Trafford Joint Strategic Needs Assessment – JSNA

Working together to understand the health needs of local people

Produced in partnership by:

Trafford Council

Trafford Primary Care Trust

Trafford Children and Young People’s Service

What’s inside?

1. Welcome

2. The vision for Trafford

3. An overview of our borough

4. Health inequalities

5. Children and young people

6. Adult health

7. Adult social care

8. Spotlight on ‘cross-cutting’ needs

  • Disability
  • Mental health
  • Drugs and drinking (substance misuse)

9. Future challenges

10. Where do we go from here?
1. Welcome

Welcome to this summary of the 2008-2012 Trafford Joint Strategic Needs Assessment – or JSNA for short.

Over the next few pages we want to tell you why we have worked together as a partnership to produce this JSNA and what it will mean for you if you live or work in Trafford.

The full JSNA is a longer, much more detailed document. That is because it captures a huge amount of facts, figures and other information about the size and make-up of our local population, and all the factors that are having the biggest impact on our health and well-being – from our lifestyles and social backgrounds, to our jobs, housing and age.

We recognise, of course, that not everyone will want to read the full JSNA. That’s why we have produced this short, easy-to-read version.

It will still give you a useful overview of:

  • how well our health and social care services are meeting local needs now
  • where the most important gaps are
  • what we’ll focus on in order to close these gaps and keep improving.


What is a JSNA?

This JSNA looks at health and well-being across Trafford in the widest possible sense. The most important thing about it is that it is ‘joint’ - it has been produced in close partnership by the Director of Adult Social Services, the Director of Public Health and the Corporate Director, Trafford Children and Young People's Service.

That means it doesn’t look at any one thing in isolation. It recognises, for instance, that poor physical or mental health isn’t always inevitable and just something that we have to put up with. It can have a lot to do with the quality of housing we live in; what sort of educational opportunities we have had and what sort of lifestyles we lead.

When we produced our first JSNA in early 2008, it was about bringing together all this ‘intelligence’ in one place so we could make the right decisions and do the things that would have the most positive effect on Trafford and its communities over the next three years and beyond.

Updating what we know

What we have done in this latest version is to refresh and update the data. But that’s not the end of the process. We want to make sure that our understanding of local needs is as complete as possible, so we’ll continue to talk and consult with local communities, patients, service users, carers and service providers. We will use what we learn from you to guide our plans for making Trafford the safe, positive, thriving place that we all want and are working towards under our shared vision.

2. The vision for Trafford

Our top priorities as a Partnership

As well as being fully signed up to this vision, within the Trafford Partnership we have committed ourselves to these three priorities by building them into our Local Area Agreement:

  • Safety and reassurance - we will continue to build confidence in Trafford as a safe place to live, learn, work and relax and ensure that individuals and families feel safe and re-assured in their homes and local neighbourhoods.
  • Health - we will improve health for all, which remains the biggest in-equality in life in Trafford, where life expectancy can differ by as much as ten years between neighbourhoods.

Prosperity - we will ensure that through growing prosperity we can create opportunities for local individuals and families

3. An overview of our borough

Trafford is one of the smaller Metropolitan Councils and lies within Greater Manchester. It is home to an estimated 214,200 people living in 93,400 homes, and supports in the region of 124,000 jobs.

Here are some other headline facts about our borough...

Population:

Trafford’s future population is expected to grow by more than 14% over the period from 2008 to 2025. By 2012 there will be 3,500 more working age adults, 1,400 more people aged over 65 years and 1,300 more people aged under 18.

Health:

The health of people in Trafford is generally better than, or similar to, the England average. GCSE achievement and obesity in adults (an estimate) are significantly better than the England average, and road injuries and deaths is the ninth lowest rate in the country. Over 65s 'not in good health' and life expectancy are similar to the average. However, some indicators are significantly worse than the England average, such as binge drinking adults (an estimate).

Housing:

Trafford has a strong housing market with over 72.4% of households owning their own home, compared to 68% nationally. But we know poor housing can cause people stress, anxiety and depression. That’s why we don’t see housing in isolation. Through the council’s Housing Strategy, we’re aiming to give everyone in Trafford the chance to live in an affordable home of their choice, in a thriving, secure neighbourhood. We’re focusing particularly on providing suitable housing for elderly people, those with mental health needs and meeting the government’s ‘Decent Homes’ standard.

Ethnicity:

In 2007, it was estimated that 10.8% of Trafford residents considered themselves to be part of the non-white ethnic groups. That’s about 23,000 people. The largest of Trafford’s minority groups is Indian which makes up 2.6% of the total population. This is closely followed by people of Pakistani origin at 2.1%.

Economy:

Trafford retains its status as the ‘economic power house’ of the Greater Manchester conurbation. A prosperous and wealthy borough, Trafford has a strong local business base, high skill levels, a massively successful enterprising culture and above average levels of economic activity.

Deprivation:

Yet, despite our affluence and high levels of achievement, Trafford still has pockets of deprivation at neighbourhood level where local people experience social isolation and exclusion; two things that are clearly linked to poor health and a poor sense of well-being.

Where are our most deprived areas?

The map here shows the relative deprivation levels for specific areas in Trafford. The information has been drawn from national statistics that combine a number of factors, (including social and housing issues) into a single deprivation ‘score’ for each small area in England.

Overall, Trafford is becoming less deprived, but three areas in our borough, Clifford, Partington and Sale West (shown in red) are still among the 5% most deprived in the country.

4. Health inequalities

Health remains one of the biggest inequalities in life in Trafford. But, it’s not just a matter of geography that determines how healthy you and your family are likely to be – as well as our genes, better prevention and treatment for the major causes of death and linked to this it’s often a matter of lifestyle choices that we make. What we eat; how much exercise we do; whether we smoke; and how much alcohol we drink, can all have a big impact on our health and life expectancy.

Currently, many of Trafford’s existing health problems lie in disadvantaged neighbourhoods, as well as among home-owning pensioners and the elderly. In the future, though, a major health concern may include more affluent professional groups who have the highest levels of alcohol consumption.

Trafford’s Health Profile 2009

Trafford, like other areas, has a formal, Government-funded Health Profile. This uses a long list of measurements (or ‘indicators’), such as poverty and crime levels, obesity, teenage pregnancy, life expectancy and infant deaths, to provide a unique snapshot of the health of our population. We can use this to compare ourselves to other parts of England and to help assess whether our population’s health is improving, and whether health gaps are closing.

Our nationally developed ‘Health Profile’ for Trafford compares us with data for England and together with local data shows us the following:

  • we had significantly worse than England average levels of physically active children in 2007/08
  • 2008 measurements of obesity among primary school age children in Reception Year showed levels slightly above the national average; and
  • 2008 measurements of obesity among primary school age children in Year 6 showed levels below the national average.
  • there is a higher than England average proportion of adults who binge drink
  • there is a higher than England average number of deaths from smoking, although the estimated numbers of adults who smoke is significantly better than the England average.

What do we need to do now?

There is already a wide range of services and support to help people in Trafford avoid ill health and improve their well-being, including the Healthy Schools Programme and stop-smoking services. But there are still big areas of need, including:

  • more support to help people avoid binge drinking
  • more opportunities for physical activity among children
  • better access to health advice and tests, in disadvantaged neighbourhoods.

5. Children and young people

We believe that the Trafford Children and Young People’s Service (CYPS) provides good support to our younger population and their families. We know, however, that keeping up the quality of services and improving year after year is about four important things:

  • ensuring that all children grow up in loving and stable families so that they enjoy positive physical and emotional well being
  • providing all children and young people with good educational outcomes in our increasingly knowledge based society
  • developing new and more joined-up ways of delivering care and support – the CYPS brings together education, social care and health professionals to work together as multi-skilled teams to improve the outcomes for children, young people and their families.
  • giving children, young people and their families a meaningful role in shaping the services that affect them

The Government's aim is for every child, whatever their background, to have the support they need to:

  • be healthy
  • stay safe
  • enjoy and achieve
  • make a positive contribution
  • achieve economic well-being

Be healthy

Overall in Trafford, the health of children and young people is good. Services to help mothers stop smoking and encourage breastfeeding are strong, and the take-up of childhood immunisations in Trafford is excellent.

Added to this, we have a higher-than-average involvement in the Healthy Schools Programme (a national scheme that brings together healthy eating, exercise and learning) and the dental and general health of children in care is good. We are now developing a more joined-up approach to sexual health provision and education, which is a major priority for young people.

Stay safe

Safeguarding children is our highest priority and we have made significant improvements in this area. We have worked well with our partners, in particular the police and health services, to achieve better safeguarding standards and the results are being felt. For example, well over 90% of young people who have left care are in suitable accommodation.

Enjoy and achieve

Our schools and education attainment levels in Trafford continue to be among the best in the country. Absences and exclusions are well below the national average in both our primary and secondary schools. Our children in care have some of the best educational outcomes in the country. Trafford is leading on ‘narrowing the gap’ in educational achievement between vulnerable children and young people and their peers across Greater Manchester, as part of the ‘Greater Manchester Challenge’, a three year project funded by DCSF.

Make a positive contribution

Our Children and Young People (CYP) Plan states that we will only know our services are good when children and young people tell us they are. School Councils are well established and the Trafford Youth Cabinet means young people have a direct role in making important decisions about services.

We have commissioned a group of young people recently to research and make recommendations on bullying and cyber bullying in the north of the borough. We’re starting to see a positive impact on crime too; the rate of re-offending has been reducing each year since 2002, although it still remains higher than the national average. We will also be doing more to support disabled children, young people and their families to access a wider range of short breaks, childcare and support them during their transition into adulthood.

Achieve economic well-being

Trafford does consistently well in ensuring young people, aged 16 years and upwards, are placed in education, training and employment. In 2005 we had 83% of 17 year olds in work-based learning, compared to 76% nationally. We have also seen a steady increase in the numbers of young people completing an apprenticeship, and above average rates for 19 year olds achieving either a level 2 or 3 qualification. Added to this, we have more teenage mothers and young people with learning difficulties in employment, education and training (EET).

6. Adult health

We have seen big improvements in health across the borough, with life expectancies going up, partly because of improvements in the treatment of circulatory diseases such as heart disease and stroke. Yet, despite this progress, the big issue we still need to tackle is health inequalities. For instance:

  • why, if you are a man living in the most income deprived part of Trafford, can you expect to live ten years less than a man in the least income deprived part of the borough?
  • why are you more likely to suffer from cardio vascular (heart) disease if you are from the Indian, Pakistani, Bangladeshi or Black communities in Trafford?
  • why, if you are lesbian, gay, bi- or trans-sexual, might you have poorer health compared to the rest of the population?

On page 7 there is a map showing the levels of deprivation across the different areas in Trafford. It’s important here too because there are clear links between deprivation and poor levels of health. We know that our most economically and socially deprived neighbourhoods in Trafford have the greatest levels of health deprivation - some of the worst deprivation being in the north of the borough, within the ward of Clifford, but also with pockets of deprivation within the wards of Bucklow-St Martin’s and St Mary’s.

More generally, there are significant differences in health throughout the borough and the gap between neighbourhoods is not improving as fast as planned. This is not just unfair, it’s unacceptable. That’s why reducing these health inequalities remains such a major focus of this JSNA, the PCT Commissioning Strategic Plan and a top priority for the Trafford Partnership.

Tackling early deaths in Trafford

Circulatory diseases, such as heart disease and stroke, cancer and respiratory disease (affecting lungs and breathing) are among the major causes of death in Trafford.

We have already made some very positive progress in tackling some of these problems. In some areas, for instance, we have reduced and have fewer early deaths caused by circulatory diseases. Additionally, death rates from respiratory disease are lower in Trafford than in Greater Manchester and the North West as a whole.

But there is still a great deal of work to do to ensure that people in Trafford get the early advice, care, tests and treatment they need to reduce their risks of getting these killer diseases, or avoid early death because of them.

Some facts about the ‘big three’ diseases:

  • cardio vascular (heart) disease is significantly higher in the Indian, Pakistani, Bangladeshi and Black communities than the White population.
  • over the last few years there has been a slowing in the rates of early deaths from cancer in Trafford and we need to improve knowledge and awareness for earlier cancer presentation and faster, better treatments for improved survival rates.
  • chronic obstructive pulmonary disease (COPD) is still a major cause of death in Trafford linked to smoking patterns.

What are we doing about this?

Death rates in Trafford including all age all cause death are generally decreasing and life expectancy is rising. But there are still big gaps and inequalities between wards. For instance, the age standardised death rate for all ages and all causes of death is twice as high in Clifford compared to that in Hale.

Reducing the gap between the highest and lowest performing areas of Trafford is a high priority for the Trafford Partnership – we’ve had a positive start and made a reduction but we need to do more.

Among the big areas we’ll focus on are:

  • improving people’s awareness of the symptoms of heart disease and cancer so they can get earlier help from doctors - particularly in the most deprived wards and among the Indian, Pakistani, Bangladeshi and Black communities.
  • introducing the national bowel screening programme to Trafford – as well as the school-based HPV immunisations to help fight the causes of cervical cancer.
  • reduce cholesterol levels and tackle high blood pressure - through medicines and lifestyle changes – as well as reducing smoking in the most deprived wards.
  • making better use of technologies in the home to help patients with long-term conditions such as COPD manage their own health more confidently.
  • use national alert systems such as the Met Office Weather Watch scheme to warn people about cold snaps that might make their illness worse.

7. Adult social care