Health

4.1 Key Facts

• Female life expectancy in Barnet is 85.5 years, the 6th highest of all the London boroughs and significantly better than both London (84.3 years) and England (83.1 years), for 2015-17. For Barnet males, life expectancy is 82.2 years, which also the 6th highest of all the London boroughs and significantly better than both London (80.5 years) and England (79.6 years).
• Smoking, poor diet, alcohol, physical activity and high blood pressure are the most common causes of major illnesses leading to premature mortality.
• The mortality rate from all cardiovascular disease for Barnet in 2014-16, was 61.3 per 100,000 which is significantly lower than the averages for both the England (73.5 per 100,000) and London (74.9 per 100,000). In terms of premature (under 75) mortality from all cardiovascular diseases, Barnet has the 6th lowest rate of all the 32 London boroughs.
• In 2016, there were 5,301 live births (2,726 males and 2,575 females) in Barnet (only 1.3% to mothers aged less than 20 years and 35.7% to mothers aged 30-34 years). The highest birth rate in Barnet was in women aged 30-34 years (116.5 per 1,000 women) in Barnet, compared to 107.3 per 1,000 for London and 112.4 per 1,000 in England, for the same age group.
• During 2016, the percentage of live births (at term) under 2.5 kg in Barnet (3.05%), is similar to both England (2.79%) and London (3.01%).  Data for 2011-2015, show that in Barnet wards, the percentage of live births which were low birth weight (< 2,500 g) was highest in Totteridge (4.2%) followed by Brunswick Park (3.5%) and Finchley Church End (3.5%). The wards with the lowest proportion of underweight births were Garden Suburb (2.2%), followed by Mill Hill (2.3%) and Oakleigh (2.4%).

4.2 Strategic Needs

• Mortality is considerably higher in the most deprived areas of the borough, compared to the least deprived. The life expectancy of people living in the most deprived areas of the borough are on average 7.6 years less for men and 7.9 years less for women than those in the least deprived areas, based on a comparison of the 10% most deprived and 10% least deprived areas in the borough.
• For 2016/17, the recorded prevalence of coronary heart disease (CHD) for all ages in Barnet (2.5%) is significantly higher than the London average (2.0%). Compared with the other London boroughs, Barnet is ranked 7th highest on prevalence of CHD.
• The recorded prevalence of stroke or transient ischaemic attacks (TIAs) in the Barnet GP registered population for 2016/17 is 1.3%, significantly higher than the London average (1.1%). This prevalence ranks Barnet 6th highest of the London boroughs. The rate of hospital admissions for stroke (all ages) in Barnet (177.8 per 100,000) for 2016/17 is significantly higher than the national (England) rate (169.2 per 100,000).
• Only 31.3% of eligible people in Barnet received an NHS health check between Q1 2013/14 and Q4 2017/18. This proportion was the third lowest of all the London boroughs and significantly lower than the England average (44.3%).
• Between 2015 and 2017, the cancer screening coverage in Barnet was significantly worse than the national (England) average for bowel, cervical and breast cancers.
• In 2016/17, the recorded prevalence (all ages) of mental health problems (including schizophrenia, bipolar affective disorder and other psychoses) for Barnet is 1.01%, which is significantly higher than the rate for England (0.92%).
• Between 2013-14 and 2016-17, the percentage of adult patients accessing dental care in Barnet was lower than both London and England.
• For at risk individuals only 46.2% in Barnet received a flu vaccination during 2016/17, which was significantly lower than the averages for London (47.1%) and England (48.6%).

4.3 Causes of Death

In Barnet, the top three broad causes of mortality in both men and women are circulatory diseases, cancers and respiratory diseases.[1] Circulatory diseases led to 2,321 deaths (males 1,036, females 1285), cancers caused 1,851 deaths (males 962, females 889) and respiratory diseases resulted in 947 deaths (males 438, females 509), during 2012-2014. In the same period, dementia and Alzheimer’s disease was associated with 715 deaths, with over twice as many deaths in females as in males.[2] The percentages of deaths by gender, broken down by broad causes, are shown in Figures 4.1 and 4.2.

Figure 4.1: Causes of death in females in Barnet

Source: Public Health England (PHE, 2016), Segment Tool.

Figure 4.2: Causes of death in males in Barnet

Source: Public Health England (PHE, 2016). Segment Tool.

Female life expectancy in Barnet is 85.5 years, the 6th highest of all the London boroughs and significantly better than both London (84.3 years) and England (83.1 years), for 2015-17.[3] For Barnet males, life expectancy is 82.2 years, which also the 6th highest of all the London boroughs and significantly better than both London (80.5 years) and England (79.6 years).[4]

Inequalities do however exist in the borough in life expectancy, based on gender, location and deprivation. Women in Barnet have a significantly higher life expectancy than men and the life expectancy of people living in the most deprived areas of the borough are on average 7.6 years less for men[5] and 7.9 years less for women,[6] than those in the least deprived areas, based on a comparison of the 10% most deprived and 10% least deprived areas in the borough.

At ward level, there is also disparity between wards in terms of life expectancy. Based on data for 2011-2015, the highest female life expectancy was found in Garden Suburb ward (89.5 years) and the lowest in Burnt Oak (81.4 years), a significant difference of 8.1 years.[7] As can be seen from Figure 4.3, the wards with higher female life expectancy are predominantly clustered in the central and southern areas of the borough.

Figure 4.3: Barnet average female life expectancy at birth, by ward, 2009–2013

Sources: Office for National Statistics (Health state life expectancy at birth and age 65 by 2011 Census wards, England and Wales, 2009 to 2013); Ordnance Survey (borough and ward geographical data).

Figure 4.4 shows the life expectancy for males in Barnet by ward. As with female life expectancy, the wards with higher life expectancy for males are generally clustered in the central and southern regions of the borough. Based on data for 2011-15, Finchley Church End has the highest male life expectancy (85.9 years) and Burnt Oak the lowest (78.3 years), a significant difference of 7.6 years.[8]

Figure 4.4: Barnet average male life expectancy at birth, by ward, 2009–2013

Sources: Office for National Statistics (Health state life expectancy at birth and age 65 by 2011 Census wards, England and Wales, 2009 to 2013); Ordnance Survey (borough and ward geographical data).

For males, circulatory disease is the greatest contributor to the gap in life expectancy between the most and least deprived quartiles in Barnet (Figure 4.5), whilst for females it is cancer, based on data for 2010-12. The second biggest contributor for males is cancer and the third, respiratory disease. In contrast, for females, the second and third biggest contributors to the gap in life expectancy are circulatory disease and mental & behavioural causes (e.g. dementia and Alzheimer’s disease) respectively.[9]

The three main causes of excess deaths in Barnet’s most deprived areas are coronary heart disease, lung and “other cancers” (i.e. not lung cancer) in males and Alzheimer’s disease / dementia, “other circulatory disease” (i.e. not stroke or coronary heart disease) and “other cancers” in females.[10]

Figure 4.5: The life expectancy gap between the most and least deprived quintiles in Barnet, broken down by broad cause of death and gender

Source:  Public Health England (PHE, 2016). Segment Tool for Barnet.

[1] Public Health England (PHE, 2016). Segment Tool. Table 2 (p.7). Available at: https://fingertips.phe.org.uk/profile/segment/area-search-results/E12000007?search_type=list-child-areas&place_name=London

[2] Public Health England (PHE, 2016). Segment Tool. Available at: https://fingertips.phe.org.uk/profile/segment/area-search-results/E12000007?search_type=list-child-areas&place_name=London

[3] Public Health England (PHE, 2018). Public Health Profiles. Life expectancy at birth (Female), 2015 – 17. Available at: https://fingertips.phe.org.uk/profile/health-profiles/data#page/3/gid/1938132696/pat/6/par/E12000007/ati/102/are/E09000003/iid/90366/age/1/sex/2

[4] Public Health England (PHE, 2018). Public Health Profiles. Life expectancy at birth (Male), 2015 – 17. Available at: https://fingertips.phe.org.uk/profile/health-profiles/data#page/3/gid/1938132696/pat/6/par/E12000007/ati/102/are/E09000003/iid/90366/age/1/sex/1

[5] Public Health England (PHE, 2018). Public Health Profiles. Life expectancy at birth (Male), Inequalities. 2015-17. Available at: https://fingertips.phe.org.uk/profile/health-profiles/data#page/7/gid/1938132696/pat/6/par/E12000007/ati/102/are/E09000003/iid/90366/age/1/sex/1

[6] Public Health England (PHE, 2018). Public Health Profiles. Life expectancy at birth (Female), Inequalities, 2015-17. Available at: https://fingertips.phe.org.uk/profile/health-profiles/data#page/7/gid/1938132696/pat/6/par/E12000007/ati/102/are/E09000003/iid/90366/age/1/sex/2

[7] Public Health England (2017). Local Health Profiles. Available at:http://www.localhealth.org.uk/#z=491412,213479,63196,42495;v=map13;i=t4.le_nm_f;l=en

[8] Public Health England (2017). Local Health Profiles. Available at:http://www.localhealth.org.uk/#z=491412,213479,63196,42495;v=map13;i=t4.le_nm_f;l=en

[9] Public Health England (PHE, 2016). Segment Tool for Barnet (Chart 5, p. 9). Available at:https://fingertips.phe.org.uk/profile/segment/area-search-results/E12000007?search_type=list-child-areas&place_name=London

[10] Public Health England (PHE, 2016). Segment Tool for Barnet (Table 5, p. 13). Available at:https://fingertips.phe.org.uk/profile/segment/area-search-results/E12000007?search_type=list-child-areas&place_name=London

4.4 Causes of Ill Health

During 2014-16, there were a total of 2,019 premature (under 75 years) deaths in Barnet giving a mortality rate of 250 per 100,000, which ranked Barnet 29th out of 324 local authorities in England.[11]

Table 4.1 below shows the premature mortality rates associated with a number of leading causes of death and provides ranking compared to the other local authorities in England. As can be seen from the table, Barnet has rates of premature mortality due to cancer (all), lung cancer (all ages), heart disease, heart disease and stroke, lung disease, liver disease and injuries, which are significantly lower than the national average (designed “green” in the “Premature mortality outcomes” column of Table 4.1). For breast cancer, colorectal cancer and stroke, Barnet has premature mortality rates that are better than average and within expected limits (shown as yellow).

Many of the conditions leading to premature mortality within the borough are strongly linked to lifestyle factors (such as smoking, poor diet, physical inactivity and alcohol consumption), so there is still scope for improvement. The major diseases linked to premature mortality in Barnet are covered in more detail in the following sections.

Table 4.1: Common causes of major illness, major diseases leading to premature mortality, premature mortality rates by cause and premature mortality ranks and outcomes in Barnet

Source: Public Health England (PHE, 2018). Healthier Lives: Premature mortality.

[11] Public Health England (PHE, 2018). Healthier Lives – Mortality Rankings. Barnet: All local authorities. Available at: https://healthierlives.phe.org.uk/topic/mortality/area-details#are/E09000003/par/E92000001/ati/101/pat/101

4.5 Cardiovascular Disease

Cardiovascular disease (CVD) is a general term for diseases of the heart and blood vessels as well as vascular diseases of the brain. It includes coronary heart disease (CHD), heart attack, hypertension, stroke and congenital heart disease. Worldwide, CVD is the largest cause of death and remains one of the major causes of preventable mortality. CVD is the number one killer disease globally and one of the major causes of preventable mortality.[12] In 2016, there were approximately 152,500 deaths due to CVD in the UK, of which 51.4% were male and 48.6% female. As a proportion of all deaths in that year, CVD accounted for 26.7% of deaths in men and 24.4% in women. There were 42,300 premature deaths in the UK due to CVD in 2016, which was 27.8% of all deaths due to CVD that year. As a proportion of all premature deaths that year, CVD accounted for 24.7% in men and 17% in women.[13]

During 2014-2016, the premature (under 75) mortality rate in Barnet due to preventable CVD was 38.8 per 100,000.[14] The premature mortality rate from all cardiovascular disease for Barnet in 2014-16, was 61.3 per 100,000 (see Figure 4.6), which is significantly lower than the averages for both the England (73.5 per 100,000) and London (74.9 per 100,000). In terms of premature (under 75) mortality from all cardiovascular diseases, Barnet has the 6th lowest rate of all the 32 London boroughs (not including City of London).[15]

Figure 4.6: Under 75 mortality rates from all cardiovascular diseases: directly standardised rates (per 100,000) for London local authorities, 2014-16

Source: Public Health England (2018). Public Health Outcomes Framework: Indicator 4.04i (based on ONS source data).

[12] World Health Organisation (WHO, 2011). Global Atlas on cardiovascular disease prevention and control (pages VI, 3). Available at: http://www.who.int/cardiovascular_diseases/publications/atlas_cvd/en/

[13] British Heart Foundation (2018). Cardiovascular Disease Statistics 2018. Available at:https://www.bhf.org.uk/what-we-do/our-research/heart-statistics/heart-statistics-publications/cardiovascular-disease-statistics-2018

[14] Public Health England (PHE, 2018). Public Health Outcome Framework. 4.04ii - Under 75 mortality rate from cardiovascular diseases considered preventable, 2014 – 16. Available at:https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000044/pat/6/par/E12000007/ati/101/are/E09000003/iid/40402/age/163/sex/4

[15] Public Health England (PHE, 2018). Public Health Outcome Framework. 4.04i - Under 75 mortality rate from all cardiovascular diseases 2014 – 16. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000044/pat/6/par/E12000007/ati/101/are/E09000003/iid/40401/age/163/sex/4

4.5.1 Coronary Heart Disease

For 2016/17, the recorded prevalence of coronary heart disease (CHD) in Barnet (2.5%) is significantly lower than England (3.2%), but significantly higher than the London average (2.0%). Compared with the other London boroughs, Barnet is ranked 7th highest on prevalence of CHD. During that year, 9,941 people in Barnet had coronary heart disease (CHD) recorded on their GP patient register, although there has been a downward trend in recent years in the recorded prevalence of CHD in the borough.[16]

The rate of hospital admissions for CHD (for all ages) in Barnet for 2016/17 was 425.0 per 100,000 which was the 5th lowest of the 32 London boroughs and significantly lower than the England average (515.8 per 100,000). During the 10-year period between 2006/7 and 2016/17, the rate of hospital admissions for CHD (all ages) in Barnet fell significantly from 760.3 per 100,000 to 425.0 per 100,000.[17]

[16] Public Health England (PHE, 2018). Public Health Profiles. CHD: QOF prevalence (all ages). Available at:https://fingertips.phe.org.uk/search/coronary%20heart%20disease#page/3/gid/1/pat/6/par/E12000007/ati/101/are/E09000003/iid/273/age/1/sex/4

[17] Public Health England (PHE, 2018). Cardiovascular Disease Profile. CHD admissions (all ages) 2016/17. Available at:https://fingertips.phe.org.uk/profile/cardiovascular/data#page/3/gid/1938133108/pat/46/par/E39000018/ati/152/are/E38000005/iid/90988/age/1/sex/4

4.5.2 Stroke

In 2016/17, the recorded prevalence of stroke or transient ischaemic attacks (TIAs) in the Barnet GP registered population was 1.3%, significantly lower than England (1.7%), but significantly higher than the London average (1.1%). This prevalence ranks Barnet 6th highest of the London boroughs. Based on this Quality Outcomes Framework (QoF) data, there are 5,164 people of all ages diagnosed as either having a stroke or TIA.[18]

The rate of stroke mortality in the under 75-year population was 11.3 per 100,000 in 2014-16, which was the 7th lowest of all the London boroughs and similar to the England average (13.4 / 100,000).[19]

In Barnet, the standardised mortality ratio (SMR) for deaths from stroke (all ages) for 2011-15, by ward was the highest in Child’s Hill (116.5) followed by Burnt Oak (110.9), Coppetts (105.4), Woodhouse (103.4) and Underhill (102.1). All other wards in Barnet had an SMR for stroke of less than 100, with the lowest rate found in Totteridge ward (48.9), where the SMR is statistically significantly lower than Child’s Hill, Burnt Oak, Coppetts, Woodhouse or Underhill. [20]

For 2016/17, the rate of hospital admissions for stroke (all ages) in Barnet (177.8 per 100,000 people) was significantly higher than the national rate (169.2 per 100,000 people). Over the decade between 2006/7 and 2016/17, there was no statistically significant change in the hospital admissions rate due to stroke in Barnet.[21]

Between 2011/12 and 2015/16, the standardized admission ratios (SAR) for emergency hospital admissions for stroke (all ages, persons) in Barnet were highest in the wards Burnt Oak (161.3), Colindale (129.6) and Totteridge (123.3), while the lowest were in Garden Suburb (77.7), East Barnet (84.1) and Finchley Church End (89.1).[22]

Figure 4.7 shows the standardized admissions ratios (SARs) for emergency hospital admissions for coronary heart disease (CHD), stroke, myocardial infarction (MI), chronic obstructive pulmonary disease (COPD) and all causes, in Barnet, compared to the England for 2011/12 – 2015/16. For Barnet, the SARs for CHD, MI, COPD and all causes were lower than England (100), with only stroke (105.4) showing a higher SAR.[23]

Figure 4.7: Emergency hospital admissions (SAR) for all causes, coronary heart disease (CHD), stroke, myocardial infarction (MI) and chronic obstructive pulmonary disease (COPD) for Barnet, 2011/12 - 2015/16

Source: Public Health England (2017). Local Health Profiles. Disease and Poor Health. 

[18] Public Health England (PHE, 2018). Public Health Profiles. Stroke: QOF prevalence (all ages). Available at:https://fingertips.phe.org.uk/search/stroke#page/3/gid/1/pat/46/par/E39000018/ati/152/are/E38000005/iid/212/age/1/sex/4

[19] Public Health England (PHE, 2018). Public Health Profiles. Stroke mortality rates, under 75 years (age standardised) 2014 – 16. Available at:https://fingertips.phe.org.uk/search/stroke#page/3/gid/1/pat/46/par/E39000018/ati/152/are/E38000005/iid/91061/age/163/sex/4

[20] Public Health England (2017). Local Health Profiles. Available at:http://www.localhealth.org.uk/#sid=24;i=t4.allages_stroke;sly=wd16_DR;z=513617,197550,18079,12173;v=map13;l=en

[21] Public Health England (PHE, 2018). Public Health Profiles. Stroke all age admission trends, 2016/17. Available at:https://fingertips.phe.org.uk/search/stroke#page/3/gid/1/pat/46/par/E39000018/ati/152/are/E38000005/iid/90986/age/1/sex/4

[22] Public Health England (2017). Local Health Profiles, Available at:http://www.localhealth.org.uk/#sly=wd16_DR;sid=33;i=t3.em_adm_stroke;z=514315,204880,26088,17566;v=map13;l=en

[23] Public Health England (2017). Local Health Profiles. Disease and Poor Health.  Available at:http://www.localhealth.org.uk/#z=504953,204641,37252,25083;v=map14;sid=4;l=en;sly=ccg17_DR

4.5.3 CVD Prevention

There is considerable variation in the recorded prevalence of CHD (all ages) in the GP registered population of Barnet ranging from 1.2% to 4.2%, with a CCG average of 2.5%, for 2016/17. Although the Barnet prevalence of CHD is lower than the England average (3.2%), the significant differences between GP practices warrants further investigation.[24]

Similarly, for 2016/17, there is also considerable variation in the recorded prevalence of stroke or TIA (all ages) in the GP registered population of Barnet ranging from 0.5% to 1.9%, with a CCG average of 1.3%. Although the Barnet prevalence of stroke or TIA is lower than the England average (1.7%), there are significant differences between the GP practices in terms of stroke prevalence.[25]

Within the borough, a range of initiatives have been implemented to reduce the effects of behavioural risk factors associated with CVD, such as physical inactivity, obesity, tobacco use and alcohol abuse.  The NHS Health Check Program[26] is one such initiative, aimed at spotting the early signs of heart disease, stroke, type 2 diabetes, kidney disease and dementia, through medical testing of people aged 40-74 years old.

Between Q1 2013/14 and Q4 2017/18, a total of 100,633 people in Barnet aged between 40 and 74 years were eligible for an NHS Health Check. Of these eligible people, 72,859 people (72.4%) were offered a health check, but only 31.3% (n = 31,491) received an NHS health check during this period. This proportion was the third lowest of all the London boroughs and significantly lower than the England average (44.3%). [27] [28]

[24] Public Health England (2018). National General Practice Profiles. CHD: QOF prevalence (all ages), 2016/17. Available at: https://fingertips.phe.org.uk/profile/general-practice/data#page/3/gid/3000008/pat/152/par/E38000005/ati/7/are/E83044/iid/273/age/1/sex/4

[25] Public Health England (2018). National General Practice Profiles. CHD: QOF prevalence (all ages), 2016/17. Available at: https://fingertips.phe.org.uk/profile/general-practice/data#page/3/gid/3000007/pat/152/par/E38000005/ati/7/are/E83044/iid/212/age/1/sex/4

[26] NHS Health Check (2018). Available at: https://www.healthcheck.nhs.uk/

[27] Public Health England (2018). NHS Health Check. People invited for an NHS Health Check 2013/14 Q1 - 2017/18 Q4. Available at: https://fingertips.phe.org.uk/profile/nhs-health-check-detailed/data#page/3/gid/1938132726/pat/6/par/E12000007/ati/102/are/E09000003/iid/91111/age/219/sex/4

[28] Public Health England (2018). NHS Health Check. People receiving an NHS Health Check 2013/14 Q1 - 2017/18 Q4. Available at: https://fingertips.phe.org.uk/profile/nhs-health-check-detailed/data#page/3/gid/1938132726/pat/6/par/E12000007/ati/102/are/E09000003/iid/91112/age/219/sex/4

4.6 Cancers

The three most common cancers in Barnet are breast, prostate and colorectal, as in both London and England. At the end of 2015, there were 10,102 cancer cases in Barnet, of which 56.5% were female and 43.5% male, with over half (54%) aged over 60 years. The overall prevalence rate for all cancers (all ages) is 2,661 per 100,000 in Barnet, which is lower than the national (England) average (3,270 per 100,000). Similarly, the prevalence in Barnet of breast cancer (734 per 100,000), prostate cancer (460 per 100,000) and colorectal cancer (272 per 100,000) is lower than the national average for breast (1,714 per 100,000), prostate (1,205 per 100,000) and colorectal (395 per 100,000) cancers. However, whilst the London average prevalence rates for breast (1,285 per 100,000) and prostate (888 per 100,000) cancers are higher than Barnet, London has a lower prevalence of colorectal cancer (253 per 100,000) and a lower overall cancer prevalence rate (2,416 per 100,000).[29]

[29] National Cancer Registration and Analysis Service (2018). The Macmillan-NCRAS Work Plan: The UK Cancer Prevalence Project. UK Cancer Prevalence Project Releases. Available at:http://www.ncin.org.uk/about_ncin/segmentation

4.6.1 Cancer Incidence

In 2016, the standardized incidence rate for all cancers in Barnet CCG (538.76 per 100,000) was significantly lower than the average for England (601.49 per 100,000). The incidence rates of prostate (148.09), colorectal (55.88), and lung (59.41) cancer were also lower to the national (England) average rates for these cancers (174.16, 68.84 and 77.66 per 100,000 respectively). The incidence rates (per 100,000) for Barnet CCG of breast (183.64), ovarian (26.78), stomach (10.76) and cervical (6.04) cancer are similar the national rates for these cancers (i.e. 167.43, 23.65, 10.89 and 9.42 per 100,000, respectively).[30]

Data for 2011-15 shows that for new cases of cancer, the standardised incidence ratio (SIR) varies by the type of cancer across Barnet wards. Breast cancer incidence was the highest in Finchley Church End (124.9) and the lowest in Colindale (74.1). Totteridge ward had the highest incidence of colorectal cancer (97.6) and Hendon (61.3) the lowest incidence (SIR). Lung cancer incidence was lowest in Garden Suburb (52.6) and highest in Colindale (100.8). The incidence of prostate cancer was highest in Brunswick Park (111.5) and lowest in Finchley Church End (68.5). Overall, Underhill had the highest incidence ratio of all cancers (97.5), and Garden Suburb had the lowest incidence of all cancers (78.6) during 2011-2015. [31]

[30] Public Health England (2018). National Cancer Registration & Analysis Service (NCRAS). CancerData. Incidence > Standardised Rates. Available at:https://www.cancerdata.nhs.uk/incidence/age_standardised_rates

[31] Public Health England (2017). Local Health Profiles. Available at:http://www.localhealth.org.uk/#sly=wd16_DR;sid=17;i=t3.inc_prostate_cancer;z=442813,250657,169091,109120;v=map13;l=en

4.6.2 Cancer Mortality

In 2016, Barnet had the lowest percentage of deaths due to cancer (25.4%) of any of the London boroughs. A lower proportion of people died from cancer in Barnet than both London (28.7%) and England (28.0%).[32]

Similarly, in 2014-16, Barnet had the lowest premature (under 75 years) mortality from cancer (103.3 per 100,000) of all the London local authorities (excluding City of London) and was significantly lower than both London (126.8 per 100,000) and England (136.8 per 100,000).[33]

[32] Public Health England (2018). Public Health Profiles. Cancer deaths (%), Persons, All Ages.2016. Available at:https://fingertips.phe.org.uk/search/cancer#page/3/gid/1/pat/46/par/E39000018/ati/152/are/E38000005/iid/91568/age/1/sex/4

[33] Public Health England (2018). Public Health Outcomes Framework. 4.05i - Under 75 mortality rate from cancer, 2014 – 16. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000044/pat/6/par/E12000007/ati/101/are/E09000003/iid/40501/age/163/sex/4

4.6.3 Cancer Survival

For Barnet adults (aged 15-99 years) diagnosed with cancer in 2015, the one-year survival index for all types of cancer combined (76.4%) is higher than the England average (72.3%). However, one-year survival for breast cancer in Barnet (96.1%) is similar to the England average (96.7%). For colorectal cancer patients in Barnet CCG, have a one-year survival of 85.2%, which is higher than the national average (80.4%). Similarly, one-year survival for Barnet patients diagnosed with lung cancer in 2015, is 44.3%, which is higher than the England average of 40.7%.[34]

[34] Office for National Statistics (ONS, 2017). Statistical bulletin: Index of cancer survival for Clinical Commissioning Groups in England: adults diagnosed 2000 to 2015 and followed up to 2016. Available at:https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/bulletins/indexofcancersurvivalforclinicalcommissioninggroupsinengland/adultsdiagnosed2000to2015andfollowedupto2016

4.6.4 Cancer Screening

Between 2015 and 2017, the cancer screening coverage in Barnet was significantly worse than the national average for bowel, cervical and breast cancers (see Appendix to the JSNA).[35]

Figure 4.8: Breast cancer screening coverage (%) in Barnet, London and England, 2011–2017

Source: Public Health England, Public Health Outcomes Framework.

Figure 4.8 shows the proportion of women resident in Barnet who were eligible for breast cancer screening and who were adequately screened within the previous three years.  The proportion of women screened in Barnet has remained significantly lower than England from 2010 to 2017. Looking at the Barnet trend in breast cancer screening over time, the proportion of eligible women screened has increased significantly between 2010 and 2017 from 64.6% to 68.9%.

[35] Public Health England (2018). Public Health Outcomes Framework. Trends in Health Improvement. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/4/gid/1000042/pat/6/par/E12000007/ati/101/are/E09000003/iid/22001/age/225/sex/2

4.6.5 Cancer Registration

The “Be Clear on Cancer” programme[36] is a series of campaigns led by Public Health England, but delivered in partnership with NHS England, Cancer Research UK and the Department of Health to increase public awareness of the early signs of cancers and promote early diagnosis. Barnet CCG joined Be Clear on Cancer in July 2013, to promote the early detection of cancers in the borough.

To encourage the early detection of cancers, the NHS Barnet CCG joined the campaign in July 2013. During 2014-16, Barnet had the 2nd lowest registration rate for lung cancer (58.5 per 100,000) of any of the London boroughs, which was significantly lower than both London (75.7 per 100,000) or England (78.6 per 100,000).[37]

Barnet also had the 2nd lowest registration rate for oral cancer (11.9 per 100,000) with the London boroughs during 2014-16, which was significantly lower than both London (14.7 per 100,000) or England (14.7 per 100,000).[38]

[36] Cancer Research UK (2018). Be Clear on Cancer. Available at: https://www.cancerresearchuk.org/health-professional/awareness-and-prevention/be-clear-on-cancer

[37] Public Health England (PHE, 2018). Public Health Profiles. Lung cancer registrations, 2014 – 16. Available at:https://fingertips.phe.org.uk/search/REGISTRATION#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/1205/age/1/sex/4

[38] Public Health England (PHE, 2018). Public Health Profiles. Oral cancer registrations, 2014 – 16. Available at:https://fingertips.phe.org.uk/search/REGISTRATION#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/1206/age/1/sex/4

4.7 Respiratory disease

4.7.1 Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is the name given to a group of lung conditions that lead to breathing difficulties, including chronic bronchitis (inflammation of the airways) and emphysema (damage to the air sacs in the lungs).[39] 

[39] NHS Choices (2016). Chronic Obstructive Pulmonary Disease (COPD). Available at:https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/

4.7.1.1 COPD Prevalence

In 2016/17, there are 4,379 people on GP registers for COPD in Barnet. The COPD prevalence rate for NHS Barnet CCG is 1.07% in 2016/17, which is lower than both London (1.15%) and England (1.87%). Compared with the other London CCGs, Barnet is ranked 20th out of 32, in terms of COPD prevalence, although there is considerable variation in the COPD prevalence among the GP practices in the borough, ranging from 0.26% to 2.79%.[40] 

[40] NHS Digital (2017). Quality and Outcomes Framework (QOF) - 2016-17. Available at:https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/quality-and-outcomes-framework-qof-2016-17

4.7.1.2 COPD Hospital Admissions

During 2016/17, the rate of emergency hospital admissions for COPD in Barnet (240 per 100,000) is the second lowest of the London boroughs and significantly lower than both London (399 per 100,000) and England (417 per 100,000).[41]

The standardised admissions ratio (SAR) of emergency hospital admissions for COPD (all ages) varies considerably across the wards in Barnet (see Figure 4.9) with the highest ratio in Burnt Oak ward (132.8) and the lowest ratio in Garden suburb ward (31.2).[42]

Figure 4.9: Emergency hospital admissions rates for COPD by wards in Barnet, 2011/12 – 2015/16

Source: Public Health England (2017). Local Health: Emergency admissions for COPD.

[41] Public Health England (PHE, 2018). Public Health Profiles. Emergency hospital admissions for COPD, 2016/17. Available at:https://fingertips.phe.org.uk/search/COPD#page/3/gid/1/pat/6/par/E12000007/ati/101/are/E09000003/iid/92302/age/202/sex/4

[42] Public Health England (PHE, 2017). Local Health Profiles. Available at:http://www.localhealth.org.uk/#z=484080,217554,72570,48799;v=map13;i=t3.em_adm_copd;l=en

4.7.2 Asthma

The recorded prevalence of asthma (all ages) in Barnet (4.36%) is the 6th lowest of all the London boroughs in 2016/17 and lower than both London (4.62%) and England (5.94%). There are 17,871 people on GP asthma registers in Barnet, although there is considerable variation in the prevalence between the GP practices, ranging from 2.59% to 6.54%.[43]

[43] NHS Digital (2017). Quality and Outcomes Framework (QOF) - 2016-17. Available at:https://digital.nhs.uk/data-and-information/publications/statistical/quality-and-outcomes-framework-achievement-prevalence-and-exceptions-data/quality-and-outcomes-framework-qof-2016-17

4.7.3 Risk Factors

Smoking and influenza virus infection of the respiratory system are two important risk factors for COPD and asthma.

In 2016/17, the recorded prevalence of smoking in Barnet (14.8%) is the 4th lowest of any London borough and significantly lower than either London (17.3%) or England (17.6%).[44]

The percentage of COPD patients in Barnet CCG who had an influenza immunisation was 79.3% in 2016/17, which was similar to England (79.2%) but significantly higher than the London average (76.9%). The proportion of COPD patients receiving an influenza immunisation was the same as in 2015/16, but significantly lower than the figure in 2014/15, when 82.5% of COPD patients received the influenza vaccination.[45]

[44] Public Health England (2018). Public Health Profiles. Smoking prevalence in adults - current smokers (QOF),2016/17. Available at:https://fingertips.phe.org.uk/search/smoking#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/91547/age/188/sex/4

[45] Public Health England (2018). National General Practice Profiles. Influenza immunisation given 1 Aug - 31 Mar (COPD). Available at: https://fingertips.phe.org.uk/profile/general-practice/data#page/3/gid/2000006/pat/46/par/E39000018/ati/152/are/E38000005/iid/90609/age/1/sex/4

4.8 Mental Health

Mental illness represents a major challenge on a global scale, with an estimated 300 million people suffering from depression, 60 million from bipolar affective disorder, 50 million from dementia and 23 million from schizophrenia. To date, health systems internationally have not responded adequately to the burden created by mental disorders, creating a wide gap between the need for treatment and the provision of services.[46]

Against this background, the London Borough of Barnet have made the improvement of mental health and wellbeing a key priority within their Joint Health and Wellbeing Strategy.[47]  In 2016/17, Barnet CCG spent £62.5m on mental health, with a planned spend of £64.8m for 2017/18, representing 13.8% of their total allocation.[48]

[46] World Health Organization (WHO, 2018). Mental disorders factsheet. Available at:http://www.who.int/en/news-room/fact-sheets/detail/mental-disorders

[47] London Borough of Barnet (2015). Keeping Well, Promoting Independence: A Joint Health and Wellbeing Strategy, 2015 – 2020 (p.16). Available at: https://www.barnet.gov.uk/citizen-home/public-health/Key-strategic-documents-and-plans/Joint-Health-and-Wellbeing-Strategy-2015-2020.html

[48] NHS England (2018). Mental Health Five Year Forward View Dashboard. Mental Health Five Year Forward View Dashboard Q1 and Q2 2017/18. Available at: https://www.england.nhs.uk/publication/mental-health-five-year-forward-view-dashboard/

4.8.1 Adult Mental Health

In 2016/17, the recorded prevalence (all ages) of mental health problems (including schizophrenia, bipolar affective disorder and other psychoses) for Barnet is 1.01%, which is significantly higher than the rate for England (0.92%), but significantly lower than the London average (1.10%).[49]

Over 20,000 adults (aged 18+) in Barnet are recorded in the depression registers within the borough’s GP surgeries, during 2016/17. The prevalence of adult depression in the borough is 6.4%, significantly lower than the average for both London (6.6%) and England (9.1%).[50]

There were 3,225 new cases of adult depression recorded in GP registers in Barnet during 2016/17, showing the incidence rate of 1.0% for Barnet, which is significantly lower than the national (England) average of 1.5%.[51]

The rate of detentions under the National Mental Health Act in Barnet during 2017/18 (Q3) is 47.3 per 100,000, which is similar to the national average (42.9 per 100,000), but lower than in London overall (60.0 per 100,000).[52]

For 2016/17, the rate of emergency admissions for intentional self-harm in Barnet (98.7 per 100,000) is significantly lower than the England average (185.3 per 100,000), but significantly higher than the rate for London (98.7 per 100,000). Compared to the other London boroughs, Barnet is ranked 8th highest in terms of emergency admissions for self harm.[53]

In contrast, the rate of hospital admissions for unintentional and deliberate injuries in children aged 0-14 years for Barnet during 2016/17 is 61.7 per 10,000, which is the 6th lowest of the London boroughs and significantly lower than both London (78.1 per 10,000) and England (101.5 per 10,000).[54]However, during 2014-16, the suicide rate (for people aged 10+) in Barnet (9.7 per 100,000), is similar to both the London (8.7 per 100,000) and England (9.9 per 100,000) averages.[55]

Additional detail on suicide rates in Barnet is provided by Figure 4.10, which depicts the quality and outcomes of the mental health services provided by Barnet and compares them to England. Compared to national figures, Barnet is low in terms of stable and appropriate accommodation for people (both males and females) in contact with mental health services, satisfaction with social care protection and employment of people with mental illness or learning disability.[56]

Figure 4.10: Quality and outcomes of mental health services in Barnet compared to England

Source: Public Health England (PHE, 2018). Mental Health and Wellbeing JSNA. Quality & Outcomes. Key: Red square: Significant concerns over data quality; Yellow square: Some concerns; Green: Robust.

[49] Public Health England (PHE, 2018). Severe Mental Illness. Severe mental illness recorded prevalence (QOF): % of practice register (all ages), 2016/17. Available at: https://fingertips.phe.org.uk/profile-group/mental-health/profile/severe-mental-illness/data#page/3/gid/8000030/pat/46/par/E39000018/ati/152/are/E38000005/iid/90581/age/1/sex/4

[50] Public Health England (PHE, 2018). Common Mental Health Disorders. Depression recorded prevalence (QOF): % of practice register aged 18+. Available at: https://fingertips.phe.org.uk/profile-group/mental-health/profile/common-mental-disorders/data#page/3/gid/8000026/pat/46/par/E39000018/ati/152/are/E38000005/iid/848/age/168/sex/4

[51] Public Health England (PHE, 2018). Common Mental Health Disorders. Depression recorded incidence (QOF): % of practice register aged 18+. Available at: https://fingertips.phe.org.uk/profile-group/mental-health/profile/common-mental-disorders/data#page/3/gid/8000026/pat/46/par/E39000018/ati/152/are/E38000005/iid/90646/age/168/sex/4

[52] Public Health England (PHE, 2018). Public Health Profiles. People subject to Mental Health Act: rate per 100,000 population aged 18+ (end of quarter snapshot),2017/18 Q3. Available at:https://fingertips.phe.org.uk/search/Mental%20Health%20Act#page/3/gid/1/pat/46/par/E39000018/ati/152/are/E38000005/iid/90413/age/168/sex/4

[53] Public Health England (2018). Public Health Profiles. 2.10ii - Emergency Hospital Admissions for Intentional Self-Harm, 2016/17. Available at:https://fingertips.phe.org.uk/search/A%20and%20E#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/21001/age/1/sex/4

[54] Public Health England (2018). Public Health Profiles. 2.07i - Hospital admissions caused by unintentional and deliberate injuries in children (aged 0-14 years), 2016/17. Available at:https://fingertips.phe.org.uk/search/unintentional#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/90284/age/26/sex/4

[55] Public Health England (2018). Public Health Profiles.4.10 - Suicide rate (Persons), 2014 – 16. Available at:https://fingertips.phe.org.uk/search/suicide#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/41001/age/285/sex/4

[56] Public Health England (PHE, 2018). Mental Health and Wellbeing JSNA. Quality & Outcomes. Available at: https://fingertips.phe.org.uk/profile-group/mental-health/profile/mh-jsna/data#page/1/gid/1938132924/pat/6/par/E12000007/ati/102/are/E09000003

4.8.2 Children's and Young People's Mental Health and Wellbeing

As shown in Figure 4.11, the estimated prevalence in Barnet of any mental disorder (8.3%), emotional disorder (3.2%), conduct disorder (5%) and hyperkinetic disorders (1.4%) for children aged 5-16 years are all lower than the national averages (9.2%, 3.6%, 5.6% and 1.5% respectively).[57]

Figure 4.11: Children and Young People, Mental health indicators for Barnet compared to England

Source: Public Health England (PHE, 2018). Children's and Young People's Mental Health and Wellbeing Profiling Tool. Identification of need. Key: Red square: Significant concerns over data quality; Yellow square: Some concerns; Green: Robust.

[57] Public Health England (2018). Children and Young People's Mental Health and Wellbeing Profiling Tool. Identification of need. Available at: https://fingertips.phe.org.uk/profile-group/mental-health/profile/cypmh/data#page/0

4.8.3 Prevention of Mental Illness

Child and adolescent mental health services (CAMHS) support children in their behavioural and emotional wellbeing.[58] The system is organized around four tiers, with Clinical Commissioning Groups (CCGs) responsible for tier 2 and 3 services and NHS England responsible for tier 4 services.

• The primary remit of tier 1 (universal) services is to support children and young people with mental health problems, rather than providing a mental health service per se.
• Targeted (tier 2) services are for children with milder mental health problems or increased risk of mental health problems.
• Tier 3 (specialist services) are provided by multi-disciplinary teams of child and adolescent mental health professionals accessed through GP referral.
• Specialised CAMHS (tier 4) include day and inpatient services as well as highly specialised outpatient services for specific conditions.[59]

The London Borough of Barnet (LBB) Health and Wellbeing Strategy highlights the council’s commitment to improve health and wellbeing, including mental health, through service provision and local commissioning. In November 2014, the Health and Wellbeing Board identified the early identification and prevention of mental health problems as a priority and are committed to the improvement of CAMHS services to reduce waiting times for eating disorders, lower A&E presentations and reduce self-harm hospital admissions.[60]

In line with the LBB Health and Wellbeing Strategy, 100% of urgent cases of eating disorder in children and young people were seen within one week within Barnet CCG between Q3 2016/17 and Q2 2017/18. Over the same period, 87% of routine cases of eating disorder were seen within 4 weeks. During 2017/18, the planned spend for Children and Young People’s (CYP) eating disorders was £452k, with an overall annual spend on CYP mental health of £5.0m.[61]

[58] NHS Choices (2016). A guide to mental health services in England. Child and adolescent mental health services (CAMHS). Available at: https://www.nhs.uk/NHSEngland/AboutNHSservices/mental-health-services-explained/Pages/about-childrens-mental-health-services.aspx

[59] NHS England (2014). Child and Adolescent Mental Health Services (CAMHS) Tier 4 Report (p. 11). Available at: https://www.england.nhs.uk/wp-content/uploads/2014/07/camhs-tier-4-rep.pdf

[60] London Borough of Barnet (2015). Joint-Health-and-Wellbeing-Strategy-2015-2020 (p. 18-22). Available at: https://www.barnet.gov.uk/citizen-home/public-health/Key-strategic-documents-and-plans/Joint-Health-and-Wellbeing-Strategy-2015-2020.html

[61] NHS England (2018). Mental Health Five Year Forward View Dashboard. Mental Health Five Year Forward View Dashboard Q1 and Q2 2017/18. Available at: https://www.england.nhs.uk/publication/mental-health-five-year-forward-view-dashboard/

4.9 Diabetes

4.10 Oral health

Oral health is much more than having good teeth; it is essential for wellbeing and an integral part of general health. The interrelationship between oral and general health is supported by evidence, with a strong correlation between several oral diseases and noncommunicable chronic diseases (e.g. diabetes is associated with severe periodontal disease). The early detection of oral disease can be important in saving lives, through the identification of signs of oral cancer, immune disorders, microbial infections, nutritional deficiencies and injuries. Proper oral health care not only reduces premature mortality, but can also significantly improve quality of life, whilst reducing the impact on everyday activities from dental disease. Despite this, oral health remains a significantly problem across the world, with dental caries still a major issue in most industrialized countries, affecting most adults and between 60-90% of children.[74]

In this context, the World Health Organization (WHO) emphasizes the importance of availability and accessibility of oral health systems in the control of oral disease. Similarly, reduction of the risks associated with oral disease is only possible by orientating services towards primary health care and prevention. The role of services to address modifiable risk behaviours, such as the excessive consumption of sugar, tobacco and / or alcohol, is also underlined as part of an effective strategy.[75]

[74] World Health Organization (WHO, 2018). Oral health: Policy basis. Available at:http://www.who.int/oral_health/policy/en/

[75] World Health Organization (WHO, 2018). Strategies for oral disease prevention and health promotion. Available at: http://www.who.int/oral_health/strategies/en/

4.10.1 Adult Oral Health

Figure 4.12 shows the percentage of adult patients who received NHS dental care in the previous 24 months in Barnet, London and England. Between 2013-14 and 2016-17, the percentage of adult patients accessing dental care in Barnet was lower than both London and England, with dental access within the borough decreasing during the last three years under consideration.

Figure 4.12: Adult dental access (percentage of patients seen in the previous 24 months), for Barnet, London and England, 2013-14 to 2016-17

Source: NHS Digital (2018). NHS Dental Statistics.

Worldwide, oral cancers are the 6th most common, although they are less prevalent in the UK, with about 6,800 people diagnosed each year (accounting for about 2% of all cancers diagnosed). Also known as “mouth cancers,” they are more common in men than women and also in older adults, aged 50 -74 years old.[76]

In the period 2014-16, the age standardised rate of oral cancer registrations in Barnet is 11.9 per 100,000, which is significantly lower than both the national (14.7/100,000) and London (14.7/100,000) averages.[77]

Smoking and drinking alcohol can significantly increase the risk of developing oral cancers. Other risk factors include; chewing tobacco, poor diet, chewing betel nut and infection with human papilloma virus (HPV), which are a family of viruses affecting the moist linings of the body and skin.[78] When oral cancer is diagnosed early, relatively minor surgery can be used to treat it, with a very good chance that the cancer is permanently cured. So, increasing awareness of the risk factors for oral cancer within the community, reducing smoking and alcohol consumption and encouraging early reporting of symptoms are important.[79]

[76] NHS Choices (2016). Mouth cancer. Overview. Available at: https://www.nhs.uk/conditions/mouth-cancer/

[77] Public Health England (PHE, 2018). Public Health Profiles. Lung cancer registrations, 2014 – 16. Available at:https://fingertips.phe.org.uk/search/REGISTRATION#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/1206/age/1/sex/4

[78] NHS Choices (2016). Mouth cancer. Causes. https://www.nhs.uk/conditions/mouth-cancer/causes/

[79] NHS Choices (2016). Mouth cancer. Treatment. Available at: https://www.nhs.uk/conditions/mouth-cancer/treatment/

4.10.2 Child Oral Health

As part of Public Health England’s National Dental Epidemiology Programme (NDEP), a survey of 5 year old children was undertaken. The severity of decay was assessed using the average d3mft (the number of decayed teeth and those missing or filled due to decay). The results of this survey were reported in 2018 and Barnet was found to have an average d3mft similar to most other London boroughs and the national average.[80]

Figure 4.13 depicts the average number of decayed, missing or filled teeth (d3mft) in Barnet five year olds in 2017, compared to England, London and other London local authorities. The average d3mft for Barnet (0.8) is similar to both England (0.8) and London (0.9). Out of the 32 London boroughs, Barnet is ranked 20th out of 32, in terms of d3mft.[81]

Figure 4.13: The average number of dentinally decayed, missing due to dental decay and filled teeth (d3mft) among 5 year old children in London local authorities, London and England, 2017

Source: Public Health England (PHE, 2018). Oral health survey of 5-year-old children 2017.

From the opposite perspective, the proportion of five year old children who were free from obvious dental decay (Public Health Outcomes Framework indicator 4.02) for Barnet (68.0%) in 2014/15 was significantly lower than the national (England) average (75.2%), but similar to the London average (72.6%).[82]

Hospital admissions for extraction of one or more primary or permanent teeth in children aged 0-19 years are shown in Figure 4.14. The number of finished consultant episodes as a percentage of the population was lower in Barnet for children aged 0-9 years, compared with London and England. However, for those aged 10-19 years, the percentage in Barnet was either similar or higher than the national average.[83]

Child dental access in Barnet, London and England changed little between 2015/16 and 2016/17. For Barnet, 44.6% of children aged 0-17 were seen in the previous 12 months for 2015/16 compared to 45.5% for 2016/17. Similarly, for London 48.9% of children were seen in the previous 12 months for 2015/16 compared to 49.2% for 2016/17. For England, the dental access figures for children were higher for both years; 58.0% for 2015/16 and 58.2% for 2016/17.[84]

Figure 4.14: Finished Consultant Episodes (FCEs) for hospital dental extractions, as a percentage of the population, for children and adolescents aged 0-19, for Barnet, London and England, 2016/17

Source: Public Health England (PHE, 2017). Dental Health. Extractions data. Hospital episodes for teeth extraction of children 0-19Y 2011-12 to 2016-17.

[80] Public Health England (PHE, 2018). National Dental Epidemiology Programme for England: oral health survey of five-year-old children 2017. A report on the inequalities found in prevalence and severity of dental decay. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/708157/NDEP_for_England_oral_health_survey_5yr_2017_report.pdf

[81] Public Health England (PHE, 2018). Oral health survey of 5-year-old children 2017. Available at:https://www.gov.uk/government/statistics/oral-health-survey-of-5-year-old-children-2017

[82] Public Health England (2018). Public Health Outcomes Framework. 4.02 - Proportion of five year old children free from dental decay, 2014/15. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000044/pat/6/par/E12000007/ati/101/are/E09000003/iid/92441/age/34/sex/4

[83] Public Health England (PHE, 2017). Dental Health. Extractions data. Hospital episodes for teeth extraction of children 0-19Y 2011-12 to 2016-17. Available at:http://www.nwph.net/dentalhealth/Extractions_270317.aspx

[84] NHS Digital (2018). NHS Dental Statistics. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-dental-statistics

4.10.3 Oral Health Needs

There is currently no borough level data on the oral health of adults in Barnet, so a health needs assessment of their oral health could be undertaken, to identify oral health inequalities and needs within this population.

4.11 Maternity and infant health

4.11.1 Live Births and Rates

In 2016, there were 5,301 live births (2,726 males and 2,575 females) in Barnet (only 1.3% to mothers aged less than 20 years and 35.7% to mothers aged 30-34 years). The highest birth rate in Barnet was in women aged 30-34 years (116.5 per 1,000 women) in Barnet, compared to 107.3 per 1,000 for London and 112.4 per 1,000 in England, for the same age group.

The General Fertility Rate (GFR: all live births for women aged 15-44 years) for Barnet (64.8 per 1,000 women) in 2016 was similar to the GFR for London (63.6 per 1,000), but significantly higher than the rate for England (62.5 per 1,000). The crude birth rate (CBR) for the number of live births per 1,000 population of all ages was 13.7 per 1,000 for Barnet in 2016 which was significantly lower than London (14.7 per 1,000) but significantly higher than England (12.0 per 1,000). The maternity rate (number of maternities including still births per 1,000 population aged 15-44) for Barnet was 63.9 per 1,00, which was similar to London (62.8 per 1,000), but significantly higher than England (61.8 per 1,000).[85]

Between 2018 and 2035, the number of women of child-bearing age in Barnet is projected to fall from approximately 82,200 to 79,000, a fall of 3.8% over the period.[86] For 2011-2015, the Barnet wards with the highest fertility rate (per 1,000 women aged 15-44) were Golders Green (82.1/1,000), Colindale (75.6/1,000) and Edgware (74.5/1,000), whilst the lowest fertility rate was found in Brunswick Park (54.5), Woodhouse (57.5) and Coppetts (57.5).[87]

[85] Office for National Statistics (ONS, 2017). Births by mothers' usual area of residence in the UK. Available at:https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/livebirths/datasets/birthsbyareaofusualresidenceofmotheruk

[86] Greater London Authority (GLA, 2018), Borough Preferred Option population projections.

[87] Public Health England, Local Health Profiles, Fertility rate by ward, 2017. Available at:http://www.localhealth.org.uk/#z=500807,213975,53103,35756;v=map13;i=t1.fertility;l=en

4.11.2 Infant Health and Mortality

In 2016, the percentage of live births (at term) under 2.5 kg in Barnet (3.05%), is similar to both England (2.79%) and London (3.01%).[88] Data for 2011-2015, show that in Barnet wards, the percentage of live births which were low birth weight (< 2,500 g) was highest in Totteridge (4.2%) followed by Brunswick Park (3.5%) and Finchley Church End (3.5%). The wards with the lowest proportion of underweight births were Garden Suburb (2.2%), followed by Mill Hill (2.3%) and Oakleigh (2.4%).[89]

For 2014-16, the infant mortality rate (for children aged under 1 year) in Barnet (2.2 per 1,000 live births) is the 5th lowest of the London boroughs and significantly better than both London (3.2 / 1,000) and England (3.9 / 1,000).[90] Similarly, the neonatal mortality (number of deaths under 28 days per 1,000 live births) in Barnet (1.20 per 1,000 live births) is significantly better than both London (2.20 / 1,000) and England (2.74 / 1,000).[91]

[88] Public Health England (2018). Pregnancy and birth. Low birth weight of term babies, 2016. Available at:https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-pregnancy/data#page/3/gid/1938132993/pat/6/par/E12000007/ati/102/are/E09000003/iid/20101/age/235/sex/4

[89] Public Health England (2017). Local Health Profiles. Low Birth Weight of term babies, 2011-15. Available at:http://www.localhealth.org.uk/#sly=wd16_DR;i=t1.low_birth_weight;sid=33;z=510161,198327,26088,17566;v=map13;l=en

[90] Public Health England (2018). Mortality. Infant mortality, 2014 – 16. Available at:https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-mortality/data#page/3/gid/1938132996/pat/6/par/E12000007/ati/102/are/E09000003/iid/92196/age/2/sex/4

[91] Public Health England (2018). Mortality. Neonatal mortality, 2014 – 16. Available at:https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-mortality/data#page/3/gid/1938132996/pat/6/par/E12000007/ati/102/are/E09000003/iid/92705/age/23/sex/4

4.11.3 Breast Feeding

In 2016/17, breastfeeding initiation (the percentage of mothers who breastfed their infants in the first 48 hours following delivery) in Barnet is 90.9%, which is significantly better than the national average (74.5%).[92] There has been a significant increase in breastfeeding initiation in the borough since 2014/15, when 85.1% of mothers breastfed within 48 hours of delivery.[93]

[92] Public Health England (2018). Breastfeeding. Breastfeeding initiation, 2016/17. Available at:https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-breastfeeding/data#page/3/gid/1938133014/pat/6/par/E12000007/ati/102/are/E09000003/iid/20201/age/1/sex/2

[93] Public Health England (2018). Breastfeeding. Breastfeeding initiation Barnet. Available at:https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-breastfeeding/data#page/4/gid/1938133014/pat/6/par/E12000007/ati/102/are/E09000003/iid/20201/age/1/sex/2

4.11.4 Maternal Health

4.11.4.1 Smoking in Pregnancy

During 2016/17, the percentage of women in Barnet who smoked at the time of delivery (3.4%) is significantly lower than both London (4.9%) and England (10.7%).[94] 

[94] Public Health England (2018). Breastfeeding. Smoking status at time of delivery (current method), 2016/17. Available at: https://fingertips.phe.org.uk/profile-group/child-health/profile/child-health-breastfeeding/data#page/3/gid/1938133013/pat/6/par/E12000007/ati/102/are/E09000003/iid/93085/age/1/sex/2

4.11.4.2 Service Use

The percentage of women in Barnet who received an antenatal visit from a midwife or maternity healthcare professional before 13 weeks was 77.7% in Q3 of 2014/15, which was significantly lower than the national average and represents a significant decline since Q1 of 2013/14 when the figure was 85.7%. Between Q1 of 2013/14 and Q3 of 2014/15, the proportion of women in Banet CCG who received an antenatal assessment before 13 weeks was consistently significantly lower than the national (England) average.[95]

[95] Public Health England (PHE, 2018). Public Health Profiles. Antenatal assessments before 13 weeks, NHS Barnet CCG. Available at:https://fingertips.phe.org.uk/search/ANTERNATAL%20ASSESSMENT#page/4/gid/1/pat/46/par/E39000018/ati/153/are/E38000005/iid/91003/age/1/sex/2

4.12 Health Protection

4.12.1 Immunization

The process of making someone immune or resistant to an infectious disease is called “immunization” and often involves the administration of a vaccine which stimulates the person’s own immune system to combat subsequent disease or infection.[96] The NHS has developed a complete routine immunization schedule which provides information to healthcare professionals on the vaccines which protect against specific diseases and at what age they should be administered.[97]

[96] World Health Organisation (WHO, 2018). Immunization. Available at:http://www.who.int/topics/immunization/en/

[97] Public Health England (PHE, 2018). Guidance: Complete routine immunisation schedule. Available at:https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/699392/Complete_immunisation_schedule_april2018.pdf

4.12.1.1 Childhood Primary Immunizations

NHS routine childhood immunizations provide cover against a number of infectious diseases including: diphtheria, influenza, whooping cough, polio and tetanus. Evaluation of childhood immunization in England is conducted through the cover of vaccination evaluated rapidly (COVER) programme, which produces quarterly statistics.[98]

NHS immunization statistics for 2016/17 and Childhood Vaccination Coverage Statistics, 2016/17 (Table 4.2) show that Barnet rates for all childhood immunizations are lower compared to the national average.

Table 4.2: Coverage of routine childhood immunizations in Barnet compared to England, 2016/17

Source: NHS Digital (2018). Childhood Vaccination Coverage Statistics, England, 2016-17. Key: DTaP = Diphtheria, Tetanus, and acellular Pertussis (whooping cough); IPV = Inactivated Polio Vaccine; HIb = Haemophilus influenzae type b; Men C = Meningitis C; MMR = Measles, Mumps, and Rubella; Hep B = Hepatitis B (given to children of positive mothers only); PCV = Pneumococcal vaccination.

[98] Public Health England (PHE, 2018). Vaccine uptake guidance and the latest coverage data. Cover of vaccination evaluated rapidly programme. Available at: https://www.gov.uk/government/collections/vaccine-uptake#cover-of-vaccination-evaluated-rapidly-programme

4.12.1.2 Human Papillomavirus (HPV) Immunization

The human papillomavirus (HPV) immunization programme was introduced nationally in 2008, to protect girls from the main cause of cervical cancer. Originally, it was a three-dose vaccination, but following expert advice, it has been run on two dose schedules since September 2014. In Barnet, the percentage of girls aged 13-14 in 2016/17, who had received both HPV doses is 75.4% which is significantly lower than both London (77.7%) and England (83.1%) and ranked 23rd out of 32 London boroughs.[99]

[99] Public Health England (PHE, 2018). Public Health Profiles. 3.03xvi - Population vaccination coverage - HPV vaccination coverage for two doses (females 13-14 years old). Available at:https://fingertips.phe.org.uk/search/HPV#page/3/gid/1/pat/6/par/E12000007/ati/102/are/E09000003/iid/92896/age/296/sex/2

4.12.1.3 Flu and Pneumococcal (PCV) Immunization

During 2016/17, 68.1% of the Barnet population aged 65+ were vaccinated against influenza, which was significantly higher than the London average (65.1%), but significantly lower than the national average (70.5%).[100] For at risk individuals only 46.2% in Barnet received a flu vaccination during 2016/17, which was significantly lower than the averages for London (47.1%) and England (48.6%).[101]

The total cohort for pneumococcal vaccination (PCV) against pneumococcal disease in children in Barnet comprised 5,200 persons in 2016/17, of whom 4,689 were immunized yielding a coverage rate of 90.2%. This PCV coverage rate was similar to the London average (89.2%) but significantly worse than the national average (93.5%).[102]

In 2016/17, the total eligible population for immunization against pneumococcal disease in persons aged 65 years and above was 51,666 persons of whom 34,230 persons received a PPV vaccination. The PPV vaccination rate in Barnet (66.9%) was similar to both the London (64.3%) and England (69.8%) rate.[103]

[100] Public Health England (PHE, 2018). Health Protection. Population vaccination coverage - Flu, aged 65+ (%), 2016/17. Available at: https://fingertips.phe.org.uk/profile/health-protection/data#page/3/gid/1938132804/pat/6/par/E12000007/ati/102/are/E09000003/iid/30314/age/27/sex/4

[101] Public Health England (PHE, 2018). Health Protection. Population vaccination coverage - Flu, at risk individuals (%), 2016/17. Available at: https://fingertips.phe.org.uk/profile/health-protection/data#page/3/gid/1938132804/pat/6/par/E12000007/ati/102/are/E09000003/iid/30315/age/226/sex/4

[102] Public Health England (PHE, 2018). Public Health Outcomes Framework. Health Protection. 3.03v - Population vaccination coverage – PCV, 2016/17. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/6/par/E12000007/ati/102/are/E09000003/iid/30306/age/30/sex/4

[103] Public Health England (PHE, 2018). Public Health Outcomes Framework. 3.03xiii - Population vaccination coverage – PPV, 2016/17. Available at: https://fingertips.phe.org.uk/profile/public-health-outcomes-framework/data#page/3/gid/1000043/pat/6/par/E12000007/ati/102/are/E09000003/iid/30313/age/27/sex/4

4.12.2 Tuberculosis

Tuberculosis (TB) is a curable, preventable disease caused by the bacteria Mycobacterium tuberculosis. It is a contagious, airborne disease that is one of the top 10 causes of death worldwide and the top infectious killer globally. In 2016, there were an estimated 10.4 million new (incident) cases of TB and 1.7 million people died from the disease, although between 2000 and 2016, an estimated 53 million lives were saved through TB diagnosis and treatment.[104]The UK has one of the highest incidence rates of TB in Western Europe and local authorities play an important role in addressing this issue, which disproportionately affects disadvantaged and vulnerable groups such as migrants, ethnicity minorities and those with social risk factors such as homelessness or a history of imprisonment.[105]

Figure 4.15 shows the 3-year aggregated rate of TB incidence, for Barnet, London and England, between 2002-4 and 2015-17. Since 2010, the incidence rate of TB has declined significantly in Barnet, London and England, however, compared to England, the rates are still high in London and the Barnet. In recent years, the incidence of TB in Barnet has remained significantly lower than London and significantly higher than England. For example, during 2015-17, TB incidence in Barnet (18.4 per 100,000) was significantly lower than London (24.3 per 100,000), but significantly higher than England (9.9 per 100,000) (see Appendix to the JSNA).[106]

Figure 4.15: TB incidence (3 years average), crude rate per 100,000 population for Barnet, London and England, 2002-4 to 2015-17

Source: Public Health England (PHE, 2018). Barnet - TB Strategy Monitoring Indicators. TB incidence (three-year average).

[104] World Health Organization (WHO, 2018). Tuberculosis factsheet. Available at:http://www.who.int/en/news-room/fact-sheets/detail/tuberculosis

[105] Local Government Association (2018). Tackling tuberculosis: local government's public health role. Available at: https://www.local.gov.uk/tackling-tuberculosis-local-governments-public-health-role

[106] Public Health England (2018). TB Strategy Monitoring Indicators. TB incidence (three year average), Barnet. Available at: https://fingertips.phe.org.uk/profile/tb-monitoring/data#page/9/gid/1938132814/pat/104/par/E45000001/ati/102/are/E09000003/iid/91361/age/1/sex/4