HEALTH INEQUALITIES

REGIONAL APPROACH

Prepared by Yorkshire and the Humber NHSDate 16th May 2008

Paul Johnstone

Regional Director of Public Health

NHS/DH Yorkshire and the Humber

• Y&H has some of the worst health inequalities of any region - both between and within the region

• 7/14 PCTs are Spearhead areas

• Non spearhead areas have significant inequalities

• Target – to reduce inequalities in health by 10% by 2010 as measured by infant mortality and life expectancy at birth

All Age All Cause Mortality rates per 100,000 people (2002-2006), at a Middle Super Output Area level: Y&H

• New SHA in 2006 placed tackling health inequalities and meeting the 2010 targets as a top priority

• Built on existing strategy by previous RPHG, SHAs Govt Office, Regional Assembly, RDA

• Twin track approach

- NHS action

- Supporting LSP/negotiating LAAs priorities

Track 1 - NHS

• Used National Support Team visits and methodology

• Each PCT identified local priorities and NHS action needed supported by APHO and PHO tools (web link)

• SHA Chief Executive asked that all PCT CEx have a health inequalities objective.

- Ensured agenda was mainstreamed in NHS

- Most focused on smoking, statins.

- But some significant differences

• Each set a target which is measurable, industrialising intervention (1-2) which will make a difference in AAACM and narrow the health gap meeting 2010 targets.

Track 2 - LAA

• Regional PH team (based in GO and SHA) work as one whole system.

• Governance – Engine Room

• Enabled 3rd and 4th round LAAs to be drawing from same health inequalities information

National health inequalities 2010 PSA life expectancy target*: progress at 2004-06

Spearhead PCT

Department of Health 2010 PSA inequalities update (Dec 2007) YHPHO Forecast

Males Females Males Females

Hull Off-Track Off-Track Off-Track Off-Track

Barnsley Off-Track Off-Track Off-Track On-Track

Rotherham Off-Track Off-Track Off-Track On-Track

NE Lincolnshire Off-Track Off-Track Off-Track Off-Track

Doncaster Off-Track On-Track Off-Track On-Track

Bradford Off-Track Off-Track Off-Track Off-Track

Wakefield Off-Track Off-Track Off-Track Near-Track

Y&H Spearheads Off-Track Off-Track Off-Track Off-Track

*10% narrowing of life expectancy relative gap between Spearhead areas and England from 1995-97 baseline and 2009-11 target

Components of an effective regional system

• Regional vision - SHA and CEx for NHS actions - Local Govt and GO- one of 4 objectives - Regional Assembly and RDA- one of 8 objectives• information – - Needs assessment -central role of PHO and intelligence leads network - Performance information especially AAACM• Core SHA business - performance, workforce, clinical, PCT reviews• Core GO business - PH team part of wider cross GO negotiating teams• Governance- Engine room• Method- for NHS NSTs and emerging JSNAs• Sharing best practice - Fdor CEs - For other partners• New DsPH network

Is it making a difference

• Inequalities now mainstreamed in SHA business

• Clinical engagement through DARZI

• More focused on industrialising- clear evidence of this happening

• Beginning to see improvement in the data

• Use of social marketing and QOF

Local Action – Prostate Cancer

• Social norms - role model• Linked to community events –

Fireman’s Fete• Effective placement stories• Developed partnerships; now on

back of buses• Link with Services - Men’s Health

MOTs at local drop-in

BEER MATS