Key Issues

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, smoking rates and physical activity levels are, on the whole, 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 has felt the effects of ongoing austerity measures and the impact of unhealthy lifestyles characterised by obesity, physical inactivity, poor diet and alcohol misuse. The JSNA summary also highlights some local issues such as the particularly large increase in numbers of older people projected into the future, the rise of Type 2 diabetes, high levels of excess weight amongst adults, an increase in cases of tuberculosis, and a troubling number of young people being admitted to hospital for reasons connected to alcohol, substance misuse and self-harm.

The JSNA Summary also shows there has been a fall in female healthy life expectancy in Swindon since 2010-12. Healthy life expectancy is the average number of years a person would expect to live in good health based on mortality rates and self reported good health. The most likely explanation is that it’s as a result of poor self-reported health confined to the youngest age group surveyed [ages 16-19] but which is within expected limits. This is currently the only explanation of a situation where only this particular measure for females (not males) is affected and where any cause would have to be relatively short-term and recent in nature and be confined to Swindon in particular. This indicator is produced by the Office for National Statistics (ONS), who are currently consulting on a new methodology and joint investigations between the ONS and SBC are continuing. There are a number of initiatives in place in Swindon to improve the mental and physical health of young women. They include a psychiatric liaison service for young people at Great Western Hospital, training and guidance about self-harm for people working with children and young people and a self-harm service run by Swindon MIND that offers help and support to young people. Swindon also supports the You’re Welcome quality criteria for making health services young people friendly, particularly sexual health services. Good sexual health is advocated to help reduce teenage conceptions in addition to a chlamydia screening programme for those aged 15 to 24. The transition from young people’s to adult services can be challenging and work is ongoing to make services more seamless, particularly for mental health services. There are also a number of resources about health and wellbeing which are targeted at young people, such as The Dock which tells young people about the services available to them in Swindon e.g. wellbeing, college, e-safety and getting involved in volunteering and Kooth which provides access to online advice, self-help tools and counselling.

The upstream causes of ill-health (known as wider determinants) are also highlighted. Swindon is facing increasing numbers of homeless people, concerns around traffic related air quality, higher rates of recorded crime and challenges in getting more young people, especially from deprived areas, to continue to higher education. Wider determinants are considered the fundamental cause of health outcomes, and variation in how these are experienced drive health inequalities through disease patterns and behavioural risks. Addressing the wider determinants of health has a key role to play in reducing health inequalities in the borough.

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 issues from topic sections

This report contains 26 topic pages which each highlight some key issues 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.

Reducing the inequality in life expectancy between men and women.

Support those affected by the expected increase in evictions and homelessness resulting from the introduction of Universal Credit and other measures in the 2012 Welfare Reform Act.

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

Challenging stereotypes and assumptions and working with people as individuals.

Raise the profile of Swindon and challenge negative perceptions of the town with the Switch On To Swindon campaign.

Good start in life

Increase the number of women who initiate breastfeeding and support those who start to sustain breastfeeding for longer, especially in areas of deprivation which have lower breastfeeding prevalence rates.

Early identification of children and young people with autistic spectrum disorder, speech, language and communication needs or social, emotional and mental health difficulties alongside better support and provision to meet their needs and improve 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.

Improve outcomes for disabled children and children affected by domestic abuse, who are more likely to suffer abuse and neglect.

Support young carers so their emotional or physical wellbeing, educational achievement and life chances are not adversely affected.

Tackle low attainment by age 19 and subsequent lack of progress to higher education that negatively impacts the employability of young people in Swindon.

Healthy and risky behaviours

Tackling preventable risk factors for Type 2 Diabetes including supporting the NHS Diabetes Prevention Programme which focuses on weight loss, physical activity and diet.

Ensuring access and rapid treatment for sexually transmitted infections along with high partner notification rates to reduce onward infection.

Reducing the overall smoking prevalence; the number of people starting smoking; those smoking during pregnancy and prevalence rates in routine and manual occupation groups. The NHS will go smoke-free in 2019.

Build a prevention and treatment strategy which can adapt to changing profiles of drug use and with regard to diversity.

Developing a population approach to encouraging healthy behaviours and physical activity including the use of social marketing, social media and apps.

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

Mental health and wellbeing

Promote and implement the ‘Five ways to Wellbeing’ (connect; be active; keep learning; take notice; and give), as part of strategy to prevent mental health problems and develop mental resilience of the population

Early, multi-agency engagement with young people with learning disabilities to plan their transitions to adulthood, considering ambitions, skills and support needs to enable each individual to fulfil their potential.

In the future, planning for more intergenerational living would have benefits for reducing social isolation at all ages.

Raising awareness of dementia for everyone to make Swindon a Dementia Friendly Community.

Burden of ill-health

Delaying onset and slowing progression of LTCs can happen through improved public health, messaging/targeting, personalised care planning, information and supported self-care.

Reduce cholesterol and lower blood pressure for those at high risk to drive down premature death from CVD in deprived areas.

Raising awareness of the public on availability and eligibility for cancer screening programmes and empowering health professionals to promote awareness and early diagnosis.

Ensure people living with a disability will have access to a range of housing options that will help them live independently.

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

Increase the percentage of those vaccinated against seasonal flu to target levels to prevent illness and hospital admission and ease winter pressures on health services.

Reduce unnecessary short trips by car (which are the most polluting) and encourage active travel, alternatives to vehicle use and sustainable travel.

Responding to crime rates in Swindon that have been increasing over the past three years and are higher than for Wiltshire as a whole.

The rise in allegations of financial abuse against vulnerable adults.

Reduce road traffic injuries by the continued provision of road safety and awareness training and campaigns, to the public, and especially for children travelling to and from school.