Joint Forward Plan Appendix 1

Joint Forward Plan Appendix 1: Summary of the Essex and Suffolk Joint Strategic Needs Assessments.

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1. Essex Joint Strategic Needs Assessment (JSNA)

The major highlights set out in the Essex JSNA are:

Influencing conditions and behaviours linked to health inequalities

Life expectancy in Essex – at 80.1 years for males and 83.4 years for females – has decreased. The gap in life expectancy between the most
and least deprived areas of Essex has widened to 7.5 years for men and 5.8 years for women.

16.4% of children in Essex live in low-income families. While this is below the England average, this ranges from 7.9% of children in
Uttlesford to 24% in Tendring.

There are four main causes of death which contribute to over two thirds of the life expectancy gap between the most and least deprived
communities in Essex; circulatory disease, cancer, respiratory conditions, and digestive disorders are the main areas driving the
differential life expectancy gap between communities in Essex.

Combined, these four broad causes of death account for c.70% of the gap between those living in the least and most deprived areas of the
county.
Access to and the quality of the care a person receives is estimated to contribute to c. 20% of health outcomes. Many factors can impact care access and quality including effectiveness, efficiency, equity, and safety. The level of patient centred care provided is also a key contributor.

Enabling and supporting people with long-term conditions and disabilities In Essex, the forecast growth in over 65s in the next decade is 28%, with a 55% rise projected in the over 85s age cohort. Essex County Council supported 3,850 people with dementia during 2016/17,
providing services to c.2,640 people at any given time. 32% of admissions to residential care were for people known to have dementia.

17% of the population in Essex reports that they have a health problem or disability that limits their day-to-day activities and has lasted, or is expected to last, at least 12 months (2011). 38.5 per 1,000 of working age people in Essex received Disability Living Allowance in 2014.

The NHS Health Check is a health check-up for adults in England aged 40 to 74. It is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and/or dementia. At 74%, Essex has a significantly greater uptake of invites going out to the
eligible population, with around 46% of those taking up the offer of a health check. Nationally, this rate is lower, at 56%.

Whilst this take up rate has historically been better than the national average, the Essex rate has been dropping in recent years. As the
NHS Health Checks programme targets prevention work at some of the key drivers of the gap in health inequalities, further investigation on
uptake variance between deprivation areas and other vulnerable groups could help inform action on closing the health outcomes gap.

Improving Mental Health and Wellbeing

• 8.7% or 17,390 children and young people aged between 5-16 years have a mental disorder
• 16% of the population aged 16-74 across Essex has a common mental health disorder
• Up to 40% of some groups of older people have depression Suffolk and North East Essex Integrated Care Board – Joint Forward Plan 2
• 25,290 people in Essex are in contact with specialist mental health services; 4,385 on a Care Programme Approach and 160 subject to the Mental Health Act
• There is a 72.5% gap in the employment rate between those in contact with secondary mental health services and the overall employment rate. This ‘employment gap’ is growing and is significantly worse than the overall rate for England (67.4%)
• Essex has a suicide rate of 10.7 per 100,000 of population – 16.6 per 100,000 males and 5.4 per 100,000 females
• Suicide rates in Essex are higher than national and regional averages and have been increasing over the past two decades. The highest rates are in the more deprived areas of the county
• The mental health of children and young people has been particularly impacted by the Covid-19 pandemic. A national survey reports that 80% of young people with pre-existing mental health needs experienced an exacerbation and the development of new issues because of the crisis. Isolation, stress, and family relationships all contribute to anxiety and poor emotional wellbeing
• Certain groups who experienced more negative impacts due to Covid-19 were children
  o with disabilities – including health conditions and Special Educational Needs and Disabilities (SEND)
  o from ethnically diverse backgrounds
  o with pre-existing mental health problems
  o in care and care leavers
  o in the secure estate who were unable to see their families
  o in poverty

Addressing Health Behaviours

• Around a third of health outcomes for an individual can be traced back to lifestyle behaviours including tobacco use, nutrition, levels of physical activity and alcohol intake. Healthy Behaviours in SNEE is detailed in Section 5.6.3.1 of the JFP document
• Around 1 in 3 of 10- to 11-year-olds and almost two thirds of adults in Essex are overweight or obese
• Over 250,000 adults in Essex are physically inactive
• Whilst comparable to the national benchmark, with over 60% of adults being overweight or obese this is still a major health issue which can have consequences in the short and long term
• 6.3% of adults (17+) have a recorded diagnosis of diabetes
• Improving uptake of health and care services aimed at early detection and prevention can help drive key health promoting behaviours. Examples include quitting smoking, reducing substance misuse, and maintaining a healthy weight. One critical health behaviour impacting early life is smoking in pregnancy
• Drug misuse is a significant cause of premature mortality in the UK. Whilst rates in Essex have levelled off in recent years and track below the national trend, there inequalities remain wide across the county

Social determinants of health

• Around 76% of the working age Essex population is employed
• Childhood poverty leads to premature mortality and poor health outcomes for adults. 19% of children in Tendring re from lowincome families
• Public health services play a significant role in tackling violence, including crime reduction, violence prevention, responses to violence and reducing levels of reoffending, which can also prevent health inequalities
• Loneliness can have profound consequences for an individual’s well-being, and their ability to function in society. Feeling lonely is frequently linked to hospital readmissions, with longer stays requiring residential care and more frequent visits to GPs and the ED
• Across Essex c.20% of residents report feeling lonely often, always, or some of the time

2. Suffolk Joint Strategic Needs Assessment

Many people in Suffolk currently enjoy relatively good health and wellbeing. However, relative deprivation in Suffolk has increased over
recent years. Deprivation is hard to measure in Suffolk, due to the rurality of much of the county and the sparsity of some population
groups.14.5% of households live in fuel poverty. Full time workers living in Suffolk earn on average £40 less than the UK average.

Typically, Suffolk residents live longer than the national average and females live longer than males. Life expectancy at birth in 2018-20 was 84.1 years for females and 80.7 years for males in Suffolk. This is statistically significantly higher than the figures for England (83.1 years for females and 79.4 years for males).

Life expectancy in Suffolk has increased for both males and females over the last ten years. However, the latest data indicates that this
increase has slowed, and potentially stalled. Additionally, the most recent data indicates that healthy life expectancy is declining.

Children

Levels of educational attainment in the county are improving for some ages. However, they require further sustained improvement.

• More than 1 in 3 children aged 10-11 were overweight or obese in 2021/22
• One in five children aged 4-5 were overweight or obese in 2021/22
• Over half of children in Suffolk aged 5-16 (58.0%) are not active enough and do less than 60 minutes of physical activity each day (2020/21)
• 3% of 16–18-year-olds are not in education, employment, or training (October 2022)
• 7.6% of women smoke whilst pregnant and 1 in 5 mothers were obese in early pregnancy (2018/19)

Adults’ Health and Wellbeing

In 2018-20, healthy life expectancy among Suffolk residents was 67 years among males and 64.4 among females. Male healthy life expectancy is statistically significantly higher compared to England. For females, the figure is aligned to the national average. Males and females in Suffolk can expect to live over three quarters of their life in good health.

There are persistent inequalities in life expectancy for those living in the most deprived areas in Suffolk. 2018-20 data indicates that men living in Suffolk’s least deprived areas can expect to live 7.4 years longer than men in the most deprived areas. The gap is 5 years for females. This is driven in part by differences in behavioural risk factors such as obesity and smoking and disease prevalence such as
circulatory and respiratory conditions, cancers, as well as differences in exposure to wider determinants of health, for example poverty and housing.

Social mobility in some parts of Suffolk is low. Data from 2017 suggests that 4 out of 7 of Suffolk’s districts and boroughs were in the
lowest 20% for social mobility at that time.

In 2019/20 there were c.4,200 new cases of cancer in Ipswich and East Suffolk Clinical Commissioning Group (CCG) and West Suffolk CCG. National evidence indicates that approximately 4 in 10 cancers can be prevented by not smoking, maintaining a healthy weight, and eating a healthy diet. Over 1,860 deaths a year are attributable to physical inactivity in Suffolk.

In 2020/21, 62.9% of adults were overweight or obese and 30,000 people had coronary heart disease.

Older People’s Quality of Life

Suffolk is characterised by an ageing population with almost 1 in 4 of its population currently aged 65 or older. In 20 years’, time this will be closer to 1 in 3. This is likely to increase local health and care need, particularly in relation to frailty. 7,200 people aged 65 and over live with dementia (2020), further increasing demand for services.

It is projected that the number of people living with dementia will increase to c.23,000 by 2040. This increase is driven by the ageing population as dementia is more common among older people, in particular females aged over 75.

Mental Health and Wellbeing

Mental ill-health in Suffolk is increasing, reflected in rising rates of diagnosis and self-harm. However, this may also be in part due to
increased recognition of poor mental health.

Hospital admissions due to intentional self-harm have increased in Suffolk in recent years; in 2020/21 the all-age emergency admission rate in Suffolk was significantly higher than England. Areas of higher deprivation have greater admission rates. The highest admission rates
were seen in areas of Ipswich and East Suffolk (in the Lowestoft area).

There were 57 drug related deaths in 2021. In addition, 2020/21 data indicates 9.4% of people aged 16 or over in Suffolk had a low happiness score, statistically like England.

Between 2019-2021 there were 208 deaths by suicide in Suffolk, equating to a rate of 10.4 per 100,000 population, statistically like
England.