of the public to understand what services are on offer.  



What commissioning priorities are recommended?

2015/01

All Tees commissioners i.e. NHS England, the office of the Police and Crime Commissioner, the Tees Clinical Commissioning Groups, the Public Health Shared Service, the four Tees Local Authorities and Cleveland Police to consider the potential benefits of a collaborative approach to commissioning sexual violence services in Teesside.          

2015/02

Tees commissioners to consider developing a model evidence-based service specification for the Tees sexual violence services.

2015/03

Tees commissioners to take responsibility for determining what sexual violence services should be available to local residents, how they should be provided, who should contribute funding and how quality and effectiveness can be maintained.  They should carry out this responsibility in partnership with the SARC and specialist sexual violence services to ensure that appropriate pathways and services are in place for stranger cases, acquaintance cases, historical cases and domestic violence and abuse cases.   They should also be clear on how they will address the increasing level of demand.

2015/04

Tees commissioners to establish best practice in respect of the counselling provision that is delivered through the Tees specialist sexual violence and IAPT services.    They should also work with specialist sexual violence service providers to develop a model specification for the provision of counselling for victims of sexual violence.

2015/05

Develop a consistent ISVA service, ensuring that it is available for the SARC to refer into in all parts of Teesside and also ensuring that all victims of sexual violence have the opportunity to access an ISVA to discuss potential progress through the criminal justice system.

2015/06

Commissioners to work in partnership with key stakeholders and specialist sexual violence service providers, in order to clarify and confirm the role of the SARC as ‘a hub’ for sexual violence.   This should cover their requirements of the national SARC Service Specifications as well as the structure of the Teesside sexual violence services.  

2015/07

A “task and finish group” should be formed involving representatives from commissioners, stakeholders and service providers to develop and agree the data to be collated, the frequency of the data being provided and the subsequent monitoring arrangements. 

2015/08

Develop and deliver a communications plan through the TSVSG that raises awareness of sexual violence ensuring that both public and professionals are aware of what exists and where to get help.   The plan should also deliver a preventative approach by raising awareness of risks with particular vulnerable people, encourage action to be taken to reduce risk, addressing issues of consent and reaffirm what is inappropriate and unacceptable behaviour.



Who is at risk and why?

Gender

Women and children and young people are most at risk.

About 3.2 million women aged between 16 and 59 in the UK have been sexually assaulted since the age of 16;

Males (0.1%) are much more unlikely than females (0.5%) to report being a victim of the most serious sexual offences.

Single females and those who were separated were more at risk than other females (5.3% and 3.7% respectively).

Research suggests that the additional stigma attached to male rape may account for the higher under-reporting compared to female rape.

Age

Males and females of all ages can be at risk of sexual violence but the most reliable data currently available in the UK (British Crime Survey) focus on those aged 16-59.

Females aged between 16 and 19 were at the highest risk of being a victim of a sexual offence (8.2%) and as age increased the risk of victimisation reduced.

About 1-in-5 rapes recorded by police are committed against children under 16.

Deprivation

Females from households in the lowest income bracket (under £10,000 per year) showed an increased risk of victimisation (3.8%) as did full time students (6.8%), and the unemployed (3.8%).

Poverty is linked to both the perpetration of sexual violence and the risk of being a victim and is therefore more common in deprived areas. More severe forms of childhood sexual abuse are associated with higher levels of deprivation.

Economic circumstances and limited employment opportunities may lead to involvement in sex work. There are a high number of sexual assaults amongst the homeless. In one study 13% of homeless women reported having been raped in the previous 12 months, and 50% of these women were raped twice.

Having previously been sexually assaulted when young

There is some evidence that experiencing sexual abuse in childhood or adolescence is a risk factor for sexual victimisation during adulthood. Women with a childhood history of sexual abuse are 4.7 times more likely to be subsequently raped

Evidence suggests that sexual violence is a learnt behaviour in some men. Studies on boys with a history of child sexual abuse show that 1 in 5 continue in later life to molest children themselves, thus continuing the cycle of abuse.

Violence in the family

One of the most common forms of sexual violence is that perpetrated by an intimate partner. About 50% of women who have experienced domestic violence are raped within their physically abusive relationship.

Alcohol and drug misuse

It is estimated that about 50% of all sexual assaults are committed by men who have been drinking alcohol. Similarly, about 50% of all sexual assault victims report that they were drinking alcohol at the time of the assault.

Mental illness, learning and physical disability

Disabled people and those with learning impairment and mental illness are reported to be four times more likely to experience sexual violence, and yet there is under-reporting of incidents. Victims of sexual violence from these groups may have difficulty verbalising their abuse.

Housing

Factors relating to household location, and housing tenure were also related to risk of victimisation. For example, prevalence rates were higher among females in the ‘City Living’ Output Area Classification category (5.5%), people living in flats or maisonettes (3.9%), those living in an urban area (2.6%) and in rented accommodation (3.4% for social rented accommodation and 4.6% for private rented).

Lifestyle

Sexual victimisation rates were higher for females who reported visiting a pub at least once a week (4.3%) or a night club one to three times a month (5.6%). Those who visited a night club at least four times a month had the highest victimisation rate of any characteristic covered by the CSEW (9.2%).



What is the level of need in the population?

Estimated prevalence

Estimated prevalence of sexual violence victimisation in Teesside during 2013/14

The Crime Survey of England and Wales (CSEW) estimates that in Teesside (2013/14), there was around 970 victims of serious sexual assault (rape, attempted rape and sexual assault), with 812  being female victims and 158 male.   Further estimates through the CSEW indicate that there was in the region of 4,700 (4,067 female and 633 male) victims of any sexual assault during the same time period.

When comparing this to the data received from the Police, the SARC and the Teesside Sexual Violence Services, the indication is that there is likely to have been a significant number of people that have been a victim of rape and other serious sexual offences that have not reported the incident to the SARC, the Police or other sexual violence service.   There is some concern that the rise nationally on the reporting of historical incidents may also at some point have an impact on the sexual violence services who may struggle to meet the demand.

Estimated prevalence of sexual violence victimisation in Teesside since the age of 16 years

The Crime Survey of England and Wales (CSEW) estimates that in Teesside it is likely that there are around 9,416 people (16+ years) who have been a victim of one or more serious sexual assaults (rape, attempted rape and sexual assault), with 8,624  being female victims and 792 male.   Further estimates through the CSEW indicate that there is in the region of 36,171 (31,893 female and 4,278 male) people (16+ years) who have been a victim of any sexual assault.

Cleveland Police

The tables below show the numbers of sexual offences were recorded by Cleveland Police during 2013/14 compared to the previous year.  

Office for National Statistics recorded crime statistics

The recorded crime figures for England and Wales showed an increase of 20% in all sexual offences in 2013/14 compared with the previous year. This is the highest level recorded since the introduction of the National Crime Recording Standard in April 2002.

The table below provides a comparison between national trends and the recorded figures for the Teesside.  

Due to levels of previous under reporting and the impact of major investigations in certain parts of the UK it is difficult to interpret anything from the comparison with national and local trends.

Service utilisation data in Teesside

The Sexual Assault Referral Centre (SARC)

Of the above 538 referrals received at the SARC, 447 (83%) were female and 91 (17%) male.  

ARCH North East (Sexual Abuse, Rape, Counselling & Help)

Of the 415 clients referred to ARCH during the reporting period, approximately three-quarters were female, and one-quarter were male.

EVA (Emerging from violence and abuse)

The chart above outlines the number of sexual violence referrals received by EVA during the reporting period, with the main referrer being the SARC.

Harbour

The chart above outlines the number of referrals made to the Harbour Sexual Violence counselling service during the reporting period. Of the 256 people referred, 125 subsequently received a counselling service with 625 counselling sessions being delivered.  

Barnardos

During the reporting period, the SARC made 47 referrals to the Barnardos ISVA Service, all of which received a service. The 47 clients received a total of 749 ISVA sessions.  



What services are currently provided?

The Sexual Assault Referral Centre (SARC)

SARC is a Tees-wide service that provides crisis intervention, crisis support work, ISVA provision, practical and emotional support, forensic facilities, police interviewing facilities, first line medication, early evidence kits, options for non-police reporting, options for anonymous intelligence sharing, clothing and showering facilities for victims, co-ordination of all non SARC personnel, provides specialist knowledge across Teesside to health, third sector, social services etc. through training and awareness raising sessions, develops and maintains robust pathways to span the whole victim journey and case file tracking.

TASCOR

TASCOR provide the forensic examination and medical services with all adults that attend the SARC.   The service is funded by the PCC as part of the custody contract.   The on-call doctor responsible for calls within the custody environment is also responsible for calls relating to the SARC.

RVI

The RVI see children (under-16 years old) from the North East of England who are suspected of being a victim of sexual abuse. They will see 17 to 18-year-olds if the young person has learning difficulties, if they are particularly vulnerable or if they are in looked after care.  

ARCH North East (Sexual Abuse, Rape, Counselling & Help)

Arch provide the following services to victims of sexual violence and their families:

  • ISVA service – support from report to court for people progressing through the criminal justice system. The team also support those people who may be considering whether or not to make a report to police.
  • Specialist sexual violence counselling service – This is an integrative service from a person centred base and is provided for anyone who has been affected by sexual violence at any time in their lives.  This includes people who have suffered rape or sexual assault (either recent or historic) and those who experienced sexual abuse in their childhood.
  • LESA Service (Life Enhancement Skills Advisor) – Internal service only. Provides practical and emotional support to clients across a range of issues that may be impacting on their ability to recover and move on with their lives.

EVA (Emerging from violence and abuse)

As an organisation EVA Women’s Aid and Rape Crisis provide a wraparound service around domestic violence and also sexual violence.   They provide a range of free, confidential and non-judgemental specialist support for women and children who have been affected by any form of domestic and or sexual abuse at any time in their lives.  

Harbour

Harbour provides a sexual violence counselling service in Stockton-On-Tees and Hartlepool, with female and male clients, generally over 16 year-olds but they have worked with younger people when the needs have required it.   They work with all sexual violence victims and are not restricted to those that occur within a domestic violence setting. 

Foundation

The Foundation ISVA service for females aged over 14 years old that offers regular emotional and practical support to fit in with the client’s needs and help them deal with the impact of rape, sexual assault or childhood sexual abuse.   Foundation provides an assessment of need and risk, individual support and therapeutic intervention.  

Victim Support

Victim Support have specially trained volunteers who provide information to victims, practical help and emotional support.  The service is confidential and is provided regardless of whether it has been reported to the police.  Volunteers visit victims in their own home, a victim support office or somewhere else if the victim prefers.  If the victim would prefer to speak to someone over the phone then equally this can be arranged.  The service is for male and female victims.   When working with young people they tend to work with the family unit rather than just the individual victim.   Practical support includes completion of criminal injuries compensation applications and at times they receive requests from a sexual violence service to help the victim to complete this process. 

Barnardos

Barnardos ISVA team provide a specialist young person sexual violence service.   The ISVAs provide emotional and practical support through intensive face to face outreach sessions, text, letter, and telephone contact.   They act as advisors and provide holistic support for the child and the family. They also provide support related to the following:

  • Child Sexual Exploitation (CSE).
  • Therapeutic services
  • Sexual Exploitation of Children On the Streets  (SECOS)

My Sisters Place

My Sisters Place deal with sexual violence as part of the domestic violence support. 

A Way Out

A Way Out work with women involved in survival sex work (women who exchange sex for money, drugs, accommodation etc.).  The model is very much an on-street operation with a recognised ‘red-light’ area, meaning the women are constantly at very high risk of violence.

Improving Access to Psychological Therapies (IAPT)

IAPT provide a programme that helps people suffering from depression and anxiety disorders to find the best type of therapy for them.  The Local IAPT providers are:

  • Alliance Psychological Services Ltd
  • MIND
  • Starfish Health and Wellbeing
  • Talking Matters Teesside
  • Tees Esk and Wear Valleys NHS Foundation Trust - Tees Time to Talk


What is the projected level of need?

There are currently no projected levels of need.



What needs might be unmet?

There are gaps and inconsistencies in the sexual violence services across Teesside. There is a need to provide an equal service across Teesside for all, regardless of where the client lives, their sex, age or offending history among others. 

There’s currently no joint commissioning or collaborative commissioning agreement in respect of the Tees sexual violence services. This is particularly in respect of the ISVA Service, counselling, services for men and services for those that have been accused of an offence. 

There is inconsistency in respect of the ISVA and sexual violence counselling services across Teesside.

There are no services for men in Redcar and Cleveland.

A concern has been expressed that the counselling delivered for post-traumatic stress disorder (PTSD) may conflict with the National Institute for Health and Care Excellence (NICE) and World Health Organisation (WHO) Guidelines.   NICE guidance states that patient’s preference should be an important determinant of the choice among effective treatments.   PTSD sufferers should be given sufficient information about the nature of these treatments to make an informed choice.   These concerns could be addressed through consultation with the current specialist sexual violence service counselling providers. 

There may be a need to raise awareness of the Teesside Pre-Trial Therapy Protocol (PTT) with the Improving Access to Psychological Therapy (IAPT) services.  

Some mental health issues cannot be assessed for in the acute stages through the SARC. The specialist mental health assessment should be delivered through the specialist sexual violence services.

There are no service level agreements between the SARC, the Police and the ISVAs.

There are no service agreements between the SARC and the sexual violence counselling and support services.

Promotions and marketing of the sexual violence services to professionals and members of the public could be improved.   This could be co-ordinated through the SARC or delivered individually by each of the services.

Gaps within the individual sexual violence services

SARC

Emotional support where the client is being supported through the SARC ISVA and counselling may not be appropriate, clinical supervision for all staff, continued professional development for the SARC manager and SARC staff.   The SARC has the responsibility to develop robust pathways between the SARC and the sexual violence services but there is a limited resource available to do this. 

Arch

Arch lack the capacity to promote and market the sexual violence services to stakeholders such as GPs, mental health services and members of the public.   This could be improved through collaboration with the SARC.

Eva

There is currently a counselling waiting list.

Harbour

There is currently a lack of funding and commissioning restraints

Victim Support

There is no ISVA. An enhanced service from within victim support, specialist services for BME clients and specialist services for young sexual violence clients would be beneficial.

Barnardos

Addressing peer on peer sexual violence is required.

A Way Out

Specialist ISVA for women involved in sex work is required. More provision for sexual abuse counselling is needed as there is currently a waiting list. An appropriate knowledge concerning women involved in sex work and the abuse they suffer is necessary.

Tees Esk and Wear Valley (TEWV)

There needs to be more knowledge within TEWV of the role and responsibilities of the SARC and the other sexual violence services cross Teesside. There needs to be more information available from TEWV around what is on offer to support families of those that have been involved in a sexual violence incident.



What evidence is there for effective intervention?

The following list of standards, guidelines and accreditations are applied across the Teesside sexual violence services to ensure that there is effective intervention through the services:

  • The Teesside Sexual Violence Strategy Group – Core principles and service standards (including children & Young Persons) also Teesside Sexual Assault Referral Centre (Helen Britton House) operating standards
  • National SARC standards.
  • National occupational ISVA standards – These are delivered through Lime, Culture, CAADA, New Pathways and Warwick University.
  • NICE clinical guideline - 26 Post-traumatic stress disorder (PTSD). The management of PTSD in adults and children in primary and secondary care. Issued: March 2005 guidance.nice.org.uk/cg26
  • British Association for Counselling and Psychotherapy.
  • Rape Crisis England and Wales.
  • Lime Culture
  • CAADA

Abbey A, Ross LT, McDuffie D. Alcohol's role in sexual assault. In: Watson RR, editor. Drug and alcohol abuse reviews: Volume 5 addictive behaviours in women. Totowa NJ: Humana Press, 1994.

Acierno R, Resnick H, Kilpatrick DG, Saunders B, Best CL. Risk Factors for Rape, Physical Assault, and Post-traumatic Stress Disorder in Women: examination of Differential Multivariate Relationships. Journal of Anxiety

Disorders 1999;13(6):541–63.

Cunningham S, Drury S. Access All Areas: A Guide for Community Safety

Partnerships on Working More Effectively with Disabled People: Report for

NACRO, 2002.

Department of Health. Home Office, Association of Chief Police Offices. Revised National Service Guide. A Resource for Developing Sexual Assault Referral Centres. In:

http://ww2.reading.gov.uk/documents/community-living/communitysafety/

ResourceforDevelopingSexualAssaultReferralCentres.pdf, editor, October 2009.

Department of Health and Association of Chief Police Officers. Response to sexual violence needs assessments (RSVNA) toolkit: informing the commissioning and development of co-ordinated specialist services for victims of sexual violence (2011).

Farley M, Howard B. Prostitution, violence and post-traumatic stress disorder. Women & Health 1998;27(3):37-49.

Farley M, Kelly V. Prostitution: a critical review of the medical and social sciences literature. Women and Criminal Justice 2000;11(4):29-64.

Her Majesty Government. Cross Government Action Plan on Sexual Violence and Abuse 2007.

Martin SL, Ray N, Sotres-Alvarez D, Krupper LL, Moracco KE, Dickens PA, et al. Physical and Sexual Assault of Women With Disabilities. Violence Against Women 2006;2006(12):823.

Miller, D. (2002) Disabled Children and Abuse. London: NSPCC Information Briefing.

Sin CH, Hedges A, Cook C, Mguni N, Comber N. Disabled people’s experiences of targeted violence and hostility. Manchester: Office for Public Management, Equality and Human Rights Commission, 2009.

Tees Sexual Violence Needs Assessment  2012.

Watkins B, Bentovim A. The sexual abuse of male children and adolescents: a review of current research. Journal of Child Psychology and Psychiatry 1992;33:197-248.



What do people say?

The Crime Survey of England and Wales (CSEW)

The CSEW measures the extent of crime in England and Wales by asking people whether they have experienced any crime in the past year.  The survey has measured crime in this way since 1982 and is a valuable source of information for the government about the extent and nature of crime in England and Wales.   It records crimes that may not have been reported to the police, so it is used as an alternative to police records.

In 2013, around 50,000 households across England and Wales were invited to participate in the survey with three-quarters of households invited to take part actually doing so.

As well as the main crime questionnaire, the annual CSEW includes an additional self-completion module that asks males and females, aged 16 to 59, about their experience of sexual offences in the last year.  This estimate of victimisation has the benefit of including offences that do not come to the attention of the police.

The table below provides the CSEW estimation of prevalence of being a victim of a sexual offence for those aged 16-59 years in the 12 months prior to the survey.

England and Wales                                            

% who were victims once or more

 

Males

Females

All

Any sexual offences (including attempts)

0.4

2.5

1.5

Most serious sexual offences (including attempts)

0.1

0.5

0.3

Rape  (including attempts)

0.1

0.4

0.2

Assault by penetration (including attempts)

0.0

0.2

0.1

Most serious sexual offences (excluding attempts)

0.1

0.4

0.2

Rape (excluding attempts)

0.0

0.3

0.2

Assault by penetration (excluding attempts)

0.0

0.1

0.1

Other sexual offences

0.4

2.3

1.3

Compared to the needs assessment prepared in January 2012, there is little change and where there is variation; the changes are no greater than 0.1%. 



What additional needs assessment is required?

There is a need to develop a much greater understanding of the issues of sexual violence within the BME community

There is a need to develop a greater understanding of the needs of the Lesbian, Gay, Bisexual and Transgender (LGBT) community and assess if people are aware of and have confidence in the current services.

There is a need to develop a greater understanding of the needs of those living with some form of disability and assess if they are aware of and have confidence in the current services.

Further research needs to take place to understand the needs of those that may report incidents of sexual violence that occurred whilst in prison and also have a greater understanding of the needs of victims of historical incidents of sexual violence who are in custody.

Further research could take place in respect of the perpetrators of sexual violence.



Key contact

Name: Graham Strange

Job title: Tees Sexual Violence Strategy Group Coordinator

e-mail: graham.strange@safeinteesvalley.org

Phone number: 07972407297

References

 

 

Local strategies and plans

Teesside Sexual Violence Strategy Group –Core Principles and Service Standards (including children and young people) also Teesside Sexual Assault Referral Centre Operating Standards.

National strategies and plans

NHS England – Securing Excellence in Commissioning sexual assault services for people who experience sexual violence – 13.6.13

Public Health functions to be exercised by the NHS Commissioning Board – Service Specification No. 30, Sexual Assault Services – November 2012

Other references

National Institute for Health and Care Excellence (NICE) Post-traumatic stress disorder (PTSD) - The management of PTSD in adults and children in primary and secondary care. Issued: March 2005.   NICE clinical guideline 26.

DAC Beachcroft – NHS England – Health & Justice (Durham, Darlington and Tees) Commissioning Responsibilities in respect of Sexual Assault Referral Centres

Ministry of justice, Home Office and Office for National Statistics - An Overview of Sexual Offending in England and Wales January 2013

 



Domestic violence victims

Domestic violence is currently defined as:

‘Any incident of threatening behaviour, violence or abuse between adults who are, or who have been, in a relationship, or between family members. It can affect anyone regardless of his or her gender or sexuality. The violence can be psychological, physical, sexual, or emotional.’ (Home Office 2008).

Domestic violence includes issues of concern to black and minority ethnic and refugee communities, such as so called ‘honour based violence’, female genital mutilation and forced marriage.

Domestic violence is rarely a one-off incident and should instead be seen as a pattern of abusive and controlling behaviour through which the abuser seeks power over their victim.  Domestic violence occurs across society, regardless of age, race, sexuality, gender identity, religion, wealth and geography.

One in four women experience domestic violence over their lifetimes and between 6-10% of women suffer domestic violence in a given year (Council of Europe, 2002).

Domestic violence has the highest rate of repeat victimisation of any other crime type. Seventy three per cent of incidents of domestic violence were experienced by repeat victims, and of the victims interviewed, just under half were victimised more than once, and nearly one quarter were victimised three or more times. (British Crime Survey, 2010/11)

On average, two women a week are killed by a violent partner or ex-partner, which constitutes nearly 40% of all female homicide victims.  (Povey, (ed.), 2005; Home Office, 1999; Department of Health, 2005.)

The relationship between the effects of domestic violence, physical and mental well-being is well documented. Psychological and physical effects of abuse can be felt for many years often with the continuation of psychological/mental health issues, chronic physical health problems as well familial and socioeconomic impacts.



What are the key issues?

The British Crime Survey 2009/10 indicates that domestic violence and abuse continues to be under reported.

The Safer Hartlepool annual strategic assessment 2010-2011 indicates:

  • Both domestic-related violence and incidents continue to increase in Hartlepool.
  • Hartlepool Basic Command Unit (BCU) has the second highest domestic incident rate in the Cleveland Force area.
  • Domestic violence accounts for 40% of violent crime in Hartlepool, where repeat victimisation is evident.
  • One in ten assault-related presentations to A&E and the Minor Injury Unit were domestic-related.
  • Alcohol continues to be a contributory factor, with 47% of domestic violence crimes linked to alcohol.
  • Females are at greater risk of domestic violence and abuse, but one in ten victims is male.

Domestic violence is a major indicator of risk to children and young people (Department of Health, 2003). Within Hartlepool over 150 children witnessed a domestic-related crime.



What commissioning priorities are recommended?

2012/01

Develop, implement and monitor the Safer Hartlepool Domestic Violence Strategy 2012–2015 to break the cycle of domestic violence in Hartlepool, focusing on:

  • Prevention & Early Intervention: Increase awareness and knowledge of the impact of domestic violence, services and options available and intervene early to reduce violence and the escalation of violence.
  • Provision of Services: Provide support to victims/survivors, and children whose lives are blighted by domestic violence and to perpetrators and ensure that they face minimal barriers in accessing the support they need.
  • Partnership Working: Work closely with partners to obtain the best outcome for victims and their families.
  • Justice Outcomes and Risk Reduction for Victims: Take prompt action to reduce the risk to victims and their family. Empower victims to support the criminal justice process to ensure perpetrators are brought to justice.


Who is at risk and why?

Gender 

Women are much more likely than men to experience domestic abuse. Analysis of 10 separate prevalence studies has shown that 1 in 4 women will experience domestic violence over their lifetimes. [1]

Women are also more likely than men to be the victim of multiple incidents of abuse. 32% of women who had ever experienced domestic violence did so four or five (or more) times, compared with 11% of men. Women constitute 89% of all those who have experienced 4 or more incidents of domestic violence.

Age

Younger women

Younger women under the age of 30 years old are shown to be most at risk of domestic violence, with those aged between 16-19 at greater risk (10.1% of respondents to the BCS), closely followed by the 20–24 year old age group (9.2% of respondents). [2]

Children and young people

Domestic violence is also a child protection issue. Children can experience abuse both directly and indirectly.  On a national basis the Home Office estimate that three quarters of a million children witness domestic abuse every year and that three quarters of children living with a child protection plan live in households where domestic violence occurs. [7]

Domestic violence can have an impact upon a child’s emotional, behavioural and cognitive development. Its effects can include anxiety, fear, withdrawal, highly sexualised and aggressive behaviour, reduced educational attainment, failure to acquire social competence, anti-social behaviour and also in some cases the use of substances. [8]

Older people

Older people may become more vulnerable and therefore more dependent on others for help and support. As with domestic violence and abuse, elder abuse can present in several different forms including physical abuse, sexual abuse, emotional abuse, financial exploitation and neglect – whether intentional or not.

Pregnancy

Research shows that 30% of domestic violence starts or escalates during pregnancy. With the same study showing that domestic violence has been identified as a prime cause of miscarriage, or still birth and of maternal deaths in childbirth. [3]

A further study into women receiving antenatal and postnatal care to examine the prevalence of domestic violence and its associations with obstetric complications and psychological health, found that 23% of women involved had a lifetime experience of domestic violence, and 3% had experienced violence in the current pregnancy. These figures are recognised as underestimates due to the sensitive nature and reporting of abuse.  [4]

Separation

Women who separate from their partner are at a much higher risk of domestic violence than women in other marital circumstances. The BCS study found that 22% of separated women were assaulted in the previous year by their partners or ex partners.

Socioeconomic factors

People living in poor and financially insecure households are more likely to suffer from domestic violence. Domestic violence can also lead to poverty as it often creates instability, difficulties in maintaining employment and increases in ill health. As abuse is also found in households that are financially better off.

Ethnicity

There is no significant difference in the risk of domestic violence by ethnicity reported in the BCS. However women from ethnic minorities may have greater difficulties in accessing services due to language, inter-generational issues, and cultural differences. [5]

Disability

National research shows that women with a disability are twice as likely to experience abuse as women living without a disability. Issues facing disabled women can make it harder for them to access support. They may be more physically vulnerable and socially isolated than other women relying heavily on the abuser for basic care needs and access to the wider community. [6]

Perpetrators

Perpetrators of domestic violence are often still a part of the family. Perpetrators of violence frequently have complex needs, and behaviours, which can include mental health issues, substance misuse issues, self-harm, and offending behaviour. 

Lesbian, gay, bisexual or transgender (LGBT)

Domestic abuse and violence is a considerable problem for members of the LGBT community. People in this group can be reluctant to seek help for fear of homophobia and may be unable to turn to family or friends for support if they are not ‘out’ about their sexuality.  This can leave such people who suffer from domestic violence especially isolated and at risk of further abuse.



What is the level of need in the population?

Gaining a comprehensive picture of domestic violence in Hartlepool remains challenging, due to the sensitivity and nature of this crime type. The key agencies for reliable local data are the police, specialist support services, the local authority and health.

Hartlepool has a population of approximately 90, 000 of which 37, 200 are women aged 16 years and over. Using the Violence against Women and Girls ready reckoner, and based on regional data from the British Crime Survey, the estimate for an area the size of Hartlepool would be that:

  • 4,800 women and girls aged between 16-59 years have been a victim of domestic abuse in the past year.
  • 2,000 women and girls aged between 16-59 years have been a victim of sexual assault in the past year
  • 5,700 women and girls aged between 16-59 years have been a victim of stalking in the past year.

The British Crime Survey (2010/2011) estimates that 25% of women will experience domestic abuse violence at some point in their lifetime, indicating 9,300 possible survivors in Hartlepool.

Hartlepool Multi-Agency Risk Assessment Conference (MARAC) statistics indicate that 4% of high risk cases related to males, 6% related to victims with a registered disability and less than 1% of victims were from the BMER community.

Local research indicates that approximately 20% of males who identify themselves as victims are also linked to perpetrator behaviour.

Over two-thirds of Specialist Support service users have children, where self-reporting indicates that 2 in 10 children are classified as Child In Need (CIN) and a further 7% are subject to Child Protection Plans.

There is an association between domestic violence and high levels of deprivation with Stranton, Brus, Dyke House and Owton wards collectively accounting for almost one half of domestic violence offences in Hartlepool.

The successful implementation of the Domestic Violence Strategy 2012-2015 will increase awareness and knowledge of domestic violence in Hartlepool. It is expected that service demand in the form of incident reporting and access to support services will increase.



What services are currently provided?

Cleveland Police Vulnerability Unit – The North Tees Vulnerability Unit deal with issues of crime relating to domestic violence, child abuse and vulnerable adults.

Hartlepool Domestic Violence Forum – The forum brings together key agencies and practitioners to oversee the delivery of the domestic violence strategy and action plan.

Hartlepool Safeguarding Children Board (HSCB)

To increase the awareness and understanding of domestic violence and the impact on children, the HSCB have provided a tailored training course for frontline staff and practitioners.

Refuge Service

Harbour Hartlepool Refuge has six self-contained units, as well as a room to accommodate emergency overnight stays.  The refuge can be accessed 24 hours a day, and staff provide support and guidance to women and their children.

Sexual Violence Counselling Service

Harbour's counselling programme offers support to victims of sexual abuse or rape. Qualified counsellors work with male and females aged 18 years and over on an individual or group basis.

Children's Outreach

Harbour's Children's Outreach Team works with children aged 3-16 years who are living with domestic abuse or experiencing a chaotic lifestyle. Services include one to one support and group work sessions. The Children's Outreach Team also works with young people to promote healthy and respectful relationships.

Perpetrator Programme

Harbour provides a programme for men who have been violent or abusive to a partner or ex-partner and can demonstrate their intention to change their behaviour.  The programme is voluntary and, after initial assessments, comprises of a 30 session rolling programme of group work.

Freedom Programme

The Harbour Freedom Programme is a free 12-week course that will help women to understand the beliefs held by abusive men and the effect of abuse upon children. The programme aims to help participants to help themselves and increase their self-confidence.

Target Hardening

The provision of enhanced security measures and advice allows victims to remain in their own home, and prevent the risk of repeat victimisation.

Specialist Domestic Violence Courts (SDVC)

The SDVC is dedicated specifically to cases of domestic violence which aims to offer victims of domestic abuse greater support for bringing perpetrators to account. The SDVC uses a multi-agency approach to combine both criminal and non-criminal justice interventions to provide a more co-ordinated response to cases of domestic violence.

Independent Domestic Violence Advisors (IDVAs)

IDVAs are independent professional advisors that work with victims from the point of crisis to assess the level of risk, discuss the range of suitable options available to victims and develop coordinated safety plans.

Independent Sexual Violence Advisors (ISVAs)

ISVA's provide support and advice to victims of recent and historic sexual violence and abuse throughout and beyond the criminal justice process.

Multi Agency Risk Assessment Conferencing (MARAC)

MARAC is a multi-agency meeting that focuses on the safety of high risk domestic violence victims.  Probation, Police, Housing, Local Authority, Health and IDVA are a few of the agencies that attend MARAC.

Sexual Assault Referral Centres (SARC)

SARCs are one-stop locations where victims of recent sexual assault can receive medical care and counselling quickly and where forensic evidence can be obtained for potential prosecutions.

Community Domestic Violence Programme (CDVP)

The CDVP is a court mandated programme that may form part of a community sentence or be a condition of a prison licence. It is a programme for men who have committed at least one act of violence against a spouse or partner.



What is the projected level of need?

It is difficult to predict the true prevalence of domestic violence, due to the difficulties in obtaining reliable information and the recognised levels of under-reporting. 

Domestic violence is not reducing at the same rate as other types of violent crime. There is the possibility for domestic violence to increase in the forthcoming year as many families struggle financially in the current economic climate.



What needs might be unmet?

Gaps include:

Data Sharing

Improved data sharing across statutory agencies, voluntary sector and between departments within the Local Authority is needed.

Referral Protocols

All agencies including voluntary sector, Police, Health, Local Authority Departments, Housing and the Crown Prosecution Service needs to be involved in developing and/or agreeing to referral protocols for clients.

Workforce Development & Training

Raising the awareness domestic violence with frontline practitioners and professionals, including Education and Health professionals through training and effective practice.

Strengthen Protection

The need for the early identification and clear referral process for vulnerable children and pregnant mothers who are at risk of domestic violence.

Young Perpetrators & Victims

Identification and support for young perpetrators and victims of domestic violence, challenging their behaviour and attitudes.

Provision of Specialist Services

Limited availability of specialist services in Hartlepool for the BMER community, LGBT community and male victims of domestic violence.



What evidence is there for effective intervention?

National Guidance

The National Institute for Clinical Excellence (NICE) is currently undertaking a review, which will provide recommendations for good practice based upon the best available evidence of effectiveness. The public health guidance is due to be published in February 2014 and is titled: Preventing Domestic Violence: How social care, health services, and those they work with can identify, prevent, and reduce domestic violence. 

Home Office: Call to end violence against women and girls. Action Plan 2011 http://www.homeoffice.gov.uk/publications/crime/call-end-violence-women-girls/vawg-action-plan?view=Binary

Home Office: Tackling Domestic Violence: Effective Interventions and Approaches 2005 http://dro.dur.ac.uk/2556/1/2556.pdf

Home Office: Tackling Domestic Violence: Providing Support for Children who have witnessed domestic violence 2004 http://ndvf.org.uk/files/document/848/original.pdf

Department of Health: Responding to domestic abuse: A handbook for health professionals 2005 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4126161

Department of Health: Improving Safety, Reducing Harm: Children, Young People and Domestic Violence 2009 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_108697



What do people say?

Respondents to a local survey (Viewpoint 36) felt that domestic violence in Hartlepool is a problem, with 86% of respondents stating that they would report the incident to the Police.

Three quarters (73%) of Viewpoint members agreed that more education about domestic abuse is needed for the general public. This is accompanied by the need to promote local support services.

Consultation with Domestic Violence Support Service users continues.



What additional needs assessment is required?

No additional needs assessment is currently required.



Key Contact

Topic lead

Name: Clare Clark

Job title:

e-mail: Clare.Clark@hartlepool.gov.uk

Phone number:

Topic author

Name: Lisa Oldroyd

Job title:

e-mail: Lisa.Oldroyd@hartlepool.gov.uk

Phone:

 

References

 

Local strategies and plans

 

National strategies and plans

 

Other references

 



Carers

Carers are people who provide (or intend to provide) a substantial amount of care on a regular basis to people who require support to maximise and/or maintain their independence (Department of Health, 2008). Although ‘substantial’ and ‘regular’ are not defined in legislation or guidance, in many cases the potential impact is self-evident.

Recognising carers and the contribution they make to society is important for raising their profile and identifying better ways of helping them to help others. Historically the needs of carers have been overlooked. Whilst this situation is improving, many carers remain socially excluded, suffer from caring-related ill-health and, once they have ceased caring, find themselves in a difficult economic position, often with little or no pension provision.  This can lead to the carers needing to access health and social care services for themselves and may impair their ability to continue providing care to the cared for person.

The economic value of unpaid care is estimated to be £87 billion nationally (Carers UK & University of Leeds, 2011).  For Hartlepool this would be around £172 million.

This topic links with

 



What are the key issues?

The Hartlepool Carers Strategy 2011 identifies nine priorities areas for action:

  1. Information and communication
  2. Access to health services
  3. Access to financial resources
  4. Support with assessments
  5. Remove discrimination of carers
  6. Flexibility for a life of your own
  7. Training and support to care
  8. Emotional support
  9. Work, education and leisure.

 



What commissioning priorities are recommended?

2012/01
Identify carers so that effective support and information can be made available at the time when it is needed. This includes identification of carers in primary care.

2012/02
Enable carers to access the right information in the right place at the right time.

2012/03
Promote representation from “hard to reach groups” and should include people whose first or only language is not English, people from BME communities and deaf people.

2012/04
Build on the work already done to identify carers in primary health care to ensure all carers are known to their GPs.

2012/05
Improve emotional support and mental health of carers by improving support regarding well-being, self-help and mutual support, identify more options to have a ‘life of one’s own’ and improve the range of opportunities for short breaks, respite, and activities where the cared for and carer can enjoy together and enable appropriate medical and psychological support.

2012/06
Improve access to work, education and leisure for carers by working with employers and educational institutions.

2012/07
Improve data collection locally to better identify carers and the amount of support they offer so that a more accurate figure is obtained.



Who is at risk and why?

The National Carers Strategy (DH, 2010a) identified the needs of carers in five main areas:

  • Carers will be respected as expert care partners and will have access to the integrated and personalised services they need to support them in their caring role.
  • Carers will be able to have a life of their own alongside their caring role.
  • Carers will be supported so that they are not forced into financial hardship by their caring role.
  • Carers will be supported to stay mentally and physically well and treated with dignity.
  • Children and young people will be protected from inappropriate caring and have the support they need to learn, develop and thrive and to enjoy positive childhoods.


All carers are at risk of poor health and well-being due to their caring role.  Carers of different client groups (i.e. different types of illness of the cared for person) face different challenges but these challenges can put them all at risk of poor health and well-being. However, some have an increased risk of poor physical and mental health.

Age
The 2001 Census shows that the peak age for caring is 50 to 59. More than one-in-five people aged 50-59 (1.5 million across the UK) provide some unpaid care (Carers UK, 2012).

Young carers
There are 175,000 young carers in the UK, of whom 13,000 care for over fifty hours a week (2001 Census). Some carers can be as young as 5 years old. Younger carers encounter specific problems, for example 68% of young carers report that they are bullied at school.  Young carers, many of whom are providing inappropriate levels of care, are at risk of not only poor health and well-being, but their caring role can also impact on their emotional and social development and on their education.

Working age carers
There is little information about working age carers although we do know most carers fall into this age group.  Nationally, just less than one in eight (13%) adults aged 16 to 64 in full-time employment care for a sick, disabled or elderly person. However, the prevalence of caring is highest of all among the economically inactive, just over one in five (21 per cent) of whom were spending time caring for someone.  About half of carers spending the most time (between 20 and 49 hours) caring per week were in employment in 2001. The challenges of combining paid work and informal care seems to particularly affect those undertaking substantial hours of caring per week (DWP, 2009).

Older carers
This group of carers is at higher risk of poor health as they have the additional problems associated with ageing.  A survey of experiences of older carers showed that 65% had long-term conditions or disabilities themselves, and 69% said their caring role had an adverse effect on their mental health (Princess Trust for Carers, 2011).

Gender
In the UK, more women than men have a caring role; 58% of carers are women and 42%  are men (Carers UK, 2012).

Socioeconomic status
Over one in five (21%) economically inactive people are carers, a rate that is more than 50% higher than for people in full-time employment (Department of Work and Pensions, 2009).
For carers who give up work there will be an impact on pension contributions and an increased risk of poverty in later life.  Amongst carers:

  • 45% are depressed about their financial position,
  • 62% have no savings,
  • 15% have turned to drink or drugs to cope with their financial situation (Princess Royal Trust for Carers, 2010).

The skills of carers are lost to the workforce and economy.

Ethnicity
Carers in the BME community can be reluctant to seek help, are often unaware of the support available and can become isolated in their role.  Bangledeshi and Pakistani men and women are three times more likely to provide care compared with their white British counterparts (Carers UK, 2012).

Carers providing care for a substantial number of hours per week
Increased time spent caring can increase the risk of poor health as the stress involved may increase and the carer has less time to consider their own health. This is particularly relevant to older carers whose health is at risk due to the normal ageing process.



What is the level of need in the population?

In the 2001 census, 9,853 people from Hartlepool identified themselves as carers (11.1% of the population and similar to the national average).  A total of 2,680 of those carers identified themselves as providing over 50 hours of care per week (3% of the population). More recent information is not currently available but will be when the findings from the 2011 census are published.

The majority of carers are over 50 years old. The Projecting Older People Population Information System (POPPI) estimates that 11.3% of people aged 65 years and over living in Hartlepool identify themselves as carers. For those aged 65 to 74 years where the prevalence is highest, 14.6% are carers. These are similar to regional and national rates.

The amount of support provided by men and women is disproportionate with women in Hartlepool providing 60% of care as opposed to 40% by men. This ratio is the same for the Tees Valley and the North East of England but differs slightly from  England and Wales as a whole (58% women and 42% men).

In the 2001 census 2,706 people between the age of 18 and 64 stated that they had a moderate or serious personal care disability (Projecting Adult Needs and Services Information, PANSI). At the same time 4,840 people aged 65 years and over stated that they were unable to carry out at least one personal care task themselves (POPPI). The vast majority of these were aged 75 years and over.   These two definitions are slightly different as the figures are drawn from separate data bases. However the combined finding is that there are over 7,500 people in Hartlepool who need the support of carers to enable them to carry out activities of daily living.
 



What services are currently provided?

Adult carers

  • Carers Information Service: an information service which co-ordinates and directs carers to available training.
  • Carers awareness training for professionals.
  • GP carers project to increase identification of carers for primary care.
  • Hartlepool Carers, the local voluntary sector organisation for carers provides:
    • A single contact focusing on home-based support and personalisation.
    • A Carers Card scheme where carers are able to claim discount on purchases and services from local suppliers.
    • Emotional and practical support for carers.
  • Continuous development of a carers self-directed assessment questionnaire (CSDAQ) and carers resource allocation system (CRAS).
  • A carers grant supports the positive promotion of carers in Hartlepool, focusing on Carers’ Rights Day and Carer’s Week.
  • The Carers Strategy Group allocated funding to projects that support carers.
  • Support for carers of people with dementia is offered through the “Dementia Café” and carers group by Hospital of God.
  • Carers can access carers’ Personal Budgets and use them in the form of “Direct Payment” from the local authority.

Younger carers
The Young Carers Project element of Hartlepool Carers, a local voluntary sector organisation, provides the service to young carers. Children and young people access the Young Carers Project through a range of sources, typically through self-referral or a referral from a number of statutory agencies or voluntary sector organisations.  The support services delivered by the Young Carers Project that have evolved via this partnership are:

  • One-to-one support for young carers and their parents / carers (advice, assistance, practical and advocacy);
  • Family support;
  • Themed group work (junior and senior groups);
  • Holiday and respite activities (access to and respite);
  • Volunteer services;
  • Counselling;
  • School liaison and one-to-one work;
  • Transitions for 16 to 19-year-olds (education, employment, training and support and link to Adult Services);
  • Support young carers to attend regional events and the national young carers’ convention;
  • Raising awareness of young carers and the issues that affect their lives.
     

 



What is the projected level of need?

By 2030, the number of people aged 65 and over providing unpaid care to a partner, family member or other person, by age, is projected to rise from 1,696 to 2,418 (POPPI). Comparable figures are not available for people aged 18 to 64 years or younger carers. However older carers are the largest group by far.

 

2011

2015

2020

2025

2030

Aged 65+ not providing care

12,638

13,891

15,029

16,414

18,416

Aged 65+ giving 1 to 19 hours care per week

703

772

838

889

1,004

Aged 65+ giving 20 to 49 hours care per week

206

226

243

258

290

Aged 65+ giving 50+ hours care per week

787

863

932

998

1,124

Total aged 65+ giving some care

1,696

1,861

2,013

2,145

2,418

 

In the same age group (65 and over) the number of people in Hartlepool needing assistance with personal care tasks is predicted to increase by 20% by 2020 and 50% by 2030 (POPPI).

 

2011

2015

2020

2025

2030

Population aged 65 and over unable to manage at least one self-care activity on their own

4,957

5,433

5,938

6,617

7,423

 

For people aged 18 to 64 who have a moderate or serious physical disability the number fluctuates over the next two decades.  There is a forecast increase of 2.5% by 2020, but it is expected to be 2% below the 2011 number by 2030 (PANSI). This indicates that the number of people in this category will not grow at the rate for older people.

 

2011

2015

2020

2025

2030

Total population aged 18-64 predicted to have a moderate or serious physical disability

5,817

5,805

5,954

5,926

5,698

 

 



What needs might be unmet?

Identification of Carers
The local authority carried out 1,538 carer assessment during 2010/11. Hartlepool Carers is in contact with approximately 700 other carers. However the 2001 census shows 9,853 people who identified themselves as carers (11% of Hartlepool’s population). It means that potentially there are over 7,600 carers not in contact with either formal or voluntary support. This figure is likely to increase when the results of the 2011 census are known.

Even if the number of carers in the 2001 census who said they carried out more than 50 hours a week of caring is used (2,680), this still exceeds the number known to the local authority  and key carers support agency by more than 400.

The Hartlepool Carers Strategy identifies the need for appropriate information, tailored to differing caring situations such as:

  • new carers;
  • those carers who are coping but need to be kept up to date with what support and particularly finances may be available ;
  • carers who are now finding it hard to cope or where circumstances are deteriorating.

This information needs to include benefits and financial advice including working tax credits.

More needs to be done to identify younger carers particularly, but not exclusively, those whose parents are involved with substance misuse or have mental health issues.  Schools in particular should be aware of the needs of child carers.

Adequate support with assessment
Anecdotally, many carers report that they are not aware that they have had a carer’s assessment even though a carer’s assessment has been recorded (source: comments collected during the consultation on the Carer Strategy in 2010/11). A robust assessment is the gateway to carer support. The new Carers Self-Directed Assessment Questionnaire (CSDAQ) will support this following implementation in the summer of 2012.

Access to health services and awareness of carers within general practices
Awareness of carers within primary health care has markedly improved following a local initiative rising from 100 to 700 cares registered with their GP (source: - Hartlepool Carers GP registration programme).  However, this is well short to the number known to the local authority and Hartlepool Carers.

Health services need to be aware of the importance of carers’ health and well-being and their role as an expert regarding the person they care for, but also the risk of neglecting their own health. Identification of carers in general practices is now a requirement of the Quality and Outcomes Framework (QOF).

The emotional support and mental health of carers
The mental health of carers has been highlighted as an issue where further support is needed. The Carers Strategy action plan identifies that further work is needed to:

  • improve support regarding well-being and self-help;
  • identify options for mutual support;
  • identify more options to have a ‘life of one’s own’;
  • improve the range of opportunities for short breaks, respite, and activities that the cared for and carer can enjoy together;
  • get appropriate medical and psychological support.

Deaf carers and carers from BME communities
Recent consultation indicates that carers in the deaf community find it harder to access information and support.
Hartlepool has a relatively small population from black and other ethnic minority communities, but carers in these communities have been recognised as hard to reach.

Removal of discrimination of carers
Clear pathways are needed to ensure that young carers are are identified and supported at an early stage.

Adult carers areas of concern include the lack of recognition of their key caring role when accessing services for themselves (such as health services) which can severely restrict their ability to access rigid systems, such as appointment systems.

Training and support
Work is needed to ensure that when carers are identified they can then easily access appropriate training both to assist them in their caring role but also to allow them to remain in employment, train or retrain for employment.

Carers and employment
Work is needed to help carers remain in or return to employment. Awareness of carers’ issues remains very mixed with employers. Some larger statutory organisations have already initiated family-friendly policies but anecdotally carers are still reporting that they have had to give up working because of the dual demands.

A scheme to support carers into employment lost its funding when the Working Neighbourhoods Fund was withdrawn in 2011 and has only partially been able to continue functioning due to voluntary sector support.

The Carers Strategy identifies the need for:

  • family / carer friendly employment, training and education;
  • better and timely access to information on employment issue;
  • better and timely access to support to stay in work.

 



What evidence is there for effective intervention?

National Guidance
Our health, our care our say (Department of Health, 2006)
Sets out the government’s commitment to put people more in control and make services more responsive to the needs of individuals. Innovation is encouraged to allow greater service user choice and there is an emphasis on prevention and earlier intervention and more support to maintain mental health and emotional well-being.

Recognised, valued and supported (Department of Health, 2010a)
Sets out the support needed by carers to maintain / improve their health and well-being and to carry out their caring role in four main areas:

  • Supporting carers to identify themselves as carers at an early stage
  • Enabling carers to fulfil their educational and employment potential
  • Provision of personalised support for carers and those they support
  • Supporting carers to remain mentally and physically well.

Carers and Personalisation: improving outcomes (Department of Health, 2010b)
A guide on emerging evidence, including examples to illustrate how the principles of personalisation have been applied, emphasising the value of finding ways forward that make sense and work best locally.  Includes:

  • Carers as expert care partners & whole family approaches
  • Early intervention and prevention
  • Making self-directed support processes work for carers.


New Approaches to Supporting Carers’ Health & Wellbeing. (Centre for International Research on Care, Labour & Equalities & University of Leeds 2011)

This programme was developed by the Department of Health as part of its commitments made in the National Carers Strategy in 2008. The commitments included new measures to improve carers’ health and well-being. The programme focused on breaks, health checks and better NHS support for carers. Sites looked at new and innovative ways to engage with carers and deliver services.

The programme was delivered over 18 months and supported over 18,500 carers. Analysis of the programme produced evidence-based conclusions and recommendations for improving carer support services:

  • Breaks from the caring role enable some carers to build confidence and some to change their behaviour and activities which can be beneficial to their health and well-being and improvements to ability to communicate. Flexible and personalised breaks are life enhancing for carers and have the potential to prevent “burn-out”/ health deterioration and so sustain their caring role.
  • Health checks for carers have a positive impact. Four months after implementing health checks one-quarter of carers reported how they looked after their health and the amount of exercise they took had improved. Health checks can lead to sustained self-care and healthier behaviour for carers.
  • Creative and innovative approaches which are flexible to support delivery are more effective than standardisation.
  • Success can be achieved by establishing carers’ champions in GP practices linked to other partner agencies. In hospital successful practices included ward-based initiatives which involved nurses, doctors and health care assistants and made services and support available in the hospital setting.
  • Services need to be accessible from a variety of venues to suit carers’ circumstances and at key points in the carers’ journey, especially when caring first arises, at points of stress and on a regular basis when caring is long-term and intensive.
  • More effective support is achieved by local authorities, NHS organisations and voluntary organisations working together and this partnership should be strengthened in all localities.
  • Local carer support partnerships will develop more effective services by involving a diverse range of carers in service development and should offer them suitable training. Partnerships should work with carers to review carers’ needs, identify local priorities for developing carer support and selecting the leading and supporting agencies needed to deliver different types of carer support services.
  • In delivering support to a wide range of carers and reaching carers not already in touch with services, local partnerships should work flexibly and sometimes on an ad hoc basis to engage carers in specific target groups. To establish and sustain support for some groups of carers, flexible networks, where appropriate involving agencies outside the health and social care system which are trusted by carers or which work with people who are carers, may be required.
  • Effective carer support at the local level should always include a varied portfolio of carer support services which can be adapted to meet individual needs. Flexible and personalised services should be available to carers in a timely manner and be capable of responding rapidly to carers’ needs.
  • Portfolios of carer support need to be agreed locally between local authorities, NHS organisations, voluntary sector organisations and other agencies where appropriate. Carers need support with health, stress, information on how to access suitable support, service available, equipment and home adaptations, income maintenance, self-care, healthy lifestyles and maintaining a life outside of caring, access to education, training, work and leisure; emergency planning and how to access occasional or regular breaks for their caring role.


A review of research on interventions to support carers (Parker et al, 2010) found that:
“The strongest evidence of effectiveness of any sort from our meta-review is in relation to education, training and information for carers.” However, they noted that, overall, the evidence base is poor.
 



What do people say?

Following the consultation with carers in Hartlepool during 2010 and 2011, nine priorities were identified for action:

  • Information and communication: Carers told us this was their first priority
  • Access to health services
  • Access to financial resources
  • Support with assessments
  • Remove discrimination of carers
  • Flexibility for a life of your own
  • Training and support to care
  • Emotional support
  • Work, education and leisure.

Whilst it is impossible to obtain the views of every carer, the consultation that took place attempted to make sure that views of carers had been expressed and noted.
 



What additional needs assessment is required?

The predicted growth in the numbers of people needing assistance from carers and the estimate of carer numbers are currently based on the 2001 census. More recent data from the 2011 Census will become available in 2012/13 enabling a more accurate assessment of carer needs.

Consultation with known carers needs to be maintained and occur on a regular basis. This should build on techniques such as “Working Together for Change” which make carers key partners in any new developments of services .

Representation from “hard to reach” groups should be promoted and should include people whose first or only language is not English, including people from BME communities and deaf people who use British Sign Language.

 



Key Contact

Name: Jeanette Willis
Job title:
E-mail: Jeanette.Willis@hartlepool.gov.uk

Phone:

References


Local strategies and plans


Hartlepool Borough Council (2012). Who cares for carers? A multi-agency strategy for carers in Hartlepool 2011-2016.



National strategies and plans

Department of Health (2010a) Recognised, valued and supported: next steps for the Carers Strategy.

Department of Health (2008). Carers at the heart of 21st century families and communities: a caring system on your side, a life of your own.

Department of Work and Pensions (2009) Employment support for carers

 

Other references

 

Carers UK (2012). Facts about carers.

Carers UK (2012). The cost of caring: how money worries are pushing carers to breaking point.

Carers UK & University of Leeds (2011). Valuing carers – calculating the value of unpaid care.

Centre for International Research on Care, Labour & Equalities & University of Leeds (2011). New Approaches to Supporting Carers’ Health & Wellbeing: Evidence from the National Carers’ Strategy Demonstrator Sites Programme.

Department of Health (2010b). Carers and Personalisation: improving outcomes.

Department of Health (2010). Our health, our care our say.

Parker, G; Arksey, H; and Harden, M (2010). Meta-review of international evidence on interventions to support carers. Social Policy Research Unity, University of York

Princess Royal Trust for Carers (2010) Broke and Broken: Carers battle poverty and depression.

Princess Royal Trust for Carers (2011).  Always on call, always concerned: A Survey of the Experiences of Older Carers.

Projecting Adult Needs and Service Information (PANSI)

Projecting Older People Population Information (POPPI)


 



End of life care

Around half a million people die in England each year, of whom almost two-thirds are aged over 75. The large majority of these deaths follow a period of chronic illness such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia. Most deaths occur in NHS hospitals.

The pattern of deaths in relation to age profile, cause of death and place of death have changed radically over the course of the past century. A hundred years ago most people died in their own homes and acute infections were a much more common cause of death.  A far higher proportion of deaths occurred in childhood or early adult life.

With the changes in the past century, familiarity with death within society as a whole has decreased. Many people nowadays do not experience the death of someone close to them until they are well into midlife. Many have not seen a dead body, except on television. As a society we do not discuss death and dying openly.

Although individuals may have different ideas about what would, for them, constitute a ‘good death’, for many this would involve:

 

  • being treated as an individual, with dignity and respect;
  • being without pain and other symptoms;
  • being in familiar surroundings; and
  • being in the company of close family and/or friends.

 

Some people die as they would have wished, but many others do not. Some people experience excellent care in hospitals, hospices, care homes and in their own homes. But the reality is that many do not. Many people experience unnecessary pain and other symptoms. There are distressing reports of people not being treated with dignity and respect and many people do not die where they would choose to.

How we care for the dying is an indicator of how we care for all sick and vulnerable people. It is a measure of society as a whole and it is a litmus test for health and social care services.

In the past, end of life care within the NHS and social care services has had a relatively low profile. Reflecting this, the quality of care has been very variable. Implementation of this strategy will make a step change in access to high quality care for all people approaching the end of life. This should be irrespective of age, gender, ethnicity, religious belief, disability, sexual orientation, diagnosis or socioeconomic deprivation. High quality care should be available wherever the person may be: at home, in a care home, in hospital, in a hospice or elsewhere (National End of life Strategy, DH, 2008).



What are the key issues?

Raising the profile

Improving end of life care will involve working in partnership to consider how best to engage with local communities to raise the importance of end of life care. This may involve engagement with schools, faith groups, funeral directors, care homes, hospices, independent and voluntary sector providers and employers amongst others.

A public health approach will be taken to raise the profile through initiatives such as compassionate communities and an End of Life Charter.

 

Strategic commissioning

As the services required by people approaching the end of life span different sectors and settings, it is vital that an integrated approach to planning, contracting and monitoring of service delivery should be taken across health and social care. All relevant provider organisations should be involved in the commissioning process.

 

Identifying people approaching the end of life

Caring for those approaching the end of life is one of the most important and rewarding areas of care. Although it is challenging and emotionally demanding, if staff have the necessary knowledge, skills and attitudes, it can also be immensely satisfying. However, many health and social care staff have had insufficient training in identifying those who are approaching the end of life, in communicating with them or in providing optimal care.

 

Care planning in advance – ‘Deciding Right’

All people approaching the end of life need to have their needs assessed, their wishes and preferences discussed and an agreed set of actions reflecting the choices they make about their care recorded in a care plan. In some cases people may want to make an advance decision to refuse treatment, should they lack capacity to make such a decision in the future. Others may want to set out more general wishes and preferences about how they are cared for and where they would wish to die. These should all be incorporated into the care plan. The care plan should be subject to review by the multidisciplinary team, the patient and carers as and when a person’s condition, or wishes, change. For greater effectiveness, the care plan should be available to all who have a legitimate reason for use (for example, out-of-hours and emergency services).

 

Co-ordination of care

Within each local health economy mechanisms need to be established to ensure that each person approaching the end of life receives co-ordinated care, in accordance with the care plan, across sectors and at all times of day and night.  This includes the development of community palliative care registers.

 

Rapid access to care

As the condition of a person may change rapidly, it is essential that services are marshalled without delay. If a person is likely to live for only a matter of weeks, days matter. If the prognosis is measured in days, hours matter. Therefore, medical, nursing and personal care and carers’ support services should be made available in the community continuously, including in care homes, sheltered and extra care housing and can be accessed without delay. It is evident that provision of continuous services can avoid unnecessary emergency admissions to hospital and can enable more people at the end of their life to live and die in the place of their choice.

 

Provision of high quality services in all locations

Commissioners will wish to review the availability and quality of end of life care services in different settings. These will include services provided in hospitals, in the community, and in care homes, sheltered and extra care housing, hospices and ambulance services.

 

Last days of life and care after death

The Leadership Alliance for the Care of the Dying Patient published “One Chance to Get it Right” (DH, 2014), with the aim of improving peoples experience of care in the last few days and hours of life.  It sets out the approach for the care of dying people that health and care organisations and staff caring for dying people in England should adopt. It should apply irrespective of the place in which someone is dying e.g. hospital hospice own or other home and during transfers between different settings.

 

Involving and supporting carers

The family, including children, close friends and informal carers of people approaching the end of life, have a vital role in the provision of care. They need to be closely involved in decision-making, with the recognition that they also have their own needs. For many this will have been the first time they have cared for someone who is dying. They need information about the likely progress of the person’s condition and information about services which are available. They may well also need practical and emotional support both during the person’s life and after bereavement. Carers already have the right to have their own needs assessed and reviewed and to have a carer’s care plan.

 

Education and training and continuing professional development

Ensuring that health and social care staff at all levels have the necessary knowledge, skills and attitudes related to care for the dying will be critical to the success of improving end of life care.

 

Measurement and research

Good information on end of life care is needed by patients, carers, commissioners, clinicians, service providers, researchers and policy makers. Each group will have somewhat different questions to ask and therefore different priorities for information.  This could include tools such ‘family’s voice’ which has been used in community and hospital settings.



What commissioning priorities are recommended?

2012/01

Reduce inequalities and improve identification through de-stigmatising death and dying and encouraging healthcare professionals and people with end of life care needs, their families and carers to engage in open conversations. Remains a priority

 

2012/02

Improve the quality of care including care after death, through holistic assessments and timely interventions in the right place by a knowledgeable, caring and competent workforce. Remains a priority

 

2012/03

Increase choice and personalisation through care planning and advance care planning, including advance statements and advance decisions to refuse treatment and provision of resources that enable these choices to be achieved. Remains a priority

 

2012/04

Ensure care is co-ordinated and integrated across all sectors involved in providing end of life care. Remains a priority

 

2012/05

Improve the psychological, physical and spiritual well-being of people with end of life care needs and their carers through access to an appropriately trained and resourced workforce. Remains a priority

 

2012/06

Focus on outcomes For example, end of life pathways; use of 'Deciding Right' documentation; ‘family voice’ feedback; care and co-ordination measures i.e. use of General Practice palliative care registers; response times for practical help; and complaints related to end of life care. Remains a priority

2015/01

Ensure that people approaching the end of their lives are cared for and die in their place of choice.



Who is at risk and why?

Earlier identification of people nearing the end of their life and inclusion on the register leads to earlier planning and better co-ordinated care (National Primary Care Snapshot Audit)

We know that too few patients are currently included on the Quality and Outcomes Framework (QOF) palliative care/ Gold Standards Framework (GSF) registers, and that there are a disproportionately low numbers of non-cancer patients. But we also know that if patients are recognised early and included on the register, they receive better co-ordinated, proactive care that is more in line with their preferences.

So how can we improve earlier recognition of these patients? The Prognostic Indicator Guidance asks three key questions:

  1. The surprise question. Would you be surprised if the patient were to die in the next months, weeks or days? If not, what can you do now to support them?
  2. Are there general indicators of decline and increasing need? These include decreased functioning and activity, for example increasingly bed-bound, reduced response to treatment, refusal of active treatment, repeated admissions, increasing impact of co-morbidities, worsening symptoms (such as increased breathlessness), and being admitted to a nursing home.
  3. Are there specific clinical indicators related to their condition? These could be, for instance, indicators for conditions such as heart failure, respiratory disease or dementia.

If the answer is yes to any combination of these, then these patients should be included on the palliative care register and ideally prioritised – (coded green, amber or red) – according to need so that support can be more focused. In addition, extra support should be made available, advance care planning discussions begun and the process of proactive planning initiated.

The complexities of defining when a person has entered the end-of-life phase means that, in practice, a group of people will need access to end-of-life services for a longer period than the final 12 months of life. Two notable groups are young adults and people with dementia.

Advances in medical treatments means that many children, who would have died in childhood, now live into adulthood and consequently may need palliative care services for much longer than 12 months. In 2010 approximately 2,500 children and young people aged 15–24 years died in England.

Adult services might not meet the specific needs of young adults therefore commissioners may also wish to consider the needs of this specific group when planning services for adults. Also, in the NICE guide for commissioners 'End-of-life care for people with dementia', the benchmark highlights that 66,000 people who die each year with dementia are likely to need end-of-life care before death and many of these people will need palliative and end-of-life services for much longer than 12 months.

The National End of life Care Intelligence Network ‘Deprivation and death: Variation in place and cause of death’ (2012) report improves our understanding of socioeconomic deprivation as a factor influencing end-of-life care. It highlights variations, some of which are known – for example, differences in age and cause of death by deprivation group. Others are less well known, for example differences in place of death by deprivation group.

 

General

  • Socioeconomic deprivation is a major determinant of where, when and how people die.

 

Place of death

  • People living in the most deprived quintile are more likely to die in hospital (61%) than people living in other quintiles (54–58%).
  • Death in care or nursing homes, often the usual place of residence for very elderly people, was less common among people living in the most deprived quintile (11%) than any other quintile (16–20%).

 

Cause of death

  • For each underlying cause (cancer, cardiovascular disease, respiratory disease and ‘other’ causes), people living in the most deprived quintile were most likely to die in hospital.
  • For each underlying cause (cancer, cardiovascular disease, respiratory disease and ‘other’ causes), within each age group (under 65, 65–84 and 85 and over), people living in the most deprived quintile were most likely to die in hospital, with the exception of deaths caused by cardiovascular disease and respiratory disease in the under 65 age group.
  • There are more deaths caused by smoking-related cancers of the lung, oesophagus, head and neck, bladder, cervix and liver in people living in the most deprived quintile (10,459) than in the least deprived quintile (6,524), and similarly more deaths caused by chronic respiratory disease in the most deprived quintile (8,820) than in the least deprived quintile (4,761).
  • There are fewer deaths from malignant melanoma, breast and prostate cancer in the most deprived quintile (3,091) than any of the other quintiles (3,987–4,563).

 

Deaths by age

  • About one-quarter (27%) of deaths in the most deprived quintile were people aged 85 and over compared with 35–40% in each of the other quintiles. This is largely because people in the most deprived quintile die younger.
  • There were twice as many deaths of people aged under 65 in the most deprived quintile (22,632) as in the least deprived quintile (11,294).
  • Among deaths of people aged under 65 years:
    • cancers associated with smoking caused twice as many deaths in the most deprived quintile (2,754) as in the least deprived quintile (1,416);
    • heart disease caused more than twice as many deaths in the most deprived quintile (3,886) as in the least deprived quintile (1,545);
    • chronic respiratory disease caused four times as many deaths in the most deprived quintile (1,251) as in the least deprived quintile (313);
    • external causes (accidents, assaults, self-harm) accounted for twice as many deaths in the most deprived quintile (2,031) as in the least deprived quintile (1,030).
  • Among deaths of people aged between 65 and 84 years:
    • cancer is the most common cause of death for each deprivation quintile, and most common in the least deprived quintile (38% of deaths compared to 32–35% in the other quintiles);
    • respiratory disease accounts for nearly twice as many deaths in the most deprived quintile (7,512) as in the least deprived quintile (3,936);
    • less than 16% of people who die at this age live in the most deprived quintile;
  • Among deaths of people aged 85 years or older:
    • heart disease and stroke cause more than a third of deaths at this age, a proportion that is consistent across deprivation quintiles.


What is the level of need in the population?

In Hartlepool, the numbers of deaths have been falling in recent years, despite increasing population size.  In 2013 there were 94 fewer deaths than a decade earlier.

 

Cancer is the leading cause of death in Hartlepool, accounting for nearly three in ten deaths.  The three major causes of death: cancer; circulatory disease; and respiratory disease, account for 70% of all deaths in Hartlepool.  Compared to Halton (a similar area), Hartlepool has slightly fewer deaths from cancer and similar proportions from circulatory and respiratory diseases.

 

In Hartlepool, most people (51%) die in a hospital.  Higher proportions of people die in hospital with increasing age.  Deaths at home and in hospices are most common for people aged under 65 years.  People aged 85+ are the most likely to die in a care home.

 

There were 220 deaths in hospices in Hartlepool in the three years 2008-10.  Of these, 187 (85%) were people with cancer as an underlying cause of death compared with 95% in the rest of Teesside.  Proportionately more people die in hospices in Hartlepool than elsewhere in Teesside.

Palliative care registers are maintained by general practices.  In Hartlepool practices, the proportion of people on palliative care register varied from 0.2% to 1.2% of people registered with the practice.

 

Further details regarding end-of-life data are available at:

http://fingertips.phe.org.uk/profile/end-of-life



What services are currently provided?

Good quality end of life care should span all services and conditions and should be a generic skill throughout the workforce.

Specific specialist services include:

 

  • Specialist Palliative Care Nursing
  • Specialist Palliative Care consultants
  • Hospice care
  • Marie Curie Services
  • Macmillan
  • Bereavement services
  • Allied Health Professionals
  • Community & Specialist Nursing
  • Psychologists

 

End of life services that are currently available are being mapped.



What is the projected level of need?

In 2015, Hartlepool is estimated to have 8,100 residents aged over 75 years.  By 2020 this will have risen to 8,700 (a 7.4% rise) and by 2025 there will be 10,400, a 28% increase from the 2015 figure.

It is likely that this increase in the older population will lead to a corresponding increase in the need for end of life care services.

 



What needs might be unmet?

People receiving end of life care require services from a range of providers from the health, social care, community and voluntary sectors.  Sometimes these services might not be fully co-ordinated.

The majority of people are dying in hospitals, but expressed preferences of the majority show that they would prefer to die in a different setting.



What evidence is there for effective intervention?

Care of the Dying Adult, (NICE, 2015) Guidance currently out for consultation and due to be published in December 2015

National End of life Strategy, Department of Health, 2008

Case studies and documents from http://www.endoflifecareforadults.nhs.uk/

Map of Medicine end of life pathways.



What do people say?

People’s preferences regarding place of death

Several large scale surveys of the public have been undertaken in recent years to ascertain people’s preferences and priorities in relation to end of life care. These surveys are complemented by detailed research based on focus groups and interviews with older people and those who are approaching the end of life. Although people’s preferences and priorities may change as death approaches, these changes will be linked on occasion to the concerns regarding the availability of services for their preferred place of care. The main findings can be summarised as follows:

 

 

    • Most people would prefer to be cared for at home, as long as high quality care can be assured and as long as they do not place too great a burden on their families and carers;
    • Some research has shown that some people (particularly older people) who live alone wish to live at home for as long as possible, although they wish to die elsewhere where they can be certain not to be on their own;
    • Some people on the other hand would not wish to be cared for at home, because they do not want family members to have to care for them. Many of these people would prefer to be cared for in a hospice; and
    • Most, but not all, people would prefer not to die in a hospital although this is in fact where most people die.


What additional needs assessment is required?

Refresh of End of Life Profiles



Key Contact

Name: Paul Whittingham

Job Title: Commissioning Manager, North of England Commissioning Support (NECS)

e-mail: paulwhittingham@nhs.net

phone: 01642 745059

References

Local strategies and plans

NHS Hartlepool and Stockton CCG – Clear and Credible plan refresh document

NHS Hartlepool and Stockton CCG - End of Life Strategy (due to be published Oct 2015)

National strategies and plans

Department of Health (2014). One Chance to Get it Right: how health and care organisations should care for people in the last days of their life.

 

Other references

Public Health England. (2015). End of Life Care Profiles.

The Marie Curie Palliative Care Institute Liverpool, (2011).

National End of life Care Intelligence Network, (2012). Deprivation and death: Variation in place and cause of death

National Institute for Health and Care Excellence (NICE). Care of the Dying Adult -  (Due for publication December 2015)

 



Ex-forces personnel

The military needs to recruit about 20,000 men and women each year to the armed forces. This workforce is drawn from a broad section of society, including areas of high unemployment and people with few qualifications. Recruits are required to adapt to military life and ethos and, where essential, give up a few of the freedoms they had as civilians.

To equip personnel with the necessary skills and attitudes for the full spectrum of military operations (including war fighting), the services instil a culture of discipline, reliance on others and acceptance of orders. Although personnel can have a long fulfilling career, the majority of them will leave the armed forces at least 25 years before the current national retirement age and will need to pursue a second career. When individuals leave the armed services they are often referred to as ‘veterans’.

A veteran is anyone who has served for at least one day in the armed forces, whether regular or reserve. This also applies to Merchant Navy seafarers and fishermen who have served in a vessel at a time when it was used for military operations by the armed forces. 

The veterans’ community is a wide and disparate population (there are an estimated 4.5 million veterans in the UK). However, as an individual’s circumstances change over time, the needs of veterans will not be identical and will be determined by factors such as their experience before, during and after their military service, including their transition from military to civilian life.

The veterans’ community can be divided into three broad groups. These groups are veterans who:

  • Following a service career, return successfully to civilian life;
  • Have suffered ill health or injury as a result of service. In cases of death, their widows and dependants should receive proper support from the government or community;
  • Have been unable to make a successful transition to civilian life.

When servicemen and women leave the armed forces, their healthcare is the responsibility of the NHS. All veterans are entitled to priority access to NHS hospital care for any condition, as long as it's related to their service, whether or not they receive a war pension.



What are the key issues?

National evidence shows that:

  • More than one-quarter of service leavers reported that they found the return to civilian life was not as they expected or harder;
  • A small minority of service leavers experience severe difficulties such as homelessness;
  • Awareness of the different support which is available varies between service leavers, particularly between early service leavers and those who have served longer;
  • Some service leavers find it difficult to access services when they are discharged. This is due to the lack of information provided locally;
  • The processes, procedures and criteria that local services often apply make it difficult for service leavers to prove eligibility;
  • There is a lack of awareness and understanding of the unique experiences and challenges of service personnel of civilian professionals and institutions. This has an impact when considering the awareness of veterans’ health issues and in particular the special needs of older and disabled veterans;
  • Levels of alcohol misuse are substantially higher in UK armed forces personnel than in the general population;
  • According to British research, 9% of people who experience combat develop late onset post-traumatic stress disorder (PTSD);
  • The National Ex-Services Association indicates as much as 7% of the UK prison population (over 6,000 prisoners) are veterans;
  • The main findings from a survey of 10,000 serving personnel were:
    • 4% reported probable post-traumatic stress disorder;
    • 20% reported other common mental disorders; 
    • 13% reported alcohol misuse.


What commissioning priorities are recommended?

2012/01

Raise awareness of the entitlement of veterans to priority access to NHS care by NHS staff.

2012/02

Work in partnership with other agencies and the voluntary and community sectors to prevent homelessness, tackle unemployment and other social exclusion issues amongst veterans, where the problems have arisen from their service.

2012/03

Ensure the effective and timely direct transfer of medical records from Defence Medical Services to GPs when individuals leave the armed forces.

2012/04

The Joint Health Overview and Scrutiny Committee of North East Local Authorities report on the regional review of the health needs of the ex-service community was formally launched in March 2011. The report identified 47 areas for improvement, including 12 areas specifically related to mental health. These include:

  • A strong role for the new local Health and Well-being Boards in assessing needs and co-ordinating service provision;
  • Enhanced awareness among primary care providers and GPs of the particular mental health needs of the ex-service personnel and particularly of the need for priority treatment for health care needs arising from their service;
  • Appropriate training is required by commissioners of NHS services. This should guide them on how to:
    • Produce guidance specifically for primary care providers and GPs to explain the priority healthcare entitlement;
    • Identify ex-servicemen and women;
    • Adapt their systems to accommodate priority treatment for the ex-service community;
    • Accept referrals from ex-service charities, including the Royal British Legion and Combat Stress, but also smaller local organisations providing for some of the most marginalised/excluded ex-service personnel;
  • Local authorities and GP consortia should be actively engaged in joint planning and commissioning of services with the NHS;
  • Local authorities should be actively engaged in the North East NHS Armed Forces Network and consider how they can take on a leadership role in relation to veterans mental health issues;
  • Primary care and acute trusts should take steps to improve awareness of veterans mental health issues among health workers generally, including appropriate training and supervision.

Some groups within the ex-service community may need special attention, including prisoners and early service leavers (those who leave the service after less than four years).



Who is at risk and why?

Centre for Military Health Research at King’s College London

The Ministry of Defence and NHS Partnership Board commissioned the Centre for Military Health Research at King’s College London to review recent and upcoming research publications. The following factors were identified as increasing the risk of alcohol misuse and/or mental health problems:

  • being young;
  • being male;
  • being in the Army, rather than another branch of service;
  • holding a lower rank;
  • experiencing childhood adversity;
  • being exposed to combat;
  • deployment length over the “Harmony Guidelines” (in the case of the Army, roughly 12 months front-line service over a 3-year period);
  • being a Reserve;
  • having a mental health problem while in service;
  • Being an early service leaver;
  • Post-traumatic stress disorder makes up only a minority of cases of mental health disorders.

Suicide

Those who leave the services early and were young are up to three times more likely to commit suicide than the general population

Length of service

Those who had served a shorter time found the transition to civilian life most difficult.

Socioeconomic

Many recruits are drawn from educationally and socially disadvantaged backgrounds and, in many cases, also join with weak basic skills.



What is the level of need in the population?

Association between active service and mental health problems in armed service personnel involved in recent conflicts has been reported in UK research. A very recent study of 10,000 serving personnel (83% regulars; 27% reservists) found lower than expected levels of PTSD. Common mental disorders and alcohol misuse were the most frequently reported mental disorders among UK armed forces personnel. In particular, levels of alcohol misuse overall were substantially higher than in the general population.

The main findings were:

  • 4% reported probable post-traumatic stress disorder;
  • 19.7% reported other common mental disorders;
  • 13% reported alcohol misuse; 
  • Regulars deployed to Iraq or Afghanistan were significantly more likely to report alcohol misuse than those not deployed; 
  • Reservists were more likely to report probable post-traumatic stress disorder than those not deployed; 
  • Regular personnel in combat roles were more likely than those in support roles to report probable post-traumatic stress disorder;
  • Experience of mental health problems was not linked with the number of deployments.

Referrals of veterans to Tees, Esk and Wear Valleys NHS Foundation Trust are reported to be at the rate of approximately 10-12 veterans per quarter, or up to 50 a year.

Source: An evaluation of six Community Mental Health Pilots for Veterans of the Armed Forces (K Dent-Brown, A Ashworth, M Barkham, Saxon, D et al).



What services are currently provided?

Mental health

Veterans' Wellbeing Assessment and Liaison Service (VWALS)

The VWALS is a new mental health and wellbeing service to support veterans and their families in the north east. the service is accessable directly, through GPs or another health, social care or third sector service.

Medical Assessment Programme (MAP)

MAP offers help and treatment to any veteran of any conflict, no matter how long ago, and their carers (Tees, Esk and Wear Valleys NHS Foundation Trust).

The Service Personnel and Veterans Agency (SPVA)

The SPVA is part of the MoD, acts as a single point of contact to provide advice for serving military personnel, ex-service personnel and their dependants.

Combat Stress

Combat Stress provides specialist residential and community outreach mental health care for veterans.

Pilot projects

The MoD and NHS are running six veterans mental health pilot projects across the UK. The aim of these projects is to increase knowledge and understanding of veterans’ mental health needs among mainstream NHS staff, to improve access to mainstream NHS services.

Housing

Joint Service Housing Advice Office (JSHAO)

Provides service personnel, service leavers and ex-service personnel still occupying service family accommodation as irregular occupants with comprehensive advice on housing options (including civilian housing information, advice and where possible placement into social housing).

MOD Referral Scheme

Provides a route into low-cost, social housing for Service leavers, married or single. It is administered by the JSHAO.

Single Persons Accommodation Centre for the Ex-Services (SPACES)

Spaces is designed to help single persons leaving the Service to find appropriate accommodation. It is an accommodation advice and placement service.

SSAFA Forces Help

A national charity helping all veterans and their dependants on a range of welfare issues including housing.

Veterans Aid (formerly EFC - the Ex-Service Fellowship Centres)

The objective of Veterans Aid is to relieve distress among ex-Service men and women of the Royal Navy, Royal Marines, Army, Royal Air Force and the Merchant Navy and their widows or widowers who are in crisis.

Home Base

A service for people who are facing homelessness as they leave the armed forces. It is run by Community Housing and Therapy (CHT) and aims to help clients integrate successfully into civilian life.

Stoll (formerly Sir Oswald Stoll Foundation)

A charity with a mission to ensure vulnerable and disabled ex-Servicemen and women live as independently as possible. It provides housing and support for vulnerable veterans including those who have experienced homelessness and other issues.

Prisoners

Prison In-Reach

The Prison In-Reach project provides support to veterans who are serving prison sentences and to their families, with the aim of aiding rehabilitation and reducing the risks of re-offending.



What is the projected level of need?

The circumstances of future veterans will be very different from those of many of today’s veterans. For example, there will be fewer veterans of the conscription era and a greater proportion of veterans will be former reservists. These changed circumstances will bring with them different opportunities, expectations and requirements. Likewise, the nature of conflict is evolving as a result of changing technology, different sorts of threats and the increased emphasis on peace-keeping and similar operations. In particular, service in the armed forces is likely to remain a unique experience with challenges and opportunities that have no parallel in civilian life and which may affect personnel well after they return to civilian life.



What needs might be unmet?
  • The level of resettlement support is determined by the length of military service and is not dependent on the rank of the service leaver.
  • Service leavers who are discharged compulsorily have no entitlement to formal support.
  • All early service leavers are often discharged at very short notice making it difficult to provide appropriate support packages to prepare them for the transition to civilian life.
  • There is a lack of awareness and understanding of the unique experiences and challenges of service personnel by civilian professionals and institutions. This has an impact when considering the awareness of veterans’ health issues and in particular the special needs of older and disabled veterans.


What evidence is there for effective intervention?

Content under development



What do people say?

The University of Sheffield Centre for Psychological Services Research

During 2008-11 the Ministry of Defence (MoD) funded a programme at six sites within the NHS to test out ways of providing mental health care to veterans of UK armed forces. The Centre for Psychological Services Research was commissioned to undertake an evaluation of these sites, in comparison with three existing services for ex-service personnel.

Responses were received from 13 clients at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV), from a total of 70 questionnaires distributed (a response rate of 18.6%). The themes from the questionnaire were identified as follows:

  • Problems with distance to services;
  • There is a need for more sessions/centres/staff;
  • There is a problem with seeing non-forces staff;
  • There is a need for assessments/treatments/information in and when leaving forces;
  • There is a need to let the client set the pace of therapy.


What additional needs assessment is required?

Content under development



Key contact

Name: To be advised

Job title:

e-mail:

Phone number:

References

National Audit Office and Ministry of Defence (2007). Leaving the Services

Ministry of Defence (2006). Strategy for Veterans

Chief Medical Officers Letter Gateway Reference 13406 Access to health services for Military Veterans – Priority Treatment 2010



Migrants

Migrants are widely described as people who belong to (or have an allegiance) to one state/country, but move into another for the purpose of settlement.

Migrant populations are diverse, and many have social, cultural and health needs. Migration is driven by many reasons (including economic, family reunion, study, humanitarian reasons or human trafficking). As a consequence migrants may have several diverse health and social care needs.

Migrant populations have different health and wellbeing issues depending on lifestyle risk factors, cultural practices, country of origin, genetic and hereditary factors and wider determinants (poor housing, lower economic opportunities, unemployment and living in deprived areas).

This topic links to the following JSNA topics:



What are the key issues?

Migrants have poor access to (and uptake of) services compared to the general population.

Migrants are often housed in unsatisfactory conditions with inadequate heating.

Emergency accommodation does not always meet some of the cultural needs of migrants.

Migrants often live in more deprived and unsafe neighbourhoods.

Migrants experience racism and discrimination.

Many migrants become isolated, which can lead to poor mental and physical health.
Migrant workers are often subject to exploitation (such as unfair pay and exposure to unsafe working).

Migrants often work below their qualification level. This may be due to a lack of language skills and lack of recognition of overseas qualifications and work experience.

Mental health problems (including post-traumatic stress disorder) are common in refugees and asylum seekers, but also common in other migrant populations due to isolation, racism or lack of access to services. Low self-esteem and self-worth have been identified locally among migrants.

Sexual health issues including sexually transmitted infections, HIV and unwanted pregnancies as well as accessing culturally appropriate services are problematic for some migrants.

There is a lack of (or incomplete) screening and immunisations (including communicable diseases, cervical smears, breast screening and hearing and eye checks) for migrants.
Migrants have poor access to dental care and some may have a lack of understanding of dental health needs.

Hypertension and diabetes among some of the migrant population (such as South Asians) is higher than the general population.

Behavioural health problems (including alcohol misuse and smoking) may be a problem for some migrants.

There is a lack of advice and support for the transition period from asylum status to refugee status locally.  Eligibility and accessibility of services (e.g. housing, benefits, education and health) may lead to health problems.

There is a lack of comprehensive data to reflect the current migrant population in Hartlepool.

The local Housing Support for (Jomast) migrants is not made aware of the decisions on individual asylum cases in a timely manner.

There are not enough interpreting services due to the ever changing needs of the community. The services that are available are not flexible enough to meet the needs of migrants.

Anecdotal evidence suggests that some migrant populations consume a diet of high saturated fat, high sugar and salt which can contribute to an increased risk of diabetes and heart disease.

There is evidence that migrants fail to register with a new GP when they move elsewhere.

Some asylum seekers receive temporary registration (when entitled to full registration), and therefore they do not have an NHS number and so cannot access the full range of services available.

Migrants present more often to hospitals due to poor access to primary care and communication needs.

 



What commissioning priorities are recommended?

Due to the small number of migrants seeking asylum in Hartlepool, the following priorities have been identified:

2015/01
Ensure the migrant population received the information and advice on how to access local services
by working closing with the voluntary sector, faith groups, employers and landlords.

2015/02
Investigate the best way to improve information and data sharing amongst services
in order to provide better support to new migrants.

 

 



Who is at risk and why?

Age

Migrants are likely to have more children than the general population.

The population of older migrants will rise over the next few years.

Gender

Women from South Asian communities are less physically active compared with their white counterparts.

Obesity is more likely to be reported in Black Caribbean and Pakistani girls and Indian and Pakistani boys.

Socioeconomic status

Migrants often live in deprived areas. Poverty, isolation and discrimination lead to poor health outcomes (especially for mental health).

Ethnicity

Black African: High risk of infectious diseases, mental disorders, pneumonia, HIV, perinatal disorders and diabetes.
Afro-Caribbean: High risk of diabetes, prostate cancer, mental disorders and cerebrovascular disease.
Asian: High risk of tuberculosis, diabetes, chronic heart disease, cerebrovascular disease, perinatal conditions, and respiratory diseases.
Chinese: High risk of cancer, digestive system issues, congenital anomalies and diseases of the eyes and ears.

Tuberculosis rates are highest amongst Black Africans, followed by Pakistani, Indian and Bangladeshi groups.

Uptake of preventative services (such as cervical cancer smears) is lower in South Asian women.

Asian children have lower levels of physical activity but are less likely to report smoking or alcohol consumption behaviours.

The highest levels of accidents recorded are in the Black Caribbean population.

Education

Children who have English as an additional language have lower levels of attainment compared with children who have English as their first language.

Employment

Migrant workers may find it difficult to access services due to long working hours and/or shift patterns.

Lifestyle

Bangladeshi men have higher smoking prevalence (44%) compared to men in the general population (27%).

Destitute refused asylum seekers

Asylum seekers who are declined entry are required to leave the UK once all appeals have been concluded. They then automatically become destitute as all forms of support will be withdrawn including accommodation and subsistence payments. Homelessness ensues with mental health often worsened.

 



What is the level of need in the population?

Hartlepool

Nationality: non-British

Hartlepool has a lower non-British population (1%) compared to the North East (3.2%) in 2010.

Country of birth: non-UK

The proportion of Hartlepool’s population born outside the UK (2%) is lower than the regional average (5%) in 2010.

Births to non-UK-born mothers

The proportion of births in Hartlepool to mothers who were born outside the UK (6%) is higher than the North East (10.3%).

New international arrivals

In 2010, the formal estimate from the Office for National Statistics (ONS) was for about 320 new migrants who will stay more than a year (‘long term migrants’) to arrive in Hartlepool.

The National Insurance Number (NINo) data only records migrants over the age of 16, who are planning to work or claim benefits and would therefore not take account of dependants.

Net migration

Source: ONS

Net migration in Hartlepool has significantly increased in the last 6 years. In 2010, net migration was 190.

Country of origin (NINO)

There has been a fairly predictable flow of just under 50 workers from other countries arriving each year. The top country of origin is Poland followed by the Republic of Latvia.

Workers registration scheme

In Hartlepool, the total number of workers on the Workers Registration Scheme in 2010 (20) was considerably lower than in 2007 (90).

Asylum seekers
As of March 2015 there were 142 people (all families or single parent families) seeking asylum and accommodated in 38 properties in Hartlepool. All properties for Hartlepool asylum seekers are provided via Hartlepool Borough Council by Jomast.

 



What services are currently provided?

Refugee services
The North East Refugee Service (NERS) provides support and advice on a variety of matters, along with volunteering opportunities for asylum seekers and refugees.

Housing
Hartlepool Borough Council’s Housing Department offer a range of housing assessments, emergency accommodation (if appropriate) and a gateway service that will refer on to support agencies where needed.

 



What is the projected level of need?

While net migration to Hartlepool was 190 in 2010, future net migration is projected to stabilise as immigration decreases and emigration increases. This projection assumes no changes in policy or international conditions.

 



What needs might be unmet?

The needs of older migrants including access to social care and social inclusion services are not being met.

Identifying mental health problems, such as depression and dementia, and the provision of appropriate support to reduce the risk of suicide or need for crisis interventions, where needed.

Mental health needs for those asylum seekers to deal with emotional issues during transition.

Suitable temporary accommodation for some seeking asylum at transition period is required.

Screening for chronic medical conditions, allowing for early identification and support to enable appropriate management of particular conditions.

 



What evidence is there for effective intervention?

Social Care Institution for Excellence (2010) Good practice in social care for asylum seekers and refugees.

Access to the NHS by migrants and overseas visitors for primary care staff and commissioners.

Rose, N et al (2011). Including Migrant Populations in Joint Strategic Needs Assessments

Audit Commission (2007) Crossing borders: Responding to the local challenges of migrant workers.

NHS Evidence - Provides the best available evidence on health needs and access to health care of migrant and minority ethnic groups, and on the management of the health care service for these groups.

NICE (2010). A model for services provision for pregnant women with complex social factors (CG110)

NICE (2011). Preventing type 2 diabetes: population and community-level interventions in high-risk groups and the general population (PH35)

Department of Health (2003). Caring for dispersed asylum seekers: a resource pack.

Department of Health (2011). Female genital mutilation: multi-agency practice guidelines.

Health Protection Agency (2006). Migrant health - a baseline report.

 



What do people say?

Research undertaken by the Salaam Centre in Hartlepool (between October 2010 and March 2011) looked at the level of satisfaction of migrating communities in Hartlepool accessing housing services.  The research sample consisted of 62 people.

This research found that there was a significant gap in knowledge on eligibility criteria, property allocation process and sources of information available to migrant communities.

These gaps arise mainly as a result of language barriers and poor knowledge of the housing system. The majority of respondents stated that they were unaware of the location of the housing office.

 



What additional needs assessment is required?

A better understanding of the health needs of migrants based on the wider determinate of health (Dahlgren and Whitehead) model is required.

 



Key contact

Name: Sharon Robson
Job title: Health Improvement Practitioner
e-mail: sharon.robson@hartlepool.gov.uk
Phone number: 01429 523783

References

Local strategies and plans

 

National strategies and plans

 

Other references

Faculty of Public Health (2008). The health needs of asylum seekers
Home Office – Migration statistics
Home Office (2014). Female genital mutilation: guidelines to protect children and women
Home Office (2014). UK European Migration Network Annual Policy Report 2013
North of England Refugee Service
Office for National Statistics – International migration topic
The Migration Observatory



Travellers

Gypsies and travellers have been a part of British society for centuries. There are around 300,000 Gypsies and travellers in the United Kingdom. In England, between 90,000 and 120,000 Gypsies and travellers live in caravans and up to three times as many live in conventional housing.   

Gypsies and travellers have significantly poorer health than the general population.

This topic has links to the following JSNA topics:



What are the key issues?

There are no private, socially rented or unauthorised Gypsy and traveller pitches in Hartlepool and transient unauthorised encampments are usually of a relatively short duration.

Consultation with health workers was undertaken as part of the Tees Valley Needs Assessment. There was a suggestion that there was some need for health services but that these were often declined. The survey showed that there were a small number of households where some people had significant health problems (particularly mobility issues and visual impairments).

 



What commissioning priorities are recommended?

No commissioning priorities recommended at this time.

 



Who is at risk and why?

Age

  • Life expectancy for Gypsies and travellers (GT) is 10 years less than the national average
  • Infant mortality is twenty times higher than the national average.
  • There are low levels of immunisation for children; this is due to high mobility, lack of continuing care or a lack of specialist health visitors for the GT community.
  • The GT expectation is for adolescent males to be economically active at an early age and for young females to care for the home and children.

Gender

Women

  • Experience domestic abuse.
  • Low uptake of screening services (including cervical screening).
  • Higher rates of maternal death.

Men

  • Not accessing services, particularly healthcare services due to the health belief  (self-reliance and staying in control) and attitude of acceptance of ill-health.
  • High risk of premature death from cardiac disease.

Socioeconomic status

  • Income reliant on self-employment.

Environment

  • GTs living in a trailer (on a council site) or in a house are more likely to have long-term illness (chest pain, asthma and bronchitis are significantly higher) than those on a private site or empty land.
  • GTs are more likely to be caring for a dependent relative as they would be ashamed to give any impression that they were unable or unwilling to look after their older members.
  • Larger than average size families often live in unsuitable accommodation.

Mental health

  • GTs are more likely to experience social exclusion. 
  • GTs often do not settle in a tenure that wasn’t desirable (i.e. when they move into “bricks and mortar”) and can suffer from poor mental health as a result.

Education

  • The average age of dropping out of full-time education for GT children is 11 to 13-years-old. Reasons for drop out could be family mobility, gender roles and expectations, different views on age of maturity, concerns about sex education and peer influences. 
  • Less than 10% of GT children obtained five GCSEs A*-C grades (including English and maths), compared to a national average of 53%.
  • There is a rising trend of elective home education among Irish travellers.

Ethnicity

  • Nearly two-thirds (63%) of young travellers are bullied or attacked because of their ethnicity.
  • Victims of race hate crime are largely unreported.

Learning disabilities

  • GTs are likely to be identified as having special educational needs (SEN), and are also four times more likely to be excluded from school as a result of their behaviour.


What is the level of need in the population?

A Tees Valley Gypsy and Traveller Accommodation Needs Assessment was commissioned in July 2007 by the five Tees Valley local authorities and the Tees Valley Joint Strategy Unit. The main focus of this assessment was on accommodation needs and planning, but also considered education, health and policing.

There is currently no need to address Gypsy and traveller health needs in Hartlepool as there is no Gypsy population and the number of travellers is low. Any unauthorised encampment will be assessed individually and appropriate services engaged. There are no designated permanent or transit sites for travellers. Over the last five years there have been on average six encampments per year (the average stay duration is less than one week).

 



What services are currently provided?

A multi-agency approach is adopted case by case as needs arise.

 



What is the projected level of need?

It is estimated that by the year 2026, only six residential pitches would be needed in Hartlepool. Should that provision arise, there will be a need for other services (including health and education).

 



What needs might be unmet?

Content under development.

 



What evidence is there for effective intervention?

Primary Care Service Framework: Gypsy and Traveller Communities, 2009

Department for Education: Improving the Outcomes for Gypsy, Roma and Traveller Pupils: Final Report, 2010

Communities and Local Government: Designing Gypsy and Traveller Sites: Good Practice Guide, 2008

Friends, Family and Traveller: Finding Health Care,  2014

 



What do people say?

Content under development.

 



What additional needs assessment is required?

Content under development.

 



Key contact

Name: Sharon Robson
Job title: Health Improvement Practitioner
e-mail: sharon.robson@hartlepool.gov.uk
Phone number: 01429 523783

References

Local strategies and plans

 

 

National strategies and plans

 

Other references

 



Offenders

The term ‘offender’ refers to an individual who has come into contact with the criminal justice system by committing a crime or violating a law.

The link between offending, re-offending and the impact on health is well known.

Offenders and ex-offenders are far more likely to be more socially isolated and marginalised than the general population and to have a broader range of health concerns. As the number of people who come into contact with the criminal justice sector increases, there will be an increasing number of ex-offenders in communities.

There is a real need to divert offenders who have serious mental health problems away from prison and into the appropriate health service facilities. The needs of those suffering from physical health problems and from substance misuse and abuse must also be addressed.

This topic links with the following JSNA topics:



What are the key issues?

National

  • 90% of prisoners have substance misuse problems, mental health problems or both;
  • 72% of male prisoners and 70% of female prisoners suffer from two or more mental health disorders;
  • 20% of prisoners have four or five major mental health disorders;
  • 83% of prisoners smoke (averaging 16 cigarettes per day);
  • 9% of prisoners suffer from severe and enduring mental health illness;
  • 10% of prisoners have a learning disability;
  • up to 50% of new prisoners are estimated to be problem drug users;
  • 40% of prisoners declare no contact with primary care prior to detention;
  • People who have been in prison are up to 30 times more likely to commit suicide (in the first month after discharge from prison) than the general population;
  • 20% of male and 37% of female sentenced prisoners have previously attempted suicide;
  • There is often poor continuity of health care information on admission to prison, on movement between prisons and on release;
  • 49% of male, sentenced prisoners were excluded from school (2% in general population).

Local

  • The re-offending rate (36.6%) for adults and juveniles in Hartlepool is greater than the national average.
  • 510 offenders were responsible for over one-half of detected crime in Hartlepool (10% of these offenders were juveniles).
  • One-in-four crimes is committed by a repeat offender in Hartlepool.
  • Substance misuse (particularly Class A drug misuse) continues to be an influencing factor in the offending behaviour of the prolific and priority offenders (PPOs) and high crime causers (HCCs) adult client group.
  • Poor accommodation, lack of training and education has a detrimental effect upon offending behaviour.


What commissioning priorities are recommended?

2012/01

Ensure that the mental health needs of offenders are identified and supported.

2012/02

Ensure that the learning difficulties and/or disabilities of offenders are identified and supported.

2012/03

Ensure that effective interventions take place in respect of blood borne viruses in the prisons and the community.

2012/04

Ensure that all drug-related strategies and services continue to develop an outcome-based focus in line with the outcomes described in the HM Government Drug Strategy 2010.

2012/05

Ensure that the needs of female offenders are identified and supported.

2012/06

Ensure that pathways into suitable and sustainable accommodation and employment continue to be developed and supported.

2012/07

Ensure that the needs of children of offenders are supported, giving particular attention to the following principles:

  • The trauma experienced by children during the arrest of a family member(s) should be minimised;
  • Parents should be placed in a prison near to their family base with an appropriate level of visits allowed; and
  • Specialist support (especially mental health) for children who have parents in contact with the criminal justice system should be provided.


Who is at risk and why?

Content currently being revised.



What is the level of need in the population?

Content currently being revised.



What services are currently provided?

Criminal Justice Integrated Team (CJIT)

The CJIT provide access to drug and alcohol treatment for offenders. Most treatment is based upon an order of the court.  Arrest referral workers operate in the Hartlepool custody suite and provide assessment and brief interventions.  At court if an individual’s offending behaviour is linked to drugs or alcohol use, then the court can require treatment as a part of the sentence.  If an individual is imprisoned then treatment can continue during their sentence and on release.

Hartlepool Drugs Intervention Programme (DIP)

The DIP is part of the Hartlepool CJIT. The DIP Scheme started in 2003. It is funded by the government as part of its strategy for tackling drugs and reducing crime.  Engaging with DIP is voluntary. 

Custody Triage scheme

The triage process aims to reduce the number of young people entering the criminal justice system for low level offences by diverting them into positive activities and mainstream services, instead of charging them and taking them to court. Since its implementation in January 2010 it has worked with 153 young people in Hartlepool. Interventions and diversionary activities delivered during this time period include:

  • Reparation work;
  • Offending behaviour sessions;
  • Substance misuse workshops; and
  • Specialist victim services.

Re-offending rates are low with 18% of the young people choosing to offend after the triage intervention.

Team around the Household

Team around the Household is an innovative approach to reducing crime and disorder in Hartlepool. This is done by identifying and addressing the offending behaviour of people in persistently problematic households who are having a negative effect on families, neighbourhoods, and communities in the town.



What is the projected level of need?

In line with a projected increase in crime levels there is potential for offending and re-offending rates to increase. 

The DTV Probation health needs assessment identifies several trends that are getting worse, especially those related to mental health and to smoking.

Early indications are that alcohol and drug misuse continue to have a significant impact on offender health with alcohol misuse a particular concern. The Local Alcohol Profile (LAPE) shows that there are more alcohol-related admissions locally each year and that alcohol-related mortality is increasing for males.

The evidence base from national data sets and research would indicate that mental health continues to be a key area of concern and that overarching issues such as accommodation and employment affect offender health.



What needs might be unmet?

Mental health

There is clearly a high level of need amongst offenders in respect of mental health. It has already been identified in local and national needs assessments that this is an issue.

Learning difficulties/disabilities

It is unknown how many offenders have learning difficulties/disabilities that are undiagnosed and therefore have unmet support needs.

Substance misuse

Alcohol misuse remains a major problem with the long-term consequences for healthcare. Access to support via primary, secondary and specialist care is available, but this needs to be extended (especially in relation to early interventions). The type of drug(s) an offender uses dictates the intervention/s offered to them. This process needs to be further developed to meet the changing profile in substances used.

Smoking

Smoking remains a major risk to health. There are some processes in place for dealing with smoking and other lifestyle risks (staff working within the criminal justice system or via referral to community services) but this does not meet all the needs of the client group.

Housing & employment

Access to appropriate housing and to employment is a key priority. This has a major impact on reducing offending and improving health.

Female offenders

There are difficulties associated with engaging females into support and/or treatment and there is the possibility that vulnerable women will not use services.

Young offenders

If youth offending service officers do not have access to the relevant training and associated support then it increases the possibility that young offenders health needs will be unmet.

Children of offenders

The level of need is not currently known for children of offenders. Investigation, effective interventions and integrated working is required.

Needs analysis

There is a need to improve processes for identifying unmet needs. There is an under-reporting of mental illness, learning disabilities and blood borne viruses.



What evidence is there for effective intervention?

Content currently being revised.



What do people say?

The 2012 Health Needs Assessment for both local prisons details the findings of focus groups and surveys of offenders, including the perception of the quality and accessibility of the different healthcare services.

Holme House

The highest rated services for quality at HMP Holme House were:

  • Nurse led clinics (46%);
  • Sexual health (40%);
  • Immunisations and vaccinations (38%).

The lowest rated services for quality at HMP Holme House were:

  • Physiotherapy (28%);
  • Dentist (27%).

The highest rated services for accessibility at HMP Holme House were:

  • Nurse led clinics (39%);
  • Sexual health (37%);
  • Immunisations and vaccinations (38%).

The lowest rated services for accessibility at HMP Holme House were:

  • Dentist (18%);
  • Podiatry (15%).

Kirklevington Grange

The highest rated services for quality at HMP Kirklevington Grange were:

  • Mental health services (89%);
  • Nurse led clinics (84%);
  • Immunisations and vaccinations (82%).

The lowest rated services for quality at HMP Kirklevington Grange were:

  • Physiotherapy (43%);
  • Dentist (43%);
  • Physical disabilities (33%).

The highest rated services for accessibility at HMP Kirklevington Grange were:

  • Mental health services (100%);
  • Learning disabilities (100%)
  • Immunisations and vaccinations (92%).

The lowest rated services for accessibility at HMP Kirklevington Grange were:

  • Dentist (50%);
  • Physiotherapy (50%);
  • Podiatry (50%).

The perception of quality and accessibility scores tended to be higher at HMP Kirklevington Grange than HMP Holme House.

Durham Tees-Valley (DTV) Probation Trust

Stopping smoking was identified as a main need by 24% of respondents to the 2011 DTV Probation Trust HNA questionnaire.

The DTV Probation Trust caseloads for mental health have increased in 2011 and this is clearly an area where signposting, support and further investment will be required. 

DTV Probation HNA 2011 report states than 20% of respondents are currently misusing illegal or prescription drugs. 26% of respondents felt they wanted or needed to cut down on their drug use.

The DTV Probation HNA 2011 showed a considerable rise in the number of respondents who felt they should cut down their drinking; from 35% in 2008 to 47%.  Nationally, just under 5% of adults disclose drinking at harmful levels and 17.5% disclose being binge drinkers (Source: Local Alcohol Profiles England http://www.lape.org.uk/data.html).

In 2011, there were a higher number of offenders (47%) who felt guilty about their drinking, than 39% in 2008.

In 2011, there was an increase in the number of offenders who had had a drink first thing in the morning from 24% in 2008 to 29% in 2011.

The DTV Probation Trust caseload has had an increase in the number of respondents who identify themselves as smokers (from 72.8% in 2008 to 77% in 2011).



What additional needs assessment is required?
  • Within prisons, issues such as housing and employment need to be addressed in the health needs assessments as these all impact heavily on health outcomes.
  • The needs of children of offenders require further investigation.
  • An assessment of need is required for young offenders who have speech, language and communication problems.
  • The “Big Diversion Project” needs to be used to gather information for future needs analysis.
  • Further information may be accessible via HM Courts Service and as the JSNA develops, this will be considered and updated where appropriate.


Key contact: Denise Ogden

Job title:

e-mail: denise.ogden@hartlepool.gov.uk

Phone number:

References

Besemer, S., Geest, V., Murray, J., Bijleveld, C.C.H.J. & Farrington, D.P. (2011). The relationship between parental imprisonment and offspring offending in England and the Netherlands. British Journal of Criminology, 51(2), 413 – 437

British Association for Sexual Health and HIV (2011). National Guidance on Commissioning Sexual Health and Blood Borne Virus Services in Prisons. London: Author

Brooker, C., Fox, C., Barrett, P. & Syson-Nibbs, L. (2009). A Health Needs Assessment of Offenders on Probation Caseloads in Nottinghamshire & Derbyshire: Report of a Pilot Study. Lincoln: University of Lincoln

Brooker, C., Sirdifield, C., Blizard, R., Maxwell-Harrison, D., Tetley, D., Moran, P., Pluck, G., Chafer, A., Denney, D. & Turner, M. (2011). An Investigation into the Prevalence of Mental Health Disorder and Patterns of Health Service Access in a Probation Population. Lincoln: University of Lincoln

Bruce, R. & Hollin, C.R.  (2009). Developing CitizenshipEuroVista:  Probation and Community Justice, 1, 24-31

Butler, T., Richmond, R., Belcher, K., Wilhelm, K. & Wodak, A. (2007). Should smoking be banned in prisons? Tobacco Control, 16 (5), 291 – 293

Condon, L., Hek, G. & Harris, F. (2008). Choosing health in prison: Prisoners' views on making healthy choices in English prisons. Health Education Journal, 67 (3), 155 – 166

de Viggiani, N. (2007). Unhealthy prisons: Exploring structural determinants of prison health. Sociology of Health & Illness, 29 (1), 115 – 135

Department for Work and Pensions (2001). Barriers to Employment for Offenders and Ex-Offenders. London: Author

Department for Work and Pensions (2009). Delivering Better Housing and Employment Outcomes for Offenders on Probation. London: Author

Department of Health (2004). Choosing Health: Making Healthier Choices Easier. London: Author

Department of Health (2009a). The Bradley Report – Lord Bradley’s Review of People with Mental Health Problems or Learning Disabilities in the Criminal Justice System. London: Author

Department of Health (2009b). Improving Health, Supporting Justice: The National Delivery Plan of the Health and Criminal Justice Programme Board. London: Author

Department of Health (2011). No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of all Ages. London: Author

Dickens, G., Stubbs, J., Popham, R. & Haw, C. (2005). Smoking in a forensic psychiatric service: A survey of inpatients' views. Journal of Psychiatric and Mental Health Nursing, 12 (6), 672 – 678

Edwards, J.S.A., Hartwell, H.J., Reeve, W.G & Schafheitle, J. (2007). The diet of prisoners in England. British Food Journal, 109 (3), 216 – 232

Fawcett Society (2007). Provision for Women Offenders in the Community. London: Author

Fischer, J., Butt, C., Dawes, H., Foster, C., Neale, J., Plugge, E., Wheeler, C. & Wright, N. (in-press). Fitness levels and physical activity among class A drug users entering prison. British Journal of Sports Medicine.

Health Protection Agency (2011). Shooting Up - Infections among People who Inject Drugs in the UK 2010. An Update: November 2011. London: Author

Herbert, K., Plugge, E., Foster, C. & Doll, H. (2012). Prevalence of risk factors for non-communicable diseases in prison populations worldwide: A systematic review. The Lancet, 379 (9830), 1975 – 1982

Herrington, V., Hunter, G., Curran, K., & Hough, M. (2004). The Feasibility of Assessing Learning Disabilities among Young Offenders. London: King’s College London

Homeless Link (2009). Criminal Justice. London: Author

Laub, J. & Sampson, R.J. (2001). Understanding desistance from crime. Crime and Justice: A Review of Research, 28, 1 – 70  

LeBel, T.P., Burnett, R., Maruna, S. & Bushway, S. (2008). The “chicken and egg” of subjective and social factors in desistance from crime. European Journal of Criminology, 5 (2) 131 – 159 

MacAskill, S. & Hayton, P. (2006). Stop Smoking Support in HM Prisons: The Impact of Nicotine Replacement Therapy. Executive Summary and Best Practice Checklist. Stirling: Institute for Social Marketing: University of Stirling

MacLeod, L., MacAskill, S. & Eadie, D. (2010). Rapid Literature Review of Smoking Cessation and Tobacco Control Issues Across Criminal Justice System Settings. Stirling: Institute for Social Marketing, University of Stirling

Maruna, S. (2001). Making Good: How Ex-Convicts Reform and Rebuild Their Lives. Washington, DC: APA Books 

Merrall, E. L. C., Kariminia, A., Binswanger, I. A., Hobbs, M. S., Farrell, M., Marsden, J., Hutchinson, S. J. & Bird, S. M. (2010). Meta-analysis of drug-related deaths soon after release from prison. Addiction, 105, 1545 – 1554

Ministry of Justice (2007). Children of Offenders Review: A Joint Department for Children, Schools and Families/Ministry Of Justice Review to Consider how to Support Children of Prisoners to Achieve Better Outcomes. London: Author

Ministry of Justice (2010a). Compendium of Re-Offending Statistics and Analysis. London: Author

Ministry of Justice (2010b). Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders. London: Author

Ministry of Justice (2010c). Understanding Desistance from Crime. London: Author

Ministry of Justice (2011). Working with Children and Families of Offenders - A Guide for Local Authorities and Partnerships. London: Author

Murray, J., Farrington, D.P. & Sekol, I. (2012). Children's antisocial behavior, mental health, drug use, and educational performance after parental incarceration: A systematic review and meta-analysis. Psychological Bulletin, 138 (2), 175 – 210

Murray, J., Farrington, D.P., Sekol, I. & Olsen, R.F. (2009). Effects of parental imprisonment on child antisocial behaviour and mental health: A systematic review. Campbell Systematic Reviews, 4

National Institute for Clinical Excellence (2007a). Drug Misuse: Psychosocial Interventions (CG51). London: Author

National Institute for Clinical Excellence (2007b). Drug Misuse: Opioid Detoxification (CG52). London: Author

National Institute for Clinical Excellence (2010a). Alcohol Use Disorders in Adults and Young People: Prevention and Early Identification (PH24). London: Author

National Institute for Clinical Excellence (2010b). Alcohol-use disorders - Diagnosis and Clinical Management of Alcohol-Related Physical Complications (CG100). London: Author

National Institute for Clinical Excellence (2011). Alcohol Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence (CG115). London: Author

National Treatment Agency for Substance Misuse (2009). Breaking the Link - The Role of Drug Treatment in Tackling Crime. London: Author

Newbury-Birch, D., Harrison, B., Brown, N. & Kaner, E. (2009). Sloshed and sentenced: A prevalence study of alcohol use disorders among offenders in the North East of England. International Journal of Prisoner Health, 5 (4), 201 – 211

North East Public Health Observatory (2011). The Social Care Needs of Short-Sentence Prisoners. Stockton: Author

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Plugge, E., Neale, J., Dawes, H., Foster, C. & Wright, N. (2011). Drug using offenders’ beliefs and preferences about physical activity: Implications for future interventions. International Journal of Prison Health, 7 (1), 18 – 27

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Prison Reform Trust (2007). No One Knows: Prevalence and Needs of Offenders with Learning Disabilities and Difficulties. London: Author

Prison Reform Trust (2009). Too Little Too Late: An Independent Review of Unmet Mental Health in Prison. London: Author

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Ritter, C., Stöver, H., Levy, M., Etter, J.F. & Elger, B. (2011). Smoking in prisons: The need for effective and acceptable interventions. Journal of Public Health Policy, 32 (1), 32 – 45

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Child sexual exploitation

Child sexual exploitation (CSE) is a form of child sexual abuse. As with all types of abuse, it can have a devastating impact on the child or young person who is being exploited. Child sexual exploitation is a shocking crime with consequences that can exact a toll on the young people who are subjected to it, for some, throughout the course of their lives. It can disrupt their social lives and education. The health impact on victims of CSE are broad:

  • Long-term sexual, physical and psychological harm
  • Developing drug and alcohol misuse habit
  • Increased sexually risky behaviour (in some cases leading to teenage pregnancy)
  • Domestic servitude, neglect and violence
  • Self-harm and suicide

The National Working Group for Sexually Exploited Children and Young People (2008) define child sexual exploitation as involving exploitative situations, contexts and relationships where young people (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities.

CSE can occur through the use of technology without the child’s immediate recognition; for example being persuaded to post sexual images on the Internet/mobile phones without immediate payment or gain. In all cases, those exploiting the child/young person have power over them by virtue of their age, gender, intellect, physical strength and/or economic or other resources. Violence, coercion and intimidation are common, involvement in exploitative relationships being characterised in the main by the child or young person’s limited availability of choice resulting from their social/economic and/or emotional vulnerability.



What additional needs assessment is required?

Map universal service provision regarding CSE to understand what is being provided.



What do people say?

An independent inquiry into young people’s views about  CSE in Northern Ireland (2014) demonstrated the following common themes:

Awareness of CSE

  • Very few young people said they had an understanding of CSE prior to the session -  those who had heard of it , tended to describe more general child abuse than specific CSE behaviours.
  • Young people said that apart from some ‘stranger danger’ information or talks about keeping safe online, the subject was not covered in schools – many felt that this was part of a general prohibition around talking about sex in any form.
  • Young gay people said that there was no mention of LGBT relationships or safe sex advice in schools.
  • Many participants felt that young people could find themselves being sexually exploited without realising it.
  • Some young people felt that a relationship between an older and younger person wasn’t always exploitative – it would depend on the balance of power.

Identifying those at risk

Participants suggested a comprehensive range of young people who might be at particular risk. These included those:

  • With very little money – from poorer backgrounds
  • In care
  • With a disability
  • With low self-esteem
  • Who are LGBT (through being bullied/black mailed)
  • Who aren’t aware of CSE
  • From broken homes/bad family situations
  • Who are quiet/isolated with few friends
  • Who have a mental illness
  • Who are young carers
  • Who are young mothers
  • Who are on the streets
  • Who are involved in drinking or taking drugs

All groups made the point that anyone can be vulnerable.



What evidence is there for effective intervention?

Given that targeted approaches to tackling CSE are still relatively new, there is limited evidence about ‘what works’.

Following a thematic review across 8 local authorities nationally and drawing on feedback from over 150 children and young people, Ofsted (2015) concluded that ‘children and young people are more effectively protected from child sexual exploitation when Local Safeguarding Children’s Boards have an effective strategy and action plan that supports professionals to work together and share information well.  This activity, when combined with a whole system approach of awareness raising, the early identification of both victims and perpetrators and disruption and prosecution, is the only route to the effective protection of children and young people from CSE in our towns and cities’.



What needs might be unmet?

There is a requirement to establish clear referral pathways for all agencies to identify CSE concerns.

There is a lack of assessment/collation and development of intelligence concerning CSE about victims/perpetrators/locations.

There is currently no effective performance management data set and reporting arrangements to manage CSE performance effectively.

There is a gap in training for recognising, protecting and referring children for practitioners in respect of CSE.

There is a need to build awareness and resilience in children and young people to help prevent them being sexually exploited.

There is a requirement to develop a communication strategy to raise awareness of CSE.

There is a requirement to inform elected members and senior managers about the impact of child sexual exploitation.



What is the projected level of need?

Due to the problems understanding the scope of the level of need it is difficult to know what the projected level of need is.  However, the likelihood is that the numbers of young people who are at risk, or who are victims of CSE, will increase.



What services are currently provided?
  • Barnardos - A CSE worker has been commissioned from Barnardos and is based within the Interventions Team. They are responsible for training practitioners to build capacity and resilience, prevention work with schools and hold a case load of young people who are at risk or victims of CSE.
  • ISVA (Independent Sexual Violence Advocate Service) - Work with anyone under 18 who has experienced sexual violence and reported it to the police. Workers support young people through the criminal justice process. There is  a specialist worker who supports therapeutically.
  • Bridgeway - Therapeutic Service, Sexual Harmful Behaviour Work - Healing work for young people who have experienced sexual abuse. Working with young people who exhibit sexually harmful behaviour.
  • Stay Safe Project - Operation Stay Safe – supporting young people on the streets at risk of CSE. Working in partnership with police, social care and 0 to 19-year-olds. The priority of this operation is to identify vulnerability in under 18s on the streets of Hartlepool (usually Friday nights 10pm-4am).
  • Locality Teams (North and South) – provide early intervention programmes to young people who have been identified as being at risk of CSE.


What is the level of need in the population?

There is currently no national dataset for child sexual exploitation (CSE) so at present it is not possible to make comparisons with other areas. Data currently available from the VEMT meetings is presented to the HCSB on a quarterly basis and informs the multi-agency action plan for combating sexual exploitation. A common dataset has been agreed between the safeguarding boards in Teesside and a new comprehensive dataset will be published each quarter from March 2016.

The main model of child sexual exploitation in Hartlepool illustrated by the VEMT data is the ‘boyfriend model’ and exploitation of younger girls by older men. Social networks/media is a key factor in this model of exploitation. There is little evidence of organised exploitation by groups or gangs.

The available data for Hartlepool from  April 2014 to March 2015 shows:

  • A total of 50 cases were discussed in the Hartlepool monthly VEMT practitioners Group meetings.  It should be noted that the status of each child can change from one meeting to the next. Therefore, the figures below show the status of the child at the end of the reporting period.
  • Number of children open to VEMT = 8
  • Number of children discussed, but not added to agenda = 21
  • Number of children deferred pending further information = 6
  • Number of children closed to VEMT = 24 (this equates to 21 children)
  • 84% of the cases discussed in VEMT were girls and 16% for boys
  • Young people between the ages of 10 and 18 have been referred into the VEMT practitioners group.   The table below shows the breakdown of gender by age:

Age

10

11

12

13

14

15

16

17

18

Number Females

<5

0

<5

7

7

15 (12 individuals)

8

9

<5

Number of males

0

<5

0

<5

0

<5

<5

5

0

 

  • Over 60% of referrals have concerned young people (mainly girls) between the ages of 14 and 15
  • Referrals into the VEMT have only been collected since February 2015 and the main referrals have been made by Children’s Services, Planning and Information Officer FCSH.
  • The main reasons for young people being referred into the VEMT include young people being at risk and becoming exploited through going missing alone or with friends, being groomed through social media; and associating and becoming exploited by older men
  • 78% of young people referred into the VEMT are open to statutory social services; 24% of the referrals were made for children who are looked after (LAC) and 42% of referrals were made for children in need (CIN); 2% of young people were subject to child protection plans; 6% were looked after children placed in Hartlepool by another local authority; 4% of records were restricted (assumed known to social services) and 22% of young people are from the general population.


Who is at risk and why?

Any child or young person may be at risk of sexual exploitation, regardless of their family background or other circumstances. This includes boys and young men as well as girls and young women. However, some groups are particularly vulnerable. These include children and young people who have a history of running away or of going missing from home, those with special needs, those in and leaving residential and foster care, migrant children, unaccompanied asylum-seeking children, children who have disengaged from education, children who are abusing drugs and alcohol, and those involved in gangs.

The English Children’s Commissioner estimated 16,500 children to be at risk in the year to March 2011 and identified 2,409 victims; where gender was known, seven in 10 were girls and one in 10 were boys.  The age range of those affected appears to be going down too, with evidence of some 10-year-olds being involved and an incident with a four-year-old. Some of the children and young people also have other vulnerabilities, including a history of familial child abuse, but children from any background irrespective of class or ethnicity may be affected. Young people themselves may be involved in recruiting their friends and also act as perpetrators too.

The following are typical vulnerabilities in children prior to abuse[1]:

  • living in a chaotic or dysfunctional household (including parental substance use, domestic violence, parental mental health issues and criminality)
  • history of abuse (including familial child sexual abuse, risk of forced marriage, risk of honour-based violence, physical and emotional abuse and neglect)
  • recent bereavement or loss
  • gang association either through relatives, peers or intimate relationships
  • attending school with young people who are sexually exploited
  • learning disabilities
  • unsure about their sexual orientation or unable to disclose sexual orientation to their families
  • friends with young people who are sexually exploited
  • homelessness
  • lacking friends from the same age group
  • living in residential care
  • low self-esteem or self-confidence
  • young carers
  • mental health of young person.

The following signs and behaviour are generally seen in children who are already being sexually exploited2:

  • missing from home or care
  • physical injuries
  • drug or alcohol misuse
  • offending
  • repeat sexually-transmitted infections, pregnancy and terminations
  • absence from school
  • change in physical appearance (i.e. significant weight loss)
  • evidence of sexual bullying and/or vulnerability through the internet and/or social networking sites
  • estranged from their family
  • receipt of gifts from unknown sources
  • poor mental health
  • self-harm
  • thoughts of/ or attempts at suicide
  • recruiting others into potentially exploitative and risky situations.


 



What commissioning priorities are recommended?

Based on the Tees CSE strategy and the VEMT action plan the following recommendations have been identified:

2015/01

Ensure the implementation of CSE referral form/risk assessment tool

2015/02

Ensure the assessment of multi-agency intelligence submissions regarding CSE concerns to the Police.

2015/03

Train all frontline staff (universal and targeted) to recognise, protect and refer children who are, or are at risk of CSE.

2015/04

Identify both potential and validated training packages for use with :

  • children and young people
  • parents
  • schools
  • safeguarding professionals.

2015/05

Develop a co-ordinated VEMT awareness raising and communication strategy to increase public understanding of CSE and increase confidence in a VEMT approach.

2015/06

Develop an effective performance management data set and reporting arrangements to effectively manage CSE performance paying particular attention to vulnerable groups.

2015/07

Ensure that elected members and senior managers understand the impact of child sexual exploitation.



What are the key issues?

Confusion about sexual activity and the issue of consent

The fact that young people are engaged in what they view as consensual sexual activity does not mean that they are not being exploited.

  • Victims of sexual exploitation may be coerced into sexual activity with the perpetrators or they may feel unable to say no.
  • Some young people may not recognise that they are being sexually exploited; instead believing they are behaving as they wish.
  • 16 and 17-year-olds are often viewed as being more in control of their own choices and so less vulnerable to exploitation.
  • Sexual activity between young people of the same age is often perceived as being consensual, but exploitation may still be occurring.

Child sexual exploitation and risk-taking behaviour

Victims of sexual exploitation often display challenging, offending or risk-taking behaviour. Negative attitudes from professionals who view these children as 'troublemakers' can prevent them from getting the protection they need. However risk-taking behaviour is a key indicator of abuse.

  • When dealing with troubled children, practitioners need to see young people as vulnerable children in need of protection rather than focusing on their challenging behaviour.
  • Victims of exploitation who engage in offending behaviour should not be criminalised, but instead need protection and support.
  • Perseverance is required to engage with young people. They may not realise they are being exploited, have had negative experiences with professionals in the past, or be scared of the consequences of talking about their abuse.

Vulnerability of children in local authority care, foster care or residential care

Being in care can make young people more vulnerable to sexual exploitation. Many have had difficult starts to their lives and experienced neglect, abuse or trauma. Perpetrators target children’s homes because of the high vulnerability of the children placed there and how easily they can make contact with the children.

Disclosure of sexual exploitation

Young people are unlikely to disclose sexual exploitation due to: 

  • fear of perpetrators
  • loyalty to perpetrators
  • lack of knowledge or acceptance that they are being exploited
  • or lack of trust and fear of authorities.


Key contact: Deborah Clark

Job title: Health Improvement Practitioner

e-mail: Deborah.Clark@Hartlepool.gov.uk

Phone number: 01429 523397

References

1 Department for Children, Schools and Families (DCSF) and Home Office (2009) Safeguarding children and young people from sexual exploitation: supplementary guidance to Working together to safeguard children (PDF). London: Department for Children, Schools and Families (DCSF).

2. Office of the Children’s Commissioner (2012) “I thought I was the only one. The only one in the world.” The Office of the Children’s Commissioner’s Inquiry into Child Sexual Exploitation in Gangs and Groups Interim report.

3. Department for Children, Schools and Families (2009). Safeguarding Children and Young People from Sexual Exploitation: Supplementary Guidance to Working Together to Safeguard Children London: HMSO; 2009.

4. Department for Children, Schools and Families (2009). Safeguarding Children and Young People from Sexual Exploitation: Supplementary Guidance to Working Together to Safeguard Children London: HMSO; 2009.

5. NSPCC (2011) Sexual Abuse: A Public Health Challenge.

6. Ofsted (2014) Framework and evaluation schedule for the inspection of services for children in need of help and protection, children looked after and care leavers (single inspection framework) and reviews of Local Safeguarding Children Boards (130216).

7. Ofsted (2014) The sexual exploitation of children: it couldn’t happen here, could it?

8.Paula Keenan, Children in Northern Ireland (2014) Young People’s Views on child sexual exploitation.



Special educational needs

The Government’s Children and Families Act (2014) is transforming the system for children and young people with Special Educational Needs (SEN) and disabilities (D) so that services consistently support the best outcomes for them. SEND is a key theme in joint commissioning between Local Authority and the Clinical Commissioning Group and the legislation particularly requires this. The reforms required address the needs of children and young people from 0-25 years.

Definition for Special Educational Needs (Special Educational Needs and Disability Code of Practice, 2015)

Children have special educational needs if they have a learning difficulty which calls for special educational provision to be made for them.

Children have a learning difficulty if they:

  1. Have a significantly greater difficulty in learning than the majority of children of the same age; or
  2. Have a disability which prevents or hinders them from making use of educational facilities of a kind generally provided for children of the same age in schools within the area of the local education authority
  3. Are under compulsory school age and fall within the definition at (a) or (b) above or would so do if special educational provision was not made for them.

Children must not be regarded as having a learning difficulty solely because the language or form of language of their home is different from the language in which they will be taught.

Special educational provision means:

  1. For children of two or over, educational provision which is additional to, or otherwise different from, the educational provision made generally for children of their age in schools maintained by the LEA, other than special schools, in the area.
  2. For children under two, educational provision of any kind.

See section 312, Education Act 1996

A revised Special Educational Needs and Disability (SEND) 0-25 Code of Practice was published in 2015, it describes that the main changes from the SEN Code of Practice (2001) and reflects the changes introduced by the Children and Families Act 2014.  These are:

  • The Code of Practice (2015)covers the 0-25 age range and includes guidance relating to disabled children and young people as well as those with SEN
  • There is a clearer focus on the participation of children and young people and parents in decision-making at  individual and strategic levels
  • There is a stronger focus on high aspirations and on improving outcomes for children and young people
  • It include guidance on the joint planning and commissioning of services to ensure close co-operation between education, health and social care
  • It includes guidance on publishing a Local Offer for children and young people with SEN or disabilities
  • There is new guidance for education and training settings on taking a graduated approach to identifying and supporting pupils and students with SEN (to replace School Action and School Action Plus)
  • For children and young people with more complex needs a co-ordinated assessment process and the new 0-25 Education, Health and Care plan (EHC plan) replace statements and Learning Difficulty Assessments (LDAs)
  • There is a greater focus on support that enable those with SEN to succeed in their education and make a successful transition to adulthood
  • Information is provided on relevant duties under the Equality Act 2010
  • Information is provided on relevant provisions of the Mental Capacity Act 2005
  • There is new guidance on supporting children and young people with SEN who are in youth custody

Children with Special Educational Needs JSNA is linked with the following other topic areas:

Education

Learning disabilities

Autism

Physical disabilities

Sensory disabilities

Mental and behavioural disorders



What additional needs assessment is required?

To be determined.



What do people say?

Hartlepool has an active Parent Led Forum who consults using various methods and engages with families who have children who are affected by special educational needs and disability. 

As a result of this parents and young people told us what their priorities are for the development of short break provision. The next steps identified at the Ninth parent conference, during a parent/ provider workshop, drop in and parent led forum meetings delivered between March and July 2015 highlighted a number of areas as issues that need development or improvement and these are listed below:

  • Holiday play schemes
  • Extended activities out of school hours (term time)
  • Family based short breaks/parent led activities
  • Specialist toy loan services including tots time (stay and play
  • Sport/physical activities
  • Increase access to information
  • Continue to support parent participation to influence the development of services
  • Increasing the capacity of the workforce to support children and young people in a broader range of settings regardless of their disability
  • Special Educational Needs and disability (SEND 0-25 transition)

A survey of parents with deaf children by National Deaf Children’s Society (2013) regarding the SEN reform identified the following key points:

  • Parents of deaf children do not believe the reforms will be successful, largely due to funding cuts and existing capacity constraints.
  • Proposed new Education, Health and Care plans need to be parent-friendly and accessible but with a clear and objective focus on the needs of the child. There also needs to be stronger accountability against health services.
  • Parents want more and specific information about services for deaf children through the local offer. They also want more information about the quality of services.
  • Parents question the point of a local offer if each local authority isn’t required to provide a basic minimum service for all deaf children, regardless of where they live.
  • Above anything, parents want to be listened to and meaningfully involved.

Consultation with Children and Young people undertaken to develop our Emotional health and Wellbeing Plan in 2015  highlighted the  following Feedback from young people in Hartlepool, about what they want to see:

  • Raised awareness about mental health and wellbeing;
  • Better access – via community based, young people friendly buildings;
  • Anti-bullying campaign – to cover different types of bullying, what people think it is, ways of overcoming;
  • The voice of children and young people heard and opinions valued;
  • Support available at key transition points;
  • Improvement in emotional and physical wellbeing of young people through a revised curriculum for life.


What evidence is there for effective intervention?

CG72 Attention deficit hyperactivity disorder: diagnosis and management, 2013

www.nice.org.uk/guidance/cg72

Antisocial behaviour and conduct disorder in children and young people

http://publications.nice.org.uk/antisocial-behaviour-and-conduct-disorders-in-children-and-young-people-recognition-intervention-cg158

CG128 Autism in under 19’s: recognition, referral and diagnosis, 2014

www.nice.org.uk/guidance/cg128

CG17 Autism in under 19’s: support and management, 2013

www.nice.org.uk/guidance/cg170

QS51 Nice quality standard for autism

http://guidance.nice.org.uk/QS51

CG 145 Spasticity in children and young people with non-progressive brain disorders: management of spasticity and co-existing motor disorders and their early musculoskeletal complications.

www.nice.org.uk/nicemedia/live/13803/60023/60023.pdf

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities who have behaviour challenges, May 2015

www.nice.org.uk/guidance/ng11

CG137 The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care (NICE, 2012).

http://publications.nice.org.uk/the-epilepsies-the-diagnosis-and-management-of-the-epilepsies-in-adults-and-children-in-primary-and-cg137/about-this-guideline

The Better Communications Research Programme (BCRP) was a 3 year research programme, the findings of which are summarised on the following website:

http://www2.warwick.ac.uk/fac/soc/cedar/better/

The Communication Trust produces a number of publications which support the evidence for effective intervention, including:

  • Case Studies Report
  • Communication Friendly Checklists – to identify communication supportive environments
  • Communication Supporting Classroom Observation Tool

and many more useful resources/information.

http://www.thecommunicationtrust.org.uk

The Communication Trust also holds the ‘What Works’ database of evidenced interventions to support children’s speech, language and communication. This is endorsed by the Royal College of Speech and Language Therapists (RCSLT):

http://www.thecommunicationtrust.org.uk/projects/what-works/

The children’s charity I CAN also a number of publications highlighting the evidence around speech, language and communication difficulties and interventions:

http://www.ican.org.uk/en/What_is_the_issue/I%20CAN%20Evidence.aspx



What needs might be unmet?
  • There is a requirement to fully understand the need of the population in respect of Special Educational Needs
  • There is a requirement that children, young adults and parents inform and shape the commissioning of services to enable the personalisation of their support.
  • There is a need to improve the outcomes and quality of plans by the establishment of a quality assurance process.
  • There is a need to ensure the transition between child and adults services is seamless and that children and young people have access to effective and quality services.


What is the projected level of need?

National Pupil projections (July 2014) suggest that by 2020 numbers of pupils in state-funded schools will rise by 8%; 6% in primary, 11% in secondary and 16% in special schools.  If disability prevalence rates do not change there is clear indication that the number of disabled / SEN children in primary school will increase whilst the number aged over 16 will reduce.



What services are currently provided?

Health

Occupational Therapy Service and Paediatric Physiotherapy

The Paediatric Physiotherapy Learning Disability Service is delivered by the South Tees Hospitals NHS Foundation Trust via the Physiotherapy block contract.

The Paediatric Physiotherapy is delivered by North Tees and Hartlepool Foundation trust  for children with disabilities   preschool and in mainstream schools

Children with complex needs are treated from 0-19yrs are often seen in a community setting. As recommended by the NSF for Children they are seen in a location most appropriate for them, this maybe in their home, a nursery, school or children centre setting.

Schools with specialised units will usually have a paediatric physiotherapist and/or Occupational Therapist (OT’s) attached to them. The Therapists will assess, treat and advise within the schools and write programmes for parents and teachers. The Occupational Therapists can complete environmental assessments within schools.

Therapists will also assess and advise on equipment such as chairs and standing frames to improve function and aid the postural management of the child.

OT’s offer fine motor and hand writing assessments, they will provide exercise that can be completed at school and home.

Therapist will offer training to school staff and children’s 1-1’s in order that they have a greater understanding of the child’s condition and so that they are competent to carry out the child’s therapy programme.

If a child requires both Physiotherapy and Occupational Therapy, the Therapists will work together with the child, family and school to promote a “joined up” therapy plan.

Paediatric Audiology

Children’s audiology services are provided from the following location:

One Life Hartlepool
Park Road, Hartlepool

The Paediatric Audiology Service is a 0 – 19 paediatric service which includes the following:

  • Follow up screenings from the Newborn Hearing Screening Programme
  • Assessments due to parental or professional concerns about hearing and/or speech and language development
  • Follow up assessments from school screening programme
  • Diagnosis of temporary and permanent childhood hearing loss
  • Fitting of high specification digital hearing aids and providing continued assessment and support for this cohort of patients

Staff are experienced in working with children with disabilities and additional needs.  Our up to date facilities mean we can cater for children with extra needs comfortably.

Further information can be accessed from:

www.nth.nhs.uk/services/audiology/

Hearing and Visually Impaired Services

Following local government reorganisation in 1996, the Hearing Impaired Service and the Children’s Services for the Visually Impaired have been operated through a joint arrangement between Hartlepool, Middlesbrough, Redcar and Cleveland and Stockton local authorities. The service provides effective educational support to children and young people attending mainstream schools with hearing impairments or visual impairments as directed by the contracting authorities. The service will as part of its role;

  • attend mainstream schools with hearing impairments or visual impairments as directed by the contracting authorities
  • ensure that children should have their needs as assessed as early as possible
  • provide support by appropriately qualified staff
  • provide support appropriate to pupils’ needs and consistent with service capacity
  • regularly review the nature and extent of support provided
  • focus on pupil progress and outcomes
  • establish and maintain effective lines of communication with schools, other professionals and parents

Speech and Language Therapy

The service works with children and young people, from birth to 19 years old, who have speech, language and communication needs or difficulties with eating, drinking and swallowing. As well as occurring on their own, these difficulties are common in children who have other diagnoses such as autism spectrum disorder, learning difficulties or cerebral palsy. Speech, language and communication needs might include difficulties in:

  • making the sounds needed for speech to be understood by other people
  • putting words and sentences together to ask for something, tell a story or hold a conversation
  • making sense of what other people say
  • understanding and using body language and eye contact
  • stammering, where sounds or words are repeated or need a lot of effort to produce
  • a persistently unusual voice quality, which might sound harsh, breathy or hoarse

Further information can be accessed on the departmental website:

www.nth.nhs.uk/services/speech-language-therapy/children/

Community CAMHS/ Learning Disability Service

This service is provided by Tees Esk and Wear Valleys NHS Foundation Trust.

The North of Tees learning disability child and adolescent mental health service (LD CAMHS) provides a range of specialist health services to children and young people, aged between 0 - 18 years, with a wide range of learning disabilities (mild, moderate and severe) and their families. In addition to their learning disability, the referred child or young person will be experiencing significant mental health problems or complex needs.

The team aims to:

  • Provide a multi-disciplinary assessment, diagnosis and therapeutic intervention for the child, young person and their family
  • Support the development of individual early intervention strategies across a spectrum of disabilities
  • Provide consultation, training and support to families and colleagues working within education, social services and other agencies.
  • Support transition to adult mental health of Learning Disability Service

A child or young person accessing the service may experience a range of difficulties and these may include: challenging behaviour, depression, anxieties, tics, autism, ADHD, sleep difficulties, parenting problems, developmental delay, toileting problems, attachment issues and relationship issues. 

Further information can be assessed on the Trust Web site:-

http://www.tewv.nhs.uk

The Hartlepool Psychology Team

The Hartlepool Psychology Team applies psychology to improve outcomes for children and young people, particularly those with special or additional educational needs. The Team work with Children and young people aged 0-19 or up to the age of 25 if there is an Education, Health and Care plan in place.

The team work in consultation with parents, schools, early years settings, and other agencies  in relation to issues and concerns related to the learning, emotional and social development of children and young people.  The Psychology Team seek to work in a collaborative, solution-focussed way in order to:

  • maximise learning outcomes of children and young people
  • promote the pro-social behaviour and emotional well-being of children and young people
  • support schools and early years settings in the development of their capacity to improve outcomes for children and young people
  • support schools and early years settings to promote inclusion
  • support parents and carers to enhance the educational, social and emotional development of their children and young people 

Small STEPS

The Small STEPS team work under the supervision of the Educational Psychology Team to offer outreach support for adults supporting young children (typically 0-7 years) with significant additional or special learning needs, mainly children with, or being assessed for, Autism Spectrum Disorder or with profound/complex learning needs.  Working with families, in daycare settings or schools’ EYFS, and through targeted groups,  small STEPS can offer advice and support with:

  • Planning play and activities to promote learning and social skills and follow through targets set by professionals
  • Visual supports to help with promoting understanding, routines, making choices etc.
  • Planning for smooth transitions, preparing for new events and working through difficult times
  • Routines and self-help skills like dressing, toileting etc.
  • Promoting inclusion in all aspects of life
  • Finding information and training and developing links with others who can help and support
  • Helping Teaching Assistants and parents gain confidence and share ideas
  • Training on a wide range of topics; team members are licensed National Autistic Society EarlyBird Plus and Healthy Minds trainers

Hartlepool Information, Advice and Support Service

Provides impartial and independent information, advice and support for families of children and young people 0 – 25 years who have special educational needs and or a Disability.

The service will provide support in order to that parents with children and young people themselves with Special Educational Needs and/ or a Disability are fully involved in the education.

The service will over a range of information, advice and support, including, attendance at meetings, legal challenge, someone to talk to in confidence, help with the whole process on the EHC Assessment process, including  first tier tribunal and much more. More information about the service can be accessed using the following link.

http://www.hartlepool.gov.uk/education

Independent Support

To provide families with access to a trained Independent Supporter to provide support and information who are involved in the  transfer of a current educational statement  to an EHC plan or to support and inform parents and young people through the Education, Health and Care Plan process.

The service will provide time limited help to support parents and young people during the EHC Needs Assessment and Planning Process, including sign posting to information on the Local Offer of Services and Personal Budgets

Web Link: http://www.hartlepool.gov.uk/education

Web Link: www.hartlepool.fsd.org.uk/send

Local Offer

Provides information about services that are available for children and young people with special educational needs and disabilities between the ages of 0 – 25 years.

The Local Offer will:

  • Give information about education, health and care services
  • Give information about leisure activities and support groups
  • Hold all information in one place
  • Be clear, comprehensive and accessible
  • Make service provision more responsive to local needs and aspirations
  • Be developed and reviewed with service providers and service users

Web Link: www.hartlepool.fsd.org.uk/send

Parent Led Forum -  1 Hart 1 Mind 1 Future

A group of parents and carers of children with special educational needs and disabled children aged 0 – 25 years, who work alongside the local authority, education, health service and other service providers to make sure they plan, commission, deliver and monitor the needs of children and families. The group does this through active parent participation and ensuring parents have a voice.

1 Hart 1 Mind 1 Future believes it is important to enable families with children with SEN and disabilities to live a fulfilling and active life.

Link: www.onefuture.org.uk

Facebook: 1 Hart, 1 Mind, 1 Future Group Forum

Short Breaks for Families of Disabled Children

Short Breaks provide disabled children and young people with the opportunity to spend time away either with or without their parents to be able to relax and have fun, positive experiences with their friends and peers. They also provide families with a break from caring responsibilities; giving parents a chance to unwind, rest and spend time with their other children.

Our aim is to ensure that families of disabled children have the support to they need to live ‘ordinary lives’ as a matter of course. Disabled children and their families have the same human rights as others, including the right to the same quality of life as those who do not have a disability. However we recognise that all families are different, so they need different levels of support and different types of short breaks depending on the age and developmental need of the child; families may need more support because of their family circumstances, this may be for a short period or it may be for longer.

Reference: Short Break Service Statement web link: www.hartlepool.gov.uk/specialeducationalneedsanddisabilities



What is the level of need in the population?

Age & Gender

Older age groups (11-15 years) are more likely to have statements of SEN/EHC Plans.

The likelihood of having SEN without a statement peaks in the mid age bands (6-10 years).

Proportion with SEN by age and gender in state-funded primary, state funded secondary and special schools

(source: January School Census)

SEN is more prevalent in boys, for pupils with and without statements. The proportion of boys with a Statement of SEN or EHC Plan is more than double that of the girls.  For boys, Specific Learning Difficulty is the most prevalent need type.  As can be seen from the table below the most common need types vary significantly between genders.

Primary Need

Moderate Learning Difficulty and Speech, Language and Communication Needs account for the highest number of pupils in 2015 and 2016 and both have increased during this period.  Specific Learning Difficulty has also seen an increase in the number of pupils with this as a primary need.

The percentage of pupils with Social Emotional and Mental Health as a primary need is also high but has decreased between 2015 and 2016.

A breakdown of the four most common primary needs by phase of education can be seen below:

Socio-economic status

The more deprived a ward or neighbourhood is the more likely it is to have higher levels of incidence amongst pupils.

Source: SEN2 Return 2015 & School Census January 2015

The proportion of pupils with SEN without a statement/EHC Plan continues to fall, with 2014-15 showing the sharpest rate of decrease since the 2011 peak; figures for Statements or EHC Plans show little change.

Number and percentage of pupils with SEN in state-funded schools in Hartlepool and in England, as a percentage of the total number of pupils in all schools

The change in trajectory would appear to coincide with a change in categorisation and code recording of SEN which has resulted in a number of children previously recorded as School Action no longer recieving SEN support.  This is following government direction to ensure that underachieving pupils are not recorded as SEN.

Distribution of pupils with SEN

Pupils with Statements of SEN/EHC Plans in state funded provision by type of setting 2010 to 2015

The table above shows that previous trends are continuing in 2015; the proportion of pupils with statements of SEN attending maintained special schools continues to increase slowly.  The gradual increase in the proportion in state funded primary schools and the decrease in state funded secondary schools is a reflection of general population trends.

Although the trends above follow that of the national picture, the distribution of pupils with Statements of SEN in schools is quite different, as illustrated below.

Pupils with statements of SEN/EHC Plans by placement in January 2015

(Source: January School Census)

As can be seen from the charts above, a greater proportion of pupils with Statements/EHC Plans are educated in Special provision in Hartlepool than for the same cohort nationally.

Workflow

The number of school age children for whom the LA maintains a Statement of SEN or an EHC plan has increased in 2015.  However, the number of new Statements/EHC Plans issued remains at a similar level to 2014.  The number of post school age young people with a Statement of LDA has remained static.

Outcomes for children with SEN



Who is at risk and why?

Gender

Boys are two and half times more likely to have statements of special educational needs /EHC Plans at primary school and nearly three times more likely to have statements in secondary schools than girls.

Age

The latest national data suggests that younger children are more likely to have speech, language and communication needs than older children.  Older children between the ages of 11 and 15 years are more likely than younger children to have specific and moderate learning difficulties and behavioural, emotional and social difficulties.

Ethnicity

Nationally the percentages of disabled children by ethnic group fairly closely mirrors the percentages of children aged under 17 by ethnic group in the population.  According to the school SEN returns for January 2013, Black pupils were most likely and Chinese pupils least likely to have special educational needs.

Looked after children

Children looked after are three and half times more likely to have special educational needs compared to all children.  Children looked after are over more than 10 times more likely than all pupils to have a statement of special educational needs.

Socioeconomic

Research suggests that disability prevalence varies according to socio-economic background, with children from semi-skilled and unskilled manual families having a higher prevalence of both mild and severe disability than children from professional family backgrounds  

Free school meal entitlement

Pupils with special educational needs are much more likely to be eligible for free school meals compared to those without special educational needs.



What commissioning priorities are recommended?

2016/01

The leads from the Local Authority, CCG and partner agencies will complete an analysis of services to identify gaps in provision and duplication of services to enhance commissioning processes in order that we can jointly commission to collectively achieve and sustain our vision.

2016/02

The  SEND Service will collate information and data from individual plans to identify common themes.  Ensure representation from children and young people, families, to influence planning and commissioning of services with involvement at each stage of planning.

2016/03

There will be a focus on developing the individual outcomes within the EHC plans to ensure that they are personal, achievable and measurable. The outcomes will be aspirational for children and young people supported by their families, communities and services.

2016/04

Establish a clear pathway across each service/organisation area, delivered through a comprehensive staff training programme across agencies to improve the transition from children’s services to adult services for children with special educational needs and disabilities.



What are the key issues?
  • There currently isn’t a clear understanding of needs to ensure effective commissioning of services.
  • There are opportunities for families, children and young people to share their views on services and needs, however, communication between all partners needs to improve to use this information to enable co-production of processes to inform commissioning and shaping of services.
  • The assessment/early identification that leads to children/young people/adults to have an integrated plan requires improvement.
  • Transition between services is fragmented between different agencies e.g. conflicting age cut off points into adult services in Health, Education and Social Care.


Key contact: Danielle Swainston

Job title: Assistant Director (Prevention, Safeguarding and Specialist Services)

e-mail: danielle.swainston@hartlepool.gov.uk

Phone number: 01429 284144

References

Local strategies:

  • HBC Special Educational Needs/Disability Policy (2014)

National strategies and plans:

  • SEND Code of Practice: 0-25 years (2015)
  • Children and Families Act (2014)
  • Care Act (2014)
  • Equality Act (2010)
  • Education Act (1996)


Wider Determinants
Introduction

In his review of health inequalities, one of Sir Michael Marmot’s key messages is that “Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.”  The review identified six policy objectives which require action to reduce health inequalities.  These are:

  • Give every child the best start in life;
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives;
  • Create fair employment and good work for all;
  • Ensure healthy standard of living for all;
  • Create and develop healthy and sustainable places and communities; and
  • Strengthen the role and impact of ill-health prevention.

The topics within this theme are important contributors to the social determinants of health.  This summary attempts to identify the most important issues contained within each topic and, from these, highlight those which are the most important for action in addressing health needs and inequalities in Hartlepool.

What are the most important messages from each topic?

Crime

  • Crimes committed for financial gain including burglary, robbery and all theft offences continue to be prominent in Hartlepool.
  • Nationally, alcohol consumption is linked to 44% of violent offences, creates problems at weekends and in particular locations, and is associated with antisocial behaviour.
  • There is an association between levels of crime and deprivation.  Crime rates in the most affluent wards are less than half of those in the most deprived wards.

Education

  • Educational attainment rates at Key Stage 1 (aged 7 years) and at GCSE level are below England.
  • Not enough schools are judged by OFSTED to be ‘Good’ or ‘Outstanding’.

Employment

  • There is a high rate of worklessness in Hartlepool, fewer than average jobs per working-age resident and higher than average number of unemployed people per vacancy.
  • Unemployment varies between wards, with the highest rates occurring in Manor House and Victoria wards.

Environment

  • Hartlepool’s environment needs to be improved in terms of tackling derelict land and buildings; making streets safer, cleaner and greener; and developing, maintaining and improving green spaces.
  • Tackle climate change and maintain sea defences.
  • Hartlepool has 6,900 dwellings (21.2%) which contain households in fuel poverty.

Housing

  • There will be a 50% rise in the proportion of residents aged 75 by 2028, with increased demand for suitable housing.
  • About one-third of homes in Hartlepool is classed as non-decent.
  • There are estimated to be 6,900 (21.2%) households in fuel poverty within Hartlepool.


Poverty

  • There are between 7,500 and 10,500 people in Hartlepool who are not claiming benefits that they are entitled to.  Claiming a fraction of these benefits could be worth millions of pounds to the people and economy of Hartlepool.  A systematic approach to maximising rightful benefit uptake would help the most vulnerable and disadvantage people.
  • Over 6,000 children in Hartlepool are growing up in poverty and there are many areas where more children are in poverty than not.  Children eligible for free school meals have worse educational outcomes than their peers.

Transport

  • Too many people are injured in road traffic collisions.  Children in the 10% most deprived areas in England are three times more likely to be pedestrian casualties than those in the least deprived areas.
  • Opportunities for physically active transport (walking and cycling) in the relatively compact town of Hartlepool need to be maximised to help both physical and mental health.
  • Availability of public transport limits some people’s access to employment in the early morning and may isolate some residents from public services and could affect mental health by limiting access to social opportunities in the evening.

What should be the highest priorities for commissioners?

Short-term (1 to 2 years)

  • Tackle alcohol-related crime.  This would help relieve weekend pressures on A&E services, reduce domestic violence, and tackle location-based hotspots.
  • Develop a systematic approach to maximising benefits claimants, improving the lives of disadvantaged people and boosting the local economy.

Medium-term (3-5 years)

  • Ensure school readiness of children and parents.
  • Improve the quality of housing in the private rented sector, including thermal efficiency.
  • Optimise opportunities for job creation for all, but with a focus on young people in Hartlepool.

Long-term (over 5 years)

  • Develop transport infrastructure to maximise physically active travel and minimise injury and death.
  • Create an environment which supports health and wellbeing.


 

 

 

Summary Authors

Carole Johnson
Head of Health Improvement
Hartlepool Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service
 

 



Crime

Crime and the fear of crime are key factors that affect people’s quality of life and sense of well-being.

There is a direct link to health through such things as violent injury, rape and other offences against the person, and less directly via the psychological trauma of experiencing crimes such as burglary or vandalism.

Fear of crime affects the health of the wider community via, for example, restrictions on unsupervised outdoor play for children and social isolation of older people.

It has been acknowledged that the actual rick of becoming a victim of crime is much lower than the perceived fear of crime and victimisation. Fear of crime can have a devastating effect on quality of life and more focus is being placed upon providing reassurance to residents and ensuring that they know how best to protect themselves from becoming a victim without raising fear unnecessarily.

Crime reduces the effectiveness of healthcare systems through violence against NHS staff, damage to property, and costs of replacement, repairs and security. Alcohol and illegal drug dependency increase crime, and have an impact on health care services. http://www.wales.nhs.uk/sitesplus/888/page/43763

This topic is associated with:

Offenders

Alcohol misuse

Illicit drug use

Domestic violence victims

Sexual violence victims



What are the key issues?

Acquisitive crime

Acquisitive crime (any crime committed for financial gain including burglary, robbery and all theft offences) continues to be prominent in Hartlepool. This is particularly true in relation to metal thefts, where roofs of domestic and commercial premises have been targeted, and also where commercial premises are burgled for metals.

Alcohol and drugs

Alcohol-related crime is a growing problem in the UK and 44% of victims of violent crime perceived that the offender was under the influence of alcohol.

There continues to be a clear link between class A drug misuse, particularly heroin, and the occurrence of acquisitive crime.

Location

There is a strong link between crime/ASB and deprivation/unemployment. There is potential for an increase in crime rates due to the current economic climate.

Violent offences

Domestic violence is estimated to account for at least 16% of all violent crime.



What commissioning priorities are recommended?

2012/01

Develop, implement and monitor the Safer Hartlepool Partnership (SHP) strategy 2011-2014 to tackle crime, disorder, substance misuse and reduce offending in Hartlepool by focusing on the following strategic objectives and priorities:

Reduce crime and repeat victimisation for:

  • Acquisitive crime (domestic burglary and theft);
  • Violent crime (including domestic violence & abuse);
  • Support victims and reduce the risk of repeat victimisation.

Reduce the harm caused by drug and alcohol misuse by:

  • Reducing substance misuse through a combination of prevention, control and treatment services.

Create confident, cohesive and safe communities by:

  • Tackling anti-social behaviour through a combination of prevention, diversion and enforcement activity.
  • Protecting and supporting vulnerable victims and communities.
  • Improving public reassurance and the fear of crime by actively communicating, engaging and involving local people.

Reduce offending and re-offending by:

Preventing and reducing offending, re-offending and the risk of offending.



Who is at risk and why?

Socioeconomic status

There is a strong correlation between locations of higher crime and high levels of deprivation and unemployment.

Unemployed people are twice as likely to be burgled and be victims of violence as the average person.

Gender

Men are more likely to commit a crime than women.

More young males are associated with ASB incidents.

Females are at a greater risk of domestic violence (82% of victims are female).

There is a high prevalence of female victims who repeatedly suffer violence.

Age

Young households are more than twice as likely to be the victims of violence as the average household.

Males aged 20-29 tend to account for the highest proportion of victims of violence associated with the night-time economy.

Females aged 25-34 are at the most risk of domestic violence.

Females aged 25-34 are at the most risk of theft from the person.

It is very rare that elderly people are victims of crime, but they are vulnerable to distraction burglaries.

Older people are more likely to suffer fear of crime and worry about being a victim.

Ethnicity

The 2010/11 British Crime Survey (BCS) showed that the risk of being a victim of personal crime was higher for adults from a mixed background than for other ethnic groups. It was also higher for members of all BME groups than for the white group.

Mental health

People with severe mental illness are responsible for one in 20 violent crimes.

Alcohol

Alcohol arrest data indicates that around 44% of offences are linked to alcohol.

Drugs

Offenders who use heroin, cocaine or crack cocaine commit between one-third and one-half of all acquisitive crimes.

Females, young people, stimulant users and those from the BME community remain under-represented within treatment.

Repeat victims

There is a high prevalence of repeat victims (3.2%).

Young men aged 16 to 24 have the highest risk (13%) of being a repeat victim of violence.

Single parents

Lone parents are twice as likely to be burgled as the average person.

Security

Households with less than ‘basic’ home security measures were considerably more likely to have been victims of burglary (3.4%) than households with ‘basic’ or ‘enhanced’ home security measures (1.4% and 0.7% respectively).



What is the level of need in the population?

The Safer Hartlepool Partnership strategy to tackle crime, disorder, substance misuse and reduce offending includes the local performance indicators to reduce key crime categories.

Crime Category

2009/2010

(Baseline Year)

2010/2011

April 2011 – September 2011

All Crime

7664

7356

3844

Domestic Burglary

415

419

199

Vehicle Crime

545

509

248

Shoplifting

776

816

407

Local Violence

1151

1133

550

Criminal Damage to Dwellings

1729

1460

799

 

Socioeconomic status

There is a strong correlation between crime prevalence and the level of deprivation. Crime rates in the most affluent wards are less than half of those in the most deprived wards.



What services are currently provided?

Partnership working is strong in Hartlepool. The organisations responsible for the Safer Hartlepool Partnership, are the police, Hartlepool council, police authority, fire authority, Hartlepool primary care trust and probation service.

Through the development of effective strategies, the following multi-agency theme groups focus on the key issues affecting Hartlepool:

  • Substance misuse
  • Reducing violence
  • Reducing offending & re-offending
  • Improving public confidence and engagement
  • Prevent Silver Group
  • Neighbourhood Joint Action Group (JAG)

In addition, the separate Safeguarding Boards for adults and children provide the strategic lead for protecting children and vulnerable adults from harm.



What is the projected level of need?

There is a potential for increases in repeat and vulnerable victims in the current economic climate. Data for 2009 to 2011 suggests that crime rates in Hartlepool are likely to increase in 2012.



What needs might be unmet?

While there is a commitment to maintain high levels of service and support during times of austerity, it is clear that the pressures on budgets and the impact this will have on capacity will affect the level of service delivered.  This in turn could potentially lead to a lack of community reassurance linked with the wider feeling that public services are stretched at a time when unemployment is high.



What evidence is there for effective intervention?

Home Office Effective Practice

http://www.homeoffice.gov.uk/crime/partnerships/effective-practice1/effective-practice-publications/



What do people say?

Cleveland Police local public confidence survey

Hartlepool has the highest percentage of people in Tees who agree that the police and council are dealing with crime and anti-social behaviour issues that matter in their area. However, Hartlepool has the highest percentage of people in Tees whose quality of life is affected by fear of crime and anti-social behaviour.

Area

People who agree that police and council are dealing with crime and ASB issues (%)

People whose quality of life is affected by fear of crime and ASB (%)

Hartlepool

78.7%

18.0%

Middlesbrough

74.3%

15.0%

Redcar and Cleveland

72.7%

15.0%

Stockton-on-Tees

75.3%

14.3%

Since 2004 Hartlepool Borough Council has undertaken a MORI household survey every two years. In the 2010 survey, crime and safety continues to feature as one of the top issues in Hartlepool to improve the quality of life.



What additional needs assessment is required?

No additional needs assessment is required at present.



Key Contact

Name: Denise Ogden

Job Title:

e-mail:denise.ogden@hartlepool.gov.uk

phone:



Education

Education creates greater opportunity for economic and social choice. The educational opportunities of children and young people are affected by a range of factors including poor levels of self-esteem and physical activity. Future life chances and health are directly linked to educational attainment.

This topic is most closely related to the following topics:

 



What are the key issues?
  • Children in their early years, particularly between 0-3 years, are not making good enough progress in terms of their early development, with large gaps in personal, social and emotional development, expressive arts and mathematics.
  • Attainment in Key Stage 1 (average point score) remains significantly below the national average in reading and mathematics despite showing a five year improvement trend.  Attainment in writing is broadly in-line with the national average.
  • Whilst attainment in Key Stage 2 is broadly average, this masks a large attainment gap between disadvantaged pupils and all other pupils which is in the bottom quartile nationally.  In addition, progress in reading is not as rapid as progress in writing and mathematics.
  • The percentage of pupils achieving GCSE 5 A*-C including maths and English is now broadly in-line with the national average and represents a ten year improvement trend.  However, both attainment and progress in mathematics is substantially lower than in English, particularly for boys.
  • In addition, attainment at GCSE in science and in modern foreign languages is significantly below the national average.
  • Participation rates for 17 and 18 year olds have significantly improved.  Grades achieved, however, are below the national average and the percentage of students achieving a level 3 qualification (or equivalent) at age 19 is below the national average.
  • A lower proportion of young people than that found nationally progress to university.  A significantly lower than average number of disadvantaged pupils progress to higher education.
  • Only two of the town’s six secondary schools are judged by Ofsted to be good or outstanding.  In addition, the Pupil Referral Unit has been judged as requiring improvement.


 



What commissioning priorities are recommended?

2015/01

Offer schools a coherent school improvement/continuous professional development package through a targeted, flexible and, where necessary, bespoke Service level agreement.

2015/2

Offer a high quality school leadership programme that targets senior and middle management, aspiring leaders and governors and is appropriate for the needs of school leaders and managers in Hartlepool and the Tees Valley.

2015/3

Commission high quality support for all schools identified as causing concern through the updated 2015 Hartlepool Schools Causing Concern: Support and Challenge Protocol.

2015/4

Commission additional support for mathematics, particularly in secondary schools, to raise attainment at GCSE and improve rates of progress between Key Stage 2 and Key Stage 4.

2015/5

Introduce Reading Recovery as a catch-up intervention programme for 6-7 year olds in the schools where disproportionate numbers of pupils do not achieve Level 2B in reading in Key Stage 1 assessments.

2015/6

Commission research, informed by the conclusions and recommendations of the Hartlepool Education Commission, to develop innovative approaches to further closing the gaps in achievement between learners from low-income families and in-care and all other young people.

2015/7

Work with schools to develop new approaches to supporting the emotional and physical well-being of children and young people both through the curriculum and the wider school support services.

2015/8

Review and re-commission Hartlepool’s behaviour attendance and alternative education provision so that children with challenging behaviour can re-engage in their education as a result of high quality support and teaching.



Who is at risk and why?

Age
Adults with few or no qualifications are at a disadvantage when it comes to returning to and remaining in the labour market.
Adults in the criminal justice system are more likely to have a poor school history and poor educational attainment.

Gender
Boys typically achieve less than girls at all stages of their learning.

Socioeconomic status
Children from poorer backgrounds are much less likely to experience a good home learning environment, which is very important for children’s early educational development.

The achievement gap for poorer children widens particularly quickly during primary school, being affected by low parental aspirations; how far parents and children believe their own actions can affect their lives; and, behavioural problems.

The pattern of under-achievement is harder to reverse by the teenage years, but disadvantage and poor school results continue to be linked, including through low expectations for higher education; a lack of material resources; engagement in anti-social behaviour; and young people’s belief in their own ability at school.
Research shows that cognitive skills are passed from parents to children.

Ethnicity
Children from black or minority ethnic groups may require additional support to improve their English language skills to enable them to engage with areas of the curriculum adequately.

Special educational needs
A physical or learning disability might require additional support, either on a group or individual basis, to ensure attendance at school and/or individual learning progress.

Looked after children
Chaotic and traumatic life experiences can mean that children in the care of the local authority do not achieve key learning outcomes within the same timescale as their peers.

Offenders
Nearly half (49%) of male, sentenced prisoners were excluded from school compared with 2% in the general population.  More than half of male prisoners (52%) and 71% of female prisoners have no qualifications, with 65% having numeracy ability less than an average 11-year-old and 48% with a reading ability less than an 11-year-old.  One in ten prisoners has a learning disability.  At any one time, only one-third of prisoners have access to education. (Natale, 2010).  See the offenders topic for further details.

 



What is the level of need in the population?

Key Issues

  • Significantly below average pupil attainment in reading and mathematics in Key Stage1.
  • Attainment at age 11 is similar to the national average but the rates of progress through secondary education slow down.
  • Performance in GCSE mathematics significantly below the national average.

 

Primary Schools

RAISE Online 2010-2015 shows that attainment at Key Stage 1 in Hartlepool in reading, writing and mathematics is improving but is either below or significantly below the national average.

 

Key Stage 1 Summary

  • Children in year 1 complete the national Phonics Screening Check.  In 2014, 80% achieved the required standard.  This is an increase from 75% in 2013.  The national benchmark in 2014 is 74%.  Girls outperformed boys again in 2014 but the gender gap narrowed from 10% in 2013 to 4% in 2014.  Those children entitled to free school meals (FSM) did not perform as well as their non-FSM peers.  This gap widened in 2014 from a gap of 9% points in 2013 to 12% points in 2014.
  • Standards at Level 2+ in reading, writing and mathematics were very similar in 2014 compared to 2013.  Data indicate that Hartlepool children are just below national benchmarks by 3% points in reading, 1% point in writing and 2% points in mathematics in this measure.  Girls outperformed boys once again this year, with the gender gap being 5% in reading, 4% points in writing and 3% in mathematics.  These gaps all widened slightly in 2014.  FSM children continue to underachieve relative to their non-FSM peers in Hartlepool; in reading this gap is 11%; in writing it is 10%; and in mathematics it is 8%.
  • Overall standards in the more challenging Level 3+ indicator for reading, writing and mathematics fell slightly in 2014 compared to 2013.  The largest fall of 3% point was in reading.

Average points score at Key Stage 1, Hartlepool 2010-14

 

 

2010

2011

2012

2013

2014

Number of children

1017

1078

1096

1139

1139

Reading

Hartlepool

15.1

15.1

15.7

16.2

15.9

 

National

15.7

15.8

16.0

16.3

16.5

 

Difference

-0.6

-0.7

-0.3

-0.1

-0.6

Writing

Hartlepool

14.0

13.8

14.6

14.9

14.9

 

National

14.4

14.4

14.7

14.9

15.1

 

Difference

-0.4

-0.6

-0.1

0

-0.2

Maths

Hartlepool

15.1

15.1

15.5

15.7

15.7

 

National

15.7

15.7

15.9

16.1

16.2

 

Difference

-0.6

-0.6

-0.4

-0.4

-0.5

 

Source: RAISE Online DfE/Ofsted December 2014

 

At aged 11, primary schools in Hartlepool generally have levels of attainment similar to the rest of England.  In terms of level thresholds, in 2015, 79% of pupils attained at level 4+ in each of reading, writing and mathematics, which matched the national average (79%).

 

Level Thresholds Key Stage 2, Hartlepool 2014

 

%L4+

%L4B+

%L5+

Mathematics

Hartlepool

88

78

41

National

86

76

42

Difference

+2

+2

-1

Reading

Hartlepool

90

78

48

National

89

78

49

Difference

+1

0

-1

Writing

Hartlepool

86

n/a

33

National

85

n/a

33

Difference

+1

n/a

0

Spelling, Punctuation and Grammar

Hartlepool

78

70

54

National

76

68

52

Difference

+2

+2

+2

 

 

Average Points Score at Key Stage 2, Hartlepool 2011-14

 

2011

2012

2013

2014

Mathematics

Hartlepool

27.8

28.5

29.0

29.0

National

27.6

28.4

28.7

29.0

Difference

+0.2

+0.1

+0.3

0

Reading

Hartlepool

28.4

28.9

28.7

29.1

National

28.1

28.8

28.5

29.0

Difference

+0.3

+0.1

+0.2

+0.1

Writing

Hartlepool

26.3

27.5

27.8

27.9

National

26.4

27.3

28.5

27.9

Difference

+0.1

+0.2

+0.2

0

Spelling, Punctuation and Grammar

Hartlepool

n/a

n/a

28.1

28.8

National

n/a

n/a

28.0

28.6

Difference

n/a

n/a

+0.1

+0.2

 

Key Stage 2

  • Standards at Level 4+ all remain above national benchmarks.  Reading rose by 2% points to 90% in 2014 which is above the national average of 89%.  Standards in writing increased by 1% this year to 86% against a national figure of 85%.  Mathematics fell slightly by 1% point to 88% in 2014 compared with at national average of 86%.  Girls outperformed boys once again this year: in reading by 4% (national gap 4%); in writing by 8% (national gap 9%); in mathematics by 3% (national gap 0%).  FSM children continue to underachieve relative to their non-FSM peers in this key measure.
  • Standards in the more challenging Level 5+ indicator for reading rose by 5% point to 49% this year (national average 50%), whilst writing improved by 2% points to 33% (national average 33%).  In mathematics standards remained static at 41% (national average 42%).  Girls outperformed boys in reading by 7% (national gap 5%) and in writing by 17% (national gap 15%).  In mathematics boys outperformed by 3% in Hartlepool, whereas boys outperformed girls by 4% points nationally.
  • In Spelling, Punctuation and Grammar (SPaG), 78% attained at Level 4+, an increase of 2% points on 2013, (indicative national average 2014 is 76%), whilst 54% attained at the more challenging Level 5+, an increase of 10% points on 2013 (indicative national average 2014 is 52%). Girls performed better than boys in this examination by 12% (national gap 9%), and FSM performed less well than their non-FSM peers.
  • The proportion on children making the expected progress in reading from Key Stage 1 to Key Stage 2 rose slightly this year to 94%, above last year’s national average.  For writing, the proportion of children making expected progress rose to 96%.  It is anticipated that this will be above the national average once again this year.  The proportion of children making the expected progress in mathematics remained static at 93%.  It is anticipated that this will be above the national average once again this year.  The proportions of children making more than the expected progress from Key Stage 1 to Key Stage 2 increased in all subjects in 2014.  The proportions were 39% in reading, 36% in writing and 38% in mathematics.  These compare very favourably with last year’s national averages.

 

Secondary

Attainment at GCSE has shown an improving trend over a long and sustained period and is now virtually in line with the national average as measured by GCSE 5A*-C including maths and English.

5 or more A*-C grades at GCSE including English and Maths, Hartlepool 2005-2014

 

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

Hartlepool

35.8

37.5

38.6

39.2

48.5

49.6

56.4

48.8

59.0

55.1

National

44.7

45.6

46.3

47.6

49.8

53.5

59.0

59.4

59.2

53.4

Difference

-6.9

-8.1

-7.7

-8.4

-1.3

-3.9

-2.6

-10.6

-0.2

+1.7

 

Progress in secondary schools in Hartlepool in English is stronger than in mathematics.  Progress in mathematics is a key development issue for Hartlepool.

% of Pupils making expected progress in Hartlepool Secondary Schools

 

2008

2009

2010

2011

2012

2013

2014

English

Hartlepool

48.6

57.1

55.0

61.7

49.7

62.5

71.5

National

64.2

64.7

69.3

71.8

68.0

70.4

71.6

Difference

-15.6

-7.6

-14.3

-10.1

-18.3

-7.9

-0.1

Mathematics

Hartlepool

48.1

49.6

53.9

57.5

62.3

62.9

53.5

National

56.8

57.9

62.0

64.8

68.7

70.7

65.5

Difference

-8.7

-8.3

-8.1

-7.3

-6.4

-7.8

-12.0

 

Key Stage 4 Outcomes Summary

  • Attainment:  the key indicator of 5A*CEM decreased from 59% in 2013 to 55% in 2014.  The national figure fell at a faster rate from 60% to 55%.  For the second year running Hartlepool is now performing at the national average in this measure; Hartlepool was significantly below the national average in 2012.
  • Attainment in English improved for the third year running in 2014 with Hartlepool students having an average points score of 38.8 compared with a national average of 38.7.  Standards of English attained by students in Hartlepool are broadly average.
  • Attainment in mathematics dipped to 36.0 in 2014 compared to 38.1 in 2013, against a national dip from 38.8.  Standards of mathematics attained by students in Hartlepool are significantly below the national average by a third of a GCSE grade on average.
  • Attainment in science improved for the third consecutive year in 2014.  Hartlepool students attained an average points score of 41.4 compared to 40.1 in 2013.the national average for science in 2014 is 42.5 which means that attainment in science in Hartlepool is significantly below this; however the gap is narrowing quickly.
  • Girls outperformed boys once again in 2014, and the gender gap remained the same on average.  The average GCSE for boys was a grade C- (a half GCSE grade difference).  In terms of 5A*CEM, 60% of girls attained this in 2014 compared to 61% of girls nationally; only 47% of boys attained this standard compared to 50% of boys nationally.  There is no clear trend to demonstrate that the gender gap is closing over time.
  • The proportion of disadvantaged students attaining 5A*CEM improved from 39% in 2013 to 40% in 2014.  This means the gap between the attainment of this group of students and other students nationally narrowed for the third consecutive year.
  • The key attainment measure (5A*CEM) of students with special educational needs (those with and without a statement) was similar to national benchmarks for these groups.
  • Progress in English:  the proportion of students making the expected progress from Key Stage 2 to Key Stage 4 (KS2-4) in English improved from 63% in 2013 to 72% in 2014.  The national average is 70%.  The proportion of students making more than expected progress in English improved for the third consecutive year to 27% in 2014 compared to a national average of 32%.
  • The proportion of disadvantaged students making expected progress increased from 48% in 2013 to 59% in 2014.  The proportion of disadvantaged students making more than expected progress in English also increased, from 12% in 2013 to 20% in 2014.  The gap between Hartlepool disadvantaged students and other students nationally narrowed in 2014 for progress in English.
  • Progress in mathematics: the proportion of students making the expected progress from KS2-4 in mathematics fell for the third consecutive year from 62% in 2013 to 54% in 2014.  The national average is 65%.  The proportion of students making more than expected progress in mathematics also fell for the third consecutive year to 17% in 2014 compared to a national average of 29%.
  • The proportion of disadvantaged students making expected progress decreased from 49% in 2013 to 41% in 2014.  The proportion of disadvantaged students making more than expected progress in mathematics also fell, from 14% in 2013 to 8% in 2014.  The gap between the Hartlepool disadvantaged students and other students nationally widened in 2014 for progress in mathematics.
  • Floor Standard:  for the fifth consecutive year all Hartlepool secondary schools are above the current government floor standard which

 

 

Attendance

Validated data up 2013 indicates that attendance in both primary and secondary schools is lower than national attendance rates, although unvalidated 2014 data appears to indicate that attendance has improved over the last 12 months up to December 31st 2014.

Total % absence from schools – authorised and unauthorised – 2009-2013 Hartlepool

 

2009

2010

2011

2012

2013

Primary

Hartlepool

5.17

5.10

5.30

4.6

5.0

 

National

5.30

5.21

5.0

4.4

4.7

 

Difference

-0.13

-0.11

-0.3

-0.2

-0.3

Secondary

Hartlepool

7.25

6.99

6.90

6.5

6.2

 

National

7.21

6.80

6.50

5.9

5.8

 

Difference

+0.4

-0.11

-0.4

-0.6

 

 



What services are currently provided?

In Hartlepool there are:

  • 30 Primary schools
  • 5 Secondary schools
  • 3 Special schools
  • 1 Sixth form college
  • 1 Further education college
  • 1 Pupil referral unit

 

Hartlepool Local Authority (LA) offers school improvement support in a range of ways:

  • A School Improvement service level agreement that enables schools to receive support for pupil progress and attainment from a range of LA services.
  • A School Improvement Partner (SIP) is provided for every school to offer support and challenge to the headteacher.  The SIP provides a written termly report to the LA.
  • Commissioning support from other schools or outside agencies to provide additional resources for schools where not available from the LA.
  • Strategic Partner of the Hartlepool Teaching School Alliance to broker school-to-school support.
  • Termly meetings with headteachers to provide updates and information.
  • Training provided for teachers, classroom assistants and school leaders.
  • Support and training for governing bodies to enable them to fulfil their statutory support and challenge roles.
  • Half termly Headteacher updates to ensure that senior school staff are up to date with current issues.
  • Weekly Headteacher Noticeboard emailed to all schools as a digest of all announcements/events that week.
  • The Inclusion Team monitors the achievement of vulnerable groups and provides schools with additional support for individual children.
  • The Educational Psychology Team offers additional support for all vulnerable pupils ranging from informal support to parents to formal assessment advice for SEN Panels.
  • School attendance – close monitoring of overall attendance, persistent absence and inclusion levels is carried out by the Attendance Team in the Inclusion Service.
  • Looked after Children – the Virtual Headteacher coordinates all educational support for looked after children.

 

 

 



What is the projected level of need?

The Hartlepool Education Improvement Strategy 2014-15 details the areas of improvement that will require additional resources over the next three years if progress is to be made against the targets set.

Areas for development are:

  • Ensure all schools in Hartlepool are judged by Ofsted to be good or outstanding.
  • Raise achievement in EYFS to be in line with the national average.
  • Raise attainment in Level 2B+ mathematics in Key Stage 1 to ensure pupils can successfully access the Key Stage 2 curriculum.
  • Improve rates of progress in reading between Key Stage 1 and Key Stage 2.
  • Improve achievement in Key Stage 4 mathematics.
  • Improve participation and achievement in Key Stage 4 science and modern foreign languages.
  • Raise achievement at Key Stage 5 A-level and level 3 qualifications at age 19.
  • Reduce the achievement gap between disadvantaged learners and all other learners in each Key Stage.
  • Increase participation at Key Stage 5 in education, employment and training at age 18+.
  • Reduced the number of teenage conceptions per 1000 15-17 year old girls.
  • Reduce hospital admission due to substance misuse in 15-24 year olds.
  • Improve attendance in both primary and secondary schools and further reduce persistent absence.

 



What needs might be unmet?

Hartlepool Local Authority is confident that it can meet all the needs highlighted within this document.

A review of the current provision for those pupils exhibiting challenging behaviour is currently taking place as the there is insufficient capacity at present to fully and successfully meet this growing need in primary-aged pupils, particularly aged 5-7 years.  Provision for 7-11 year olds currently exists on a ‘guest’ provision basis at the primary special school.  Provision for pupils in Key Stage 3 and 4 is currently at the Pupil referral Unit and the secondary special school.  Neither provision as yet is a good as the respective headteacher would wish, with the accommodation providing high levels of challenge to successfully managing behaviour in both cases.



What evidence is there for effective intervention?

The Education Endowment Foundation Toolkit (Higgins el at, 2013) is an accessible summary of educational research which provides guidance for teachers and schools on how to use their resources to improve the attainment of disadvantaged pupils.  The Toolkit covers 30 topics, each summarised in terms of their average impact on attainment, the strength of the evidence supporting them and their cost.  It highlights feedback; meta-cognition and self-regulation; peer tutoring; and early years intervention as the top four evidence-based interventions.

The Centre for Excellence and Outcomes in Children and Young People's Services (C4EO) provides a range of products and support services to improve outcomes.  Excellence in local practice, combined with national research and data about 'what works' is being gathered in one place.

Ofsted provides Our expert knowledge, a resource that brings together expert knowledge.  It includes survey reports and examples of good practice by both key stage and subject.

 



What do people say?

To be completed.

 



What additional needs assessement is required?
  • There needs to be a comprehensive assessment of the needs for therapy services including physiotherapy, speech and language therapy and occupational therapy.
  • The needs of all vulnerable groups need to be assessed.

 



Key contact

Name: Dean Jackson

Job title: Assistant Director, Performance and Achievement

e-mail: dean.jackson@hartlepool.gov.uk

Phone number: 01429 523736

 

References

Local strategies and plans

Hartlepool Children’s Trust (2009). Children and Young People’s Plan 2009-2020.

RAISE Online 2011 Hartlepool Borough Council (OFSTED / DFE)

 

National strategies and plans

Department for Education (2010). The Importance of Teaching - The Schools White Paper 2010.

Department for Education (2012).  Statutory Framework for the Early Years Foundation Stage 2012.

Department for Education (2012).  Development Matters in the Early Years Foundation Stage (EYFS).

Department for Education (2012).  Support and aspiration: A new approach to special educational needs and disability - Progress and next steps.

 

Other references

Allen, G (2011). Early Intervention: The Next Steps - An Independent Report to Her Majesty’s Government.

Centre for Excellence and Outcomes in Children and Young People's Services (C4EO).

Department for Communities and Local Government (DCLG, 2011). English indices of deprivation 2010.

Department for Education (2012d). School performance tables for Hartlepool.

End Child Poverty (2012). Child Poverty Map of the UK, 2012.

Higgins, S., Katsipataki, M., Kokotsaki, D., et al. (2013). The Sutton Trust-Education Endowment Foundation Teaching and Learning Toolkit.

Natale, L (2010). CIVITAS Factsheet – Education in prisons.

The Social Exclusion Unit (2002). Reducing reoffending by ex-prisoners.

 



Employment

Employment has a major positive impact on an individual’s long-term health and wellbeing as well as that of their family members.  It can influence social mobility, economic independence, housing, and income levels.

Unemployment, however, can be both a cause of and a result of ill health.  The negative effects of unemployment on health and wellbeing can be linked to poverty and low income levels.  Long-term unemployment; limiting illnesses; low paid, short-term and temporary employment; and low level skills can affect an individual’s ability to gain and sustain employment.  The current economic climate presents particular obstacles to gaining employment for specific age groups (for example, 18-24 year olds and people aged over 50 years) and also for people who have recently been made redundant and may need to re-train to secure available employment opportunities.

This topic has strong links to the following JSNA topics:

 



What are the key issues?

The health and wellbeing of residents is important for Hartlepool’s economic prosperity. Regular paid work greatly reduces the risk of isolation, improves quality of life and the health of an individual and helps rehabilitation and recovery.
When considering how to improve the health of Hartlepool’s population, the key issues that need to be considered and addressed are:

  • How to support long-term unemployed and economically inactive adults to overcome barriers to employment, such as health and wellbeing matters.
  • How the Economic Regeneration Forum and Health and Wellbeing Board can work in partnership to ensure that employment and business support services are linked to health provision.
  • How to improve the labour supply links to skills training, apprenticeship programmes, job creation and future job opportunities.
  • How to improve links to pre-employment programmes that include health initiatives for adults who are long-term unemployed and have a health condition.
  • The profile of preventative health services is raised with employers so that more employed adults are supported to remain in work.
  • There is support to improve the skills of and provide in-work mentoring for employed adults.
  • There are high levels of workless adults within Hartlepool, with over 5,000 adults claiming Incapacity Benefit (IB).  Three-quarters of IB claimants are reported to be “not fit for work” due to mental health conditions including stress, anxiety and depression.

 



What commissioning priorities are recommended?

2012/01
Complete a comprehensive needs assessment
to understand the health service requirements of unemployed and employed adults.  Particular qualitative and quantitative research should be undertaken on how both cohorts have potentially differing needs for health service provision. This has been partially achieved / completed.

2012/02
Improve links to existing services for employed adults
to ensure that they are adequately connected to early intervention health programmes such as Improving Access to Psychological Therapies (IAPT) service. This will require increased engagement with employers which can be facilitated by the Economic Regeneration Forum. This has been partially achieved / completed.

2012/03
Provide Intermediate Labour Market (ILM) placements
to provide work experience with supportive employers who understand the challenges faced by long-term unemployed adults re-entering employment. This has been partially achieved / completed.

2012/04
Commission pre-employability programmes
that incorporate healthy lifestyle and fitness to work sessions.  These should be focused at pre-Work Programme customers. This has been partially achieved / completed.

2012/05
Provide experienced Information, Advice and Guidance (IAG) officers
based within the community and as an integral part of multidisciplinary teams, including health professionals to provide appropriate careers advice and signpost to suitable provision. This has been partially achieved / completed.

2012/06
Promote a healthy and supportive working environment
that includes implementing health initiatives and raise awareness of how to tackle in-work stress, anxiety and depression. This has been partially achieved / completed.

2012/07
Provide early access to health provision for employed adults
, specifically targeted at preventing those adults reaching the stage of being classified as ‘long-term sick’. This has been partially achieved / completed.

2014/01
Develop the Tees Valley Strategic Economic Plan which details a range of priorities for the sub-region, supported by European Funding. A range of task and finish groups with key partners are established, with the aim of identifying commissioning priorities.

 



Who is at risk and why?

Age
Youth unemployment has more than doubled since January 2005 but has fallen from its recent peak of 13.6% in January 2010 and remains some way below its highest point of 20.5% in January 1995.

In England, people aged 18-24 years are nearly twice as likely to be claiming Job Seekers Allowance than the general population (6.6% and 3.6%, respectively) and three times more likely than those aged 50 to 64 years (Nomis, 2012).

Older people face a number of potential barriers to labour market participation including out of date skills and qualifications, discrimination by employers in relation to age and higher expectations of salary upon entering the labour market.

Gender
Men are more likely to be economically active than women (83.9% and 72.0% respectively).  Male unemployment is 7.9% in England, compared with 7.4% for females.  Men in full-time employment earn more than women in full-time employment (£533.30 and £433.00 per week, respectively) (Nomis, 2012).

Socioeconomic status
Two-fifths of all adults aged 45-64 on below average incomes have a limiting longstanding illness or disability, one-and-a-half times the rate for those on average incomes and three times the rate for those on high incomes (The Poverty Site, 2010).

Ethnicity
There is strong evidence to suggest that ethnic minorities remain less well integrated into the regional labour market than their White British counterparts. Previous research suggests that different ethnic minority groups face a range of barriers in accessing the UK labour market.

Black African, Black Caribbean, Pakistani and Bangladeshi households are more likely to be workless than other ethnic groups (The Poverty Site, 2011).

Refugees face a number of distinct personal and structural barriers to economic participation including issues such as English language acquisition, lack of confidence and self-esteem, lack of UK work experience, references and proof of overseas qualifications.

Disability
In 2010/11, 6.3% of adults with learning disabilities were in employment in England (Learning Disabilities Observatory, 2012) compared with 71.8% of the population.

Disabled people are less likely to be employed (49%) than non-disabled people (78%).  Of those who are employed, about one-third of disabled people are in part-time employment compared with one-quarter of non-disabled people (Office for Disability Issues, 2012).

Low skilled adults
Having low or no skills is a major cause of unemployment and is widely acknowledged as one of the main barriers preventing unemployed people from returning to and remaining in the labour market.

Lone parents
Lone parents face issues such as finding childcare and childcare costs, domestic responsibilities, location of employment and emotional support.

Mental health
People with mental health problems have significantly lower employment rates than other working age groups.  Mental health problems can lead to significant disruption in people’s lives and those suffering from problems can experience issues in relation to confidence, self-esteem, concerns in relation to coping mechanisms and impact upon work.

Carers
About half of carers spending the most time (between 20-49 hours) caring per week were in employment in 2001.

Approximately one in five carers has to give up work, which affects pension contributions and increases the risk of poverty in later life.

Offenders
Offenders often have problems which can affect employment prospects (for example, drug dependency, homelessness and employer discrimination).


Non-group specific
Diabetes is the leading cause of blindness in the working age population.

People with autism spectrum disorders (ASD) may need support from services, because impaired capacity for social interaction hampers their chances of employment and achieving independence.

Communities where worklessness has remained high over the last ten years now suffer further from the effects of the recession. The unemployment rate gap between those local authorities with the highest and lowest rates had narrowed over fifteen years.  There is now concern for those who are already long-term unemployed and who live in existing vulnerable economies where unemployment is expected to increase and available vacancies will further decline (Houghton et al, 2009).

The North East Regional Joint Health Review and Scrutiny Committee examined the health needs of the ex-servicemen and their families.  Roughly one person in twelve in the UK is a member of the ex-service community: either a veteran of the armed forces or a carer, dependant or close family member of a veteran.  The employment needs and associated health and wellbeing in relation to this group continues to be a high priority, and work will continue locally to complement that taking place regionally.

 



What is the level of need in the population?

There are 58,300 working age adults within Hartlepool.  The overall worklessness rate remains high, recently rising to 31.2%.  This equates to 10,600 working age adults claiming a key benefit – higher than the North East and national rates of 26.6% and 23.8% respectively.  Of this workless group, over 6,000 adults are on Incapacity Benefit (IB) and are unfit for work.

Hartlepool has been affected by the recent recession which saw an increase in the numbers of people claiming Jobseekers Allowance (JSA).  Claimant count rates in Hartlepool increased from an average 2,450 in 2004 to 2008 to over 4,600 in 2012 and 2013.  The number is now reducing.  JSA claimant count rates in Hartlepool tend to be twice the rate seen nationally (Nomis, 2013).

Claimant count trned, Hartlepool, 2004 to 2014

Within Hartlepool, two wards have claimant count rates below the England average.  There is a near eight-fold difference in rates, from 1.3% in Rural West to 10.2% in Victoria.  There are no wards in Hartlepool with rates in the middle quintile for Teesside, highlighting the divide between areas with lower and higher unemployment.
Unemployment map, Hartlepool wards, Apr 2014

The Annual Population Survey estimates unemployment, as not all unemployed people are in receipt of JSA.  This estimates about 6,600 people to be unemployed in Hartlepool in 2013, more than the 5,800 in 2012 considerably more than the 2,450 JSA claimants identified.  Unlike the latest fall observed in JSA claimants, unemployment in Hartlepool appears to have increased to 15.5%, compared with 7.6% in England (Nomis, 2014).

Unemployment (survey-based) trend, Hartlepool, 2004 to 2014

Comparing Hartlepool with Halton (a similar area) and other Tees local authorities, shows that Hartlepool has a high rate of unemployment.

Benchmark of unemployment, Tees and comparators, 2013/14

The level of key benefit claimants in Hartlepool is almost double the rate in Great Britain and higher than the North East.  Total claimant rates are also higher than the North East and Great Britain.  Worklessness remains a major challenge in Hartlepool.  The largest group of claimants are in receipt of Employment Support Allowance (ESA) and incapacity benefits (IB).  Over 65% of ESA/IB claimants have been in receipt of those benefits for more than five years with 57% of claimants being male.  Rates of ESA/IB are above the GB average.

Working-age client group - key benefit claimants, Hartlepool, February 2014

 

Hartlepool

 

North East
(%)

 

Great Britain
(%)

number

%

Job seekers allowance (JSA)*

3,590

6.2

4.3

2.9

Employment support allowance (ESA) and incapacity benefit (IB)*

5,480

9.4

7.9

6.2

Lone parents*

1,160

2.0

1.5

1.2

Carers

1,280

2.2

1.9

1.4

Others on income-related benefits*

420

0.7

0.5

0.3

Disabled

740

1.3

1.3

1.2

Bereaved

120

0.2

0.2

0.2

Total key out-of-work benefits

10,650

18.3

14.2

10.6

Total claimants

12,790

21.9

17.6

13.3

* = key out-of-work benefits

Total key out-of-work benefits may not add up as individuals may be in receipt of more than one benefit.

Source: Nomis (2014)

 

The number of people receiving Incapacity Benefit and Employment Support Allowance in Hartlepool has reduced from about 8,000 in 2001 to about 5,500 in 2014, a 30% reduction in thirteen years.

Low skilled adults
Although adult skills attainment has improved in recent years, skills levels remain low in Hartlepool.  About 8,300 (14.2%) of people aged 16-64 have no qualifications, compared to 9.3% for GB as a whole.  An above average proportion of Tees Valley residents have poor numeracy and literacy skills, 28% and 27% respectively (DFES Skills for Life Survey 2003).  In addition, 20% of adults in Tees Valley have only entry levels of literacy skills compared to 16% in England, and 67% in Tees Valley have only entry levels of numeracy skills compared to 47% in England.

Qualifications, Hartlepool, January to December 2013

 

Hartlepool

North East

Great Britain

number

%

%

%

NVQ4 and above

13,900

23.8

28.1

35.2

NVQ3 and above

27,900

47.9

51.7

55.8

NVQ2 and above

38,700

66.3

70.4

72.5

NVQ1 and above

46,000

78.9

83.7

84.4

Other qualifications

4,100

7.0

5.6

6.3

No qualifications

8,300

14.2

10.7

9.3

Notes

Numbers and % are for people aged 16-64

% is a proportion of resident population of area aged 16-64

No qualifications: No formal qualifications held

Other qualifications: includes foreign qualifications and some professional qualifications

NVQ 1 equivalent: e.g. fewer than 5 GCSEs at grades A-C, foundation GNVQ, NVQ 1, intermediate 1 national qualification (Scotland) or equivalent

NVQ 2 equivalent: e.g. 5 or more GCSEs at grades A-C, intermediate GNVQ, NVQ 2, intermediate 2 national qualification (Scotland) or equivalent

NVQ 3 equivalent: e.g. 2 or more A levels, advanced GNVQ, NVQ 3, 2 or more higher or advanced higher national qualifications (Scotland) or equivalent

NVQ 4 equivalent and above: e.g. HND, Degree and Higher Degree level qualifications or equivalent

Source: ONS annual population survey (NOMIS)

 

Moving directly from an inactive benefit to a work-ready benefit may be extremely stressful for customers, especially those who may not have worked for long periods of time. The results of the Work Capability Assessment (WCA) for October 2008 to August 2010 show that 75% of customers have been classified as ‘fit for work’.

Having low or no skills is a major cause of unemployment and is widely acknowledged as one of the main barriers preventing unemployed people from returning to and remaining in the labour market.

Young people
The number of young people (aged 18 to 24 years) who are unemployed in Hartlepool rose from about 700 in 2005 to over 1,400 in 2012, but has now reduced to about 900.  Youth unemployment in Hartlepool tends to be at about twice the rate seen nationally, and higher than the North East.  In Hartlepool, more than 1 in 10 young people aged 18-24 are unemployed.

Youth unemployment trend, Hartlepool, 2000 to 2014

In January 2014, 290 young people (aged 16-18 years) in Hartlepool were not in education, employment and training (NEET), some 7.8% of this age group and higher than the England average of 5.3% but similar to the North East average of 7.6%.  Halton (a similar area) has a rate of 8.4%.

Not in education, employment or training, Hartlepool, 2013

Across the Tees Valley, fewer than 2% of 16-18 year olds are ‘long-term’ NEET remaining completely outside of the system between their 16th and 18th birthdays. The majority of young people move in and out of the system; typically over 50% of the NEET group is actively seeking education, employment or training at any one time.

Hartlepool has a higher proportion of part-time jobs compared to the North East and Great Britain.  There is a higher than average proportion of jobs in manufacturing and construction but a lower proportion in services.

Employee jobs by working pattern and industry sector, Hartlepool, 2012

 

Hartlepool

North East

Great Britain

Employee jobs

%

%

%

Total employee jobs

27,800

-

-

-

Full-time

17,500

63.2

65.6

67.3

Part-time

10,200

36.8

34.4

32.7

Employee jobs by industry

 

 

 

 

Primary Services (A-B: agriculture and mining)

0

0.1

0.2

0.3

Energy and Water (D-E)

1,000

3.5

1.4

1.1

Manufacturing (C)

4,000

14.6

11.1

8.7

Construction (F)

1,400

5.0

5.3

4.5

Services (G-S)

21,300

76.9

81.9

85.5

    Wholesale and retail, including motor trades (G)

4,400

15.9

14.2

16.1

    Transport storage (H)

600

2.3

3.7

4.6

    Accomodation and food services(I)

1,900

6.8

6.6

6.9

    Information and communication (J)

200

0.7

2.7

3.9

    Financial and other business services(K-N)

3,100

11.3

16.1

21.5

    Public admin, education and health (O-Q)

9,700

35.0

34.1

28.1

    Other Services (R-S)

1,400

4.9

4.5

4.5

Source: ONS annual business inquiry employee analysis / nomis

Notes:

% is a proportion of total employee jobs

 Employee jobs excludes self-employed, government-supported trainees and HM Forces

 Data excludes farm-based aggriculture

 

Job density is defined as the ratio of number of jobs in an area compared with the working age population.  In Hartlepool, there are about 30,000 jobs, giving a job density of 0.52 jobs per working age adult, compared with 0.78 in Great Britain (Nomis, 2014).

Hartlepool has 10.8 JSA claimants for every Job Centre Plus notified vacancy, compared with 3.7 claimants per vacancy in Great Britain (Nomis, 2012). This data set is no longer being updated.

 



What services are currently provided?
National Measures

Get Britain Working
National Government introduced welfare reforms in 2010 and introduced the Work Programme.  The Work Programme represents a step change for Welfare-to-Work, creating a structure that treats people as individuals and allows providers greater freedom to tailor the right support to the individual needs of each customer.  It has replaced previous programmes for unemployed people.

  • The Work Programme - helps individuals prepare for, find and stay in work. There are eight eligible customer groups and it is mandatory for people aged 18-24 years after receiving JSA for nine months.
  • Community Work Placements - aims to equip jobseekers with a valuable period of experience in a work-based environment, enabling them to develop the disciplines and skills associated with sustained employment, as well as to move them into employment.
  • Work Clubs - are for anyone who is unemployed and looking for work. They give people the opportunity to make the most of the local knowledge that's available, to support them in their search for a job.
  • Work Together - the opportunity to volunteer with a local voluntary organisation to help learn new skills and improve chances of finding work.
  • Work Trials – a voluntary opportunity which provides the chance to try out a job for up to 30 days.
  • Work Experience - gives anyone aged 18 to 24 years and receiving JSA the opportunity to take part in a work placement.
  • New Enterprise Allowance – provides help and financial support to set up a business for anyone in receipt of JSA for six months, Income Support (if a Lone Parent) or Employment Support Allowance (Work Related Activity Group).
  • Enterprise Clubs - help to become self-employed or to start a business.
  • Sector-based Work Academies – offer training, work experience and a guaranteed interview for anyone aged over 18 and in receipt of JSA or Employment Support Allowance (Work Related Activity Group).

Specialist disability employment support

  • Work Choice - is a programme to support disabled people with complex, disability-related barriers to help them find and stay in suitable employment. 
  • Access to work - can help if a person’s health or disability affects the way they do their job. It gives them and the employer advice and support with extra costs which may arise because of individual needs. It includes support for those who wish to move into self-employment.
  • Disability Employment Advisers - if people need extra employment support because of a disability, the local Jobcentre will put them in touch with one of their Disability Employment Advisers (DEAs).  DEAs can give help and support regardless of an individual’s situation. They can help people find work, or they can help them to gain new skills even if they have been out of work for a long time or have no work experience.


Drug or alcohol support - This voluntary service is for people who have a dependency on drugs or alcohol that affects them finding or keeping work.  It can also help people who have a problem with both drugs and alcohol.

Education Funding Agency (EFA) - The 16-19 Bursary Fund is a scheme intended to help the most vulnerable 16-19 year olds in full-time education.

SFA Apprentice Grant for Employers (AGE) - The AGE 16 to 24 Grant for Employers aims to support businesses, who would not otherwise be in a position to do so, to recruit individuals aged 16 to 24 into employment though the Apprenticeship programme.

DFE Youth Contract - The purpose of the Youth Contract programme for 16- and 17-year-olds is to engage young people who are hardest to reach and support them into education, training or a job with training.

DWP Families with Multiple Problems (FamilyWise) - supports disadvantaged families, facing multiple barriers to work, to move closer towards and into sustainable employment.

DCLG Troubled Families - the programme is targeted on families identified through a set of national criteria which include juvenile offending, involvement of any family member in Anti-Social Behaviour (ASB), exclusion from school or unauthorised absence levels of 15% or more, and receipt of a range of worklessness benefits.

National Careers Service - provides information, advice and guidance to help individuals make decisions on learning, training and work opportunities. The service offers confidential and impartial advice supported by qualified careers advisers.

 

Tees Valley Measures

 

Tees Valley Jobs and Skills Investment Scheme - offers businesses a 12 month wage subsidy of up to 50% towards the cost of a new trainee, apprentice or graduate of any age.  There is no limit to the number of people that a company can employ, providing the posts are additional and can be sustained for a minimum of two years.

Tees Valley Workforce Skills – provides a range of training and support to up-skill employees within businesses employing less than 250 people.

YES Project - a Tees Valley wide initiative being delivered by Youth Directions for Stockton which works with NEET young people to support them into Education, Employment or Training.

Graduates for Business - an initiative from Teesside University aimed at helping graduates to get their foot on the first rung of the career ladder by assisting them in finding employment with SME’s based in the North East.  Graduates can be placed on a register to be offered vacancies as and when they arise.  Businesses can access up to £11,000 as salary support to employ a graduate, and the University provides a free recruitment service.

 

Local initiatives in Hartlepool

 

Hartlepool Works Consortium – This is an employment and skills consortium which has membership from over forty providers who work within a set strategic framework to develop collaborative and targeted interventions, with a specific focus on priority groups or unemployment ‘hotspot’ areas. Details of the network and further information can be found at www.investinhartlepool.com.

 

 



What is the projected level of need?

Due to the broader travel-to-work area a Tees Valley perspective is provided to project the level of need.  Hartlepool has 14% of the Tees Valley population.

The Tees Valley Strategic Economic Plan (Tees Valley Unlimited, 2014) sets out the economic vision for Tees Valley for the next 10 years.  It forecasts the following level of need.

Tees Valley currently has 281,000 jobs and a working age population of 421,000.  To bring employment levels up to the national rate, an additional 28,000 jobs are needed.  Tees Valley Unlimited’s (TVU’s) target is to create 25,000 new jobs in the Tees Valley over the next decade, a 10% increase on 2014.  These will bring over £1 billion of gross value added (GVA) benefits, closing the gap between Tees Valley and national employment rates and matching the private sector employment rates in Manchester, Birmingham and Leeds.

These 25,000 new jobs will be achieved in the following sectors, noting the forecast reduction in ‘other manufacturing’:

Net Job Creation, Tees Valley, 2015-2025

 

Employment

GVA

Low Carbon

+2,500

£147m

Advanced Manufacturing

+2,500

£147m

Other Manufacturing

-5,000

-£250m

Construction

+4,000

£231m

Tourism and retail

+2,000

£57m

Finance and Business Services (ex digital)

+8,000

£307m

Logistics

+2,000

£118m

Telecoms and Digital

+2,000

£87m

Higher Education

+1,000

£31m

Health (Care)

+4,000

£116m

Other services

+2,000

£62m

Total

+25,000

£1,052m

Source: Tees Valley Strategic Economic Plan, Tees Valley Unlimited (2014)

 
Demographic changes are also an issue.  It is predicted that the number of people over the age of 65 will rise over the next ten years, along with an increase in those aged 55 to 64 (prevalent in process and advanced manufacturing jobs) and a fall in the number of young people entering the labour market. Those aged over 55 are likely to leave the workforce during the next ten years, taking their skills and experience with them. The replacement demand in Tees Valley between 2010 and 2020 could be as high as 120,000 people across all occupations. At the same time, the number of people aged 15-24 will decline, with new entrants to the workforce over the same period diminishing. The number of school leavers (aged 15-16) in Tees Valley will shrink over the coming years; by 2017 there will be 900 fewer students in this group than in 2013. The combined effect will produce a shift in the profile of the workforce over the next ten years and measures need to be put in place now to reduce the impact upon the local economy.
 
 


What needs might be unmet?

A comprehensive assessment of the relationship between service provision and demand is required.

Further research is needed to evaluate if the services offered to both unemployed and employed adults meet their needs.  Any increase in the unemployment rate could mean that demand outstrips supply.

  • The potential of a new group, recently unemployed people, who may have an increased need for health services.  Unemployment could have a detrimental effect not only to an individual’s health, but to other members of their family. Adults who are at risk of redundancy or are made redundant may not seek help because of the stigma attached to mental health problems or by the reluctance to admit that there is a problem.
  • To ensure that there are regular reviews of unmet needs, it is important that statutory agencies, health services, post-16 providers and employers’ work together to debate where there are service gaps and how these can be closed through existing services.
  • Employers would value access to independent expert advice on the functional capabilities of sick employees, especially in longer-term absence and instances where there is risk never working again.

If an Independent Assessment Service (IAS) is not introduced nationally, then consideration should be given to how existing local health and employment services, particularly those who currently offer in-work mentoring, human resources and employer advice can work together to sustain adults in work.

 

 



What evidence is there for effective intervention?
Young People (up to 25)

Hidden Talents 2: Re-engaging young people, the local offer (Local Government Association, 2013) contains examples of good practice and successful projects. The LGA used evidence from successful projects to make proposals suggesting a whole-system approach based on a new level of collaboration between local and national services and a more fitting distribution of responsibilities.  The model ultimately seeks:

  • to integrate and sequence re-engagement services for the most disengaged young people up to 24, by making local partnerships default commissioners of re-engagement support;
  • to reconnect provision to employer demand in local labour markets, by flexing skills and employment services around occupational and sector funding priorities jointly set by local partners with government;
  • for local services for hardest-to-reach young people with national welfare to work services and programmes to unlock value by co-designing support packages for this group.

Some of the examples are dependent upon responsibilities moving from National to Local Government but substantial elements of the good practice could still be implemented without that change.

The following are examples of good practice in the Hidden Talents Document:

Wakefield – early identification and targeted joint working

Wakefield Council is taking a holistic view to transitioning young people through primary school, secondary schools and into post-16 education.  In one year the number of school leavers becoming disengaged dropped from 6% to 5.5%. Over the same period applications for post-16 learning via the Wakefield online prospectus increased by 22%, up to 86% by March 2012.

The authority has developed detailed data analysis to understand the current cohort and map provision, identifying young people at risk and tracking them through school, and developing information-sharing tools to inform pre and post-16 provision – a smart phone application was developed to inform young people of the opportunities ahead.

A Targeted Youth Service works with Connexions and the local third sector to provide bespoke programmes for most at risk groups – it includes the Back on Track project giving young people hands on employment experience to complement formal learning. Since 2010 it has, for instance, increased the number of young offenders re-engaging following a court order increased from 58% to 80% in 2012.

Hartlepool – bespoke employability programmes

Hartlepool’s Going Forward Together programme was the centre piece of its strategy to engage high risk young people. The programme supported over 600 of the most disengaged 14-19 year olds, with 75% progressing into education, employment and training. Despite the recession, the local authority reduced the number of disengaged young people from 9% at the end of 2007, to 7.4% in 2011, and plans to reduce to 6.7% by 2012/13.

The programme was targeted at young people identified by schools or Connexions who required additional support, such as young offenders, care leavers, or young people from disengagement ‘hotspots’.  The local authority, Connexions, schools, and training providers collectively designed bespoke engagement programmes. All provision was routed through a single referral point in the Council’s Integrated Youth Support Service, which conducted eligibility checks and offered targeted careers advice and guidance, before a referral to a named mentor that could draw on a range of wrap around services from a number of providers.

As part of the personalised intervention, subcontractors from the public, private and third sector offered varied and unique pre-employability programmes focused on helping young people remain economically active post 16 - including everything from Foundation Learning to Jobcentre Plus provision.

Since February 2011, 182 young people had been registered onto the programme; with 97% retention rate and 99% achievement rate, with 65% of participants progressing into work or learning.

Gateshead – simplified offer to employers
The Gateshead Apprenticeship Plan commits to increasing the number of apprenticeships by 600 before 2014, and increase the number of apprenticeships for 14-16 year olds to 260. Gateshead Strategic Partnership is working with the National Apprenticeship Service, Connexions, and the Gateshead Collective, a network of eight work-based learning providers, to deliver the plan’s priorities.

The single offer co-ordinates information relating to apprenticeships across the Borough, and provides a central resource with a common message for employers, and reduces the number of approaches from providers. The plan targets seven priority growth sectors for Gateshead, including science, digital and creative, and retail and tourism.

Within the model, the local authority plays a commissioning role shaping provision around local economic priorities, acting as a corporate parent for young apprentices from care. Ten partnership groups will help deliver the plan across Gateshead, with the National Apprenticeship Service acting as the delivery body.

Newcastle – Apprenticeship Plus
Newcastle City Council is leading the way on apprenticeships, for instance as an employer it has over 120 apprentices. Newcastle has also developed an Apprenticeship Plus service, which offers employers that want to recruit an apprentice an holistic, rounded service – including assistance with recruitment, arranging the delivering of training, and a salary subsidy programme for apprentices which complements NAS’s Apprenticeship Grant for Employers. The city is to build on this as part of its city deal, developing an apprenticeship hub. Furthermore, young people are assisted in interview preparation and those that apply but are not successful have the option of additional support to help fill any skills gaps. As a result, more than 50 apprenticeship opportunities have been created for young people from Newcastle’s more disadvantaged areas.

 

Further examples of good practice from Tees Valley include:

Youth Employment Initiative - Stockton
Following the success of the Future Jobs Fund in Stockton it was decided to develop this initiative to provide 165 employment opportunities for young people aged 16-24.

  • Opportunities were for at least 12 months, providing work for 35 hours or more per week and were paid at least at the national minimum wage;
  • All jobs were suitable for long term unemployed young people between 16 and 24,
  • Jobs were additional – i.e. they would not exist without this funding;
  • Opportunities had to be part of an apprenticeship framework;
  • The work undertaken directly benefitted local communities;
  • Organisations received 39 weeks subsidy for wages.

Foundation for Jobs – Darlington
Launched in early 2012 the Foundation for Jobs (FFJ) project had four key elements: promote vocational opportunities (both training and employment); increase the number of apprenticeships; build links between schools and business (and address perceptions of apprenticeships and industries in general); develop internships and entrepreneurial skills.

A full time project co-ordinator ensured that activities across all four strands were delivered and in the first year of the project 123 apprenticeships were created, over 1,100 young people attended practical/interactive themed sessions; 124 Internships were taken up and 66 young people received advice on starting their own business. The impact both in terms of actual numbers but also in terms of changing attitudes is evident amongst those working with young people in Darlington and all other Tees Valley Local Authorities are looking at FFJ as a template for their activities.

It is clear from the project’s first annual report (July 2013) that the project is performing well and exceeding the targets. The report states “Foundation for Jobs has taken a different approach to addressing youth unemployment; tackling attitudes and perceptions at a grassroots level.” It continues: “The first year of the programme has produced a blueprint for investment both in Darlington and further afield.”

 

Talent Match – Middlesbrough
Talent Match is targeting young people who are furthest from the jobs market, including those who are completely outside of the benefits, work and training system and facing severe barriers to gaining the skills they need to get into work. Talent Match boosts opportunities for young people in selected areas by bringing together partnerships of employers, education providers and others, led by local charities.

In Middlesbrough the Prince's Trust was granted more than £1.4 million from the Big Lottery Fund to deliver Talent Match.  Focusing on the areas of Gresham, University, Middlehaven, North Ormesby & Brambles Farm, Thorntree, Pallister, Park End and Beechwood Talent Match identifies, engages, inspires and supports eligible young people from the most deprived areas in Middlesbrough to enable them to move into sustained employment or enterprise by matching them with a dedicated mentor who helps boost their confidence and skills, and supports them back into the workplace.

Over the five year project 500 young people who have been unemployed for 12 months or more will increase in confidence, motivation and self-esteem; at least 100 young people will be supported into sustained employment or self-employment, lasting for a minimum of 6 months.

 



What do people say?

The evaluation of the highly successful Tees Valley InWork Support project found that ‘Employers, partners and providers agree that an early intervention to health programmes and support to help all adults to fully participate within the labour market is important for improving the health of the local population.’

 

 



What additional needs assessment is required?

The Hartlepool Economic Assessment was completed in 2010 and endorsed by the Council in March 2011. The assessment provides a detailed needs analysis of the drivers that directly, and indirectly, impact on Hartlepool’s economic capacity. It provides a wide range of information relating to social, economic and environmental issues, such as employment and skill levels and the health and wellbeing of the population.

This led to the development of the Hartlepool Economic Regeneration Strategy (ERS) 2011-2021 and ERS Action Plan 2014-2017. The ERS provides a clear framework for the future direction and delivery of the Council and relevant partner’s services, aimed at maximising economic growth for Hartlepool and improving outcomes for residents, including helping people into sustained employment.

Whilst the Economic Assessment and ERS provide a significant level of detail relating to economic and regeneration matters, there is still a need for a full needs assessment to understand the health service requirements of unemployed and employed adults.
 

 



Key Contact

Name: Scott Campbell

Job Title: Performance Officer

e-mail: scott.campbell@hartlepool.gov.uk

phone: 01429 284306

 

References

Local strategies and plans

Hartlepool Borough Council (2011). Economic Assessment

Hartlepool Borough Council (2014). Hartlepool Economic Regeneration Strategy 2011-2021

Hartlepool Borough Council (2011). Hartlepool ERS Action Plan 2014-2017

Tees Valley Unlimited (2014). Tees Valley Strategic Economic Plan

Tees Valley Unlimited (2014). Tees Valley European Structural & Investments Fund Strategy

Tees Valley Unlimited (2011). Tees Valley Local Enterprise Partnership’s Statement of Ambition 2011.

Tees Valley Unlimited (2011). Tees Valley Unlimited Partnership Business Plan.

Tees Valley Unlimited (2009). Tees Valley Economic Assessment.

 

National strategies and plans

Department for Communities and Local Government (DCLG, 2009), The Houghton Review: Tackling worklessness – a review of the contribution and role of English local authorities and partnerships.

Marmot, M et al (2010), The Marmot Review: Fair Society, Healthy Lives. Strategic review of health inequalities in England post-2010.

 

Other references

ACEVO (2012). Youth unemployment: the crisis we cannot afford

Department for Works and Pensions (DWP, 2012). Qualitative Study of offender employment review: final report.

Houghton, S; Dove, C; and Wahhab, I (2009). Tackling Worklessness: A Review of the contribution and role of English local authorities and partnerships.

Joint Health Overview of Scrutiny Committee of North East Local Authorities (2011). Regional Review of the Health Needs of the Ex-Service Community.

Learning Disabilities Observatory (2012). Learning Disability Profiles 2012

Ministry of Defence (2008). The Nation’s Commitment: Cross-Government Support to our Armed Forces, their Families and Veterans.

Nomis (2012).  Labour market profile for England, September to November 2012.

Nomis (2014). Labour market profile - Hartlepool.

Office for Disability Issues (2012). Disability Equality Indicators.

Murrison, A (2010). Fighting Fit: a mental health plan for servicemen and veterans

The Poverty Site (2010). Longstanding illness/disability.

The Poverty Site (2011). Work and ethnicity.

 



Environment

The environment has a significant effect on health and wellbeing.  High quality environments have a key part in helping people to live healthier and happier lives. Environmental problems such as noise, air pollution, food safety, pest control and contaminated land can have a significant impact on individual and population health.  Climate change continues to pose significant future risks to human health if actions are not taken now both to reduce carbon emissions and reduce energy demands to sustainable levels.

This topic is most closely associated with:

 



What are the key issues?

Hartlepool’s environment needs to be improved in terms of tackling derelict land and buildings; making streets safer, cleaner and greener; and developing, maintaining and improving green spaces, parks and recreational areas.

If climate change is to be tackled, then greenhouse gas emissions need to be reduced and Hartlepool needs to prepare for the anticipated impacts of climate change such as increased storm events; increased risks from pests and diseases; increased risk of food poisoning; and potentially higher rates of skin cancer.

Sea defences must be maintained to prevent major flooding in coastal areas.  Surface water flooding poses a threat to other areas of Hartlepool, and the likelihood and severity of such incidents will increase.

Four areas in Hartlepool are identified as important areas to develop noise action plans.  Six stretches of highway in Hartlepool have been identified as priority or important areas under the Environmental Noise Directive.  There are high levels of complaints about noise from domestic and commercial premises, building sites and road transport.

There are estimated to be 6,900 dwellings (21.2%) which contain households in fuel poverty within Hartlepool.  Improving the energy efficiency of existing homes will have significant health benefits and reduces greenhouse gas emissions.

There is a large demand for pest control treatments in Hartlepool.

 



What commissioning priorities are recommended?

2012/01
Create sustainable neighbourhoods
by bringing derelict land and buildings back into use; making streets safer, cleaner and greener; and developing, maintaining and improving green spaces, parks and recreational areas.

2012/02
Ensure that a proactive response to climate change is adopted in Hartlepool
by ensuring that buildings do not suffer from water ingress; raising awareness of the risks of skin cancer; planning and testing emergency responses to flooding.

2012/03
Tackle nuisance noise
by developing noise action plans in identified areas; tackling highways where noise is a problem; and ensure that noise investigation and enforcement services are maintained.

2012/04
Maintain air quality and reduce pollution
so that no Air Quality Management Areas are designated in Hartlepool.

2012/05
Ensure a decent standard of housing
by reinvigorating priority neighbourhoods with high quality design and construction of new homes, giving access to vulnerable groups; driving up standards in existing homes where a priority will be improving energy efficiency and providing affordable warmth products; and investing in property to enhance fuel efficiency.

2012/06
Provide an effective pest control service
to mitigate against pests which harbour diseases, bacteria and parasites.

2012/07
Ensure water quality
by sampling both drinking and bathing water (for example, in swimming pools, hydrotherapy/spa pools and Jacuzzis).

2012/08
Reduce work-related death, injury and ill-health
, ensuring that resources are focused on the areas which present the highest risk.  Management of asbestos, gas safety and cellar safety are identified as priority areas.

 



Who is at risk and why?

Age
Older people are at increased risk of death in winter months compared to other times of year and other age groups.  Fuel poverty and a lack of affordable warmth affects older people more than other age groups and contributes towards excess winter deaths.

The people most at risk from the effects of air pollution are the very young, older people and those who already have a predisposing illness which air pollution can exacerbate.  People with asthma are particularly at risk during episodes of high air pollution levels.  One in eleven children and one in twelve adults in the UK suffer from asthma (Asthma UK, 2010).  In certain situations it is possible that air pollution plays a part in the induction of asthma in some individuals who live near busy roads, particularly roads carrying high numbers of heavy goods vehicles (Committee on the Medical Effects of Air Pollution, 2010).

Socioeconomic status
It is estimated that climate change will have a disproportionate impact on disadvantaged, vulnerable and deprived groups compared to the rest of the population.  The following health impacts of climate change for the UK are identified (Health Effects of Climate Change in the UK, 2008, DH):

  • heat-related health problems and worsening air quality, causing increased pollution-related illness and deaths;
  • increased risk of contaminated drinking water, water-borne infections and exposure to toxic pollutants;
  • increased prevalence of food poisoning and water-borne disease linked to warmer weather;
  • increased rates of sunburn and skin cancer;
  • social disruption, injury, disability and death as a consequence of extreme weather-related events such as hurricanes and river, coastal and flash floods.

Noise can cause annoyance, interfere with communication and sleep, cause fatigue and damage hearing. Physiological effects of exposure to noise include constriction of blood vessels, tightening of muscles, increased heart rate and blood pressure and changes to stomach and abdomen movement. Occupational noise can lead to temporary or permanent hearing loss.  Noise is reported to be responsible for 3% of ischaemic heart disease in the UK, for 3% of tinnitus and causes a rise in stress hormones leading to increased risk of strokes, heart attacks and reduced immune system (WHO, 2011b). The same report says 2% of Europeans suffer severely disturbed sleep and 15% can suffer severe annoyance. People living near busy roads and those with noisy neighbours are most at risk, including the most vulnerable such as housebound, the already sick (who’s condition could be worsened), the young and elderly.  Noise proliferates in areas of deprivation where houses are most densely populated and more likely to be near busy roads.

Reports on the medical effects of air quality suggest that the short-term impact results in the premature death of between 12,000-14,000 vulnerable people in the UK each year and between 14,000-24,000 hospital admissions /readmissions per year. Air quality is one of the government’s 68 indicators in the Sustainable Development Strategy. People in poorer areas tend to live close to pollution sources including busy roads and industrial sites.

Air quality
Air pollution is a major environmental risk to health. By reducing air pollution levels, the burden of disease from respiratory infections, heart disease, and lung cancer can be reduced (WHO, 2011a).

In cities, people inside vehicles are exposed to greater levels of fine particulate matter and carbon monoxide concentrations than cyclists and pedestrians (Kaur et al, 2007).  However, due to increased respiration and longer travel time, pedestrians and especially cyclists may inhale greater concentrations of pollution over the course of their journey – except when they are able to use walk/cycle paths away from motorised traffic (Dirks et al, 2012).

The Lancet series ‘The health benefits of tackling climate change’ (2009) documented the benefits of reducing emissions such as the reduction of motor vehicle use through more walking and cycling.  This will not only diminish transport emissions but reduce obesity, lower the rate of chronic diseases caused by physical inactivity and lessen the health-damaging effects of air pollution.

Contaminated land
Contaminated land poses risks to both human health and the environment depending on the types and volumes of pollutants present at particular sites.

Pest control
Infestations by pests can affect everyone, but tend to affect disadvantaged populations more due to poorer housing conditions, improper storage of food waste and cleanliness.  About 80% of mild or moderate asthmatic children have a positive allergy skin test to cockroach and dust mite allergens.  Rats can spread several diseases (for example, salmonellosis, leptospirosis, and typhus) and carry mites and lice. Rats, mice, cockroaches and bedbugs can be a source of anxiety, affecting mental health and wellbeing (WHO, 2008).

Energy efficiency
Climate change is, in large part, driven by emissions of greenhouse gases such as carbon dioxide. To reduce emissions will require a level of energy efficiency in homes and buildings that is currently uncommon in the UK.  Major policy changes on new buildings, and incentives to modify existing buildings, plus a large shift to strategic and local renewable energy generation and smart power grids is required.

Green space
Access to the natural environment and other open spaces has significant benefits for health and wellbeing, by reducing stress, improving mental well-being and encouraging greater levels of physical activity across all age groups. Safe, green spaces have the potential to increase communal activity in different social groups, increase residents’ satisfaction with their local area and improve air and noise quality. Open space provision also acts to mitigate climate change, reducing the impacts of flooding and heat waves and reducing CO2 emissions.

The frequency of visits to open space declines significantly with increasing distance from the open space, with the exception of young people. There is a statistically significant decrease in the likelihood of achieving physical activity recommendations and an increase in the likelihood of being overweight or obese associated with increasing distance to formal green space (Natural England, 2011).

 



What is the level of need in the population?

Energy efficiency and home energy conservation
An estimated 11,300 dwellings in Hartlepool (34.8% of the stock) are classed as non-decent.  The majority of dwellings are non-decent because of Category 1 hazards (18.5%) and thermal comfort failure (15.4%).  In Hartlepool non-decent dwellings are most associated with low rise, purpose built flats, the private-rented sector and properties built before 1919.  Non decency is also associated with heads of households aged 16 to 24 and those aged over 75.  The Central sub-area has 44.1% of dwellings classed as non-decent.  The total requirement for repair in all dwellings that fail under the repair criterion of the Decent Homes Standard is £21.2 million, an average cost of £4,500 per dwelling.

Fuel poverty and affordable warmth
A fuel poor household is one which cannot afford to keep adequately warm at reasonable cost. This is defined as when a household needs to spend more than 10% of its disposable income to adequately heat the home.  There are estimated to be 6,900 (21.2%) households in fuel poverty in Hartlepool (Private Sector House Condition Survey, 2009), significantly above the 11.5% found in the English House Condition Survey, 2006.  The highest rate of fuel poverty was found in the Central sub-area at 25.8% followed by the South sub-area at 19.1%.  Average energy efficiency in Hartlepool, using the Government’s Standard Assessment Procedure (SAP), is 51 (on a scale of 1 to 100), slightly higher than the England average of 49.

Pest control
In 2011/12, there were 1,323 requests for pest control treatments in Hartlepool.

Noise
DEFRA has identified four areas in Hartlepool which they classify as Important Areas for Noise Action Plans.

There continues to be high levels of complaints about noise emanating from domestic and commercial premises, building sites and road transport.

There are currently 6 stretches of highway in Hartlepool that have been identified as priority or important areas under the Environmental Noise Directive. The national noise action plan requires the highways authority to implement an action plan to reduce the levels of traffic noise at each of these locations.

Water quality
Hartlepool Water supplies around 33 million litres of water to 90,000 people in Hartlepool, including the surrounding villages of Greatham, Dalton Piercy, Elwick, Hart and Wynyard. Northumbrian Water Ltd supplies the village of Newton Bewley.

In addition to public water supplies, Hartlepool Council monitors the water quality of 5 swimming pools and 5 hydrotherapy/spa pools.

Working environment
Hartlepool Council is responsible for enforcement of health and safety legislation in approximately 1,300 premises, primarily comprising offices, shops, hotels and catering and leisure activities.  During 2011/12, 16 visits were made to investigate work-related accidents and 64 following requests for health and safety service.  In 2009/10, there were 59 major injuries in Hartlepool, an increase from 54 in 2008/9 (Health and Safety Executive).

 



What services are currently provided?

The following services are delivered to address environment-related priorities, and incorporate a range of reactive and proactive measures:

  • Neighbourhood management – Neighbourhood Area Teams provide day-to-day environmental and amenity maintenance of the highway and other public areas, including services such as street cleansing, grounds maintenance, minor repairs to street lights, footpaths and highways.
  • Waste and environmental services – Provide waste and recycling services including household and trade refuse, recycling and bulky waste collection.  The team promotes waste minimisation and offers a subsidised home compost bin service.  In addition, environmental action and enforcement services are provided.
  • Regeneration and planning services – Provide consultancy and enforcement services on aspects of building and development control, including a planning advisory service (one-stop-shop and access to the Government’s online planning portal).  The service ensures that buildings in Hartlepool meet building regulations and regulates the impact of new development on its surroundings.  Other services include encouraging occupancy and improvements to vacant commercial properties; Seaton Carew regeneration master planning; Hartlepool’s built heritage (comprising over 200 listed buildings and 8 conservation areas); Hartlepool’s ecology, including Sites of Special Scientific Interest (SSSI’s), local wildlife sites and nature reserves; arboriculture including advice and information on trees in conservation areas, tree preservation orders and planning considerations with regard to trees and high hedges legislation; planning policy including preparation and adoption of the Local Plan for Hartlepool and links including Neighbourhood Planning.


The Public Protection section of Hartlepool Borough Council consists of three discrete teams:

  • The Commercial Team carries out inspections, complaint investigation and sampling to ensure that food is safe and fit to eat and that workplaces are safe.
  • The Environmental Protection Team is involved with noise and pollution-related matters, pest control and managing and promoting the open market.
  • The Trading Standards & Licensing Team ensures that the business sector complies with a wide range of trade and consumer legislation. The team also issues and carries out enforcement relating to a large variety of licences, including alcohol, entertainment, takeaways, taxis, gambling and fireworks.


Climate Change
Information on low-carbon living is available on the Council website Smarter Living page.

The Energy Saving Trust is a national organisation that provides advice and information on energy efficiency and carbon reduction.

Feed in Tariffs and the Renewable Heat Incentive offer financial incentives for renewable energy installations, such as solar photovoltaic panels and heat pumps.

The Green Deal is a Government scheme introduced in 2013 that provides low interest loans for energy efficiency projects such as insulation and renewable energy installations.  The guiding principle of the Green Deal will be that savings on energy bills will be sufficient to meet loan repayments, so there will be no extra financial outlay for the recipient.

The Environment Agency offers a free Flood Alert service to residents and businesses.  Once subscribed, any flood alerts that may impact upon the resident or business are communicated via text message or email, so that action can be taken (for example, sand bags, water pumps).

Registered providers in Hartlepool are investigating photovoltaic systems (these use daylight to generate electricity for use in the property) for their stock.

The Community Energy Saving Programme (CESP) is another Government initiative to improve energy efficiency and reduce household bills.  CESP is an obligation on the bigger gas and electricity suppliers to deliver energy saving measures to households.  The programme specifically targets areas of low income using the Indices of Multiple Deprivation (IMD).  Homes owned by Tees Valley Housing in Hartlepool are being improved through this programme. However, this programme ended in December 2012.

The emerging Core Strategy also has a requirement for a minimum of 10% of the energy on new housing developments (of 10 dwellings or more) to be supplied from decentralised and renewable or low carbon sources.


Housing services
Regional loans assists owner-occupiers and private landlords to undertake essential home improvements which help improve residents’ long-term health and wellbeing and maintain their independence.

Financial assistance for empty property owners is delivered in partnership with Housing Hartlepool to help landlords to bring long-term empty properties back into use through a lease and repair model.

Selective licensing operates in 6 designated areas for privately rented dwelling houses.

Landlord accreditation is a voluntary scheme for landlords which aims to improve management and conditions in private rented housing.

Housing regeneration support services, which included empty properties, highlight the significant needs and numbers of vulnerable households.

Noise, air pollution and pest control
Public protection provide a wide range of services including:

  • inspections & investigation of complaints in relation to noise control
  • air pollution control
  • air quality management
  • pest control.


‘Out of Hours’ Noise Patrol – Hartlepool Borough Council currently operates a late night service at weekends that responds to complaints about excessive noise nuisance. The service operates between June and August.

Water quality
Public Protection Officers, currently:

  • sample the public drinking water supply for bacteriological and chemical quality.
  • sample private water used for commercial food production purposes.
  • monitor the water in commercial bathing and leisure facilities, such as swimming pools, hydrotherapy/spa pools and Jacuzzis.


Working environment
Health and safety interventions are carried out including inspections, campaign visits, investigations into reported work-related accidents and complaints. These visits frequently focus on topics such as management of asbestos, gas and electrical safety, slips, trips and falls and working at height.

 



What is the projected level of need?

Climate change
Average temperatures in North East England are expected to increase.  Average annual rainfall is expected to increase, and much of this will fall during extreme weather, leading to an increase in the risk of flooding.

Fuel poverty and affordable warmth
The level of fuel poverty in Hartlepool is forecast to increase for several years due to rising fuel prices and prevailing economic conditions.

Noise
The public is becoming more aware of noise and the expectation of a quieter environment has increased in recent years. It is predicted that the number of complaints about noise will increase over the next few years.

 



What needs might be unmet?

An average of 50 additional people die each winter in Hartlepool. Their needs for more appropriate housing and care may contribute to this.

 



What evidence is there for effective intervention?

Reducing particulate matter (PM10) pollution from 70 to 20 micrograms per cubic metre can cut deaths related to air quality by around 15% (WHO, 2005).

 



What do people say?

In 2010, 26% of people living in Hartlepool cited that improvements to the environment were required to improve their quality of life.  This was highlighted as one of the key priorities alongside Crime and Community Safety.  This primarily encompassed the general appearance of the area, litter and rubbish, dog fouling and run down, empty or boarded up properties. 

Two-thirds of people (68%) were satisfied with public parks and spaces, but this is a reduction on satisfaction in previous surveys.  An increasing proportion of residents say that poor quality parks and open spaces are a problem in their area.

In the Household Survey in 2010, up to one-quarter of residents said that derelict buildings are a particular issue within the coastal and central areas of Hartlepool.

The Ward Councillor consultation in 2012 included the following:

  • Create safer and more sustainable neighbourhoods by decreasing levels of anti-social behaviour, litter (including drug-related) and dog fouling and improve road safety by traffic calming and management measures.
  • Improve access to public transport and ensure services are fit for the needs of the population.
  • Provide accessible and quality green spaces and facilities for local people (including young people).
  • Address key vacant buildings and land that are currently detrimental to adjacent neighbourhoods.
  • Promote partnership working to ensure effective and efficient service delivery in environmental management.



Climate change
A range of climate change questions were included in the Council’s Viewpoint survey in 2010, with the following findings:

  • 98% of respondents were aware of climate change;
  • 76% of respondents claim to know ‘a great deal’ or ‘a fair amount’ about climate change;
  • 14 % claimed to be unconcerned about climate change;
  • 5% are not willing to make lifestyle changes to help tackle climate change; and
  • 59% of respondents are fearful for the wellbeing of future generations as a result of climate change.  Only 14% are not fearful.  The remainder were unsure.


Wide ranging consultation was undertaken during the development of Hartlepool’s Housing Strategy 2011-2015. The main themes emerging from consultation that link with the environment were:

  • Sustainable communities – reducing anti-social behaviour, preventing homelessness.
  • Sustainable / environmental homes – installing solar panels, feed-in tariffs.
  • Affordability – rents; cost to buy homes; cost to build / renovate homes; financial inclusion / fuel poverty.
  • Making links between housing, health, education, planning and transport services.
  • Dealing with empty homes and how to drive demand.
  • Effective management of the private-rented sector and use of enforcement powers.



The Council’s Viewpoint panel in 2008 found:

  • 93% considered rubbish to be a big or fairly big problem in the town centre,
  • 82% thought people vomiting or urinating in public was a big or fairly big problem,
  • 68% thought noise from people leaving pubs and clubs was a big or fairly big problem.

 



What additional needs assessment is required?

Explore investment opportunities for public realm initiatives, improvement of green open spaces and derelict land and buildings.

 



Key contact

Name: Denise Ogden

Job title: Assistant Director (Neighbourhood Services)

e-mail: denise.ogden@hartlepool.gov.uk

Phone number: (01429) 523201

 

References

Local strategies and plans

Hartlepool Borough Council (2010). Neighbourhood Management and Empowerment Strategy.

Hartlepool Borough Council (2007). Climate Change Strategy 2007-2012.

Tees Valley Unlimited (2010). Climate Change Strategy 2010 to 2020.

Tees Catchment Flood Management Plan, 2009.

Tees Valley Air Quality Report 2011.

Tees Valley Green Infrastructure Strategy, 2008.

 

National strategies and plans

Department of Energy and Climate Change (DECC, 2011). Fuel Poverty Strategy

DECC (2010). Warm Homes, Greener Homes.

Environment Agency (2011). National flood and coastal erosion risk management strategy for England.

UK Renewable Energy Strategy, 2009.

Environment Agency (2009). Water resources strategy for England and Wales.

 

Other references

Chartered Institute of Environmental Health (2008).  The Impact of Climate Change on Pest Populations and Public Health.

Chartered Institute of Environmental Health (2009). The Role of Pest Management in Protecting Public Health.

Climate UK (2012). UK Climate Change Risk Assessment: North East Summary.

Committee on the Medical Effects of Air Pollution

Department of Energy and Climate Change (DECC, 2012). Getting the measure of fuel poverty: final report of the fuel poverty review.

Department for Environment, Food and Rural Affairs (DEFRA, 2009). UK Climate projections.

Department for Environment, Food and Rural Affairs (DEFRA, 2012). UK Climate Change Risk Assessment.

Department of Health (DH, 2008). The Health Impact of Climate Change: Promoting Sustainable Communities.

Environment Agency (2012). Flood Maps.

Faculty of Public Health and Natural England (2010). Great Outdoors: How our Natural Health Service Uses Green Space to Improve Well-being.

Health Protection Agency (2008). Health Effects of Climate Change in the UK.

Natural England (2011). Green Space Access, Green Space Use, Physical Activity and Overweight.

UKCIP (formerly UK Climate Impacts Programme)

West Midlands Public Health Observatory (2010). Excess Winter Deaths (EWD) in England.

World Health Organization (WHO, 2005). Air quality guidelines - global update 2005.

World Health Organization (WHO, 2008). The Public Health Significance of Urban Pests.

World Health Organization (WHO, 2011a). Air quality and health - Fact sheet 313.

World Health Organization (WHO, 2011b). Burden of disease from environmental noise.

 



Housing

Housing has an important impact on health and well-being: good quality, appropriate housing in places where people want to live has a positive influence on reducing deprivation and health inequalities by facilitating stable/secure family lives.  This in turn helps to improve social, environmental, personal and economic well-being.  Conversely, living in housing which is in poor condition, overcrowded or unsuitable will adversely affect the health and well-being of individuals and families.

The value of good housing needs to been seen as more than ‘bricks and mortar’. The Department for Communities and Local Government (DCLG, 2006) define a decent home as ‘a home that is warm, weatherproof and has reasonably modern facilities’. Failure to address the investment needs of poor housing conditions will have a detrimental impact on the occupiers’ health and well-being.

A decent, affordable home is an essential requirement for tackling health inequalities and reducing the burden on health and social care services and cost to the public purse.

This topic includes homelessness and fuel poverty.

This topic is most closely linked with:

 



What are the key issues?

Key issues for housing in Hartlepool have been identified through the development of the Housing Strategy 2011-2015.

  • The proportion of residents aged 75 and over will increase by 50.7%, from 7.5% of the population in 2007 to 11.3% by 2028 and the proportion of residents aged 60-74 will increase by 28.8%.  This will put increasing strain on resources directed at the housing and support needs of older people.
  • Within Hartlepool, the percentage of empty properties in the private sector exceed the national average and also the Tees Valley average.
  • An estimated 11,300 dwellings in Hartlepool (34.8% of the stock) are classed as non-decent. The majority of dwellings are non-decent because of Category 1 Hazards (6,000 dwellings, 18.5%) and thermal comfort failure (15.4%).
  • There are estimated to be 6,900 (21.2%) households in fuel poverty within Hartlepool.
  • In 2009/10 homelessness acceptance figures reduced to 18 from 28 the previous year.  Homelessness acceptances are highest among young people.

 



What commissioning priorities are recommended?

2014/01
Update the Private Sector Stock Condition Survey
in order to understand the housing conditions of all residents in the private sector and especially to understand the housing needs of older residents who are asset rich but cash poor.

2014/02
Carry out a housing needs assessment for people with mental health problems a dementia
to fill a gap in local knoledge about the housing requirements of these population groups.

2014/03
Reinvigorate priority neighbourhoods with high quality new homes
, to give access to vulnerable groups.

2014/04
Reduce the number of long-term empty properties
by bringing them back into use and making their standards higher than ‘fit for purpose’ (that is investment is higher than the value of the property).

2014/05
Fund adaptations
thereby enabling people in need to stay in their homes longer and reduce stays in hospitals and care facilities.

Previous commissioning priorities:

2012/01
Reinvigorate priority neighbourhood
s with high quality new homes, to give access to vulnerable groups. Partially met: the Council has continued with the Housing Market Renewal programme to reinvigorate priority neighbourhoods with over 100 new build properties built on regeneration sites since 2012. In addition the Council has implemented an empty homes programme across our priority neighbourhoods which include the purchase and refurbishment of 100 long-term empty homes which provide much needed affordable good quality accommodation for local residents.

2012/02
Drive up standards for existing homes
where a priority will be improving energy efficiency and providing affordable warmth products.  Invest in property to enhance fuel efficiency to generate further funding for investment. Partially Met: the ‘Warm up North’ scheme was launched in September 2013, a partnership including Hartlepool Borough Council, British Gas and eight other Local Authorities in the region. The purpose of this scheme is to deliver a scheme to improve the energy efficiency of homes in the North East. The scheme is divided into two key parts – the Energy Company Obligation (ECO) and the Green Deal (GD). The initial emphasis following the launch of the scheme was around the ECO delivery, which focussed on the provision of free boilers, cavity and loft insulation to homes of eligible households who were in receipt of one or more qualifying benefits. A wide range of products is available to enable householders to benefit from energy efficiency measures and reduce their fuel costs. Regular promotional work through the partnership is undertaken to publicise the scheme. Since the launch of the scheme to the end of March 2014, 167 enquiries had been made to Warm up North from Hartlepool. Of those, there had been 67 jobs completed (the majority of which were new boilers) and there were 18 further jobs in progress.

2012/03
Reduce the number of long-term empty properties
by bringing them back into use and making their standards higher than ‘fit for purpose’ (that is investment is higher than the value of the property). Partially met: the Council’s Empty Homes Strategy has been used to reduce the number of long-term empty homes in Hartlepool with an average of 60 long-term empty homes being brought back into use each year through the Councils assistance. The Council with partners has implemented a number of incentive schemes including the acquisition of 100 units through the Clusters of Empty Homes Project and a lease and repair programme in partnership with Thirteen group. This has resulted in a significant improvement of the quality and standard of properties in the town and provided affordable accommodation for local people. Enforcement action has been taken where necessary to ensure long-term empty homes are brought back into use including the use of CPO and Enforced Sale.

2012/04
Fund adaptations
thereby enabling people in need to stay in their homes longer and reduce stays in hospitals and care facilities. Partially met: during 2012-2013 the Council received £540,000 from Central Government for Disabled Facilities Grants (this includes an extra allocation received in January 2013). The Council also received £167,000 from the PCT in January 2013 to fund adaptations. During 2012-2013 148 DFGs were carried out to enable people to remain or return to their homes and to live independently. At the end of 2012-2013 there were 76 people on the waiting list for an adaptation. During 2013-2014 the Council received £434,717 from Central Government for Disabled Facilities Grants and with this funding 116 DFGs were carried out to enable people to remain or return to their homes and to live independently. At the end of 2013-2014 the waiting list for an adaptation nearly doubled to 144 applicants illustrating an increasing demand on a limited budget. Funding for 2014-2015 is made up from £451,155 from Central Government, £200,000 from the Clinical Commissioning Group Better Care Fund (to support over 65’s preferably with long-term conditions) and £91,000 from Child and Adult Services to fund applicants with care needs. During the first two quarters of 2014-2015 48 DFGs have been carried out and there remain 105 applicants on the waiting list.

2012/05
Invest in appropriate ‘housing-related’ support services
(for care leavers, those with learning disabilities, those with complex needs, families with a history of tenancy failure etc.) to ensure individuals/households can live independently. Partially met: Gainford House managed by Stonham HA, providing supported accommodation for 16 to 25 year olds with complex needs, has recently been successful in achieving funding to expand the current scheme to provide an additional 6 units and is due to be completed in Spring 2015.

 



Who is at risk and why?

Age
An ageing society poses great challenges for appropriate housing. Most homes and communities have not been designed to meet people’s changing needs as they get older. Inclusive housing and wider environmental design is key to people’s health and well-being, and the suitability of the built environment plays a critical role in the provision of social care and health services. This demographic change needs to be considered when planning homes and neighbourhoods.

Although overall life expectancy has been increasing for both men and women, the number of years spent with a limiting illness or disability has also been increasing. According to the ONS, in 1981 men could expect to spend 12.8 years of their life with a limiting illness or disability and women 16 years.  By 2007, these figures had risen to almost 14 and 17 years respectively. Such changes in life expectancy are anticipated to have an impact on the demand for care in later life (Measuring unmet needs for social care amongst older people, September 2011).

Approximately 30% of people over 65 fall each year, and for those over 75, the rates are higher. Between 20% and 30% of those who fall suffer injuries that reduce mobility and independence and increase the risk of premature death (World Health Organisation Health Evidence Network, 2004).

The greatest burden of excess winter mortality is among older people (County Durham and Tees Valley Public Health Network, 2006, Institute for Health Equity, 2011).

There are over 1.6 million children in the UK living in housing that is overcrowded, temporary, run down, damp or dangerous.  Children living in overcrowded housing are up to 10 times more likely to contract meningitis.  Children in unfit and overcrowded homes miss school more frequently due to illness and infections. Poor housing conditions increase the risk of severe ill health or disability up to 25% during childhood and early adulthood. Children living in bad housing are significantly more likely to suffer respiratory problems. Living in bad housing as a child leads to a higher risk of low educational achievement. This in turn has long term implications for economic well-being in adulthood due to an increased likelihood of unemployment or working in low paid and insecure jobs (Shelter, 2006a).

Homeless children are more likely to show signs of behavioural problems such as aggression, hyperactivity and impulsivity.  Nearly half of young male offenders on remand and 42% of young female offenders sentenced have experienced homelessness (Shelter, 2006a).

An increased duration of living in overcrowded accommodation is significantly associated with children feeling unhappy about their own health.  An increased duration of living in accommodation in poor condition is significantly associated with being bullied in or out of school, getting into trouble with the police and having long-standing illness, disability or infirmity (Shelter, 2011).

The Institute for Fiscal Studies (2011) predict significant increases in poverty among children and working-age adults by 2013/14 as a result of the government’s tax and benefit reforms, including cuts in Local Housing Allowance (LHA).

Gender
There are no gender-specific housing issues.  However, women have greater life expectancy than men and it is likely that any deficits in appropriate housing suitable for older single occupancy will affect more women than men.

Socioeconomic status
Households in poverty live in dwellings with damp problems more often than the general population (12% and 8% respectively).

Ethnicity
Damp problems occur in 8% of all households but in 15% of ethnic minority households.

Homelessness
Nationally, homelessness in April to June 2011 was 17% higher than the same quarter of 2010.  There were 48,330 households in temporary accommodation on 30 June 2011.

There is a strong overlap between experiences of more extreme forms of homelessness and other support needs, with nearly half of service users reporting experience of institutional care, substance misuse, and street activities (such as begging) , as well as homelessness. Traumatic childhood experiences such as abuse, neglect and homelessness are part of most street homeless people’s life histories.  Most complex needs were experienced by homeless men aged 20-49, and especially by those in their 30s (Joseph Rowntree Trust, 2011).

The life expectancy of homeless people is 30 years less than the rest of the population.  On average, homeless people live until the age of 47, and for homeless women, it is further reduced to just age 43. They are consistently less likely to take up routine screening, health checks, and vaccinations and it is essential to engage this group with existing public health programmes.  Ill health is more likely within homeless households, including those in temporary accommodation.  School absenteeism is more prevalent amongst children in homeless households; and they are more prone to delayed development of communication skills (Shelter, 2006b).

Homelessness is linked to nutritional deficiencies, and obesity is increasingly common (Food Standards Agency, 2007).  Rough sleeping is accepted to be inherently harmful to good health, and either contributes to, or exacerbates, health problems such as physical and mental health issues, and drug and alcohol misuse (Crisis, 2011; Department of Health, 2010).

Housing conditions and types
Almost 5 million UK dwellings (21%) had one or more Category 1 hazards in 2009. The most common types of Category 1 hazards were related to falls affecting  about 1 in 8 (12%) of dwellings, followed by excess cold (8%).

In 2009, 20% of UK households lived in homes with substantial disrepair. Privately rented households were much more likely to live in such homes (32% compared to 17% for owner occupiers and 19% for social renters).  The likelihood of private renters living in dwellings in substantial disrepair increased markedly the longer they had been resident in their current home, from 27% for those resident for less than one year to 54% of those resident for 20 years or more.

Around 8% of dwellings had damp problems in 2009. This problem is less common in owner occupied stock (6%) but higher for private rented dwellings and local authority dwellings (15% and 12% respectively).

Less than half of households (44%) lived in homes with fully modern electrical wiring in 2009.

Terraced houses, converted flats and dwellings built before 1919 are far more likely to have any Category 1 hazards relating to falls than other dwellings.

Overcrowding
While 8% of households live in dwellings with damp problems this was notably higher for households containing five or more people (11%).

Welfare reform
A study for Shelter, carried out by the Cambridge Centre for Housing and Planning Research (2010), estimates that private sector tenants who claim Local Housing Allowance (LHA) will lose an average of £12 per week and that between 136,000 and 269,000 households will be unable to afford their rent, with about half of these likely to be evicted or move on voluntarily.

Housing Benefit claimants, including those renting from councils and housing associations, and private rented sector tenants who receive traditional Housing Benefit rather than LHA, will be hit by increases in non-dependant deductions from April 2012.

Working-age families deemed to be living in ‘under-occupied’ social rented housing will have their Housing Benefit cut, while there will also be a cap on the benefits that may be claimed by any individual working-age household.

According to the National Housing Federation (news article 9th November 2011) the Housing Benefit changes alone will leave 642,160 households worse off by an average of £39 per month.

Fuel poverty
It is estimated that 3.5 million households in England were living in fuel poverty in 2010, with a projected rise to 3.9 million in 2012 (DECC, 2012a).

Living in cold homes has effects on both physical and mental health. But the most serious is its contribution to Britain’s unusually high rates of ‘excess winter deaths’.  Many of these excess winter deaths could be prevented through warmer housing (Institute of Health Equity, 2011).

 



What is the level of need in the population?

Housing Need

The current housing stock in Hartlepool is :

Property type and size of occupied dwellings: Hartlepool

Property type

No. Bedrooms (Table %)

 

 

 

 

 

One

Two

Three

Four

Five or more

Total

Base (No.)

Detached house

0.0

0.5

4.5

7.0

1.9

13.9

5,537

Semi-detached house

0.1

6.7

19.1

2.7

0.6

29.2

11,671

Terraced house

0.0

14.1

16.9

2.8

0.9

34.8

13,890

Bungalow

1.2

4.6

1.0

0.2

0.2

7.1

2,854

Maisonette

0.5

0.0

 

 

 

0.5

201

Flat/apartment

7.9

5.2

0.6

0.0

 

13.7

5,477

Caravan/Park Home

0.0

0.3

 

 

 

0.3

124

Other

0.3

 

0.2

 

 

0.4

177

Total

10.0

31.4

42.2

12.7

3.7

100.0

 

Base

3,995

12,538

16,868

5,062

1,469

 

39,932

Source: 2011 Household Survey

 

The Census 2011 tenure information for Hartlepool is:
Owner Occupation 60%
Private Rented  15%
Affordable*  24%
Other   1%
* This include social rent / intermediate / affordable rent
The private rented market in Hartlepool has doubled since the 2001 Census from 7% to 15%

Hartlepool has a self-contained functional housing market, with most people tending to remain in the Borough, with small inward migration to new housing areas. 
Analysis of general market supply and demand suggests that the open market is generally balanced. However, in Hartlepool there is a notable shortfall of detached houses in the inner suburbs and town centre and across the district generally; shortfall of terraced properties in the outer suburbs; and bungalows across most of the district; market in rural area most balanced in terms of supply meeting demand. Supply of terraced dwellings rural areas, flats in Inner and Outer Suburbs; and one bedroom properties in the Town Centre and Outer Suburbs considerably greater than demand.

House prices in Hartlepool have tended to lag behind the regional median figure and have increased from £49,000 in Q1 2000 to £106,133 in Q1 2011, an increase of 116.6%. Prices peaked in Q2 2008 at £115,000.

During 2010, lower quartile prices across the Tees Valley area were around £81,000 (Darlington £87,735, Hartlepool £73,000, Middlesbrough £68,000, Redcar and Cleveland £82,500 and Stockton on Tees £95,000).

House prices in Hartlepool, 2008-2011

District

 

Percentiles

 

Year

2008

2009

2010

2011*

Hartlepool

Lower Quartile (25%)

£76,000

£70,000

£73,000

£74,000

 

Median (50%)

£108,000

£104,950

£109,725

£101,000

 

Upper Quartile (75%)

£146,250

£140,000

£147,775

£140,000

 

Key market drivers

There are three key primary drivers influencing the current (and future) housing market: demographic, economic and dwelling stock characteristics.

The following demographic drivers will continue to underpin the operation of Hartlepool’s housing market and the Tees Valley market area:

  • An increasing population in Tees Valley, with 2008-based ONS population projections predicting a population in 2033 of 601,700 compared with 563,300 in 2010, an increase of 38,400 (6.8%);
  • Over the next few decades, there will be a ‘demographic shift’ with the number (and proportion) of older people increasing. In 2010, ONS projections suggested for Tees Valley that there were 94,000 people aged 65 and over, 44,000 aged 75 and over and 12,000 aged 85 and over. 2008-based ONS projections suggest an increase of 50,000 people aged 65 and over, and 31,000 aged 75+ and 15,000 aged 85 and over by 2033;
  • ONS trend-based projections  indicate that the number of households in Tees Valley is expected to increase 234,000 in 2008 to 262,000 in 2026 and to 272,000 in 2033. This represents an annual increase to 2033 of around 1,520 households. The rate of increase is predicted to be 17.9% for Hartlepool. Although the total number of households is predicted to grow, the aging population means that most of the growth will be in older person households. Over the period 2008-2026, the total number of households is expected to increase by 24,000. Of this increase, 20,000 will be from households headed by someone aged 65 or over; 9,000 will be attributed to households with a household reference person aged 15-44 and there will be a decline of 5000 households with a household reference person aged 45-64;
  • The 2011 household survey indicates that the largest household groups are couples with children (28%), single adults (under 60) 19.1%, couples (under 60 with no children) (16.4%), lone parents (11.2%), singles over 60 (10.9%), couples over 60 (10.4%) and 3.8% are other household types; and
  • Regional household projections suggest that the proportion of singles and other household types is likely to increase in the future.

The Tees Valley 2012 Strategic Housing Market Assessment identified that following economic drivers underpin the operation of the Tees Valley market area:

  • 58.4% of household reference people are economically active and are in employment according to the 2011 household survey; a further 19.8% are retired; 8.9% are permanently sick/disabled; 6.1% are either looking after the home, in training or provide full-time care; 6% are unemployed and available for work; and  0.7% are in full-time education/training;
  • 87.9% of people in employment work within the Tees Valley area. Of those working outside, 2.6% worked in North Yorkshire, 3.1% in County Durham, 5.4% elsewhere in the UK and 1.0% outside the UK;
  • According to the ONS Annual Survey of Hours and Earnings, lower quartile earnings in 2011 across the Tees Valley area were £17,581 which compares with £17,316 for the North East region and £18,720 for England. Median incomes were £23,722, compared with a regional median of £23,447 and a national median of £26,395.

In June 2014 there were 2,620 active applicants on the Tees Valley housing register in Hartlepool.  35% of these (927) were in priority bands 1-3 (those identified as in the greatest housing need). This has increased since 2011 when 25% of the housing register was comprised of applicants in housing need.

Across the Tees Valley sub-region, the proportion of active housing register applicants is above average in the 25-59 age group.  The proportion of applicants from minority ethnic groups is reflective of the national picture.

Profile of housing register applicants, Tees Valley, 2014

Group

Housing register applicants

Population (Census 2011)

Under 25

14%

30%

25-59

63%

44%

60+

23%

21%

White British

84%

86%

Source: Compass Housing Register October 2014

 

Older people
The population in Hartlepool is projected to rise with both the number and proportion of older people increasing. In 2010 the population was estimated at 91,300 and is projected to increase to 95,600 by 2025. In 2010 16.6% of the population were over 65 and this is projected to increase to 20.7% by 2025 equating to an extra 4,700 over 65s (Tees Valley Unlimited May 2012).

457 units of extra care accommodation have been developed in Hartlepool to improve the housing options available to older residents. In addition, over 105 units of bedsit accommodation have been decommissioned by Housing Hartlepool and Anchor Trust.

Other vulnerable people

Disability
In Hartlepool, 39% of households contain someone with an illness/disability.  However, this increases to 58% amongst social renters.  Of those people with an illness or disability, 43% have a physical disability and 24% have an age-related illness/disability (Hartlepool Strategic Housing Market Assessment 2007).

In May 2013 there were 439 applicants to Compass needing a certain property type due to their disability. This has increased from 320 applicants in July 2010.  Since 2005/06 the numbers of people re-housed into adapted accommodation has doubled.

Re-housing applications, Hartlepool, 2005/06 to 2013/14

Year

No. re-housed

2005/06

53

2006/07

59

2007/08

100

2008/09

113

2009/10

117

2010/11

120

2011/12

115

2012/13

104

2013/14

98

 

Funding for Disabled Facilities Grants (DFGs) continues to be inadequate to cover the referrals from Occupational Therapy.

Funding for disabled facilities, Hartlepool, 2004/05 to 2014/15

Year

Total funding (£)

Number of DFGs completed*

Number on Waiting List at end of Year**

2004/05

406,000

 

 

2005/06

498,221

 

 

2006/07

448,500

 

 

2007/08

441,500

 

 

2008/09

680,310

 

 

2009/10

674,955

152

 

2010/11

686,199

184

 

2011/12

790,000

178

 

2012/13

825,000

148

76*

2013/14

437,717

116

144

2014/15

742,155

48 (during Q1 and Q2)

105 on the waiting list (Oct 2014)

*Monitoring commenced during 2010

** Monitoring commenced during 2012

 

About 1.5% of the population in Hartlepool has a learning disability.  In Hartlepool, 72% of people with a learning disability live in settled accommodation (for example, the family home or own tenancy). The aim is to improve this figure to 75% over the next three years. In Hartlepool there has been a reduction in residential care as the housing model of choice.

In Hartlepool 1% of the population has an autistic spectrum disorder. Adults with autism should expect to live in accommodation that meets their needs.  For people in this client group the design of the environment in the property is an important issue.

In 2014 it is estimated that there are around 9,000 people aged 18-64 years in Hartlepool with a common mental health disorder.

Supported housing providers support over 2,000 people within Hartlepool, including older people with support needs, offenders, people with learning disabilities, people with mental health problems, people with alcohol problems, single homeless people, teenage parents, women at risk of domestic violence and young people at risk.

Homelessness

Homelessness data for 2009/10 to 2013/14 shows that the households Hartlepool Council had a statutory duty to accept as homeless and find housing for increased significantly during 2013/14.

Homelessness presentations and advice, Hartlepool, 2009/10 to 2013/14

Homeless Presentations

2009/10

2010/11

2011/12

2012/13

2013/14

Eligible, unintentionally homeless and in priority need

19

19

23

9

35

Eligible, homeless and in priority need but intentionally so

7

0

5

3

10

Eligible, homeless but not in priority need

3

13

5

3

5

Eligible but not homeless

3

2

1

4

6

Ineligible households

0

0

0

0

2

Total Homeless Presentations

32

34

34

19

58

Housing Advice Cases that would have been homeless without our intervention

Prevented – client assisted to resolve situation and remain in their home

47

51

34

28

52

Relieved – client assisted into alternative accommodation before becoming homeless

291

305

297

269

268

Total households prevented from being homeless

338

356

331

297

320

 

The priority need reasons of these households are shown below.

Reason for priority housing need, Hartlepool, 2011/12 to 2013/14

Year

Dependent Children

16/17 year old

Leaving Care

Mental Illness

Pregnant

Other

2011/12

15

2

1

1

1

0

2012/13

7

0

0

0

2

0

2013/14

6

2

2

2

0

8

 

Housing conditions

The 2009 Private Sector Housing Condition Survey found:

Private sector housing condition, Hartlepool, 2009

Characteristic

Percent

Non-decent dwellings

34.8%

Non-decent dwellings with category 1 hazard

18.5% (53% of non-decent dwellings)

Non-decent dwellings in private rented sector

58.2%

Non-decent dwellings in owner occupied sector

30.2%

Non-decent dwellings with income <£15,000

86.3%

Households in fuel poverty

21.2%

 

The 2011 Household Survey reviewed the extent to which households were satisfied with the state of repair of their dwellings with 8.8% of households in Hartlepool expressing dissatisfaction. Proportionately private and social renters were more likely to express dissatisfaction.

Fuel poverty

It is estimated that 18.5% of households in Hartlepool are in fuel poverty (National, 14.6%).   A household is said to be in fuel poverty if it needs to spend more than 10% of its income on fuel to maintain a satisfactory heating regime. Although the emphasis in the definition is on heating the home, fuel costs in the definition of fuel poverty also include spending on heating water, lights and appliance usage and cooking costs. Source: Deptartment of Energy & Climate Change.

Gypsies and Travellers

In 2014, Hartlepool commissioned a revised GTAA for the borough and the final report is awaiting publication (November 2014). The study recommends the following:
There is a need for 5 additional pitches in the Borough over the next 15 years.
However the demand for said pitches is relating to young adults and elderly persons.
Due to their circumstances they are unlikely to ever move to a pitch as they are currently in bricks and mortar housing. So the need is highly unlikely to be manifested in demand. Therefore there is no need to provide a dedicated site in the Local Plan; just a criteria based policy in case the demand is manifested.

 



What services are currently provided?

Disabled Adaptations – Within Housing Services the Special Needs Housing Team administers the Disabled Facilities Grant funding for major adaptations to clients own homes which enable older people and disabled adults and children to maintain their independence, health and well-being in the home of their choice

Handyperson Service - Within Housing Services the Special Needs Housing Team operates a minor adaptations service (costing under £500) for people who fall below the threshold for making an application for a Disabled Facilities Grant. This is aimed to prevent falls, reduce risk or prevent deterioration.

Rehousing Service – Within Housing Services the Special Needs Housing Team administers applications to the Tees Valley Compass Choice Based Lettings Scheme from waiting list applicants with a medical priority who need adapted accommodation. Adapted social rented housing is advertised through Compass.

Financial Assistance through Regional Loans - This scheme assists owner-occupiers to undertake essential home improvements which help improve their long-term health and wellbeing and maintain their independence. The Council remains committed to the Regional Loans Scheme however funding levels are low and a waiting list is held for eligible home owners.

Financial Assistance for Empty Property Owners – This is a scheme delivered in partnership with Housing Hartlepool that assists landlords to bring long-term empty properties back into use through a lease and repair model

Houses in Multiple Occupation (HMOs) Licensing Scheme – ensures HMOs are safe and properly managed. The Housing Act 2004 introduced mandatory licensing for certain HMOs.  Mandatory licensing applies to HMOs that comprise of three or more stories and are occupied by 5 or more people who form more than one household.  Some of the most vulnerable members of society are housed in this type of accommodation. 

Enforcement of Housing Conditions – The Housing Standards Officers undertake inspections following requests from residents with regards to their living accommodation and follow up action is taken depending on circumstances ranging from informal action to enforcement.

Area Based Interventions – The Housing Standards Officers undertake proactive area based surveys to identify any emerging issues with regards to property condition and take appropriate follow up action.

Selective Licensing - The final proposal to introduce a new selective licensing scheme in the town is currently being considered (November 2014).

Good Tenant Scheme – Within Housing Services the Landlord/Tenant Unit processes applications to this scheme. It is a service for prospective tenants to obtain references to enable them to access private rented accommodation in Hartlepool.

Housing Advice and Homelessness Prevention – Within Housing Services the Housing Advice Team offers a free and confidential service to residents covering a range of housing and related issues, as well as operating the Council’s statutory duties for homelessness. The team will try to resolve housing issues or help to find suitable alternative accommodation.

Floating support – Within Housing Services the Housing Advice Team operate a floating support scheme to help people successfully manage and sustain their tenancies.

Housing Management of Council owned Stock – the Council has 182 units of stock. 82 units were built in 2009/10 under the Local Authority New Build Scheme and a further 100 units have been acquired through the Empty Homes Programme. All properties which have been built or refurbished achieve high standards of energy efficiency, many of which have photo voltaic panels, double glazing and smart meters installed. Housing Services will take over management of these properties in April 2015.

Social Lettings Agency – the Council has approval to set up a social lettings agency to manage private rented properties on behalf of private landlords. It is anticipated that this service will commence in 2015/16 and its main aim is to assist with improving the quality and management of the private rented sector across the town.

Hartlepool Council Children and Adults Services provide Assistive Technology, Reablement Services, Supported Access to Independent Living Services (SAILS), and Housing Related Support Services.

Registered Providers - Registered providers provide minor and major adaptations services for their customers to help them maintain independent living.

Thirteen Care and Support – The Independent Living Team based within "Thirteen Group" will continue to provide a holistic re-housing and property adaptation service to its vulnerable and mobility restricted residents based within the borough of Hartlepool.

This may include major or minor adaptations being undertaken in their current home or the use of a specialist housing team to identify alternative accommodation to meet their long term independent needs as assessed by Social Care Occupational Therapy.

Assistance will also be offered to clients with age related conditions who wish to downsize from their current accommodation to a more manageable housing option.

 



What is the projected level of need?

The population in Hartlepool is projected to rise with both the number and proportion of older people increasing. In 2010 the population was estimated at 91,300 and is projected to increase to 95,600 by 2025. In 2010 16.6% of the population were over 65 and this is projected to increase to 20.7% by 2025 equating to an extra 4,700 over 65s. (Tees Valley Unlimited, May 2012)

In 2014 Hartlepool commissioned a revised Strategic Housing Market Assessment for the borough and the final report is awaiting publication (November 2014).  The 2007 Strategic Housing Market Assessment provided the following information:

  • The proportion of the population aged 60 and over will increase and the rate of increase will be highest amongst people aged 75 and over.
  • Future requirements from older people suggest 81% would want to stay in their own home with support when needed. Nearly one-quarter stated a preference for sheltered accommodation.
  • About 39% of households contain someone with an illness/disability, with the highest proportions amongst social renters (58% of social renters – this in part reflects the age profile of social renters).
  • The need for property adaptations (see table):

Properties requiring adaptaion in the next five years, Hartlepool

Adaptation to property

Households requiring adaptation in next 5 years (%)

Insulation

18.6

Better heating

18.1

Double glazing

16.5

Adaptations to bathroom

15.4

Security alarm

11.5

Adaptations to kitchen

10.6

Increase the size of property (e.g. extension)

9.1

Internal handrails

7.3

Downstairs WC

6.9

Stairlift

6.7

External handrails

4.6

Community alarm service

4.1

Improvements to access

3.6

Wheelchair adaptations

2.9

Lever door handles

2.2

Room for a carer

2.0

Total Households

39,270

 

Limiting long-term illness

  • Hartlepool has a larger proportion of people with poor health than the average for Tees Valley and England as a whole.
  • Currently, it is estimated that around 8,600 pensioners, out of a total population of 15,200 people aged over 65, have one or more health problems or illnesses that limit their ability to lead a full life.
  • By 2025 this figure is projected to grow from 8,600 to be around 11,500 people (out of a total population of 20,200).
  • By 2025 it is projected that 6,600 people aged over 65 will need help with self-care and 7,200 will need help with domestic tasks, but only 3,800 are projected to be supported by the local authority.
  • There is a projected growth in the number of unpaid carers, from 2,700 in 2008 to 3,500 in 2025. There will also be an increase in the proportion of carers who will be aged over 75, providing over 50 hours of care and in poor health themselves.

Waiting list information
In June 2014 there were 2,620 active applicants on the Tees Valley housing register in Hartlepool.  35% of these (927) were in priority bands 1-3 (those identified as in the greatest housing need). This has increased since 2011 when 25% of the housing register was comprised of applicants in housing need. In May 2013 there were 439 applicants to Compass needing a certain property type due to their disability. This has increased from 320 applicants in July 2010.  In the next few decades the older population in Hartlepool is expected to rise and this will present significant challenges in ensuring access to housing choice. The Council will seek to identify and deliver a range of alternative accommodation and support models to improve the housing options available to older residents.

It is estimated that approximately 320 additional newly forming households each year will need to be accommodated in the borough over the next 15 years.  It is expected that there will continue to be demand for dwellings of all types and tenures. However it is expected that there will be a greater need for family houses; bungalows; and accommodation for older people.

 



What needs might be unmet?

There are considerable pressures on the resources that are available to deliver the aims of the Housing Strategy and resources are likely to be further reduced as the Council has to achieve considerable savings. There is also continuing demand on budgets such as Disabled Facilities Grants.

Funding will be required to meet the following needs:

  • Disrepair in the private sector stock and Category 1 hazards.
  • The provision of disabled adaptations to meet waiting list demand.
  • Housing related support services.
  • Handyperson service.
  • Emergency Accommodation for homeless households.
  • Emergency accommodation and resettlement/move on accommodation for persons with chaotic lifestyles.
  • Appropriate housing for vulnerable and older people which would allow them to stay independent for longer.
  • Affordable housing to address the identified shortfall for both general needs and specialist accommodation.Lack of suitable accommodation for people under the age of 55 with a disability.

As a result of the Welfare Reform Act 2012, a mismatch of family size and available accommodation has emerged resulting in low demand for family sized houses in certain locations for social landlords. There has also been an increase in tenants moving from the social rented to the private rented sector.

 



What evidence is there for effective intervention?

Review of Housing Supply: delivering stability: securing our future housing needs (Barker, 2004)

Our Health, Our Care and Our Say: A New Direction for Community Services (DH, 2006)

Tackling homelessness and exclusion: understanding complex lives (JRF, 2011)

How to reduce the risk of seasonal excess deaths systematically in vulnerable older people to impact at population level (DH, 2010)

Fair society, healthy lives (The Marmot Review of Health Inequalities, 2010)

What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls? (World Health Organisation Health Evidence Network, 2004).

Commissioning housing support for health and wellbeing (CSIP, 2008b)

Good housing leads to good health (Chartered Institute of Environmental Health, 2008)

Healthy homes programme (Liverpool City Council)

 



What do people say?

Consultation with BME communities in Hartlepool was undertaken in May 2011 and the key findings of this research include:

  • BME groups still desire to be homeowners.
  • Shared ownership schemes are an option for the younger, working community (aged 20-44).
  • There is a lack of understanding of eligibility for social housing and a negative image of the Choice Based Lettings system.
  • There is limited knowledge of available housing, eligibility and access.
  • The options for social housing are limited due to size and location of properties.
  • There are poor standards of accommodation for participants living in private rented accommodation.
  • Overcrowding among BME communities is evident in the private rented sector and in owner-occupation.
  • Neighbourhood problems exist in relation to anti-social behaviour and racial harassment.

Wide ranging consultation was undertaken during the development of Hartlepool’s Housing Strategy 2015-2020. The main themes emerging from consultation were:

  • Linking the economic regeneration strategy with new house building, training and apprenticeships
  • Understanding the type of housing people aspire to and how this fits with the local employment situation
  • Tackling low demand and social problems in declining neighbourhoods
  • Building new affordable housing
  • Providing services and infrastructure to sustain development
  • Catering for the needs of an ageing population
  • Property condition
  • Oversupply of some property types
  • Impact of welfare reform on demand for social housing
  • Regulation of the private sector
  • Improving housing and health links and capturing information on fuel poverty
  • Promotion of retrofit
  • Making it easier for people to move by removing barriers and simplifying processes
  • Improving information sharing between agencies
  • Mental health and substance misuse issues for offenders
  • Improving understanding around referral pathways for people with learning disabilities or mental health issues
  • Lack of single person accommodation
  • Issues of digital inclusion and exclusion
  • Responding to the needs of asylum seeker families
  • Catering for the needs of gypsies and travellers
  • Sustaining investment in adaptations through DFG funding and housing provider funding
  • Dealing with the ageing population and responding to the needs of residents with dementia

Consultation also took place with residents at the Housing Partnership’s Face the Public event in August 2014. 80 residents were surveyed.

53% of respondents knew that Housing Services is now located in the Civic Centre. This is an improvement on the previous year where 48% knew where to access services/advice.
Housing concerns were much the same as the previous year – repairs, energy efficiency, and traffic. However less people had a concern about anti social behaviour (12 compared to 31) and less were concerned about affordability (2 compared to 10).

The answers to the questions on welfare reform were also much the same as the previous year. People who rent responded that 75% had not been affected and 95% of homeowners had not been affected (last year 89% of respondents had not been affected).

When asked if residents were happy where they live 88% of respondents said yes compared to 80% the previous year.

In reply to thinking about immediate future need in the next 2 years, respondents said:

 

2013

2014

Stay where you are

74%

60%

Move to a bigger house

6%

12%

Move to a smaller house

9%

18%

Move to a new area within the town

9%

7%

Move out of the area

4.5%

3%

Other

10 responses

 

 

In reply to thinking about longer term housing needs in the next 3-10 years, respondents said:

 

2013

2014

Stay where you are

67%

64%

Move to a bigger house

5%

14%

Move to a smaller house

18%

4%

Move to a new area within the town

9%

8%

Move out of the area

6%

10%

Other

13 responses

 

 

Residents were also asked about digital inclusion.  75% of respondents said that they have access to the internet. 79% have their own PC, laptop and tablet. When asked about using public internet services 76% replied no to this question.

 



What additional needs assessment is required?

The Strategic Housing Market Assessment for Tees Valley was updated in 2012. This provided an up-to-date assessment of the current housing market, the future housing market, housing need, and housing requirements for specific household groups.

However, a Strategic Housing Market Assessment for Hartlepool is currently being developed and should be published during December 2014.

Hartlepool Housing Strategy for 2015-2020 is currently being consulted on. The following issues have been raised and will be included in its development:

  • Mapping services for homeless people – identifying gaps in provision
  • Identify the particular housing needs for people with dementia, mental health issues, learning disabilities
  • Identify the particular housing needs for offenders
  • Looking at demand for social housing, especially family sized accommodation
  • Removing barriers to Choice Based Lettings and improving access to social housing
  • Looking at the impact of digital by default on vulnerable people
  • Examining the levels of fuel poverty in the town

 



Key Contact

Name: Karen Kelly
Job title: Principal Housing Strategy Officer
e-mail: karen.kelly@hartlepool.gov.uk
Phone number: 01429 284117

 

References

 

Local strategies and plans

University of Salford (2009). Tees Valley Gypsy and Traveller Accommodation Needs Assessment

 

National strategies and plans

Department for Communities and Local Government (DCLG, 2011). Planning Policy Statement 3.

Department for Communities and Local Government (DCLG, 2010). Local decisions: a fairer future for social housing.

Department for Communities and Local Government (DCLG, 2009) The English Housing Condition Survey – Housing Stock Report 2009

Department for Communities and Local Government (DCLG, 2008) Lifetime Homes, Lifetime Neighbourhoods – A National Strategy for Housing in an Ageing Society

Department of Energy and Climate Change (2008). The UK Fuel Poverty Strategy: 6th annual progress report.

Department of Health (2011). Cold weather plan for England.

HM Government (2011). Localism Act 2011.

HM Government (2008). The Housing and Regeneration Act 2008

HM Government (2004). The Housing Act 2004

HM Government (2002). Homelessness Act 2002

 

Other references with dates

Cambridge Centre for Housing and Planning Research for Shelter, (2010) Housing benefit changes and their effects on the private rented sector.

Care Services Improvement Partnership (CSIP, 2008a). The Extra Care Housing Toolkit.

Care Services Improvement Partnership (CSIP, 2008b) Commissioning housing support for health and wellbeing.

Chartered Institute of Environmental Health (2008) Good housing leads to good health.

County Durham and Tees Valley Public Health Network (2006). Cold kills.

Crisis (2011). The Hidden Truth About Homelessness.

Department of Energy and Climate Change (DECC, 2012a). Annual report on fuel poverty statistics 2012.

Department of Energy and Climate Change (DECC, 2012b). Fuel poverty sub-regional statistics 2010.

Department of Health (2010). Healthcare for Single Homeless People.

Food Standards Agency (2007). Homelessness and food poverty.

Housing Learning and Improvement Network (2011). Living Well and Home Inquiry.

Institute for Fiscal Studies (2011). Children and working age poverty from 2010-2020.

Institute for Health Equity (2011). The Health Impacts of Cold Homes and Fuel Poverty.

Joseph Rowntree Trust (2011) Tackling homelessness and exclusion: understanding complex lives.

National Centre for Social Research (2008). The Dynamics of Bad Housing: the impact of bad housing on the living standard of children.

National Housing Federation (2011). News article (login required)

Northern Housing Consortium (2011). A foot in the door: a guide to engaging housing and health.

Office for National Statistics (ONS, 2011). Measuring unmet needs for social care amongst older people. (in Population Trends, No. 145)

Shelter (2011). Improving outcomes for children and young people in housing need: A benchmarking guide for joint working between services.

Shelter (2006a). Chance of a Lifetime.

Shelter (2006b). Against the odds.

West Midlands Public Health Observatory (WMPHO, 2011). Excess Winter Deaths in England Atlas.

World Health Organisation Health Evidence Network (2004). What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls?



Poverty

In his review of health inequalities – many of which are greatly determined by poverty – Professor Sir Michael Marmot said:

‘People with higher socioeconomic position in society have a greater array of life chances and more opportunities to lead a flourishing life. They also have better health. The two are linked: the more favoured people are, socially and economically, the better their health. This link between social conditions and health is not a footnote to the ‘real’ concerns with health – such as health care and unhealthy behaviours – but should become the main focus.

Consider one measure of social position: education. People with university degrees have better health and longer lives than those without. For people aged 30 and above, if everyone without a degree had their death rate reduced to that of people with degrees, there would be 202,000 fewer premature deaths each year. Surely this is a goal worth striving for.  It is the view of all of us associated with this Review that we could go a long way to achieving that remarkable improvement by giving more people the life chances currently enjoyed by the few. The benefits of such efforts would be wider than lives saved. People in society would be better off in many ways: in the circumstances in which they are born, grow, live, work, and age. People would see improved well-being, better mental health and less disability, their children would flourish, and they would live in sustainable, cohesive communities.’

Fair Society, Healthy Lives, February 2010

Many health-related issues are worse for people living in poverty, including an increased risk of dying prematurely.  People living in poverty are less likely to benefit from education to the same degree as others; are less likely to be in professional, managerial and skilled jobs; and are more likely to live in poor housing and in neighbourhoods where crime is more prevalent and where community safety is threatened.  All of these conditions and circumstances can have an adverse effect on physical and mental health and well-being.

Poverty, or relative poverty, is commonly defined in terms of households with an income which, after tax, is below 60% of the median (average) household income (Aldridge et al, 2012).  As such, the income required to prevent poverty depends upon household composition.

This topic is most closely associated with:



What are the key issues?

The impact of welfare reform.

Money management and debt.

Worklessness and employment opportunities.

Educational attainment including money management skills.

 



What commissioning priorites are recommended?

2015/01
Ensure residents are fully informed about ongoing changes to welfare and have access to robust benefit and entitlement advice
. This includes access to wider services from the voluntary sector including e.g. foodbanks.  Flexible support needs to be available for those both in and out of work in order to maximise entitlement.

2015/02
Ensure residents are able to take up money management and debt advice
. Accessible money advice services are needed to support residents to tackle escalating debt and to understand how to prioritise their spending. Children and young people need to be educated in money management.

2015/03
Ensure that all unemployed and economically inactive adults have greater access to employment and training initiatives
, ensuring initiatives already in place are well promoted and accessible to all (e.g. FamilyWise).  This will require a partnership approach to develop bespoke programmes that will meet the needs of residents.

2015/04
Close the gap in educational attainment
between disadvantaged children and other children.

2015/05
Create Intermediate Labour Market programmes with employers who understand the challenges faced by the long term unemployed.


2012/01 - replaced by 2015/01 and 2015/02
Ensure residents have access to finance and benefits advice.

2012/02 - replaced by 2015/03
Ensure that all unemployed and economically inactive adults have greater access to employment and training initiatives.  This will require employment and training providers to work closer together to develop bespoke programmes that will help adults overcome barriers to employment.

2012/03 - remains a priority , now 2015/04 
Close the gap in educational attainment between disadvantaged children and other children.

2012/04- replaced by 2015/03
Raise awareness of existing employability programmes, such as FamilyWise.

2012/05- replaced by 2015/05
Create Intermediate Labour Market (ILM) programmes for the long-term unemployed by all partners pooling resources.

 



Who is at risk and why?

Context
Relative poverty has fallen between 1997 and 2012 from 17% to 15% before housing costs (HBAI, 2014).

The oldest members of the population are amongst the lowest numbers of people living in poverty and children are amongst the highest.

An analysis of the impact of Welfare Reform in the North East suggests that around £380m will be lost as a result of the benefit cap, changes to disability related benefits, council tax benefit and housing in the social sector (ANEC, 2013).

There are insufficient job vacancies available to meet demand. 

Age
1 in 6 pensioners currently live in poverty with a drop of 6 percentage points in the past five years – this is the biggest fall in poverty across all age groups in the last decade (HBAI, 2012).  

For the first time ever there are now more children living in poverty in working than workless households. This equates to 3.7 million children living in poverty of which 1.4 million are in a workless household (End Child Poverty, 2013).

The Institute of Fiscal Studies (IFS) predicts a growth in child poverty of 400,000 between 2011 and 2015 with a total of 800,000 children by 2020.  If the Benefits Uprating Bill currently being debated in Parliament goes through, a further 200,000 children will be affected. On average this equates to 1 in 5 children in the UK (20.2%).  Furthermore, the IFS estimates that one in five (20.2%) UK children grow up in relative poverty (household income below 60% of the median before housing costs) compared with 15% of the general population (IFS, 2011).

Gender
Male unemployment is 6.0% compared to 3.0% for females. Female full-time workers are paid less than their male counterparts - £410.60 per week for women compared with £517.60 for men (NOMIS, 2014).

Women continue to be the largest proportion of lone parents (92%) and more than 60% work (Gingerbread, 2014). 

Socioeconomic status
Households often reach crisis point before taking action to address their money issues and debt. Despite this money advice service providers advise they are struggling to cope with demand.  When the cost of day to day essentials outstrips benefits and low-paid wages households turn to high cost lenders to make ends meet.    

Ethnicity
There are significant differences in the proportion of people in poverty by ethnic group with the poverty rate consistently lower amongst white people. Over the last three years the average poverty rate was at least double for all other ethnic groups ranging from 38% for Black/ British to 42% for ‘Other’ groups (Joseph Rowntree Foundation, 2013).

Family size
Couple households and those without children are the least likely to be in poverty.  Single parent families have the highest poverty rates of 54% for those aged 16-34 and 40% for those aged 35-64.  Younger couples with children also had a higher poverty rate at 30% than older couples with children at 20% (Joseph Rowntree Foundation, 20143).

Other risks
In 2013/14 more than 913,000 people in the UK were helped by Trussell Trust food banks compared to 346,000 in 2012/3. Sanctioning of DWP benefits accounts for 83% of foodbank referrals.

 



What is the level of need in the population?

Summary
Between 2004 and 2010, Hartlepool became slightly less deprived relative to other local authority areas in England.  However, between 2010 and 2015, it became relatively more deprived, falling from 24th to 18th most deprived local authroity in England. Hartlepool continues to have areas containing high numbers of people living in poverty.  Relative deprivation seems to have improved particularly for older people.

Overall
The English Indices of Deprivation 2015 (ID 2015) show Hartlepool is the 18th most deprived of 326 local authority areas in England (DCLG, 2015).  In 2010 it was the 24th most deprived.

ID 2015 measures deprivation at lower super output area (LSOA) level.  There are 58 LSOAs in Hartlepool, 25 of which (43%) are in the most deprived quintile in England.  Nineteen LSOAs (with a combined population of 31,100) are in the most deprived 10% of LSOAs in England and 3 of these (population 4,200) are in the most deprived 1% in England.

The most deprived areas in Hartlepool, 2015

LSOA code

LSOA Name

Ward where LSOA located

Population

E01011994

Hartlepool 002F

Headland and Harbour

1,563

E01011973

Hartlepool 005A

Victoria

1,277

E01012000

Hartlepool 007E

Headland and Harbour

1,389

Source: ID 2015

 

Hartlepool IMD 2015 by LSOA


The health inequalities indicator for local authorities shows that life expectancy for the most deprived in Hartlepool is lower than for the least deprived.  For men, the difference is 12.3 years and for women it is 8.2 years. The differences in England are 7.7 and 5.6 years respectively.  The differences between most and least deprived groups in Hartlepool are the 16th largest in England for men and 46th largest for women (of 351 local authority areas).  In Barrow-in-Furness (a similar area) the differences are 9.6 years for men and 6.8 years for women (Network of Public Health Observatories, 2011).

Hartlepool health inequalities indicator 2006-10

Children
Children are said to be in poverty if living in families in receipt of out-of-work means-tested benefits, or families in receipt of tax credits where reported income is less than 60% of median income (HMRC, 2012a).  In Hartlepool, 6,200 (21.9%) children are growing up in poverty by this measure (HMRC, 2012b).  There are eight LSOAs in Hartlepool where more than half of all children are growing up in poverty.

Areas where more than half of children are in poverty, Hartlepool, 2010

LSOA code

LSOA Name

Ward where LSOA located

Children in poverty

E01011973

Hartlepool 005A

Grange and Stranton

 185 (58.8%)

E01011958

Hartlepool 003D

Dyke House

 165 (58.0%)

E01011974

Hartlepool 005B

Stranton

 150 (57.4%)

E01011956

Hartlepool 003B

Dyke House

 215 (55.5%)

E01011953

Hartlepool 002B

Brus

 305 (54.6%)

E01011999

Hartlepool 007D

Stranton

 290 (54.4%)

E01011977

Hartlepool 012C

Owton

 275 (50.4%)

E01011978

Hartlepool 012D

Owton

 210 (50.1%)

Source: HMRC

 

Hartlepool child poverty indicator by LSOA 2010

The Indices of Deprivation 2010 contains an Income Deprivation Affecting Children Indicator (IDACI) for LSOAs (DCLG, 2011).  In Hartlepool, one LSOA is in the most deprived 1% in England, namely E01011999 in Stranton ward, and an additional 19 LSOAs are in the most deprived 10% in England by this measure (20 of 58 LSOAs, 34%).

The proportion of children eligible for free school meals varies from 5 to 6% in Rural West and Hart wards to over 40% in De Bruce and Headland & Harbour wards (Tees Valley Unlimited, 2012).  Educational outcomes for children who are eligible for free school meals are worse than for the general population.  The gap is wider at GCSE than at the end of key stage 2.

Hartlepool educational attainment and disadvantage, 2012

Working age adults
In Hartlepool, there are about 4,700 people claiming Job Seekers Allowance (JSA), 8.0% of the working age population (November 2012).  This compares with 3.8% in Great Britain (Nomis, 2012).

In November 2012 there were 1,740 people in Hartlepool who had been claiming JSA for more than 1 year.  For 18-24 year-olds, the rate was 4.9% compared with 3.0% of the working age population and 1.7% of people aged 50-64 years (Nomis, 2012).

In April 2012, there were seven LSOAs in Hartlepool where more than 15% of the working age population claimed JSA.  This compared with a Hartlepool average of 8.0%, a North East rate of 7.6% and 4.9% in Great Britain.  The following map shows LSOAs lower than the England rate in green and those lower than the North East rate in yellow.

Areas where more than 15% of the working age population claim Jobseeker’s Allowance, Hartlepool, April 2012

LSOA code

LSOA Name

Ward where LSOA located

JSA Claimants

E01011973

Hartlepool 005A

Grange; and Stranton

174 (21.2%)

E01011950

Hartlepool 008A

Burn Valley

195 (18.7%)

E01012000

Hartlepool 007E

Stranton

145 (17.5%)

E01011958

Hartlepool 003D

Dyke House

109 (16.9%)

E01011978

Hartlepool 012D

Owton

147 (16.2%)

E01011999

Hartlepool 007D

Stranton

171 (15.7%)

E01012001

Hartlepool 008D

Foggy Furze

179 (15.1%)

Source: www.nomisweb.co.uk

 

Hartlepool JSA claimants April 2012

Older people
In Hartlepool, there are no LSOAs in the most deprived 1% of LSOAs in England for income deprivation affecting older people (DCLG, 2011).  However, 18 of the 58 LSOAs (31%) are in the most deprived 10% of LSOAs in England for this indicator – three times the number expected.

Hartlepool IDAOPI 2010 LSOAs

Additional details can be found in the poverty chapter from Hartlepool JSNA 2010.

 



What services are currently provided?

Hartlepool is a small town where services are effectively delivered in partnership with the public, private and voluntary sectors.

The council’s First Contact and Support Hub offers information, advice and guidance to children, young people, their families, vulnerable adults and the services that work with them.  Specialist support includes access to early intervention and social care, advising on the impact of welfare reform, maximising benefits and entitlement and referring to support services throughout the voluntary and independent sectors.

Hartlepool makes full use of national services such as The Work Programme, Work Trials and Community Work Placements.  Some examples of services currently provided locally include:

Training, Volunteering and Employment:

  • Adult Education
  • Family Wise (DWP Families with Multiple Problems)
  • Tees Valley Jobs and Skills Investment Scheme
  • Think Families Think Communities (DCLG Troubled Families)
  • Youth Engagement and Support Project

Money Matters:

  • Citizens Advice Bureau
  • Food Connect (Food Bank)
  • Money Wise Community Bank – Credit Union
  • Trussell Trust Food Bank
  • West View Advice and Resource Centre

Family Support:

  • Changing Futures
  • Hartlepool Families First
  • PATCH

Specialist Services:

  • Hartlepool Carers
  • Hartlepool MIND
  • Hyped

 



What is the projected level of need?

Child poverty - The Institute of Fiscal Studies (IFS) predicts a growth in child poverty of 400,000 between 2011 and 2015 with a total of 800,000 children by 2020.  If the Benefits Uprating Bill currently being debated in Parliament goes through, a further 200,000 children will be affected. On average this equates to 1 in 5 children in the UK (20.2%) and 1 in 3 in Hartlepool (33%).  Furthermore, the IFS estimates that one in five (20.2%) UK children grow up in relative poverty (household income below 60% of the median before housing costs) compared with 15% of the general population (IFS, 2011). 

The projections in Working Futures 2010-2020 indicate that many long-term employment trends will continue, including shifts towards a knowledge- and service-based economy and increases in high-paid and low-paid jobs at the expense of those in the middle (Joseph Rowntree Foundation, 2012b). These changes in employment structure will contribute to an increase in poverty rates by 2020, although it is the growing gap between benefits and wages that is the main driver of increasing relative poverty rates.

Absolute poverty will rise considerably in the next few years as earnings growth is forecast to be weak but inflation high. Real median household income will remain below its 2009/10 level in 2015/16 (Joseph Rowntree Foundation, 2011).

Pensioner poverty is forecast to continue to fall to around 14% in 2017.  By 2025, between 8 and 11% of pensioners are expected to be in poverty but this is dependent on national pension policy (Pensions Policy Institute, 2011).  However, the fall in the rate of pensioner poverty coincides with a rising pensioner population, so the number of pensioners in poverty in Hartlepool may not change significantly.

The phased introduction of Universal Credit from April 2014 is expected to lessen the impact of austerity measures on low-income, working age families compared to others.  Households with one earner (either with or without children) are expected to benefit more than other household types (Family and Parenting Institute, 2012; Joseph Rowntree Foundation, 2011). The universal credit system does not give people any more money if they are out of work, and in many cases, such as for some under 25s, most disabled children and severely disabled adults, it allows less to live on. Even in work, some groups may be worse off, or find incentives are not so generous, when compared to the various threads of the ‘old system’ (Child Poverty Action Group, 2013).

UK levels of personal debt continue to rise with the average amount owed per UK adult (including mortgages) of £28,674.  Average consumer borrowing (including credit cards, motor and retail finance deals, overdrafts and unsecured loans) per UK adult is £3204. Debt is the second largest enquiry for Citizen Advice Bureaux (behind benefits advice).  28,900 properties were take into possession in 2013 with 278,355 mortgage accounts in arrears.24,282 individual insolvencies were agreed in 2013 (The Money Charity, 2014).

 



What needs might be unmet?

Maximising income
Not all benefits are claimed by those who are entitled to them.  The following table shows key benefit take-up nationally and the number of people who may be entitled and do not claim.  There is lower take-up of pension credit, council tax benefit and jobseekers’ allowance compared with other benefits.  Assuming benefit uptake in Hartlepool is similar, and that Hartlepool has 0.152% of the population of Great Britain, the number of people not claiming benefits can be estimated.

Estimated take up of income-related benefits, Hartlepool, 2009/10

Benefit

Estimated take-up (Great Britain)

Estimated number of people with unclaimed benefits in Hartlepool

Income Support and Employment and Support Allowance (Income Related)

77-89%

400 to 900

Pension Credit

62-68%

1,800 to 2,400

Housing Benefit (including Local Housing Allowance)

78-84%

1,100 to 1,700

Council Tax Benefit

62-69%

3,600 to 4,900

Jobseeker's Allowance (Income-based)

60-67%

700 to 900

Source: DWP, 2012a

 

Recent changes to benefits and entitlements as a result of welfare reform may further affect the number of unclaimed benefits. However, the introduction of Universal Credit (currently still being tested in pilot areas) is expected to bring about ‘a radical new approach’ and will be assessed according to circumstances over a calendar month. It is designed for those both in and out of work.  When fully operational more people could take up entitlement than ever before however full roll out of the programme is not expected to be in place until at least 2020.  In the mean time there may still be many people, counted in thousands, not claiming their full benefit entitlement that could lift them out of poverty.

Food needs
There is an unmet need for food.  Trussell Trust Foodbank in Hartlepool is providing more than 300 parcels a month to individuals and families in need. Benefit delays, Benefit Changes and generally living on a low income are the three most common reasons for referral (The Trussell Trust, 2014).

Employment needs
In Hartlepool job density (the ratio of number of jobs in an area compared with the working age population) is 0.52 jobs per working age adult compared to 0.78 in Great Britain (NOMIS, 2014), indicating that there are fewer jobs available in Hartlepool compared to Great Britain as a whole.

 



What evidence is there for effective intervention?

End Child Poverty
A coalition of over 100 charities committed to ending child poverty in the UK, End Child Poverty believes that action needs to be taken at a local, regional and national level both to embed the principles of the Child Poverty Act and to end child poverty by 2020. Actions at a local level include:

  • Protect families with children in decisions about local benefits
  • Undertake a strategic needs assessment of child poverty in their local area
  • Ensure child poverty is a strategic priority for the Health and Wellbeing Board

Joseph Rowntree Foundation
For over 100 years, the Joseph Rowntree Foundation (JRF) has investigated the root causes of poverty, monitoring its effects on people and places in the UK. Today, in a context of globalisation, financial and economic strain, austerity measures and extensive welfare reform, those at greatest risk are the poorer members of society. As poverty isn't just about money, JRF tries to understand exactly how much money does matter, and its interplay with other factors such as housing, education, aspirations and culture.  It searches for practical strategies to reduce poverty, and wider social and economic inequalities, focusing particularly on the contribution that work, skills and economic growth can play now and in the future. Its work includes:

  • an anti-poverty strategy for the UK;
  • child poverty in the UK;
  • education and poverty;
  • forced labour (contemporary slavery) in the UK;
  • minimum income standards;
  • poverty and social exclusion; and
  • poverty and ethnicity.

 

The Marmot Review (‘Fair Society, Healthy Lives’)
In November 2008, Professor Sir Michael Marmot was asked by the then Secretary of State for Health to chair an independent review to propose the most effective evidence-based strategies for reducing health inequalities in England from 2010.
The final report, 'Fair Society Healthy Lives', was published in February 2010 (Marmot Review, 2010), and concluded that reducing health inequalities would require action on six policy objectives:

1. Give every child the best start in life;
2. Enable all children, young people and adults to maximise their capabilities and have  control over their lives;
3. Create fair employment and good work for all;
4. Ensure healthy standard of living for all;
5. Create and develop healthy and sustainable places and communities; and
6. Strengthen the role and impact of ill-health prevention.

Each of these policy objectives is influenced by the scale and distribution of poverty.

 

Additional resources for tackling poverty can be found at:

The Poverty and Social Exclusion website

Child Poverty Action Group

Townsend Centre for International Poverty Research

 



What do people say?

Poverty Ends Now (PEN)
A team of young people from the region have created a manifesto to end child poverty. Children from some of the most deprived parts of the North have drawn up a manifesto to launch in Parliament on October 15th 2014. This includes:

  • Every family in Britain should meet a minimum standard of living, not just surviving
  • An equal school experience for all
  • Affordable, decent homes for everyone
  • Every young person should have access to three affordable, healthy meals a day
  • For all to feel and be safe within their communities and at home
  • Make sure all young people have affordable transport everywhere

Children North East (CNE)
Children North East worked with four regional schools to look at ways to eliminate poverty in school. Children and young people experiencing poverty consistently told CNE that they felt discriminated against during the school day.  For example they couldn’t afford to go on school trips; were made to stand out because of the way Free School Meals were administered and found the costs of uniforms and resources a strain.  Tangible action against poverty could be taken if more focus was placed on the school day.

 



What additional needs assessment is required?

Whilst the Child Poverty Strategy and Action Plan have been refreshed, the local Needs Assessment needs to be reviewed and updated.

The impact of welfare reform, and in particular Universal Credit, needs to be understood locally and actions put in place to mitigate negative effects.

A thorough understanding of money management issues and levels of debt are needed at a local level in order to inform the commissioning of appropriate services.

 



Key contact

Nsme: Penny Thompson

Job title: Advice and Guidance Hub Manager

e-mail: penny.thompson@hartlepool.gov.uk

Phone number: (01429) 284878

 

References

Local strategies and plans

Hartlepool child poverty strategy 2011-2015.

Hartlepool child poverty needs assessment (2012).

Hartlepool child poverty action plan (2013).

 

National strategies and plans

 

Department for Education (2014), Child Poverty Strategy 2014-17

Department for Education (2012). A New Approach to Child Poverty: Tackling the Causes of Disadvantage and Transforming Families' Lives.

HM Government (2011). Opening Doors, Breaking Barriers: A Strategy for Social Mobility.

 

Other references

Aldridge H, Kenway P, MacInnes T and Parekh A. (2012). Monitoring poverty and social exclusion 2012.

Department for Communities and Local Government (DCLG, 2011). English indices of deprivation 2010.

Department for Work and Pensions (DWP, 2012a). Income Related Benefits: Estimates of Take-Up.

Department for Work and Pensions (DWP, 2012b). Households below average income 2010/11.

Family and Parenting Institute (2012). The impact of austerity measures on households with children.

HM Government (2010). The Foundation Years: preventing poor children becoming poor adults.

HM Government (2011). Early Intervention: The Next Steps.

Her Majesty’s Revenue and Customs (HMRC, 2012a). Technical information for the revised local child poverty measure.

Her Majesty’s Revenue and Customs (HMRC, 2012b). Child poverty statistics.

Institute for Fiscal Studies (IFS, 2012). Inequality and poverty spreadsheet.

Joseph Rowntree Foundation (2011). Child and working-age poverty from 2010 to 2020.

Joseph Rowntree Foundation (2012). Monitoring poverty and social exclusion 2012.

Joseph Rowntree Foundation (2012b). The impact of employment changes on poverty in 2020.

Kempson, E and Collard, S (2012). Developing a vision for financial inclusion.

Marmot Review (2010). Fair Society, Healthy Lives.

Network of Public Health Observatories (2011). Health inequality indicators for local authorities and primary care organisations.

Nomis (2012). Labour market profile, November 2012.

Pensions Policy Institute (2011). The implications of Government policy for future levels of pensioner poverty.

Tees Valley Unlimited (2012). Area profiles.

The Trussell Trust (2012). UK Foodbanks project.

Work and Pensions Committee (2009). Tackling pensioner poverty.

 



Transport

Transport has an impact on health through transport-related accidents, active travel, public transport, air quality and access to a range of services. 

Transport can affect people by giving access to employment opportunities, education, leisure, healthcare and diverse food supplies. The development of an efficient transport network and vehicles has the potential to benefit health.

Increasing levels of motorised traffic have contributed to air pollution, noise, vibration, danger from vehicles and an increased fear of traffic. These issues particularly affect the most deprived and most vulnerable people in communities.

The rise in personal car use has meant liberation for people who are young and more affluent. More deprived, elderly and disabled people can become trapped in ‘residential islands’ surrounded by dense traffic, or without the means to access more distant facilities and services in out-of-town developments. This also applies to people in rural areas faced with dwindling local facilities and longer travel times.

Road traffic casualties are still one of the main public health challenges in the UK particularly for children and young adults.

The rise in personal car ownership levels has contributed to people being less active. This is a significant contributor to obesity, diabetes and cardiovascular disease.

This topic has links to the following JSNA topics:



What are the key issues?

Road Safety

In 2013, there were 142 road traffic collisions in Hartlepool. This resulted in 189 casualties, of which, 19 were serious casualties and 170 slight casualties. 

Car occupants were the largest casualty group, contributing to 53% of all casualties (although approximately 98% of these car occupant casualties are slight injuries).   

Of the 189 casualties, 38% of them were ‘vulnerable’ road users (pedestrians, cyclists and motorcyclists). Of the 19 serious casualties, 89% of them were ‘vulnerable’ road users.    

Due to a significant growth in the levels of cycling in Hartlepool, the number of cycle-related casualties has increased. 

Using approved Department for Transport methodology, the estimated cost of road traffic casualties in Hartlepool in 2013 was £14.6million.  This figure includes medical and healthcare costs, lost economic output, pain, grief and suffering, material damage, police costs, insurance administration and legal costs. 

Active Travel

In Hartlepool (47.1%), significantly fewer people are active compared with England (56%).

In Hartlepool, an estimated 30.6% of adults are classed as obese.

In Hartlepool, almost one in four children aged 11 years old are obese.



What commissioning priorities are recommended?

2015/01

Road Safety Education – Provide training for all pupils in year 3 and year 4. This aims to raise awareness of traffic, reduce child casualties and encourage walking as a mode of travel.

2015/02

Adult Cycle Training – Ensure ‘Bikeability’ training is available for adults, to help ensure cycling continues to grow and increases safety for cyclists. The training aims to provide knowledge, skills and confidence for people to cycle in urban areas. 

2015/03

Provide active travel promotion schemes in schools and workplaces in order to build upon the success of the recent ‘Walk to School’ outreach programme.



Who is at risk and why?

Various factors influence the demand for transport as shown below.

Factors that affect transport demand (Litman, 2012)

Age

Older (over 65-year-olds) and younger (18 to 20-year-olds) drivers are at particular risk of serious and fatal injuries on the roads.

Children are becoming less physically fit as they age. 

Gender

A higher percentage of boys than girls (aged 2-15 years) meet the Government’s recommendations for physical activity.

There is no current evidence suggesting gender plays a significant role in determining the prevalence of obesity in adults.  However, the NCMP shows that boys are significantly more likely to be obese than girls.

Socioeconomic status

Children in the 10% most deprived wards in England are more than three times as likely to be pedestrian casualties as those in the 10% most affluent wards.

Although the most deprived areas produce the lowest levels of pollution, they are actually exposed to the highest levels of air pollution.

More people are active in households with higher income. 

The distribution of overweight and obesity has a significant social gradient, with prevalence among people who are socially and economically deprived.

Disability

Disabled people are most likely to suffer an injury due to a trip or fall and therefore, will require longer periods of medical care than other groups. 

Children and young people with a disability take part in physical activity and sport less frequently and their experiences are less positive than their non-disabled peers (Sport Scotland, 2006).

Ethnicity

Injury rates are higher in black children when compared to their white and Asian peers.

People from minority ethnic groups tend to be less active compared to their white peers (The Information Centre, 2006).

Environment

People living within close proximity of motorised traffic can be affected as traffic vibration and noise cause stress, while congestion, traffic speeds and inconsiderate driving are a source of annoyance and fear for many.

Nationally in 2011, the majority (61%) of road collision related fatalities occurred on rural roads (40% on rural A roads and 21% on other rural roads).

While the evidence is varied, studies tend to show that cyclists and pedestrians are exposed to lower fine particulate matter and carbon dioxide concentrations when compared to those inside vehicles. The proximity to the pollution source(s) has a significant impact on the level of exposure levels experienced.

Time

Nationally, whilst deaths peaked during the evening rush hour (and potentially dark nights), with a peak of 173 between 18:00 and 19:00 there were fatalities throughout the whole day.

Friday, Saturday and Sunday accounts for 50% of all deaths. Saturday and Sunday show evening peaks related to the periods following likely pub drinking and parties. On Sunday there are peaks following likely lunchtime drinking.



What is the level of need in the population?

Vulnerable road user group casualties

In 2013, there were 23 children injured in road traffic collisions.  Of these, 17 were classified as ‘slight’ and 6 were classified as ‘serious’ casualties. 

In 2013, there were 11 child pedestrian casualties (including 5 serious), which represents 35% of all pedestrian casualties.  In addition, there were and 5 child cycle casualties (1 serious), equating to 20% of all pedal cycle casualties. 

A further analysis of child pedestrian collisions has been undertaken.  This has shown a trend towards collisions occurring later in the day in the autumn period.  The analysis has also found that children failing to look properly and their behaviour being careless or reckless being the two most common causation factors. 

In 2013, there were 24 (23 were male) pedal cyclist casualties. This is a 20% increase compared to 2012.  Of the 24 casualties, 20 were classified as ‘slight’ and 4 were ‘serious’. Only 8 of these were wearing a cycle helmet. 

In 2013, 4 pedal cycle casualties were children.

Physical inactivity

In Hartlepool, 30.6% of adults are classified as obese. Results from the National Child Measurement Programme (NCMP) show that by year six, 24.4% of children are obese. These levels of obesity are significantly higher than the England average. 

Figures from Public Health England (2013) show that the proportion of physically active adults in Hartlepool (47.1%) is worse than the England average (56%).

Data from automated cycle counters located around Hartlepool show a 30% increase in cycle trips from 2011 to 2013.

In 2011, schools collected ‘mode of travel’ data for their pupils via the annual school census.  This showed that 55% of pupils walked to school, 24% travelled by car, 3% car shared, 17% travelled by bus, and 1% cycled to school. 

The 2011 census found that people travelled to work as the following:

  • Car driver (63%);
  • Walk (12%);
  • Passenger in a car (9%);
  • Bus (7%);
  • Working from home (3%). 
  • Cycle (2%);
  • Train (1%);
  • Taxi (1%); and
  • Motorcycle (<1%);

From this, it is apparent that only 14% of the working population travel actively.

Tees Valley Transport Monitoring Report

The Tees Valley Transport Monitoring Report (http://www.teesvalleyunlimited.gov.uk/media/39881/tees_valley_monitoring_report.pdf) provides a wealth of statistical data for all modes of transport and monitors trends and changes over recent years. Several examples of tables within this document are shown below:

Traffic-related casualties

Tees Valley casualties by severity

Tees Valley casualties by age

Average vehicle speed

Tees Valley bus patronage



What services are currently provided?

The third Local Transport Plan (LTP) has enabled ‘Safer and Healthier Travel’ as one of Hartlepool’s main objectives.  The Table below shows current road safety/active travel work undertaken in Hartlepool:

Service delivered

By whom

Future issues

Capital Infrastructure improvements – Road Safety and sustainable transport initiatives

Local Authority/LEP

Local Transport Plan funding is in place until 2020. 

As part of Tees Valley Growth Deal there is provisionally £8.3m available to enhance sustainable access to employment across the Tees Valley. 

Pedestrian training to primary school children

Local Authority

Local Authority funding has ceased and no training has been delivered since July 2013.   

Bikeability Cycle Training – Offered to all Y6 pupils at schools in Hartlepool

Local Authority

DfT have committed funding until March 2016. 

Road Safety promotion  including;  School based young person education, Road awareness education and events, Car Seat advice (U 4’s), Speed awareness courses, Driver improvements, National Driver Offender Rehabilitation, Motorcyclist training, Cleveland Safety Camera Partnership

Local Authority, Cleveland Police, Cleveland Fire Brigade, 3rd Sector

From April 2015 Road Safety will be delivered on a zero budget basis in Hartlepool.  HBC are not providing any revenue for Road Safety Promotional work. 

School Crossing Patrol  Service – helping to ensure safety outside of schools as well as enabling  & encouraging walking to school

Local Authority

HBC have committed funding for the 15/16 and 16/17 financial years. 

Walk to School Outreach Project – Walk to School Promotion / Incentive Scheme. 

Local Authority / Living Streets

This project is funded via the DfT’s Local Sustainable Transport Fund up until March 2015. 

School Safety 20mph Zones

Local Authority

These schemes have been funded from the Local Transport Plan.

 


What is the projected level of need?

There are currently no projected levels of need but as part of the Cleveland Casualty Reduction Strategy, Hartlepool Borough Council monitors casualties against particular indicators.  The indicators, progress to date and targets for the future are set out below:

  • A 40% reduction in the total number of Killed and Seriously Injured (KSI) (compared to the 2005-2009 baseline of 35) by 2020. 
  • A 50% reduction in the number of Children Killed and Seriously Injured (Child KSI) (compared to the 2005–2009 baseline of 7) by 2020.
  • Monitor vulnerable road user casualties in comparison to the 2005–2009 baseline for these modes.


What needs might be unmet?

The current economic climate has placed severe pressures upon levels of investment in transport infrastructure. Traditional traffic engineering interventions on the road network are capital intensive and becoming increasingly difficult to fund, particularly as all of the ‘easy wins’ have already been made. There are thus fewer higher-return sites available in an already highly engineered environment, and those that remain are costly, and with poorer returns. Major reductions in the capital budget therefore mean that far fewer schemes can be delivered.

Most accidents recorded in Hartlepool are as a result of human error, so investing within a programme aimed at addressing this is critical. Softer measures in education, training and publicity will have a crucial role to play in making roads safer. However, public sector revenue budget cuts and the removal of specific funding streams such as the road safety grant have placed pressure on this area too. 

There is no revenue being provided to address the above needs beyond March 2015, therefore, no road safety education (other than child Bikeability training which is funded by the DfT) will be provided, unless alternative sources of funding can be found. 

Bikeability cycle training aims to encourage people to cycle in safety in urban areas.  At the current time we can only deliver training for pupils in year 6.  Bikeability could be delivered to adults to encourage the use of this mode of active travel and to be safe whilst doing so.  We have seen growth in cycling in Hartlepool already but accompanied by increases in pedal cycle casualties, this trend may continue without suitable education for adult cyclists in addition to children.   

The only promotional activity relating to active travel for school journeys is the Walk to School Outreach Project.  Funding for this project was provided by the DfT and the project ends in March 2015.



What evidence is there for effective intervention?

A wide range of evidence on the scale of impact on health in Hartlepool and the effectiveness of interventions are available:

Benefits of Investing in Cycling – British Cycling (2014)

2013 Road Casualty Review – Hartlepool Borough Council (2014)

Statement of Transport Ambition – Tees Valley Unlimited (2011)

Tees Valley Monitoring Report – Tees Valley Unlimited (2013)

Hartlepool Local Transport Plan – 2011

NICE - Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation

NICE – Promoting Physical Activity for Children and Young People

Child pedestrian training

A number of studies have been undertaken around the effectiveness of pedestrian training.  The consensus is that training helps pupils identify safer places to cross the road following the training and that they feel safer when out walking and are therefore more likely to be able to walk and play out independently. 

Active travel promotion in schools

The Walk to School Outreach project is a Department for Transport funded project that aims to encourage walking to school as it can have significant health, environmental and safety benefits.  The project includes work such as parent surveys, school route audits and working school council’s.  From this, barriers that prevent or discourage walking have been identified.          

Bikeability

The DfT commissioned a research study which has evaluated the impact and perceptions of cycle training, with a specific focus on Bikeability, and found positive results. 

Benefits of investing in cycling

In 2014, British Cycling produced a document entitled ‘Benefits of Investing in Cycling’ by Dr Rachel Aldred.  It listed some key benefits of working to increase levels of cycling in England which include:

  • Increasing cycling to Danish levels would save the NHS £17bn within 20 years;
  • Shifting just 10% of journeys from car to bike would reduce air pollution, save 400 productive life years and increase mobility of the nation’s poorest families by 25%; and
  • More cycling and other sustainable transport could reduce road deaths by 30%.


What do people say?

Consultation on road safety is a key part of various capital schemes that are delivered.  Concerns are often raised relating to speed (or perceptions of speed) of vehicles that pose problems for other road users.  This can be other vehicles, but often it is relating to vulnerable road users. 

Bikeability

The DfT commissioned a research study which has evaluated the impact and perceptions of cycle training, with a specific focus on Bikeability, and found positive results.  The research, undertaken by Ipsos MORI, has now been made public. It shows that Bikeability schemes enjoy a very high degree of customer satisfaction.

  • 98% of parents surveyed said they were satisfied with the Bikeability scheme;
  • 76% of these were very satisfied;
  • 93% of parents feel that it has had a positive impact on their child’s safety when cycling on the road;
  • 93% of children feel more confident about riding their bike generally; and
  • 86% of children feel more confident about riding their bike on the road.

When the children were asked what the main thing that they learnt from taking part in Bikeability:

  • 68% said ‘to ride my bike more safely’;
  • 53% said ‘to ride my bike safely on the road’; and
  • 36% said ‘to ride my bike with confidence’.


What additional needs assessment is required?

Additional assessments required include:

  • Identify barriers to adopting sustainable and active travel lifestyles;
  • Identify preferred methods of travel to schools, work and for leisure purposes;
  • Whether incentivising take up of active travel has any impact on residents;
  • What are the projects that will bring about the greatest community, environmental and health benefits when engaging with safe and active travel; and
  • Identify those areas where safe and active travel promotion can be used as an intervention and provide GPs/health care professionals with a remedy which contributes to recovery.


Key contact: Tony Davison

Job title: Sustainable Travel Officer

e-mail: tony.davison@hartlepool.gov.uk

Phone number: 01429 523259

References

Benefits of Investing in Cycling – British Cycling (2014)

2013 Road Casualty Review – Hartlepool Borough Council (2014)

Statement of Transport Ambition – Tees Valley Unlimited (2011)

Tees Valley Monitoring Report – Tees Valley Unlimited (2013)

Hartlepool Local Transport Plan – 2011

NICE - Walking and cycling: local measures to promote walking and cycling as forms of travel or recreation

NICE – Promoting Physical Activity for Children and Young People

Cycle count data

Road Traffic Collision Casualty data

Public Health & Local Government Association -  Healthy people, healthy places briefing Obesity and the environment: increasing physical activity and active travel

TRL – Road Safety Education Best Practice (2012)



Behaviour and Lifestyle
Introduction

Behaviours, such as smoking, excessive use of alcohol, the use of illicit drugs, low levels of exercise and physical activity, engaging in unsafe sex, and a poor diet all impact on physical health and mental wellbeing.  It is known that each of these lifestyle risk factors is unequally distributed in the population and that there are differences in these behaviours associated with income, educational achievement and social class.

There is compelling evidence that lifestyle risk factors tend to cluster than present in isolation.  It is estimated that in England 70% of the adult population have two or more lifestyle risk factors (King’s Fund, 2012).  Whilst there has been an overall decline in the proportion of the population with three or four unhealthy risk factors from 33% of the population in 2003, to 25% in 2008, these reductions have not been equally distributed across the population. The percentage of people with three or more lifestyle risk factors is continues to increase for people from lower socio-economic and educational groups. For instance  people with no educational qualifications were  more than five times as likely as those with higher education to have four lifestyle risk factors in 2008, compared with only three times as likely in 2003.

This variation in the distribution of lifestyle risk factors contributes to the gaps in length and quality of life between deprived and affluent groups locally and nationally. The major causes of illness and premature deaths (deaths before age 75 years) in Hartlepool are circulatory diseases, cancer, respiratory disease and digestive diseases (including liver disease).  Lifestyle risk factors such as smoking, excessive alcohol use, poor diet and physical inactivity are known to contribute to these major causes of premature deaths.

Alcohol misuse

  • Levels of alcohol-related harm in Hartlepool are among the highest in England.  There are a higher number of alcohol-related hospital admissions and higher alcohol-specific mortality compared to England.
  • Alcohol misuse impacts upon physical and mental health, as well as having a detrimental effect on social cohesion, crime, violence and community safety.
  • Alcohol-related harm is a major problem in Hartlepool impacting on individuals, families and communities.

Illicit drug use

  • There is insufficient information in Hartlepool to accurately estimate levels of drug misuse.
  • The proportion of successful treatment outcomes for opiate users in Hartlepool is not as high as in England, but for non-opiate users they are similar to England.

Smoking

  • More than one-in-four (28.2%) adults in Hartlepool are estimated to smoke regularly. The smoking prevalence rises to almost one-in-two adults in some deprived wards and disadvantaged population groups.
  • In Hartlepool, 21.7% of women smoke throughout their pregnancy posing a significant health risk both to mother and unborn child.  This rate is 70% higher than England (12.7%) and higher than the North East.
  • About one-in-five of all deaths in Hartlepool is estimated to be as a result of smoking.  Smoking-related deaths in Hartlepool are about 40% higher than in England.

 

Diet and nutrition

  • Eighty-one percent of adults in Hartlepool do not eat the recommended five daily portions of fruit and vegetables compared with 71% in England.  In England, 82% of school-aged children do not eat five portions of fruit and vegetables each day.
  • Breastfeeding rates in Hartlepool are among the lowest in England and the gap is widening.
  • There is low uptake of healthy start vitamin supplements in babies and infants.

 

Physical inactivity

  • More than one-third of the adult population of Hartlepool is inactive.  Significantly fewer adults take part in the recommended weekly levels of physical activity in Hartlepool compared with England.
  • There is variation in the quantity of PE provided at schools within Hartlepool.  In Hartlepool, walking and cycling to school is more common than in England; about six in ten primary school children and about half of secondary school pupils travel actively.
  • The groups with the lowest levels of physical activity are women (particularly those aged 14-24 years); black and minority ethnic (BME) groups; those with a limiting illness/disability; and lower socioeconomic groups.

Obesity

  • The obesity rate for Hartlepool adults continues to be significantly higher than England and increasing. There are inequalities in relation to the prevalence of obesity according to income, social deprivation, age, ethnicity and disability.
  • Childhood obesity almost doubles from 11.0% in reception year to almost 21.2% in year 6 pupils.
  • The increasing prevalence rates of obesity increases demand on health services and costs to the NHS and wider economy.

Sexual health

  • Hartlepool rates of sexually transmitted infection and HIV tend to be similar to or lower than England.
  • Local teenage pregnancy rates are higher than England, but the gap has been narrowing.
  • Termination of pregnancy in under-18s is similar to England and Hartlepool has a lower uptake for Long Acting Reversible Contraception (LARC) compared to the regional and national averages.
  • There is low uptake of screening and preventative services, particularly for chlamydia and HIV.
Recommendations

The recommendations below relate to the Marmot review: Fair Society, Healthy Lives, the former National Support Team recommendations for tackling Health Inequalities and latest national policy and professional guidance.

Short-term (1-2 years)

  • Commission and deliver integrated public health services and programmes that address multiple lifestyle risk factors rather than taking an approach that focuses solely on single issues. Ensure that these interventions are accessible and acceptable to those at highest risk.
  • Ensure equitable access to sexual health services (prevention, early identification, awareness and treatment services) at address the high teenage pregnancy rates and sexually transmitted infections. 
  • Give all children the best start in life by tackling smoking in pregnancy, obesity in pregnancy, low breast feeding rates and low uptake of healthy start vitamins.

Medium-term (3-5 years)

  • Maximise the opportunities of creating a health promoting environment through enforcement, planning, regeneration and licence application processes.  This could include considering the restriction of planning permission for hot-food takeaways, alcohol premises (representations and cumulative impact areas), tackling availability, supply and demand for illicit drugs and tobacco.
  • Strengthen the role of primary care, social care and VCS organisations in delivering lifestyle and behaviour modification programmes.
  • Strengthen the use of community assets in addressing lifestyle risk factors.

Long-term (over 5 years)

  • Ensure that all town planning, regeneration and transport programmes incorporate active transport routes and that future planning complements strategies to reduce alcohol related crime and violence in the town centre.
  • Improve maternal and child health by addressing the social causes of poor health including; teenage pregnancy, educational attainment, unemployment, food poverty and maternal mental health.

 

Summary authors

Carole Johnson
Head of Health Improvement
Hartlepool Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service


Reference

King’s Fund (2012). Clustering of unhealthy behaviours over time: Implications for policy and practice.



Alcohol misuse

Alcohol misuse is consuming more than the recommended limits of alcohol.

Many people are able to keep their alcohol consumption within the recommended limits, so their risk of alcohol-related health problems is low. However, for some, the amount of alcohol they drink could put them at risk of damaging their health.

There are three main types of alcohol misuse:

  • Hazardous drinking: Drinking over the recommended limits;
  • Harmful drinking: Drinking over the recommended limits and experiencing alcohol-related health problems;
  • Dependent drinking: Feeling unable to function without alcohol.

Many people who have alcohol-related health problems are not alcoholics.

In 2009/10, around one million hospital admissions were due to an alcohol-related condition or injury.

The short-term risks of alcohol misuse include:

  • Alcohol poisoning, which may include vomiting, seizures (fits) and unconsciousness;
  • Injuries requiring hospital treatment, such as a head injury
  • Violent behaviour that might lead to being arrested by the police;
  • Unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs);
  • Loss of possessions, such as a wallet, keys and/or phone, leading to feelings of anxiety. 

Long-term alcohol misuse is a major risk factor for a wide range of serious conditions, such as:

  • Heart disease;
  • Stroke;
  • Liver disease;
  • Liver cancer and bowel cancer.

As well as health problems, long-term alcohol misuse can lead to social problems such as unemployment, divorce, domestic abuse and homelessness.

The Department of Health’s national alcohol strategy ‘Safe. Sensible. Social’ outlined the next steps for reducing the harm associated with alcohol. Within the strategy, it defines the following terminology for drinking categories:

  • Low risk drinking: Drinking alcohol within the current guidelines on alcohol consumption;
  • Increasing risk drinking: Drinking between 22 and 50 units per week for males and between 15 and 35 units per week for females;
  • Higher risk drinking: Drinking over 50 units per week for males and over 35 units per week for females and experiencing harm such as alcohol-related accidents, acute alcohol poisoning, hypertension or cirrhosis of the liver;
  • Dependent drinking: Continued drinking despite harm usually characterised by an inner drive to consume alcohol with the drinker experiencing withdrawal symptoms when they cease drinking;
  • Binge drinking: Drinking over eight units a day for men and over six units a day for women.


What are the key issues?

The levels of alcohol-related harm in Hartlepool are among the highest in the country.

Hospital admission episodes for alcohol-attributable conditions (formerly NI39) in Hartlepool are significantly worse that the England average and just below the regional average.

In 2013/14, alcohol-related hospital admissions (Broad) in Hartlepool were 1,472 per 100,000 population. This is significantly worse than the England average.

Adults and young people are more likely to be admitted to hospital for alcohol-related harm in Hartlepool than in most other areas, with the rate of under 18-year-olds admitted to hospital with alcohol-specific conditions being the second highest rate in the region.

Hartlepool is just below the England average for violent crimes attributable to alcohol.

Many children in Hartlepool are living with a parent with an alcohol problem.

Hartlepool is ranked 320th (out of 326 Local Authority areas) in the country for the percentage of increasing risk drinkers in the population.

It is estimated that alcohol misuse in Hartlepool costs around £42 million. This equates to £459 per head of population which is the second highest LA in the North East.

In Hartlepool, alcohol is a contributing factor for more than half of all assault presentations to A&E and 14% of all anti-social behaviour recorded incidences with the Police.

There were 383 individuals accessing treatment at specialist alcohol misuse services in Hartlepool in 2013/14.

Stronger communities: social marketing & public education

  • National and local advertising may increase levels of drinking, especially by young people; and
  • Social marketing is not being fully utilised to reduce alcohol use in the population.

Supporting children and young people

  • Low numbers of young people access treatment services;
  • There are gaps in data collection within services; and
  • There is a high number of children living with parents who are in treatment, potentially leading to safeguarding issues;

Safer communities and sustainable environments

  • The needs of domestic violence victims and perpetrators may not be met;
  • There is a lack of information related to the success of alcohol treatment orders;
  • There are problems with the effective use of drink banning orders and direction to leave notices;
  • There is no effective system for utilising A&E data for community safety purposes;
  • There is currently no co-ordinated approach in Hartlepool in relation to the Police Reform and Social Responsibility Act 2011;
  • Alcohol-related violence is a problem in Hartlepool; and

There is currently no local or national legislation to set a minimum price for alcohol per unit.



What commissioning priorities are recommended?

2012/01

Children and young people

  • Ensure early identification and effective management of children and young people with alcohol problems;
  • Ensure seamless transition and effective management and safeguarding of young people during transition to adult services2012Adul;

2012/02

Adults

  • Reduce alcohol admissions by joint working with primary and secondary care clinicians and the voluntary and community sector;
  • Increase and ensure equitable access to treatment for dependent drinkers;
  • Ensure the local model of delivering services includes:
  • Asset-based community approaches;
  • A family approach;
  • A targeted approach for location and individuals.
  • Tackle a broad base of health issues of clients;
  • Utilise social marketing approaches to raise awareness and raise the profile of prevention.2012/03Social marketing and public education

2012/03

Social marketing and public education

  • Continue to support co-ordinated regional approaches to lobby and advocate reducing alcohol-related harm through national, regional and local policies;
  • Build upon the experience gained from the current social marketing and by commissioning further work if appropriate;2012/04

2012/04

Wider determinants and control measures

  • Wider determinants and control measurEnsure a co-ordinated approach to tackle alcohol-related harm by agencies and partners;
  • Explore together with neighbouring authorities the possibility of introducing minimum unit pricing for alcohol.

2012/05

Improve partnership work between sectors to:

  • 2012/05Improve partnership work between sectors to:
  • Develop an evening and late night offer that is broader than youth-oriented and alcohol-based activity;
  • Promote responsible drinking;
  • Reduce alcohol violence and alcohol-related harm in the town centre.


Who is at risk and why?

Age

There are more hospital admissions related to alcohol consumption in the older age groups than in the younger age groups (2010/11).

On average, teenagers drink twice as much now as they did in 1990.

Children and adolescents are at increased risk due to:

  • Changes in physiological development;
  • Inexperience;
  • Experimentation and generally higher tolerance of risk;
  • Early exposure leading a greater chance of developing illness in later life;
  • Alcohol seriously impairing brain development in young people.

Older people are considered to be at increased risk due to:

  • Physiological changes (increased susceptibility);
  • The higher risk interaction with prescribed medication;
  • The stresses of ageing including the risk of isolation.

Gender

In 2007, 33% of men and 16% of women were classified as hazardous (increasing risk) drinkers. This includes 6% of men and 2% of women estimated to be harmful (higher risk) drinkers, the most serious form of hazardous drinking, which means that damage to health is likely.

26% of men drink more than 21 units in an average week. For women, 18% drink more than 14 units in an average week.

The average weekly alcohol consumption is 16.4 units for men and 8.0 units for women.

In 2009/10, 63% of alcohol-related admissions were for men.

Physiological differences mean that women may be at greater risk than men. Pregnant women are also generally identified as a population at risk.

Mental health

The prevalence of alcohol dependence is almost twice as high among those with psychiatric disorders compared with the general population. Higher levels of stress are also linked to higher alcohol consumption.

Socioeconomic and environmental factors, and other determinants

High levels of deprivation are an influencing factor on alcohol consumption.

High levels of alcohol misuse are associated with clients who were unemployed and/or had difficulties with housing.

Many children and young people who live with substance misusing parents and carers are suffering ill effects. They are often neglected, suffer from domestic violence and are at an increased risk of misusing alcohol and illegal drugs themselves.

Risk exposure to alcohol-related harm is associated with:

  • Parental drinking;
  • Poor nutrition, health care, education and social networks (that is disadvantage, deprivation and inequality);
  • Certain professions, including those associated with the drinks industry (e.g., bar work), and those associated with higher stress levels (e.g. law enforcement).


What is the level of need in the population?

The charts below are some examples of the data that is available from the Local Alcohol Profiles for England. For a full area profile on alcohol in Hartlepool please use this link.

Mortality

The chart below shows that the rate of alcohol-specific mortality in Hartlepool in 2007-11 was significantly higher than the England average. However, this rate has decreased, and as of 2011-13, the rate is similar to the England average.

The chart below shows that the rate of alcohol-related mortality in Hartlepool is similar to the England average.

Hospital admissions

The chart below shows that the rate of alcohol-specific hospital admissions in Hartlepool is significantly worse than the England average. Although in 2013/14, the gap between Hartlepool and England had reduced.

The chart below shows that the rate of alcohol-related hospital admissions (Broad) in Hartlepool is significantly worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions (Narrow) in Hartlepool is significantly worse than the England average.

The chart below shows that the rate of alcohol-related hospital admissions for under 18-year-olds in Hartlepool had been significantly worse than the England average up until 2013. However, this rate has decreased, and as of 2014, the rate is similar to the England average.

Impact

The chart below shows that the rate claimants of benefits due to alcoholism in Hartlepool is similar to the England average.



What services are currently provided?

Intrahealth

Intrahealth deliver the Specialist Drug and Alcohol Prescribing Service working in partnership with all treatment providers.

DISC (Developing Initiatives Supporting Communities) substance misuse service

Disc are contracted to deliver a number recovery-orientated services ranging from structured psychosocial interventions, relapse prevention & aftercare, harm reduction & needle exchange and recovery & reintegration.

Lifeline Service User and Family Support Service

Lifeline is available to ex-users and to anyone who has been directly affected by someone else’s substance misuse. This includes parents, partners, grandparents and siblings.

Lifeline Education Training and Employment Service

Lifeline ETE Service offers support for ex-users and their families for education, training and employment.

HYPED

HYPED is a DISC project that is contracted to deliver the recovery-orientated treatment services for those clients aged 18 and under and also responsible for the partnership working with all other treatment providers for those clients 18 and over during transition into adult treatment services.

All service providers in Hartlepool work in partnership to deliver a holistic approach to recovery from alcohol misuse from tier-1 to tier-4 for all clients.



What is the projected level of need?

Hartlepool has experienced a rise in social and economic deprivation in recent years with unemployment continuing to rise.

Alcohol-related hospital admissions in the North East indicate an increasing trend.

The proportion of crime that is alcohol-related has not decreased. This could be in part due to better recording mechanisms and improved data quality.

Research undertaken by Balance North East indicates increasing risk within the local population.



What needs might be unmet?

Hartlepool residents need to receive adequate information about levels of drinking and associated risks. To ensure the local community receives these messages, all partnership staff need to undertake the e-learning ‘Information and Brief Advice’ training.

NICE (public health guidance 24) recommends that commissioners should ensure at least one-in-seven dependent drinkers can get treatment locally.

The number of GPs referring people to treatment services varies greatly as does the information available regarding population alcohol consumption. Demand, as seen by GPs is, not reflected in referrals to treatment in the community.

Adult treatment demand

  • There could be an under-representation of BME communities in treatment;
  • Dependency in higher socioeconomic groups is not reflected in treatment;
  • Demand for detoxification heavily outweighs provision; and
  • The needs of domestic violence victims and perpetrators may not be met.

Adult service provision and delivery

  • There is insufficient provision for inpatient detoxification in Hartlepool;
  • Intra-agency referrals are low, which may affect sustained improvement;
  • Current models of care may not correspond with NICE guidelines;
  • Best packages of care may not be deliverable within existing funding; and
  • There are data gaps in respect of treatment outcomes, specifically concerning impacts on wider health, reduced offending and re-attendances.

Wider determinants and control measures

  • Joint working with the private sector is required to change the culture and develop an alternative evening and late night experience;
  • Minimum unit pricing needs co-ordination; and
  • Co-ordinated action is needed to implement the new powers in Police Reform and Social Responsibility Act 2011.

Substance misuse

  • It is a priority to address alcohol use amongst problematic drug users, as evidence suggests many drug treatment clients are drinking at harmful levels.

Housing

  • There continues to be a need for those requiring treatment for alcohol misuse and the need for accommodation in Hartlepool.

Children & families of alcohol users

  • More robust data is required in respect to the number of children affected by parental alcohol misuse;
  • Transitional issues between young persons and adult treatment need to be addressed; and
  • The needs of young people living with drug and/or alcohol using parents in treatment are not being met.


What evidence is there for effective intervention?

NICE is developing guidance relating to alcohol use disorders over the next two years. This will focus on the prevention and early identification of alcohol use disorders through to the clinical management of acute alcohol withdrawal and alcohol-related liver disease and pancreatitis. The guidance will also focus on the management of alcohol dependence and psychological interventions.

Adult treatment

Public health guidance: Alcohol use disorders in adults and young people: prevention and early identification (published June 2010) - Centre for Public Health Excellence (CPHE) at NICE

Clinical guideline: Alcohol use disorders in adults and young people: clinical management (published June 2010) - National Collaborating Centre for Chronic Conditions (NCC-CC)

Clinical guideline: Alcohol use disorders: management of alcohol dependence (publication expected February 2011) - National Collaborating Centre for Mental Health (NCC-MH)

Best et al, ‘Research For Recovery: A Review of the Drugs Evidence Base’ (2010) [http://www.scotland.gov.uk/Publications/2010/08/18112230/0]

Children and young people

DfE, ‘Drugs: Guidance for Schools February 2004 – Curriculum Standards for KS1, KS2, KS3 and KS4 (Ref DfES/0092/2004)’, and ‘Drug Education: an entitlement for all 2008’

NTA, ‘Commissioning Young People’s Specialist Substance Misuse Treatment services’ (2008)

NTA, ‘Young people’s specialist substance misuse treatment: Exploring the Evidence’ (2009)

NICE, ‘Community-Based Interventions to Reduce Substance Misuse Among Vulnerable and Disadvantaged Children and Young People’ (2007)

Social marketing and public education

Within the public sector, see The Alcohol Learning Centre [http://www.alcohollearningcentre.org.uk/]

Safer communities and sustainable environments

NICE, ‘Alcohol-use disorders: preventing the development of hazardous and

harmful drinking’ (2010) [http://www.nice.org.uk/nicemedia/live/13001/48984/48984.pdf]

Night-time economy

Alcohol Concern (Hadfield and Newton), ‘Factsheet: Alcohol, Crime and Disorder in the Night-time Economy’ (2010), [http://www.alcoholconcern.org.uk]



What do people say?

Balance North East

A recent survey undertaken by Balance showed that:

  • 80% wanted greater restrictions on alcohol advertising;
  • 77% believed that children were exposed too much to alcohol advertising;

68% believed advertising encourages children to drink at a younger age and drink more.



What additional needs assessment is required?

Hartlepool will deliver the ‘Substance Misuse Plan’ to ensure all appropriate alcohol treatment is delivered to all clients. This will be updated annually.



Key Contact

Name: Sharon Robson

Job Title: Health Improvement Practitioner - Drugs & Alcohol

e-mail: sharon.robson@hartlepool.gov.uk

phone: 01429 523783

References

Local strategies and plans,

Hartlepool Alcohol Strategy

Safer Hartlepool Partnership, Strategic Assessment 2013.

Balance (North East Alcohol Office)

National strategies and plans,

The Governments Alcohol Strategy, March 2012

The Department of Health’s national alcohol strategy ‘Safe. Sensible. Social’ outlined the next steps for reducing the harm associated with alcohol.



Illicit drug use

Drug misuse refers to the use of a drug for purposes for which it was not intended or using a drug in excessive quantities.

‘Drug addiction is a chronic condition characterised by the risk of repeated relapse and remission. It can take an individual several attempts over a number of years to finally overcome his or her dependency and lead an addiction-free life. There is no quick solution and what may work for one person will not necessarily work for another’ (Drug Treatment & Recovery in 2010/11, National Treatment Agency for Substance Misuse, October 2011).

All sorts of different drugs can be misused, including illegal drugs (such as heroin or cannabis), prescription medicines (such as tranquilisers or painkillers) and other medicines that can be bought off the supermarket shelf (such as cough mixtures or herbal remedies).

In the UK there are high levels of drug misuse, including high rates of heroin and crack cocaine use.

People who misuse drugs often have a range of health and social problems, which may have lead them to misuse drugs or may be a consequence of their addiction.

The 2009/10 British Crime Survey estimates that 8.6% of 16 to 59-year-olds living in England and Wales had tried illegal drugs in the last year.

Among young people, this figure is more than twice as high, with an estimated 20% of 16 to 24-year-olds having used illegal drugs in the last year.

For the people who take them, illegal drugs can be a serious problem. They're responsible for between 1,300 and 1,600 deaths a year in the UK, and destroy thousands of relationships, families and careers.

This topic links with the following JSNA topics:

Alcohol misuse

Crime

Offenders

Housing

Employment



What are the key issues?

Numbers in treatment

The rate of people dependant on drugs in Hartlepool (18.6 per 1,000 population) is more than double the national average (8.7 per 1,000 population). More than half of those users (63.7%) are currently accessing treatment services for support and this is higher than the England average (53.4%).

The total number of individuals in Hartlepool accessing treatment in 2012/13 was 861 (5.5% increase from the previous year). Nationally, the number of people accessing drug treatment has fallen by 1.1%.

Changing drug trends, poly drug use

In Hartlepool, heroin is the primary drug for 74% of service users; many of them are also using other substances (including cannabis, alcohol and prescription drugs). The number of users of crack cocaine and benzodiazepines has reduced by 85% and 28% respectively.

Successful completions & length of time in treatment

The proportion of successful completions for opiate and non-opiate clients in Hartlepool is below the national average. Within this group, one-third are retained in treatment for more than six years.

Offending

Drug-related offences in Hartlepool have reduced by 6.5%. However, drug use and drug dealing remains a community concern (particularly in the most disadvantaged communities).

Young people

It has been identified that there is a change in trends for the younger generation of drug users and these changes present challenges for treatment providers. Therefore, methods of engagement and support may need to change accordingly.



What commissioning priorities are recommended?

2012/01

Ensure that the four principles for commissioning a drug treatment system that promotes successful recovery journeys are thoroughly embedded in Hartlepool. These four principles are:

  • Recovery is initiated by maintaining (and where necessary improving) access to early and preventative interventions and to treatment;
  • Treatment is recovery-orientated, high quality and effective;
  • Treatment delivers continued benefit and achieves appropriate recovery-orientated outcomes (including successful completions);
  • Treatment supports people to achieve sustained recovery.

2012/02

Ensure that all strategies and services continue to develop an outcome-based focus in line with the outcomes described in the HM Government Drug Strategy 2010.



Who is at risk and why?

Age

Fewer drug users under 30-years-old are coming into treatment for heroin and/or crack dependency.

Younger age groups are using illicit substances (cannabis) and this may create new or additional demands upon the treatment system.

Older, entrenched drug users find it difficult to make progress through the treatment system.

Larger proportions of those admitted into hospital for drug-related reasons are in the younger age groups.

The young people most at risk of escalating to problematic substance misuse are those in vulnerable groups, including:

  • looked after children;
  • sexually exploited children;
  • adolescents with mental health problems;
  • those persistently missing from home;
  •  not in education employment or training (NEETS);
  • excluded from school;
  •  persistent truants;
  • on alternative education for attendance and behavioural issues; and
  • those young people living with adult drug/alcohol users.

Gender

The gender split of those in treatment is male (73%) and female (27%).

By contrast, 46% of people admitted to hospital for drug-related reasons were female. It appears that some women may still be prevented from gaining access to treatment.

Socioeconomic status

Deprivation is associated with the problematic use of particular drugs such as heroin and crack cocaine.

Deprivation is linked most strongly with the extremes of problematic use and least with casual, recreational or intermittent use of drugs.

The more deprived the user is, the less likely they will access care and treatment.

The chances of overcoming drug problems are less among people who are disadvantaged.

Deprived areas often suffer from greater and more visible public nuisance from drug taking and supplying.

Poor areas with high unemployment levels can provide an environment where drug dealing becomes an established way of earning money.

Deprived people living in overcrowded and sub-standard accommodation are more likely to share injecting equipment and more likely to get hepatitis, HIV and tuberculosis.

Mental health

In the Co-morbidity of Substance Misuse and Mental Illness Collaborative Study (COSMIC) (quoted in the DrugScope response to the ‘New Horizons’ consultation) the NTA found that:

  • Nearly 75% of drug service users have a mental health problem;
  • 30% of drug service users have ‘multiple morbidity’ (or complex need);
  • Over one-third of drug users have a psychiatric disorder.

In 2011, the Mental Health Network updated their factsheet ‘Key facts and trends in mental health’ and it recognised that ‘the dual problem of mental ill health and substance misuse remains a challenge for mental health services’. It continues that ‘between 22-44% of adult psychiatric inpatients in England also have a substance misuse problem’. ‘Research indicates that urban areas have higher rates of dual diagnosis than rural areas’.

Housing

Three-quarters of single homeless people have a history of problematic substance misuse (rising to more than 80% of rough sleepers).

More than 40% of single homeless people cite drug use as the main reason for homelessness, while two-thirds report increasing problem substance misuse after becoming homeless.

Addaction (2005) found that 83% of substance misusers felt that having appropriate housing was one of the most important support services required to help them stay free of drugs.

Employment

The Department for Work and Pensions study ‘Problem Drug Users’ (2010) describing experiences of employment and the benefit system, included the following extract:

‘Studies have found that users of ‘hard’ drugs such as heroin and crack cocaine are significantly less likely to be in employment than other adults of working age’ (MacDonald and Pudney, 2001, 2002). Research has also found that duration of unemployment is associated with the number of drugs an individual has used (Plant and Plant, 1986).

Parenting

There are approximately 250,000 to 350,000 children who may be exposed to the consequences of problem drug use.

Children of drug misusers are more likely to:

  • Come to the attention of social services for either abuse or neglect (neglect is the most common);
  • Enter the care of relatives who themselves may require support;
  • Experience behavioural and/or psychiatric problems;
  • Engage in substance misuse; and
  • Be vulnerable to physical, emotional and educational problems.

The lifestyle of families with a substance-misusing parent can also be characterised by chaos and lack of routine, as well as social isolation.

Crime

There are strong links between drug use and crime.

Ethnicity

There are higher proportions of cannabis users in treatment from ‘Asian/Asian British’ and ‘Black/Black British’ communities than those from white ethnic backgrounds.



What is the level of need in the population?

Information for 2012/13 shows that in Hartlepool:

  • The estimated prevalence of drug users is 1,101.
  • The number of people currently in treatment is 563.
  • The gender split for those in treatment is 72% male and 28% female.
  • The population of treatment naive for 12/13 was at 294.

Successful completions & length of time in treatment

Successful completions for opiate and non-opiate clients in Hartlepool are below the national average. Within this group a third are retained in treatment for more than six years.

Proportion of clients still in treatment in years

 

 

Under 2 years

2 - 4

years

4 – 6 years

6 years & over

Average (years)

Opiate Clients

38.0%

18.8%

10.9%

32.3%

4.3

Non-Opiate Clients

87.7%

5.5%

4.1%

2.7%

1.0

 

SHP Strategic assessment

The SHP Strategic assessment states that:

  • There is an increase in the number of those accessing treatment;
  • Less than two thirds of drug users are known to treatment services;
  • Heroin continues to be a primary drug for adults in Hartlepool;
  • Cannabis and alcohol are the primary drugs for young people; and
  • There is a clear relationship between the misuse of drugs and acquisitive crime.


What services are currently provided?

Adults

Developing Initiatives for Support in the Community (DISC) deliver the following services in Hartlepool:

  • Structured psychosocial interventions, relapse prevention and aftercare;
  • Harm reduction and needle exchange; and 
  • Recovery and reintegration.

Lifeline deliver the following services in Hartlepool:

  • Service user and family support; and
  • Education, training and employment.

Addaction deliver the following service in Hartlepool:

  • Specialist drug & alcohol clinical Service.

Tier 4 Rehabilitation is delivered depending on individual need.

Young people

HYPED deliver drug & alcohol treatment services in Hartlepool for under 18-year-olds.



What is the projected level of need?

Although the former North East Public Health Observatory (NEPHO) have reported a marked change in treatment demand regionally, caution should be used in translating recent trends into future demand.



What needs might be unmet?

Drug users who repeatedly re-present within treatment services have multiple needs that are currently unmet.

There isn’t any targeted work for those who remain in treatment for long periods of time.

The harm that recreational drug use can bring to individuals and communities is not being addressed.

Communication between all partners and treatment providers needs to improve.

There needs to be a smoother transition between services, particularly for those young people entering adult treatment from young people’s services.

The needs of young people living with drug using parents or siblings to address hidden harm needs to be addressed.

There needs to be stronger links (by the use of in-reach) to prisoners who are due to be released into community-based treatment provision.

There is a larger cohort of older heroin and/or crack users who have remained in treatment for four years or more and there is a need to work more proactively to address this issue and reduce the number of years in treatment.



What evidence is there for effective intervention?

Research For Recovery: A Review of the Drugs Evidence Base ; a recent review commissioned by the Scottish government of the evidence base for treatment and for a recovery approach.

The principal publications supporting models of current drug treatment can be sourced from the NTA and NICE websites:

Professor Michael Gossop, ‘Treating drug misuse problems: evidence of effectiveness’ (2006)

NICE, ‘Drug misuse: Psychosocial interventions’ (CG51, 2007)

NICE, ‘Psychosis with coexisting substance misuse’ (CG120, 2011)

NICE, ‘Drug Misuse and dependence UK Guidelines on Clinical Management’ (2007)

NICE, ‘Drug Misuse: Opioid detoxification NICE Clinical Guideline’ (2007)

NICE, ‘Drug Misuse Psychosocial Interventions NICE Clinical Guideline 51’ (2007)

NICE, ‘Interventions to reduce substance misuse among vulnerable young people’ ( 2007)

NICE, ‘Methadone and buprenorphine for the management of opioid dependence NICE Technology Appraisal 114’ (2007)

NICE, ‘Needle and syringe programmes: providing people who inject drugs with injecting equipment’ (2009)

NTA, ‘Addiction to Medicine’ (2011)  

NTA ‘Models of care for treatment of adult drug misusers: Update 2006’ (2006) 

NTA, ‘Prescribing services for drug misuse’ (2003)

NTA, ‘Treating cocaine/ crack dependence’ (2002)

NTA, ‘Routes to Recovery: Psychosocial Interventions for Drug Misuse’ (2010).

The evidence base for recovery-oriented treatment is as yet much less centralised.

Young people (under 18-years-old)

All schools have been supported by the specialist service to deliver drug education to the guidance contained within the evidenced based-documents: ‘Drugs: Guidance for Schools February 2004 – Curriculum Standards for KS1, KS2, KS3 and KS4 (Ref DfES/0092/2004)’, and ‘Drug Education: an entitlement for all 2008’

The young people’s integrated specialist treatment service is commissioned in line with NTA guidance contained within the evidenced-based documents: ‘Commissioning Young People’s Specialist Substance Misuse Treatment services’ (NTA: 2008: Guidance on commissioning young people’s specialist substance misuse treatment services’ [online] Available at  http://www.nta.nhs.uk/publications/documents/commissioning_yp_final2.pdf) and ‘Young people’s specialist substance misuse treatment’.

The pharmacological interventions for young people are delivered by the specialist service in accordance with the NICE guidance (National Institute for Health and Clinical Excellence (NICE) (2007a). Methadone and Buprenorphine for the Management of Opioid Dependence. London, UK: NICE).

National Institute for Health and Clinical Excellence (NICE) (2007b) Naltrexone for the Management of Opioid Dependence. London, UK: NICE.

National Institute for Health and Clinical Excellence (NICE) (2007c) Community-Based Interventions to Reduce Substance Misuse Among Vulnerable and Disadvantaged Children and Young People. London, UK: NICE.



What do people say?

Content under development.



What additional needs assessment is required?
  • Investigate the appropriate means of improving aspiration of drug misuse
  • Gather evidence of why people drop out of treatment.
  • Broaden the links with family services; to identify the impact drug use can have on the family unit.
  • More detailed needs assessment for young people to enable targeted early interventions that will deliver more focused education messages.
  • Further research about the use of enhancement drugs due to the significant increase of clients reporting the use of these drugs. It is known that some clients are injectors of anabolic steroids, growth hormones and other peptide hormones that could potentially see an increase in clients seeking help and advice. The longer-term effects are largely unknown therefore it is essential that research and harm minimisation is addressed for these potential clients in Hartlepool.


Key Contact:             Paul Edmondson-Jones

Job Title:                 Director of Public Health

e-mail:                    Paul.edmondson-jones@hartlepool.gov.uk

Phone number:         01429 523773

 

Key contact:             Sharon Robson

Job title:                 Health Improvement Practitioner – Drugs & Alcohol

e-mail:                   sharon.robson@hartlepool.gov.uk

Phone number:         01429 523783



Smoking

Smoking is the single largest cause of preventable mortality in England. This is recognised in the Government’s Public Health White Paper ‘Healthy lives, healthy people', which states that ‘reducing smoking rates represents a huge opportunity for public health.'

Approximately 8.5 million people in England smoke and about half of all long-term smokers will die from smoking with half of those in middle age.

Tobacco use is one of the Government’s most significant public health challenges and causes over 80,000 premature deaths in England each year.

The health risks from tobacco smoking are well established. In 2006-7 there were approximately 1.4 million hospital admissions with a primary diagnosis of a disease that can be attributable to smoking.

Smoking is estimated to cost the NHS in England £2.7 billion a year and £13.7 billion in wider costs to society through sickness, absenteeism, the cost to the economy, social care, environmental pollution and smoking-related fires.  This burden impacts on every GP surgery and hospital, every local authority and every family whether they smoke or not. 

As a drug medically proven to be every bit as addictive as heroin, most tobacco users start as children.  The majority wish they could stop and are overwhelmingly in favour of helping stop the next generation becoming addicted to smoking.

About one-third of all cancer deaths can be attributed to smoking.   These include cancer of the lung, mouth, lip, throat, bladder, kidney, stomach and liver.

Chronic obstructive pulmonary disease (COPD) is the second most common cause of emergency admission to hospital and one of the most costly diseases in terms of acute hospital care (DH, 2010).  This is primarily a ‘smokers’ disease.

Provision of effective local NHS Stop Smoking Services is just one of a range of local tobacco control measures that need to be in place to reduce smoking prevalence.   Fresh North East has developed an evidence-based multi-component tobacco control programme based on an eight key strands approach that local alliances are encouraged to follow.

Smoking is linked most closely to the following JSNA topics:

Respiratory diseases

Circulatory diseases

Cancer

Poverty

Alcohol misuse

Illicit drug use



Who is at risk and why?

Socioeconomic status

The prevalence of smoking amongst people in the “routine and manual” socio-economic group is higher than amongst those in the “managerial and professional” group.

Smokers from the most affluent areas are more likely to die earlier than none smokers from the most deprived areas.

Gender

The prevalence of cigarette smoking is higher for men than women.

Age

For women, smoking is highest amongst 20 to 24-year-olds; for men the highest rate is amongst 16 to 19-year-olds, 20 to 34-year-olds and 35 to 49-year-olds.

Approximately two-thirds of current and ex-smokers who had smoked regularly at some point in their lives started smoking before they were aged 18 years old.

More than a quarter of 11 to 15-year-old children have tried smoking at least once and approximately 6% of children are regular smokers. Girls are more likely to smoke than boys; 9% of girls are likely to have smoked in the last week compared to 6% of boys.

Ethnicity

Bangladeshi and Irish men were more (Indian men less) likely to report smoking cigarettes than men in the general population.  Self-reported smoking prevalence is higher among women in the general population than most minority ethnic groups, except Irish (26%) and Black Caribbean women (24%).

Smoking in pregnancy

Women who smoke in pregnancy are more likely to be younger, single, of lower educational attainment and in unskilled occupations.

Mental health

There is a strong association between smoking and mental health problems.  The highest levels of smoking occur among inpatients in mental health units where up to 70% of people smoke, often heavily.  People with mental health problems are therefore at even greater risk of smoking-related harm than the general population.

Evidence suggests that people with mental health problems show the same level of motivation to quit smoking as the general population and are able to quit when offered evidence-based support.

Prisoners

Rates of smoking in prisons are extremely high.  Approximately 80% of prisoners smoke, compared with 22% of the UK population as a whole.



What is the level of need in the population?

Smoking Prevalence

The proportion of adults aged 18+ in Hartlepool estimated to smoke regularly is 24.0%, representing approximately 17,000 people.  This rises to over 30% among people employed in routine and manual (R&M) occupations. 

In Hartlepool, there is a strong correlation between smoking prevalence and the level of deprivation.  The more deprived the area, the higher the smoking prevalence.   Smoking rates in the most affluent wards (Quintile 5) are less than half of those in the more deprived wards (Quintile 1).  The chart below shows the estimated smoking prevalence in Hartlepool at 30.9% for the years 2003-05, indicating prevalence by ward.

Stop smoking service

During 2013/14, Hartlepool NHS Stop Smoking Service saw 2344 smokers set a quit date with their support.  This represents 11.2% of the estimated smoking population.    922 people reached the 4-week quit target successfully, which is (4.4%) of the estimated smoking population.   Since NHS Stop Smoking Services were established in 1999, Hartlepool consistently had the highest number of quitters per 100,000 population in England.  In line with National and Regional trends there has been a reduction in the number of people accessing services, however, despite this, in 2013/14 Hartlepool still managed to have the 10th highest 4-week quit rate in the Country per 100,000 population.

Despite achievements it has to be recognised that Stop Smoking Services and stop smoking interventions in isolation should not be regarded as the main drivers for reducing smoking prevalence.   A comprehensive tobacco control plan involving a range of partners is required. 

To ensure a whole health system approach to tackling smoking it is vital that all professionals raise the issue of smoking through a brief intervention and refer to Specialist Stop Smoking Services for support.

The most effective way of stopping smoking is provided by NHS Stop Smoking Services.  Quitting with support from NHS Stop Smoking Services (SSS) is up to four times more likely to result in prolonged abstinence from smoking than quitting without any assistance.

The chart below states that 9% of the smokers in Hartlepool accessed the Stop Smoking Service in 2014/15.

The chart below states that approximately 3.6% of the smokers in Hartlepool have quit smoking in 2014/15.

The chart below shows the % of smokers setting a quit date and quitting at 4-weeks over a nine year period (04/05 – 12/13). Since 2004/05, the success rate has reduced both locally and nationally.

Social segmentation

Mosiac groups K & O (see below) make up 38% of the population of Hartlepool (the largest two groups in Hartlepool). These two groups have much higher than average smoking rates. According to Mosaic, on average, 40.48% of group O and 32.35% of group K are smokers.

Smoking during Pregnancy

Smoking during pregnancy poses a significant health risk to both the mother and the unborn child. There are high rates of smoking during pregnancy in Hartlepool. The current target is to ensure a 1% reduction per year in women smoking during pregnancy, with a view to reaching the target of 15% by 2015. The 2013/14 level was 18.2% - a decrease of 3.5% from 2012/13.

Passive smoking and children

According to the 2010 Royal College of Physicians' report, "Passive smoking and children", parents who smoke in front of their children significantly increase their child's risk of disease and ill-health.  Based on these national figures it is estimated that there are over 256 additional incidents of childhood disease each year within Hartlepool directly attributable to passive smoking.  These diseases are lower respiratory infections, middle ear infections, wheeze, asthma and meningitis.

Young people

In Hartlepool, 4.4% (2009-12) of 11-15 year olds are regular smokers.

In Hartlepool, 1.4% (2009-12) of 11-15 year olds are occasional smokers.

Mortality

Deaths in Hartlepool attributed to smoking (391 per 100,000) are higher than the national average (289 per 100,000). The rate is decreasing year-on-year.

Benchmarking

Benchmarking is the process of comparing one district with another.

The following chart shows that Hartlepool is worse than Halton for many of the indicators used in the Tobacco Control Profiles apart from smoking attributable mortality, smoking attributable deaths from heart disease and deaths from COPD.

Source: Tobacco Control Profiles (www.lho.org.uk)

The cost of tobacco control

The estimated cost of smoking in Hartlepool is over £26 million.

Source: Balance - Local tobacco control toolkit



What services are currently provided?

Smoking Cessation

The Tees Specialist Stop Smoking Service working through North Tees and Hartlepool NHS Foundation Trust, provide 10 stop smoking clinics within Hartlepool in a variety of community locations with easy access and at varied times, covering 6 days of the week.  In addition there are 5 pharmacies in the town, supported by the Specialist Service, increasing choice of provision and out of hours availability.  Two of these pharmacies have received additional training, shadowing and mentorship from the Service to deliver an intervention to young people and/or pregnant women.   Pharmacies use a tariff based system with additional reward for supporting young people, pregnant women and those from disadvantaged wards.    There are no plans at present to increase the number of pharmacies providing a stop smoking service, but they will be regularly reviewed to ensure performance is maintained.

Services provided by the Specialist Stop Smoking Service include:

  • Support and advice to clients and staff.
  • Pharmacotherapies – Nicotine Replace Therapy (NRT), (offered on prescription or via a voucher system in specific settings); Bupropion (Zyban); Varenicline (Champix).
  • Help, advice and support will be offered to clients wishing to use non-licensed nicotine-containing products they have purchased themselves to quit nicotine addiction.  
  • Carbon monoxide monitoring and calibration.
  • Telephone helpline support.
  • Workplace stop smoking support.
  • An enhanced support to quit programme for clients who need more dedicated support
  • Training a wide range of professionals in brief interventions.
  • Active case finding for lung health,  Now in service spec.
  • Active case finding for lung health, although this is not currently in the service specification.
  • An effective partnership with midwifery services to deliver a smoking in pregnancy programme.
  • Support to five pharmacies, offering stop smoking support through a tariff system.
  • Promotion of services through a variety of methods.

Tobacco Control

In order to reduce smoking prevalence a comprehensive tobacco control plan involving a range of partners has to be in place in addition to Stop Smoking Services.

Through the ring-fenced Public Health budget there is currently a specific post within Trading Standards in Hartlepool dedicated to tobacco control. 

Trading Standards contribute to the tobacco control agenda through:

  • Undertaking regular test purchasing.
  • Identification of traders selling counterfeit, imported cigarettes.
  • Ensuring retailers comply with relevant legislation – not selling single cigarettes, dispensing machines, age display notices, general signage, point of sale advertising.
  • Participation in regional and local campaigns to raise awareness of illegal sales, smuggling, counterfeiting and tobacco advertising and promotion through partnership working with Her Majesty's Revenue and Customs and Police.

Environmental Health Officers ensure current legislation is enforced and monitor any breaches through general compliance work by inspection and routine visits.

Secondhand smoke

There are three secondhand smoke trainers in Hartlepool trained by Fresh North East to deliver the Smoke Free Families message to anyone working with children and families.  Two of the trainers are from the SSS with training courses scheduled into the Service’s training programme.  The third trainer is employed by the Fire Service.

Smoke Free Hartlepool Alliance

There is an active local Alliance made up of a wide range of partners with a remit to raise the profile of tobacco control and to champion local implementation of a smokefree future. The Alliance develops, delivers and monitors an annual action plan based on regional and national guidance.   Local Alliances are very strongly supported by Fresh North East, established in 2005 to help the North East take a co-ordinated and comprehensive approach to reducing the harm caused by tobacco.   The concerted efforts of the many partners involved with the Fresh programme have helped the North East to achieve the biggest drop in adult smoking rates in England over the 9 years.  In addition, a regional Making Smoking History Partnership was set up in 2013 and is working to get local support and action to establish a vision of a 5% smoking prevalence by 2025.

Smoking education for young people

Hartlepool currently provides a theatre in education programme for all year 7 pupils in secondary schools.  The production and accompanying workshops inform the audience of the exploitation of young people and third world countries by the tobacco industry.  Funding from the British Heart Foundation has been achieved to continue this work for four years

Smoking education is also delivered as part of a Risk Taking Behaviour Programme in secondary schools.

Based on in-depth consultation with young people a stop smoking service specifically for young people will be commissioned through youth workers in a youth setting using a voucher scheme to provide the appropriate nicotine replacement along with advice and support.   For the first year Public Health funding will be used with an expectation of the work being embedded into mainstream practice of youth workers if it is successful.   Linked to this will be a further theatre in education production for year 10 pupils in secondary schools to launch and promote the new service.



What is the projected level of need?

No projections at present.



What needs might be unmet?

Education and support of young people

Young people continue to take up smoking.  There is a continuing need to educate young people on the harms of cigarettes and the benefits of not smoking.  Training needs to be given to youth/community workers in smoking awareness and brief interventions and also to identify positive role models to emphasise the 'no smoking being the social norm' message.

As very few young people access current Stop Smoking Service provision there is also a need to set up a dedicated Stop Smoking Service for those young people who are addicted to smoking and wish to quit.  A pilot project was tried offering a stop smoking clinic specific to young people to run in the same building as a young person’s contraceptive clinic, but this did not attract young people to attend and had to be closed.

There are four pharmacies in Hartlepool operating under the Community Pharmacy Stop Smoking Enhanced Service scheme but currently they are only able to offer stop smoking support to young people aged 16 and over.  However, the intention stated in the Service Level Agreement is that suitably experienced and trained pharmacy staff will be able to offer a service to young people aged 12 and over, adhering to Fraser Guidelines for young people aged between 12 and 16.

It is recommended that suitable training to support this young age group is developed and delivered as soon as possible to meet the Government target ambition 'To reduce rates of regular smoking among 15 year olds in England to 12% or less by the end of 2015'.

Young people under the age of 18 still have illegal access to cigarettes.

Health Inequalities – smoking in most disadvantaged wards

Smoking rates are highest in the most disadvantaged electoral wards.  Data from the MOSAIC programme indicates that stop smoking provision in Hartlepool is set up in the areas of highest smoking prevalence and SSS data shows the highest number of quit dates set each quarter come from the most disadvantaged wards.  However, the percentage of successful 4-week quits from the most disadvantaged wards are lowest, thereby perpetuating health inequalities.   

Smoking during pregnancy

  • Many pregnant women continue to smoke, thus failing to give their child the best start in life. Based on extensive consultation with midwifery services across the region an intervention called BabyClear was developed and rolled out across the region during 13/14.  Part of the intervention is a hard-hitting risk perception tool which specially trained midwives use with women who show no desire to quit smoking.  The pilot phase has ended with evaluation due in Spring 2015.   The work now needs to be embedded in practice within the Foundation Trust.
  • Smoking at Time of Delivery Data (SATOD) is now only available nationally as a Hartlepool and Stockton on Tees CCG area.   Each Local Authority is mainly interested in own data to get a true reflection and this may become a pressing issue.  Data coming direct from the Foundation Trust on individual areas is often not clear as they cover a wider range of communities than Stockton on Tees and Hartlepool.

Second hand smoke

Many non-smokers continue to suffer the effects of second-hand smoke, particularly at home and in private cars.   Smoking in cars when children are present is currently under government consultation prior to it becoming law. (August 2014)

Mental health patients

The physical health needs of mental health patients are not being fully met by difficulties in engaging staff in undertaking the relevant brief/intermediate intervention training.  A top down approach is required.

Use of information

More information on general lifestyle issues (such as weight gain) should be available in community clinics.

More social marketing is needed to identify barriers to accessing Stop Smoking Services and quitting and also use of MOSAIC to target messages appropriately.

Stop Smoking Services

The development of a model of working in the SSS that offers more flexible support to reach more smokers as it is evident from the numbers accessing services that not all smokers feel they can, or want to, stop smoking in the way currently available.

The SSS needs to develop new ways of working such as considering harm reduction approaches and how to support clients using e-cigarettes

Pharmacies and prescribing

Currently 5 pharmacies are funded to provide a stop smoking service through a tariff system.  This was commissioned primarily to improve access in terms of extended opening hours and increased convenience and choice of stop smoking services.   Community pharmacies must apply to join the Scheme by completing a self-assessment document to demonstrate that they can comply with the Scheme requirements.  Selected pharmacies must agree to adhere to a service level agreement involving appropriate governance procedures; providing an appropriate level of trained staff; and collecting the full gold standard dataset in a timely manner, reimbursed under a tariff payment system.

Other pharmacies in Hartlepool have expressed an interest in providing this service and one additional pharmacy has been added to the list of providers.  Two out of the 5 pharmacies have undertaken additional training, shadowing and mentoring to extend this work to enable pharmacies to provide an enhanced service particularly for clients who are routine and manual workers, pregnant women and young people, thereby contributing to a reduction in health inequalities. There are no plans to increase numbers at the current time.

From Statistics on NHS Stop Smoking Services;  England 2009/10 experimental statistics from SSS indicate that varenicline was the most successful smoking cessation aid between April 2009 and March 2010.  Of those who used varenicline 60% successfully quit, compared with 50% who received bupropion only and 47% who received NRT.   Clinical Governance requirements for the Stockton & Hartlepool SSS stipulate that if clients wish to be prescribed Varenicline, medical records must first be verified by their own GP to ensure there are no underlying medical conditions that would prevent its use.  When medical records are confirmed clients are then asked to attend for a specific appointment at a designated community clinic with an appropriately trained nurse prescriber.  Delays for clients are often experienced through waiting for confirmations from GPs, leading to frustrations for clients and SSS staff.    There is continued pressure on the SSS to reduce prescribing costs.  There are plans to develop a Patient Group Direction to enable greater use of varenicline.

Tobacco control

  • Continued investment in comprehensive, multi-component tobacco control.
  • Continued capacity within Trading Standards and Environmental Health Departments within the Council to contribute to the tobacco control agenda
  • Engagement of a variety of other local authority departments in tobacco control work such as adult and children’s services, housing and planning


What evidence is there for effective intervention?

NICE Guidance

  • Smoking cessation services (PH10) This guidance recommends that for the first time, all health professionals, including GPs seeing patients at a consultation, nurses in primary and community care, hospital clinicians, pharmacists and dentists, should advise everyone who smokes to stop and refer them to an intensive support service (for example, NHS Stop Smoking Services).
  • Brief interventions and referral for smoking cessation (PH1) This guidance recommends that all smokers should be advised to quit and referred to NHS Stop Smoking Service in primary, secondary and community care settings. For those who do not accept the offer, pharmacotherapy should be offered to them. Brief interventions for smoking could include opportunistic advice to stop, assessment of patents’ commitment to quit, offer of pharmacotherapy and/or behavioural support and provision of self-help material as well as referral to more intensive support e.g. NHS Stop Smoking Service. 
  • Quitting smoking in pregnancy and following childbirth (PH26) The recommendations mainly cover interventions to help pregnant women who smoke to quit and their partners and others in the household who smoke to quit. It also includes training for midwives to deliver interventions as well as a referral pathway from maternity services to NHS Stop Smoking Services. 
  • School-based interventions to prevent smoking (PH23) This guidance is for all those responsible for preventing the uptake of smoking by children and young people aged under 19. Information on smoking should be integrated into the curriculum and anti-smoking activities should aim to develop decision-making skills and include strategies for enhancing self-esteem.
  • Workplace interventions to promote smoking cessation (PH5) This guidance recommends employers to provide support to employees with help to stop smoking, including development of smoking cessation policy, promoting the Stop Smoking Services and allowing time off to attend smoking cessation services.
  • Preventing the uptake of smoking by children and young people (PH14) The recommendations focus on communication methods (mass media) and point-of-sales measures. These should be combined with regulation, education, cessation support and other activities as part of a comprehensive strategy.
  • Smoking cessation - varenicline (TA123) The guidance recommends varenicline as an option for smokers who have expressed a desire to quit smoking and it should be prescribed only as part of a programme of behavioural support.  
  • 2002/021 NICE recommends use of smoking cessation therapies The guidance recommends the use of pharmacotherapy such as Nicotine Replacement Therapies (NRT) in conjunction with advice and encouragement to help smokers who wish to quite.
  • Smokeless tobacco cessation – South Asian communities (PH39) - This guidance aims to help people of South Asian origin who are living in England to stop using traditional South Asian varieties of smokeless tobacco.
  • Smoking cessation: supporting people to stop smoking (QS43) This quality standard covers smoking cessation, which includes support for people to stop smoking and for people accessing smoking cessation services.
  • Tobacco: Harm Reduction Approaches to Smoking (PH45)
  • Smoking cessation in secondary care - acute, maternity and mental health services. (PH48) - This guidance aims to support smoking cessation, temporary abstinence from smoking and smokefree policies in all secondary care settings.
  • Smoking cessation in secure mental health settings - Guidance for commissioners. The guidance for commissioners provides: evidence on the effects of smoking on mental health the benefits of smoking cessation case studies where providers have successfully implemented NICE guidance PH48.
  • Introducing self-assessment for NICE guidance smoking cessation in secondary care: mental health settings (PH48) A practical guide to using the self-assessment mode- The self-assessment model offers a:
    • free-to-access model for self-assessment that can assist in evaluating the effectiveness of action to address harm from tobacco
    • suite of videos that set the scene and explain the benefits of action
    • replicable workshop format that can be delivered at a local level to support local action to reduce the harm of tobacco


What do people say?

A survey was undertaken by the Stop Smoking Service in January 2014 with 80 responses completed in Hartlepool clinics.   Responses are shown below :

  • 98% of respondents said the times of the Stop Smoking Clinics were convenient to them although a small number expressed a desire for more evening appointments
  • 100% of respondents felt the venue suitable for them
  • 99% of respondents felt  the length of time they had to wait within the drop in session to be acceptable
  • 96% felt they were given sufficient privacy when discussing personal details with the clinic staff
  • Respondents who used champix (varenicline) as a cessation aid felt that the length of time to wait for a first appointment was acceptable.
  • 100% of respondents felt they got enough support and encouragement from the Stop Smoking Service staff during their visits
  • 98% respondents said they had been offered a choice of treatments to help in stopping smoking
  • 98% felt they had been given sufficient information about their treatment
  • Those respondents who needed to telephone the Service mostly found it easy to contact them.  One person found it hard to get through at times
  • 94% of respondents said they would go back to the service for help with stopping smoking if they started smoking again.
  • 97% of respondents said they would recommend this service to other smokers who want to stop smoking.
  • 92 respondents were very satisfied with the Stop Smoking Service

In 2012 Fresh NE commissioned NEMs to consult locally on illicit tobacco the results for Hartlepool show :

  • 79% of smokers in Hartlepool say they do not buy illegal tobacco
  • 77% of smokers who buy illegal tobacco in Hartlepool agree it enables them to smoke when they could not afford to do so otherwise
  • 89% of people in Hartlepool say illegal cigarettes are a danger to children as they can buy them easily and cheaply

 

In 2014 Public Health in Hartlepool commissioned NEMS to undertake a survey of local smokers to inform the Stop Smoking Service Review.   A total of 420 interviews were conducted across the Hartlepool Borough catchment.  Interviewing took place across 2 main centres within the Borough: Hartlepool town centre and Seaton Carew.

Interviews were conducted in July and August 2014 using in-street interviewing.

Sampling was done among all those aged 16 and over. Quota controls were applied on gender and age, with all respondents meeting the criteria of being resident within the Borough of Hartlepool and a current smoker.  (James, not sure how much of the results to put in here – I have attached for information/guidance.   I am happy to add, just don’t know how much!!)

Household surveys

Since 2004 Hartlepool Borough Council has undertaken a MORI Household survey every 2 years.  One of the many questions is about smoking status. When asked about smoking habits, one in three (30%) Hartlepool residents say they smoke cigarettes.  There are significantly more people smoking in Neighbourhood Renewal Fund areas (39%) than in wider Hartlepool (17%) with North Hartlepool and the New Deal for Communities area being the areas where people are most likely to smoke (56% and 49% respectively).



What additional needs assessment is required?

No further needs assessment is required at this stage.  There is a strong evidence base for effective intervention. 

Some identified needs are unmet and these should be addressed.



What commissioning priorities are recommended?

2015/01

Identify and commission key hub functions from the SSS including quality assurance for all providers;  training, mentoring and competency assessment for health and health-related professionals who are working in partnership with the Service;  central data co-ordination and monitoring ;  authorisation and payment of tariff systems for providers. Action complete

2015/02

Commission delivery services appropriate for Hartlepool.  This would mean a mix of nurse-led provision, pharmacy provision and provision within the secondary care setting. Action complete

2015/03

The recently implemented risk perception approach (BabyClear) is embedded as part of mainstream midwifery services.

2015/04

An active case-finding approach for chronic obstructive pulmonary disease (COPD) is included in the new SSS contract. Action complete

2015/05

New school nursing contract and health visitor contracts include smoking support. Action complete

2015/06

An appropriate intervention, based on the views of young people,  to support smoking cessation for young people be implemented

2015/07

Consider payment by results using a tariff payment system for Stop Smoking Services as some areas are currently implementing and evaluating this approach. Action no longer being considered.

2015/08

Invest in comprehensive, multi-component tobacco control.

2015/09

Ensure Trading Standards and Environmental Health Departments within the Council have the capacity to contribute to the tobacco control agenda.

2015/10

Engage a variety of other local authority departments in tobacco control work such as adult and children's services, housing and planning.



What are the key issues?

Estimated smoking prevalence in Hartlepool (24.0%) is significantly higher than the national average (18.4%).

There is a high rate of smoking during pregnancy in Hartlepool (18.2%). This is significantly higher than the national average (12.0%). 

The number of deaths in Hartlepool (391 per 100,000) that are attributable to smoking is significantly higher than the national average (289 per 100,000).

Parents who smoke in front of their children significantly increase their child's risk of disease and ill-health.

In Hartlepool, 6% of children aged 11-15 years old smoke.

In Hartlepool, around 256 children need GP or hospital treatment every year from breathing in other peoples smoke.

Smoking costs the Hartlepool NHS £4.1 million per year.

Smoking costs social care in Hartlepool £1.7 million per year.

Stop Smoking Services (SSS) have seen a decrease in the numbers of people accessing services both nationally and in Hartlepool.

The most likely reason for the decrease in people accessing an SSS is the emergence of electronic cigarettes and the likely arrival of other nicotine-containing devices currently in development provide an alternative to tobacco. Opinion is still somewhat divided on the use of these but a recent statement from Fresh North states:

“Although not completely without risk, experts estimate that electronic cigarettes carry 95% less risk than smoking

People from the most disadvantaged areas with the highest smoking prevalence have least success in 4-week quit rates, thus widening the gap in inequalities.

There is continuing need to educate young people on the harmful effects of tobacco and exploitation carried out by the tobacco industry, and also provide dedicated services to help young people stop smoking when they want to quit.

Smoking has a cost implication in the workplace in terms of days of lost productivity due to high absenteeism levels from smokers compared to non-smokers and smokers taking additional breaks and other associated costs.

Research shows that effective smoking cessation treatment is not routinely offered to people with mental health problems. On average, people with mental illness die five to ten years younger than the general population.

Research shows that effective smoking cessation treatment is not routinely offered to people with mental health problems. On average, people with mental illness die five to ten years younger than the general population. However, since the beginning of 2015 both mental health trusts in the region have been working with Fresh North East, the Strategic Clinical Networks and Public Health England to improve the physical health of patients with mental health problems and the first topic to be tackled is smoking.  The mental health trusts are proposing to go completely smoke-free early in 2016 and plans are being made to support both staff and patients.



Key contact

Name: Carole Johnson

Job title: Head of Health Improvement

e-mail: Carole.Johnson@hartlepool.gov.uk

Phone: 01429 523668

References

Local strategies and plans, with dates
  • Hartlepool Tobacco Alliance Action Plan, 2011/12
  • Fresh North East Regional Delivery Plan, 2011/12
National strategies and plans with dates
  • Stop smoking service delivery and monitoring guidance, 2011/12
  • A smokefree future: a comprehensive tobacco control strategy for England, February 2010
Other references with dates

 



Diet and nutrition

Good nutrition has a key role to play both in the prevention and management of diet-related diseases such as cardiovascular disease (CVD), cancer, diabetes and obesity (WHO, 2003). Healthy eating during childhood and adolescence is vital as a means to ensure healthy growth and development and to set up a pattern of positive eating habits into adult life. The promotion of evidence-based healthy eating messages is fundamental. Alongside this, it is necessary to ensure that guidelines concerning a nutritionally adequate diet are implemented to help prevent diet-related deficiencies and malnutrition in vulnerable infants, children and adults.

In the UK, the poorer people are, the worse their diet, and the more diet-related diseases they suffer from. This is known as food poverty. Poor diet is a risk factor for the UK’s major causes of death: cancer; coronary heart disease (CHD); and diabetes. It is only recently that the immense contribution it makes to poor health has been quantified: poor diet is related to 30% of life years lost in premature death and disability (De Rose et al, 1998).

Tackling food poverty is recognised as key to achieving government targets on reducing inequalities; reducing illness from cancer and CHD; and improving the health of children and older people. However, action needs to be more than health professionals giving advice to individuals. It must change the ‘food environment’ – that is, accessibility, affordability, culture – in which people live (O’Neil M, 2005).

Poor diet is a major health risk. It contributes to:

 

  • almost 50% of CHD deaths
  • 33% of all cancer deaths
  • increased falls and fractures among older people
  • low birth weight and increased childhood illness and mortality
  • increased dental disease in children.

This topic is most closely linked to:

 

 



What are the key issues?

Breastfeeding rates are amongst the lowest in England and the gap between Hartlepool and England is widening.

At all ages, the proportion of people who are overweight and obese is higher than England.  Only half of adults eat a healthy diet. (53.5% of adults consuming 5 portions of fruit and vegetables per day, Public Health Outcomes Framework, 2015)

There is low uptake of vitamin supplements through the Healthy Start scheme.

People in vulnerable groups and those with low incomes are at increased risk of having malnutrition from diet-related illness.

There is inconsistent advice on optimal nutrition from professionals.

There is a high concentration of fast-food take-away outlets per head of population.



What commissioning priorities are recommended?

2012/01
Implement evidence-based best practice to maximise breastfeeding initiation and continuation.  Ensure appropriate support services are in place and that health professionals are appropriately trained to provide support and consistent advice throughout antenatal and postnatal periods. Amended from 2012, remains a priority.

2012/03
Increase promotion and uptake of the national Healthy Start initiative, in particular vitamin supplements, to both professionals and the target audience. Amended from 2012, remains a priority.

2012/04
Ensure targeted support and increase Health Check uptake for those identified as most at risk of malnutrition.  This includes tackling wider determinants by providing debt advice, improving housing conditions and ensuring access to affordable food. Amended from 2012, remains a priority.

The following commissioning priorities are new for 2015:

2015/01

Improve children’s diet during early years of life alongside work to promote healthy weight.

 

2015/02

Prevent and support the management of diabetes through a healthy diet.

 

Other priorities that are not necessarily related to commissioning include:

2012/02
Promote healthy eating, making use of national campaigns and brands, and develop joint working with key sectors, such as planning and transport departments, to ensure the potential for physical activity and healthy eating is maximised, including the use of health impact assessments to address the causes of obesity. Remains a priority.

2012/05
Develop consistent and integrated strategies among all health and social care providers to detect, prevent and treat malnutrition.  Make appropriate training available to staff in all settings so that they have a common basic knowledge of nutrition and the skills to promote a nutritionally adequate diet. Remains a priority.

2012/06
Ensure that good quality and healthy food is provided by working with local public sector service providers, such as schools, hospitals, and prisons. Remains a priority.

2015/03

Support the delivery of cookery training, especially for priority groups in line with the emerging evidence base.

 

2015/04

Work with partners to improve healthy cooking practices and healthy food provision in retail outlets and reduce the proliferation of fast food take away outlets.



Who is at risk and why?

Nationally, there have been positive changes in the diet of British people over 15 years (Scientific Advisory Committee on Nutrition, SACN, 2008).  However, the latest data from the National Diet and Nutrition Survey shows that overall, the UK population is still consuming too much saturated fat, added sugars and salt, and not enough fruit, vegetables, oily fish and fibre (Public Health England 2014).  Additionally, there are still several areas of concern.

 

Age
Infants, children and young people

Rates of breastfeeding have increased for all age groups nationally (Health & Social Care Information Centre, 2010).  However, young mothers have 50% lower breastfeeding initiation rates and are then less likely to continue breastfeeding compared to older mothers.

It is estimated that 30% of hospital admissions would be avoided for each additional month of full breastfeeding and that 100% of full breastfeeding among 4-month-old babies would avoid 56% of hospital admissions in babies who are younger than 1 year (UNICEF, 2012).

The diets of under-fives in the UK are too low in vitamins A and C, iron and zinc and, for some groups of children, vitamin D.  Children’s diets also contain too few fruits and vegetables, too much of the type of sugars that most contribute to tooth damage, and too much salt (Caroline Walker Trust, 2006).

Children are eating too many unhealthy snacks.  Nearly three in ten secondary school pupils are snacking on crisps, sweets or fizzy drinks three or more times a day (British Heart Foundation, 2011)

Children aged 11-18 have low iron intake, predominantly among girls where 46% have a mean daily intake below the recommended amount. This has implications for growth and development, and an increased risk of iron deficiency anaemia (Whitton et al. 2011).

Dietary habits seem to be set at an early age and seldom improve spontaneously (Frémeaux et al, 2011).


Young adults aged 19-24 years

The Scientific Advisory Committee on Nutrition (2008) found that:

 

  • Almost all (98%) young adults in this age group consumed less than the minimum recommended intake of fruit and vegetables. Mean consumption was 1.6 portions per day.
  • This group exceeded the maximum recommendation of added sugar (11% of food energy) with mean intakes sugar at 16% food energy. The main source was soft drinks with the average intake being 8-9 cans each week.
  • Almost one-third of women in this age group have a low vitamin D status.
  • Over 40% of young women had an iron intake below the recommended level.
  • One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Adults aged 65 years and over living in institutions
There is evidence of low intake and status for a number of vitamins and minerals for older people living in institutions. In October 2006, the Food Standards Agency issued nutrient and food-based guidance for UK institutions. Malnutrition was found to affect more than 1 in 3 adults on admission to hospitals, more than 1 in 3 adults admitted to care homes in the previous 6 months, and 1 in 5 in adults on admission to mental health units in the UK (British Association for Parental and Enteral Nutrition, 2010). Most of those affected were in the high risk category. Malnutrition is common in all types of care homes and hospitals, all types of wards and diagnostic categories, and all ages.  According to the report, much of the malnutrition present in institutions originates in the community.

Gender
Almost one-third of women aged 19-24 have a low vitamin D status.

Over 40% of young women had an iron intake below the recommended level.

One-fifth of young men had a salt intake above 15g per day; the recommended maximum is 6g.

Some men, following divorce, consume a poor diet (e.g. living on “Pot Noodles” and takeaway food) due to their lack of cooking skills (Eng et al. 2005).

Socioeconomic status
Women from disadvantaged groups have a poorer diet and are more likely either to be obese or to show low weight gain during pregnancy and their babies are more likely to have a low birth weight. Mothers from these groups are also less likely to take folic acid or other supplements before, during or after pregnancy (Food Standards Agency, 2009).

Mothers in low socioeconomic position continue to have a strong impact on patterns of infant feeding (Health and Social Care Information Centre, 2010). Incidence of breastfeeding remains higher amongst mothers in managerial and professional occupations. However across the UK as a whole, breastfeeding rates increased in all socioeconomic groups (Health and Social Care Information Centre).

Nationally, breastfeeding rates amongst mothers in routine and manual occupations increased from 65% in 2005 to 74% in 2010, therefore narrowing the gap between the highest and lowest socioeconomic groups.

Mothers in lower socioeconomic groups are more likely to introduce solid foods earlier than recommended and their children are at a greater risk of both ‘growth faltering’ (that is, they gain weight too slowly) in infancy and obesity in later childhood (Armstrong et al, 2013). In addition, average daily intakes of iron and calcium are significantly lower, and rates of dental caries are significantly higher among children from manual groups compared with those from non-manual groups (Gregory et al. 1995; Health and Social Care Information Centre, 2015).

About 39% of people from low income groups report that they worry about having enough food to eat before they receive money to buy more. Similarly, about one-third (36%) report that they cannot afford to eat balanced meals. Overall, one-fifth of adults in low income groups report reducing the size of, or skipping, meals. Five per cent report that, on occasion, they have not eaten for a whole day because they did not have enough money to buy food (Food Standards Agency, 2008).

 

People have adopted a wide range of strategies to try and manage shortfalls in household income, and using food banks is often the last resort (Lambie-Mumford et al. 2014; Perry et al. 2014). However, more people are using them to make ends meet and the evidence suggests that need is driving demand, not supply (Cooper, Purcell & Jackson, 2014). Research in West Cheshire suggests that 47% of referrals to food banks were the result of problems with social security benefits with a further 20% the result of low, insecure incomes and 11% due to debt (Spencer, Ogden & Battarbee, 2015).

Many areas of dietary concern for people in lower socioeconomic groups were similar to that of the general population (Scientific Advisory Committee on Nutrition, 2008); but the following were more marked:

 

  • Average consumption of fruit and vegetables was lower with the average daily intake being 2.5 for women, 2.4 for men, 2 for girls and 1.6 for boys.
  • Intakes of added sugar, especially amongst children and saturated fats were above current recommendations.
  • Intakes of dietary fibre fell below current recommendations.
  • Evidence of inadequate nutritional status for iron, folate and vitamin D.
  • A substantial proportion of men and women were overweight or obese.

Ethnicity
People from South Asian and African-Caribbean communities tend to have a greater prevalence of vitamin D deficiency, which is thought in part to be due to darker skin tone (SACN, 2008).

Compared with white Europeans, South Asian children reported a higher mean intake of total energy, total fat, polyunsaturated fat and protein whilst carbohydrate (particularly sugars), vitamins C and D, calcium and iron were lower. These differences were larger for Bangladeshi children (Donin et al. 2010).

Compared with white Europeans, Black African and Black Caribbean children had lower intakes of total and saturated fat, fibre, vitamin D and calcium. (Donin et al. 2010)

Vulnerable groups
Learning disabilities
People with a learning disability have a greater prevalence of health problems. It is well established that they are nutritionally vulnerable. Historically, many people with a learning disability lived in long-stay hospitals where many nutritional problems occur. These problems can include the following; underweight (this leads to less resistance to infections and less resistance to pressure sores); overweight; constipation; dehydration and specific nutrient deficiencies. The main other issue cited is the higher prevalence of obesity and underweight in this population (The Caroline Walker Trust, 2007).

People suffering mental ill health
Self-neglect and disorganised lifestyles may be a symptom of mental health needs and may result in malnutrition. The 2007 National Nutrition Screening Week found 19% of adults admitted to mental health units were ‘malnourished’. Poor nutrition has been associated with a number of mental illnesses such as depression (Dipnall et al, 2015).

Depression increases the risk of mortality by 50% and doubles the risk of coronary heart disease in adults. People with schizophrenia or bipolar disorder have higher rates of obesity, abnormal lipid levels and diabetes. They are also less likely to benefit from public health programmes and mainstream screening (Department of Health, 2011).

 

Other Areas

There is increasing concern about the consumption of energy drinks in adolescents and young adults (particularly males), especially in terms of sugar content, impact on behaviour including increased risk taking and substance misuse and adverse effects affecting the cardiovascular and neurological systems (Ali et al. 2015; Sanchis-Gomar et al. 2015). A survey by the European Food Safety Authority (2013) found that 21% of UK adults were high chronic consumers of energy drinks (European average 12%), with an equivalent figure of 19% in adolescents (European average 12%).  The average consumption for adolescents in the UK was 3.1 litres per month, the highest in Europe (average 2.1 litres). Concerns over behaviour have led some schools to ban them whilst others have gone further by encouraging local shops not to sell them to students. However, robust evidence in relation to behaviour is sparse or non-existent.



 



What is the level of need in the population?

Healthy eating adults
The nationally produced Public Health Outcomes Framework provides local authority level data on healthy eating for adults. The 2014 data for Hartlepool shows 53.5% of adults eating at least 5 portions of fruit and vegetables per day, the same as the England average. 

Deprivation

Hartlepool is ranked as the 18th most deprived local authority area nationally (Index of Multiple Deprivation, 2015).  As a consequence, those living in the most deprived areas may face additional barriers to accessing and consuming a healthy diet. Evidence would suggest that locally this is the case due to the high rates of obesity and physical inactivity in these areas.

Breastfeeding
Breastfeeding initiation in Hartlepool is significantly lower than England.  Although rates have tended to increase in Hartlepool, greater increases are seen in comparable areas and the gap is widening.  In 2014/15, breastfeeding initiation rates were 49.6% in Hartlepool (one of the lowest rates nationally) compared to 74.3% in England. 

By the time babies are six to eight weeks old, only about one in five (20%) are being breastfed, less than half the proportion seen in England as a whole. 

Breastfeeding rates vary considerably within Hartlepool.  In Manor House and De Bruce wards, fewer than one-third of mothers initiated breastfeeding, compared with more than two-thirds in Rural West ward (Source: Tees Public Health / North Tees and Hartlepool NHS Trust).

Using the Mosaic social segmentation classification shows that the highest proportion of babies are born into families living in areas typified by Types ‘O’ and ‘K’, where fewer than 30% of babies are breastfed at birth.  Significant numbers of babies are born into families living in areas typified by Mosaic Types ‘E’ and ‘F’, where breastfeeding is initiated for about half of all births.

Using the Mosaic 'types' shows that the highest number of births is in Type O69, where over 80% of babies are not breastfed at all.

 

Healthy Start

Nationally collated data indicates that uptake of the Healthy Start scheme overall is progressing well in Hartlepool, with 81.7% of those eligible (n=1,489) taking part. Eligible beneficiaries are those who qualify to apply for Healthy Start (e.g. at least 10 weeks pregnant or have a child under four years old and the family gets: Income Support, or Income-based Jobseeker’s Allowance, or Income-related Employment and Support Allowance, or Child Tax Credit). Beneficiaries become entitled, once their completed Healthy Start application form has been processed and approved by the Healthy Start Issuing Unit.

 

Healthy Start Vitamins uptake is calculated based on the number of eligible children/mothers, multiplied by 1.5 per quarter (this gives you the potential number of drops/tablets consumed each quarter). Uptake is expressed as a percentage of the number of vitamins reimbursed over the potential number of vitamin reimbursement by the Healthy Start recipients in that area. This is based on the Healthy Start Reimbursement forms collected from local authorities, charities or Trusts. No forms were received for Hartlepool in 2014/15 therefore there is no data in relation to Healthy Start Vitamins uptake for the area.


School meals

School meals in Hartlepool meet the new National School Food Standards for school lunches set by the Government.  In 2014/15, school meal up take in primary and special schools in Hartlepool (70%) was higher than England (44%) and the North East (60%).  Uptake in secondary schools (61%) is also higher than both the regional and national averages (45% and 38% respectively).  Hartlepool has 29% of primary school children and 23% of secondary school children who are eligible for free school meals, higher proportions than England.

 

 

 

 



What services are currently provided?

Primary care
One-to-one consultations on nutrition and dietary advice are available within primary care. General practices also carry out brief interventions, particularly as part of the Tees Healthy Heart Check programme, to improve adults’ lifestyle behaviour including dietary habits.  The Hartlepool Health Trainer Service also provide weekly weight management clinics in some GP practices.

Antenatal care

Community midwifery services provide antenatal advice on dietary intake and supplements including folic acid and vitamin D.

 

Secondary care
North Tees and Hartlepool NHS Foundation Trust Nutrition and Dietetic Department provides specialist support for children, young people and adults, including diabetes and other long-term conditions, allergy advice and prevention of malnutrition.

Where appropriate health professionals in the acute and community settings are trained to identify those patients who are suffering from malnutrition, or are at risk, using the Malnutrition Universal Screening Tool (MUST). The Trust has a High Impact for Nutrition Group to ensure processes are followed and improved if needed. The community setting will be using this model to increase capacity.

Community services
Community Midwifery Services provide antenatal advice on diet and supplements, including folic acid and vitamin D.   Weight monitoring is also carried out at booking appointment to help assist risk level.

Mental health and learning disabilities

Tees, Esk and Wear Valleys NHS Foundation Trust cover a wide range of mental health, learning disability and substance misuse services. The dietetic team are implementing two pathways of care for malnutrition and weight management. 


In-patient food provision is monitored to ensure that menus provided for in-patient settings meet the nutritional guidelines and needs of the client group.  Healthy options are promoted using a traffic light food labelling system together with the provision of health promotion education groups and sessions for people with learning disabilities.

Health Trainer Service
Health Trainers help adults to develop healthier behaviours and lifestyles. The service offers practical support and signposting to appropriate services to help clients change their own behaviours by making informed choices and goals.  Typically, the service encourages people to eat more healthily, manage weight if appropriate and to drink sensibly.  The service also refers and signposts clients to services help people to stop smoking, participate in increased physical activity, undergo an NHS Health Check or support with mental health / debt management and other issues.

EDAN / Type-2 Diabetes prevention and support

Nutritional support is provided alongside physical activity as part of a prevention and support programme for clients at risk of, or diagnosed with, Type-2 Diabetes.  Delivery is provided through Hartlepool Borough Council Public Health (Sport & Recreation and Health Improvement).

Substance misusers
Drug and alcohol support services offer breakfast and brunch clubs as a way to engage substance misusers. Support is provided if needed with cooking and shopping skills to support service users in living independently.



Voluntary sector
Families First operate a health bus which is used to carry out health audits and lifestyle advice.
Hartlepool Mind provide a 6-week programme that addresses emotional and psychological factors for weight management as well as lifestyle improvements to provide long-term solutions.

Café 177 A healthy bistro run for young people by young people.




Breastfeeding support

Antenatal support sessions are provided by maternity services.  Following discharge from the midwifery service, locality health visiting teams and children’s centres support mothers further with breastfeeding and infant feeding.

 

Families in it Together Hartlepool (FiiT Hart)

Bespoke one-to-one family weight management programme incorporating physical activity and nutirional / behavioural support, provided by Hartlepool Borough Council Public Health (Sport & Recreation and Health Improvement).


Healthy Start scheme
The scheme provides pregnant women, new mothers and young children with free Healthy Start vitamins, which can reduce the risk of health problems associated with vitamin deficiencies (for example, rickets and spina bifida). Women supported by Healthy Start are entitled to free vitamins during pregnancy and until their child is one year old, while children aged from six months to their fourth birthday are also eligible.
 

Weaning programmes/advice
The Health Visiting service provides weaning advice when appropriate and when requested by parents.  Children’s Centres also offer advice and structured weaning programmes which support parents by providing safe and practical advice.


Learning Disabilities
General practices carry out annual health checks on patients registered with a learning disability and a Health Facilitator supports practices.

A DVD (Eat Well, Live More) has been developed by people with learning disabilities which is proving to be a valuable resource to educate clients with a learning disability and their carers.
 

Workplace initiatives

 The regional Better Health at Work Award encourages employers in the North East to consider how they can improve the health of their workforce.  Implementing and promoting healthy eating is an integral part of the scheme including the development of a healthy eating policy.

 

HBC Environmental Health (alongside Planning) are working with several established fast-food take-away outlets to promote healthier cooking and catering practices, including low-fat / low-salt / low-sugar menu options (sharing of good practice and healthy recipes between outlets), provision of water, and restricted salt shakers in fish and chip outlets, and mapping of A5 hot food take away outlets, to inform the planning process.

 

 



What is the projected level of need?

Breastfeeding at 6-8 weeks is forecast to increase slightly, based on historical data.  However, the rate is increasing more slowly than that seen in the North East, thus widening the gap.

Other emerging nutritional deficiencies may also increase locally, and with the elderly population predicted to increase, the prevalence of malnutrition may also increase subsequently impacting on local NHS services and health costs.

 



What needs might be unmet?

 

Training and building capacity

There is increased demand for the Health Trainer service, which is currently the only provider of diet and nutrition advice in the community at the tier 1–2 level of intervention. Therefore there is a need to review referrals and pathways to meet current and future demand.
 

There is a need for capacity and capability building in Hartlepool for frontline staff to ensure every contact maximises the health improvement opportunity, and to ensure consistent nutrition advice and support, particularly for those who care for vulnerable children and adults.


There is no consistent approach to educational needs and standards of practice for nutritional care and support in care settings, particularly linked to malnutrition.


Demand for cooking skills development and practical advice on healthy eating is high, but meeting this demand is subject to available staffing resources, funding and facilities.

 

Breastfeeeding
For breastfeeding, there are unmet needs for:

 

  • A universal model of antenatal information giving/contact with pregnant women delivered by health visiting teams to identify and act upon barriers to healthy feeding choices for babies.
  • An increase in the capacity of health professionals to be able to support women with breastfeeding in the first two weeks after delivery when Hartlepool has its greatest ‘drop off’ in the numbers breastfeeding.
  • A comprehensive paid peer support programme (NICE 2008a, 2008b, 2006)
  • Multiple ‘Breastfeeding Welcome’ venues, both statutory and private retail, in Hartlepool.
  • More ‘local’ breastfeeding support groups.

 

Vulnerable adults and children

Increased support and education for adults who move from a care setting to independent living and those already in supported living is needed as often they lack the resources and knowledge to purchase and eat a balanced diet, particularly for those adults with learning disabilities and mental ill health.


Black and minority ethnic groups

There is a need for targeted healthy eating and weight management services for the BME population.

Healthy Start scheme
As the Healthy Start scheme is significantly under utilised for vitamin supplements there is a need to raise the awareness of the scheme, in relation to the vitamin element particularly, both with professionals and families.

 

Learning Disabilities
There is a need for intensive engagement with people with learning disabilities to develop a greater understanding of healthy eating and weight management.  There is a particular need for increased support and education for adults who move from a care setting to independent living and those already in supported living as often they lack the resources and knowledge to purchase and eat a balanced diet.

It is essential that staff working with people with learning disabilities, in particular the care providers’ workforce, receive basic nutrition awareness and identify champions in areas to enable them to support people with learning disabilities to make healthy meals.  Certain areas such as staff training are currently being addressed via support from the Health Trainer Service.There is also a lack of specialist help available to support people with learning disabilities who are diagnosed with diabetes.

Malnutrition

There is a lack of awareness about the correct use of identification tools for malnutrition and processes followed in community care and social care settings.



What evidence is there for effective intervention?

National Institute for Health and Clinical Excellence (NICE) 
Public Health Guidance

Behaviour change at population, community and individual levels (PH6)Maternal and child and nutrition. (PH11)

Prevention of cardiovascular disease. (PH25)

Physical activity and dietary intervention for weight management before, during and after pregnancy. (PH27)

Preventing type 2 diabetes - population and community interventions. (PH35)

Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47)

Behaviour Change: Individual Approaches (PH49)

 Overweight and Obese Adults – Lifestyle Weight Management (PH53)

Clinical Guidance

Nutrition Support in Adults. (CG32)

Postnatal Care. (CG37)

Obesity: The Prevention, Identification, Assessment and Management of Overweight and Obesity in Adults and Children (CG43). (CG43)

Food Allergy in Children and Young People (CG116)

Lipid Modification: Cardiovascular Risk Assessment and Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181)

Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189)

Department of Health

National Service Framework for Children, Young People and Maternity Services: Maternity Services.

Infant Feeding Recommendation

Healthy Lives, Healthy People: A Call to Action.

Interventions to Promote Breastfeeding

The UNICEF Baby friendly Initiative (BFI) suggests the following core practices in maternity and community services.

 

  • The delivery of an appropriate mix of education and/or support programmes routinely delivered by health professionals, practitioners and peer supporters. This includes:
    • Informal, practical breastfeeding education in the antenatal period, delivered in combination with peer support programmes to women on low incomes.
    • A single session of informal breastfeeding education delivered during the antenatal period, targeting women on low incomes.
    • Practical breastfeeding support from a health professional/practitioner in the early postnatal period.
    • Peer support programmes in antenatal and/or postnatal periods to women on low incomes.
  • Changes to policy and practice within the community and hospital setting including:
  • Supporting effective positioning and attachment.
  • Encouraging unrestricted baby-led breastfeeding.
  • Encouraging the combination of supportive care.
  • Teaching breastfeeding technique and reassurance for women with ‘insufficient’ milk.
  • Peer or volunteer support to be delivered by telephone in late antenatal and early postnatal periods to complement face to face support.
  • Breastfeeding education and support from one professional in the antenatal and early postnatal period.
  • One-to-one, needs-based professional education in the antenatal period and peer support for up to 1 year targeting white, low income women.
  • Media programmes that use local images for specific target groups, including teenagers.

A systematic review of professional support interventions for breastfeeding (Hannula et al, 2008) concluded that:

• Interventions expanding from pregnancy through to birth and the postnatal period were more effective than interventions concentrating on a shorter period.
• Intervention ‘packages’ using various methods of education and support from well-trained professionals were more effective than interventions concentrating on a single method.
• During pregnancy the effective interventions were interactive, involving mothers in conversation
• The BFI approach when combined with ‘hands off teaching’ was effective.
• Interventions that were effective during the postnatal period were: home visits; telephone support and breastfeeding centres combined with peer support.
• Professionals need breastfeeding education and the support of their organisations to act as breastfeeding supporters.
• Mothers benefit from breastfeeding encouragement and guidance that supports their self efficacy, feelings of being capable and empowered and that is tailored to their individual needs.

Children and Young People
One of the biggest challenges when trying to improve the diets of women, children and families is how to help them change their behaviour (rather than just their knowledge and attitudes). NICE guidance (see links above) emphasises that a multidisciplinary approach (involving and supporting the families themselves and the wider community) is the most effective option. It is important that professionals involved adopt a non-judgemental, informal and individual approach based on advice about food, rather than just nutrients.

Overall, the evidence suggests that dietary interventions which recognise the specific circumstances facing low income families, teenage parents and mothers from minority ethnic or disadvantaged groups are likely to be more effective than generic interventions. NICE suggest that services need to be accessible and applicable to everyone, including those with learning, physical or other disabilities. NICE also emphasise the importance of monitoring and evaluating new interventions.

Knai, et al. (2006). Getting children to eat more fruit and vegetables: A systematic review.

Townsend et al. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students.

Adults
A systematic review showed the effectiveness of 'paraprofessionals' (trained and supervised community food workers and health trainers) or peer educators who are trained and supervised by nutritionists to deliver education and skill-based programmes to low-income populations. The review found that managers will need to ensure that the intervention has been developed from a theoretical base, has a specific message about increasing fruit and vegetable consumption, and has a component about behaviour change (Cilska et al, 2004).

Story et al (2008). Creating healthy food and eating environments: Policy and environmental approaches.

Pomerleau et al (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature.

 Other documents:

 

Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing. British Medical Journal, 344, d8287

 

Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding. Journal of Clinical Nursing, 21 (13-14), 1943 – 1954

 

Government Office for Science (2007) Tackling Obesities: Future Choices. London: Author

 

Lara J, Hobbs N, Moynihan PJ. et al. (2014). Effectiveness of dietary interventions among adults of retirement age: a systematic review and meta-analysis of randomized controlled trials. BMC Medicine, 12, 60

 

McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health, 15, 457

 

Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review. Pediatrics, 135 (3), e687 - e702

 

National Obesity Observatory – for a wide variety of publications and information related to obesity

 

Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD001141



What do people say?

General Population
There is a lack of local consultation and data on what people say about diet and nutrition-related issues.   Viewpoint 1,000 is a Hartlepool survey which is carried out regularly throughout the year to consult with local people on a range of issues.   In January 2012 there were questions about healthy lifestyle and the maintenance of a healthy weight.   It will endeavour to find out what people already know and how best to support them in lifestyle change and maintenance of a healthy weight.

A community consultation was carried out as part of the Health Trainer Services review in 2014.  A summary of the results of the consultation are available via the Hartlepool Obesity JSNA here (http://www.teesjsna.org.uk/hartlepool-obesity/)

Breastfeeding
In the past year Hartlepool health visitors collected individual feedback from 844 women, of whom 348 initiated breastfeeding at birth.  117 women ceased breastfeeding before the health visitors primary visit, and gave the following information :

 

  • Exactly how long they breastfed for;
  • If they had stopped breastfeeding and why; and
  • Their recommendations for the type of support that might have helped them.


The findings showed that the peak times for stopping feeding were within the first 4 days of birth and also at day 7.  Common themes in mothers’ responses for ceasing to breastfeed include:

 

  • Positioning and attachment difficulties in the first few days of feeding;
  • A feeling that they were unable to breastfeed, felt to be too difficult;
  • A feeling that the baby couldn’t breastfeed;
  • Painful breastfeeding;
  • Mother’s concern that their baby may not be getting enough milk; and
  • Mother’s concern that she was not producing enough milk.


Many of these concerns involve women’s expectations of what breastfeeding is like in reality, a perception that feeding isn’t going well and an anticipation that a solution could not be found.

This feedback provides vital information on subjects that staff can work with women in the antenatal and early postnatal period to reassure about the early days of breastfeeding, reinforce information on the signs that breastfeeding is going well and advise on local help available for feeding issues.

Women themselves have repeatedly requested:

 

  • More help and support during the earliest days of breastfeeding their child;
  • A ‘Mum to Mum’ peer support programme in both the hospital and community settings;
  • Clearly identified ‘Breastfeeding Welcome’ venues in Hartlepool; and
  • More breastfeeding support groups.


The North East SHA commissioned research with mothers on reasons for their infant feeding choices. The most common reasons for planning to use infant formula were:

 

  • Participants did not like the idea of breastfeeding;
  • Other people can feed the baby;
  • Inconvenient due to mother’s lifestyle;
  • Previous children were fed with infant formula;
  • Participants had breastfed previous children and didn’t like it.


The most common reason for planning to breastfeed was that ‘breastfeeding is best for health of the baby’.

During audit preparation prior to the UNICEF Baby Friendly Initiative, both the women who were bottle feeding, but had initiated breastfeeding and women who were breastfeeding asked for local breastfeeding support groups as they had seen these on the television.


Women and families value the support that is provided by peer groups. This was identified in the final recommendations of the Public Health North East social marketing benchmarking research.


Women also highlight that embarrassment is a large part of choosing not to breastfeed and not knowing where would be “safe” to breastfeed when in public. 



What additional needs assessment is required?

 

  • Audit of identifying malnutrition and processes used when malnutrition is identified in care settings.
  • Analysis of the results of the CQUIN Maternity and Health Visitor Antenatal Contact Pilot.
  • Continuing use of the UNICEF Baby Friendly audit of information given to pregnant women and mothers in the first months of feeding.
  • Continuing health visitor data collection and analysis of results.
  • Analysis of the impact of the peer support pilot.
  • Further insight into the availability of fast food take-away outlets and shops selling affordable, healthy food in Hartlepool, particularly in relation to schools and areas of deprivation (ward mapping).

 

  • An analysis of training needs for those working in care settings and for frontline staff.Needs analysis to determine the level of breastfeeding services that might be required locally and to calculate the cost of commissioning breastfeeding services by:

 

  • identifying indicative local service requirements;
  • reviewing current commissioned activity;
  • identifying future change in capacity required; and
  • modelling future commissioning intentions and associated costs.
  • Develop a better understanding of local beliefs and attitudes to diet and nutrition and use this insight to commission culturally appropriate interventions aimed at improving diet and nutrition in target populations.

 



Key Contact

Name: Steven Carter

Job Title:  Health Improvement Practitioner

e-mail: steven.carter@hartlepool.gov.uk

phone:  01429 523587

 

References

National strategies and plans

Department of Health (2004). National Service Framework for Children, Young People and Maternity Services: Maternity Services.

Department of Health (2004). Infant Feeding Recommendation.

Department of Health (2011). Healthy Lives, Healthy People: A Call to Action.

Scientific Advisory Committee on Nutrition (2015). Carbohydrates and Health. London: The Stationary Office

Local strategies and plans

Public Health North East (2012). North East Infant Feeding Weaning and Nutrition Guidelines

NHS Tees Breastfeeding Strategy 2010-2015

North Tees and Hartlepool Breastfeeding Action Plan

Other references

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British Association for Parenteral and Enteral Nutrition (BAPEN, 2010). Nutrition Screening Survey in the UK in 2007

British Heart Foundation (2011). The real five-a-day? UK kids feast on chocolate, energy drinks and crisps.

Caroline Walker Trust (2007). Eating well: children and adults with learning disabilities

Caroline Walker Trust (2006). Eating Well for Under 5’s in Childcare – Practical and Nutritional Guidelines.

Ciliska, D; Miles, E; O'Brien, M.A; et al, (2004). The effectiveness of community interventions to increase fruit and vegetable consumption in people four years of age and older.

Department of Health (DH), (2011). No health without mental health

DeRose L, Messer E, Millman S, (1998). Who's hungry? And how do we know? Food shortage, poverty, and deprivation.  New York: United Nations University Press.

Dipnall JF, Pasco JA, Meyer D. et al. (2015). The association between dietary patterns, diabetes and depression. Journal of Affective Disorders, 174, 215 – 224

Donin, AS; Nightingale, CM; Owen, CG et al (2010). Nutritional composition of the diets of South Asian, black African-Caribbean and white European children in the United Kingdom: The Child Heart and Health Study in England (CHASE). British Journal of Nutrition, 104, 276-285

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Food Standards Agency (2008). Low Income Diet and Nutrition Survey

Food Standard Agency, (2009). Annual Report of the Chief Scientist 2008/09

Frémeaux, AE; Hosking, J; Metcalf, BS et al (2011). Consistency of children's dietary choices: annual repeat measures from 5 to 13 years. British Journal of Nutrition, 106, 725-731

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Hannula, L; Kaunonen, M; Tarkka, MT, (2008) A systematic review of professional support interventions for breastfeeding. Journal of Clinical Nursing 17(9):1132-43

Health & Social Care Information Centre (2010). Infant Feeding Survey 2010. London: Author

Health & Social Care Information Centre (2015). Child Dental Health Survey 2013, England, Wales and Northern Ireland. London: Author

Herbert K, Plugge E, Foster C & Doll H. (2012). Prevalence of risk factors for non-communicable diseases in prison populations worldwide: A systematic review. The Lancet, 379 (9830), 1975 – 1982

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Jolly K, Ingram L, Khan KS. et al. (2012). Systematic review of peer support for breastfeeding continuation: meta-regression analysis of the effect of setting, intensity, and timing. British Medical Journal, 344, d8287

Kaunonen M, Hannula L. & Tarkka MT. (2012). A systematic review of peer support interventions for breastfeeding. Journal of Clinical Nursing, 21 (13-14), 1943 – 1954

Knai, C., Pomerleau, J., Lock, K. & McKee, M. (2006). Getting children to eat more fruit and vegetables: A systematic review. Preventive Medicine, 42, 85-95

Lambie-Mumford H, Crossley D, Jensen E, Verbeke M & Dowler E. (2014). Household Food Security in the UK: A Review of Food Aid. London: DEFRA

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McGill R, Anwar E, Orton L. et al. (2015). Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health, 15, 457

Moran VH, Morgan H, Rothnie K. et al. (2015). Incentives to promote breastfeeding: A systematic review. Pediatrics, 135 (3), e687 - e702

National Institute of Health and Clinical Excellence (2006). Behaviour Change at Population, Community and Individual Levels (PH6). London: Author

National Institute of Health and Clinical Excellence (2006). Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition (CG32) . London: Author

National Institute of Health and Clinical Excellence (2008). Maternal and Child Nutrition (PH11). London: Author

National Institute of Health and Clinical Excellence (2010). Prevention of Cardiovascular Disease at Population Level (PH25). London: Author

National Institute of Health and Care Excellence (2010). Weight Management Before, During and After Pregnancy (PH27). London: Author

National Institute of Health and Care Excellence (2011). Food Allergy in Children and Young People: Diagnosis and Assessment of Food Allergy in Children and Young People in Primary Care and Community Settings (CG116). London: Author

National Institute of Health and Care Excellence (2011). Preventing Type 2 Diabetes: Population and Community-Level Interventions (PH35). London: Author

National Institute of Health and Care Excellence (2013). Managing Overweight and Obesity among Children and Young People: Lifestyle Weight Management Services (PH47). London: Author

National Institute of Health and Care Excellence (2014). Behaviour Change: Individual Approaches (PH49). London: Author

National Institute of Health and Clinical Excellence (2014). Lipid Modification: Cardiovascular Risk Assessment and the Modification of Blood Lipids for the Primary and Secondary Prevention of Cardiovascular Disease (CG181). London: Author

National Institute of Health and Care Excellence (2014). Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults (CG189). London: Author

National Institute of Health and Care Excellence (2014). Overweight and Obese Adults - Lifestyle Weight Management (PH53). London: Author

National Institute of Health and Clinical Excellence (2014). Quality Standard for Nutrition Support in Adults (QS24). London: AuthorNHS Information Centre, (2010). Infant Feeding Survey 2010

O' Neill M, (2005). Putting food access on the radar.

ONS (2011). Fertility assumptions: 2010-based national population projections.

Pomerleau, J., Lock, K., Knai, C. & McKee, M. (2005). Interventions designed to increase adult fruit and vegetable intake can be effective: A systematic review of the literature. Journal of Nutrition, 135, 2486-2495

Public Health England (2014). National Diet and Nutrition Survey: Results from Years 1 to 4 (combined) of the Rolling Programme for 2008 and 2009 to 2011 and 2012. London: Author

Renfrew MJ, McCormick FM, Wade A. et al. (2012). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD001141

Sanchis-Gomar F, Pareja-Galeano H, Cervellin G, Lippi G, Earnest CP. (2015). Energy drink overconsumption in adolescents: implications for arrhythmias and other cardiovascular events. Canadian Journal of Cardiology, 31 (5), 572 – 575

Scientific Advisory Committee on Nutrition (SACN, 2008). The Nutritional Wellbeing of the British Population

Spencer A, Ogden C & Battarbee L. (2015). #cheshirehunger - Understanding Emergency Food Provision in West Cheshire. Chester: West Cheshire Food Bank

Story, M., Kaphingst, K.M., Robinson-O’Brien, R. & Glanz, K. (2008). Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health, 29, 253-272

Townsend, N., Murphy, S. & Moore, L. (2011). The more schools do to promote healthy eating, the healthier the dietary choices by students. Journal of Epidemiology and Community Health, 65, 889-895

UNICEF (2012). Breastfeeding reduces hospital admissions.

Whitton, C; Nicholson, SK; Roberts C; et al (2011). National Diet and Nutrition Survey: UK food consumption and nutrient intakes from the first year of the rolling programme and comparisons with previous surveys. British Journal of Nutrition, 106, 1899-1914

WHO (2003) Diet, nutrition and the prevention of chronic diseases.

 



Printed from TEES JNSA Website.
URL: http://www.teesjsna.org.uk/hartlepool-diet-and-nutrition/
Printed: 22/08/2014

 

 



Physical inactivity

Increased levels of physical activity can assist in tackling many of the important health challenges faced by the UK. It can help in the prevention and treatment of over 20 chronic conditions, including coronary heart disease, stroke, type two diabetes, cancer, obesity, mental health problems and musculoskeletal conditions (Department of Health, 2004). An evidence review concluded that physical activity could be the best buy in public health (Morris, 1994).  Helping inactive people to move to a moderate activity level will produce the greatest reduction in risk of ill health (Department of Health, 2009).

Physical activity in childhood has a range of benefits including healthy growth and development, maintenance of energy balance, mental well-being, improved academic performance and social interaction, and reduces osteoporosis risk in later life (Department of Health, 2004).  Active children are less likely to smoke, or to use alcohol/get drunk or take illegal drugs (Physical Activity Task Force, 2002).  Active children are more likely to become active adults (Telema, 2009).

In the UK physical inactivity is responsible for 1 in 6 (17%) of deaths (Lee et al 2012), this makes it as dangerous as smoking (Wen, 2012). Physical inactivity in England is estimated to cost £7.4 billion a year (Everybody Active, Ever Day, 2014); The NHS cost alone is £900 million based on 2006/07 costs (Scarborough et al, 2011).   In Hartlepool the cost of inactivity is estimated as £22,791,547 and is ranked in the most inactive quartile 134/150 local authorities with the physically inactive population being 34.76% (Turning the Tide of Inactivity 2014).

This topic is most closely associated with the following JSNA topics:



What are the key issues?

Most people aren’t doing enough exercise. The Health Profile for Hartlepool (2014) shows that only 12.7% of adults in the town carry out 5x30 minutes moderate physical activity per week. This is below the North East average (14.4%) and national average (13.8%). In Hartlepool with a population of 92,000 this equates to 80,316 people not participating in the recommended physical activity to benefit health.

There are too many children who are overweight: 11.2% of children in reception year of primary school are very overweight; this rises to 24.4% in year 6.

Facilities are abundant but they are not appropriately placed within Hartlepool and they are in various states of disrepair and accessibility.

 



What commissioning priorities are recommended?

The following strategic priorities remain.  No additional priorities have been identified.

2012/01
Implement joint commissioning to support a move from a mainly project-based approach
to one which embeds healthy weight in all commissioning decisions. Update – Movement of the Sport and Recreation service into Public Health has been a positive move and links with the CCG and Health and Wellbeing Board are effective as has been an exercise in joint commissioning facilitated by an external agency in 2013. This work to embed cohesiveness and healthy weight into commissioning decisions continues.

2012/02
Provide early interventions from preconception up to age 2 years
to address the rising levels of child obesity. Update – Specific project work has been undertaken to address this area of concern however it is proving incredibly difficult to engage with pregnant women and also new mums who are particularly at risk or in low income families. This work is ongoing and remains a priority alongside family interventions to gain and maintain a healthy weight.

2013/03
Develop and agree healthy weight protocols for adults, children and families
which explain the role of all professional groups from early prevention to specialist treatment. This should include input from key partners including extended services, sport and recreation and play.  Update – the Hartlepool Healthy Weight Healthy Lives group is compiled of key organisations which input into prevention and intervention services. This group meets regularly and will continue to do so to enable the cross fertilisation of interventions and ideas and joined up working to a common goal of reducing the number of people who are of an unhealthy weight and need to change their behaviour.

2012/04
Implement family-based interventions
as these are the most successful approach to tackling obesity in children. Advice from the former National Support Team (NST) recommends that extended services are pivotal to engage with parents to tackle obesity. Update – as per earlier update there has been some work carried out setting up and building relationships with agencies/key staff who encounter overweight young people and their families and a pilot project set up to try and improve the situation in Hartlepool. This work is slow as it requires a much more time consuming personal approach to behaviour change however, results so far are positive and it continues to gather momentum.

2012/05
Develop strategies for both walking and cycling
which include a multi-agency approach.  Update – Walk About in Hartlepool has received national accreditation for the programme from Walking for Health (Ramblers and Macmillan Cancer Support). This programme continues to be popular and grow. Cycling is a developing sport within the town and links have been forged with the Sustainable Transport Team and now Summerhill has become a hub for Cycling and has its own Cycle Clinic. This area continues to remain a priority.

2012/06
Increase community access to existing school facilities
Update – this is still highlighted as a need in the town’s strategic documents and work has been completed in terms of the open spaces assessment which now includes school premises. This are will remain a difficult one but there is headway currently.

2012/07
Support the Community Activities Network to provide a base for commissioning opportunities in Hartlepool
and as a central point for discussion and planning.  Update – The Community Activities Network has morphed in recent years and now can come together for any key need but operates more as a funding body with its main aim to increase physical activity and fund new innovative projects to address this. This work will continue into 15/16 and is coordinated by Hartlepool Borough Council.

2012/08
Commission a single website that brings together the physical activity opportunities available in Hartlepool
instead of having multiple sources of information, although steps must be taken to avoid increasing health inequalities via the ‘digital divide’. Any such site should incorporate the current and emerging opportunities offered by social networking.  Update – The Council Website still faces criticism and this are still needs attention. There is a focus on the promotion of activities, incentives, use of social media by the Council for 15/16. There will also be an audit carried out via HBC in 2015 looking at increasing levels of physical activity.

 



Who is at risk and why?
Children and young people


Physical activity among children aged 2–15 varies according to a range of factors including gender, ethnicity and socioeconomic status (The Information Centre, 2008a; 2008b).

Gender
A higher percentage of boys than girls aged 2-15 years meet the Government’s recommendations for physical activity (32% and 24% respectively). Among girls the proportion meeting the recommendations generally decreases with age, ranging from 35% in girls aged 2 to 12% among those aged 14. There was a less consistent pattern with age among boys (The Information Centre, 2009).

By contrast, most children perceive themselves as being either very or fairly active compared with children their own age (The Information Centre, 2011). In addition, a substantial number of British adolescents believe themselves to be more physically active than they actually are (Corder et al, 2011).

Ethnicity
Children from minority ethnic groups tend to be less active compared to their white peers (The Information Centre, 2006).

Familial factors
There is a strong positive link between a child’s activity levels and that of their parents, particularly among girls (The Information Centre, 2008b). Furthermore, in terms of childhood obesity, this may be confined to those whose same-sex parents are also obese (Perez-Pastor et al, 2009).

Parents are an important influence on their child’s physical activity behaviour, yet most incorrectly consider their children to be sufficiently active (Corder et al, 2010).

Socioeconomic Status
Physical activity levels in children are related to household income, with those in the lowest income bracket more likely to be active: 36% compared to 25% in boys, and 30% and 22% among girls. This is perhaps surprising, since children in lower income groups are often found to have less healthy lifestyles (National Obesity Observatory, 2011; The Information Centre, 2009b).

Age
Children are becoming less physically fit as they age.  51% of boys and 34% of girls aged 4-10 years met the recommended levels in 2008, but only 7% of boys and no girls aged 11-15 years did so (National Obesity Observatory, 2011).

Disability
Children and young people with a disability take part in physical activity and sport less frequently and their experiences are less positive than their non-disabled peers (Sport Scotland, 2006).

Sedentary behaviour
On weekdays, 10% of children aged 2 to 9 years old were sedentary for six hours or more, but the proportion increased steeply in older children to over 60% of 15-year-olds. The proportion increased significantly across all age groups at weekends.

Household income was significantly associated with sedentary behaviour - for both boys and girls, as household income decreased, the average number of hours spent watching TV increased (The Information Centre, 2009b).

The main method of children aged 5-16 years getting to and from school is walking (41%), while 33% of this age group is being driven to school. Just 2% used a bike to travel to school as their main mode of transport (Department for Transport, 2011).

Adults


Evidence shows that certain population groups tend to have lower levels of physical activity including over 55-year-olds, some black and minority ethnic (BME) groups, disabled people, young women aged 14-24 years and lower socioeconomic groups (Sport England, 2011).

Gender and age
Based on the 2008 Health Survey for England, 39% of men and 29% of women met the Government’s recommendation for physical activity.  Women were significantly less physically fit than men, and fitness decreased significantly with age. The decline was steepest for men, although more males were physically fit in every age group (The Information Centre, 2009).

Ethnicity
Physical activity levels tend to be lower in ethnic minority groups (except Black Caribbean/African and Irish), especially South Asians (The Information Centre, 2006). Only 11% of Bangladeshi and 14% of Pakistani women were reported to have achieved the recommended amounts of physical activity, compared with 25% in the general population (Department of Health, 2009).

Socioeconomic status
There is an association between household income and physical activity; more people are active in households with higher income.  The degree of associa