Chapter 10: Strengthen the role and impact of ill-health prevention

The focus of ill-health prevention has had to shift to tackling Covid since early 2020.  

The pandemic has significantly disrupted the daily routines of citizens, with the requirement to stay at home and avoid close contact with others.

Conditions in key social determinants of health have deteriorated and COVID-19 containment measures appear to have resulted in some changes to health behaviours such as smoking and diet choices, increasing inequalities and causing concerning deteriorations in mental health.

In a Gateshead Council survey, in February/March 2021, nearly two thirds of residents said that their health and wellbeing has got worse during the pandemic. 

During lockdowns and with a more sedentary lifestyle for those working from home, eating and exercise habits have changed for some. According to Public Health England research, four in 10 (41%) adults in England say they have put on weight since the first lockdown in March 2020. Almost over half a stone (4.1kg) was gained on average by those who put on weight, with one in five (21%) reporting putting on a stone or more. (Gov.uk (26 July 2020) Press release: Campaign launched to help public get healthy this summer). Exercise and positive mental health are also linked. 

Another side-effect of the pandemic has been impacts on dietary habits. With most people stuck at home and children absent from school, there are concerns that sugar consumption and snacking behaviours increased. We know that the main cause of tooth decay is the frequent consumption of sugary foods and drinks, so it is likely that we will see the effects of this in people's oral health in the future. 
Lorenzo Iafrate, Dental Core Trainee 3 in Dental Public Health and Dr Rhiannon O'Connor, Specialty Trainee in Dental Public Health 

There has also been a change in smoking behaviours. 

During lockdown we saw an increase in the number of young people starting smoking but there were also increases in the number of existing smokers making quit attempts which has kept our smoking rates stable. National lockdowns severely affected the provision of local stop smoking services; however, our providers have worked extremely hard to adapt their ways of working and continue to provide support to smokers who need it. 
Gemma King, Public Health Programme Lead, Gateshead Council 

In a survey of families and friends of someone with an alcohol, drug or gambling problem, nearly half (42%) said that their family members' alcohol, drug use, or gambling has increased during lockdown. (Addiction (2020) Families in Lockdown (opens new window) The effects of the Covid-19 lockdown on the family and friends of someone with an alcohol, drug or gambling problem) 

The UK was already at crisis point with alcohol long before Covid, but the pandemic saw a tipping point. Cheap alcohol together with the terrible anxieties of Covid created a 'perfect storm' which resulted in millions more drinking at risky levels, problems for families and heavy use turning into dependency. In the North East alone, around 855,000 adults and 60% of male drinkers were drinking above low risk limits during 2020 and nearly one in four heavier drinkers ended up drinking more. Deaths from alcoholic liver disease increased by a staggering 20.8% during the Covid-19 pandemic, by far the highest yearly increase on record - fuelled by rising consumption of wine and spirits; and the North East suffered the most, with the biggest increase in alcohol specific deaths, particularly in the most deprived groups of the population.
 

It is clear that people in Gateshead recognise the serious problems associated with alcohol and there is strong support for more national action to tackle alcohol harms in our communities.
 

We believe that the Government needs to introduce an evidence-based alcohol strategy, which tackles the cheapest strongest alcohol, restricts promotion and availability and funds treatment, to bring an end to the rising burden of alcohol-harm and death. 
Sue Taylor, Head of Alcohol Policy, Fresh and Balance 

We can evidence a link between substance misuse and mental wellbeing. The impact of COVID-19 has seen a significant increase in the amount of people referring into substance misuse services, this has been for a range of substances used. Data would identify that alcohol and non-opiate referrals are the substances which have seen the most significant increase. Regular communication with our mental health colleagues would suggest other providers may have also seen an increase in referrals.
Sarah Beat, Service Manager, Gateshead Recovery Partnership

Service users have continued to receive support throughout the pandemic, although the way services have operated has had to change. 

Health services were reprioritised to manage the increased demand from Covid-19-related illness, and to allow for new social distancing restrictions, which meant fewer patients could be treated. While this was a necessary precaution, in most sectors this has led to reduced treatment of existing conditions and a backlog of unmet care needs. 

In addition to managing our own demand, primary care is also dealing with the consequences of waiting list delays for patients who need to be treated in secondary care. They may need an operation. In primary care, we can only manage the symptoms they have as best we can until they are seen in secondary care and patients are getting really frustrated, it's having an impact on their mental health. It is really affecting their wellbeing and everyday living.
 

We understand that some patients are having a really difficult time and it is more difficult to access services at times. This can make them frustrated and unfortunately some take it out on practice staff. We've had to remove a patient from our list who was regularly aggressive and abusive as it was affecting staff health. Recruiting extra staff is really difficult at the moment - locum GPs, locum nursing staff and receptionists. We're finding it difficult to get locum cover for annual leave, even paternity leave and that's affecting staff morale. 
Teresa Graham, Business Partner and Practice Manager, Second Street Surgery, Oxford Terrace and Rawling Road Medical Group and CBC Health GP Federation.  

This pandemic has been the biggest challenge the NHS has ever faced. I'm so proud of the speed and the way we have risen to those challenges.
 

We have transformed the whole organisation to care for patients with Covid-19. Our staff have worked tirelessly and have gone above and beyond.
 

Despite the ongoing challenges of the pandemic, we have continued to provide maternity services, vital cancer treatments and all the emergency services you would expect.
 

We also launched our Covid vaccination hub which delivered over 10,000 vaccines involving staff from across the hospital's teams, alongside practice staff, volunteers and local partners including Gateshead Council and Community Based Care, and GPs.
 

We continue to encourage the public to get their Covid and flu vaccinations as well as continuing to follow guidance to keep themselves and their loved ones safe. 
Andrew Beeby, Medical Director, Gateshead Health NHS Foundation Trust 

Access to dental care has worsened significantly because of the pandemic. In the latter half of 2019 (prior to the pandemic), data shows that 33% of Gateshead residents accessed NHS primary care dental services. Dental practices subsequently closed in March 2020 for all but the most urgent cases, reopening in June 2020 but with much restricted capacity due to increased cross-infection requirements. This led to only 9% of Gateshead residents accessing care in the latter half of 2020. This figure increased to 18% in the first half of 2021, reflecting the fact that capacity in dental services is improving, but has not yet returned to pre-pandemic levels. 
Lorenzo Iafrate, Dental Core Trainee 3 in Dental Public Health and Dr Rhiannon O'Connor, Specialty Trainee in Dental Public Health 

Adult Social Care is an essential service to help people with disabilities and/or additional needs live a thriving life. In the first year of the pandemic, Adult Social Care in Gateshead has seen demand for its services often change in response to national lockdowns, with some areas seeing a marked increase in activity. 

Between the end of March 2020 and the end of March 2021: 

• An additional 1598 contacts were made to Adult Social Care (a rise of 18%)  
• To ensure people were receiving the right type of care and support 747 more reviews were carried out (a rise of 16%) 
• Contacts from the QE Hospital rose dramatically across this period with 1349 more received (a rise of 100%), much of it linked to the increased demand on the NHS to move people out of hospital and into the community  
• More adults needed to be assessed as a result of safeguarding concerns with 130 more safeguarding enquiries being undertaken (a rise of 36.7%) Neglect and acts of omission being the single largest reason for the concerns  
• More adults were assessed for care and support needs, 236 more assessments were commenced (a rise of 7.3%) and 230 more completed (a rise of 7%) 

The figures above reflect activity to the end of March 2021. Since then, the demand for support from Adult Social Care has continued to increase as the pandemic has continued with on average 20% more contacts coming into Adult Social Care per month compared to the same period over the previous year (a total increase of nearly 900 contacts). 

The Adult Social Care system in Gateshead is under significant and sustained pressure, as a result of a range of factors relating both to the pandemic and post pandemic changes. As with many other sectors, the social care workforce is markedly struggling post pandemic, with colleagues experiencing fatigue, people leaving to join other sectors, and new worker recruitment being very challenging. The impact of these pressures is felt directly by our most vulnerable people in Gateshead, at a time when the whole health and care sector is experiencing increased demand with reduced capacity. 
Steph Downey, Service Director, Adult Social Care, Gateshead Council

Next - Chapter 11: How big is your 'us'