Improving health and social care

Health

Health and health care needs in Wandsworth are affected by the unusual age structure of its population.  An exceptionally high proportion are aged between 20 and 44 (53.7%, compared to 42.8% of the London population and 35.1% of the population of England). People in this age range use generally make less use of health care services than older people or young children, a fact that is reflected in NHS funding allocations for Wandsworth.  However, they can be expected to place a high level of demand on some health provision, for example sexual health, substance misuse, or maternity services. Promotion of healthy lifestyles is also a priority.

There are sharp contrasts within Wandsworth, with several wards in the most deprived fifth of areas in England and others in the least deprived fifth. Annual Public Health Reports have demonstrated, across a range of measures, that the health of people in the more deprived wards is worse than those in the more affluent wards. Overall, life expectancy for women in Wandsworth is close to the national average, with life expectancy for men being below average.

Wandsworth Teaching PCT is responsible for commissioning health services on behalf of the Borough's population, as well as an additional 58,700 who are registered with Wandsworth GP practices but live outside the Borough, a total of 328,000 people.

The following are key data on health outcomes:-

• On average, men in Wandsworth live shorter lives than those in England as a whole. Female life expectancy is similar to that of England. Life expectancy is increasing overall more rapidly than the national rate of increase.
• There is a seven year difference in life expectancy  between people living in more affluent parts of the borough and those living in the less affluent parts of the borough.
• Expressed as directly age standardised mortality rates, cardiovascular disease mortality has also dropped but the rate of early deaths from heart disease and stroke is high compared to the average for England.
• Between 1998 and 2006, the teenage pregnancy rate had dropped by 18.7%, but is still above the London and national averages;
• 20.5% of children in year 6 in Wandsworth Schools in the2006-07 academic year were obese, above the national average of 17.5% although just below the London average of 20.8%;
• There are high and increasing rate of sexual transmitted diseases, although this may partly reflect good access to diagnostic and treatment services.

We want to

• Improve health and social care services in order to improve outcomes for people with health problems and disabilities
• Strengthen preventive healthcare, including screening, immunisation and targeted health improvement services (e.g. smoking cessation services)
• Promote healthy lifestyles, focussing particularly on those aspects of lifestyle most associated with poor health (i.e. diet, physical activity, alcohol consumption, smoking, and sexual health)
• Addressing the broader determinants of health. These include educational attainment, the physical and social environment, and economic well-being.

We want to ensure that the pattern of improving health outcomes over the past ten years is maintained and that the benefits are shared across the whole of the borough, including the more deprived wards.

In its Commissioning Strategy Plan, Wandsworth Teaching Primary Care Trust aims to promote healthy living and deliver high quality healthcare by commissioning services for the next 5 years and beyond that are modern, truly patient centred and in the most appropriate setting.

Adult Social Care

There are many adults within Wandsworth who need care, help and support in their daily lives to maintain their independence. Local people may have needs that arise from:-

• physical disabilities;
• sensory problems affecting sight, hearing or speech;
• short or long term illnesses;
• learning disabilities;
• mental health difficulties;
• substance misuse.

The Council is funding social care support for 2711 people between the ages of 18 to 64. Of these 632 are in residential or nursing homes and 2079 are being supported to live at home through various forms of support that includes home care, day services, meals provision and a range of services designed to promote independence.

The Commission for Social Care Inspection routinely monitors adult Social Care services. The latest assessment of the Council's performance in adult social services was carried out in 2007. The assessment looks in detail at services and outcomes for the main client groups. It also looks at broader themes such as health and well-being, and independence and choice.  The Council received an overall two star rating out of a maximum of three. Within this overall score the Council was judged 'good' at delivering outcomes with a 'promising' capacity to improve.

Nevertheless the assessment highlighted several important areas for improvement which are being taken forward in detailed action plans: for example, increasing the take up of Direct payments (which give service users greater control over their choice of care), improving performance on the speed of delivery of equipment and supporting more people with learning disabilities in residential care to more independent living.

The Council, Health and other services (including the third sector) work closely together to ensure that services are effectively commissioned and delivered. Formal partnership agreements are in place with local NHS Trusts on services for people with learning disabilities and mental health, Intermediate Care, Equipment and Substance Misuse services to underpin partnership working.

We would like every person requiring social care, irrespective of their illness or disability, will be supported to:

• Live independently
• Stay healthy and recover quickly from illness
• Exercise maximum control over their own lives
• Participate as active and equal citizens, both economically and socially
• Have the best possible quality of life, irrespective of illness or disability
• Retain maximum dignity and respect.

Older People
Wandsworth's pensioners form only 12.6% of its population compared to 15.5% of London as a whole. Between 1991 and 2006, the number of older people fell from around 45,000 to 35,000. When the population of older people is broken down further, it becomes clear that the most significant reductions occurred within the 60-74 and 75-84 year old populations.

There is also a continuing shift in the ethnicity of the older population in Wandsworth. In 1991, 97% of those aged 75 or older were white whereas, in 2006, it is estimated that this proportion has reduced by 10%. 

There has also been a noticeable shift in the tenure of pensioner households.  Between 1991 and 2001, there has been a substantial decrease in the number of social rented households which include pensioners, a similar proportionate decrease in private rented pensioner households but the number of older owner occupiers is relatively unchanged and now forms around half of the total pensioner population. 

The Wandsworth pensioner population has possibly become more asset-rich, with an increasing population owning their own home.  It is, however, also possible that an increased proportion of pensioner households own their own home but are cash poor. 

There has been a decrease in the number of residents in residential care services from over 600 in 1999 to around 400 in 2007. This reflects the move to supporting more residents, who would previously have been considered for residential care, in their own homes using intensive home care packages. A similar picture is shown by the pattern of admissions to Care Homes with nursing.

In 2006/07 94 older people for every 1000 adults aged 65 or over in the borough were helped to live at home. This ranks Wandsworth 17th out of the 32 London boroughs. For the same period the number of households receiving intensive home care for more than 10 contact hours and 6 or more visits for every 1000 adults aged 65 or over was 24.49. This placed Wandsworth 8th out of the 32 London boroughs. 95.7% of older clients received services within 4 weeks, which placed Wandsworth 1st out of the London boroughs.

We would like Wandsworth to be a borough where older People will be able to realise their potential for physical, social and mental well-being throughout their later years and remain as independent as possible, in control of their own lives and living with dignity, in safety and security, and when they need help, with the care they need.

To find out more about improving health and social care in Wandsworth look at the Profile of Wandsworth. This will also give you a picture of the practical steps we want to take. Tell us what you think by completing the online questions.