Key Challenges

Introduction

Evidence suggests that in many ways the health of Swindon’s population is similar to England as a whole. This in itself presents many challenges. While average life expectancy and smoking levels are improving there are still wide inequalities amongst our population and no sign that the health gap is being reduced.

Like other places across the country, Swindon people have been damaged by the economic recession and associated austerity measures and also by growing problems of obesity and physical inactivity and the rise in Type 2 diabetes. The JSNA summary also highlights some local issues such as the particularly large increase in numbers of older people projected into the future, high levels of inactivity and excess weight amongst adults, a low uptake of the NHS Health Check, and a worrying number of young people being admitted to hospital for reasons connected to alcohol, substance misuse and self-harm.

The increasing prevalence of long term conditions is also highlighted, in particular people having two or more conditions. The financial pressures facing the public sector in the coming years indicate a radically new approach is required, to be adopted by services and the public alike, to tackle this trend.

There is a growing realisation that health and wellbeing is everyone’s business. Swindon has a thriving voluntary sector and wide acceptance that individual and community assets have a major role to play in meeting needs. People are more than passive recipients of services and, as the carers section shows, in reality most care is provided by individuals, families and friends themselves.

Key challenges from topic sections

This report contains 26 topic pages which each highlight some key challenges for that topic. The following pages provide a summary of some of these issues grouped under six broad headings. They are not the only, nor necessarily the most important ones, but are shown in this format to highlight the range of issues that Swindon is facing at the present time and how they are interconnected.

General

The age structure of the population is projected to change with significantly higher growth in the older age groups than in the younger groups.

The ambition of increasing the length of time and percentage of lide spent in good health, adding life to years not just years to life, needs to be delivered.

Action to reduce health inequalities will need continued investigation to understand and address:

The population of Swindon is becoming more ethnically diverse and may require services more sensitive to the risk profile and needs of different groups.

Good start in life

The challenges facing children and young people with Special Educational Needs and Disabilities need to be better understood along with why they experience poorer outcomes.

A key prevention priority around domestic abuse is to tackle the hidden harm of abuse within the home that significantly impacts the health and well-being of children witnessing violent acts; on the mental health of victims; risk of suicide; and substance misuse issues, including smoking.

The effectiveness of the response to children and young people who are at risk from criminal exploitation including, but not limited to, child sexual exploitation must be continued to be developed.

Educational attainment in Swindon needs raising at the end of secondary school to the England average and the attainment gap between disadvantaged pupils and their peers addressing.

Healthy and risky behaviours

The NHS Diabetes Prevention Programme will be rolled out in 2017 which will focus on weight loss, physical activity and diet.

The built environment needs to be designed so that being active becomes an easy choice for Swindon residents.

There needs to be open access to contraceptive services and specialist young people sexual and reproductive health outreach services.

The overall smoking prevalence, the number of people starting smoking, those smoking during pregnancy and the higher prevalence rates in routine and manual occupation groups all needs to be reduced.

Through the Active Swindon Partnership, health and wellbeing should be improved for all by increasing and widening participation in sports, leisure and cultural activities.

Healthy ageing including physical activity needs promoting along with other healthier lifestyle choices as protective factors for falls and osteoporosis. Those at high risk of a fall need identifying and considering for their ability to benefit from interventions to improve strength and balance.

Mental health and wellbeing

There needs to be a focus on young women, who have emerged as a high-risk group, with high rates of common mental disorders (CMDs), self-harm, and positive screens for post-traumatic stress disorder (PTSD) and bipolar disorder.

The care pathway for women with maternal mental health difficulties including those with chronic low-level problems needs improving.

There is a need to coordinate early, multi-agency engagement with young people to plan their transitions to adulthood, considering ambitions, skills and support needs to enable each individual to fulfil their potential.

Dementia needs diagnosing in a timely fashion and support services must be in place for people who need them post diagnosis.

Burden of ill-health

With increasing prevalence of long term conditions, in particular people having two or more conditions, and the financial pressures facing the Health Services in the coming years, a radically new approach is required, to be adopted by services and the public alike, to tackle this trend.

The percentage of patients with a serious heart attack who are reached by ambulance services and provided with primary angioplasty treatment within the 150 minute target needs to be increased to the England average.

The public’s awareness of the availability and eligibility for cancer screening programmes should be raised and health professionals empowered to promote awareness and early diagnosis.

Health services need to respond to the increasing numbers of older people with a range and a combination of disabilities.

There is increasing demand for social care: promoting being active, strength and balance and good social networks will allow people to be more resilient and live independently for longer.

Carers need to be supported to care effectively and safely; look after their own health and wellbeing, fulfil their education and employment potential, and have a life of their own alongside caring responsibilities.

Health protection and safeguarding against harm

Pneumococcal Polysaccharide Vaccine (PPV) coverage needs increasing to the target levels (previous year’s England value) and the percentage of at risk individuals vaccinated against seasonal flu increasing to the target of 75%.

Homelessness need to be reduced and prevented and the use of temporary accommodation limited by focusing on those exiting the private rented sector.

Reporting of domestic abuse is increasing, enabling more effective harm reduction interventions. However, given its hidden nature, the levels could be much higher than currently reported.