Deprivation, staff shortages and older population leading to poorer health outcomes for Scarborough's residents compared to inland neighbours
Behind the beautiful scenery, Scarborough is facing a variety of issues that are leading to poorer health outcomes for its residents compared to their inland neighbours.
The contrast is stark when examining the figures, which show those born in Scarborough have lower life expectancy than both the county and national average, a trend mirrored in other coastal locations around England.
The report states there are many reasons for poor health outcomes in coastal areas including a larger proportion of older residents; higher levels of deprivation; difficulties in attracting healthcare staff and access to health services.
Data from Public Health England (PHE) shows from 2017-19 in the local authority of Scarborough life expectancy for men at birth was 78.1.
This is in the bottom 25th percentile compared to the rest of the country and below the national average of 79.8.
For women across the same time period life expectancy was 82.8, below the national average of 83.4.
Dr Asif Firfirey, a GP at Eastfield Medical Centre, has worked in this area for 15 years and knows first hand how these issues are affecting the patients he treats.
He explained how ongoing problems such as seasonal work and poor aspiration in areas of Scarborough with high deprivation have lasting effects on people’s health, echoing Mr Whitty’s report.
“A lot of issues that have been there have been increased by the pandemic,” he said. “There are lots of mental health issues.
“It’s not just about health services, it’s looking at long term provision of housing, schooling and parks.”
The report highlights deprivation as a key factor contributing to the disparity between coastal communities and their inland neighbours.
Deprivation is connected to higher levels of mental health issues as well as obesity and smoking.
Figures from Public Health England show that in the local authority of Scarborough in 2019/20, 69.6% of adults were classified as overweight or obese, above the English average of 62.8%.
Between 2017 and 2019 the suicide rate in Scarborough was 16 per 100,000 people, the 10th highest in England.
Nine neighbourhoods in the local authority of Scarborough were among the 10% most deprived neighbourhoods in the country, according to the The English Indices of Deprivation 2019.
The recruitment and retention of staff in health and social care is another common problem on the coast.
Analysis by Health Education England (HEE), responsible for the co-ordination of education and training within the health and public health workforce, has found that despite coastal communities having an older and more deprived population, they have 14.6% fewer postgraduate medical trainees, 15% fewer consultants and 7.4% fewer nurses per patient.
Dr Firfirey said that as many services that had previously been based in Scarborough Hospital have been moved to York after the merger of the two trusts in 2012, fewer medical trainees were now coming through the Scarborough area.
He said: “If a trainee wants to specialise in something like vascular surgery, [Scarborough] doesn’t feel like an attractive prospect.
“It is difficult to recruit in this area. We’ve had a bit of a dip in trainee applicants and a large part of the GP cohort retired at the same time across the patch.”
Professor Whitty stated the disparity between higher levels of disease in coastal areas and fewer staff needs to be addressed by HEE.
A spokesperson for York and Scarborough Teaching Hospitals NHS Foundation Trust, said: “It is well documented that staffing shortages within the NHS and wider healthcare continue to be a key challenge across the country, and our hospitals are no different.
“It is acknowledged that we have difficulty recruiting trained nurses and doctors at Scarborough Hospital, and in some specialities this is increasingly difficult.
“However, we are absolutely committed to increasing and strengthening our workforce on the East Coast which we are doing through a number of initiatives, including developing new roles, a successful partnership with Coventry University for nursing opportunities, as well as overseas recruitment.”
What needs to be done
Prof Whitty’s report does recognise the health benefits that can come from living on the coast, but made several recommendations to government to tackle inequality.
He is calling for a cross-government national strategy to address the housing, environment, education, employment, economic and transport inequalities which all impact on the overall health of coastal communities.
Dr Firfirey continued: “[Scarborough] is a beautiful, wonderful place but there are issues that need to be addressed. Chris Whitty’s report has acknowledged them but now we need action.
“The thing is, I love the work I do,” he said. “We see ourselves as part of the community, it’s not just treating patients’ conditions but improving their lives.”
A spokesperson for NHS North Yorkshire Clinical Commissioning Group, which is responsible for commissioning health services across the county, including hospitals, said: “The recent Chief Medical Officer report on coastal communities supports the view of NHS North Yorkshire CCG that there needs to be focussed work to improve the health of coastal communities in areas such as Scarborough, Whitby and Bridlington.
“The CCG and North Yorkshire County Council have committed to work to reduce health inequalities in areas such as improving cardiovascular and respiratory health and improving earlier access to cancer care.”
County council confronts inequality
North Yorkshire County Council, who are responsible for the health of residents and public health services, have acknowledged the disparity between health outcomes across the country.
Richard Webb, NYCC’s director of health and adult services, said: “ We really welcome this report from Chris Whitty, it’s important there’s a focus on the health of coastal communities.
"It’s an issue that we raise on lots of occasions and we often make the comment that actually there are significant health issues and inequalities in coastal areas, and indeed rural areas.”
He emphasised that the Yorkshire coast was a great place to live but there were issues to address. He continued: “Someone living in the centre of Scarborough will have twenty years less of healthy life compared with someone who lives in Hutton Rudby.
“That’s a big gap and it’s bigger than some of the gaps we see in some of our urban areas across England and the wider UK.”
Mr Webb explained the county council has seen stop-smoking rates increase and were pushing NHS England to address the problems residents in Scarborough were having accessing dental care.
He said a successful economy is an important part of people’s health, and NYCC continue to push initiatives to stimulate the local economy such as the A64 dualling project and improving rail services to the coast.