Cheshire East by yaofenjin

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									         Cheshire East
Joint Strategic Needs
           Assessment




          A First Look
         Cheshire East Joint Strategic Needs Assessment



 Foreword
 Introduction
 People of Cheshire East
 Inequalities in Health
 Factors that affect health and well being
     •   Income & Housing
     •   Lifestyles
            o Smoking
            o Diet
            o Physical activity
            o Alcohol
Major Health issues
     •   Circulatory Disease
     •   Cancer
     •   Mental Health
            o Dementia
     •   Sexual Health
            o Teenage pregnancy
            o Chlamydia
     •   Diabetes
 Services for health and well-being
     •   Access to services
     •   Hospital Admissions
     •   Preventive services




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Foreword

 Partnership Working with Local Government in Cheshire

 The people of Cheshire are currently served by two Primary Care Trusts and two
 tiers of local government with Adult and Children's Services provided by Cheshire
 County Council and other services such as Environmental Health provided by six
 Borough Councils. Each of these seven Councils has a Local Strategic
 Partnership which leads the delivery of a community strategy. The complexity of
 this arrangement is further compounded by the fact that there is currently no
 coterminosity between Primary Care Trust and Council boundaries.

 However, as a result of local government reorganisation, there will be two new
 unitary authorities from 1st April 2009: Cheshire East Council and Cheshire West
 and Chester Council. In response to this, both Primary Care Trusts are seeking
 to change their boundaries to achieve coterminosity with the new council areas
 by 2010. The benefits of Primary Care Trusts and Councils working together to
 serve the same population are well demonstrated in other areas, for example
 Knowsley.

 The Cheshire Joint Strategic Needs Assessment process is directed by a
 steering group which comprises Directors of Public Health from Western
 Cheshire Primary Care Trust and Central and Eastern Cheshire Primary Care
 Trust; both Directors of Commissioning; Cheshire County Council’s Director of
 Adult Services; Cheshire County Council’s Director of Children's Services;
 Director of Joint Commissioning; plus nominated leads from the Safer-Stronger
 Communities LAA block; and Economy and Environment LAA block. After the
 careful consideration of the uniquely complex and changing circumstances in
 Cheshire, the steering group concluded that a common process should be used
 to develop two Joint Strategic Needs Assessments covering the populations of
 the two new councils: Cheshire West and Chester Council and Cheshire East
 Council.

 The Cheshire vision for Joint Strategic Needs Assessments

 Given that the clear starting point for Cheshire’s Joint Strategic Needs
 Assessments is that it should be a joint understanding of needs and priorities
 owned by both of Cheshire’s Primary Care Trusts and our Council partners, we
 have engaged with a wide range of stakeholders to develop a shared vision and
 understanding.

 We are very clear that Cheshire’s Joint Strategic Needs Assessments are
 dynamic needs assessments which are hosted on websites to enable them to be
 continually up-dated and refined as new information and intelligence is
 developed locally, nationally and internationally. We are also clear that our needs
 assessments are available to professionals and the public alike.


Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 In this sense the Joint Strategic Needs Assessment is never completed but
 rather a repository where increasingly more sophisticated understanding of need
 is available at different levels for different audiences. So for example: a policy
 maker in the Local Council can easily find priorities for tackling health
 inequalities; a commissioning manager developing tier 1 and tier 2 alcohol
 services can access the detailed needs assessment for alcohol to inform
 commissioning plans and a community group developing a parish plan can
 access information specific to their locality. This is an ambitious approach which
 is endorsed by our partners.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Introduction
 The Joint Strategic Needs Assessment (JSNA) is a shared statement on the
 health and wellbeing needs of the population of Cheshire East, which the Council
 and the Primary Care Trust have a legal duty to undertake in order to inform
 commissioners and providers on the development and improvement of services
 to address needs.

 The aim of the JSNA is to:

     •   Identify the health and wellbeing needs of the population
     •   Identify groups whose needs are not being addressed
     •   Provide information to be used in the planning, development and delivery
         of health and social care services over the next three to five years, and set
         a clear direction for the next ten years.
     •   Identify the causes and impacts of health inequalities and attempt to
         address these in the design of services.

 A comprehensive assessment of all the available information has been made and
 this report sets out the initial findings.

 People across Cheshire East have varying health experiences and outcomes
 and it is important to identify areas where there are high levels of ill-health and
 where needs are not being met. There are many different factors that affect
 health including housing, income, employment or unemployment, access to
 amenities and services and service organisation. Lifestyle choices such as diet,
 exercise, smoking and alcohol consumption also impact upon people’s health.
 Services for people with long-term conditions and disabilities must also be
 addressed.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 The People of Cheshire East
 In 2006, the estimated resident population of Cheshire East was 358,800. The
 area has an older population structure than England, with 17.8% (30,500) of the
 population being over 65 compared with 15.9% nationally. This results in a high
 ‘old age’ dependency ratio i.e. low numbers of working-age supporting a high
 non-working dependant older population. The percentage of ‘older’ or ‘frail’ old is
 also considerably higher, 2.3% (8,200) persons 85 and over compared to 2.1%
 nationally. There are internal variations in age structure, with Crewe and
 Middlewich having a higher proportion of children and young people than the
 area average. Nantwich and Knutsford have the highest percentages of older
 people.


 The population of Cheshire East is projected to increase by 6.1% to 380,500
 people by 2016, with the population aged 65+ increasing by 29.0% and the
 population aged 85+ by 41.5%. The number of under 5’s is predicted to increase
 by 7.4% and the number of under 15’s by 2.4%.



                                 Cheshire East Population Projections
                                              85+
                                             80-84
                                             75-79
                                             70-74
                                             65-69
                                             60-64
                                             55-59
                                             50-54
                                             45-49
                                             40-44
                                             35-39
                                             30-34
                                             25-29
                                             20-24
                                             15-19
                                             10-14
                                               5-9
                                               0-4

   10       8       6        4          2            0       2          4        6    8   10
                                     Percentage of population (%)
                        2006 Estimate - Males             2006 Estimate - Females
                        2016 Projection - Males           2016 Projection - Females
                        2026 Projection - Males           2026 Projection - Females




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 In recent years there has been an upward trend in fertility. We have used two
 assumptions to predict the number of live births from 2008 to 2011. Firstly, we
 assume that age-specific fertility rates will remain constant. Under this scenario
 numbers of live births will initially increase, then decline from 3,773 in 2007 to
 3,713 by 2011. The second scenario assumes a rise in age-specific fertility
 consistent with the last few years. Under this scenario the Total Fertility Rate (a
 measure of the average number of births per woman) would steady increase
 from 1.96 in 2008 to 2.06 in 2011, resulting in the number of births remaining
 almost constant at around 3,975 annually.


 Cheshire East birth projections

            Total Period Fertility
                Rate (TPFR)                                  Live births

                                                                               ONS
            Scenario1 Scenario2                         Scenario1 Scenario2 projections
    2008      1.92      1.96                    2008      3900      3969           3900
    2009      1.92      1.99                    2009      3838      3973           3900
    2010      1.92      2.03                    2010      3775      3975           3900
    2011      1.92      2.06                    2011      3713      3975           3900



 In 2005, 97% of the population of Cheshire East was White British, with people
 from other ethnic groups accounting for the remaining 3%. This is an increase of
 1.25% from the 2001 Census and is largely made up of working age Black and
 Asian populations.

 There were 2,270 new National Insurance Number Registrations in respect of
 foreign nationals in 2007/08. 1,250 of these were in Crewe and Nantwich
 parliamentary constituency. Between 2006 and 2008, according to GP registers,
 the number of people giving their place of birth as Poland increased by 64.5%
 (2,086 people) and those giving their place of birth as Slovakia increased by 54%
 (191 people), supporting the observation of a large migration into the area from
 Eastern Europe.

 Estimates of the number of ‘gypsies’ and ‘travellers’ in Britain range from 90,000
 to 300,000. Anecdotal evidence suggests that Cheshire East has a sizeable
 number of ‘travellers’ or ‘gypsies’. In July 2006, there were estimated to be
 around 163 caravans on a combination of authorised and unauthorised
 encampments.

 80% of the population identified themselves as ‘Christian’ in the 2001 Census.
 Nearly 19% said they had ‘no religion’ or did not identify their religion. The
 remaining 1% was represented by a diverse range of religions, but there were


Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 significant Muslim communities in Crewe and Macclesfield. Around 0.5% of the
 populations of the boroughs of Crewe and Nantwich and Macclesfield identified
 themselves as Muslim, but nearly 5% of the population of one LSOA in St Johns
 was Muslim, as was 3% of the population of one LSOA in Wilmslow Dean Row
 and Handforth.




     •   The projected increases in the residents over 65 and particularly the ‘frail’
         old (85 and over) will need to be considered in service development
         proposals. This is a potentially vulnerable group who will require more
         input from both social and health services and are more likely to struggle
         with accessing those serve requirements.
     •   International migration means that we need to consider presenting
         information in other languages and formats.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
Inequalities in health
While overall health is good within Cheshire East, this masks some differences
within the area. Nearly 80% of people in Macclesfield Town Tytherington rate their
health as ‘good’ compared with 62% in West Coppenhall and Grosvenor.

This picture of differing health experiences is seen more clearly when examining life
expectancy. Cheshire East has an overall life expectancy higher than the national
average for both males and females (78.26 and 81.97 years respectively). However,
life expectancy at smaller geographies or at town level reveals huge inequalities with
life expectancies ranging from 71.58 years for males in Coppenhall East to 93.27
years for females in Wilmslow Town South East. The largest gap inside a town is
13.9 years for women in Macclesfield.

The pattern of health experience is complex; some of the more affluent areas
experience low life expectancy, for example, amongst women in Bollinbrook and Ivy,
Macclesfield, where life expectancy is 79.53 years. Rurality and primary care
provision may play a part in determining health experience. The areas with poor self-
reported health do not match the areas of low life expectancy; this may be because
the expectations of patients living in deprived areas are lower than those of their
more affluent neighbours. In Waldron MSOA in Crewe, 32.6% of people rate their
health as ‘fair’ or ‘not good’, yet the area is in the highest life expectancy quintile for
men and the second highest for women.

Life Expectancy at birth by ward, 1993-2003




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
       Cheshire East Life Expectancy Gap
                                                  Congleton                                                                                                                                                                   Crew e & Nantw ich
                      Male                                                             Fe ma l e                                                                                                         Male                                                                        Fe ma l e
4. 0           3. 0           2. 0     1. 0                      0             1. 0                  2. 0     3. 0                                                         4. 0               3. 0                     2. 0         1. 0                    0               1. 0                 2. 0                  3. 0


                                                                                                                      I nf e c t i ous & pa r a s i t i c di s e a s e s                                                                                                                                                      I nf e c t i ous & pa r a s i t i c di s e a s e s


                                                                                                                      E x t e r na l c a us e s                                                                                                                                                                               E x t e r na l c a us e s


                                                                                                                      D e a t hs unde r 2 8 da y s                                                                                                                                                                            D e a t hs unde r 2 8 da y s


                                                                                                                      D i ge s t i v e                                                                                                                                                                                        D i ge s t i v e


                                                                                                                      Ot he r                                                                                                                                                                                                 Ot he r


                                                                                                                      R e s pi r a t or y D i s e a s e                                                                                                                                                                       R e s pi r a t or y D i s e a s e


                                                                                                                      C a nc e r s                                                                                                                                                                                            C a nc e r s


                                                                                                                      C i r c ul a t or y D i s e a s e                                                                                                                                                                       C i r c ul a t or y D i s e a s e


4. 0          3. 0           2. 0     1. 0                 0. 0                1. 0                  2. 0     3. 0                                                         4. 0              3. 0                      2. 0        1. 0                   0. 0              1. 0                 2. 0                  3. 0
                                            Li f e e x pe c t a nc y y e a r s ga i ne d                                                                                                                                              Li f e e x pe c t a nc y y e a r s ga i ne d




                                                 M acclesfield                                                                                                                         Life Expectancy gap betw een m ost deprived and least deprived quintile
                      Male                                                            Fe ma l e
4. 0           3. 0          2. 0     1. 0                   0               1. 0                  2. 0     3. 0
                                                                                                                                                                             10 0 %

                                                                                                                   I nf e c t i ous & pa r a s i t i c di s e a s e s


                                                                                                                   E x t e r na l c a us e s
                                                                                                                                                                              80%


                                                                                                                   D e a t hs unde r 2 8 da y s                                                                                                                                                                                      Inf ecti ous &par asi ti c di seases
                                                                                                                                                                              60%                                                                                                                                                    Exter nal causes
                                                                                                                   D i ge s t i v e                                                                                                                                                                                                  Deaths under 28 days
                                                                                                                                                                                                                                                                                                                                     Di gesti ve
                                                                                                                   Ot he r                                                                                                                                                                                                           Other
                                                                                                                                                                              40%
                                                                                                                                                                                                                                                                                                                                     Respi r ator y Di sease
                                                                                                                   R e s pi r a t or y D i s e a s e                                                                                                                                                                                 Cancer s
                                                                                                                                                                                                                                                                                                                                     Ci r cul ator y Di sease
                                                                                                                   C a nc e r s                                               20%


                                                                                                                   C i r c ul a t or y D i s e a s e


4. 0          3. 0           2. 0    1. 0                 0. 0              1. 0                   2. 0     3. 0
                                                                                                                                                                                  0%
                                                                                                                                                                                          Mal es            Femal es                       Mal es           Femal es                         Mal es         Femal es
                                        L i f e e x p e c t a nc y y e a r s g a i n e d                                                                                                            C ongl e t on                            C r e we & N a nt wi c h                              M accl esf i el d




       Data Source:                        Cheshire East Joint Strategic Needs                                                        Assessment. Emerging Findings – A First Look
       APHO Health Inequalities Intervention Tool
       http://www.lho.org.uk/HEALTH_INEQUALITIES/Health_Inequalities_Tool.aspx
The Association of Public Health Observatories (APHO) Health Inequalities
Intervention tool allows us to examine the gap in life expectancy between the most
deprived and least deprived fifth within the three boroughs. The bar charts show the
increases in life expectancy that would occur in the most deprived fifth if the death
rates for specific diseases were the same as those experienced in the affluent
quintile. The stacked bar chart shows the contribution of various causes of death to
the life expectancy gap. More detailed analysis using the tool leads to the following
conclusions:


   •   Coronary Heart Disease (CHD) is the single biggest contributor in both men
       and women;
          o Congleton males 9.8% (0.52 years) and females 16.5% (0.80 years)
          o Crewe & Nantwich 16.4% (1.15 years) and females 11.2% (0.64 years)
          o Macclesfield 31% (2.13 years) and females 13% (0.72 years)

   •   Lung cancer is the biggest contributing cancer type in both men and women
          o Congleton males 8.5% (0.45 years) and females 9.3% (0.45 years)
          o Crewe & Nantwich 7.1% (0.5 years) and females 12.1% (0.69 years)
          o Macclesfield 10.6% (0.73 years) and females 5.4% (0.3 years)

   •   COPD contributes between 6.3% (Males Crewe & Nantwich) and 11.4%
       (Females Crewe & Nantwich)

   •   Chronic cirrhosis of the liver contributes between 3.4% (Males Macclesfield)
       and 7.4% (Males Congleton)

   •   Deaths from diseases of the nervous system are major contributors in men
       (5.9%, 0.31 years) and women (3.1%, 0.15 years) in Congleton and in women
       (4.7%, 0.27 years) in Crewe & Nantwich

   •   Suicides and undetermined injuries are an important concern
          o Congleton Males 2.1% (0.11 years)
          o Crewe & Nantwich Males 3.6% (0.25 years)
          o Macclesfield Females 4.3% (0.24 years)



   •   To inform priority setting, the PCT is grouping areas with the lowest life
       expectancies and examining which disease or age groups impact the most in
       each area.

   •   The quality of Primary care provision for certain preventable diseases is also
       being examined.



Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 The graph below shows that the decline in death rates in the more affluent
 Middle Super Output Areas (MSOAs) has slowed since 2005 and has started to
 reverse. This means that the projected reduction in the inequalities gap is partly
 due to the worsening situation in the affluent areas rather than an accelerated
 decline in the most deprived MSOAs.


 Projected all age all cause mortality for Cheshire East
                                                                                           Most Deprived                     Least Deprived

                    1000                                                                   Most Deprived Forecast            Least Deprived
                                                                                           baseline 2001                     Forecast baseline 2001

                               900                                                         Most Deprived Forecast            Least Deprived Forecast
                                                                                           baseline 2005                     baseline 2005
  DSR per 100,000 population




                               800

                               700                          Current difference
                                                            in rate 266.3 (628
                               600                          deaths)

                               500

                               400

                               300          Forecast baseline 2001:                      Forecast baseline 2005:
                                            Projected difference in rate                 Projected difference in rate
                               200          299.0 (approx. 705 deaths)                   232.6 (approx. 548 deaths)

                               100

                                 0
                                     2001   2002   2003    2004    2005    2006   2007   2008      2009        2010   2011    2012       2013
                                                                                  Year




 The infant mortality rate in Cheshire East (children who die before their first
 birthday) at 3.8 per 1,000 is lower than the national average (5.0 per 1,000).
 However, the rate is significantly higher in the borough of Crewe and Nantwich at
 5.2 per 1,000. Evidence suggests that there is a clear link between infant deaths
 and deprivation. This is difficult to establish locally as numbers of deaths are
 small and fluctuate year on year.

 As well as enabling people to live longer, residents should experience a good
 quality of life. Residents should remain active and in good health, enabling them
 to maintain independence for as long as possible. 16.8% of the population
 (59,000 people) in Cheshire East suffer from a long-term illness, health problem
 or disability that limits their daily lives. There is a clear link with deprivation. All
 the small area geographies with statistically higher standardised illness ratios
 than the North West (>113.98) fall in the 40% most deprived nationally.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Ward level estimates of healthy life expectancy at birth reveal huge inequalities
 across Cheshire East. The healthy life expectancy for males in Grosvenor ward
 in Crewe is just 60.4 years, whereas the healthy life expectancy for males in
 Knutsford Norbury ward is 81 years. For women, healthy life expectancy at birth
 in Delamere ward in Crewe is 65.8 years and in Knutsford Norbury, 82.1 years.
 There is a clear link between a high healthy life expectancy and low deprivation.

 Ward level estimates of disability free life expectancy range from 53.6 years for
 males in Grosvenor ward to 73.2 years for males in Knutsford Norbury ward. For
 females, the lowest disability free life expectancy of 59.1 years occurs in Maw
 Green ward in Crewe and the highest of 74.3 years occurs in Knutsford Norbury.
 Again, there is a strong link with deprivation, but there are some anomalies.
 Plumley ward has a low level of deprivation and a disability free life expectancy
 for males of 56.2.

 Incapacity benefit can be claimed by people of working age who are unable to
 work due to illness or disability. Across Cheshire East nearly 11,500 people of
 working age claim Incapacity benefits and 12.1% claim Severe Disability
 Allowance. 40% of Incapacity Benefit claims are associated with Mental
 Disorders. However, this data excludes residents who have not paid sufficient
 National Insurance contributions, distorting the picture.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Factors that affect health and well-being
 Income & Housing

 Unemployment in Cheshire East has remained low. The household workless rate
 at 8.4% is below the national average (14.2%). In 2007, 48% of disabled people
 and up to 41% of people with health problems in Cheshire East were classed as
 economically inactive. Some of these people may want to seek meaningful
 employment and might encounter barriers to this.
 In 2001, 10.4% of the population (36,700 people) were providing unpaid care of
 between 1 and 50 hours per week, similar to the England average of 9.9%. Of
 these people, 7.8% provided part-time care of 1 to 20 hours.
 The overall percentage of the working age population educated to NVQ Level 3
 and above is 50%, although in Crewe and Nantwich it is only 38.4%, one of the
 lowest figures in the North West (44.0%). 9% have no qualifications, compared
 with the average in the region (15%).
 Gross earnings for full-time work are higher at £490
 per week compared with the regional average of
 £459. However, this masks the low pay in Crewe
 and Nantwich of £395. Women in full-time work earn
 approximately 30% less. Income deprivation occurs
 in areas with high levels of general deprivation and
 affects all age groups. However, there are some
 uneven patterns. Macclesfield Town South has the
 highest level of income deprivation affecting children in Cheshire East but the
 LSOAs within it fall into quintiles four and five for overall deprivation nationally
 (with quintile 1 being the most deprived).
                              23% of the population (83,300) of Cheshire East
                              experience barriers to housing and services. This
                              includes    measures      of   housing     affordability,
                              overcrowding, homelessness, tenure and access to
                              local amenities and services. Rurality compounds these
                              issues, the top 5 ranked LSOAs are within Acton,
                              Minshull & Wybunbury and Nantwich and Crewe Rural.
                              3.1% of households in Cheshire East are classed as
                              over-crowded, compared with 5.4% in the North West.
 As many as 8,940 households (6%) across Cheshire East experience fuel
 poverty, (spending more than 10% of total household income on maintaining a
 satisfactory heating regime). Although the most deprived in terms of fuel poverty,
 the MSOA of St Johns in Crewe, is neither the most deprived nor has it a high
 proportion of older residents relative to other areas with lower fuel poverty.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Lifestyles
 Smoking

 Smoking is the single most preventable cause of ill health and premature death.
 Approximately 530 people died last year from smoking-related diseases in
 Cheshire East, 10 people per week. 46% died before the age of 75 (243 deaths).
 There are approximately 58,000 adult smokers in Cheshire East (19.3%).
 National evidence suggests that smoking prevalence has been falling but the
 main reductions have occurred in the skilled and professional socio-economic
 groups. This will further widen the health inequalities gap. Smoking prevalence
 was already higher in the more deprived areas; Crewe town has an estimated
 smoking rate of 25.4%, the more affluent Poynton only 13.7%. Rural areas have
 lower percentages than the towns, Macclesfield Rural the lowest at 12.7%.


 Modelled smoking estimates, adults (over 16s) by town, 2003-05

                                         Estimated
                                         number       Percentage
  Crewe                                  15801        26.2%
  Macclesfield                           11030        22.2%
  Middlewich                             2335         21.3%
  Nantwich                               2298         20.4%
  Congleton                              4497         20.1%
  Sandbach                               2758         18.1%
  Alsager                                1818         16.9%
  Wilmslow                               4300         16.7%
  Knutsford                              1805         15.9%
  Crewe & Nantwich Rural                 2442         15.0%
  Congleton Rural                        2664         14.0%
  Poynton                                1611         13.7%
  Macclesfield Rural                     4358         12.7%
  Cheshire East                          57716        19.3%




 The effectiveness of Stop Smoking Services is well established. Central and
 Eastern Cheshire PCT Stop Smoking Services saw 7,011 clients in 2007/08,
 9.1% of the estimated number of smokers. 3,085 smokers (44%) were supported
 to quit at four weeks. The England rate for 2006/07 was 53%. Identification by
 healthcare professionals is a critical factor, although recording of smoking status
 on GP Practice systems is currently only at 55%.

 Smoking during pregnancy can lead to an increased risk of miscarriage,
 premature birth and even stillbirth. For the baby it can lead to low birth weight,
 delayed growth, higher risk of cot death and breathing problems and asthma.


Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Locally, 19.6% (1,002) of women were known to be smokers at the time of
 delivery. There is a slight variation across the two main maternity units (22% Mid
 Cheshire and 19% East Cheshire). Percentages are significantly higher in all
 three of the former boroughs, approximately 4% higher than the England
 average. Identification of smokers early in pregnancy proves difficult, social
 pressure may prevent mums notifying health professionals and therefore delays
 access to smoking cessation services.




 National Survey data indicates a decline in the proportion of pupils both stating
 that they have tried smoking (33% in 2007) and those who are classified as
 regular smokers i.e. smoking at least once a week (6% in 2007 from 9% in 2003).
 We estimate that there are 1,800 11 to 15 year olds in Cheshire East who are
 regular smokers. National data indicates that 65% of young smokers purchase
 their cigarettes from shops.



     •   Smoking Cessation services must continue to target the more deprived
         areas and areas with low life expectancy.
     •   We need to ensure that stop smoking messages use language and
         images that impact on young people.
     •   We also need to tackle shops who sell cigarettes to children under 18.
     •   We need to ensure that smoking status is constantly reviewed on
         healthcare systems, currently assume non-smoking as some individuals
         who have previously given up may re-start after periods of stress, illness
         being a stress trigger.
     •   Around 1,000 women each year continue to smoke throughout their
         pregnancies. Major health gains could be achieved if these women were
         supported to stop smoking.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Diet

 A balanced diet helps to maintain good health. People need to understand how
 they can improve and maintain their own and their family’s health.

                            Breastfeeding is the best nutritional start; it provides
                            health benefits for both mother and baby. Breastfeeding
                            initiation rates are very much lower in Cheshire East than
                            nationally. In 2006/07 only 62.8% of women in Congleton
                            borough, 63.0% in Crewe and Nantwich and 62.8% in
                            Macclesfield breastfed their babies, compared to a
                            national rate of 69.2%. More recent data shows a 14%
                            difference across the two main maternity units, Mid
                            Cheshire 68% and East Cheshire 54%. Both Trusts are
                            showing significant improvements already in 2008/09.
                            We are now looking at ways of encouraging mums to
                            continue breastfeeding for at least 6-8 weeks.


 It has been recognised that there is a link between health, behaviour and
 achievement in children. The national Healthy Schools Programme is a long-term
 initiative that uses a whole school approach to enable children to make informed
 healthy lifestyle choices. Currently 63% of schools have Healthy School status
 across Cheshire; this is in line with the national average.

 Percentage of overweight and obese children 2006/07

                               Reception    Yr 6
                               %            %
  Crewe                        21.9%        38.5%
  Nantwich                     13.0%        33.3%
  Crewe & Nantwich Rural       17.4%        27.1%
  Alsager                      19.4%        30.0%
  Congleton                    23.3%        24.2%
  Middlewich                   16.8%        36.3%
  Sandbach                     12.8%        30.9%
  Congleton Rural              19.3%        32.8%
  Knutsford                    26.3%        26.3%
  Macclesfield                 26.1%        31.7%
  Poynton                      16.7%        29.7%
  Wilmslow                     25.9%        24.5%
  Macclesfield Rural           25.8%        27.8%
  Cheshire East                22.2%        31.5%
  England                      22.9%        31.6%




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 The National Height and Weight Measurement programme revealed that the
 percentage of children who were either obese or overweight (22.2%) in local
 authority schools falling within the Cheshire East boundaries was similar to the
 national figure (22.9%).
 Obesity in adults in Macclesfield Borough (20.1%) is at a significantly lower rate
 than the England average (23.6%). Both Congleton Borough and Crewe and
 Nantwich Borough are not significantly different from England. The relationship
 between social-economic status and obesity is not fully understood, particularly
 in men. Nationally prevalence of obesity is higher in adult women living in areas
 of higher deprivation. Local estimates indicate that towns with higher deprivation
 appear to have higher overall percentages of obese adults. Crewe at 26.1% has
 the highest percentage within Cheshire East. There does not appear to be any
 relationship with rurality.
 Estimates of Obesity, adults (16 and over), 2003-05
                                                 Harmful                     Protective
                                                                        5 portions of fruit &
                                              Adult obesity             vegetables per day
                                            Number      %               Number         %
 Crewe                                       15736      26.1%             12804      21.2%
 Middlewich                                  2709       24.7%             2516       23.0%
 Congleton                                   5412       24.1%             5206       23.2%
 Nantwich                                    2657       23.6%             2668       23.7%
 Macclesfield                                11499      23.1%             11628      23.4%
 Sandbach                                    3508       23.0%             3759       24.6%
 Crewe & Nantwich Rural                      3660       22.5%             4743       29.1%
 Congleton Rural                             4272       22.5%             5477       28.9%
 Alsager                                     2201       20.4%             2989       27.8%
 Poynton                                     2369       20.2%             3246       27.7%
 Macclesfield Rural                          6881       20.1%             10683      31.3%
 Knutsford                                   2213       19.6%             3113       27.5%
 Wilmslow                                    5024       19.5%             7005       27.2%
 Cheshire East                               68141      22.8%             75837      25.4%

 Lifestyle estimates indicated that fruit and vegetable consumption amongst adults
 is reasonable across Cheshire East; estimates are not significantly different from
 the England average of 26.3%. However, data at a town level shows that
 consumption of 5 or more portions a day ranges from 21.2% to 31.3%,
 Consumption is lower in towns that have higher levels of poverty; Crewe is the
 lowest at 21.2%. However, rurality does appear to influence fruit and vegetable
 consumption, Crewe and Nantwich Rural is 7.9% higher than the Crewe town
 area.
    •   Community health professions need to co-ordinate their effort with
        maternity colleagues to ensure continuing support for breastfeeding
        mums.
    •   Increased coverage of the childhood measurement programme this
        year will enable more detailed analysis of childhood weight issues,
        including an analysis of underweight children.
Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Physical activity

 Regular exercise is important for both physical and mental well-being. Increasing
 residents’ activity levels would contribute to the prevention and management of
 over twenty conditions and diseases including coronary heart disease, diabetes,
 cancer, osteoporosis and weight management. In older adults it improves
 mobility and balance, therefore, reducing the risk of a fall. The Active People
 Survey 2005-2006 provides data on frequency and level of activity undertaken by
 adults. Current recommendations are for adults to participate in a minimum of 30
 minutes of at least moderate intensity activity at least five times a week.

 Nationally 11.6% of adults meet the exercise recommendations. Locally
 Macclesfield residents are the most active with 15.5% achieving the participation
 recommendations. Residents of Crewe and Nantwich are the most inactive with
 only 9.8% of adults managing to exercise regularly.

 Adults meeting physical activity participation recommendations

                           Age ranges
                                        16-34              35-54               55+
                           All Ages     Male    Female     Male     Female     Male    Female
  Congleton BC             12.0%        26.3%   12.1%      13.1%    11.3%      9.5%    5.3%
  Crewe & Nantwich BC      9.8%         11.9%   15.1%      11.6%    8.1%       7.9%    6.5%
  Macclesfield BC          15.5%        21.6%   21.0%      21.2%    16.7%      12.0%   6.4%
  England



 The School Sports Survey 2007 collected information about levels of participation
 in physical education and organised school sports events for schools taking part
 in the School Sport Partnership Programme. This indicated that locally pupils
 exceed the national average with rates of 89% in Crewe and Nantwich and 91%
 in Congleton and in Macclesfield. The national participation rate was only 86%.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Alcohol

 Alcohol is a serious public health problem in Cheshire East. Estimates indicate
 that binge drinking – drinking more than 10 units of alcohol for men and 7 units
 for women in a single session - is significantly higher at 21.4% compared to the
 England average of 18.0%. The figures for Congleton are 21.3%, for Crewe and
 Nantwich 22.2% and for Maccesfield 21.1%. Although there seems to be a
 relationship with deprivation, the differences are not large. However, rurality does
 seem to have a protective effect. Rates are higher in all the urban areas
 compared to their rural counterparts; Crewe and Nantwich town (23.7%) is 6.8%
 higher than Crewe and Nantwich Rural 2 (16.9%).


 Estimates of binge drinking, adults (16 and over), 2003-05

                                         Numbers     Percentage
  Crewe                                  14283       23.7%
  Middlewich                             2581        23.6%
  Nantwich                               2616        23.2%
  Macclesfield                           11250       22.6%
  Alsager                                2431        22.6%
  Congleton                              4977        22.2%
  Poynton                                2508        21.4%
  Sandbach                               3256        21.3%
  Wilmslow                               5404        21.0%
  Knutsford                              2319        20.5%
  Congleton Rural                        3376        17.8%
  Macclesfield Rural                     6002        17.6%
  Crewe & Nantwich Rural                 2827        17.4%
  Cheshire East                          63828       21.4%



                                  According to the North West Alcohol Profiles, there
                                  are 92 alcohol-attributable deaths each year in men
                                  within Cheshire East and 77 in women. This
                                  equates to an average loss of 10 months of life
                                  across the three former boroughs in males and 5
                                  months in females. 25% of the male deaths were
                                  from Chronic Liver Disease (23 deaths) and 23%
                                  (18 deaths) for females.

 There have been dramatic year on year increases in alcohol-related admissions,
 averaging 13.4% each year over the last 5 financial years. If this trend continues
 the admission rate will be in the region of 3870 per 100,000 admissions by 2012-
 13. This would be approximately 170 additional admissions a week.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
                                            Trajectory and target for alcohol related admissions (NI39 Indicator)

                                4500.00
                                4000.00
   Admission rate per 100,000




                                3500.00
                                3000.00
                                2500.00                                                                                                       Rate per 100000
                                                                                                                                              Trajectory projection
                                2000.00
                                                                                                                                              +1% decrease/year
                                1500.00
                                1000.00
                                 500.00
                                   0.00
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 In 2006/07, there were nearly 2,600 crimes in Cheshire East relating to alcohol;
 nearly 70% involved violence and 1.2% were sex related.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Major Health Issues
 Circulatory Disease
 Circulatory disease (heart disease, heart attacks, heart failure and stroke) is the
 biggest killer, accounting for nearly 40% (1251) of all deaths within Cheshire
 East. Since 1993 there has been a 65% (673) reduction in the number of deaths.
 However, this decline has slowed over the last 5 years. There are significant
 differences across the Authority. For males, there is a three fold difference
 between Macclesfield Town South (479 per 100,000) and Congleton West (133
 per 100,000). Areas of high deprivation have significantly higher rates, twice that
 of more affluent areas (347 per 100,000 and 165 per 100,000 respectively).
 Deaths also tend to occur around 10 years prematurely in males living in areas of
 low life expectancy.
 GP Practices hold registers of chronic diseases such as Coronary Heart Disease.
 New figures indicate that the number of known sufferers match expected
 numbers. However, the numbers of patients recorded as being hypertensive are
 lower than expected. In Wilmslow only 48% of the expected numbers are
 recorded.
 Observed and Expected CHD and Hypertension by Towns



                             CORONARY HEART DISEASE                 HYPERTENSION
  Town Area                  Observed Expected   Obs/Exp            Observed Expected   Obs/Exp
  Crewe                      3014     3251       93%                10065    17191      59%
  Nantwich                   584      812        72%                2195     3867       57%
  Crewe & Nantwich Rural     740      718        103%               2563     4667       55%
  Alsager                    609      569        107%               2054     3331       62%
  Congleton                  1090     1193       91%                3586     6924       52%
  Middlewich                 427      433        99%                1952     2922       67%
  Sandbach                   763      753        101%               2377     4604       52%
  Congleton Rural            898      970        93%                3084     6122       50%
  Knutsford                  549      628        87%                1854     3551       52%
  Macclesfield               2181     2252       97%                7868     13888      57%
  Poynton                    610      594        103%               2156     3701       58%
  Wilmslow                   985      1234       80%                3624     7530       48%
  Macclesfield Rural         1475     1931       76%                5247     11603      45%
  Cheshire East              13924    15337      91%                48625    89901      54%




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
     •   Rigorous case-finding at a practice level of patients with contributory
         conditions such as high blood pressure, high blood cholesterol, overweight
         and obesity etc. (Focusing on complete ascertainment of those at 20%
         risk of Coronary Heart Disease over next 10 years)

     •   Investigate geographical differences in primary and secondary care to
         explain and reduce some of the geographical differences in death rates.

     •   Target early risk modification at men in their 30s and 40s in areas of high
         deprivation and low life expectancy.

     •   Investigate why the rate of decline in mortality has slowed in recent years.

     •   One of Central and Eastern Cheshire PCT’s World Class Commissioning
         Priorities is effective control of blood pressure.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Cancers
 Cancer deaths constitute 26% (956) of all deaths locally, making it the second
 biggest killer. Cancer is not a single disease and the age, sex and geographical
 distribution of cancers can vary greatly. Breast, prostate, lung and colorectal
 cancers are the major cancer groups, they account for 55% (1,090) of new
 cases. Cancer mortality has been declining steadily since 1993. 91% of new
 cases occur in the over 55s. This means that the ageing population has actually
 resulted in an increase in number of deaths by 3.6% (34 extra deaths). Affluent
 areas are significantly lower, with a rate almost half that of the most deprived fifth
 of people (230.9 per 100,000 compared with 148.6 per 100,000). The towns of
 Wilmslow, Alsager and Middlewich have higher incidence than average (15%,
 12% and 10% respectively).

 Deaths for Cancers by deprivation, Persons all ages, 2004-2006

                                            300
   Directly Standardised Rate per 100,000




                                                                                                                     DSR
                                            250                                                                      Cheshire East
                                                                                                                     England
                                            200


                                            150


                                            100


                                            50


                                              0
                                                  Cheshire East   Quintile 2    Quintile 3     Quintile 4   Cheshire East
                                                  Most Deprived                                             Least Deprived
                                                                   IMD2007 Deprivation National Quintiles


 It is estimated that over half of cancers could be prevented if people adopted
 healthy lifestyles. During 2005 to 2007 there were 384 cancer deaths related to
 smoking alone. Over 145 cancer deaths could be saved a year by eradicating
 smoking and by providing timely and effective treatment for all cancers amenable
 to healthcare in the under 75s.

 Early detection is vital in increasing survival rates from cancer. Across Cheshire
 East, breast and cervical screening rates are substantially higher than the
 national rate. However, there is no room for complacency. In Central and
 Eastern Cheshire PCT, the uptake rate for cervical screening among women
 aged 25-29 is falling. In 2006/07, only 75.2% of this age group had had a




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 cervical screen in the last three years. In Crewe, 7.0% of women aged 25-64
 have no cervical screening record and in Wilmslow, 6.9%. Wilmslow has lower
 uptake rates than other areas of the PCT for both breast and cervical screening
 and whilst there is unlikely to be a direct link to the high rates of female cancers
 within the town, awareness and attitudes to cancer would bear investigation.




     •   Target women in the 25-34 age groups where cervical screening uptake is
         declining year after year.

     •   The Cancer 62 day wait is a further World Class Commissioning priority
         for Central and Eastern Cheshire PCT. Although the PCT performs well,
         there is room for improvement. Small numbers of breaches can cause
         huge fluctuations and there is a need for continued monitoring.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Mental Health

 On average, at any one time one in six adults has a mental health problem.One
 in four GP consultations are related to a mental health issue. Mental wellbeing is
 associated with better physical health.
 Groups at greater risk of mental health problems:
     •   Older people (and their carers) face a range of potential mental health
         problems, including loneliness, depression, acute confusional states,
         dementia and alcohol misuse. Many of these issues remain undetected.
     •   People living in poverty tend to have the highest rates of anxiety and
         depression. Those with the greatest needs sometimes face the greatest
         barriers to accessing help and support.
     •   Looked after children and adolescents (those children in foster or
         residential homes, or subject to care orders) are at higher risk of
         emotional, conduct and other disorders, and commonly experience social
         disadvantage.
 People with mental health problems may also suffer from stigma and
 discrimination from other people including health and social services
 professionals.




     •   Improving mental wellbeing requires a broad partnership to address
         factors as education, nutrition, the build environment, safety and public
         order, economic security, parenting, relationships, schools, employment,
         physical activity and substance abuse, which all influence mental health
         and wellbeing, as well as the provision of adequate mental health
         services.

 Dementia

 Dementia is a progressive condition. Although it can affect people of all ages it is
 more common in older people, affecting 1 in 14 people over 65. Independent
 living becomes progressively harder as sufferers gradually lose memory,
 reasoning and communication skills.

 There is estimated to be 4,500 suffers in Cheshire East over the age of 65, 64%
 are likely to be women. Using current population projections from the Office of
 National Statistics and prevalence estimates for dementia this number will have
 increased by 9% to 4, 900 by 2010. There is an estimated 100 people with early
 onset dementia in Cheshire East.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Predicted number of people with dementia for Cheshire East 2006-2025

             5000


             4500


             4000


             3500
                                                                                                                                Females 85+
                                                                                                                                Females 80-84
             3000                                                                                                               Females 75-79
                                                                                                                                Females 70-74
   Numbers




                                                                                                                                Females 65-69
             2500
                                                                                                                                Males 85+
                                                                                                                                Males 80-74
             2000                                                                                                               Males 75-79
                                                                                                                                Males 70-74
                                                                                                                                Males 65-69
             1500


             1000


             500


               0
                    Males   Females   Males   Females   Males   Females   Males   Females   Males   Females   Males   Females
                             2006         2008              2010              2015              2020              2025




 Dementia has a disproportionate impact on quality of life, it is estimated that it
 contributes 11.2% of all years lived with disability in people over the age of 60. It
 is estimated that dementia costs over 17 billion each year, which equates to 25K
 per person with late onset dementia.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Sexual Health

 Teenage Pregnancy

                   The teenage pregnancy rate for Cheshire East (31.1 per
                   1,000) is lower than the England rate (41.1 per 1,000) in 2004-
                   06. Across Cheshire East there equates to approximately four
                   conceptions a week to girls under the age of 18. This rate is
                   not consistent across the Authority; Crewe and Nantwich has
                   the highest rate at 43.9 per 1,000. Unfortunately the decline in
                   Congleton and Crewe and Nantwich boroughs has slowed;
                   this means that the 2010 target will not be met. There is a
                   wealth of evidence associating high rates of teenage
                   pregnancy with poverty, poor educational attainment and low
 self-esteem.    There is a high rate of conceptions leading to abortion
 (approximately 50%), particularly in Macclesfield borough (56.7%). This
 reinforces the assumption that a large proportion of conceptions are unplanned.
 Crewe and Nantwich has the lowest percentage leading to abortion (37%). The
 deprived wards of Coppenhall, Delamere, Grosvenor, Maw Green and St
 Barnabas in Crewe all have significantly higher rates of teenage pregnancy. This
 means adequate support needs to be provided for in these ‘hotspots’ to enable
 these teenage mums to either return to work or education to secure a better
 future.


 Teenage pregnancy: Under 18 conceptions plotted against 2010 target


                                                                                                  Target
                   70.0                                                                           Macclesfield
                                                                                                  Cheshire County
                                                                                                  Congleton
                   60.0                                                                           Crewe & Nantwich
                                                                                                  Linear (Macclesfield)
                                                                                                  Linear (Congleton)
                   50.0
   Rate per 1000




                                                                                                  Linear (Crewe & Nantwich)

                   40.0

                   30.0

                   20.0

                   10.0

                    0.0
                          1998


                                 1999


                                        2000


                                               2001


                                                      2002


                                                             2003


                                                                     2004


                                                                            2005


                                                                                   2006


                                                                                          2007


                                                                                                 2008


                                                                                                         2009


                                                                                                                 2010




                                                                    Year




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Chlamydia

 Chlamydia is the most common sexually transmitted infection within the UK. The
 spread is exacerbated by the lack of symptoms in the majority of people infected.
 If untreated, it can lead to infertility and pelvic inflammatory disease. The number
 of confirmed cases has been steadily rising at both the clinic at Leighton (350 in
 2005) and Macclesfield (347 in 2005) hospitals. This may be as a result of
 increased awareness of Chlamydia. Locally, 13.8% of sexually active 15-24 year
 olds were screened, with approximately 10% of tests being positive. The age-
 sex- distribution indicates the high risk groups are men in the 20-24 and 45+ age
 groups. Women are contracting the virus younger than men with larger number
 of cases recorded in the under 19s.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Diabetes

                              Diabetes mellitus is a condition that affects the way a
                              body processes glucose, this lead to elevated levels of
                              sugar within the blood. Type 1 is where the body is
                              unable to produce any insulin, the hormone that
                              enables the body to process glucose to enter the cells.
                              Type 1 usually appears before the age of 40 and is the
                              least common type. Type 2 develops when the body is
                              unable to produce sufficient insulin or the insulin
                              produced is not working effectively. Type 2 accounts for
                              85-95% of diabetes. Diabetes leads to increased risks
                              of heart disease, retinopathy, blindness, stroke, lower
                              limb amputation, depression, erectile dysfunction,
                              kidney failure, complications during pregnancy, nerve
                              damage and metabolic Syndrome.
 There is an estimated 14,000 people with Diabetes in Cheshire East, 4% of the
 total population. This is lower than the actual observed recorded on GP registers.
 This indicates that detection rates are extremely good within primary care. There
 were 113 diabetic deaths over the last 3 years, 72% occurred in the 75s and
 over.
 Estimates of Diabetes (Type 1 and 2), all ages, 2003-05
                                    DIABETES MELLITUS (Types 1 and 2)
 Town Area                         Observed   Expected      Obs/Exp
 Crewe                               3387       3052         111%
 Nantwich                             607         667         91%
 Crewe & Nantwich Rural               797        674         118%
 Alsager                              505         494        102%
 Congleton                           1138       1092         104%
 Middlewich                           610        429         142%
 Sandbach                             782        673         116%
 Congleton Rural                      913        873         105%
 Knutsford                            534        564          95%
 Macclesfield                        2371       2213         107%
 Poynton                              659        531         124%
 Wilmslow                             1008       1184         85%
 Macclesfield Rural                  1384       1713          81%
 Cheshire East                       14695      14160        104%

 Being obese increases the risk of developing type 2 diabetes, in females 13
 times greater and in men 5 times. It is estimated nationally nearly half of all
 diabetes is attributable to obesity. Within Cheshire East obesity levels in adults
 are not significantly higher than the England average. However, childhood
 obesity is steady increasing and this will lead to more cases of early onset
 diabetes type 2. A sedentary lifestyle increases the risk of developing type 2 by
 30-40%.



Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Services for Health and Wellbeing
 Access to services
 Local transport policies need to developed in partnership with the health service.
 This will ensure that residents can access not only health services, but also
 important community resources such as schools and shops with the full range of
 foodstuffs necessary for a healthy balanced diet. Cheshire East faces particularly
 problems because of its rurality and affluence, this may leave older people and
 people on low incomes unable to access essential services. Nationally, 14% of
 adults, and over 70% of people aged over 85, have a physical disability or long
 standing health problem which prevents them from going out on foot or using
 public transport, and access to community or more specialist transport services
 may be limited.


     •   Joint developement of transport polices and town planning to enable
         access to services.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Hospital Admissions

 The risk of both emergency and elective admissions rises with age from the age
 of 65 onwards. The table above shows admissions for residents of Cheshire East
 by town and broad age groups. It is clear that emergency admissions are higher
 both in terms of numbers and age-standardised rates in the towns of Crewe and
 Macclesfield. This corresponds with the locations of the two main hospital Trusts.
 The admissions are lowest in the rural community which suggests a possible
 accessibility issue.

 Admissions in the three years 2004/05, 2005/06 and 2006/07 by town and age

                                                 Emergency Admissions                          Elective Admissions
                                                      Age standardised rate per                     Age standardised rate per
                                          Numbers            100 people              Numbers               100 people
                Town                      under 75s    0-19    20-64    65-74        under 75s       0-19    20-64    65-74
 Crewe                                      16155       8.5      7.2     13.5          15487          3.2      8.3     16.2
 Nantwich                                    2570       7.5      7.1     11.4           2516          2.9      7.0     15.9
 Crewe & Nantwich Rural                      2917       6.2      4.6     10.5           3468          2.6      6.5     15.1
 Alsager                                     1929       5.8      5.0     10.7           2788          3.1      8.1     18.0
 Congleton                                   4344       6.9      5.2     10.2           4899          2.7      6.8     14.4
 Middlewich                                  2622       7.8      6.4     12.3           2812          3.3      7.9     17.2
 Sandbach                                    2854       6.4      5.0     10.8           3429          3.1      6.8     15.7
 Congleton Rural                             3047       6.4      4.1      9.1           4243          2.8      6.5     15.1
 Knutsford                                   2193       7.1      5.5     10.6           2785          4.5      7.4     18.0
 Macclesfield                               12780       9.7      6.8     14.5          11190          3.6      7.0     16.6
 Poynton                                     1895       5.9      5.0      9.6           2653          4.6      7.1     16.9
 Wilmslow                                    4418       6.1      4.9      9.7           5517          3.9      6.5     16.6
 Macclesfield Rural                          5637       7.0      4.5      9.2           6896          3.2      5.9     13.8
 Cheshire East                              63361                                      68683




 Top 10 reasons for hospital admissions

                     Emergency Admissions                                             Elective Admissions
 HRG code                  Description             Numbers   HRG code                      Description                Numbers
 E36        Chest Pain <70 w/o cc                   4880     C58        Intermediate Mouth or Throat Procedures        2221
 P06        Minor Infections                        4845     B13        Cataract Extraction and Insertion of Lens      2168
 P03        Upper Respiratory Disorders             3638     S22        Planned Procedures Not Carried Out             1971
 F47        Abdominal Disorders <70 w/o cc          3056     L21        Bladder Minor Endoscopy w/o cc                 1844
 P13        Intestinal or Metabolic Disorders       2750     J37        Minor Skin Procedures w/o cc                   1637
 S16        Poisoning and Toxic                     2747     H10        Arthroscopy                                    1588
 E35        Chest Pain >69 or w cc                  2002     M05        Upper Genital Tract Minor Procedures           1467
 M09        Threatened Spontaneous Abortion         1849     A07        Intermediate Pain Procedures                   1262
 F46        Abdominal Disorders >69 or w cc         1736     M06        Upper Genital Tract Intermediate Procedures    1248
 D99        Elderly with Respiratory Diagnosis      1728     L20        Bladder Minor Endoscopy with cc                1208




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Analysis of admissions by Health Resource Groups (HRGs) shows us the top ten
 reasons for admissions. In terms of numbers of admissions the main reason for
 emergency admissions are chest pain in the under 70s where a suspect heart
                                         attack has been excluded (HRG E36),
                                         followed by minor infections (HRG
                                         P06). For elective admissions, the
                                         main reason are cataracts (HRG B13)
                                         and Intermediate Mouth or Throat
                                         Procedures (HRG C58).

                                            The Darzi review undertaken by
                                            Central and Eastern Cheshire Primary
                                            Care Trust identified that whilst the
                                            current urgent care system provides a
 wide range of services, accessibility and inconsistent care provision encourages
 inappropriate usage.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Preventive Services

 Childhood immunisations prevent deaths and disabilities. Uptake rates for
 childhood vaccinations in the Central and Eastern Cheshire Primary Care Trust
 area have generally been similar or better than the national and regional
 averages. MMR uptake has remained at or below 88% for the last seven years
 and is unlikely to improve without special effort. This uptake level is insufficient
 to prevent sporadic cases or clusters of disease. In 2007 there were 16
 notifications of measles, 46 of mumps and 8 of rubella in Central and Eastern
 Cheshire PCT. Approximately 340 more infants will need to be immunised each
 year to achieve the target uptake of 95% that is needed.

 There are an increasing number of childhood vaccines available, and the routine
 childhood schedule now protects children against a range of diseases including
 pneumococcal disease, meningococcal meningitis type C and, most recently,
 human papillomavirus, the cause of cervical cancer. Vaccines also protects older
 persons from the effects of influenza, which can include bronchopneumonia and
 death, and can prevent newborn children acquiring hepatitis B infection from their
 mothers.



     •   Needs analysis to identify where the lowest uptake rates are, and which
         factors are influencing the uptake rates in those areas.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look
 Acknowledgements
 This report was written by the Central and Eastern Primary Care Trust Public
 Health Information Team, Sara Deakin and Rhonwen Ashcroft. The PCT would
 like to thank everyone involved in the Joint Strategic Needs Assessment across
 Cheshire including Western Cheshire PCT JSNA analytical and project team,
 Karen Davies and Amanda Curtis from Cheshire County Council. Special thanks
 to Wendy Meredith, as Lead Director of Public Health for the Joint Strategic
 Needs Assessment. The PCT has also used various Crown copyright data
 sources from Office for National Statistics, NOMIS in the production of this report
 and the supporting technical data. We have also included images from the
 National Health Service Photo Library plus freedigitalphotos website
 http://www.freedigitalphotos.net.




Cheshire East Joint Strategic Needs Assessment. Emerging Findings – A First Look

								
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