Ealing PCT
Profile
The Race for Health Programme focuses on Southall in the west of Ealing Borough. The population of Southall is 69,612, about 22% of Ealing Borough (pop 315,000). There are larger proportions of under 5’s and over 65’s than for Ealing as a whole. Deprivation affecting children and older people is worse than the Borough average.
More than 75% of Southall’s population is of minority ethnic origin. Most are of Asian ethnic origin, followed by Black ethnic groups. Southall has Ealing’s highest percentage of Asian residents. The proportion of Ealing school pupils from minority ethnic origin ranges from just under half to more than 99%.
Our BME population faces big issues…
Deprivation: Southall neighbourhood has an Index of Multiple Deprivation score of 31.47, the highest in Ealing.
Poor quality of housing: this has a major impact on health. In Southall, 27.6% of households are overcrowded, significantly higher than the average of 19% in Ealing as a whole.
Unemployment: there is comparatively high unemployment in an area of London with very good employment levels.
Over-all poor health: Southall has higher than average over-all mortality. The Standardised Mortality Ration is 126.8 compared to 101.6 for Ealing as a whole, against and England benchmark of 100.
Coronary Heart Disease: a particular concern. Circulatory disease (including coronary heart disease and strokes) accounts for around 35% of all deaths.
Diabetes: Southall has the highest prevalence of diabetes in Ealing. In Southall Broadway the estimated prevalence rate is 12.60% for males. The high prevalence is mainly due to higher risk amongst South Asian communities.
Tuberculosis: rates of new tuberculosis infections varied between 133 cases per 100,000, in Norwood Green, up to 180 in Dormers Wells. The average for Ealing was 76, and Southall’s overall rate of 156.6 was the highest of the Ealing neighbourhoods. The rate of tuberculosis notifications in Ealing is the third highest of the London Boroughs and about six times the rate for England.
Screening: In 2005/6 over 54.3% of eligible women received breast screening, and 74% received cervical screening. These rates were the lowest in Ealing.
Mental Health: Southall has four of the six Ealing wards with the highest admissions rates for depression and the ward with the highest psychosis admissions rates
Our workforce needs…
A representative workforce: the ethnic profile of the workforce broadly reflects that of the population as a whole. The PCT has made considerable efforts to ensure that the ethnic profile is reflected at all levels of the organisation, and continues to do so.
Development schemes: several Black and Minority Ethnic staff have attended the National Breaking Through Programme in past years. The PCT will promote the 2008 programme to staff. For two years the PCT ran a Local Breaking Through programme for more junior managers. The PCT ran a mentoring scheme and is committed to developing similar schemes in the future.
A safe and supporting working environment: the 2006 staff survey revealed higher levels of bullying and harassment experienced by staff in the PCT than one year ago. There are plans to address bullying and harassment through a series of workshops to allow staff to voice their views. The PCT aims to develop a set of values and principles in relation to bullying and harassment. Bullying and Harassment Advisors will be recruited from within the workforce to enable people to find the help they need. The PCT provides financial and administrative support to the BME Staff Network, which amongst other projects is making efforts to provide support for staff who experience bullying and harassment.
Commissioning raises issues…
Our overall target is for 70% of health care to be provided out of hospital, with hospital care focused on those who are most sick and in need of interventions beyond the scope of primary care. This means that there is increasing emphasis on prevention, efficient rehabilitation and integration of health and social care services.
Some key issues for race equality, health promotion and health services are:
- Making information accessible for all groups, for example, older people who do not speak English.
- Improving awareness of risk factors and the effect of lifestyle on health.
- Screening, early detection and prevention of cardiovascular disease.
- Screening for breast cancer.
- There are thought to be up to 5,000 in Ealing with undiagnosed diabetes, and many of these would be expected to live in Southall.
- The health infrastructure is not consistently adequate for modern primary care. Southall neighbourhood is served by twenty-two GP practices of which 11 are single handed. The average GP list sizes in Southall are greater than the average list size in Ealing. Eight of the GP premises are classified as being below minimum standards and are too small to provide a full range of primary care services.
- The PCT supports West London Mental Health Trust in working towards race equality through the Delivering Race Equality Programme.
We are proud of:
A new health centre in Southall Broadway: bringing many services to the heart of the community including:
- TB screening, diagnosis and treatment services
- Access to primary care for refugees, asylum seekers and other temporary residents
- Support for local GP practices providing chronic disease management e.g. phlebotomy services.
The Choosing Health Programme: supports a range of projects, for example, physical activity at the Dormers Wells Community Centre and the GP-led Southall Health Improvement Project (SHIP), through which volunteers work in faith settings to raise awareness about healthy lifestyles and health services. Many projects are based in voluntary organisations, for example, an Asian family support worker in MENCAP.
Mental health workers in primary care and mental health community development workers are in place to help people get the services they need at the right time. The PCT is one of 12 PCT’s receiving a small amount of additional funding to pilot faster access to psychological therapies.
Community Matrons and Case Managers are in post to ensure that patients get the best care in the community, in order to prevent avoidable admission to hospital.
Refugee health advocates work in GP practices helping patients understand the health service, how to look after their health, and how to access other help, especially with housing.
A Black and Minority Ethnic and Refugee Health and Social Care Forum brings together BMER groups across the Borough to discuss key health issues.
Next steps:
Develop better responses to the demand for urgent and out of hours care, working with Ealing Hospital.
Provide better support to people to manage long term conditions. The PCT’s results of the national diabetes survey showed that many patients are not adequately involved in their care or aware of issues affecting their health.
Support GPs to redesign care outside hospital, through Practice Based Commissioning.
Continue to integrate health and social care services, e.g. for children and people with learning disabilities.
Continue to make opportunities to improve the Health Estate, in a challenging planning environment with many competing demands for space.
Work closely with the Council on health improvement and race equality. For example, tobacco control and paan-chewing. Local Area Agreements will help motivate this integrated work.
Programme Lead
Stephen James, Head of Partnerships and Diversity