Agenda item

a)    Mental Health

b)    Adult Asthma and Chronic Obstructive Pulmonary Disease (COPD)

4.         Joint Strategic Needs Assessments

4.1       Catherine Mbema provided members of the Board with details of the recently completed Joint Strategic Needs Assessments (JSNAs) on Mental Health and Adult Asthma and COPD (Chronic Obstructive Pulmonary Disease). She also outlined proposals for a revised JSNA topic selection process for 2020/21.

4.2       The Mental Health JSNA aims to understand the mental health and wellbeing needs (including dementia) of adults in Lewisham, review how well these needs are met, identify any gaps and make recommendations for improvements in service provision. Some of the key findings include:

·         Lewisham has significantly higher rates of diagnosed depression than the London average (8.2% compared to 7.1%).

·         The rate of severe mental illness (SMI) in Lewisham is significantly higher than both the London and England averages (1.3% in Lewisham compared to 1.1% in London and 0.9% in England.

·         The prevalence of mental ill health is not spread evenly across the population, and there are some population groups that have higher rates of mental ill health in Lewisham, including; BAME communities, the unemployed and those who misuse drugs or alcohol.

·         The numbers of people with common mental health disorders and severe mental illness are in Lewisham are projected to increase in the coming years.

·         There is a strong link between mental health and physical health. Adults in Lewisham who are in contact with secondary mental health services are more than three times as likely to die as people of the same age in the general Lewisham population.

4.3       Some of the key findings of the Adult Asthma and COPD include:

·         The rate of premature mortality from respiratory disease in Lewisham is the second highest in London (behind Barking & Dagenham only), at 43.4 per 100,000. Rates are higher in men than women and correlate with increasing levels of deprivation.

·         In Lewisham, the prevalence of smoking among adults is 15.5%, which equates to 35,780 current smokers.  The burden of smoking-related ill health is particularly great in Lewisham as compared to the London and national averages.

·         Lewisham also has a high level of smoking-attributable mortality, which is statistically significantly higher than the national or London average at 310.7 per 100,000 it is the second highest rate in London.

·         According to the GP register, there are 4,308 people in Lewisham with a diagnosis of COPD, which equates to a prevalence of 1.3%.  This is lower than the national average. It is widely recognised that COPD is under diagnosed across the UK. A recent estimate by Public Health England suggests that there may be over 3000 patients with undiagnosed COPD living in Lewisham.

·         According to GP registers there are 17,121 adults with a diagnosis of asthma in Lewisham. This equates to a prevalence of 5.9% in the adult population which is the same as the England average.

4.4       It was proposed that the current process for the selection of JSNA Topic Assessments be revised this year, postponing the call for topic suggestions until September 2020 and undertaking a smaller number of topic assessments (1-2) between September 2020 and March 2021. The “Picture of Lewisham” element of the JSNA will also not be updated this year. The rationale for this is as follows:

·         There are a number of JSNA Topic Assessments still outstanding from 2018/19 and 2019/20. Postponing the agreement of topic assessments for 2020/21 will allow time for these assessments to be completed, approved and published.

·         It has been proposed that the Health and Wellbeing Board review and refresh the Health and Wellbeing Strategy in 2020/21. It is likely that a Macro Level JSNA will be required to inform this process. Postponing the identification of new JSNA Topic Assessments will provide the analytical capacity to undertake this Macro Level JSNA.

·         The trends in demographics and population health and wellbeing depicted in the “Picture of Lewisham” do not change significantly from year to year. It often takes at least 3 years of surveillance to identify a change in trend. Extending the period between updates to 2 years should not adversely affect the ability of stakeholders to use the information within the profile to inform their decision-making.

4.5       The following comments and additions were made as part of the discussion by members of the Board and those in attendance:

·         Increase in cases of less severe mental health may be an indication of de-stigmatisation and improved public information.

·         Focus on smoking (re Respiratory JSNA) and preventing the take-up in children. Extend smoke-free places e.g. playgrounds.

·         Skilled technicians at respiratory hubs to process more people – are these hubs working?

4.6       Actions:

The Board noted the contents of the report and agreed the sign-off of the Mental Health and Respiratory JSNAs as well as the JSNA topic selection process for 2020/21.