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					Ealing Joint Strategic Needs Assessment update 2009-10.                 Page 1 of 105
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  Ealing Joint Strategic Needs Assessment (JSNA)




                                2009-10 update

                    Part One: Summary JSNA, pages 1 – 33 of 105




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                                             Contents of Part One

1.  Summary of the JSNA 2009-10 ....................................................................... 3
  1.1. Context and Partnerships ........................................................................... 3
  1.2. Developing and using JSNA ....................................................................... 3
  1.3. Key points from the JSNA ........................................................................... 4
2. Introduction to the JSNA................................................................................. 4
  2.1. What is needs assessment? ....................................................................... 6
  2.2. Consultation, engagement and equalities ................................................... 7
  2.3. Criteria for setting priorities ......................................................................... 8
3. Ealing: people and place ................................................................................. 9
4. Health in Ealing.............................................................................................. 11
  4.1. Summary measures of health ................................................................... 11
  4.2. Healthy life-styles ...................................................................................... 12
  4.3. Coronary heart disease............................................................................. 12
  4.4. Stroke ....................................................................................................... 12
  4.5. Diabetes ................................................................................................... 13
  4.6. Cancers .................................................................................................... 14
  4.7. Tuberculosis ............................................................................................. 14
  4.8. Mental Health............................................................................................ 15
  4.9. Alcohol ...................................................................................................... 16
  4.10. Sexual health ............................................................................................ 17
5. Ealing’s Neighbourhoods ............................................................................. 18
  5.1. Ealing & Acton .......................................................................................... 18
  5.2. Southall..................................................................................................... 18
  5.3. Northolt and Greenford, including Perivale ................................................ 19
  5.4. West Ealing .............................................................................................. 19
6. Children and young people........................................................................... 21
  6.1. Child and maternal health ......................................................................... 21
  6.2. Young people and substance misuse ....................................................... 22
  6.3. Looked after children ................................................................................ 22
  6.4. Child and Adolescent Mental Health ......................................................... 22
  6.5. Children with Additional Needs ................................................................. 23
  6.6. Key issues for public health and commissioning: ...................................... 23
  6.6.1. Be Healthy ................................................................................................ 24
  6.6.2. Stay Safe .................................................................................................. 24
  6.6.3. Enjoy and Achieve .................................................................................... 24
  6.6.4. Make a Positive Contribution .................................................................... 24
  6.6.5. Achieve Economic Well-being ................................................................... 25
7. Adults of working age ................................................................................... 26
  7.1. Mental health ............................................................................................ 26
  7.2. Substance misuse .................................................................................... 27
  7.3. Long Term Conditions, Physical disabilities, sensory impairment.............. 28
  7.4. Learning disabilities .................................................................................. 29
  7.5. Carers ....................................................................................................... 32
  7.6. Older people ............................................................................................. 33




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                   Ealing Joint Strategic Needs Assessment (JSNA)

                                      2009-10 update

1. Summary of the JSNA 2009-10
1.1.    Context and Partnerships

Ealing‟s Joint Strategic Needs Assessment 2008 – 11 is updated annually by NHS
Ealing and Ealing Council. This update document notes emerging or changing
factors and restates issues of continuing importance. The JSNA underpins NHS
Ealing‟s Strategic Plan and the forthcoming Joint Health and Wellbeing and Health
Inequalities Strategy.

NHS Ealing and Ealing Council are in the process of developing a joint Heath
Inequalities and Well-being Strategy to address long-standing health inequalities in
terms of determinants of health (e.g. income, housing, education), lifestyle, access to
services and health outcomes (mortality and illness).

The JSNA will also underpin the Children and Young People‟s Plan, which will be
produced by the new Children‟s Trust Board, and which will focus on a number of
partnership priorities for joint working. The Children‟s Trust Board was re-launched
in September 2009 having been updated to meet the new national legislative
requirements.

There are major changes in national policy, in particular personalisation which will
give social service users more choice and direct control over meeting their needs. In
Ealing, the impact of this policy is mostly in relation to adult services.

1.2.    Developing and using JSNA

            Producing a JSNA is a statutory duty on local authorities and PCTs.
            The JSNA assesses the needs of local people, looking ahead 3 – 5
             years and beyond where possible. It underpins the strategic direction of
             health and social care services for adults and children.
            The JSNA ensures that services are shaped by local communities. It
             helps to tackle inequalities and promote health, well being and social
             inclusion.
            The JSNA will underpin the Sustainable Communities Strategy, the
             Children and Young Person‟s Plan, the Health Inequalities and Well-
             being Strategy and other relevant plans and will provide a data bank of
             relevant information.
            The JSNA will influence commissioning, but is not in itself a detailed
             commissioning plan.
            Through the Health and Well-being Board and the Children‟s Trust
             Board, the Local Strategic Partnership oversee production, monitoring
             and evaluation of the JSNA.




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1.3.    Key points from the JSNA

Ealing‟s population grew from 305,000 to 309,000 between 2007 and 2008. These
figures have been contested by local sources and there is a strong case for arguing
that the figures are understated. The size of Ealing‟s population is the strongest
determinant of need for health services in the future.

Population growth is occurring at both ends of the age spectrum, with longer life
expectancy and increasing births. There are plans for new primary schools and there
is a continual need to monitor the capacity of maternity units.

There are large health inequalities, marked by differences between wards or
neighbourhoods in terms of deprivation, life expectancy, mortality and use of health
and social care services. A separate chapter of the JSNA update outlines the key
health inequalities and criteria for prioritising these in the Heath Inequalities and Well-
being Strategy.

The major issues of health, well-being and delivery of effective services have not
substantially changed in the last year. Key areas are covered below and are reflected
in NHS Ealing‟s Strategic Plan for 2010 – 13.

Ealing has seen a large increase in hospital admissions for alcohol-related conditions
over the last five years. Regional and national trends have also been upwards, but
Ealing has seen a steeper rise and admissions are the highest of all London
Boroughs.

2. Introduction to the JSNA
Ealing has high average levels of good health and prosperity. There are, however,
large inequalities in health. Some wards or neighbourhoods are amongst the most
deprived in England and the health experience of different communities varies
greatly.

The Joint Strategic Needs Assessment (JSNA) describes the key issues that affect
the people of Ealing and defines the strategic direction of services that will affect
health and well-being for the next three to five years. It is produced jointly by Ealing
Council and Ealing Primary Care Trust for the Local Strategic Partnership.

Joint strategic needs assessment considers a range of factors, including:

            The burdens of disease and ill-health
            Services currently provided and their effectiveness and costs
            The views of patients, service users and the public
            Levels of need and provision in comparable areas
            National policy, such as National Service Frameworks, Healthcare for
             London, and the Local Area Agreement.

The JSNA is not a commissioning plan or a statement of commitments to develop
particular services. It will not serve all purposes of commissioning, because more
detailed work will be required in particular areas to justify specific service
developments and changes. It will underpin commissioning strategy, however, by
highlighting key issues such as:


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            Changes in Ealing‟s population that arise from migration, ageing and
             other factors
            The influence of major determinants of health such as income, housing
             and educations
            Rising levels of demand in particular areas of health and social care,
             including acute and emergency care
            Improvements in over-all measures of health, but continuing inequalities
             in health status and access to services
            Opportunities to provide more services in primary care and reduce
             reliance on hospital care in the longer term
            Hidden need, for example undiagnosed long-term conditions such as
             diabetes and cardiovascular disease
            Developments in care and treatment, creating new opportunities for
             benefit at a cost
            The benefits to be gained from integrating health and social care and
             from promoting health, well-being and independence and preventing
             disease

The JSNA is intended as a practical resource book for commissioning, to set and
justify priorities in health and social care. It is evolving in line with the PCT‟s
development of competencies in World Class Commissioning and with emerging
needs.




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2.1.    What is needs assessment?


Needs assessment is a systematic method of gathering information about health,
wellbeing, disease and effectiveness of interventions, to bring about beneficial
change. Its focus may vary from specific diseases or services to whole populations.
There are three main complementary approaches, which should be used in
combination in order to give as complete an account of needs as possible:

Epidemiological needs assessment considers the burden of disease in a population
and the effectiveness of interventions to relieve it.
Comparative needs assessment considers the provision of services and burdens of
disease in one area in comparison with another or a national or regional average.
Corporate needs assessment considers the views of local stakeholders and the
capacity of systems to respond to identified problems.


            All factors that affect health and wellbeing are potentially relevant to
             needs assessment.
            Needs assessment can help address problems of unmet need and
             ineffective, inefficient or inappropriate care.
            There are different kinds of need. For planners, need as „capacity to
             benefit‟ is a helpful definition with some limitations. „Need‟ is not the
             same as demand and supply. Levels of service use are an inadequate
             gauge of need.
            To be successful needs assessment should ask well-defined questions
             and consider the cost-effectiveness of possible solutions. It should be
             integrated with wider planning and commissioning.


Modelling and needs assessment

We have used modelling and projection in various ways in JSNA. In particular we
compared the recorded prevalence of key long-term conditions with the prevalence
that would be expected from models based on the age, sex and ethnic structure of
Ealing‟s population. We have used this information to estimate numbers of
undetected cases, identify problems with recording of cases and estimate the scale
of list inflation. We have used information at both PCT and GP practice-level to
identify inequalities and variations in performance.

We have used prevalence models, benchmarking of best practice (for example
through National Service Frameworks) and programme budgeting data to frame our
polysystem strategy, by which we will establish polysystems in each of four
quadrants in Ealing, beginning with Southall as the neighbourhood experiencing the
greatest health inequalities.




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2.2.    Consultation, engagement and equalities

The JSNA draws on the results of partnership, involvement and consultation with
stakeholders, including service users, in many specific areas of health, social care
and well-being. Key sources of views from stakeholders include:

                  Ealing Council Residents‟ Survey
                  Healthcare for London consultation
                  Patient Advice and Liaison Service reports
                  Complaints
                  GP Patient survey
                  Integrated Commissioning Strategy consultation and feedback from
                   Partnership Boards
                  Presentations to stakeholders, including voluntary and community
                   sector organisations.
                  The local health related behaviour survey of children and young
                   people, undertaken every two years

The PCT recognises that some groups barriers both to services and to the process of
consultation and engagement. Often it is advisable to develop additional
arrangements for involvement, so that these groups can be appropriately included.
For example:

                Disabled People, involved through the Disability Equality Scheme and
                 Disability Speak Out events, Partnership Boards and Closing The Gap
                 conference in January 2009.
                Black and Minority Ethnic communities, including Gypsies and
                 Travellers, involved through the Black Minority Ethnic and Refugee
                 Health and Social Care Forum, Travellers Interagency Forum
                Refugees and Asylum Seekers, involved through the West London
                 BMER Forum and the PCT‟s Race Equality Scheme
                Lesbian, Gay, Bisexual, Transgender people: specific issues relating to
                 health were addressed at the LGBT Forum conference in 2007
                Older People: the PCT and Council sponsor an Older People‟s Forum
                 and Older People‟s Network
                Young people: regular presentations are made by the Ealing Youth
                 Forum to the Children‟s Trust Board

We have engaged with Ealing Community Network and Ealing LINk on developing
the JSNA and Health Inequalities Strategy and have worked with voluntary sector
forums on issues for BME communities, older people and people with multiple and
profound disabilities.

We are currently working with other voluntary sector forums and LSP Partnership
Boards on the same topics.




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2.3.    Criteria for setting priorities

The following criteria were agreed to select priorities, in consultation with clinicians
and other stakeholders:

            High population burden of disease
            High disease burden on individuals
            Significant local, regional or national inequalities
            Effectiveness and cost-effectiveness of interventions
            Stakeholder views, including patients, the public and health and other
             professionals and the views of under-represented groups.
            Wider impact on society
            Measurability of progress
            Affordability of intervention

Local and national strategies such as the existing Local Area Agreements were also
taken into account for the sake of synergy and efficiency.

Priorities were set in consultation with clinicians and Ealing Council stakeholders at a
Visioning Workshop in September 2009. At this workshop we presented key findings
from the JSNA together with proposals for priorities. The priorities were validated at
Professional Executive Committee and NHS Ealing Board.




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3. Ealing: people and place
Ealing‟s population grew from 305,000 in 2007 to 309,000 in 2008. It is the third most
populous Borough in London. Ealing spans inner and outer London but has an
identity built around its seven town centres and a green, suburban character. The
general prosperity of the borough is not shared by all of our communities. Poor
standards of health and education, low household incomes and high benefits
dependency are concentrated in the borough's poorer areas and among particular
communities.

The vision of Ealing's Sustainable Communities Strategy is that in 2016, Ealing will
be a successful borough at the heart of West London, where everyone has the
opportunity to prosper and live fulfilling lives in communities which are safe, cohesive
and engaged.

            Ealing has a resident population of 309,000 (Office for National
             Statistics), expected to rise to around 347,000 by 2026 (GLA).
            The GP registered population was 350,000 in 2008/9 reduced from
             359,000 the previous year on account of a major exercise to remove
             invalid registrations.
            The population is growing and dependency is also increasing, that is, the
             proportion of non-working-age to working age residents, at both ends of
             the age range.
            Currently there are 47 dependent people to every 100 people of working
             age (16-60/64 years). This is expected to increase to 55 per 100 working
             age people in 2026, taking Ealing higher than the London average,
             expected to be at 49 per 100.
            There are expected to be various long term impacts of population
             change on the health and well-being of Ealing residents, for example:
            A rising birth rate is creating demand for maternity, child care and nursery
             places and will affect planning for schools provision
            The prevalence of common diseases of old age will rise with the ageing
             population
            Rising numbers of people over-all will create demand for health and
             social services, as well as potential workforce
            Areas that are amongst the 10% most deprived nationally are in
             Southall, South Acton, Northolt and Greenford and West Ealing.
            There will be higher proportions of people in older age groups and this
             will affect need for many kinds of health and social care.
            There are 120,000 properties in Ealing and around 130,000 households.
             The Housing Market Survey, 2009, shows 19.1% of homes in Ealing
             were overcrowded, much higher than the national figure of 7.1%. The
             survey reveals 15.6 % overcrowding in all tenures.
            In school education, in 2007, 50% of pupils achieved 5A*-C grades
             including English and Math‟s in GCSE or equivalent qualifications
             compared with a national average of 47%. Results in Ealing schools
             have improved by 11% points in 3 years, which is nearly three times the
             national rate of improvement. 62% of students are now achieving five A*
             to C grades or equivalent by the end of Key Stage 4, while 94 percent


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             are achieving five A* to G grades or equivalent. Achievement of Black
             African pupils is lower than average, but improving. Over half of Ealing
             pupils do not speak English as a first language.
            The crime rate in Ealing stands at 37.5 per 1,000 population, below the
             Metropolitan Police Service average of 39.9 per 1,000 population. The
             borough experiences similar levels of crime to Brent, Hounslow, Croydon
             and Lewisham. During the period 1st April – 2nd August 2009 the wards
             of East Acton, Ealing Broadway and Greenford Broadway experienced
             the highest levels of overall crime. Northfield, Hanger Hill and Lady
             Margaret experienced the lowest.
            Burglary levels are highest in Greenford Green, Norwood Green and
             North Greenford, whilst Theft from Motor Vehicles is a particular issue in
             East Acton and Norwood Green. Violence Against the Person is of
             particular concern in Southall Broadway and Norwood Green.

            The number of domestic violence incidents reported in the borough
             dropped 6.1% between 2008 and 2009. This is a change from 767
             incidents to 720. Meanwhile the number of domestic violence incidents
             has increased by 3.2% across London. During the same time period
             racist crime has increased by 21.1% as opposed to 3.2 % for the
             Metropolitan Police Service. Homophobic Crime is increasing at rates far
             above those experienced across the Metropolitan Police Service.




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4. Health in Ealing
4.1.     Summary measures of health

All age all cause mortality

This measure considers the rate at which people die, from any cause and at any age.
In order to make rates comparable, the figures are adjusted to take into account the
age structure of a population. A Standardised Mortality Ratio (SMR) of 120 means
that 20% more people die than would be expected, if rates for a standard population
were applied.

For all Southall wards there is a SMR of between 110 and 120, the worst in Ealing,
showing that the mortality experience of Southall is the worst in Ealing.

Fourteen of Ealing‟s 23 wards have a SMR of less than 100.

The SMR for the whole Borough is 97.5, showing that the mortality is slightly better
than a European standard.

All cause mortality has been declining since at least the early 1990‟s. Ealing‟s SMR
has reduced by about 2.5 points each year since 1993. This is in line with declining
mortality in London and England as a whole.

People with a long term limiting illness

There are wards, particularly in Southall, in which over 40% of households have one
or more members living with a long term limiting illness. In Ealing as a whole,
however, 29% or households are in this category, slightly less than the national figure
of 32%.

Perception of own health

Ealing residents generally have a positive perception of their health status , with
approximately 72% reporting their health as being good, 20% fairly good and 8% not
good. These proportions are generally in keeping with those for England, London
and West London, although slightly fewer report good health on a national level
(69%).

Main causes of death

In common with the national picture, the three most common causes of death are
diseases of the circulatory system (including, for example, heart failure), cancers and
respiratory illness.

Life expectancy at birth

Life expectancy in Ealing is slightly better than nationally, but there are large
inequalities between neighbourhoods. For men there is an eight year gap between
the best and worst wards in the Borough. Life expectancy has improved slightly in the
last year, but inequalities have persisted.




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4.2.     Healthy life-styles

The Health Survey for England has produced model-based estimates common
disease risk factors such as smoking and alcohol consumption, physical activity and
obesity. There are also estimates for minority ethnic communities.

It is estimated that 18.6% of people in Ealing are smokers, compared with 23.3% in
London and 24.1% nationally. There are large ethnic and gender inequalities in
smoking rates, however. It is estimated that 25.1% of Indian men are smokers, and
this community represents a very large proportion of the population in some wards
29.4% of Black Caribbean men are estimated to be smokers.

4.3.     Coronary heart disease

Coronary heart disease (CHD) includes acute myocardial infarction and ischaemic
heart disease and is influenced by a number of lifestyle factors including obesity, lack
of physical activity, poor diet and smoking. The most important preventable cause of
CHD is smoking and approximately 20% of deaths from CHD can be attributed to
smoking. CHD is more common in lower socio-economic groups and certain ethnic
minorities, particular South Asian population. For people born in the Indian sub-
continent the death rate from heart disease is 46% higher for men and 51% higher
for women compared to the average for England and Wales.

The demographic change most liable to influence the burden of CHD in Ealing PCT
over the next 20 to 30 years is the ageing of the population.

There is a large variation in CHD mortality rates between neighbourhoods. Between
2000 and 2004 Southall had just over 20% higher mortality than Ealing as a whole.
The ward of Southall Broadway had 30% higher death rates than expected.

Key issues for public health and commissioning:

             Continuing to develop the Health Trainer programme to raise health
              awareness and skills and to support vascular health through health
              checks.
             Developing the vascular screening programme with local GPs
             Continuing to promote the Stop Smoking Service
             Reducing emergency readmissions through cardiac rehabilitation
             Improve systems for managing heart failure
             Tackling obesity through weight management, promoting physical
              activity and community and school-based activities such as cookery
              clubs and the MEND and CHALK programmes.

4.4.     Stroke

Stroke is the third most common cause of death in England and Wales, after heart
disease and cancer. It accounts for 9 per cent of all deaths in men and 13 per cent of
deaths in women in the UK. Stroke has a greater disability impact than any other
chronic disease. Nationally, over 300,000 people are living with moderate to severe
disabilities as a result of stroke.




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In line with national trends, mortality from stroke is declining. Between 1993 and
2005 the SMR fell from 120 to around 80 for the population as a whole.

Key commissioning issues are

             to reconfigure acute stroke services across London in order to create
              access to the most effective new treatments, in line with Healthcare for
              London policy
             to prevent strokes and facilitate early access to treatment through patient
              education
             to support people who have had a stroke and their families and carers
              and so to mitigate the effects of stroke.


4.5.     Diabetes

Diabetes is one of the greatest health challenges facing the UK today. The numbers
diagnosed are expected to reach over 3 million by 2010. Unless it is diagnosed and
effectively treated diabetes can put people at risk of complications such as heart and
kidney disease, blindness, strokes and amputations. Deaths from diabetes are
expected to rise by 25 per cent in the next 10 years. (Diabetes UK)

There is a registered diabetic population in Ealing of 15,418. However, there is a
known unregistered population of people with diabetes, which would significantly
increase this figure. A prevalence model estimates approximately 18,800 diabetics in
the GP registered population.

Expected diabetes prevalence varies from over 9% in Southall to less than 3% in
West Ealing. This is mainly due to differences in ethnic profile of the population.
People of South Asian origin are up to six times more likely, and Black African-
Caribbean origin up to five times more likely, to develop diabetes compared to white
people.

Key issues for public health and commissioning:

             Tackling obesity is a major factor in preventing in managing diabetes
              and its complications.
             Training for staff to implement the weighing and measuring programme
              for reception and Year 6 children.
             Raising public awareness through health education events, including
              pharmacy-based campaigns in Diabetes Awareness Week.
             GP-based screening for people with a risk factors for Type 2 diabetes, in
              order to identify undiagnosed populations.
             Developing the Health Trainer programme to promote healthy lifestyle
              widely in the population.
             Raising awareness amongst patients of how to improve health through
              self-management. This follows a poor score on Ealing‟s Diabetes Patient
              Survey in 2006 and
             Develop the Right Start structured education programme for Type II
              diabetic patients.




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             Expand the Warwick University programme to give health professionals
              stronger skills in managing diabetes.
             Specialist diabetic nursing for young people, to prevent emergency
              admissions.

4.6.     Cancers

In England I in every 3 people will be diagnosed with cancer in their lifetime. Cancer
is a major cause of death in men and women. People from deprived backgrounds are
more likely to get some types of cancers and are more likely to die once diagnosed.

In England I in every 3 people will be diagnosed with cancer in their lifetime. Cancer
is a major cause of death in men and women. People from deprived backgrounds are
more likely to get some types of cancers and are more likely to die once diagnosed.
Between 1950 and 2005, age-standardised cancer mortality in England and Wales
changed very little. However, mortality from the other main causes - heart disease,
stroke and infectious diseases - declined. Consequently, cancer has been the most
common cause of death in females since 1969 and in males since 1995.

There are large inequalities in mortality ratios from cancer between wards and
neighbourhoods. Northolt West End and Acton central as having the highest ratios
for under 75 year olds at 112 and 109 respectively. The lowest are in Southall Green
(76), Walpole (75) and Lady Margaret (73).

In 2005/06 1,866 women were invited for breast screening in Southall. The uptake
rate was 55%, compared to 58% in Ealing PCT as a whole. The London region as
has the lowest coverage rates for the breast screening programme in England.
Southall has one of the lowest rates of uptake of the screening service within Ealing
PCT. In 2005/06 South Southall had the highest percentage of returned mail in
Ealing PCT indicating that the mobility of the population compounds problems in
promoting the uptake of the service.

Screening data from London and England for 2005/06 indicated that there was a
continuing decrease in the number of women attending for cervical screening
particularly amongst younger age group.

Deaths from the three most common cancers (lung, prostate/breast, colo-rectal) in
1999 constituted just under half of all cancer deaths in Ealing.

Key issues for commissioning and public health:

             Promoting the West London wide breast screening programme and
              addressing cultural and language issues that affect awareness and
              access
             Promoting cervical screening through GP practices
             Developing the national bowel cancer screening programme
             Developing the Stop Smoking Service

4.7.     Tuberculosis

Tuberculosis disease in Ealing has stabilised over the three years with around 250
patients diagnosed in Ealing every year. Compared to the North West London sector,



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Ealing has the highest number of notifications and has the second highest rate in the
sector.

Southall is particularly affected by TB as the incidence in this area is significantly
higher than the rest of Ealing. Compared to London, the rate in Southall is around
four times the rate in London.

In Ealing, the ethnic minority groups are mostly affected by tuberculosis, in particular
the Black-Africans and Indians have high numbers of people affected by TB. Most TB
patients were not born in the UK and have come from South-East Asia and Somalia.

Key issues for commissioning and public health:

             Outreach to minority ethnic communities to ensure uptake and
              completion of treatment
             Tracing contacts of TB patients to minimise the risk of TB transmission.


4.8.     Mental Health

In England 1 in 4 people will experience mental health issues within their lifetime.
Mental Health disabilities are amongst the most debilitating of illnesses and impact
on individuals‟ abilitiy to participate in their communities and lead healthy lives. It is
acknowledged that individuals with mental health issues also are more likely to have
physical health problems and substance misuse issues than the general population.
Improving local residents‟ mental health is one of the key strategic health priorities for
NHS Ealing.

Analyses of the Mental Health Needs Index (MINI) 2001 and National Psychiatric
Morbidity Study (NPMS) 2000 suggests that Ealing‟s mental health index (1.23) is
average for London (1.25) but slightly higher than neighbouring PCTs Hammersmith
(1.11) and Hounslow (1.16). London boroughs generally report higher levels of
Common Mental Illnesses than England as a whole.

Within Ealing, over the last ten years, there has been an average of 29 suicides per
year. There has been little evidence of an upwards or downwards trend over this
period although in 2008 and up to the end of November 2009 there were 18 and 20
deaths respectively, indicating a significant reduction in the yearly rates of suicide.
The ratio between male and female suicides in Ealing is similar to the national picture
of 3:1 men to women. Although the average age of an individual is in the low 40s,
men in the 25 to 34 year age group and women in the 35 to 44 year age group are
particularly vulnerable.

There are differences in how our local community access mental health services.
Ealing has higher age standardised admission ratios for Black minority groups to
psychiatric inpatient services than the London average. Ealing has lower age
standardised admission ratios for other BME groups to psychiatric inpatient services
than the London average (Count me In Census (2006/07). Ealing has higher than
the London average (rate per 100,000 population) in contact with mental health
services.

In Ealing, some 2,500 are estimated to have late onset dementia (over 65‟s) and the
numbers are expected to increase by up to 15% by 2020.



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In 2007 there were an estimated 115 people with early onset dementia. This figure is
projected to increase by 9% to 125 by 2011 and to 133 by 2016 (13% increase on
2007).
A recent needs assessment on dementia, conducted in 2008, identified that
awareness about dementia and mental health in general amongst the local public
was low, particularly among BME communities. It further reported that knowledge
among GPs varied considerably, evident in differing levels of assessment referrals
and early diagnoses.

Commissioning issues include the following:

             Improving access to effective treatment of common mental health
              disorders in primary care, through the Primary Care Mental Health &
              Wellbeing service so that up to 5000 clients will benefit from the service
              per annum.
             Continuing to implement NICE guidance for mental health disorders.
             Advocacy and self-help for mental health service users.
             Improving the quality, productivity and safety of mental health services
              locally.


4.9.     Alcohol

Ealing has the highest alcohol-related hospital admissions in London. The rate is 500
alcohol-related hospital admissions per 100,000 population. Men and middle aged to
older people account for high admission levels, women‟s and younger age
admissions are lower.

Based on the Alcohol Needs Assessment Research Project (2005), which used ONS
data for populations aged 16-64 and adjusted for regional drinking patterns, the
estimated number of harmful and dependent drinkers in Ealing is 23,000. It is
estimated that some 37,000 people in Ealing are hazardous drinkers (including binge
drinkers).

People from black and minority ethnic communities are precieved to drink less than
white British, Irish and European communities, although there is a suggested hidden
alcohol issue arising with the dominant Asian contingent in Southall within the
Punjabi Sikh comunity. BME communities account for c.41% of Ealing‟s population,
which reduces the overall drinking problem in the borough. This however, is balanced
out by the large Irish (4%) and Polish (2%) populations whose alcohol consumption
levels are above those of the white British population.

Public drinking is a concern in Ealing Broadway, Hanwell, Acton, Northolt. Binge
drinking is high amongst 18 – 24 years. There are higher proportions of this age
group in the population and Eastern European migrants are highly represented in this
group.

Key issues for public health and commissioning:

             Improve education and awareness, particularly in schools, colleges and
              the most deprived areas in Ealing




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            Build treatment capacity and training in primary care which includes
             screening brief advice increasing community detoxification and setting
             clear referral pathways into community alcohol services

            Expand hospital alcohol liaison service and ensure there are clear
             protocols and pathways into the service.

            Ensure there are clear protocols and pathways into alcohol services from
             Accident and Emergency.
4.10.   Sexual health

Chlamydia is the most commonly reported sexually transmitted infection, with around
30 new cases every month. The next most common infections are anogenital warts,
herpes and gonorrhea. Usually fewer than three cases of syphilis are reported each
month.

There were 659 people living with HIV in Ealing in 2006, a rise of 47% since 2002.
This is a measure of all people who have HIV infection and not just new cases. So
the rise may be due both to better survival of patients and to increase in
transmission.

Teenage pregnancy rates have declined in Ealing over the last decade, and teenage
conception rates have fallen by 8 percentage points between 2003 and 2007. Rates
are low in comparison with London, except for areas of Northolt. There is a
continuing need to support young people in making healthy choices with regard to
sexual health and also to support young parents.

Key issues for public health and commissioning:

            Promoting Chlamydia screening in partnership with pharmacists and
             young people‟s organisations
            Addressing personal and social health education through the Healthy
             Schools programme
            Raising awareness of prevention through community organisations and
             the Choosing Health programme
            A detailed sexual health needs assessment is being undertaken and will
             be available during December 2009.




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5. Ealing’s Neighbourhoods
For the purposes of the JSNA, the Borough of Ealing is divided into four
neighbourhoods which roughly reflect the groupings of GP practices that make up
Local Commissioning Groups (LCGs). This is in order to support the function of the
LCGs which will be increasingly responsible for commissioning on behalf of local
people.

5.1.     Ealing & Acton

Ealing & Acton neighbourhood comprises nine of Ealing‟s twenty-three wards with a
population of 123,924, about 39% of Ealing Borough. There are large inequalities in
the neighbourhood, which contains some of the most and the least deprived wards in
Ealing. These inequalities are reflected in varying rates of death and disease for
common causes such as coronary heart disease and cancers.

Around 28% of the Ealing & Acton population is of minority ethnic origin.10% are of
Asian ethnic origin, followed by Black ethnic groups (nearly 8%).

Ealing & Acton overall has the lowest standardised ratio (85.7%) of people with
limiting long-term illness (LLTI) compared with Ealing as a whole. East Acton (105)
and South Acton (111.2) have higher than average limiting long term illness scores.

The quality of housing has a major impact on health. In Ealing & Acton, 18.2% of
households are overcrowded. East Acton has the worst housing deprivation score in
Ealing & Acton.

For the 75+ population the percentage that lives alone is 67.3%, higher than the
64.8% of Ealing as a whole.

Hanger Hill has the lowest rates of unemployment in Ealing, with South Acton and
Acton Central ranking 5th and 9th respectively.

Ealing & Acton has lower than average overall mortality compared with a standard
population with an SMRof 94.5 compared to 97.5 for Ealing as a whole for all ages.

5.2.     Southall

The Southall neighbourhood consists of five of Ealing‟s twenty-three wards in the
south west of the Borough, as follows.

The population of Southall is 69,612, about 22% of Ealing Borough (population
309,000).

More than 75% of Southall‟s population is of minority ethnic origin. Most are of Asian
ethnic origin, followed by Black ethnic groups. Southall has Ealing‟s highest
percentage of Asian residents. The proportion of Ealing school pupils from minority
ethnic origin ranges from just under half to more than 99%.

Southall is a neighbourhood that generally ranks high in all deprivation scores as well
as being affected by a number of chronic diseases compared to Ealing as a whole.
There are exceptions though with lower levels of child poverty than other
neighbourhoods. Mental health, diabetes and tuberculosis are particular problems.


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The poor health of Southall is reflected in the different mortality ratios in which
Southall generally has a higher then expected mortality.

Southall is served by twenty-two GP practices of which 11 are single handed. These
are divided into two commissioning groups. The patients registered with Southall
GP‟s are distributed throughout Ealing and other PCTs. The average GP list sizies in
Southall are greater than the average list size in Ealing. Eight of the PG premises are
classified as being below minimum standards and are too small to provide a full
range of primary care services.

Southall has a high overall all elective admissions rate for the <75s. It ranks the
second highest in Ealing as a whole and is significantly higher then Ealing‟s rate
overall.

5.3.     Northolt and Greenford, including Perivale

Northolt and Greenford neighbourhood comprises six of Ealing‟s twenty-three wards
in the North West of the Borough, including Perivale.

Nearly 40% of Northolt and Greenford‟s population – and nearly 50% in North
Greenford and Perivale - is of minority ethnic origin. More than half of the minority
ethnic residents are Asian, mainly from south Asia. After Southall, Northolt and
Greenford has Ealing‟s highest percentage of Asian residents. The proportion of
Ealing school pupils from minority ethnic origin ranges from just under half to more
than 99%.

Northolt and Greenford neighbourhood has an Index of Multiple Deprivation score of
23.75, almost the same as for Ealing as a whole. However, the score for Northolt
West End ward is higher than 32, making it the third most deprived ward in the
Borough. Greenford Green, Perivale and North Greenford have correspondingly low
scores.

Northolt West End, Greenford Broadway and Northolt Mandeville are three of the
worst five Ealing wards for deprivation affecting children. Northolt and Greenford as a
whole is the second worst of the four neighbourhoods on this measure. The Sure
Start programme for children and families is specific to Northolt, in recognition of the
high levels of need in this area.

Northolt and Greenford neighbourhood has lower than average over-all mortality
compared with a standard population, even in Northolt West End which has the
highest relative mortality of all the five wards.

The neighbourhood is served by twenty-four GP practices, of which four are run by a
single GP. The patients registered with Northolt and Greenford GP‟s are widely
distributed throughout Ealing. Measures of health need based on ward populations
are therefore a relatively limited indicator of GP patients‟ need.

5.4.     West Ealing

West Ealing is a relatively small geographical area covering three of Ealing‟s twenty-
three wards.




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Amongst the population of Ealing (315,000), approximately 39,042 live in West
Ealing. The age structure in West Ealing is similar to that of the Borough: 6.5% of
the population are aged under 5 and 10.8% are aged over 65 years.

The London Borough of Ealing is ethnically diverse. In West Ealing, 76% of the
population are White; the remaining 14% are from minority ethnic groups, with Asian
groups being the largest at 9.6%.

            10.8% of West Ealing residents are aged over 65
            Northfield is amongst the least deprived wards in England: there are
             variations between Northfields and the other West Ealing wards.
            66.8% of pensioners in West Ealing live alone.
            Unemployment is relatively low in West Ealing.
            The rates of long-term limiting illness reported amongst West Ealing
             residents are average to low.
            The rate of CHD is slightly higher in Northfield than in Ealing as a whole.
            76% of the eligible female population received smear tests.
            Elthorne has the 2nd highest rate in Ealing for admissions for psychosis.
            The rates of under 18 conceptions has been rising in Elthorne and is
             higher than the average borough.
            The rates of bacterial sexually transmitted infections continue to
             increase, nationally and locally.
            Elthorne (from Oct. 95 to Dec. 2008) had the highest number of suicides
             & unexpected deaths.




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6. Children and young people
6.1.     Child and maternal health

Ealing has a relatively young population with people under the age of 25 making up
30.6% of the total. The population of 0 to 19 year olds is expected to further increase
by 2011, with a projected increase of more than 25% in the 0-4 population since
2001, following a significant rise in birth rates in recent years.

Population change 2001 to 2011

Year               0 to 4             5 to 15            16 to 19           Total
Per cent           26.9               4.3                2.9                9.9


Between the years 2003-2005, there were a total of 14,085 live births to women
resident in the London Borough of Ealing, with an average of about 4,695 per year.
Births in Ealing have risen in line with London rates, with an increase of 673 births or
13% in Ealing over the 4.5 year period from 4391 in 2001/2 to the 5064 in 2006. Most
of the increase is attributable to births to mothers whose own country of birth is
overseas.

Low birth weight is a significant risk for infant mortality and morbidity in the first year
of life. Evidence suggests that babies who are born with low birth weight have
increased risks later in life of developing of chronic diseases, including increased risk
of becoming obese, insulin resistance syndrome and high blood pressure. Ealing has
a higher proportion of babies born with low birth weight than the average for London
and for England. There are considerable variations across the borough ranging from
11.4% in Southall Broadway to 6.2% in Hobbayne.

Between 1990-1992 there were 7.2 infant (less than 1 year old) deaths per 1,000 live
births and between and this reduced to 4.1 per thousand by 2003-5. There has been
a steady decline in rates in Inner and Outer London, and a fluctuating downward
trend Ealing‟s rate.

The Child Death Overview Panel has collated data which indicates that there were
four unexpected deaths of children aged 2- 18 years during 2008/09.

In Ealing, the average number of decayed, missing or filled teeth (dmft) amongst 5
year old children was 4.84 in 2005-2006, higher than the average for England 3.85
and for London 4.45 (NCHOD, 2006). Poor oral health of children is strongly
associated with socio-economic deprivation.

Entitlement to Free School Meals is also associated with deprivation. Nationally the
average figure is 16% in primary and 13% in high schools. These figures are much
higher in Ealing at 23% in primary and 26% at high school level. This clearly reflects
a high level of pupils from low-income families in Ealing‟s schools particularly at high
school where entitlement to Free School Meals is double the national average.

There are 1,400 children with a statement of special educational needs in Ealing.
Approximately 600 of these children attend one of the six special schools in the
borough.




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Between 2004 and 2007 there were 1079.5 hospital admissions for all injuries per
100,000 children aged 0-14 years. While the actual number of hospital admissions
for accidental injuries amongst children aged 0-14 years (1,907) was below that
which may be expected (2,543) there are considerable variations across the
borough. In Northolt and Greenford and in West Ealing the directly age-standardised
rates are higher than for Ealing as a whole.

6.2.     Young people and substance misuse

In 2008/09, there were 110 young people in specialist treatment in Ealing, an
increased of 49% (n=56) since 2007/08. This increase is likely to be a result of better
identification of young people using misusing substances. Data from neighbouring
Boroughs, adult treatment services and national survey data suggest that there are
likely to be more young people in Ealing eligible for specialist treatment services who
have not been identified.

From analysis of young people in specialist treatment for substance misuse, young
people from Asian and other BME groups are under-represented in treatment. This is
in contrast to the number of Asian adults in treatment, which reflects the large Asian
population in Ealing. The majority of young people in treatment present with cannabis
related issues.

6.3.     Looked after children

There were 411 looked after children at the end of November 2009 an increase of 20
children compared to one year before. Thirty-three of these children are
unaccompanied asylum seeking children, an increase from 28 a year earlier, while 25
of the total cohort are children with long-term disabilities. There is significant over
representation of black and dual heritage children among looked after children in the
Borough, which in line with national trends.

The number of children with a child protection plan has decreased by 9% since 2008
to 322 children in March 2009.

There were 374 children leaving care at the end of November 2009 in Ealing.
Education, employment or training performance for care leavers remains very good
with those engaged at 70% in 2008/9. In addition Ealing currently has amongst the
highest numbers of care leavers nationally in higher education at 17% for 2008/9.

Placement stability for looked after children (LAC) is recognised as a priority, as it is
directly linked to better educational and other life chance outcomes. Placement
stability has improved consistently over the last two years in Ealing and it is now
rated as very good, with number of moves indicator (NI 62) reduced from 7.5% at the
previous year end to 6.45% at end of March 2009.

6.4.     Child and Adolescent Mental Health

In Ealing, it is estimated that approximately 4051 children have hyperactivity, conduct
or emotional disorders.

National data from the Young Minds website and from MIND indicates a prevalence
of particular mental health issues amongst children and young people. Transposing
national data onto local figures, we can estimate the following for Ealing:




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             There are approximately 73,873 people under 18 in the borough and we
              can estimate that between 7387 and 14774 of these will have mental
              health difficulties.
             Between 357 and 714 adolescents between 15 and 19 in Ealing may
              have attempted suicide.
             Between 357 and 1429 adolescents between 15 and 19 in Ealing will
              have experienced significant depression.
             Approximately 339 may have Obsessive Compulsive Disorders.
             Up to 143 girls between 12 and 19 years of age will have had anorexia
              nervosa, and up to 143 girls will have had bulimia nervosa.
             Around 2867 adolescents between 12 and 19 self-harm.
             47% of children assessed as having a disorder will also have a parent
              with poor mental health.

6.5.     Children with Additional Needs

             Between January and November 2009, 21 new children have received
              Continuing Care assessments and 17 were offered care. There are 5
              children awaiting assessments.
             A rough estimate is that we will expect to receive 3 referrals per month
              form a variety of sources.


6.6.     Key issues for public health and commissioning:

             The rise in the birth rate may have implications for school places and
              child health services. If children recently born in Ealing stay here there
              will be a need for 600 additional secondary school places.
             Early identification of children and young people at risk of mental illness
              or substance misuse and promoting access to specialist services
             Work to reduce the number of children living in poverty will support the
              safe and healthy development of Ealing‟s children.
             There is a need for early intervention and support to children and
              families most at-risk of requiring safeguarding interventions.
             Training for healthcare staff in addressing risk factors for low birthweight
              such as smoking and nutrition
             Continuing implementation of NICE guidance on antenatal and postnatal
              care
             Developing a strategy that encompasses childhood accident prevention
             Promoting the Healthy Schools Programme.
             Continuing funding of the Continuing Care Co-ordinator to continue to
              improve discharge processes, equipment provision and the transition to
              working with social work teams and therapies.
             Identify effective practices from the „Healthy Lives, Brighter Futures‟
              funded pilot work for young people with complex medical health needs,
              including palliative care.




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The JSNA will underpin the Children and Young People‟s Plan and the Children‟s
Commissioning Strategy from 2009. The Children and Young Person‟s Plan is the
joint statement of needs and strategy. The Children and Young Persons‟ Plan
(CYPP) 2006 - 2009 has five broad aims: staying healthy, keeping safe,
achievement, making a positive contribution and economic well-being.

The CYPP is refreshed on an annual basis. The main features of the 2009-10 update
are summarised below:

6.6.1.       Be Healthy
– encourage healthy lifestyles

1. Transform the provision of and access to universal and targeted health services for
all children and young people
2. Deliver more equal health outcomes across the borough
3. Expand the range and accessibility of early intervention services to improve
children and young people‟s emotional health. Target more intensive interventions
where indicated
4. Enable parents, children and young people to make healthy lifestyle choices

6.6.2.         Stay Safe
– ensure that Ealing is a safe place for children to grow up

1. Prioritise safeguarding of children, by ensuring robust child protection systems
across all provision and implement the revised Working Together Guidelines
anticipated in autumn 2009
2. Improve the speed and quality of multi-agency assessments of children and
families in need, review thresholds and embed the Common Assessment Framework
(CAF)
3. Reduce the number of children who commit crime or who are victims of crime,
particularly serious youth violence and gang related activity
4. Improve safety in the local community, including in the parks, play areas and on
the streets
5. Integrate children‟s services and prioritise early identification and intervention and
support for parents

6.6.3.       Enjoy and Achieve
– encourage children in Ealing to love learning and achieve their potential

1. Give children the best start in life through high quality early years services
2. Raise the achievement and attainment of all children and young people
3. Target the needs of children in schools and early years settings for whom English
is an additional language
4. Transform outcomes for children and young people from vulnerable and under-
achieving groups
5. Ensure that learning is exciting and inspiring for children
6. Increase the opportunities for children and young people, to access co-ordinated
play and constructive leisure opportunities

6.6.4.         Make a Positive Contribution
– Create a thriving voice for children and young people in Ealing

1. Ensure that services are developed in ways that reflect the expressed needs of
children, young people, and parents



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2. Reduce incidence of bullying and harassment
3. Ensure all children and young people have access to support to help them make
successful transitions at key points in their lives
4. Ensure effective provision of preventative and diversionary schemes. Target
reductions in crime and anti-social behaviour, through effective engagement with
young people and local communities
5. Increase the range of youth activities in Ealing, whilst providing targeted youth
support for vulnerable young people

6.6.5.         Achieve Economic Well-being
– ensure all children and young people have the opportunity to become successful,
independent adults

1. Promote the interests of children, young people and families in the development of
private and social housing and regeneration projects in the borough through the
Sustainable Community Strategy, prioritising action to minimise the impact of the
current economic recession
2. Reduce the number of children living in poverty, through increasing families‟
access to work opportunities, tax and income advice and affordable childcare
3. Continue to implement the 14-19 Strategy in order to improve pathways for young
people into employment, education and training and continue to reduce numbers not
engaged in education, training and employment
4. Address the needs of new communities and ensure effective integration and
community cohesion




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7. Adults of working age
7.1.     Mental health

Mental health is not only the absence of mental illness but positive mental and
emotional well-being. New Horizons: a shared vision for mental health (2009)
outlines the direction of travel for mental health services in England, focusing on
prevention, wellbeing and recovery.

The Mental Health Promotion Strategy for Ealing, July 2005, has three themes: -

              o   Freedom from stigma and discrimination – security and self-
                  determination
              o   Social connectedness – improved well-being through social support
              o   Economic participation – independence, work and making a
                  contribution

             There are marked social, gender and racial inequalities in mental health
              service use.

             90% of expressed mental health needs are managed in primary care. It
              was estimated in 2000 that one in six adults in Great Britain had a
              neurotic disorder (such as anxiety or depression) and one in 200 had a
              psychotic disorder such as schizophrenia. We would expect 33,000
              adults in Ealing to have a neurotic disorder and 400 a psychotic disorder.

             There are around 1,000 hospital admissions for mental health problems
              and 4,000 people treated in secondary care each year, mainly by West
              London Mental Health NHS Trust. Comparing Ealing‟s neighbourhoods,
              South and North Southall have the highest age-standardised admissions
              rates for psychosis and depression, followed by Greenford.

             In consultations concerns of mental health service users included:-.

              o   Choice of where to receive treatment
              o   Employment
              o   Medication and choice
              o   Mental health services in primary care
              o   Advocacy
              o   Mental health promotion
              o   Help with using the benefits system
              o   Improved information
              o   Advance directives
              o   Choice in assessments
              o   Client-centred approach.

             The voluntary sector plays a key role in delivering services which
              support social inclusion, provide employment support, advocacy,
              counselling and in providing services targeted to particular ethnic
              communities and in combating stigma.




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7.2.     Substance misuse

The ten-year National Drugs Strategy (2008-2018) aims to restrict the supply of
illegal drugs and reduce the demand for them. The four strands of work are:

              o   protecting communities through tackling drug supply, drug-related
                  crime and anti-social behaviour

              o   preventing harm to children, young people and families affected by
                  drug misuse

              o   delivering new approaches to drug treatment and social re-
                  integration

              o   public information campaigns, communications and community
                  engagement


             By the best available method of estimation it is thought that there were
              2,752 problem drug users in Ealing.

             It is estimated that 47%-58% of Opiate and Crack users, up to 41%
              Opiate Users and up to 61% of Crack Users are treatment naïve.

             In Ealing there are currently no estimates on the number of problem
              drinkers in the borough although anecdotally it is often thought to be
              quite large. Demand for alcohol services is high and services have large
              waiting lists. Hospital admissions for alcohol-related diseases have
              increased considerably over the last four years, and Ealing has the
              highest rate of admissions in London.

             Service users reported that crack use is on the increase and that access
              to housing is difficult.

             Problem drug use and treatments are complex and multi-faceted. There
              is good evidence that treatment programmes produce measurable
              benefits.

             76% of clients are retained in treatment for 12 weeks or more.

             There is a longer term need for a suitable premises for a one-stop shop

             Improving access to treatment, supporting clients with housing needs
              and running a stimulant pilot within DIP are a priorities for this year.

             Priorities for the DAAT include:

              o   improving access to housing for our clients through a new borough
                  wide rent deposit scheme.



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              o   improving treatment access for clients referred via the criminal
                  justice system

              o   reducing waiting times for alcohol services

              o   ensuring that services are compliant with latest clinical guidelines

              o   stimulant pilot project within the Drugs Intervention Programme

7.3.     Long Term Conditions, Physical disabilities, sensory impairment

DDA Definition of disability:

The Act defines a disabled person as a person with „a physical or mental impairment,
which has a substantial and long-term adverse effect on his/her ability to carry out
normal day-to-day activities.‟

A long-term effect is one which has lasted at least 12 months; is likely to last 12
months; or is likely to last for the rest of the person‟s life.

Based on national and local prevalence information, the main areas of disability
affecting adults aged 18 – 65 years are:

              o   Long-term illness (e.g. stroke, diabetes, respiratory, renal, HIV)
              o   Musculo-skeletal (e.g. arthritis, mobility impairment)
              o   Sensory disability
              o   Amputation
              o   Long Term Neurological Conditions (e.g. Brain Injury, Motor Neuron
                  Disease, Multiple Sclerosis)
              o   Dual conditions (substance misuse and mental illness).

             It is estimated that there are about 45,000 disabled people in Ealing.
              14,012 Ealing residents aged 18 – 64 years are registered as disabled.
              The more common conditions reported are mobility and musculo-skeletal
              (56%), neurological (24%) and limiting long-term illnesses (10%).
             The main long term neurological conditions are Multiple Sclerosis,
              Parkinson‟s Disease and Motor Neuron Disease. There are
              approximately 650 people with Parkinson‟s Disease, 350 with Multiple
              Sclerosis and 15 – 20 people with Motor Neuron disease in Ealing.
             The proportion of younger disabled people is the second highest in
              London, although over-all prevalence is somewhat below average.

             Southall and Northolt have the highest concentrations of younger
              disabled people, followed by Greenford and Acton, whilst Central Ealing
              has the lowest.

             In 2008 User Consultations with Deaf and Hard of Hearing, People
              Living with a Long Term Neurological Condition, People Living with HIV,
              Wheelchair Users highlighted the following areas of need and
              improvement:




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              o   Increased access to deaf communicators, especially for GPs, social
                  workers and community nurses to know how to book them and use
                  them
              o   Deaf Awareness for front line staff in health and social care
                  establishments, especially hospital and GP appointments.
              o   The need for a comprehensive health and social care service directory
              o   Long Term Neurological Conditions awareness of health and social
                  care front line staff, to health conditions that change people‟s ability to
                  function from day to day, e.g. multiple sclerosis.
              o   Information, advice, signposting and general navigation of
                  opportunities for independent living.

             To continue to promote independence, choice and well being, the Long
              Term Conditions/Physical Disabilities Partnership Board will be
              developing priorities and commissioning intentions as follows:

              o   Develop a Joint Integrated Strategy for Telecare/Telehealth/Careline
                  to promote early intervention and independence
              o   Develop and implement „retail model‟ as part of Transforming
                  Community Equipment Services (TCES) to promote prevention,
                  choice and independence
              o   Develop and implement future options for Wheelchair Services to
                  ensure a high quality, responsive service to individuals
              o   Develop a programme of services for health and well being for people
                  with PD/LTC, such as self management programmes with a variety of
                  providers
              o   Identify need for community services for people with Acquired Brain
                  Injury, and those physically disabled with challenging behaviour.
              o   Improved mechanisms for early identification of physically disabled
                  people from transition from children to adults and adults to older
                  people for future demand and supply of services.
              o   As part of personalisation programme to ensure a consistent, quality
                  approach to the provision of information, advice and advocacy,
                  including signposting.

7.4.     Learning disabilities

Learning disability is defined as:
           o A significantly reduced ability to understand new or complex
              information or to learn new skills
           o A reduced ability to cope independently

             The Government Strategies “Valuing People” and „Valuing People Now‟
              recognise major shortcomings in services for people with learning
              disabilities. Working Together To Make Better Lives (2006-11) is Ealing‟s
              response, setting targets for mainstream and specialist services.

             In 2009 a total of 968 people with learning disabilities were known to
              Ealing social services. National prevalence data estimates the local
              population of people with learning disabilities should be at least 1000. In
              2008/09, 608 people with learning disabilities were provided with
              services.




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            Over 50% of adults with learning disabilities are from minority ethnic
             communities.

            Around 20% of adults with learning disabilities in Ealing have been
             diagnosed with a mental health need.

            Concerns of service users and carers include the areas of housing and
             independent living, employment, day services, social and leisure
             opportunities, advocacy, respite care, including single sex respite
             accommodation, hate crime, and access to health services.

            Important outcomes will be to increase the number of people able to live
             and work independently and locally and to reduce dependence upon
             health and residential care.

            Better health for people with learning disabilities is a key priority. People
             with learning disabilities have much greater health needs than the
             general population. They are more likely to have general health
             problems, sensory impairments, mental health problems, epilepsy and
             other physical disabilities, and uptake of regular screening is poor.
             Evidence shows that people with learning disabilities in Ealing still have
             a negative experience with local health services.

            Research conducted by Mencap has shown that almost 90% of people
             with learning disabilities have been subject to hate crime.

            Little is known about the numbers of people with learning disabilities who
             have come into contact with the criminal justice system as many of them
             are unknown to social services. Consideration needs to be given to
             ensure the criminal justice system can meet the needs of offenders with
             learning disabilities.

            Services for people with learning disabilities in Ealing cost in the region
             of £31m in 2008/09, of which just over 60% was spent on residential and
             nursing care.

            Suitable accommodation is a particularly pressing need. Many people
             with learning disabilities do not choose where they live or with whom and
             are placed in residential care. People with learning disabilities have
             limited access to mainstream housing. 50% of adults with learning
             disabilities in Ealing live with family carers. 17% of those family carers
             have been identified as being over the age of 65.

            There are more new people using services every year than there are
             ceasing services. In 2010/11 there will be an additional 17 people
             needing services, and this trend is likely to continue for the next ten
             years. At least 6 of these young people will have severe or profound
             learning disabilities.

            There is an increase in the numbers of people with profound and
             multiple learning disabilities and complex health needs due to increased



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             life expectancy. A needs analysis of this group needs to be carried out,
             particularly in relation to young people moving into adult services.

            There are 84 people over the age of 65 years with learning disabilities in
             Ealing, and this is likely to increase in the future. The prevalence of
             dementia in people with learning disabilities is higher than the general
             population. There is limited provision for older people with learning
             disabilities who have dementia and nursing needs in Ealing.

            There are insufficient services in Ealing to support parents with learning
             disabilities to develop parenting skills.

Autism Spectrum Conditions (ASC) are defined as:
         A lifelong developmental disability that affects the way a person
           communicates and relates to people around them. People with autism
           have difficulties with everyday social interaction. Asperger syndrome is a
           form of autism.

            National prevalence rates indicate that there are just over 2400 adults
             with an ASC in Ealing.

            Prevalence rates also suggest that 2300 of these adults in Ealing have
             high functioning autism and Asperger syndrome. The vast majority of
             this group is not eligible for learning disability or mental health services
             but many will need support due to reduced ability to cope independently.

            National data suggests a prevalence of 115 adults with Autism Spectrum
             Conditions who have a severe learning disability in Ealing. Whilst there
             is adequate local provision of day opportunity and respite services, there
             is a shortage of specialist organisations operating locally who provide
             residential and supported living services for adults with ASC who have a
             learning disability and challenging needs.

            Nationally, the diagnosis of children with ASC has increased ten-fold in
             the last 10 years which will place additional pressure on adult services in
             future years.

            There are no diagnostic services available locally for adults who think
             they may have an ASC.

            There are limited post diagnostic support services for adults with high
             functioning ASC and Asperger Syndrome who do not meet the eligibility
             criteria for learning disability or mental health services.

            Adults with ASC are especially vulnerable to abuse. Recent research
             conducted by the National Autistic Society suggests that all people with
             ASC will be victims of abuse at some point in their lives.

            National prevalence rates suggest that around 700 of the local adult
             population of people with ASC will experience significant mental health
             problems due to the lack of diagnosis and support. Common mental



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               health difficulties experienced will include depression, anxiety and
               schizophrenia.

              Without early diagnosis, intervention and support, adults with ASC are
               likely to develop other needs relating to eating disorders, obsessive
               compulsive disorders, extreme phobias, self harming, sexually
               inappropriate behaviours, forensic histories and substance misuse.

              Little is known about the numbers of adults with ASC who have come
               into contact with the criminal justice system, as many of them are
               unknown to social services. Consideration needs to be given to ensure
               the criminal justice system can meet the needs of offenders with ASC.

              Only 15% of people with ASC are likely to be in paid employment, and
               consequently many people with ASC are financially deprived and live at
               home with their families. There is currently no support for carers of
               adults with ASC who fall below the eligibility threshold for learning
               disabilities and mental health services, and typically these carers will not
               be known to Ealing social services.

7.5.     Carers

              There are 6 million carers in the UK and 80% of carers are of working
               age.
              3 million carers combine work with care
              Over 2.3 million people become carers each year
              3 in 5 people will become carers at some point in time
              1 in 5 carers cut back on food, 3 out of 4 carers cut back on leisure
               activities, 1 in 3 carers have trouble paying utility bills, 1 in 3 carers have
               no savings due to financial difficulties; this is particularly true for carers
               black and ethnic minority carers.
              Black and minority ethnic carers face difficulties in accessing
               mainstream public services.
              Carers are twice as likely to have mental health problems if they provide
               substantial care.
              Major research has been conducted showing carers‟ development of
               chronic/long term conditions due to caring, however, no
               control/comparative study with non-carers was conducted.
              Carers Allowance is the lowest earnings replacement benefit

Local carers

              There are estimated to be approximately 26,000 carers within the
               borough of Ealing

The Carers Partnership Board, informed by the Cares Forum and other consultative
groups have identified the following priorities for Ealing.

              o   Improve on our means of identifying carers and providing advice and
                  information to support them in their caring responsibilities



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              o   Further promote the rights of carers to have an independent
                  assessment of their own needs
              o   Re-location of Carers Centre to more central site
              o   Build on recent review of respite provision to enhance and facilitate
                  access to services which provide a break for carers

              o   Continue to promote carers one-off payments
              o   Continue to promote the uptake of benefits by carers and the
                  individuals they care for
              o   Provide more targeted support for carers to gain and sustain
                  employment
              o   Further promote uptake of the carers emergency card
              o   Promote the identification of and support to young carers
              o   Ensure carers have access to good quality healthcare

7.6.     Older people

             Around 34,000 people over 65 years of age live in Ealing, and this
              number is projected to increase by around 10% in the next ten years.

             The prevalence of disability rises steeply after the age of 70. It is
              estimated that of Ealing‟s residents aged over 75 more that 8,000 have
              mobility problems, more than 5,000 have hearing impairment and more
              than 5,000 have difficulty with personal care.

             Over 2,300 people have dementia, and around 1,000 of these are aged
              over 85. By 2016 there will be 2,840 people with late onset dementia (65
              years +), and 130 with early on-set dementia (30 - 65 years). This
              represents about 13% increase on 2007, with numbers of men growing
              faster than women. There has been a steady increase in numbers of
              people living with dementia since 2001, due to ageing of the population.

             There is a need to reduce unnecessary reliance on A&E and to focus on
              prevention and early intervention.

             The voluntary sector will continue to make an important contribution to
              health and social care for older people.

             In consultations many people mentioned the need for: -

              o   Improvements in transport
              o   Better co-ordination between agencies, looking beyond health and
                  social care, including leisure, housing, education etc.
              o   More support for housebound older people and minority ethnic
                  communities
              o   Better information, for example, about falls, continence, health eating,
                  benefits, social activities, respite care and voluntary sector
              o   Involve people more in planning, through the Better Government for
                  Older People model.

             There has been a large increase in use of social care services. In recent
              years there has been major redesign of residential and day services.



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            District nursing and rehabilitation services are used mainly by people
             over 65 years old.

            In the longer term there will be a need for more extra care sheltered
             housing places. There are enough care homes in Ealing to
             accommodate longer term demand, provided a greater share of these
             can be used by Ealing residents. The ageing population of West London
             as a whole will have an impact on supply of care home places.

For commissioning increasing independence and wellbeing of older people will
require intervention to ensure that older people:

            Can make a contribution to society, in particular through volunteering or
             community involvement and social support
            Have Material wellbeing, in particular the need to continue to increase
             income
            Improved level of health in later life through delivering preventive health
             programmes, that have an impact on health
            Increased satisfaction with home and neighbourhood including, the
             impact of factors such as access to services, transport and crime, and
             social contacts
            Have the ability to maintain independent living, while being supported
             with health and care services where needed.
            Community-based       interventions      to   maintain    older    people‟s
             independence




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