Winning Hearts and Minds A whole system approach

Winning Hearts and Minds A whole system approach to improving heart and mental health outcomes, and associated health inequalities, in Manchester. EDS 2 CVD

1. 1 Services are commissioned , procured, designed and delivered to meet the health needs of local communities 1. 5 Screening, vaccination and other health promotion services reach and benefit all local communities

Our ambition: Early deaths from heart disease will drop to 50 per 100, 000 by 2027 e r o m ! s o e N us c x e

Part of a wider programme

CVD (Prevalence and Risk) what we know. . . • As with most long term conditions, the prevalence of CVD increases with age and so is higher in older people compared with younger people. It is also higher in men compared with women and in people from a South Asian or African Caribbean ethnic group (Source: PHE Health matters: preventing cardiovascular disease) • Risk of Coronary Heart Disease (CHD) and associated hospital admissions is higher among Pakistani, Bangladeshi and Indian groups. Increased risk of hypertension and stroke among Black populations but reduced risk of CHD overall. • High cholesterol (one of the most significant clinical risk factors for CVD) is characterised by the build-up of fatty deposits in arteries, so the prevalence tends to increase with age (Source: PHE Health matters: preventing cardiovascular disease) • People with Sever Mental Illness (SMI) are 2 – 4 times likely to die of cancer, circulatory and respiratory disease

CVD (Behavioural Risk Factors) -what we know. . . • In the UK, the prevalence of smoking is higher among men compared with women. The prevalence is highest among adults aged 25 to 34 years (Source: ONS Adult smoking habits in the UK 2018 report) • Around 25% of people who describe themselves as either gay or lesbian are smokers, compared to 18% of individuals who describe themselves as heterosexual (Source: ONS Integrated Household Survey 2005) • Among men, the highest rates of physical inactivity are in the Pakistani and Bangladeshi communities. Women from the Bangladeshi and Pakistani communities have the lowest levels of physical activity. (Source: Health Survey for England 2004) • Obesity rates in men are highest among members of the White and Black Caribbean ethnic groups and lowest in Bangladeshi and Pakistani ethnic groups. Female rates are higher than male rates in all groups and are highest in Black African and Pakistani women. (Source: Public Health England based on data from the 2006 -2010 Health Surveys for England) • Smoking prevalence of people with Severe Mental Illness is 3 times more than the prevalence in the general population

People with high blood pressure – diagnosed versus predicted (model) Moss Side, Hulme and Rusholme City wide % of predicted = 60. 4% Cheetham and Crumpsall Higher Blackley Ancoats, Clayton and Bradford Gorton and Levenshulme Miles Platting, Newton Heath, Moston, City Centre Wythenshawe (Baguley) Chorlton, Whalley Range and Fallowfield Ardwick and Longsight 65% Didsbury, Burnage & Chorlton Fallowfield (old Moat) and Withington Wythenshawe (Brooklands)

People with undiagnosed high blood pressure by age group % Contribution To Overall Gap 30% Gap Between Predicted Prevalence and QOF Prevalence By Age Group Contribution 26% 25% 21% 19% 20% 15% 10% 9% 8% 5% 0% 1% 16 -24 25 -34 35 -44 45 -54 Age Bands 55 -64 65 -74 75+

Percentage of people from Black , Asian and Minority Ethnic groups by neighbourhood

Tools we use to help us understand our population needs at a street level

Manchester City Council Performance Research and Intelligence

This diagram helps to identify ways in which patients and the public can engage and participate in the different stages of the commissioning cycle.

What we have Commissioned…. . Community Led Initiatives The community-led initiatives workstream ensures that co-production principles are at the forefront of the whole WHM programme design and delivery – across all other workstreams - creating the right environment and approach to work in new ways to tackle long-term and entrenched population health issues at a local level. Relationships will be built with current groups and community development work where they already exist, and new groups will be facilitated where there are gaps. Further community development work will continue as evidence from HELP shows that a time-limited intervention of up to two years set in motion an organisational and local cultural change. Community development work of this nature is also self-renewing, by setting in motion a long-term self-governing multi-issue partnership.

1. 1 Services are commissioned , procured, designed and delivered to meet the health needs of local communities 1. 5 Screening, vaccination and other health promotion services reach and benefit all local communities

Sex Age Disability Pregnancy/ Maternity

Pregnancy/Maternity Religion Ethnicity

Age 40 -60 y Sex Disability

Outcome of commissioning Primary Care SMI Health Check Screening Percentage of SMI Patietns achieviing SMI Physical Health Checks 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Manchester Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 National • To date 30% of the eligible population has received Health Check screening • Of the eligible population, 29% Bisexual, 29% heterosexual, 31% homosexual, 29% status unknown had the SMI Health Check screening. • 11. 5% of the eligible population have a know disability • 0. 2% of the eligible population have a known gender reassignment

NHS Health Check Screening • • • NHS Health Checks are commissioned and delivered by General Practice and through targeted community model Risk increases for those of us who are overweight, smoke, have increased cholesterol, higher, raised blood sugar levels, so addressing lifestyle choices can lower that risk. However, some of us are also predisposed to raised risk because of our family history or our ethnicity, eg people of South Asian or African ethnicity are more likely to develop CVD conditions. Statistics also show that social determinants also affect health and people who live in areas of deprivation are also at higher risk. Targeted venues that ensure easy and convenient access to communities or groups where increased risk is likely have been used for the community model. These include; § Golden Centre of Opportunity, Whalley Range § Indian Senior Citizens Centre; § Moss Side Leisure Centre and Library § Khizra Mosque, Cheetham Hill § Mustard Tree § Didsbury Mosque Age Ethnicity Religion Disability

Percentage of eligible patietns achieving in last 5 years Outcome of commissioning NHS Health Check Screening NHS Health Checks 25% 20% 15% 10% 5% 0% Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 • There has been a 10% increase in health checks since commissioning this though primary care standards in July 2018 • 23 % of the eligible population have received the NHS health check over the past 5 years • 25% of the bisexual, 29% of heterosexual, 23% of the homosexual population have received the health checks in the past 5 years • 46% of the eligible carer population have received the NHS health checks • 29% of black African, black Caribbean & black British, 30% of Chinese, 29% of white or white British have received the NHS health check • 32% of people with learning disability have received NHS health check

Manchester Hypertension Challenge Community Pharmacy Find and Treat Service Community Hypertension Champions Aim: to opportunistically screen patients for Blood Pressure, Atrial Fibrillation and provide brief life style advice Aim: To raise awareness of hypertension, risks of hypertension and approaches to prevention. To enable more targeted hypertension testing in communities of interest Age Ethnicity Sex