Agenda item

Avoidable Deaths and Preventable Mortality - An Introduction

The Consultant in Public Health will provide a general overview/introduction of the topic, including:

·        information on the role of Public Health South Tees in preventing ill-health, specifically:

o   reducing inequalities through the prevention and early detection of disease and supporting the management of long-term conditions; and

·        key data and information on Middlesbrough’s rates of preventable and avoidable mortality and how these compare regionally and nationally.


The Consultant in Public Health was in attendance to provide a general overview/introduction of the topic of Avoidable Deaths and Preventable Mortality, including:


·        information on the role of Public Health South Tees in preventing ill-health, specifically:

o   reducing inequalities through the prevention and early detection of disease and supporting the management of long-term conditions; and

·        key data and information on Middlesbrough’s rates of preventable and avoidable mortality and how those compared regionally and nationally.


The information below was outlined to the scrutiny panel:


·        Life expectancy at birth, for the area of South Tees, was significantly lower than the England average. Members heard that life expectancy for Middlesbrough males was 75.4, which was 4 years below the England value of 79.4 and 9.3 years below the highest local authority area in England. It was commented that gap between South Tees and the England average was continuing to widen.

·        In terms of male life expectancy at birth, there was significant inequalities across the wards in South Tees. Members heard that there was a 14.9 year gap between the lowest life expectancy ward of Central (located in Middlesbrough) at 69.4 years to the highest life expectancy ward of Hutton (located in Redcar & Cleveland) at 84.3 years.

·        In Middlesbrough in 2022 the smoking prevalence rate was 16.5%, which was higher than the England rate of 12.7%. In England, there had been a steady decline in smoking prevalence in the adult population, with a reduction from 19.8% in 2011 to 12.7% in 2022. It was explained that in Middlesbrough, although the rates did tend to fluctuate at times, they had reduced.

·        Middlesbrough’s rates of alcohol-related mortality, alcohol-specific mortality and admission to hospital for both alcohol-specific conditions and alcohol-related conditions were significantly higher than the England average. It was also highlighted that, in Middlesbrough, the number of premises licensed to sell alcohol per square kilometre was also significantly higher than the national average.

·        All local authorities located in the North East region, apart from Northumberland, had a higher rate of those classified as overweight or obese compared to the England average. Middlesbrough's rate was 70.7%, which was similar to the North East rate.

·        In terms of premature mortality during 2019-2021, for all ages, Cancer was the most common cause of death, accounting for 25.6% in Middlesbrough, followed by Dementia and Alzheimer disease and then heart disease. For those under 75, Cancer was yet again the most common cause of death and was even higher at 32%, followed by heart disease and respiratory diseases. Locally, there were higher rates of chronic lower respiratory diseases, accidents and accidental poisoning, when compared to the England average.

·        In terms of cancer screening uptake, there was a clear correlation between the most deprived GP practices and low cancer screening uptake rates with regards to breast, bowel and cervical screening.

·        In terms of causes of death, the scrutiny panel was shown a table that identified all those conditions that were considered treatable/preventable.


A mission of the Joint Strategic Needs Assessment (JSNA) was to support people and communities to build better health, for example by recommissioning high-quality joined-up diagnostic/screening services (i.e., NHS Health checks, cancer screening) to meet the needs of service users; improve access, experiences and outcomes; and reduce inequalities. The need to reduce the prevalence of the leading risk factors for ill-health and premature mortality was also highlighted. The Live Well South Tees Board was scheduled to receive an update on the key recommendations, across the 21 goals, at its meeting in January 2024. 


It was advised that an Ill Health Prevention Partnership had recently been established to provide a link between the Live Well South Tees Board and partner organisations. The partnership focussed on the delivery of ill health prevention and considered primary prevention (preventing diseases before they developed), secondary prevention (early detection of people at risk) and tertiary prevention (managing established disease). The aim of the partnership was to act jointly and put plans in place to address some of the main ill health prevention challenges experienced locally and improve population health. For example, the partnership aimed to increase uptake of screening programmes to ensure early presentation, diagnosis, and timely access to treatment. In addition, there was a priority to work in partnership with primary care to improve uptake of prevention services (NHS Health Checks, SMI Smoking pilot, Type 2 Diabetes LCD, Digital Weight Management), ensuring the use of population health intelligence to identify need and variation across practices.


Making Every Contact Count (MECC) was an approach to behaviour change that used the day-to-day interactions that health and social care staff had with people to support them in making positive changes to their physical and mental health and wellbeing. MECC focused on the lifestyle issues that could make the greatest improvement to someone’s health. For children, the approach used Beano characters to encourage them to be healthy and active. It was advised that MECC had been rolled-out across the whole South Tees health and social care system.


Public Health provided an in-house Stop Smoking Service, which involved the delivery of a 12-week programme of behaviour change support and a full range of Nicotine Replacement Therapy (incl. free vapes - swap to stop). The service offered flexible appointments at a range of venues, including home visits for house bound/care home residents. From January 2023 to December 2023, the service had received 2021 referrals, with majority of those accessing the service being working-age adults. It was highlighted that 63% of Middlesbrough residents had successfully quit, which was higher than the England average of 54%. The most deprived wards across South Tees had the highest rates of people accessing the service. Public Health South Tees had also been involved in a pilot for a Stop Smoking Service for those suffering from severe mental illness, to enable the delivery of enhanced support and improve public health outcomes for that cohort.


In terms of cancer prevention, data was collected to identify and determine the demographic profile of those not accessing cancer screening services, meaning that messages could be targeted specifically for those people.


Targeted NHS Health Checks were undertaken, which was a mandated function of Public Health and there was a requirement to submit data on a quarterly basis to the Secretary of State. The NHS Health Checks had been designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and Dementia. It was commented that there was a shared commissioning approach across South Tees, with GPs undertaking the health checks and the North of England Commissioning Support Unit (NECS) providing data management support. The contract for those services had been extended for a further year to enable a full review of uptake rates to be undertaken and to explore ways of engaging the hardest-to-reach groups, increasing uptake rates and the provision of health checks in a range of community settings. It was explained that a tier payment system for GPs had been introduced recently to encourage reduction in health inequalities (deciles 1-3 paid more than deciles 4-7 and 8-10). Members heard that local areas were required to invite 20% of the eligible population each year. In 2022/23, 18.3% of Middlesbrough’s population had been invited, which was similar to the England average of 18.4%. In terms of demographics, more women than men were being assessed, as were more white British than other ethnicities.


Although findings from NHS Health Checks had concluded that a number of residents were suffering from particular health problems or conditions, the number of residents accessing support and interventions to manage those conditions was low.  For instance, at the point of referral, out of 1314 people with BMI over 25, and 96 with a BMI over 40, only 20 people accepted a referral to local services. Members heard that referrals could be made to the Specialist Physical Activity (SPA) Team, which supported people with health conditions, people recovering from illness and older adults to become more active by providing a range of activities.


The scrutiny panel heard that a collaborative bid had been submitted by the Local Authority, North East and North Cumbria Integrated Care Board (ICB), South Tees NHS Foundation Trust, Middlesbrough Environment City and a number of GP leads. As a result of the submission, £558k for over two years had been successfully secured, to deliver a heating on prescription pilot. The pilot aimed to target the GP practices in the most socioeconomically deprived areas. 14 of the 15 practices selected were located in Middlesbrough and the target cohort would be those patients with Chronic Obstructive Pulmonary Disease (COPD). It was estimated that there were approximately 1,322 GP patients with COPD and work had been undertaken to proactively contact those patients to offer support. Contact was being made via GP letter/text/email and then a follow-up call from the practice to support engagement and increase uptake. Members heard that those patients would then be contacted by Middlesbrough Environment City to undertake assessment of the heating infrastructure, access to required equipment and vouchers to contribute towards heating the home during winter. It was explained that patients could access up to £300 of funding to help pay their energy bills. The expected outcomes of the pilot included reduced COPD exacerbations, reduced pressure on NHS services (GP appointments/hospital admissions) and improved quality of life.


A Member raised a query regarding the low uptake of breast screening and whether residents being required to access services at North Tees and Hartlepool NHS Foundation Trust had impacted on rates. In response, the Director of Public Health advised that the ICB would be best placed to answer the query. It was explained, however, that access rates were reflective of Middlesbrough’s social profile and there was a clear correlation between the most deprived GP practices and low cancer screening uptake rates. It was highlighted that there was a need to examine and investigate the reasons for the low uptake. The Consultant in Public Health commented that the ICB would be approached to provide further insight on the issue.


A Member sought clarification regarding accidental poisoning. In response, the Director of Public Health advised that the deaths associated with accidental poisoning would primarily be caused by drug-related overdoses.


A Member raised a query regarding overweight and obesity rates. The Consultant in Public Health advised that for Middlesbrough, there was currently a gap in provision as there was no Tier 2 weight management services or programmes to refer into. The Director of Public Health advised that being overweight in childhood was strongly associated with a higher risk of obesity in later life. The Mayor commented that obesity reduced life expectancy.


A Member expressed concern regarding the high number of premises licensed to sell alcohol. In response, the Mayor advised that a report on the Council’s Licensing Policy was due to be considered by the Executive in February 2024. It was advised that, through adoption of that policy, it was envisaged that the approval of future alcohol licenses for businesses in Middlesbrough could be limited. A Member commented that preventing an increase the volume of licensed premises in the area would be extremely beneficial. In addition, a Member also commented that there was a need to restrict planning approvals for hot food take aways.


A Member raised a query regarding barriers encountered when attempting to access services. In response, the Director of Public Health advised that eligibility for screening and checks was targeted at those cohorts most at risk. It was commented that work was being undertaken to improve uptake and address barriers to access.


A Member commented that, in the past, smoking cessation clinics were delivered in Middlesbrough’s communities, which had been valuable. The Mayor explained that additional funding had recently been secured and that would enable the delivery of improved/enhanced stop smoking services.


A Member raised a query regarding the granting of alcohol licences. In response, the Mayor explained that the purpose of the cumulative impact assessment (CIA) planned to help the Local Authority to limit the licences that it granted in areas where there was evidence to show that the number or density of licensed premises may be contributing to the town’s problems. It was commented that Central, Newport, Longlands and Beechwood were three priority areas in that respect. It was anticipated that the CIA would provide an evidence-base for informed decision-making when determining future applications.


A discussion ensued and Members expressed concern in respect of young people using vapes and the health risks associated with use. The Mayor commented that work had been undertaken with Middlesbrough College, to target young people and support students to stop smoking.


A Member raised a query regarding life-expectancy and the reasons for significant inequalities across the wards in Middlesbrough. The Director of Public Health linked the widening gap between the life-expectancy of those from deprived areas and the life-expectancy of those from more affluent areas to Government policies that had been in place since 2010.


A discussion ensued regarding Middlesbrough’s life-limiting factors and the Mayor highlighted the importance of residents being able to access mental health services. The Director of Public Health commented that mental health issues were one of the main causes of long-term sickness absence. Concerns were expressed regarding Middlesbrough’s high rates of suicides and drug-related deaths. The Mayor commented that Middlesbrough would benefit from a community-based offer of mental health support. The Director of Public Health commented that although NHS England was ultimately responsible for the commissioning of mental health services, Public Health was able to influence those commissioning decisions.




That the information presented at the meeting be considered in the context of the scrutiny panel's investigation.

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