Excess winter deaths

Why this is important

Cold weather has a direct effect on the incidence of heart attack, stroke, respiratory disease, flu, falls and injuries and hypothermia. It also has indirect effects on mental health problems, such as depression, and the risk of carbon monoxide poisoning if boilers, cooking and heating appliances are poorly maintained or ventilated. Overall, the death rate in the UK is higher during winter months (from the start of December to the end of March in the UK) and this is referred to as 'excess winter deaths' (Cold weather plan for England, Public Health England).

Excess winter mortality is estimated by comparing the winter months of December to March with the average of the four-month periods before and after. For winter 2019 to 2020, deaths have been excluded where the coronavirus (COVID-19) was mentioned on the death certificate, from the main figures reported, improving the comparability of this winter's measure with previous years.

An estimated 28,300 excess winter deaths occurred in England and Wales in winter 2019 to 2020, which was 19.6% higher than winter 2018 to 2019.

The excess winter mortality index (which is used to compare between sexes, age groups and geographical areas) in England was statistically significantly higher than for winter 2018 to 2019, but statistically significantly lower than the 2016 to 2017 and 2017 to 2018 winters.
(Office for National Statistics).

Most excess winter deaths and illnesses are caused by respiratory and cardiovascular problems during moderate outdoor winter temperatures of 4–8°C depending on the region. The risk of death and illness increases as the temperature falls further.

In many cases, simple preventive action could avoid many of the deaths and illnesses associated with the cold. Many of these measures need to be planned and undertaken before cold weather starts. The UKHSA Cold Weather Plan for England provides guidance on how to prepare for and respond to cold weather, which can affect everybody's health. It outlines actions for the NHS, public health, social care and other community organisations, to support vulnerable people who have health, housing or economic circumstances that increase their risk of harm.

NICE quality standard for tackling Excess Winter Deaths (QS117) and local actions are expected to contribute to improvements in the following outcomes:

• excess winter deaths
• morbidity
• fuel poverty
• exacerbation of current health problems
• timely discharge
• rates of hospital admissions and re-admissions

The Barnsley picture and how we compare

• Barnsley’s 2019-2020 excess winter deaths rate (18.3%) is similar to the England rate of 17.4%.
• Barnsley is ranked 8 out of 16 comparator authorities (where 1 is the highest rate).
• Barnsley’s 2019-2020 rate of 18.3% is significantly lower than rates in previous years, and the second lowest since 2011/12.
• The main underlying causes of excess winter deaths are respiratory diseases. During 2013-2020, in Barnsley, there were 75% more deaths from influenza and pneumonia and chronic lower respiratory diseases in winter months than in non-winter months.
• There are large variations in excess winter death rates within Barnsley, with rates ranging from 11.1% in Old Town ward to 41.2% in Darton East ward.

What we're doing and the assets or services we have

Cold homes and affordable warmth

• The Warm Homes service commenced in April 2019 with external funding. The service provides a single point of access as part of the Council’s in-house service ABLE, to support residents vulnerable to fuel poverty, cold related ill health and preventing EWDs. Since going live, hundreds of private sector households have been supported to reduce their energy bills and keep warm by installations of new boilers, benefit maximisation and switching energy suppliers.

• DIAL Warm Connections service is now delivered across the borough, following the successful programme in North Area Council. This service provides case worker support for energy efficiency and income maximisation support for fuel payments.

• A Winter Warmth campaign is running from November 2021 to March 2022. This co-ordinated digital and traditional marketing campaign between BMBC and CCG focused on where residents know where to get help on:

  • keeping warm and well
  • making sure residents know to get their flu jab
  • how to reduce falls
  • help that’s available to keep their homes warm throughout winter.

• The campaign also included a community toolkit for frontline workers, fuel poverty training and energy advice sessions with the public.

Flu vaccination uptake (2020/21)

• High uptake for all eligible children, exceeding regional and national averages.
• In the 65+ age group, Barnsley’s uptake rate (82.6%) was significantly higher than the England rate (80.9%).
• Uptake in the under 65’s (at risk) group (57.2%) was also significantly higher than regional and national rates.
• During 2020/21 flu Season, 760 employees (24% of the workforce) received the vaccination through our in-house programme, voucher scheme or pharmacy reimbursement. In addition to these 240 employees reported that they had received the vaccination via their GP or pharmacy through our mid-season flu survey.
• The health care and social worker vaccination programme continues to go from strength to strength through the offer of vaccination in employing health care organisations, social care organisations, local authority organisations, private and community organisations across Barnsley.

COVID vaccination uptake (November 2021)

• The first dose uptake of the COVID-19 vaccination in Barnsley for those aged 12 and above (82%), compares favourably to the England average (76.9%) as of 5 November 2021.
• Second dose uptake is at 75.5%, higher than the England average (70.4%)

Falls prevention

• Barnsley has higher rates of hospital admissions due to falls in people aged 65 or over (2019/20 data), and the rate is on an increasing trend. Out of 16 similar local authorities, Barnsley’s rate was the third highest. Just over 1,300 people aged 65 and over in Barnsley were admitted to hospital as a result of a fall in 2019/20.
• Similarly, the rates for those aged 65-79 and 80+ are significantly higher than the England average.

Key actions include:

• Falls integrated community service (South West Yorkshire Partnership Foundation Trust)
• Proactive care/anticipatory care for frailty
• Falls awareness - Falls Prevention week. Visit Falls prevention for further information.
• Develop older persons physical activity alliance – strength and balance programme
• Age Friendly programme - Digital Inclusion project
• Active in Barnsley Partnership What's Your Move campaign to encourage and support people to be more physically activity in Barnsley. 

Opportunities for improvement/future developments

Tackling excess winter deaths continues as a key priority for the Barnsley 2030 Plan and Health and Wellbeing strategy, working with partners.

The Barnsley three-year action plan (2019-2021) was reviewed and updated this year and a web-based plan has been co-produced with partners: View the Barnsley cold weather plan 2021-22

System wide priorities:

• Identify people at risk of excess winter morbidity and mortality
• Implement a borough wide assessment of people at risk of excess winter morbidity and mortality
• Delivery and signposting to interventions to address winter morbidity and mortality
• Monitor and evaluate impact of actions to address winter morbidity and mortality
• System wide communication plan for the public and stakeholders
• Securing future funding for Warm Homes team beyond December 2021
• Retrofitting scheme for private sector housing
• Raise awareness of the impact of adverse weather through alerts, emergency preparedness and building community resilience

Resources and supporting documents

• Public Health Outcomes Framework – indicator E14
• Excess winter mortality in England and Wales (ONS)
• Fall proof booklet
• Falls prevention leaflet

Life expectancy at birth and healthy life expectancy at birth

Why this is important

What happens during pregnancy and early childhood can impact upon that child’s future prospects including levels of social and emotional development, employment prospects, and lifelong health outcomes (including life expectancy). There is a wealth of evidence which demonstrates the importance of a child’s earliest experiences on their future development and their success as adults.  By focussing on ensuring children are given the best possible start in life, we can generate the greatest societal and health benefits, for generations to come.

Barnsley’s population is also growing and ageing. Around 19% of our population is 65 years old or over and the number of residents aged 65+ is predicted to reach 60,800 by 2030; a change of 33% from 2016. Evidence tells us that older life is where health inequalities can be most stark; especially for older people who are socially isolated and have poor mental wellbeing.

Compared to the national average, Barnsley is behind the national average levels for both genders in terms of life expectancy at birth and healthy life expectancy. Importantly, this measure in recent times has seen little improvement, suggesting a lack of progress in life expectancy gains for our residents.

Historically there has been a gap between males and females in the area, which continues to the present. In the most recently available information: male life expectancy for Barnsley is 71.1 years. Female Life expectancy is 81.1 years; this is significantly behind the national average of 79.4 and 83.1 respectively.

Healthy life expectancy (an estimate of how many years a person on average can expect to free of illness or injury in their life), has improved for females in the borough.  At 61.5 years, female healthy life expectancy in Barnsley is two years behind the England average of 63.5. There is a gap of 5.7 years between healthy life expectancy for males in Barnsley (57.5 years) and the England average of 63.2 years.  

It's important that we continue to monitor this data at an electoral ward and Area Council level to tackle the challenge of health inequalities within the borough.

The Barnsley picture and how we compare: life expectancy at birth

Males

• Life expectancy at birth for men in Barnsley in 2018-2020 is 71.1 years; significantly lower than the England rate of 79.4 years
• Barnsley is ranked 131 out of 152 local authorities (where 1 is the best).  Barnsley’s current rank is lower than Doncaster and Rotherham.
• The gap in life expectancy at birth for males between Barnsley and England has increased during the period 2001-2003 to 2018-2020 (from 1.6 years to 2.3 years).
• Within Barnsley, life expectancy at birth rates for men range from 75.0 years in Kingstone ward to 82.8 years in Penistone East (a gap of 7.8 years).

*External causes includes deaths from injury, poisoning and suicide.

Females

• Life expectancy at birth for women in Barnsley in 2018-2020 is 81.1 years; lower than the England rate of 83.1 years.
• Barnsley is ranked 130 out of 152 local authorities (where 1 is the best). Barnsley’s current rank is higher than Doncaster and Rotherham which were ranked 133 and 136 respectively.
• The gap in life expectancy at birth for females between Barnsley and England has increased during the period 2001-2003 to 2018-2020 (from 1.1 years to 2.0 years).
• Within Barnsley, life expectancy at birth rates for women range from 78.7 years in Stairfoot ward to 86.2 years in Penistone East (a gap of 7.5 years).​

The Barnsley picture and how we compare: healthy life expectancy at birth

Males

• Men, at birth, in Barnsley could expect to live 57.5 years in 'good' health (5.7 years less than men in England overall).
• Barnsley is ranked 138 out of 146 local authorities (where 1 is the best).  Barnsley’s 2017-2019 rank is lower than Doncaster and Rotherham.
• The gap in healthy life expectancy at birth for males between Barnsley and England has increased slightly by 0.2 years during the period 2009-2011 to 2017-2019 (from 5.5 years to 5.7 years).

Females

• Women, at birth, in Barnsley could expect to live 61.5 years in 'good' health (2 years less than women in England overall).
• Barnsley is ranked 94 out of 146 local authorities (where 1 is the best).   Barnsley’s 2017-2019 rank is higher than Sheffield, Rotherham, Doncaster and Wakefield.
• The gap in healthy life expectancy at birth for females between Barnsley and England has decreased by 4.4 years during the period 2009-2011 to 2016-2018 (from 6.4 years to 2 years).

Data from:

• Public Health Outcomes Framework – indicators A0.1, A0.1b
• PHE Segment Tool​

What we're doing and the assets or services we have

Our Health and Wellbeing strategy 2021-2030 sets our vision for a Healthy Barnsley and is underpinned by a series of ambitions across the life course, that we hope to achieve from pre-birth through to end of life.

The strategy strengthens the  Health and Wellbeing Board’s commitment to reducing health inequalities within the borough by focussing on the wider determinants of health (such as housing, employment and education) to give everybody in Barnsley a fair opportunity to live a healthy life.

We have set out our strategy as a ‘life course’ approach, which shows what we will do to improve health and wellbeing across a person’s life – from pre-birth to end of life. We have split this life course approach into 3 sections:

• Starting well (0-18 years)
• Living well (working age adults)
• Ageing well (65 plus)

Not everyone has the same opportunity to live a healthy and satisfying life. To understand why, we need to look at the bigger picture; various social and environmental factors affect a person’s chances to be healthy – these are known as the wider determinants of health. Factors that can impact a person’s opportunities to lead a healthy lifestyle include: employment, their surroundings, financial resources, housing, education and skills, access to food, transport and social connections. Barnsley’s Health and Wellbeing Board will focus on these wider determinants of health, to ensure everyone has a fair opportunity to live a healthy life. This emphasises both the necessity for effective health and social care as well as working in partnership with a wide range of other sectors to deliver improved outcomes.

The strategy has also been informed by the voice of Barnsley Residents, through our ‘A Day in the Life of’ which was held in November 2020; our Children and Young People’s Emotional Health and Wellbeing survey; and our Barnsley 2030 consultation

Opportunities for improvement or future development

Barnsley’s new Health and Wellbeing Strategy comes at a time when the borough is still realising the impact of Covid. Colleagues across the health and care system alongside our communities have worked incredibly hard since March 2020 to minimise the impact of Covid locally.

The pandemic has shone a light on existing inequalities within our borough. As we begin to recover from Covid we must do so in a fair and equitable way, ensuring that none of our communities are left behind.

Barnsley’s Health and Wellbeing Board has identified two key priorities: improving mental health within the borough and ensuring Barnsley is a great place for our children to be born and for our young people to grow up.

We continue to focus on understanding our life expectancy and healthy life expectancy data which adds a quality-of-life dimension to estimates of life expectancy.  Investing in prevention, early intervention and enabling healthy lifestyles will help to support our residents to stay healthy and independent. 

Partners across the health and care system will continue to work collaboratively across Barnsley to provide care closer to home, with residents experiencing continuity of care by what feels like ‘one team.

Above all we want to improve the quality of life of people in Barnsley and reduce the inequalities that exist in health and wellbeing outcomes.

Resources and supporting documents

• Barnsley Health and Wellbeing Strategy 2021-2030
• A Day in the Life of 2020 Director of Public Health Annual Report
• Marmot review: 10 years on
• Office of National Statistics: Health state life expectancy - all ages, UK

Low birth weight

Why this is important

Low birth weight is associated with an increased risk of infant mortality, childhood morbidity and poorer health later in life. There are inequalities in low birth weight, with higher proportions of low birth weight babies being born in more deprived populations and is a key indicator of poverty. This is thought to be associated with higher prevalence of lifestyle issues that increase the risk of low birth weight, such as maternal smoking and alcohol consumption.  During your pregnancy, you will receive an individualized growth chart based on your unique features.  The chart identifies the possible risk that your baby will be a low birth weight.

The Barnsley picture and how we compare

• In 2020, 2.58% of full term babies born to mothers from Barnsley had a low birth weight, similar to the England average of 2.86%.
• Compared to similar local authorities, Barnsley’s rate was the fifth lowest.
• Barnsley's rates have decreased at each time point since 2016.

Data from:

• Public Health Outcomes Framework -  indicator C04
• Public Health England (Child Health Profiles)

What we're doing and the assets or services we have

The Public Health nursing service offer the following initiatives and interventions: 

• Promotion of key public health messages and supporting lifestyle changes in relation to smoking, alcohol and having good nutrition through universal key contacts with families to motivate change in prenatal and antenatal stages.  
  
  
• Promotion and support throughout your entire pregnancy and the postnatal period of the values of exclusive breast-feeding. We have an integrated infant feeding team supporting women in the hospital and in the community. 
  
  
• Development of virtual antenatal breast-feeding support groups supporting healthy lifestyles, good nutrition and vitamin intake. 
                                                                         
• Delivery of the Healthy Child Programme and growth and development monitoring at key stages of child’s early development.
  
  
• Provision of a universal service which supports access to health care and immunisation uptake, health promotion activities and opportunities to educate women of reproductive age.
  
  
• Delivery of vaccinations in pregnancy (such as pertussis and flu) are currently offered in Maternity Healthy U & Baby (HUB) at BHFNT.

Barnsley Hospital (NHS) Foundation Trust (BHNFT) provides the following services:

• Maternity Stop Smoking Service, supporting women and their partners who smoke throughout pregnancy.
  
  
• Pathway to Barnsley Wellbeing Programme - a 12 week free physical activity programme.
  
  
• Customised growth charts for all singleton pregnancies, as recommended by the Perinatal Institute.
  
  
• Women who have had a previous ‘small for gestational age’ baby have regular growth scans in their current pregnancy. This enables identification of any growth restriction and an individual plan can be made.
  
  
• Reduced fetal movements are discussed at every antenatal appointment and women are referred into the maternity unit for monitoring if reduced movements are identified.  To encourage women to self-refer to the Antenatal Day Unit or Maternity Triage if they have any concerns.

Opportunities for improvement or future development

Low birth weight/premature birth is a greater risk for teenage mothers. The Public Health Nursing Service is working towards an intensive support programme for teenage mothers. As a result of COVID-19 developing more virtual health promotion groups and using social media as a greater platform to provide key health improvement messages for children and families.

BNHFT is working towards implementing ‘Saving Babies Lives Version 2’, which recommends changes to the provision for women receiving serial ultrasounds. You may be referred for extra scans if you have a body mass index (BMI) over 35 or if you smoke.

BNHFT midwives and obstetricians are running specialist clinics to support women with a high risk of having low birth weight babies.

Resources and supporting documents

• Antenatal care for uncomplicated pregnancies
  National Institute for Health and Care Excellence, 2008 (NICE) - Guidelines cover advice and information to be given to women during pregnancy, including antenatal and newborn screening programmes, screening for clinical conditions such as gestational diabetes and pre-eclampsia, screening for infections, lifestyle advice, provision of care and management of pregnancy symptoms and breastfeeding.