In his review of health inequalities, Sir Michael Marmot suggests that health inequalities are as a result of social inequalities and that the lower a persons position in society, the worse their health will be. The report from this review ‘Fair Society, Healthy Lives’ shows the benefits that action to address health inequalities will have on society broadly, including the benefits to the economy through a reduction in illness linked with health inequalities, which impacts on treatment costs and claims of welfare payments.

The priorities proposed as a result of the review of health inequalities highlighted economic growth as the most important measure of the countries success, which will impact more on working age adults and their families; but also produced six policy objectives to address health inequalities:

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control of 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
  • Strengthen the role and impact of health protection

The health status of the people in Tees Valley, some of whom live in the most deprived electoral wards in the country, provides significant evidence of the high demands placed on local health care, and Redcar & Cleveland is no exception. There is a need to further shift the focus of our health and social care provision to improving health outcomes and reducing inequalities, to improve the overall health of the local population within the available resources. Historically, the area has been highly dependent on heavy industry for employment and this has left a legacy of industrial illness and long-term conditions. This, coupled with a more recent history of high unemployment, as the traditional industries have retracted, has led to significant levels of health deprivation and inequalities that rank amongst the highest in the country. The area faces continuing challenges to health including: high premature mortality, low life expectancy and higher than national average levels of smoking, binge drinking and obesity.

This section cover issues principally affecting adults aged 18-65, plus those issues which are common to all adults in Redcar & Cleveland, including young adults and/or older people.  It brings together the major issues facing this population age group from the JSNA topics in the Vulnerable groups, Wider determinants, Behaviour and lifestyle and Illness and death themes.


Last updated: 2014-10-03 10:07:56
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1. What are the key issues?

Securing sustainable improvements in the future health and wellbeing of adults who live in Redcar & Cleveland will need to go beyond simply targeting interventions at adults in the most deprived geographical areas.  A more sophisticated, personalised approach that seeks to identify individuals and groups with the greatest potential to improve their health and wellbeing, wherever they live, may provide the most sustainable and equitable way to secure improvements in health and wellbeing for Redcar & Cleveland as a whole.

The key issues for commissioners in developing this approach include:

  • There is a range of wider determinants of health and environmental factors (both geographical and non-geographical) which contribute to poor health and wellbeing for adults in Redcar & Cleveland.
  • Relatively low proportions of adults currently making lifestyle choices which will contribute to improving their personal health and wellbeing
  • The system of care and support in place for adults should be improved to increase equity and overall improvements in the health and well-being of the population.

The priorities for this more personalised approach should be on a small number of issues which:

  • Have an impact on the lives of large numbers of adults in Redcar & Cleveland;
  • Act as indicators of other potential risks to health and wellbeing which can be tackled through additional interventions; and
  • Are already recognised as important by adults in Redcar & Cleveland.

Lifestyle and the impact of the economic downturn on household incomes are two such issues and are the problems around which the recommendations in this section are centred.

In 2012, the estimated smoking prevalence in Redcar & Cleveland (21.8%) was significantly higher than the England average (19.5%). The local rate for smoking in pregnancy in 2012/13 was 24.2%, almost 5% higher than the North East rate and nearly double the national average (PHOF, 2014).

Redcar & Cleveland has a similar proportion of people categorised as ‘increasing risk’ drinkers compared to north east and national averages, and has a higher proportion of binge drinkers and people admitted to hospital because of alcohol, than the national average.

The Active People Survey 2012 shows that 27.5% of adults in Redcar & Cleveland are obese, significantly higher than the England average of 23.0%. This represents an approximate 2.2% increase from the 2003-05 estimate (Health Survey for England).

Unemployment is 9.8% in the north east but 10.3% in Redcar & Cleveland (currently 6,700 people age 16-64).  In England the rate is 7.2% (2013/14).  Unemployment is not equally distributed in Redcar & Cleveland; Job Seekers Allowance (JSA) claimant rates vary eight-fold, from 12.2% in Grangetown ward to 1.6% in West Dyke ward. Of 22 wards in Redcar & Cleveland, 17 have JSA claimant rates above the England average.


Last updated: 03/10/14

2. What commissioning priorities are recommended?

Whole Council Action

1.  Growing our economy and creating more jobs

  • Attract more inward investment.
  • Help businesses thrive.
  • Increase suitable business premises.
  • Increase the rate of job creation.
  • Expand tourism activities and attractions to stimulate the local economy and increase job opportunities for local people.
  • Reduce the number of young people who are not in education, employment or training (NEET).
  • Address growing training needs and support to improve employability.
  • Help people of working age who are unemployed into work.

2. Developing great places to live

  • Develop at least 1,500 new homes over the period ending 2017.
  • Increase suitable accommodation for homeless young people.
  • Increase alternative housing options for vulnerable people.
  • Continue to reduce the overall the crime rate – even though it is slightly better than the national average – in order to prevent people’s lives being blighted by the fear of crime.
  • Increase opportunities to work together with partners on neighbourhood working.
  • Making universal services responsive and accessible by ensuring that services provided for all Redcar & Cleveland residents (libraries, leisure facilities, environmental services, etc.) are responsive to the needs of users and potential users, and are accessible to all, including those in vulnerable groups.

3. Improving quality of life

  • Reduce the life expectancy gap for both men and women between disadvantaged areas and more prosperous ones.
  • Reduce the number of people who still smoke and those who are taking it up.
  • Reduce the high rates of obesity and binge drinking, which are putting pressures on health and social care services.
  • Ensure continuous improvement in how vulnerable people are safeguarded.
  • Support people to live independent, long, happy and healthy lives, less reliant on services provided for them.
  • Increase the numbers of people who are physically active.
  • Improve transport and access to opportunities and services.


Last updated: 03/10/14

3. Who is at risk and why?

The prevalence of long-term illness increases with age.  Over half of people aged over 65 years in Redcar & Cleveland currently suffer from at least one long-term illness. They are also the main users of health and social care services.  In the working age population, long-term illness and service use are likely to be more common at older ages.

Men are less likely to access health or healthy lifestyle services or perform self-examination. Their life expectancy is generally shorter compared with women.

Women are significantly less physically fit than men, and fitness decreases significantly with age. The decline is steepest for men, although more males are physically fit in every age group.

Socioeconomic status
There is a strong link between levels of deprivation and health outcomes. Adults who live in the most deprived areas are more likely to die early, to experience in ill-health such as coronary heart disease and to have unhealthy lifestyles including higher rates of smoking, obesity and binge drinking.

The prevailing economic climate means pressure on household incomes is likely to be experienced throughout the population, with associated risks to physical and mental health and wellbeing.  While average incomes may remain higher in less deprived areas, the impact of changes in adults’ income relative to their past experience, or relative to those of neighbours in the immediate area, may carry its own risk in terms of its impact on the wellbeing of individuals and their families.

Adults from the black and minority ethnic communities are less likely to access services due to cultural and language barriers and more likely to experience health inequalities. They face more barriers to job seeking.

Adults with learning disabilities have an increased risk of premature death compared to the general population and often experience barriers in accessing services, which will impact on their health and wellbeing.

Adults with physical disabilities are more prone to mental health problems due to the problems they face as a result of their disability and the barriers caused by society.

Adults in contact with the criminal justice system are more likely to be socially excluded and experience high levels of health inequalities. They are more likely to suffer from mental health problems and learning disabilities, and to have problems with drugs and/or alcohol. The link between offending, reoffending and wider factors, including health, is widely recognised.

Identification of people at risk
The current increased focus on prevention, early intervention and personalisation means that identifying people at risk of future ill health will become central to the ability of commissioners to develop a system that will support local people to make healthy choices and take responsibility for their own health and wellbeing. Data on lifestyles is in its infancy, but early modelling work suggests that the areas with the lowest levels of deprivation do not always exhibit the highest prevalence of healthy lifestyle choices. These choices will in turn have an impact on the level of future risks in the population to health and wellbeing.

In considering a more individualised approach to identifying which adults may be at risk, two groups are highlighted:

  • Those at risk of experiencing a crisis event in the short-term which will have an impact on their need for care and support.
  • Those at risk of developing health problems in the longer-term due to their lifestyle, existing health status and/or demographic status.

Short-term crises
Adults with existing poor health or leading unhealthy lifestyles are more likely to experience a health crisis requiring intervention, treatment or support. In some cases their families are also at increased risk of a crisis event. For example:

  • Smoking, obesity or binge drinking increase the risk of heart attack.
  • Adults with diabetes have an increased risk of stroke.
  • Adults who misuse alcohol are proportionately more likely to become perpetrators of domestic abuse than the general adult population.
  • Adults with dementia have an increased risk of unscheduled admission to hospital.

Some of these adults are known to services before the onset of the crisis, but a substantial proportion of people at short-term risk of a health crisis are not. Identifying those at short-term risk will always present problems to services, but the development of a culture which supports self-care, early access to diagnosis and tests, and a non-stigmatised approach to seeking help will in turn support the identification of short-term risk.

Assessing the level of crisis events relating to economic factors is not straightforward, but research suggests a relationship between the onset of worklessness or economic hardship and health issues (Health Development Agency, 2005; Levecque et al, 2011; Solantaus et al, 2004):

  • There is a positive association between mortality and unemployment for all age groups, with suicide increasing within a year of job loss
  • During the anticipation and termination phase of factory closure, illness and health service use increase, the rate of hospital admissions doubles and conditions such as cardiovascular disease and higher blood pressure increase.
  • There is evidence to suggest a strong association between unemployment and depression. The link is stronger for younger adults, women, more highly qualified people, and people living alone. Upon re-employment, there appears to be a reversal of these effects.
  • Unemployment is considered to be a significant cause of psychological distress in itself.
  • There is an estimated 20% excess risk of death for both men actively seeking work and their wives, with the possibility that this may be higher still in areas of higher unemployment.
  • A reduction in family income increases the risk of children in the family developing mental health problems.

Long-term health risks
The links between lifestyle, health status and continuing health needs are complex.  Supporting adults to make and sustain healthy lifestyle choices for their long-term benefit is a key role of the health system.  The transition of responsibility for Public Health from NHS to local authorities provides an opportunity to refresh work on supporting healthy lifestyles and to build on Redcar & Cleveland’s strong record of working in partnership to deliver support across the system.

Obesity provides an example of one factor with an impact on long-term health, and with complex links to other factors. For example:

  • 29% of obese men and 36% of obese women have a limiting long-term illness (compared to 16% and 17% of those with a healthy weight) (DH, 2008).
  • Obese adults are at increased risk of some cancers, cardiovascular disease and diabetes.
  • People in a range of vulnerable groups (for example, those with learning disabilities, minority ethnic groups, and those in areas with the highest levels of deprivation) are proportionately more likely to be obese.
  • There is a link between adult obesity and child obesity. The link is in two directions: children of obese parents are more likely to be obese themselves, and obese children are more likely to become obese adults in the future. 
  • Maternal obesity presents additional health risks to the mother and child

Links between economically deprived communities and levels of long-term illness are well established, but there is additional evidence of links between individual economic hardship/ worklessness and the risk of developing long-term health conditions.  The impact of worklessness on physical and mental health does not appear to be related to the duration of the period of worklessness, and re-employment appears to reverse some of the effects of worklessness on psychological and psychiatric morbidity.  However, worklessness is one of a range of factors (such as eligibility for benefits) which does have an impact on household incomes and the incidence of poverty, and these are correlated with poor health and wellbeing. (HDA, 2005).  There is a positive association between mortality and unemployment for all age groups, with suicide increasing within a year of job loss, and cardiovascular mortality accelerating after two or three years and continuing for the next 10-15 years.

The incidence of long-term illness increases with age.  Reducing the incidence of long-term ill health or increasing the age of onset, through prevention or early intervention strategies, will reduce the overall ‘burden of ill health’ in Redcar & Cleveland and the effects of long-term ill health on wellbeing, service use, and the level of complexity.


Last updated: 02/10/14

4. What is the level of need in the population?

Redcar & Cleveland population
There are 79,500 people of working age in Redcar & Cleveland, about 59% of the total population compared with 61% in England (ONS, 2014).  About 21% are aged 65+ and 20% aged under 18 years in Redcar & Cleveland.

Vulnerable groups
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.

The following table estimates the number of people with vulnerabilities to poor health from selected causes in Redcar & Cleveland.

Estimates of the number of people aged 18-64 with selected conditions, Redcar & Cleveland, 2014


Estimated number

Learning disability


Moderate or severe learning disability


Autistic spectrum disorder


Moderate physical disability


Serious physical disability


Moderate or serious personal care disability


Serious visual impairment


Moderate or severe hearing impairment


Survivors of childhood sexual abuse




Wider determinants
About 14% of the working age population in Redcar & Cleveland has no qualifications, compared with 10% in England.

In Redcar & Cleveland, 11.3% of the working age population is unemployed, compared with 7.6% nationally (nomis, 2014).  The highest rates of unemployment are found in Grangetown, Coatham and South Bank wards.

Fuel poverty affect nearly one-quarter of households in Redcar & Cleveland.  Locally, there are nearly 90 ‘excess’ deaths during the winter months compared to other times of year.

The rural geography of East Cleveland leads to a perceived feeling or real risk of isolation among residents of those areas.  It can make access to education, employment and services more difficult for residents in those areas.

Behaviour and lifestyle
The Health Profile 2014 for Redcar & Cleveland shows smoking and obesity in adults are significantly worse than England.  Adult physical activity rates are also lower than England, but the difference is not statistically significant (PHE, 2014).  Binge drinking rates are significantly higher than England (LAPE, 2014).

Adult lifestyle summary Redcar & Cleveland

It is estimated that in the working-age population in Redcar & Cleveland, there are 4,700 with alcohol dependence and 2,700 dependent on drugs (PANSI, 2014).


Illness and death
The main causes of death in the working age population are cancer and circulatory diseases.  Each year in Redcar & Cleveland, about 90 people aged under 65 die due to cancer and about 50 due to circulatory diseases.   Death rates from these two disease are higher in Redcar & Cleveland than England.

Deaths under 65 from cancer and CVD, Redcar & Cleveland, 2010-12

Premature mortality is defined in terms of deaths aged under 75.  The following chart shows the number of premature deaths that would need to be prevented for Redcar & Cleveland to achieve similar rates to the North East and England.

Deaths under 75 from major causes, Redcar & Cleveland

The following table estimates the number of adults with selected diseases and health outcomes in Redcar & Cleveland.

Estimates of the number of people aged 18-64 with selected diseases and health outcomes, Redcar & Cleveland, 2014


Estimated number

Longstanding health condition caused by a stroke




Common mental disorder




Early onset dementia





Last updated: 03/10/14

5. What services are currently provided?

Universal services – available to all

  • NHS healthcare
  • Health promotion (smoking cessation, health advice)
  • Leisure services (sport, arts, libraries)
  • Adult education
  • Benefits advice and some universal benefits (for example, child benefit)
  • Environmental services (roads, green space, waste disposal, street cleaning)

Targeted services – available to individuals or communities meeting specific criteria

  • Employment support/ jobseekers’ services
  • Benefits (tax credits)
  • Support for families (Sure Start centres, after school clubs)
  • NHS healthcare
  • Community development
  • Economic development
  • Supporting diversity (translation, targeted health intervention)

Specialist support

  • Personalised packages of health and/or social care for people with complex needs, living at home or in a care home.

For a more comprehensive list of services, see individual topics.

Last updated: 03/10/14

6. What is the projected level of need?

Redcar & Cleveland population
Population projections from the Office for National Statistics show that the working age population will fall in Redcar & Cleveland, both in absolute numbers and as a proportion of the total population.

Redcar & Cleveland working age population projection, 2015-2030

Vulnerable groups
The following table shows forecasts of the number of people with vulnerabilities to poor health from selected causes in Redcar & Cleveland.  Within the working age population, the number of people in these vulnerable groups is forecast to fall slightly.  This is a reflection of the reduction of the number of people of working age.

Forecasts of the number of people aged 18-64 with selected conditions, Redcar & Cleveland, 2015-2025





Learning disability




Moderate or severe learning disability




Autistic spectrum disorder




Moderate physical disability




Serious physical disability




Moderate or serious personal care disability




Serious visual impairment




Moderate or severe hearing impairment




Survivors of childhood sexual abuse






As the proportion of older people increases, within the working age population it is likely that an increasing number of people will have to adopt caring roles to support their older relatives.

Wider determinants
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, 2012).

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.

Behaviour and lifestyle
Dependence on alcohol and drugs is forecast to reduce in this age group.

Forecasts of the number of people aged 18-64 with selected lifestyle behaviours, Redcar & Cleveland, 2015-2025

Lifestyle behaviour




Alcohol dependence




Dependent on drugs






The are no reliable forecast for many behaviours.

  • Smoking rates have decreased in recent years, more so for men than women.  It is likely that this reduction will continue.
  • Obesity rates have been increasing and this trend seems likely to continue.

Illness and death
For all ages, cancer incidence is forecast to rise and cancer mortality is forecast to fall.  Both coronary heart disease (CHD) prevalence and chronic obstructive pulmonary disease (COPD) prevalence are forecast to rise for all ages.  There are no specific forecasts for the working age population.

Forecasts of the number of people aged 18-64 with selected diseases and health outcomes, Redcar & Cleveland, 2015-2025

Lifestyle behaviour




Longstanding health condition caused by a stroke








Common mental disorder








Early onset dementia





Projections suggest that about 3,940 working age adults in Redcar & Cleveland will require personal care in connection with a moderate or serious disability by 2020, similar to the current figure of 3,990. The take up of personal budgets has been high suggesting that people are exercising significant choice and control in support provision.


Last updated: 03/10/14

7. What needs might be unmet?

Vulnerable groups

Learning disabilities

  • The majority of people with learning disabilities are not currently known to services. Information about people with learning disabilities in Redcar & Cleveland is incomplete and a detailed mapping exercise to increase understanding of the circumstances of local people would assist with strategic planning.
  • There is currently a lack of support for people with more complex health needs to provide access to community-based resources.


  • Universal community services and facilities could be developed to be more accessible to people with autism. The development of an understanding of the needs of people with autism and provision of reasonable adjustments in universal services will support people to achieve maximum independence in the community.
  • There has been a significant reliance on out of area educational and residential placements to meet the needs of people with complex support needs that could not be provided locally.

Physical disabilities

  • Independent assistance with support planning has been used in the past but is no longer widely available. This may be needed to maintain the continued high levels of uptake of direct payments.
  • Arrangements for the choice and support in the recruitment and employment of personal assistants could be improved.
  • There is an under supply of accessible single person and shared accommodation in suitable locations.

Sensory disabilities

  • Local information about how people with visual and hearing disabilities access support (and the intended outcomes) is incomplete. There is a gap in information on the use of individual budgets and also a lack of information from local people about their experiences, which could be used to inform strategic planning.
  • More suitably located and adapted accommodation should be available.

Sexual violence victims

  • There needs to be an information-sharing protocol (to include anonymous intelligence and third party reporting) between sexual violence service providers.
  • Commissioners and service providers lack clear plans for engaging individuals or groups representing BME communities in sexual violence work.
  • There is a gap between sexual violence and learning disability service providers limiting the service effectiveness for people with learning disabilities who have experienced sexual violence.
  • Non-sexual violence specific services, such as sexual health, general practice, emergency services/A&E, mental health, drug and alcohol and lesbian and gay agencies could improve the identification, recording, flagging and monitoring of sexual violence in to better co-ordinate support.
  • There is insufficient feedback from individuals that reflects their experiences for the entire victim journey.

Domestic violence victims

  • There is no guaranteed funding secured for the provision of services to support victims or perpetrators of domestic violence.
  • There appears to be an increasing number of referrals to Multi-Agency Risk Assessment Conferences (MARAC) which are not reported to the Police.
  • MARAC cases are only the tip of the iceberg. The full picture is difficult to establish due to the large number of hidden victims, who do not come forward for help.


  • Only a small proportion of the people who considered themselves to be carers in the 2011 census are known to Adult Social Care or are in receipt of services.
  • There is little information about the needs of carers from BME backgrounds; carers in work or seeking to return to work; and carers of people who have drug and alcohol problems.
  • Information services are provided at a higher level in Redcar & Cleveland and more tangible services at a lower level compared to other areas.  Many carers may require additional, non-information services.

End of life care

  • 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.

Ex-forces personnel

  • 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.


  • Unmet needs to be identified


  • Maintenance costs are rising due to the age of the travellers site. The existing units need to undergo complete refurbishment.


  • Offenders are more likely to suffer from mental health problems, have a learning disability and take part in risk taking behaviour
  • They are disadvantaged when it comes to accessing appropriate housing and employment.
  • Co-ordinated and targeted support is a significant issue for those in the criminal justice system, and those who are released into the community, which includes the opportunities available to their families also.

Wider determinants


  • The fear of crime and the perception of crime remains an issue.
  • The reporting of hate crime remains low. There needs to be increased awareness in relation to the impact of hate crime and social isolation.


  • About 11,000 working age adults have no qualifications, limiting their opportunities.


  • There is with the limited capacity in programmes available for those seeking employment.  Welfare reform is forcing more people into the labour market and these programmes are unlikely to meet the needs of a growing number of clients.
  • As voluntary and community groups lose funding, those clients who need specialist help finding less help available.  The needs of groups furthest from the labour market is projected to rise, but the support in place to meet these needs is likely to fall.


  • An average of 88 additional people die each winter in Redcar & Cleveland. Their needs for more appropriate housing and care may contribute to this.


  • There is an unmet need for about 130 affordable home each year in Redcar & Cleveland.  In five years, this would create a shortfall of 650 affordable homes.
  • There is an unmet need for affordable housing for single people aged under 25.
  • The limit to Housing Benefit for working-age households living in under-occupied social rented housing and the increased age threshold for the shared room rate of Local Housing Allowance have the potential to severely limit the already pressurised supply of accommodation for people aged under 35.


  • Not all benefits are claimed by those who are entitled to them. 
  • There is an unmet need for food.  Food banks in Redcar & Cleveland provide for households which cannot afford sufficient food.
  • There are many more people seeking work than job vacancies.


  • The ‘Dial a Ride’ service has been withdrawn and is replaced by a travel voucher scheme to support disabled residents to meet some of the costs of using alternative travel providers such as accessible taxis. It is not yet known if this has had an impact on the opportunities for disabled people to use services.
  • As the cost of oil continues to increase, low or no cost alternatives for the most at risk will need to be made available.

Behaviour and lifestyle

Alcohol misuse

  • Not all partnership staff have undertaken the e-learning Information and Brief Advice training about levels of drinking and associated risks.
  • There is insufficient local provision for dependent drinkers to access community-based treatment.

Illicit drug use

  • Additional consultation with service users is required to better understand unmet needs.


  • Too many 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 and community workers in smoking awareness and brief interventions. Positive role models need to be identified to emphasise the 'no smoking being the social norm' message.
  • Many pregnant women continue to smoke, thus failing to give their child the best start in life.
  • Many non-smokers continue to suffer the effects of second-hand smoke, particularly at home and in private cars.
  • 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.
  • The development of a model of working in the Stop Smoking Service (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 the New Routes to Quit options.

Diet and nutrition

  • Interventions for families such as antenatal classes, breastfeeding support groups and weaning groups are underutilised by those least likely to follow national advice.
  • 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.
  • There is a need for capacity and capability building in Redcar & Cleveland 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 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.
  • It is likely that people living in deprived areas may face additional barriers to a healthy diet putting them at greater risk of diet-related disease such as obesity, type two diabetes, CVD and poor oral health.

Physical inactivity

  • Declining participation in organised group sport and active leisure, could undermine the viability of clubs and leagues, leading to a further decline in opportunities and participation levels.
  • Activities currently taking place in school facilities or privately owned facilities may be reduced by removal of the opportunity, particularly arising from security and health and safety concerns.
  • Participation in active leisure in subsidised or commercial facilities, including pools and gyms, may be restricted by economic pressures and increased costs. The age and condition of some leisure centres is a concern and significant investment is required just to maintain these buildings at their current levels.
  • Reductions in subsidy to public transport may also increase barriers to participation for some forms of active leisure.


  • There is inadequate capacity building within the workforce to ensure frontline staff are trained to raise the issue of weight and offer appropriate interventions and support.
  • There is a lack of preventive services particularly focusing on a life course approach.
  • Targeted weight management service provision is required for those identified at risk in adult and child populations (i.e. BME communities; learning disabilities; maternal obesity; men; areas of high deprivation; specialist weight management support and for people with mental health needs).
  • Connection of weight management pathways and services is required, and stronger links to be made with Map of Medicine and CCG’s to ensure a co-ordinated approach.
  • If current prevalence trends continue, demand for weight management services will outstrip capacity.

Sexual health

  • Sexual health support services for young men and teenage fathers are not being provided.
  • There is inequity of access to sexual health services in Redcar & Cleveland, including for BME groups and for people living in East Cleveland.

Illness and death


  • There is a need to ensure all people eligible for cancer screening programmes are aware of the benefits of attending.
  • Late presentation can affect treatment outcomes. There is a need for improved community awareness of signs and symptoms.
  • Some general practitioners may need additional support to assist with appropriate referral mechanisms.

Circulatory diseases

  • There are gaps between actual and estimated prevalence with some CVD-related conditions.
  • There is low uptake of the NHS Health Check programme in some population groups, most notably men and people living in deprived neighbourhoods.
  • Emergency admissions indicate unmet need.

Diabetes mellitus

  • There is no routine, ongoing assessment of diabetes-related educational need.  Structured education programmes limited to those newly diagnosed.
  • People at risk of developing diabetes are not being systematically identified. When they are, many people still continue to progress to develop diabetes.
  • Despite the introduction of systematic review for patients, diabetes complications rates remain high.


  • There is a need to assess the needs of the working age population.

Mental and behavioural disorders

  • There is no comprehensive rehabilitation and recovery support pathway.
  • There are limited long-term innovative support opportunities.
  • There is a limited range of crisis provision.
  • There is a need for specialist inpatient and rehabilitation personality disorder services.
  • Access to all NICE accredited talking therapies across all tiers of mental health is required.
  • Some communities are poorly served by mental health support services.
  • There is a need for early detection and intervention for people with mental health problems accessing acute hospital services.

Oral health

  • Oral cancer screening may be targeted insufficiently.
  • There is a need for behaviour management services to reduce sedation rates.

Respiratory diseases

  • The capacity and capability of current services needs to be increased to cope with the projected increase in the number of people with COPD.
  • There is low awareness of lung health and COPD in communities that are at high risk (for example current and ex-smokers and women).
  • There is inequitable access to high quality spirometry in primary care and community settings.
  • Inappropriate admissions imply unmet need for continuing care and education and support for patients.
  • Emergency admission rates are higher than England; there is need to explore the reasons.
  • There is limited access in terms of capacity and location to supported self-management programmes based on Expert Patient evidence.
  • Many people with COPD don't have an end of life care plan.

Self-harm and suicide

  • There is a need for workforce development and for commissioned services to move to long-term commitments.
  • There are unmet client needs regarding counselling, pathway development and service linkage and a lack of ‘floating support’ to provide immediate input while patients are waiting to be seen by other services.
  • There is a need to tackle stigma and raise awareness in the population, especially in some population groups.



Last updated: 03/10/14

8. What evidence is there for effective intervention?

Institute of Health Equity (2010). Fair Society, Healthy Lives (the Marmot report)
An independent review to propose the most effective evidence-based strategies for reducing health inequalities in England.

NICE (2005). Worklessness and health - what do we know about the causal relationship? Evidence review.
Review of evidence of the causal relationship between worklessness and health

National Obesity Observatory (2010). Tackling Adult Obesity Through Lifestyle Change Interventions: A briefing paper for commissioners.
A brief guide to current best available evidence on the effective treatment of obesity through lifestyle change interventions for adults who are overweight or obese

Department of Health (2011). Mental health promotion and mental illness prevention: The economic case.
Findings of a project on the economic case for mental health promotion and prevention, based on a detailed analysis of costs and benefits for fifteen different interventions.

Topic-specific evidence is available throughout the JSNA


Last updated: 03/10/14

9. What do people say?

In the autumn of 2012 Redcar & Cleveland Borough Council undertook a residents’ survey. This survey captured the views of 2,104 residents on a range of issues from their satisfaction with the local area to the impact of the economy on the local area.  Results have been rounded, therefore may not add up to 100%.

Health and wellbeing
The Residents Survey included a short section of questions on health and wellbeing. These questions were agreed in discussion with Adults and Children’s Services Management team. The survey asked residents about their views on smoking and alcohol and the impact they had on health and well-being. In addition to this, the survey also asked residents about how satisfied they were with a range of care and support services.

This section explored issues about health and wellbeing with respondents. Here respondents were asked about whether they smoked or not. The majority (62%) said they did not smoke, whilst 19% said they used to smoke and had given up and 15% said they currently smoked.

Respondents who said that they had given up were asked to identify how they quit smoking. This question allowed respondents to choose more than one answer, therefore the responses are ranked. The data shows that the majority of respondents had given up on their own. The table below gives a breakdown by number of responses.

Method of giving up smoking, Redcar & Cleveland, 2012


No of Residents

Given up on your own (cold turkey)




Over the counter products (e.g. patches)


Stop Smoking Service drop in


Local pharmacy


Source: Redcar & Cleveland Residents’ Survey 2012


Respondents were asked ‘what made you decide to give up?’ The top two reasons respondents gave, were cost and health reasons.

The impact of alcohol
The survey asked respondents to think about the impact of alcohol on a range of illnesses and symptoms. Respondents agreed that alcohol greatly increases coronary heart disease (65%), depression (57%), cancer (46%), stroke (56%) and gaining of weight (66%).

Satisfaction with Council services
The following table gives a breakdown of satisfaction with Council services linked to adult and children’s support and care. It does not include those who were neither satisfied nor dissatisfied.

Type of service

Very or fairly


Very or fairly


Don’t know

Parks and green spaces




Sports/leisure facilities




Care and support for children and young people




Care and support for older people in a residential home




Care and support for older people in their own home (domiciliary care)




Care and support for disabled people




Results have been rounded therefore may not add up to 100%.


Quality of green spaces (physical activity)
Residents were asked about how they rate the quality of their nearest green space (park, playing field, amenity grassland). More than two-thirds (67%) felt that the quality of the nearest green space was good or very good. Nearly one-in-five (11%) rated the quality of their nearest green space as poor or very poor.

Resident assessment of green space quality, Redcar & Cleveland, 2012

Frequency of Council service use

The survey asked respondents how often they frequented the following service that are provided or supported by the Council. These services were:

  • Recycling centre/points
  • Parks and green spaces
  • Local libraries
  • Museums/ galleries
  • Sports and leisure facilities (includes swimming pools)

The service most commonly visited at least once a month was parks and green spaces (48%), followed by sport and leisure facilities (24%) and libraries (22%).  A high proportion of people never used many services. The following table gives a breakdown for each of the services.

Resident use of council-supported services, Redcar & Cleveland, 2012


At least once a month

Within the last 3 months

Within the last 6 months

Within the last year

More than a year ago

Never used

Does not apply / Don’t know / no answer

Recycling centre/points








Parks and green spaces








Local libraries








Museums/ galleries








Sports and leisure facilities








Results have been rounded therefore may not add up to 100%.


Current economic climate (mental health)
Respondents were asked to think about the current economic climate and whether they had been affected by financial difficulties in the last 12 months. Most respondents indicated that they will not be able to afford to go on holiday, or would have difficulties in paying fuel and energy bills, and they had insecurities about losing their job.



Last updated: 03/10/14

10. What additional needs assessment is required?

Content under development

Last updated: 12/10/11

Key contact

Name: Mark Adams
Job title: Assistant Director of Public Health
Phone number:  01642 771751


Local strategies and plans

Redcar & Cleveland Health and Wellbeing Strategy 2013-2018
Redcar & Cleveland Borough Council (2012). Our Plan 2012-17
NHS South Tees Clinical Commissioning Group (2012). A Clear and Credible Plan for Commissioning Health Services for the Populations of Redcar and Cleveland and Middlesbrough 2012-2017
Redcar & Cleveland Borough Council (2013). Redcar & Cleveland Public Health Annual Report 2013

National strategies and plans

Marmot Review (2010). Fair Society, Healthy Lives.


Other references

Public Health England (2014). Public Health Outcomes Framework
Public Health England (2014). Health Profiles for Redcar & Cleveland