Haverhill Health Needs Assessment

Transcription

1 Haverhill Health Needs Assessment Lead Author: Dr Victoria Matthews Lead Consultant: Dr Padmanabhan Badrinath Public Health Suffolk on behalf of West Suffolk Clinical Commissioning Group Report date: September 2013 Public Health Suffolk supporting Suffolk CCGs

2 Acknowledgements We thank Tanya Kimber for producing the maps of services in Haverhill, Katie Johnson for producing the Glossary, and Stephen Patterson, Wendy Marsh, Mashbileg Maidrag, Lynda Bradford, Imon Sultana; Oluwadamilola Haastrup; and Sarah Annon, all of Public Health Suffolk, for assistance with obtaining data and service information. We would also like to thank Nicola Warwick and Kit Day of the Business Development Team at Suffolk County Council for providing data from the Local Knowledge and InSite tools. From West Suffolk CCG, Lois Wreathall and Giles Stevens provided invaluable assistance with obtaining data. We also thank Lois and Giles, as well as Jo Finn, Adrian Lyne, and Ed Garratt for helpful feedback on the report drafts. Nicola Brunning kindly provided data on contracts and community services, while Clair Harvey from Suffolk County Council also gave helpful feedback on the report drafts.

3 Contents Executive Summary 2 Section 1 Background 4 Section 2 Methodology 6 Section 3 Current epidemiology of Haverhill population 9 Section 4 Existing services 16 Section 5 Current service use and quality 29 Section 6 Service user and professional views 34 Section 7 Conclusions and limitations 39 Section 8 Summary of current Haverhill health status 40 Section 9 The way forward 43 Appendices 44 Glossary 54 References 56 1

4 Executive Summary Background In April 2013, the West Suffolk Clinical Commissioning Group decided to pursue a more local approach to assessing health and healthcare needs to reflect the differences of the West Suffolk localities and allow more local solutions to be developed to suit each area. This was agreed following the transfer of commissioning responsibilities from Primary Care Trusts to Clinical Commissioning Groups. The focus on Haverhill resulted from concern raised by members of the local population about the high level of deprivation in the community, often a marker for health inequalities. Also, there was a perception of high levels of health service use by the population, and the PCT had closed the Crown Health Centre in 2012 which was seen by some people in the town to be a reduction in services to residents. Methodology The health needs assessment was undertaken from spring to summer 2013, and focused on the general population of Haverhill, with the scope limited to an overview of key health conditions and services. Epidemiological data were obtained from several routine sources, and triangulated with information on current services, and the views of service users and professionals. Results Haverhill has a relatively young white population, which is predicted to grow substantially over the next 20 years. Both mortality and premature mortality (death before age 75) are significantly lower in Haverhill than in England. Also self-reported health is better than the national average, with much less limiting long-term illness. Cancer mortality in Haverhill is no different than for England. However, several indicators point to poor health levels in Haverhill, particularly around respiratory illness, mental health, obesity, and alcohol. There is significantly more asthma, chronic obstructive pulmonary disease, depression, and adult obesity. Also hospital admissions are significantly higher than England for chronic obstructive pulmonary disease, self-harm and alcohol-related harm, and hip replacement. 2

5 There are numerous services, statutory and non-statutory, available to residents of Haverhill. However, many are located at the hospitals in Bury St. Edmunds and Cambridge, with access restricted by poor transport links. Conclusions The results indicate several outstanding health issues. However, there is a mismatch between these issues, and the accessibility of services, which needs to be addressed. Further actions This report has highlighted issues that will be reported to the Haverhill people, analysed further and used to develop an action plan to address the issues raised. This will start at the public meeting being held on 26 September 2013 and will be a joint exercise to build on the relationship recently started between representatives of the people of Haverhill and the West Suffolk Clinical Commissioning Group. 3

6 1.0 Background 1.1 Introduction Haverhill is a Suffolk market town on the borders of Cambridgeshire and Essex with links to the M11, Stansted airport, the Suffolk ports and the towns of Bury St Edmunds and Cambridge. There is a population of approximately 27,100 1 with plans in place for further expansion through the development of new housing. Figure 1. Map of Haverhill showing the four electoral wards. Crown copyright and database rights 2011 Ordnance Survey Digital Mapping Solutions from Dotted Eyes. Haverhill is one of the more deprived communities in Suffolk; Haverhill South, North and East are ranked amongst the 20% most deprived wards in Suffolk, although Haverhill West experiences lower levels of deprivation than Suffolk as a whole 2. Given the known association between social and economic inequalities, and health inequalities, this deprivation increases the risk of poor health amongst the residents of Haverhill. 4

7 1.2 Why we have done this assessment For some time, there has been a perception of high levels of health care use among the Haverhill population. However, it is unclear as to the extent that this reflects health needs. Needs are different from demands. In this case, need is defined as the ability to benefit, and does not equate to demand, which is the request for services. With the transfer of commissioning responsibilities from Primary Care Trusts (PCTs), to newly formed Clinical Commissioning Groups (CCGs), this is a timely opportunity to assess the health needs of the Haverhill population, and engage the community to identify the health priorities, and determine solutions. 1.3 Locality PCTs, which were abolished at the end of March 2013, covered larger geographical areas than the new CCGs and hence based their plans and services commissioned on the whole of their area. For example, the former Suffolk PCT was responsible for commissioning health and healthcare services for the whole Suffolk population, excepting Waveney. However CCGs, which commission healthcare only, cover smaller areas and hence have a greater potential to be locally focused. As they are led by GPs this gives them an opportunity to engage local communities through the local GP practices. Also, being on the borders of Suffolk, Haverhill residents may frequently access services outside Suffolk, mainly in Cambridge, or Essex, due to better transport links. It is unlikely that West Suffolk CCG will be the main commissioner for services outside Suffolk. 5

8 2.0 Methodology 2.1 Health Needs Assessment A health needs assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities. 3 A population can be defined in four ways 3 : By geographic location e.g. town, residence on a housing estate; By setting e.g. prison, workplace, school; By social experience e.g. age group, homelessness, ethnicity; or By medical condition e.g. diabetes, heart disease, mental illness This needs assessment is about a geographical population, namely the population of Haverhill. The population was defined as either residents of the four Haverhill wards (North, South, East & West), or the practice populations of the three Haverhill GP surgeries. There were no exclusions. Data was obtained for the most recent year possible, which ranged from 2005 to 2013, with the majority from For the purpose of this report, health need was defined as the population s ability to benefit from interventions i.e. there is the potential for health gain. This was to distinguish need from demand and use. For example, a person suffering from a heart attack has a health need for emergency healthcare access and specific medications. However, a person wanting cosmetic surgery for ageing would be expressing demand. Given the potentially very large range of the needs assessment, covering all demographic aspects of the population, plus all health conditions and services, the scope was restricted to key health conditions and services, and in-depth analysis of population sub-groups was not part of this needs assessment. 6

9 2.2 Data sources Epidemiological and service data The epidemiological data were obtained from two main sources: the Local Health website from Public Health England 1, and the Suffolk Observatory 2. Additional data came from the Local Futures data package 4, and the Office of National Statistics 5. The InSite tool 6 was used to obtain HouseholdACORN data on the prevalence of various health indicators according to household type. Depending on the proportion of different household types in an area, proxy figures can be determined for the prevalence of these indicators in the area of choice. Information on services came mainly from the service providers or commissioners, the relevant service websites, and the Office of the Chief Contract Officer WSCCG and Ipswich and East Suffolk Clinical Commissioning Group (I&ESCCG). Other data were supplied by West Suffolk hospital (WSH) and Addenbrooke s hospital. Service use and quality data came from the National General Practice Profiles 7, the Office of the Chief Contract Officer WSCCG and I&ESCCG, Suffolk Observatory 2, Local Health 1 and the East of England Ambulance website 8. Data were used from the Local Health website in preference to other sources, as the tool allowed data from all four Haverhill wards to be combined Views of service users and professionals A community event was held in May 2013, which was open to anyone with an interest in the health of Haverhill residents. Facilitated group sessions were held to obtain answers to four questions about the health needs of the Haverhill population, and the health needs assessment project. The questions are detailed in Appendix A. Professional opinions were obtained from Haverhill GPs via questionnaire. The questions were similar to those used at the community event, and are also detailed in Appendix A. 7

10 2.3 Data analysis Where possible, epidemiological and service use/quality data were compared to district, county and England figures, to determine whether Haverhill performed better or worse on each indicator. For most of the indicators, previous years information was not readily available, so trend analysis was not performed. 95% confidence intervals were used to determine statistical significance where these were available with the data. Statistical outliers, i.e. indicators for the Haverhill population that were significantly higher or lower than the corresponding comparators, were highlighted as areas needing further investigation. For all tables in the report, the colour shading of the values should be read as follows (except Table 13, where the comparator is the Suffolk value): Green = significantly better than the England average; Yellow = not significantly different from the England average; Red = significantly worse than the England average; White = significance either not applicable or cannot be calculated. It must be emphasised that the statistical outliers are not a cause for alarm or immediate action. Highlighting a Haverhill indicator as significantly higher or lower than the district, county or country figures helps with prioritising areas for further consideration, but does not give any indication of the reason why the value is different. Additional epidemiological data is contained in Appendix B. 8

11 3.0 Current epidemiology of Haverhill population 3.1 Population statistics The total population of Haverhill in 2011 was 27,041, with an almost even split between males and females (13,474 males and 13,567 females). The population is predicted to increase by 9,130 up to 2031 as a result of planned new housing. An additional increase of 2,620 over the same time period is likely, due to births and migration. This is based on expected growth in the St. Edmundsbury population (see Appendix B). The majority (52.9%) are in the working age group, years. 27.1% are aged under 16, and 13.4% are aged over 65 years. Compared to the district, county and country, this is a younger population. Figure 1. Haverhill Population by age group Haverhill St Edmundsbury Suffolk England < Age groups Source: Suffolk Observatory. 2 The vast majority of the population are of white ethnicity (96.05%), while the next largest ethnic groups are Asian (1.64%) and Mixed (1.27%). 4 This is quite similar to the district and county, but a more predominantly white community than for England as a whole. The main religion in Haverhill is Christianity, with 57.23% declaring this as their faith, while less than 1% follow each of the other major religions. The second largest proportion (34.70%) has no 9

12 religion. This is similar to the district and county, but with a noticeably lower proportion of Muslim and Hindu followers than for England Patterns of disease and health outcomes The age standardised mortality rate is a measure of the number of deaths in the population adjusted for population size and age. Table 1 shows that the overall age standardised mortality rate of 89.9 for Haverhill is significantly lower than the mortality rate for England, and comparable to the mortality rates for St. Edmundsbury and Suffolk. There is no significant difference between mortality rates for England and Haverhill in the five disease categories listed, although both St. Edmundsbury and Suffolk are significantly better than England for all categories except stroke. Table 1. Standardised mortality rates for Haverhill and comparator populations Haverhill St. Edmundsbury Suffolk England Overall Cancer Circulatory Coronary Heart Disease Stroke Respiratory diseases Again, for premature mortality (death before 75 years of age), Haverhill performs better than England overall, and for mortality from all circulatory disease and coronary heart disease (CHD) (see Table 2). It also appears to be comparable to district and county figures. The exception is for premature cancer mortality, where St. Edmundsbury and Suffolk, but not Haverhill, are significantly lower than the England average. 10

13 Table 2. Standardised premature mortality rates (<75 years) for Haverhill and comparator populations Haverhill St. Edmundsbury Suffolk England Overall Cancer All circulatory CHD Table 3 below shows cancer incidence (the number of new cases in the population during the year). Haverhill is not significantly different from England for overall cancer figures, as well as breast, colorectal and lung cancer. However Haverhill and St. Edmundsbury have a significantly higher incidence of prostate cancer. This higher incidence is actually attributable to four wards in St. Edmundsbury; Haverhill North, Wickhambrook, Eastgate and Westgate, and is not cause for alarm, but simply points out the statistically significant difference. Possible reasons for this difference include: more men going to the GP with potential symptoms; more testing; and/or more referrals to secondary care. There are no major risk factors for prostate cancer except age, and unlike most other cancers, prostate cancer is generally a disease which men die with, not from. This is supported by the cancer mortality rates for Haverhill, which are no different to the England rates. Although Suffolk shows red for incidence of colorectal cancer compared to England, the actual mortality from cancer is significantly better than for England. This suggests that colorectal cancer is more likely to be diagnosed, and then to be successfully treated. With regard to lung cancer incidence, although it is not significantly different from the England average, it is noticeably higher than for St. Edmundsbury and Suffolk, which are both better than the England average. The figures are shown in Table 3. 11

14 Table 3. Cancer Incidence, Standardised Registration Ratios (SRRs), for Haverhill and comparator populations Haverhill St. Edmundsbury Suffolk England All cancer Breast cancer Colorectal cancer Lung cancer Prostate cancer ACORN data 6 showed the prevalence of hearing difficulties and stomach, liver and kidney problems to be higher in Haverhill compared to Suffolk. However, the differences are not large (7% and 8% respectively), and are not necessarily significant. Analysis of Quality and Outcomes Framework (QOF) data for the three Haverhill GP practices (Table 4) shows that the prevalence figures for asthma, depression and chronic obstructive pulmonary disease (COPD) are significantly worse than England in at least one of the practice populations. Table 4. Prevalence of disease (%) in Haverhill practice populations Christmas Maltings and Clements Practice Christmas Maltings Surgery Stourview Medical Centre Suffolk PCT England Asthma Depression COPD % of babies born in Haverhill from 2007 to 2011 were low birth weight. This is not significantly different from the England proportion (7.4%), but not as good as the district (6.5%) and county (6.6%) figures, both of which are significantly better than England. 1 12

15 Teenage conception figures are separated into the four Haverhill wards (Table 5). The highest rate is 47.0 for Haverhill South, which is much greater than the figures for St Edmundsbury and Suffolk. Table 5. Teenage conceptions in girls aged years Teenage conceptions (rate/1000 ) Haverhill East Haverhill North Haverhill South Haverhill West St. Edmundsbury Suffolk In the context of self-reported health, the population of Haverhill reports significantly lower proportions of bad or very bad health, and limiting long-term illness than the England average. The proportions are mostly similar to the district and county figures, excepting a higher level of limiting long term illness for Suffolk Wider determinants of health The population of Haverhill experiences relatively high levels of deprivation. Although in comparison to the England average, Haverhill, St. Edmundsbury and Suffolk all fare significantly better, Table 6 shows that all Haverhill wards except West, are among the 20% most deprived areas of Suffolk. In fact Haverhill South is the most deprived ward in St. Edmundsbury. 13

16 Table 6. Deprivation in Haverhill, Index of Multiple Deprivation, Deprivation rank in Suffolk (out of 175) Deprivation rank in St. Edmundsbury (out of 31) Suffolk deprivation quintile (1=most deprived) Haverhill Haverhill Haverhill Haverhill East North South West For health and disability, education, and crime components of the deprivation score, Haverhill wards (except the West ward) are among the 20% most deprived wards in Suffolk. For income, all wards except West are among the 40% most deprived, with the South ward in the bottom 10% of the county. 9 Focussing specifically on education (Table 7), child development at age 5 is significantly worse than England, although this is also true of the district and county. GCSE achievement is better, but still noticeably worse than for St. Edmundsbury. The long-term unemployment rate is comparable to England s, but is higher than the rates for the district and county (Table 7). Table 7. Child development, education and employment Child development at age 5 (%) GCSE achievement (%) Long-term unemployment (rate/1,000) Haverhill St. Edmundsbury Suffolk England

17 Despite these levels of deprivation, the living environment for Haverhill residents is significantly better than the England average, with more houses centrally heated, less overcrowding and fewer pensioners living alone. 1 These figures also compare favourably with those of the district and county, with all Haverhill wards among the best 40% in the county for living environment domain Lifestyle factors With regard to healthy lifestyle factors (Table 8), the population of Haverhill is not significantly different from the England average, except for the proportion of obese adults. This is significantly worse. However, St. Edmundsbury and Suffolk perform significantly better than England on measures of child obesity and binge drinking, which suggests these may be an issue for Haverhill. Table 8. Lifestyle Indicators for Children (2009/ /12) and Adults ( ) 1 Haverhill St. Edmundsbury Suffolk England Obese children (Reception year) (%) Obese children (Year 6) (%) Obese adults (%) Binge drinking adults (%) Healthy eating adults (%) The most recent ward level data for smoking in Suffolk is based on smoking prevalence by ACORN household type. 6 Certain household types have an above average prevalence of smoking, and these form 65.9% of all households in Haverhill. In comparison, these household types form only 46.3% of all Suffolk households. In addition, the three Haverhill GP practice populations have a higher prevalence of smoking (18% 22.4%) than for Suffolk PCT (15.3%) and England (17.4%). 7 15

18 4.0 Existing services 4.1 Primary, secondary and tertiary health services Primary care There are three general practices in Haverhill; The Christmas Maltings and Clements Practice, Christmas Maltings Surgery and Stourview Medical Centre. The practice populations for each are shown below: Table 9. Practice populations of Haverhill surgeries, 2012 Practice population (registered persons) 7 Whole time equivalent (wte) GPs The Christmas Maltings and 17, Clements Practice Christmas Maltings Surgery 10, Stourview Medical Centre 3, The Christmas Maltings and Clements Practice offers the following services: specialist GP interests, ranging from mental health, and dermatology, through to women s health and paediatrics (see Appendix C for the full list); minor surgery; baby and travel clinics, clinics for asthma, COPD, heart disease, and hypertension; wound dressing; Well Person and New Patient checks; electrocardiograms (ECGs), blood tests and blood pressure checks. The surgery offers extended hours to 8pm Thursdays, as well as Saturday morning surgery. There is a telephone triage service for on the day requests, so that anyone who needs to be seen on the day receives a same day appointment. These triage slots are also used for patients who have been asked to book an early appointment by a doctor. Walk-in patients are accepted in emergency situations, and for patients without a telephone. Christmas Maltings Surgery offers a wide range of services, which include: specialist GP interests (see Appendix C), counselling for alcohol and substance misuse; mental health counselling; travel clinic; minor surgery; smoking cessation services; sexual health and 16

19 contraceptive advice, including Chlamydia testing; clinics for diabetes, kidney and respiratory problems; blood pressure, heart disease and warfarin monitoring; and weight reduction and dietary advice. The surgery has extended hours on a Saturday morning, which are for prebooked appointments. Stourview Medical Centre offers the following services: specialist GP interests including mental health, minor surgery and reproductive health (see Appendix C); chronic disease clinics; smoking cessation services; travel vaccinations; minor injuries service; advice on weight loss and healthy eating. The surgery has extended hours on Monday until 8.10pm. Primary medical care out of hours (OOH) is provided by Harmoni. The nearest fixed base is at WSH. There is a non-permanent facility in Haverhill. This is located at the Haverhill Health Centre but flexibly manned as demand requires. There are three dental surgeries; Haverhill Dental Centre, Henderson House Dental Practice, and West End Manse. All accept NHS patients, and West End Manse offers urgent access appointments

20 The map below (figure 2) shows the location of the GP practices and dental surgeries. Figure 2. GP surgeries and dental surgeries in Haverhill. Haverhill has six pharmacies; Haverhill Pharmacy, David Holland Pharmacy, Boots, The Cooperative Pharmacy, Tesco and Sainsbury s. 10 Between them they are open all day, every day of the week. They offer free delivery, filling of dosette boxes, pharmacist advice and over the counter (OTC) medication. Boots offers a Stop Smoking service and emergency contraception. The Co-op offers flu vaccination and smoking cessation help. 18

21 The map below (figure 3) shows the location of the pharmacies: Figure 3. Pharmacies in Haverhill. There are four opticians; Wardale Williams, Billson Opticians, Specsavers Opticians, Boots Opticians Secondary care Two hospitals provide secondary care services to the population of Haverhill. They are West Suffolk Hospital (WSH) in Bury St. Edmunds, and Addenbrooke s Hospital in Cambridge. The map in figure 4 (below) shows the location of hospitals accessed by Haverhill residents. This includes Newmarket Community Hospital, listed under Integrated Community Services (section 4.2.1). 19

22 Figure 4. Hospital Locations WSH runs the following outreach clinics at Haverhill Health Centre: Rheumatology once monthly; Dermatology once weekly, with additional three clinics per month; Paediatrics once monthly; Dietetics twice monthly. Addenbrooke s runs the following outreach clinics at The Christmas Maltings and Clements Practice: Rheumatology monthly clinics; Neurology monthly; Oncology - monthly chemotherapy. Ambulance services are provided by the East of England Ambulance Service NHS Trust. There is one ambulance based in Haverhill full time, and one rapid response vehicle based there for 12 hours per day. 20

23 4.1.3 Tertiary care Addenbrooke s Hospital, Cambridge provides tertiary care for the population of Haverhill. 4.2 Community health services Community health services in the context of this report include all publicly commissioned and funded statutory health services, which are provided in the community setting. WSCCG has in the region of 200 contracts for community services commissioned on behalf of the West Suffolk population. All of these services are available to Haverhill residents. It is beyond the scope of this needs assessment to detail all these services, however, the services purchased through just two of these contracts (section below) provides an indication of how extensive these are Integrated community services Community health services in West Suffolk are provided by Serco in conjunction with several partners, including South Essex Partnership University NHS Foundation Trust (SEPT), Marie Curie Cancer Care and Community Dental Services. The partners together form Suffolk Community Health. These services are particularly aimed at patients with complex, long-term conditions. Access to the services is through a 24 hour, 7 days a week single point of access. Access to adult care services is via professional referral (or with professional consent), but children s services also allow self-referral. Within this partnership, Serco provides the following adult integrated community services: Assistive equipment and technology, including wheelchairs and communication aids; Community hospitals. Haverhill patients have access to five community hospitals, with the nearest one located in Newmarket. This offers outpatient and nursing clinic services; Planned care, including leg ulcer clinics and community phlebotomy; Urgent care; Networked specialist services, including heart failure, continence, stoma, and COPD services, and cardiac rehabilitation; Stroke rehabilitation. 21

24 SEPT provides the following specialised services: Mental Health services, including Dementia services; Neurology, including Parkinson s and Epilepsy services; Podiatry Foot and Ankle; Speech and Language Therapy; Paediatric integrated community services, including speech and language therapy, physiotherapy, occupational therapy, psychological therapies including the Autism service, community children s nursing and paediatric medical service. There is also an urgent care service; The social enterprise Community Dental Services provides community dentistry, while Marie Curie Cancer Care provides End of Life care. District nursing services are provided by Serco, and based at the Haverhill Health Centre. There are currently 8.2 wte district nurses and 2.0 wte healthcare support workers, with recruitment to vacancies in progress. Several more of these services are provided at Haverhill Health Centre, with 12 specialist clinics, of which most provide a weekly service. See Appendix D for full details Child Health Services The Health Visiting Team in Haverhill is based at the Haverhill Health Centre, but offers services at The Christmas Maltings and Clements Practice, Christmas Maltings Surgery and Children s Centres. The team currently comprises 4.2 whole time equivalent (wte) health visitors, 1.64 wte staff nurses and 1.0 wte child health advisor. A specialist health visitor undertakes newborn bloodspot screening at the child s home. There are proposals to recruit approximately three more health visitors by The School Nursing Team is also based at the Haverhill Health Centre, as well as working in the upper and primary schools of Haverhill. The service has just over 2 wte nurses Maternity services Ante-natal services are run from the Haverhill Health Centre, with both West Suffolk and Addenbrooke s community midwives based there. The services are available daily. 22

25 4.2.4 Haverhill Health Centre Other services run from the health centre include: Orthoptist clinic monthly; Abdominal aortic aneurysm screening monthly Healthy living Live Well Suffolk is commissioned jointly by Suffolk County Council and the NHS to provide healthy lifestyle services for people in Suffolk. Services provided in Haverhill focus mainly on smoking cessation and weight management. One-to-one stop smoking clinics are held weekly at two GP practices and one pharmacy, as are one-to-one personal health plans (aimed at health eating and physical activity). Group fitness sessions (Fit Fans) are run twice weekly from Haverhill Leisure Centre. A children s weight management programme, Alive N Kicking, will be offered during the upcoming Autumn term in Haverhill. From September, four 6-week community physical activity programmes will be running, two each at Haverhill Leisure Centre and Haverhill Football Club. A Cook and Eat programme at Cangle Foyer will specifically target disadvantaged young people. All the Live Well programmes are free of charge. The Active St. Eds campaign aims to increase levels of physical activity throughout the St. Edmundsbury district. In Haverhill, residents can collect active points by participating in activities at the leisure centre, and redeem the points at High Street retailers. 23

26 4.2.6 Drug and Alcohol Services Adult alcohol treatment and support services are provided by Suffolk Alcohol Treatment Service (SATS) and Phoenix Futures. SATS is the initial point of contact, with drop in services in Bury St. Edmunds. They also have a weekly satellite clinic at the Haverhill Health Centre, which offers a local appointment if requested. They provide stabilisation, and some structured support. Further structured support is available from Phoenix Futures, via referral through SATS. This service is available in Bury St. Edmunds. Drug treatment and support services are provided by CRI Suffolk Recovery Services for the adult population of Suffolk, including Haverhill. The closest service is based in Bury St. Edmunds, although there is some outreach work in Haverhill. The Bury St. Edmunds service is walk-in and available Monday to Friday. Following an initial assessment and stabilisation with CRI, Haverhill residents can then access structured programmes through Open Road. This organisation has a dedicated outreach centre in Haverhill, open twice weekly. For under 18 s, The Matthew Project is commissioned to provide drug and alcohol services. The nearest fixed base is Bury St. Edmunds, but young people can be seen at any venue of their choice Sexual health services Clinical sexual health services are provided by Cambridge Community Services NHS Trust. They hold a reproductive health clinic at Haverhill Health Centre twice weekly, with a walk-in service. The clinic offers contraception, sexual health and contraceptive information, chlamydia screening for under 25 s, abortion information and referral, and pregnancy testing and information. The closest sexual health clinic, for sexually transmitted infection diagnosis and treatment, is located in West Suffolk Hospital. Also Addenbrooke s hospital has both a Genito-Urinary Medicine (GUM) clinic, and a Sexual Health Advice Centre for under 20 s. The former is by appointment only, but the latter has a drop-in service on Mondays. Both offer telephone advice

27 The Terrance Higgins Trust provides non-clinical services on behalf of Cambridge Community Services. These include: - the C-Card scheme, available from Sainsbury s and Co-op pharmacies, school nursing services and the Cangle foyer (for residents only); - chlamydia screening for under 25 s, offered at Sainsbury s, Tesco, and Co-op pharmacies, the three GP practices, the Cangle foyer (residents only), and by school nursing services; - Sex and Relationships education, sexual health promotion sessions, training for professionals, and rapid HIV testing and chlamydia screening. These are held on an outreach basis, and previous locations included the Cangle foyer, Cineworld and the White Hart Pub Hospice St. Nicholas Hospice offers community hospice services to West Suffolk patients in their own home. The Burton Centre in Haverhill, is to be developed to provide a hospice outreach centre, so that people and families living with life-shortening illnesses can access hospice services without having to travel to Bury St. Edmunds. 25

28 The map below (figure 5) shows the location of several community services: Figure 5. Haverhill community services. 4.3 Voluntary and community sector services Community sector services in the context of this report include non-statutory health and wellbeing services, which are provided in the community setting and are not publicly commissioned. ONE Haverhill, an independent partnership of organisations in Haverhill, has plans for a One Stop Shop for Haverhill young people. It will have youth leisure activities, access to youth services, and career development support. 12 Other community services include a Citizen s Advice Bureau, a credit union, a volunteer centre and various residents groups. Leisure services and facilities include the Haverhill Leisure Centre, the Recreation ground, a golf club, Snooker and Bowl, plus several sports clubs, such as cricket, cycling, judo, hockey, running, tennis and football (see full list in Appendix E). The Befriending Scheme has a community advice hub in Haverhill every Friday, aimed at adults from vulnerable groups. 13 REACH community projects such as the Food Bank, Furniture Bank 26

29 and Christians Against Poverty CAP, aim to relieve poverty, and are run from the Resource Centre in Haverhill Transport The main public transport available to Haverhill residents is the bus service. Buses to Bury St. Edmunds are provided by Stephenson of Essex, and run Monday to Saturday. The first bus is at 06.15, and the service runs up to twice hourly until on a weekday or on a Saturday. The last return bus to Haverhill leaves at on a weekday and on a Saturday. There is no direct service to the WSH, and no service on Sundays or Bank Holidays. Buses to Cambridge are run by Stagecoach, and stop at Addenbrooke s. The service runs every day of the week, with weekday services between and Weekend buses also run all day and into the evening. On Bank Holidays there is a Sunday timetable. There are buses to Sudbury running daytimes Monday to Saturday, but none to Stowmarket. Bus passes, allowing free off-peak travel, are available to persons reaching the state pension age, and disabled persons. Off-peak periods are to weekdays, all day weekends, and bank holidays. Travel vouchers are available for disabled persons unable to walk, and for anyone who qualifies for a free bus pass but lives in a remote location with minimal bus services. These vouchers can be used for community transport, taxis or private hire vehicles, but they are not available for anyone with a bus pass. Dial a ride is a local door-to-door transport service, driven by volunteers, for local journeys where bus services are unavailable, or cannot be accessed. The journey must be booked in advance, and the fare paid is comparable to a bus journey. 15 Community transport is a volunteer transport scheme, where volunteer drivers use their own cars to transport people locally, where other transport (public or private) is not available. Journeys are arranged in advance, and the passenger pays a mileage subsidy to the driver. 15 Suffolk Links Three Towns is a demand responsive bus service, operating in set areas. Journeys are booked in advance, with pick-up at an agreed location, and transport to anywhere within the set area. The service is for anyone unable to access a bus directly, and is available Monday to Saturday, to The Three Towns service encompasses several villages, plus Haverhill and Newmarket. It links with bus services to Bury St. Edmunds. The fares are comparable to bus fares

30 4.5 Current cost of services Table 10 shows that expenditure on outpatient services and emergency admissions is lower for all three GP practices then for Suffolk PCT and England. However, elective admission spend is higher per patient, except for Stourview Medical Centre. Table 10. Expenditure ( per patient) on secondary care services, Total outpatient expenditure Expenditure on elective admissions Expenditure on emergency admissions Christmas Maltings and Clements Practice Christmas Maltings Surgery Stourview Medical Centre Suffolk PCT England

31 5.0 Current service use and quality 5.1 Primary care In Hours Service Table 11 below provides an indication of patient satisfaction with the Haverhill GP practices. Table 11. Indicators of patient satisfaction with GP practice. 2011/12 7 Clements and Christmas Maltings Stourview Medical PCT value England average Christmas Maltings Centre % recommending practice % satisfied with phone access % satisfied with opening hours % who saw/spoke to nurse or GP same or next day % reporting good overall experience of making appointment It can be seen that Stourview Medical Centre exceeds the PCT and England average performances. The other two surgeries perform comparably to the PCT and England figures for most indicators. 29

32 5.1.2 Out Of Hours Service Table 12 below shows patient contacts with the OOH services, both as the number of patients per month, and the proportion of the practice list size. For each month, these figures are compared with the Suffolk practices having the lowest and the highest level of OOH patient contact as a proportion of practice list size. Table 12. Patient contact with OOH service by GP practice, 2013 April 2013 May 2013 June 2013 No % of list No % of list No % of list Christmas Maltings Surgery Clements Christmas Maltings Surgery Stourview Medical Centre Lowest contacts Highest contacts Source: Harmoni Suffolk. Christmas Maltings Surgery has the highest proportion of its patient list contacting the OOH service. However, all three surgeries have a moderate level of OOH service use compared with the Suffolk practices having the highest proportion of patient contacts for each month. 30

33 5.2 Secondary care Hospital use Hospital admissions for daycase surgery range from 7,652.4 per 100,000 people for Haverhill West, to 12,200.4 per 100,000 people for Haverhill North. Figures for all wards except West are significantly raised compared to the Suffolk rate. Elective admissions are all significantly higher than the county rate, with the highest in Haverhill South (4,167.9 per 100,000), and the lowest in Haverhill West (3,705.5 per 100,000). Emergency admissions are significantly raised compared to Suffolk in Haverhill North (8,232.4 per 100,000) and Haverhill South (8,787.8 per 100,000). Table 13. Hospital admissions per 100,000 population by Haverhill ward Daycase surgery admissions/100,000 Elective admissions/100,000 Emergency admissions/100,000 Haverhill East Haverhill North Haverhill South Haverhill West Suffolk 8, , , , , , , , , , , , , , ,656.8 Emergency admission can be broken down into four disease categories: CHD, stroke, myocardial infarction (MI) and COPD (see Table 14). Haverhill has a significantly higher admission rate than England for COPD, while Suffolk and St. Edmundsbury are significantly better than England. Although for the other three diseases, Haverhill has comparable admissions to England, this looks less favourable when considering that the district does significantly better than the England average for CHD and stroke emergency admissions. Hospital admissions can also be examined with regard to harm and injury (see Table 14). Haverhill and St. Edmundsbury district have significantly more hospital stays due to self-harm and to alcohol related harm. This is an exception to the county, which is significantly better than the England average. Haverhill also has significantly high levels of elective admission for hip replacement, although this is comparable with the district and county (see Table 14). 31

34 Table 14. Hospital admissions for Haverhill patients, Standardised Admission Ratios (SARs), 2006/7 2010/11 1 Emergency admission Hospital admission Elective admission Haverhill St. Edmundsbury Suffolk England CHD Stroke Myocardial Infarction COPD Self-harm Alcoholrelated harm Hip replacement Knee replacement Ambulance The National target for ambulance services is to reach 75% of calls to potentially life threatening cases (termed Red 1 and 2) within 8 minutes. 9 Table 15 below shows the performance of the East of England Ambulance service against this target for calls to the WSCCG area during three months in

35 For each month, these figures are compared with the East of England CCG areas having the best and worst performance figures. See Appendix B for details of the specific CCG areas. Table 15. Percentage of ambulances reaching Red 1 and 2 calls in WSCCG area within 8 minutes NHS West Suffolk (WSCCG) Best performance Worst performance April 2013 May 2013 June 2013 Red 1 Red 2 Red 1 Red 2 Red 1 Red 2 (%) (%) (%) (%) (%) (%) % For calls from patients in West Suffolk, the ambulance response falls slightly short of these targets, except for Red 1 calls in May Comparison with the best and worst performances across the East of England region shows that while WSCCG fares a lot better than the worst performer, there is a lot of scope for improvement. The target of providing a transportable resource to 95% of Red 1 & 2 calls within 19 minutes is also unmet for the 3 months to June 2013 for West Suffolk patients (see Appendix B for figures). 9 Future plans for the ambulance service include the recruitment of 351 staff (filling existing and newly created posts), which will result in the equivalent of an extra 25 double staffed ambulances. This is planned for the 2013/14 financial year. 9 33

36 6.0 Service user and professional views Views from Haverhill residents, professionals and community representatives were obtained at the community event on 17 May 2013, and through separate communications and meetings. Section 6.0 summarises these views. Two main themes emerged; the desire for more locally based services and facilities, and improved access to local and non-local services. 6.1 Services/facilities There was a general feeling by people attending the event, that more community based services are necessary, especially given the projected population increase with the new housing developments. This includes a new GP surgery, or even a local hospital, to cater for the extra residents; Services should be located together to provide a one-stop shop, such as a Healthy Living Centre. Specific facilities and services thought to be necessary in Haverhill include local testing services (e.g. blood, urine, ECG), community rehabilitation services (such as occupational therapy, physiotherapy and cardiac), facilities for X-rays, dialysis and breast screening, and outreach clinics from the two hospitals, preferably run jointly. Other services that were highlighted can be grouped into five categories: Children and young people: locally based paediatric clinics, children s mental health services, and drop-in from drug and alcohol services at the Riverside scheme for young people; Elderly people: Older people s day centre and a specialist dementia clinic; Mental health: Volunteer-led mental health support club and a specialist GP for drug and alcohol abuse problems; Health promotion: Extra health trainer, breastfeeding areas in shops, walking groups, a good leisure centre with a hydrotherapy pool and exercise on prescription; Methods of service provision: Interactive services such as health forums, home visits, health cafes, use of tele-health, and services based in community locations, such as blood testing in the supermarket. 34

37 6.2 Access Transport Transport to services outside Haverhill, especially WSH, is a big issue for residents. For those with a car, parking is expensive and limited, while for those without a car, buses do not run directly to WSH, there are no buses after 18.00, and bus passes cannot be used before This is of particular concern when the OOH service is based at WSH. Transport is better to Cambridge and Sudbury, leading people to use Addenbrooke s A&E, rather than OOH services based in WSH. However, in all cases, transport can be very expensive, especially if several trips are required, or if a taxi is needed OOH access In addition to the transport issues with accessing face-to-face OOH care, there are long waiting times to see a doctor, and Haverhill residents would like a permanently staffed local OOH service GP access There are long waiting times to get a doctor s appointment, for example 2-3 weeks for The Christmas Maltings and Clements Practice. It can be longer to see a specific doctor. This can lead to deterioration in a patient s health, and is confusing when a shorter follow-up period has been specified by the GP or hospital. It was felt that the following was needed for GP services: Longer opening times e.g. until and weekend mornings; Walk-in appointments; Saturday morning appointments available for general use; A booking system which doesn t allow appointments to be booked up on-line, while noninternet users wait to get through on the telephone Other access issues There is a perceived need for easy access to ongoing support for long term conditions, so that patients and carers aren t left to cope on their own. The Open Road service in Haverhill is difficult to access, as all referrals have to go via Bury St. Edmunds, with the attendant transport problems. 35

38 6.3 Service quality/ training issues Primary care There is a perceived need for primary care practitioners to undergo further training around drug and alcohol misuse, mental health problems such as schizophrenia, young person s issues, and wound care. Better practice information is needed for non-internet users, including new patient information, details of opening times, and staff members Secondary care The major concern surrounding hospital service quality relates to communication. In particular: Timely provision of test and discharge information, in time for any GP follow-up appointment; An improved system for notifying appointments, to avoid people being classed as nonattenders despite not receiving the letter; An alternative to clinic attendance for communicating the results of investigations or procedures where there is nothing to report; There was also concern about pro-longed hospital stays, caused by long waits for inpatient tests, specialist assessments and discharge medications; Ambulance services Waiting times for ambulances need to be reduced. 6.4 Awareness/ communication There is a perceived need for education of the population around healthy lifestyles and selftreatment of minor illness. Also people thought it was important to raise awareness of the different health services available, what each service does, and how to access them. This could include signposting to the most appropriate service. All communication between health services and the public needs to take account of potential language barriers (both with staff and service users), mental health issues, and levels of literacy. For example, telephone triage systems can be difficult for people to use if they have speech, language or learning difficulties. 36