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, low consumption of fruit and vegetables, an increase in cases of tuberculosis, a troubling number of young people being admitted to hospital for reasons connected to substance misuse and self-harm and adults being admitted for alcohol related reasons.

The JSNA Summary also shows there has been a fall in female healthy life expectancy in Swindon since 2010-12 which looks to have reached its lowest point in 2014-16. 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. 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 and Gloucester MIND that offers help and support to young people. Swindon is also launching the Trailblazer Project which is a multi-agency approach offering support to Children and Young People in schools and other setting providing a flexible and tailored, early intervention mental health service promoting resilience, building on the strengths of the young person and focusing on holistic outcomes. 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 challenges around coping with the numbers of homeless people, concerns around traffic related air quality, increasing numbers of reported domestic abuse crimes and difficulties 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 and reducing loneliness and social isolation. 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.

Increasing the proportion of their lives Swindon residents spend in good health, especially over the age of 65.

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.

Drive business growth and promote inward investment during economic instability related to Brexit.

Good start in life

Improve maternal nutrition and reduce maternal obesity levels.

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.

Increase the number of foster carers in Swindon so that every ‘looked after child’ who should be, is placed in their home borough.

Ensuring high quality, progressive sexual and reproductive education in Swindon schools.

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

Focus on prevention by making healthy choices and reducing risky health behaviours including smoking, excess alcohol intake, lack of exercise and unhealthy eating.

Reducing the overall smoking prevalence; the number of people starting smoking; those smoking during pregnancy and prevalence rates in routine and manual occupation groups.

Reduce harm to children of alcohol dependent parents using a Tiered Intervention Model to identify and support children and families in a range of settings.

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

Increasing the numbers of people with Learning Disability who are in sustainable employment.

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.

Raise awareness of gambling related harm amongst the public and professionals.

Better organise health and social care services, including public health programmes to increase resilience and reduce loneliness.

Ensuring people living with dementia can play an active part in their local 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.

Ensure more people with Atrial Fibrillation, (a risk factor for stroke) are diagnosed and appropriately treated with anti-coagulants.

Improve cholesterol and BMI monitoring in primary care for Type 1 diabetes patients.

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

Encouraging people with hearing loss to seek help: it is estimated three times as many people could benefit from hearing aids as have them.

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

Ensure there is timely and appropriate support for people at risk of falling and those who do fall.

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.

Preventing people sleeping rough in the first place by working in partnership. Ensuring when people do end up on the streets, there is a rapid, joined-up response. Providing access to a range of appropriate services and affordable housing options, if required, to enable successful transitions from rough sleeping into independent living.

Address the criminal exploitation of children by County Lines networks that are supplying crack and heroin.

Ensure the effectiveness of multi-agency safeguarding arrangements for children with particular vulnerabilities.

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.