Health and Adult Social Care Policy & Scrutiny Committee

10 November 2020

Report of the Corporate Director of Health, Housing & Adult Social Care

2020/21 Finance and Performance first QUARTER REPORT – HEALTH AND ADULT SOCIAL CARE

Summary

1 This report analyses the latest performance for 2020/21 and forecasts the financial outturn position by reference to the service plans and budgets for all the relevant Health and Adult Social Care services falling under the responsibility of the Corporate Director of Health, Housing & Adult Social Care.

Financial Analysis

2 A summary of the service plan variations is shown at table 1 below.

Table 1: Health & Adult Social Care Financial Summary 2020/21 – Quarter 1

2019/20 Outturn £000		2020/21 Latest Approved Budget			2020/21 Forecast Outturn
2019/20 Outturn £000		Gross Spend £000	Income £000	Net Spend £000	£000	%
+2,982	ASC Older People and Physical & Sensory Impairment	36,260	-18,461	17,799	+1,677	+9.4%
+3,256	ASC Learning Disabilities and Mental Health	34,085	-8,615	25,470	+2,861	+11.2%
+351	ASC In house services	7,378	-2,596	4,782	+904	+18.9%
-670	ASC Commissioning and Early Intervention & Prevention	9,204	-10,193	-989	-48	-4.9%
-255	Central Directorate Budgets	5,045	-2,871	2,174	-264	-12.1%
-1,896	ASC Mitigations				-2,500
3,768	Adult Social Care Total	91,972	-42,736	49,236	2,630	+5.3%
0	Public Health	8,014	-8,499	-485	0	0%
3,768	Health and Adult Social Care Total	99,986	-51,235	48,751	2,630	+5.4%

+ indicates increased expenditure or reduced income / - indicates reduced expenditure or increased income

ADULT SOCIAL CARE

3 A net over spend of £2,630k is forecast for the directorate, mainly due to pressures within Adult Social Care. The majority of the overspend relates to the continuation of existing 2019/20 pressures that have been previously reported.

4 Permanent residential care is forecast to overspend by £223k based on current customer numbers. This is mainly due to the average cost of working age Physical & Sensory Impairment placements being around £11k higher than was planned for in the budget. Older People residential care is currently projected to be on budget having overspent in 2019/20 due to a reduction in the number of residential customer care packages over the first quarter of 2020/21. Permanent nursing care is forecast by underspend by £340k based on current customer numbers.

5 However, in addition to the above there are a number of customers in residential and nursing placements which are currently being paid for by Heath under the COVID-19 regulations. The current assumption is that responsibility for these customers will transfer to the Council from 1st October, which is projected to increase the net cost of residential and nursing placements by around £780k by the end of the year.

6 Home care is projected to overspend by £581k mainly due to the weekly number of hours for homecare contracts being more than was assumed when the budget was set.

7 Physical and Sensory Impairment Supported Living schemes are forecast to overspend by £671k due to there currently being eight more customers in schemes than assumed in the budget, and in addition the net cost is £8k per annum higher than budgeted for. This is offset by a projected underspend of £390k in direct payments.

8 Learning disability residential budgets are forecast to overspend by £996k. The numbers placed are in line with budget, however the net cost per placement is currently £16k more than budget. This is partially due to ongoing issues of customers no longer qualifying for 100% continuing health care (CHC) funding and responsibility passing across from Health to ASC. This appears to be an increasing trend which calls for a response from the Council, in terms of validating the decision where appropriate and redesigning the ongoing package of care if the person’s needs have changed.

9 Supported Living for Learning Disability customers is forecast to overspend by £282k. This partially due to having 5 more customers than in the budget, and also the average amount of CHC funding per customer is £7k less than was assumed when the budget was set.

10 Direct Payments for LD customers is forecast to overspend by £446k as the average direct payment per customer is around £4k more than in the budget.

11 Mental Health budgets are forecast to overspend by £942k, predominantly due to an increase in the number of residential care placements needed.

12 Be Independent is currently projected to overspend by £130k. The financial position of the service has been recovered significantly since being transferred back to the Council, but there is still work to be done in order to balance the budget.

13 There is a projected overspend of £509k on Haxby Hall. Transfer of the service to an external provider has been delayed due to COVID-19 and there is a substantial overspend on staffing due to the use of Work with York and external agency staff to cover staff vacancies pending the transfer going ahead. In addition income is down due to there being a reduced number of customers currently being placed in the home.

14 The service is working on a detailed, costed mitigation plan. This will include a continuation of the Home First principle to reduce the numbers of people needing long term residential care, continued implementation of the operating model for social care along with a review of the Better Care Fund commitments and use of health funding where appropriate.

15 Mitigation work is being focussed on reducing admissions to care, reducing the hospital length of stay and improving reablement potential. Further work is ongoing to improve business processes and upskilling frontline teams in strengths based conversations along with improving the efficiency of placements in Independent Living Schemes, improved access to information and advice, and maximising the uptake of community capacity to tackle isolation and improve resilience.

Performance Analysis

ADULT SOCIAL CARE

16 Much of the information in the following paragraphs can also be found on CYC’s “Open Data” website, which is available at

https://data.yorkopendata.org/dataset/executive-member-portfolio-scorecards-2019-2020

and by clicking on the “Explore” then “Go to” in the “Health and Adult Social Care” section of the web page.

17 Many of the comparisons made below look at the difference between the end of the 2019-20 Q1 and 2020-21 Q1 periods, in order to avoid seasonal variations. A summary of the information discussed in paragraphs 32 to 44 can be found in the table below:

Residential and nursing admissions

18 Avoiding permanent placements in residential and nursing care homes is a good measure of ensuring of how well CYC and its partners are doing in ensuring that those with the most complex needs retain as much control over their lives as possible. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential care. The quality of residential and nursing care in York remains good. We are seeing lower numbers of people entering residential and nursing care, but they are spending more time in them as residents live longer. We are mitigating against this through the development of initiatives such as supported living schemes and intensive short-term support for people who would otherwise live in residential and nursing care homes. Organisations in the health and social care system in York have signed up to a “Home First” Model which means that anyone who can go home with support does by ensuring that the right services are in place for this to happen. Where we do place people directly into a residential home from hospital, we now only do so on a temporary basis with a view to supporting them to return home where this is possible.

19 The approach of temporary rather than permanent placements from hospital has had an impact on the number of people in long-term residential and nursing care. This fell to 565 at the end of 2020-21 Q1, compared with 657 at the end of 2019-20 Q1. However, it cannot be overlooked that the impact of the COVID-19 pandemic in care homes, which resulted in a much higher than average number of deaths in 2020-21 Q1 across the city, also contributed to this lower figure.

20 There were seven admissions of younger adults (aged 18-64) and 26 admissions of older people to residential and nursing care during 2020-21 Q1. These are lower than in the corresponding period during 2019-20 for older people (68 admissions) and for younger people (10 admissions); this reflects the progress made by CYC in ensuring that people are helped to live more independent lives that would otherwise have entered residential and nursing care.

Mental Health

21 There is a strong link between employment and enhanced quality of life. Having a job reduces the risk of being lonely and isolated and has real benefits for a person’s health and wellbeing. Being able to live at home, either independently or with friends / family, has also been shown to improve the safety and quality of life for individuals with mental health issues. York continues to perform well in supporting those people with the most serious long-term mental health issues who are in contact with specialist services to be in employment. At the end of 2020-21 Q1 19% of York’s adults in contact with secondary mental health services were in employment, although this represents a slight decline from the level seen a year earlier (22% at the end of 2019-20 Q1). Although there has also been a decline in the percentage of people in contact with secondary services living independently, it remains relatively high. At the end of 2020-21 Q1 72% of York’s adults were living independently, compared with 80% at the end of 2019-20 Q1.

Delayed Transfers of Care

22 CYC and its partners are continuing to improve the way we support people to access the support they need in the community when they no longer need hospital care. Delayed transfers of care (DToC) are an important marker of the effective joint working of local partners, and are one measure of the effectiveness of the interface between health and social care services. A DToC occurs when a patient has been clinically assessed as ready for discharge from hospital, but the necessary support (from either, or both of, the NHS or Adult Social Care) is not available.

23 The overall yearly rate of DToC had been on a downward trend since the summer of 2019. However, the counting of DToC has been suspended since February 2020, as the COVID-19 pandemic began in the United Kingdom, and there has been no official confirmation from the Department of Health and Social Care that it will resume. The current expectation CYC has is that it is very unlikely to do so.

Independence of ASC service users

24 It is important that people with care and support needs are involved with and are well supported by the communities in which they live as this supports their health and wellbeing. The Adult Social Care Community Teams have been redesigned to deliver a model of community-led support. An aim of this is to increase the number of people supported through universal and preventative services and reduce the numbers dependent on commissioned care packages. There are indications that this approach appears to be having an impact. There was a decrease in the number of those supported to live independently by the use of preventative measures: this was 919 at the end of the first quarter of 2020-21, compared with 927 in the same period of 2019-20. There was also an increase in the number of people supported through commissioned care packages of 1.5% from 1,719 in Quarter 1 2019-20 to 1,745 in Quarter 1 2020-21. However, we expect that demand for services will increase during 2020-21 Q2, partly as a result of the COVID-19 pandemic.

Early Intervention and Prevention

25 Under the Care Act 2014 local authorities have a responsibility to promote the wellbeing of those potentially in need of Adult Social Care. The aim of this is to enable our citizens to live well for longer and maintain their independence; and to prevent, reduce and delay the need for formal services.

26 Although there is an increasing older population with more complex needs, the number of people approaching the council who require further social care assessment and are eligible for support remains largely unchanged from the equivalent quarter last year. The number of supported self-assessments completed in 2020-21 Q1 was 601 compared to 621 in 2019-20 Q1. From these 601 self-assessments, 392 (65%) were eligible to receive a service from CYC compared to 443 (71%) in the equivalent quarter of the previous year. In 2020-21 Q1, 41 (71%) of the 58 assessments for carers completed resulted in carers getting services; this is lower than the percentage (83%) in 2019-20 Q1, when 48 carers got services after 58 assessments had been completed. The introduction of the co-produced Live Well York website and the increase of preventative services such as Local Area Co-ordination and social prescribing offer information, advice, guidance and a means of building sustainable networks of support to help people live well in their communities, delaying the need for adult social care services. The roll-out of the community-led support model by the Adult Social Care Community Teams is aimed at ensuring that those with care and support needs are well connected to their communities and that these opportunities are fully explored before formal assessments and services are provided.

Personalisation

27 Almost all (99.9%) of those using social care received self-directed support during the first quarter of 2020-21 – unchanged from the corresponding quarter in 2019-20. The percentage receiving direct payments increased to 27% by the end of the first quarter of 2020-21, compared with 25% by the end of 2019-20 Q1.

Safety of ASC service users and residents

28 The safety of residents, whether known or not to Adult Social Care, is a key priority for CYC. The ability of CYC to ensure that their service users remain safe is monitored in the annual Adult Social Care User Survey, and for all residents with care and support needs by the number of safeguarding concerns and enquiries that are reported to the Safeguarding Adults Board.

29 During 2020-21 Q1 there were 304 completed safeguarding pieces of work, which is a 17% decrease on the number completed during the 2019-20 Q1 period (365) – this partly reflects a decrease in the number of safeguarding concerns reported during this time. CYC encourages the reporting of concerns by service providers and as stated in paragraph 32 the quality of care in York remains good. The percentage of completed enquiries where people reported that they felt safe as a result of the enquiry continues to be high, and has increased, from 89% during 2019-20 Q1 to 99% during 2020-21 Q1, and remains consistent with what has been reported historically in York. Recognising the expertise of our NHS partners in their particular fields, there has also been a small increase in the number of Safeguarding Enquiries entrusted to partners which are then reported back to the council (45 in 2020-21 Q1 compared with 44 in 2019-20 Q1).

Sickness rates of Adult Social Care staff

30 In the HHASC directorate, which includes Adult Social Care, the number of sickness days taken per full-time employee fell from 13.4 in the year to June 2019 to 12.8 in the year to June 2020. Work continues to reduce this further, and to be able to separate out information for ASC staff only once the People directorate (to be created on an interim basis later in the year) is in operation.

PUBLIC HEALTH

31 The most recently available Public Health data (as at 3^rd February 2020) has been used for this report. Since the previous performance report new data has become available on: NHS health checks, smoking in pregnancy; smoking cessation and substance misuse treatment (relating to 2019-20 Q3); IAPT and the Healthy Child service (2019-20 Q2), child obesity and physical activity (2018-19), under 18 conceptions (2018-19 Q3) and alcohol specific mortality rates (2016-18).

32 The Public Health data presented in the performance report relates to York residents. As an example, for data on hospital admissions, only people with a York postcode as their usual residence, regardless of which hospital they attend, will be included in the York figures. Attendances at York hospital by people who live outside the City are not counted in the York figures: they will appear against the data for their ‘home’ local authority. The same principle applies if the data is reported on a Vale of York CCG Footprint. There are some minor exceptions to this general rule for some indicators: people living outside York may be counted in the Health Check data if they are registered with a York GP. Also children living outside York attending a York school are included in some of the published National Child Measurement Programme (NCMP) measures.

Directly Commissioned Public Health services

Health Trainer Service (NHS Health Checks and Smoking Cessation)

33 The Health Check programme aims to help prevent heart disease, stroke, diabetes and kidney disease. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess, raise awareness and support them to manage their risk of cardiovascular disease. A high take up of NHS Health Check is important to identify early signs of poor health, and lead to opportunities for early interventions.

34 During 2019-20 Q2 in York a total of 1,500 people were invited for a health check and 315 checks were carried out. The total number of people in York who are estimated to be eligible for a health check is 54,783. We are required to invite the eligible population for a check once over a five-year period. The figure above means that 0.6% of York’s eligible population therefore received a check in the quarter: a lower rate compared with the regional (2.1%) and national (2.0%) averages. In 2019-20 Q3 the number of checks carried out increased to 379 (out of 2,560 invites) which means that 0.7% of York’s eligible population therefore received a check in the quarter. The regional and national comparisons for 2019-20 Q3 were not available at the time this report was written (5 February 2020).

35 Closer work with Primary Care Networks is being undertaken, which will see health checks being delivered in a primary care setting leading to a more joined up service for the patent. Health Checks are delivered from various locations across the City. We aim to target this service to those most at risk. Our approach is more than just identifying risk, and that is why we now deliver a Health Trainer Service, which aims to provide individuals with advice and support to tackle the things that increase their risk, such as excess weight, high blood pressure, lack of exercise and poor diet. The Health Trainers put the individual at the centre and work with them to help achieve the health goals that matter to them.

36 The Health Trainer service also provides support for people that want to stop smoking. This includes one-to-one advice as well as access to medications that make the journey to being smoke free easier. We have recently formed a Tobacco Alliance in York so that we can ensure that we tackle some of the wider issues that lead to people taking up smoking, such as ease of access to cheap illicit tobacco products.

37 In 2018/19 the Health Trainer service received 331 referrals or self-referrals for smoking cessation support, and 28% of clients who were seen by an advisor were successfully quit at 4 weeks. As a proportion of York’s smoking population (an estimated 19,000 smokers), the number of referrals was low. The service has recently created extra capacity to see more smokers per year in an increased number of community venues, and by raising awareness of the service and through multi-agency work with the recently established York Tobacco Control Alliance, referrals were expected to rise.

38 In the first three quarters of 2019-20 there has been an improvement in referral and quit rates. Referrals increased from 94 in 2019-20 Q2 to 133 in 2019-20 Q3. There have been 316 referrals in the three quarters to date. The percentage of clients that were seen by an advisor who successfully quit at four weeks has risen to 48%. In the first three quarters of 2019-20, a total of 88 smokers set a quit date and 50 of those (57%) had quit smoking at the four week follow up. Of the smokers who set a quit date, 21 were pregnant and 10 of these (48%) had quit smoking at the four week follow up.

Substance Misuse

39 Individuals successfully completing drug / alcohol treatment programmes demonstrate a significant improvement in health and well-being in terms of increased longevity, reduced alcohol related illnesses and hospital admissions, reduced blood-borne virus transmission, improved parenting skills and improved physical and psychological health.

40 A total of 1,072 adults in York were in structured treatment for substance misuse during 2018-19. The breakdown by substance is: 504 people for opiate use, 368 for alcohol use, 121 for alcohol and non-opiate use and 79 for non-opiate use. Wait times were good, with only one person out of 139 new starts having to wait longer than three weeks to commence treatment. A higher proportion of eligible clients had received a HepatitisC antibody test (87.5%) compared with the England average (84%). Of those people receiving substance misuse treatment, 10 died in the year: the number in 2016-17 was 20, so this has halved since then. A higher proportion of alcohol users entering treatment had concurring mental health and substance misuse issues (67.1%) compared with the England average (53.5%). This is also the case with alcohol and non-opiate users (71.4% in York, 58.3% in England). A higher percentage of opiate clients in treatment in 2018-19 in York (27.8%) were in contact with the criminal justice system compared with the national average (20.4%).

41 In the latest 18 month monitoring period to December 2019, 348 alcohol users were in treatment in York and 108 (31%) left treatment successfully and did not represent within six months. The equivalent figures for opiate and non-opiate users were 5.2% (26 out of 504) and 31.8% (57 out of 179) respectively. The York rates are currently lower than the national averages (38% for alcohol users, 5.8% for opiate users and 34.2% for non-opiate users). There is some evidence (from the previous paragraph) that the substance misuse caseload in York has more complex needs in terms of mental health issues and involvement with the criminal justice system and this may be impacting on the ability of the treatment system to produce a higher rate of successful outcomes.

42 The revised model of treatment has now been implemented after an extensive consultation period. This has been accompanied by a review of the impact of financial cuts undertaken by scrutiny members with recommendations approved by Executive earlier this year. This was undertaken as part of the scrutiny work plan and was reported on in October’s meeting.

Sexual and Reproductive health

43 Being sexually healthy enables people to avoid sexually transmitted infections and illnesses, and means that they are taking responsibility for ensuring that they protect themselves and others, emotionally and physically. It also ensures that unwanted pregnancies are less likely to occur.

44 In the period October 2017 to September 2018, there were 44 conceptions to those under the age of 18 in York. The rate of conceptions per 1,000 females aged 15-17 in York (15.8) is lower than regional (19.8) and national (16.8) averages. The long-term trajectory is downwards in York, in line with national and regional averages, although there has been a rise in York in the two most recent 12 month rolling periods. Ward-level data on under-18 conceptions is available for the period 2015-17. Westfield and Guildhall have rates which are significantly higher than the England average. Acomb, Rural West York, Osbaldwick and Derwent, Wheldrake and Haxby and Wiggington have significantly lower rates. Of under-18 conceptions in York, 53.5% of them result in termination (in line with the national average).

45 As a result of an identified need, an emergency contraception clinic was established in Westfield ward. This ward had significantly higher teenage conception rates than the York average and high termination rates, which strongly indicates that they were unwanted pregnancies. In September 2018, a collaboration between the secondary school, primary care services, the specialist sexual health service and Public Health established an emergency contraceptive clinic at the GP surgery adjacent to the school, to help support young women in considering their immediate and longer term contraception needs.

Healthy Child Service

46 There was an above-average participation rate in the National Child Measurement Programme (NCMP) in York during 2018-19: 97% of reception children and 98% of Year 6 children were measured, compared with 95% of reception children and 95% of Year 6 children nationally. The 2018-19 NCMP found that 9.5% of reception children in York were obese, which is not significantly different from the England average (9.7%), although the York figure has risen slightly from the 2017-18 level (9.3%). Of Year 6 children in York, 15.1% were found to be obese in 2018-19, which is significantly lower than the England average (20.1%) and represents a decrease of 2.3 percentage points from the 2017-18 level. There is a wide variation in obesity rates at ward level, and a strong correlation between obesity and deprivation at ward level. The NCMP programme for 2019-20 was discontinued due to the COVID-19 pandemic. Whilst some partial data is available for 2019-20, a robust update on child obesity in York may not be available until the end of the 2020-21 measurement year.

47 A York Healthy Weight Steering Group has been established and has developed a Healthy Weight Strategy for the City. This takes a life course approach to tackling unhealthy weight. Much of our focus is on how we can improve the environment in which we live, in order to support people to achieve and maintain a healthy weight. The key element within that has been signing up to the Local Authority Declaration on Healthy Weight. In terms of what we can do to support people who need help with managing their weight, much progress has been made in terms of the service offer and pathways for adults. However, a gap still remains for young people, particularly the pathway from identifying a child as being above a healthy weight in the school based child measurement programme. The Public Health Team are working to develop a model with the Health Trainer Service whereby Health Trainers can receive a direct referral and where additional support is needed, work with the family to provide advice and ongoing support.

48 In 2019-20 Q2, in York 87.4% of children received a new birth visit within 14 days, A 6-8 week review within 56 days took place for 88.9% of children, and 83.9% had a one-year review before 12 months; 71.4% had a two-year review before 30 months. The corresponding England figures for the quarter were 87.8%, 84.9%, 78.4% and 79% respectively. This means that York has similar new birth visit rates, higher 6-8 week and one-year visit rates but lower two-year review rates compared with the England average.

49 To increase the take up of two-year visits, an initiative was piloted in the West LAT where home appointment letters were sent out to those parents who had not responded to the initial invite letters. This led to an increase in take-up as only a small number cancelled the appointments offered. In addition there are plans to hold integrated two-year reviews within two local authority nurseries as a pilot in 2020.

50 At the 2.5 year review, each child’s level of development on five domains (communication, problem solving, personal and social, gross motor and fine motor function) is measured using the ages and stages questionnaire. In 2019-20 Q2, 89.4% of children in York reached the expected level of development on all five domains compared with 82.1% in England.

51 In 2019-20 Q2, 56.7% of children (with a feeding status recorded) were totally or partially breastfed at 6-8 weeks compared with an England average of 55.2%.

Other Public Health Issues

Adult Obesity / Physical Activity

52 Obesity amongst the adult population is a major issue as it puts pressure on statutory health and social care services, and leads to increased risk of disease, with obese people being more likely to develop certain cancers, over twice as likely to develop high blood pressure and five times more likely to develop type 2 diabetes. It is estimated that obesity costs wider society £27 billion, and is responsible for over 30,000 deaths each year in England.

53 The latest data from the Adult Active Lives Survey for the period from May 2018 to May 2019 was published in October 2019. In York, 487 people aged 16 and over took part in the survey, and they reported higher levels of physical activity, and lower levels of physical inactivity, compared with the national average. Positively, 74.9% of people in York did more than 150 minutes of physical activity per week compared with 63.2% nationally and 62.2% regionally. This is a higher rate than in the previous survey (73.1%), held between November 2017 and November 2018. In York, 14.2% of people did fewer than 30 minutes per week compared with 24.8% nationally and 26.4% regionally. This figure is broadly the same as the 14.4% reported for the period November 2017 to November 2018. The previous Active Lives survey showed that 84% of adults aged over 16 in York took part in sport and physical activity at least twice in the previous 28 days. This is above the national (77.5%) and regional (75.8%) averages. More up to date information relating to this was not published in the most recent survey (May 2018 to May 2019). The Active Lives Children and Young People survey for 2018-19 was published in December 2019. Of children in York in school years 1-11, 17.4% were active for more than 60 minutes each day. This is slightly lower than the England average of 19.6%.

54 The Public Health Team commissioned North Yorkshire Sport to develop a Physical Activity Strategy for the City. This work is currently underway and has involved engaging with many partners across the City. The strategy will be launched at the beginning of 2020 and will sit alongside our Healthy Weight Strategy.

Smoking: pregnant mothers

55 Smoking in pregnancy has well known detrimental effects for the growth and development of the baby and health of the mother. The Tobacco Control Plan contains a national ambition to reduce the rate of smoking throughout pregnancy to 6%, or less, by the end of 2022.

56 At the end of 2020-21 Q1, 11.5% of mothers that gave birth in York were recorded as being smokers at the time of delivery in the 12 months to that time. This represents a slight deterioration from the 2019-20 Q1 figure of 11.3%.

57 The number of smoking cessation referrals from midwives in 2019-20 Q3 was 55 compared with 29 in 2018-19 Q1. This has come about as a result of improved communication and liaison between the Health Trainer service and the midwifery department.

Smoking: general population

58 Smoking, amongst the general population, has a number of well-known detrimental effects, such as increased likelihood of certain cancers, increased likelihood of heart disease, diabetes and weaker muscles and bones. It is estimated that smoking-related illnesses contribute towards 79,000 premature deaths each year in England, and that the cost to the NHS is approximately £2.5bn each year, with almost 500,000 NHS hospital admissions attributable to smoking.

59 No new data on smoking prevalence has been released since the previous report on 17^th September 2019.

Alcohol-related issues

60 The effects of alcohol misuse are that it leads to poor physical and mental health, increased pressure on statutory health and social care services, lost productivity through unemployment and sickness, and can lead to public disorder and serious crime against others. It is estimated that harmful consumption of alcohol costs society £21 billion, with 10.8 million adults, in England, drinking at levels that pose some risk to their health.

61 In the three-year period from 2016-18, 38 men from York died from alcohol specific conditions (deaths caused wholly by alcohol consumption): a rate of 14.3 per 100,000 of population. This rate is lower than regional and national averages (17.0 and 14.7 per 100,000 population) and represents an improvement on the 2015-17 figures (43 deaths, a rate of 16.1 per 100,000). Alcohol specific mortality amongst females in York has halved, from 16 deaths during 2014-16 to eight deaths during 2016-18.

62 The Public Health team in York are continuing to deliver Alcohol IBA (Identification and Brief Advice) training to health professionals and frontline staff across the city. The training is aimed at staff who have regular contact with residents, to equip them with the skills to measure drinking levels and offer simple advice on how to reduce alcohol consumption. To date, 180 frontline staff and health professionals have received the training.

Mental health and Learning Disabilities.

63 It is crucial to the overall well-being of a population that mental health is taken as seriously as (more visible) physical health. Common mental health problems include depression, panic attacks, anxiety and stress. In more serious cases, this can lead to thoughts of suicide and self-harm, particularly amongst older men and younger women. Dementia, particularly amongst the elderly population, is another major mental health issue.

64 The 2019/20 Q2 data on improving access to psychological therapies (IAPT) in the Vale of York CCG area shows the following: referrals to IAPT (504 per 100,000) are lower than the England average (953 per 100,000). The percentage of the estimated population with anxiety and depression who enter IAPT (18%) is comparable with the England average (18.3%), and the percentage leaving treatment who have achieved reliable improvement (70.4%) is similar to the England average (71.8%).

Life Expectancy and Mortality

65 No new data on Life Expectancy or Mortality has been released since the previous report on 30^th July 2019.

Recommendations

66 As this report is for information only there are no specific recommendations.

Reason: To update the committee on the latest financial and performance position for 2019-20.

Contact Details

Authors:	Chief Officers Responsible for the report:
Richard Hartle Head of Finance: Adults, Children & Education Phone: 01904 554225 richard.hartle@york.gov.uk Patrick Looker Head of Finance: Place, Housing & Health Phone: 01904 551633 patrick.looker@york.gov.uk Terry Rudden Strategic Support Manager (Adults and Public Health) Phone: 01904 551655 terry.rudden@york.gov.uk Mike Wimmer Senior Business Intelligence Officer, Public Health Phone: 01904 554646 Michael.wimmer@york.gov.uk	Sharon Houlden Corporate Director of Health, Housing and Adult Social Care Michael Melvin Assistant Director, Adult Social Care Sharon Stoltz Director of Public Health
	Report Approved	X	Date	2 November 2020

Specialist Implications Officer(s) None
Wards Affected: List wards or tick box to indicate all					All	Y

For further information please contact the author of the report

Background Papers

2020/21 Finance and Performance Monitor 1 Report, Executive 1 October 2020