Three quarters of residents (75%) are satisfied with their local area as a place to live (2012). This is a drop from 2008, when 81% of residents were satisfied. Satisfaction varies by area: in the South East, only 65% were satisfied, compared to the North (82%) and the West (83%). (Northumberland Resident Perception Survey 2012 – link to http://www.northumberland.gov.uk/Default.aspx?page=15817).

A range of local services is needed to ensure resident satisfaction with the local area. In the Northumberland Resident Perception Survey 2012 (link to  http://www.northumberland.gov.uk/Default.aspx?page=15817), residents were presented with a list of 22 factors thought to impact on the quality of life of an area. From this they selected the following as being the most important in making somewhere a good place to live:

· Health services (42%);
· Education provision / schools (41%);
· Clean streets (39%);
· The level of anti-social behaviour (35%); and
· Affordable decent housing (35%). 

Certain key facts around those issues are mentioned later in this summary or in other sections of the JSNA. Considering only the short list of important factors above, it can be seen that at the very least, the organizations or departments providing the relevant services will include:

· Health services ( generally this will include both NHS and third sector organizations);
· Education departments and local schools;
· Street cleaning departments, refuse collection and highways authorities;
· Justice system and both the education system and various third sector organizations that help to prevent people turning to anti-social behaviour;

· Housing department, benefits advice agencies (ensuring people are claiming all the money to which they are entitled) and local employers (helping to provide employment to improve income levels).
There are many other examples where agencies or departments need to work together to ensure that other influences on quality of life are addressed. Examples include:

· Health and social services and third sector services need to be accessible to people in more remote areas.  Highways agencies and transport planners also play a part in providing good access to services.
With 97% of its land area classed as rural, the county is sparsely populated with 63 people per km². Over half of the county’s population live in the 3% of urban land found in the south east of the county  (Expansion - Map showing rural urban split (e.g. Northumberland Knowledge map showing rural and urban classification for small areas, wards (2013 ) Also, The Northumberland Knowledge site provides info on the definitions of urban/rural, etc. – might want to include a link to this))

· Water authorities and environmental departments deal with pollution (including air and water quality and noise and light pollution). Air traffic planners and road and rail planners also contribute.

Northumberland has very few complaints about noise. Only 1.8% of residents are exposed to road, rail and air transport noise of 65dB(A) or more during the daytime, compared to 5.2% in England. Only 2.6% are exposed to those noises at a level of 55dB(A) or more at night, compared to 8.0% in England (Source: Public Health Outcomes Framework (link))

Only 3.6% of mortality in Northumberland is attributable to particulate air pollution (compared to 5.1% in England (Source: Public Health Outcomes Framework (link))

Fewer than 8% of Northumberland’s population are in the worst 10% of England when it comes to living environment deprivation (which considers air quality, road traffic accidents and the quality of housing) (table and map from Northumberland Knowledge – fig 30 in report ‘Northumberland indices of deprivation’)
· Social housing managers, private housing department and local landlords or landlords’ associations ensure housing is of adequate standard, working with local builders. Housing assessments might be carried out by environmental health officers or occupational health teams. Fire services can advise or provide safety devices in the home.
83% of residents own their own homes, similar to the England average (expansion with bar chart showing
Local Authority (incl. owned by other LAs): 8,450 
Private Registered Provider: 17,350 
Other public sector: 140 
Private sector: 123,810 
Total: 149,750
And link to  https://www.gov.uk/government/statistical-data-sets/live-tables-on-dwelling-stock-including-vacants Tenure (2014)

Only 2% of Northumberland’s dwellings are overcrowded (with one bedroom fewer than would be recommended for the number of occupants), compared to 4.5% in England and Wales as a whole (2011) (Source: ONS LC4105EW Occupancy Rating (bedrooms) of -1 or less or LC4104EW Occupancy rating (rooms) of -1 or less)
41% of private housing is classed as ‘non-decent’ (expansion with definition: ‘Non decent’ is a term meaning that the dwelling does not meet the government’s 'decent homes' standards. A dwelling is defined as 'decent' if it meets the statutory minimum standard, provides a reasonable degree of thermal comfort, is in a reasonable state of repair and has reasonably modern facilities.), compared to the national average of 36%. In Northumberland this is primarily due to being difficult to keep warm because of solid wall construction (Hyperlink to A Housing Strategy for Northumberland 2013-18)
 
· Housing/homelessness departments and agencies (statutory and third sector) deal with refugees and asylum-seekers, to reduce levels of homelessness
 
For every 1,000 households, there are 1.3 homeless households (2013/14). This is lower than England’s rate of 2.3 households per 1,000. (Source: http://fingertips.phe.org.uk/profile/health-profiles/data#page/0
 
· Health and social services can identify people at risk of needing admission to residential homes and social services and housing departments can sometimes take measures to help people to stay in their own homes.
In 2013/14, Northumberland had 30 permanent admissions to residential and nursing care homes in people aged 18-64 (a rate of 16.1 per 100,000, similar to England’s. In those aged 65+, there were 345 such admissions, a rate of 500 per 100,000, better than England’s 651. (http://fingertips.phe.org.uk/profile/adultsocialcare/data#gid/1000105/pat/6/ati/102/page/1/par/E12000001/are/E06000057/iid/1164/age/183/sex/4) These are ASCOF 2a(1) and 2a(2) OR Possibly replicate charts from p17 of CCG Integration board measures report July 2015 – would need to include definitions and caveats
As on 31^st March 2014, there were 1210 Northumberland adults in permanent residential care supported by adult social services (474 per 100,000, worse than England’s 370) and 270 Northumberland adults in permanent nursing care supported by adult social services (106 per 100,000, better than England’s 133) (http://fingertips.phe.org.uk/profile/adultsocialcare/data#gid/1000105/pat/6/ati/102/page/1/par/E12000001/are/E06000057/iid/1164/age/183/sex/4) (ASC-CAR-S1)
 
· Justice system (front line police and the judiciary) help to reduce crime and can ensure appropriate treatment of young offenders
The number of recorded crimes in Northumberland has reduced over past years from 16,461 in 2008/09 to 10,352 in 2013/14. (expansion with Chart showing reduction over time. Using totals from Source: Community Wellbeing - A statistical profile of Northumberland (link))
Northumberland has a low rate of violent crime. In 2013/14, there were 4.8 violent offences per 1,000 population, compared to England’s rate of 11.1 (expansion with chart showing breakdown of crime types 09-14, as provided in Community Wellbeing - A statistical profile of Northumberland). The county also has a low rate of alcohol-related crime (expansion with chart showing northum vs England as provided in Community Wellbeing - A statistical profile of Northumberland).
Antisocial behaviour incidents in the county have reduced from 18,144 in 2011/12 to 16,316 from 2012/13 (Source: Community Wellbeing - A statistical profile of Northumberland (link))
99% of Northumberland residents say they feel very or fairly safe living in their neighbourhood (source: NK Community well-being (link))
Since 2010, Northumberland’s rate of first time entrants to the youth justice system has been lower than England’s. In 2013 there were 408 first time entrants per 100,000 in Northumberland (England had 441 per 100,000). (Expansion with chart showing trend over time since 2010 for Northumberland and England. Source: LAIT (link)). The rate of custodial sentences for young people was only 0.07 per 1000 receiving a conviction, much lower than England’s 0.68 per 1,000 (Source: LAIT (link))
Reoffending rates in young offenders have generally been lower than England’s over the last few years but in 2012 the proportion reoffending was 38.3%, whilst England’s rate was only 35.7%. (Graph showing England and Northumberland since 2006. Source: LAIT (link))
· The local community should be engaged in the development of services. Engagement and a sense of belonging contribute to greater satisfaction with the area. Public Health is working with a range of partners/colleagues, including Elected Members, the CCG, Northumbria Healthcare NHS Trust and the Voluntary and Community sector to advise the Northumberland Health and Wellbeing Board on participative/ engagement activities taking place with young people, including feedback from the young people of Northumberland.
 
· Statutory agencies and third sector agencies can work together to bid for funding for projects (e.g. Arts and Health funds from the Arts Council)



 

Our people
As with maintaining the quality of ‘our place’, a range of organizations is needed to improve the situation for ‘our people’. Again we provide a few examples:
· Health and social services and third sector organizations can ensure that issues surrounding our increasingly ageing population are properly addressed, including raising awareness of loneliness and providing support and/or accessible relevant activities.
Northumberland in 2014 has a higher than average proportion of people aged 65+ (23% compared to 17%). The proportion of people aged 85+ is forecast to grow from 3% in 2015 to 7% in 2035. 51% of Northumberland’s population is female.  


 

1. current and forecast proportions of population under 19, 20-64, 65- 84, 85+
2.  

Table 2: 2012-based Subnational Population Projections for Local Authorities in England (Excel sheet 6348Kb)
 
About 31% of pensioners in Northumberland live alone, a similar proportion to England. The proportion varies by ward link to ward ethnicity (as seen in Local Health ward reports)
 

 

Lifestyle factors

Well-being
Public Health is facilitating a collaborative commissioning approach to provide health promotion and protection through working with the LA Education services, Children’s Service and the CCG.

The public health team have been working with staff from partner agencies, and community members and champions, to deliver a World Café approach in the form of a ‘Being Well’ Café in Berwick. (Hyperlink to ‘Addressing Health Inequalities in Northumberland – An asset based public health approach’)

In South East Northumberland an Arts Council award enabled more people of all ages to get creative and work alongside artists of all kinds over a three year period from spring 2013 (the Bait project, run by a consortium). Recent analysis suggests that it increases well-being scores. (link to Link to Bait briefing and to Bait analysis June 2015)

The workplace health award programme supports businesses to improve the health of their employees. Public Health commissions the Better Health at Work Award, provided on behalf of the north-east local authorities by the TUC. This includes work within the council, which has a network of Health Advocates across the organization. (Hyperlink to HIMP Annual Report 2014-15)

Northumberland Specialist Health Improvement Service demonstrates an integrated approach to addressing the challenges in Northumberland, working in partnership with a wide range of organisations, including Local Government, Voluntary & Community Sector and Public & Private sector. The approach adopted by the service has always been to prioritise work based on local health needs though identified health inequalities and make the best use of limited resources to achieve the best possible outcomes.(Hyperlink to HIMP Annual Report 2014-15)

Ageing Well in Northumberland works collaboratively with older people to identify priorities in terms of activities and interests and make best use of existing community resources. Its partners include the council, the hospital trust, local community and voluntary organizations, housing associations and leisure services.

Third sector organizations operate across the county, coordinating a range of services and activities for older people. Parish councils, community centres, village halls and churches provide venues for activities for older people.

In the Stonewall Education Equality Index, (hyperlink) Northumberland scored particularly well for the involvement of an impressive range of partners (including public Health, Northumbria Police and Trinity Youth) in improving outcomes for lesbian, gay and bisexual children and young people. The resources recommended and used in schools to develop the Relationships and Sex Education curriculum are inclusive and comprehensive, and schools are supported well to develop an inclusive curriculum.

Health Champions are recruited from community volunteers and those working in the private and public sector, including: Royal Voluntary Service, Womens Health Advice Centre, Northumberland Fire and Rescue Service, Parish Council, Elderberries (Alnwick Garden Trust), Isos Housing and Bernicia.
To ensure that the welfare of both Travellers and the local community are protected, a Gypsy Roma Traveller Liaison Officer works closely with: landowners; local businesses and communities; the police; environmental health; the Gypsy Roma Traveller communities (link to council ‘traveller education’ web page)

Fire and rescue services, Citizen’s Advice and other voluntary sector organizations provide help and advice to Gypsies and Travellers. (link to council ‘traveller education’ web page)
 
 
Weight, physical activity and diet
Health and education sectors can monitor childhood obesity levels. Education and leisure departments and Children’s Centres can provide encouragement and opportunity for young people to participate in sport or other physical activity.

In 2013/14, 9.1% of Reception children were classed as obese (similar to England’s proportion) and 17.7% of year 6 children (aged 13-14) were classed as obese (significantly better than England’s 19.1%.) (Source: Fingertips NCMP local authority profile).

The Healthy Weights team has established close working relationships with a range of partners such as the Children's Centres, locality inclusion support teams, health and wellbeing in schools team and various youth initiatives across the county in order to raise the profile of children's healthy weight. (Hyperlink to HIMP Annual report 2014-15)

Leisure departments can ensure appropriate, accessible facilities are available (accessible by public transport, accessible to those with physical infirmities, accessible to those who work all day, culturally appropriate). Third sector organizations, particularly those for older people, can also provide opportunities and motivation.

In 2012, 25.7% of adults were classed as obese (not significantly different from England’s proportion) (Source:  PHE Northumberland Health Profile 2015 (link)). 12.98% of the CCG’s registered population  are on practice obesity registers (compared to England’s 9.42%)  but there is variation by GP practice, with proportions on obesity registers in 2013/14 ranging from 5.88% to 19.88% (chart showing % on practice obesity registers, Source: QOF. Also compile charts for localities)

In 2013, 52% of Northumberland’s adults achieved at least 150 minutes of physical activity per week, not significantly different from England’s proportion, (Source:  PHE Northumberland Health Profile 2015 (link)) and in 2014, 61.5% of Northumberland’s population met the recommended ‘5-a-day’ fruit and veg (higher than England’s proportion of 56.3% (Source: Public Health Outcomes Framework (link))
 
Sexual health
Health and education departments and third sector organizations have roles in providing advice, particularly to young people. Health sector and third sector organizations provide contraceptive services. Health sector provides screening services.

In 2013, Northumberland’s under 18 conception rate was 22.9 per 1000 girls (aged 15-17), compared to England’s 24.3 per 1000.  Although the rate has fallen over the past few years, it has not fallen as quickly as England’s rate (expansion poss chart from source: LAIT (as at jul 2015))

Across Northumberland the rate of new sexually transmitted infections (excluding chlamydia) was 484 per 100,000, better than England’s 829 per 100,000 (source: PHE sexual and reproductive health profile (link)). Northumberland’s chlamydia diagnosis rate in 2014 was 1981 per 100,000 aged 15-24, compared to England’s 2012 per 100,000 (source: LAIT (link))

Northumberland’s rate of repeat abortions in women under 25 was 22.9 in 2013, similar to England’s rate. (source: PHE sexual and reproductive health profile (link)).In young women under 18 49.2% of conceptions led to an abortion, a similar  rate to England. (source: PHE sexual and reproductive health profile (link)).
The prevalence of HIV in Northumberland is lower than in England (0.45 per 1000 people aged 15-59, compared to England’s 2.14 per 1000. http://fingertips.phe.org.uk/profile/sexualhealth/data#gid/8000035/pat/6/ati/102/page/1/par/E12000001/are/E06000057 (link))

In 2014, Northumberland’s coverage of HIV testing measured in GUM was only 48.9%, compared to England’s 68.9% (source: PHE sexual and reproductive health profile (link)). Northumberland’s uptake of Chlamydia screening in 15-24 year olds was better than England’s in 2014. Over 9,000 people were screened, a rate of 28%, compared to England’s 24% http://fingertips.phe.org.uk/profile/sexualhealth/data#page/0 (link) In 2013-14, 92% of Northumberland’s females aged 12-13 were vaccinated against HPV (human papilloma virus), higher than England’s proportion of 87% (source: LAIT (link))
 
Substance misuse

Primary health care, schools and third sector services can educate about the dangers of alcohol, particularly to young people, and provide advice, counselling and, if necessary, treatment. Ambulance services and police monitor events involving alcohol.

An estimated 23.4% of Northumberland residents aged 16+ are increasing drinkers and higher risk drinkers (England 22.3%) (Source: Know Northumberland jan 2015 population and health (link)).Estimates also suggest that 29.8% of Northumberland’s adults are binge drinkers (expand to definition ‘adults who consume at least twice the daily recommended amount of alcohol in a single drinking session (that is, eight or more units for men and six or more units for women)’, significantly higher than England’s proportion (source LAPE Northumberland profile). If ward and CCG locality data available for same time period then add There is also variation by ward and CCG locality link to binge drinking adults indicators (as seen in Local Health ward and CCG locality reports)

In 2013/14 there were over 4300 alcohol-related hospital admissions (Source: LAPE). Northumberland’s rates of alcohol-related and smoking-attributable admissions are both worse than England’s. (expand to chart showing nthum and Eng rates:  a rate of 1297 per 100,000 population, worse than England’s 1253 per 100,000 (Source: LAPE (link))

In 2013, 159 people in Northumberland died from alcohol-related conditions.  This is a rate of 47.8 per 100,000, similar to England’s (source: LAPE (link)

Good education through schools is taking place through the Drug Education consultant delivering sessions upon request from schools with a main focus on the effects of alcohol. Schools are linking their drug education to other areas of the curriculum, particularly Sex and Relationships Education (SRE) (Hyperlink to h&wb strategy promoting healthy lifestyles)
 
Primary and secondary health care, schools and third sector services can educate about the dangers of smoking and of drug misuse, particularly to young people, and provide support to stop smoking or taking drugs.

90% of schools are now accredited with achieving the Healthy Schools standard which includes preventive education around substance misuse issues. (Hyperlink to h&wb strategy promoting healthy lifestyles)

In 2013, 19.7% of Northumberland’s residents aged over 18 smoked (similar to England’s rate) (Source: Local Tobacco Control Profile (link)) An estimated 4% of children aged 11-15, 11% of 15-year olds and 18% of 16-17 year olds were regular smokers in 2009-12, similar to England’s rates. (Source: Local Tobacco Control Profile (link)) There is also variation by ward and CCG locality link to modelled prevalence of young people who smoke indicators (as seen in Local Health ward and CCG localityreports) Northumberland has higher than average rates of mothers were smokers at the time of delivery, (16% in 2013/14, higher than England’s 12%)  (Source: Local Tobacco Control Profile (link))

Northumberland’s rate of smokers who successfully quit at 4 weeks is 3917 per 100,000 smokers, better than England’s rate of 3524 (Source: Local Tobacco Control Profile (link))
In 2012/13, there were over 4500 smoking-attributable hospital admissions, costing £8.7million. This is a rate of 2184 per 100,000 population, worse than England’s 1688 per 100,000. (expand to chart showing nthum and Eng rates Source:  Local Tobacco Control Profile (link))

In 2011-13, 1910 people in Northumberland died from smoking-related conditions.  This is a rate of 312 per 100,000, worse than England’s 289 per 100,000 (link to Local Tobacco Control Profile).

The estimated rate of users of opiate and/or crack cocaine aged 15-64 was 6.5 per 1,000 population in 2011/12, significantly better than England’s 8.4 per 1,000 (Source: PHE Northumberland Health Profile 2015 (link)) In 2013, 6.8% of opiate drug users successfully completed treatment, compared, similar to England’s rate. Among non-opiate users, only 19.3% successfully completed treatment, worse than England’s rate of 37.7% (Source: Public Health Outcomes Framework (link))
 
Primary and secondary health care can work with specific organizations to educate about the dangers of smoking and of drug or alcohol misuse, and provide support to stop substance misuse.
Specific sessions were delivered on drugs and alcohol to the RAF staff who have cultural practices relating to alcohol consumption. (Hyperlink to h&wb strategy promoting healthy lifestyles)
 
Training was delivered to Macmillan Bereavement support services who note that clients often use alcohol and /or substance misuse as a coping strategy. (Hyperlink to h&wb strategy promoting healthy lifestyles)
A Public Health Nurse delivered a Young Persons Stop Smoking Service and Information Drop-In at Northumberland College (Hyperlink to HIMP Annual Report 2014-15)

The Stop Smoking Service has worked to support colleagues in secondary care (including acute mental health establishments), prisons and MoD facilities. (Hyperlink to HIMP Annual Report 2014-15)
NCC coordinates a broad range of activities to tackle the burden of tobacco on our communities. Public Health leads Smoke Free Northumberland, a multi-disciplinary alliance comprising representatives from public protection, trading standards and environmental health, wellbeing and health in schools, children’s centres and Northumbria Healthcare NHS Trust. The alliance coordinates a cross-agency action plan. Public Health also commissions the NHS Stop Smoking Service which supports a ‘whole system’ of stop smoking support delivered by itself, pharmacies and GP practices.
 
 
Life expectancy and mortality
All public sector and third sector agencies can influence life expectancy and mortality rates. Some of the actions will be preventive actions as outlined earlier (e.g. providing advice and support over lifestyle issues; immunizations and vaccinations; screening; ensuring access to services; ensuring adequate housing conditions)
 
Life expectancy at birth is 78.8 for males and 82.5 for females (2010-12). This is significantly lower than England’s life expectancy (males 79.2 and females 83.0). However, it varies across the district, being 9.6 years lower for men and 7.2 years lower for women in the most deprived areas of Northumberland than in the least deprived (link to charts p2 of PHE Northumberland Health profile 2015. Is part of PHOF 0.1i ).If ward data available for same time period then link to ward life expectancy indicators (as seen in Local Health ward reports)
 
In 2011-13, Northumberland’s mortality rate from all causes was 1019 per 100,000 people, higher than England’s rate of 978 per 100,000. (possibly chart showing where Northumberland fits compared to other Las, and also link to https://indicators.ic.nhs.uk/webview/velocity?v=2&mode=documentation&submode=ddi&study=http%3A%2F%2Fhg-l-app-472.ic.green.net%3A80%2Fobj%2FfStudy%2FP00339)
Northumberland’s mortality rates for the major causes of death among people under the age of 75 (sometimes called premature mortality) are generally lower than England’s. This is the case for cardiovascular disease (689 deaths in 2011-13), cancer (1,412 deaths in 2011-13), liver disease (178 deaths in 2011-13) and respiratory disease (319 deaths in 2011-13). However, for all persons (675 deaths in 2011-13) and for women, Northumberland’s under 75 mortality rate from communicable diseases is higher than England’s  

Click here to view premature mortality summary
Click here to view Public Health Outcomes Framework - Healthcare and Premature Mortality
Click here to view ward level data