This would have several implications for planners. There needs to be planning for more than an average number adolescent linked services such as those above. Development of maternity services do not need to be a priority since the women in the age range who are most likely to be giving birth in the next few years are underrepresented (20-24). The lower than average elderly population will mean that services catering for older people are going to be needed less than on average nationally. However if the population is assumed to be static, and the peak at middle age was to translate across in 10 or more years time, then plans will need to be made for these older service users as they age.
The health needs of the population
The health needs of the population need to be measured in order to plan for future needs. These can be assessed by looking at statistics that give incidences of disease and illness. It is also possible to look at data relating to hospital admissions including A&E admissions. Knowledge of lifestyle choices of the population contribute to the health needs of the population which have to be planned for. Hence data on smoking, drug and alcohol abuse, poor diet, stress and lack of exercise is all useful for planners.
Diseases such as cancer, heart disease and stroke are on the increase as the population as a whole tends to live longer and otherwise healthier lives. Services that for example provide treatment and care for cancer patients need to be planned for at a local level. It is sometimes the case that some areas have a higher proportion of the population that are affected by certain diseases, particularly genetic diseases. These differences need to be taken into consideration when planning future service provision. Immunisation programmes have meant that there has been a decrease in infectious diseases nationally. Planning at a local level will however have to take into consideration governmental screening and immunisation programmes. This will include for example MMR and HPV.
Statistics which are available to help planners include life expectancy, for which there are variations across the country. Statistics that are used include rates for circulatory diseases, coronary heart diseases, breast and other cancers and suicide amongst others.
By analysing the document, “The health of the people in Eastleigh 2005” which is produced by Eastleigh borough Council, I was able to look at some of the demographic trends affecting the health of the local population. I have analysed some of those differences below.
Table showing health statistics of Eastleigh borough Council, source: Eastleigh Pocket Profile Strategic plan.
For Males in Eastleigh life expectancy is 77.8, which is 1.2 years above national average. For females it is 81.5, which is 0.8 above national average. Although there are less older people than nationally (see above) they live for longer, and that will need to be taken into consideration by planners.
The major cause of death in Eastleigh is cancer (24.8%) followed by coronary heart disease (17.2%) and strokes (11.3%).However circulatory diseases and coronary heart diseases are both on the decrease. They are also both lower than the national average. The rate of circulatory diseases is 15% below national average and has fallen from 1999 to 2003 by 15% in line with national trends. Coronary heart disease is 25% below national average and has fallen by 35% from 1999 to 2003. This is very important information for planning the provision of future health care services, indicating that future needs are likely to fall and to be below national average in those areas.
Suicide rates however, although historically below national average, peaked to 10.3 (per 100 000) in 2001-3, which is above the national average of 8.7. This could be an indicator for planners that more is needed in terms of mental health services.
It is interesting to note that Breast cancer rates in the period form 1999-2001 were significantly above national average ( 94.8 compared to 71.3 per 100 000), but declined sharply to 57.2 per 100 000 by 2003. This could be evidence of local planners’ actions having had an impact on the health of the population of Eastleigh as a result of intervention.
Looking at data from the 2001 national census it is possible to get a snapshot of Eastleigh’s population health (See table below).
Table showing health snapshot of Eastleigh population compared to national.
It would therefore appear that the health of the population of Eastleigh is better than the national average.
Planning Local Services and National and Local Standards/targets
I will now describe the stages of local planning of services as needed by the local population. I will look at who the stakeholders are those who contribute to the plan and the influence of national and local targets. In order to investigate this I have researched Eastleigh borough Community plan and the local health delivery plan which develops the priorities and development plans for the Primary Care Trusts (PCT) and its partners. I have Studied Hampshire Children and Young People’s plan, which has been drawn up by Hampshire County Council in the wake of the Children’s act 2004 and Every Child Matters. I‘ve also looked at government papers that set out standards, such as Choosing Health, Our Health our Care our Say, and the NHS improvement Plan 2004. I will describe how services are organised, how and why the plan is monitored and reviewed.
Meeting the needs of local service users will be at the heart of planning decisions. The needs will include public or statutory services, for example General Practice (GP). But there are other non-statutory services that will work in partnership or will be bought into. Private services may include private carers providing home care. There are voluntary services such as Age concern, and many other informal services, such as care within the family.
NHS local planning
Local planning will be presented in a way that is ready understandable for local partners and agencies so that there is joined up delivery of health and social care services. The local PCT has a key role in representing the NHS in local planning. The focus of planning will be on health improvement and to tackle inequalities. Every plan should ensure that everyone gets a fair treatment or service.
The stakeholders in the Hampshire PCT plan are the following:
- The public (Hampshire residents)
- Patients (including patient advocate groups)
- Politicians
- Professionals (PCT staff, NHS staff, GP pharmacists, dentists, opticians, unions)
- Partners (local government, south central Strategic Health Authority, voluntary organisations)
The department of Health (DoH) is a governmental body which will set the national agenda in terms of “ideas”. The DoH has a three year planning cycle for health and social care services and it is overseen by the Strategic Health Authority.
A sound analysis of local needs, looking at demographic influences, leads to a local delivery plan (LDP). This will include how to address key health improvement issues which are drawn from the national priority areas of the local area. These currently include smoking, obesity, reducing teenage pregnancies and improving overall fitness levels. They will depend on demographic characteristics and will be affected by predictions for the future using those demographics. These then develop into local priority actions for the PCT working together with local partners.
Guiding the whole process are National standards targets and objectives. Targets are the goals that will be set. Objectives are the steps taken to achieve these targets. These targets and standards are necessary because they ensure quality of service and improvement of service. Standards are used to guide planning, and are more conceptual. A standard is a written statement that defines a level of performance or a set condition determined by an authority. The department of health sets out a planning framework (national service frameworks) which is based on standards. This will be used in planning commissioning and delivering services. An example is Every Child Matters. All NHS organisations and Social Services work to standards, which ensure minimum performance is met and improvements are made. The local PCT (Hampshire) and the Local Authority (Hampshire County Council) work together to in partnership using the NHS improvement plan. Another source of standards comes from the national Institute of Health and Clinical Excellence (NICE), which produces well researched clinical guidance. They decide which drugs doctors can prescribe for instance.
When the Government’s standards change, targets and objectives will need to change, as will the way they are organised and prioritised. National targets are to be found in the NHS improvement plan 2004, and the Choosing Health paper. In those documents the government set out targets which are currently in the process of being met. This is thanks to local partners and initiatives such as Sure Start and the Teenage Pregnancy unit. The NHS improvement plan 2004 explains the government’s plans to modernise the health service. Its emphasis is on putting service users’ needs first by encouraging more personalised care. The focus is on health promotion and well-being as opposed to illness only. It therefore takes into account, Physical, Intellectual, Emotional and Social needs. An important element of it is that it gives powers to local organisations to make decisions. The White paper “our health, our care, our say (2006)” has set out targets for:
- Better prevention and early intervention for improved health, independence and well-being
- More choice for individuals and communities
- Tackling inequalities and improving access to services
- More support for people with long term needs.
The Strategic Health Authority (SHA) for Eastleigh BCC is the NHS south Central. It is one of ten such authorities in the country. It has a budget of £4.4 billion and provides services to a population of 4 million in the South of England. The planning role of the SHA is to write a plan for the local NHS to ensure that national policy is being implemented at a local level. It organises the local NHS workforce to ensure that the local needs are met. It also manages the local NHS trusts to ensure improved value for money and performance.
Hampshire PCT is the leader of the NHS at a local level. They receive £1.6 billion of government money to spend on Hampshire’s 1.25 million inhabitants. They will be responsible for targeting resources to deliver national and local service priorities to meet the health and social care needs of the local population. The PCT works in partnership with Hampshire County Council to meet the objectives and targets of the white paper, “Our health, our care, our say”. I have listed these above. These will lead to local targets. For Hampshire these focus on the following areas:
- Healthy horizons, which is a 5 year strategy which is based on the predicted changes in demography and lifestyles in Hampshire and the expectations of local people.
- Modern lifestyle issues of obesity, smoking and lack of exercise.
These pressures are creating new demands on the NHS, it is for example predicted that there will be a 20.7% increase in obesity in Hampshire by 2012.
The other priorities which have been identified locally are:
- Community services for dermatology and gynaecology, so that they can be offered locally in General Practices.
- Mental health services (in my analysis of demographic characteristics I highlighted how there had been a spike in suicide rates)
The local plan addressing these is split into 2008-9 and then for the next 2-3 years.
There are national targets which have been incorporated in the local hospital trusts plans such as:
- 4 hour maximum wait in A&E
- 75% of category A calls to be responded to by the ambulance service within 8 minutes
- A reduction in healthcare acquired infections such as MRSA.
Hampshire County Council and Hampshire PC also have a local delivery plan to reduce teenage pregnancies which I will look at in more detail below. The target they have set themselves is to reduce conception rates by 45% to 19.8 per 1000 aged 15 to 17 years by 2010.
The Local Delivery Plan for HCC
The Local Health Delivery Plan 2005-2008 outlines the priorities and development plans for the PCT and its partners. It is supported by a multi-agency Health Improvement Partnership Board and a number of themed planning groups involving partner agencies, carers and users of services.
The Plan focuses on four key areas of:
- Health and wellbeing of the population which includes health promotion and ill-health prevention, so that people are kept out of the care system wherever appropriate
- Long term conditions to support health by promoting better self care and treatment in a community setting, or in people's homes to avoid hospitalisation wherever possible
- Access to services to ensure that people have fair and prompt access to care, to the point where waiting should no longer be an issue for the majority of service users
- Patient/user experience which promotes maximum information and choice, as well as positive experience so that service provision is more consumers focused.
Hampshire Children and Young People’s Plan 2006-9 (HCYPP)
The Children’s act 2004 was based on the standard set out in Every Child Matters. The 5 outcomes in this standard are the following:
- Be healthy
- Stay safe
- Enjoy and achieve
- Make a positive contribution
- Achieve economic well-being
In response to the children’s act 2004, Eastleigh Borough Council had to write a plan that was written in consultation with statutory and voluntary partners and had to involve Children themselves. It states how the stakeholders work together to deliver services for children. The stakeholders are:
- Hampshire county council Children services
- Strategic Health Authority
- Hampshire PCT
- Connexions
- Learning & Skills council
The aim of the HCYPP is to support parents and carers and to encourage family decision making so that children reach their full potential. A needs analysis has revealed that the children who have additional needs are:
- Looked after children
- Black and other ethnic minority children including traveller children.
- Children in poverty
- Special Educational Needs children and disabled children
- Young parents
- Young carers (there are over 2500 under 18 year olds in Hampshire caring after someone with disability or long term illness)
- Young offenders.
Children, young people, their parents and carers need services that they can access locally. There are already some organisations that are working together to provide services, including Drug Action Team, and the Child and Adolescent Mental Health Services.
The Government has also given Hampshire County Council funding to open Children’s centres. This is one of the areas where there is a lot of development. 53 children’s centres are to be established in Hampshire in the next 2 years. These are one-stop shops for children, their parents and carers. They provide pre-school education childcare and health services. It is planned that they will provide services to over 42000 children aged 0-5 or to their parents and carers.
An example of Local Planning from National Targets: Hampshire Pregnancy Partnership.
Hampshire County Council has established a plan in order to meet the following national teenage pregnancy targets:
- To reduce the teenage conception rate by 50% by 2010
- To have 60% of teenage mothers engages in education, employment of training.
This is in a context where pregnancy rates are the lowest they have been for 20 years. It is also a context where past targets have been met. The 2004 national target was a 10% reduction, which Hampshire beat by achieving a 15.8% reduction. However there are signs that there has been an increase in 'under 18' conceptions recently. The challenge for Hampshire is to attack the underlying causes of teenage pregnancy, those that lead them to becoming pregnant at a young age. It also involves offering the appropriate support and services for young parents to help them achieve their potential.
Table showing local context for teenage pregnancies
The strategy that was planned therefore needed to tackle issues of why and which young women get pregnant. The links with educational achievement and attendance were seen as needing to be addressed and the groups that are at risk identified and targeted.
Educational issues need to be tackled to reduce teenage pregnancy rates. The 14-19 education agenda is designed to encourage more young people to stay on in education. This is one of the strategies that should help given that a factor associated with high pregnancy rates is low education attainment. There is also a plan for targeted prevention programmes and targeted youth support. Pregnant teenagers should also benefit from personal teaching and support in schools. Exclusion should be fewer but when they do happen there should be better support
Poor self-esteem, mental health problems and conduct disorders need to be tackled since these too are recognised as factors affecting pregnancy rates. The plan is to tackle these issues in school, with specialised work in schools (Social Emotional Aspects of Learning, SEAL, and SEBS) and access to trained support practitioners.
Another factor associated with high pregnancy rates is early sexual activity. This can be tackled with a scheme called Delay, which is to be incorporated into Sexual and Reproductive Education. Poor contraceptive use and knowledge of contraception is also an issue which needs to be tackled through looking at education in and out of school. Alcohol and substance abuse are also factors that are associated with high pregnancy rates amongst teenagers. Tighter access to Alcohol to under 18 and parental education are needed, as is again improved alcohol and substance abuse education.
Children living in care and children of teenage mothers are groups that have been identified as needing to be targeted. Girls whose parents have low aspirations for them and living in deprivation re also at risk groups. These groups are earmarked for targeted youth support and training programmes for Leaving Care Teams for example. The 14-19 education agenda helps tackle this including by providing support for young mothers. Neighbourhood renewal and regeneration tackles deprivation. Children’s centres work on aspirations to promote positive educational choices.
The Teenage Pregnancy Unit (TPU) will implement the strategy to address many of the factors identified above. It will for instance provide information for groups that are targeted for education, by making materials such as the “rethinking” materials more widely available, or continuing to develop the “Delay” message, particularly with young men. There will be more involved in 16-17year olds in FE colleges. They will pilot SEAL materials in secondary schools. They will also work with independent retailers to promote “want respect” messages, and publish briefing sheets on teenage pregnancies.
To tackle the target group in care, they will include specialist sexual and reproductive education (SRE) modules in the new training and qualification of foster and residential carers, as well as to local authorities to use with Leaving Care Teams. They will also provide an easy to use SRE toolkit designated for teachers and carers for young people in care, designed to help them discuss SRE issues. Their work will link in to the other government initiatives to support parenting which were outlined in the Social Exclusion Action Plan.
Teenage or young parents will also be given support. The local target is for all teenage parents who cannot live at home, to be placed in either a dedicated housing project or have an intensive floating support package coordinated by a lead professional.
Bibliography
- The Health of People of Eastleigh 2005, a pocket profile
- Local Delivery Plan, our blueprint for Health, Eastleigh and test Valley south PCT, 2006
- Eastleigh Borough Community Plan, Eastleigh Strategic Partnership 2004
- Hampshire Children and Young People’s Plan, 2006-9
- Hampshire Teenage Pregnancy Partnership, where are we now? June 2007
- A2 Applied Health and Social Care, Folens 2007.