Palliative Care. Health Needs Assessment

Transcription

1 Palliative Care Health Needs Assessment September 2009

2 You know I didn t know what palliative care was. When I got this letter inviting me to this focus group and saw palliative care I had to go and look it up in the dictionary. And I find out its what I ve been getting here at the hospice. It s about my quality of life.and that s improved so much since I ve been coming here. The care and attention is marvellous. I was told at the hospital that they couldn t do any more for me.i was just left.in limbo but they have here. Why can t everyone get the care and attention that we re getting here Here you know that the staff care about you.. as well as care for you everybody should get care like that everybody. (A focus group patient) We would like to thank the many health and social care professionals who took part in this palliative care health needs assessment for their interest, their commitment and their time. We are also indebted to Jackie Mearns, Carol Gillan and Ross Chaplin who provided invaluable assistance in the analysis and presentation of the data in this report. Our special thanks go to the patients and carers and the members of the general public who spoke so freely about their views on palliative care provision in NHS Greater Glasgow and Clyde. Dr Jacquelyn Chaplin Project Manager: Palliative care for people with non malignant conditions Kate Lennon Macmillan Consultant Nurse in Palliative Care 2

3 Contents LIST OF TABLES... 5 EXECUTIVE SUMMARY... 6 INTRODUCTION NHS GREATER GLASGOW AND CLYDE POPULATION AND SERVICES COMMUNITY PROFILES - NHS GREATER GLASGOW AND CLYDE Renfrewshire CHP West Glasgow CHCP East Glasgow CHCP South West Glasgow CHCP East Dunbartonshire CHP South East Glasgow CHCP North Glasgow CHCP West Dunbartonshire CHP East Renfrewshire CHCP Inverclyde CHP Cambuslang and Rutherglen (part of South Lanarkshire CHP) Stepps/ Muirhead area (part of North Lanarkshire CHP) COMMUNITY SERVICES IN NHS GREATER GLASGOW AND CLYDE Primary Care Care Homes Marie Curie Community Nursing Service Macmillan Carers Service The Community Pharmacy Palliative Care Network Voluntary Support ACUTE SERVICES IN NHS GREATER GLASGOW AND CLYDE MENTAL HEALTH SERVICES IN NHS GREATER GLASGOW AND CLYDE SPECIALIST PALLIATIVE CARE SERVICES IN NHS GREATER GLASGOW AND CLYDE West Dunbartonshire Renfrewshire/ East Renfrewshire Inverclyde North-East Glasgow North West Glasgow South Glasgow Glasgow-wide services Greater Glasgow and Clyde wide services Summary of Hospice Services in NHS Greater Glasgow and Clyde A POPULATION BASED APPROACH EPIDEMIOLOGICAL FACTORS Annual incidence of deaths Estimated prevalence of problems/symptoms Place of care and place of death DEMOGRAPHIC FACTORS Age and Structure of Population Ethnic Composition SOCIO ECONOMIC FACTORS Indices of Deprivation THE COMPARATIVE APPROACH COMPARISON WITH OTHER NHS BOARDS SUMMARY OF BENCHMARKING APPROACH ASSESSMENT OF THE NEED FOR CORE SERVICE COMPONENTS AS COMPARED TO CURRENT SERVICES GENERALIST PALLIATIVE CARE Generalist palliative care services in the community Generalist palliative care in care homes Generalist palliative care in the hospital setting

4 SPECIALIST PALLIATIVE CARE SERVICE PROVISION Specialist palliative care beds Specialist palliative community care Specialist palliative day services Specialist palliative care hospital support SUMMARY STAKEHOLDER PERSPECTIVES SURVEY OF HEALTH AND SOCIAL CARE PROFESSIONALS Palliative Care Services in the community Palliative Care Services in the hospital setting Different components of palliative care Key themes from survey responses FOCUS GROUPS The needs of people with non-malignant conditions The inequalities and service gaps within NHS Greater Glasgow and Clyde Better continuity, co-ordination and communication The need for education and training Person centred holistic services Patients, carers and members of the general public DISCUSSION CONCLUSIONS APPENDICES REFERENCES

5 List of Tables Table No. Title Page Number Table 1 Population of NHS Greater Glasgow and Clyde by CH(C)P Table 2 Hospices, population served, number of hospice beds, Consultants in Palliative 28 Medicine involved in hospice services in NHS Greater Glasgow and Clyde Table 3 Current access to hospice beds - NHS Greater Glasgow and Clyde by CH(C)P Jan 2010 Table 4 Current access to Community CNS - NHS Greater Glasgow and Clyde by CH(C)P Table 5 Annual incidence of deaths and deaths per 100,000 population from cancer, noncancer 32 deaths and deaths from all causes by CH(C)P, NHS Greater Glasgow and Clyde and Scotland Table 6 Cancer Patients prevalence of problems. Estimated number of patients in each 33 CH(C)P population Table 7 Patients with progressive non-malignant disease - prevalence of problems. 34 Estimated number of patients in each CH(C)P population Table 8 Preference verses actual place of death where patients want to be cared for and 35 where they currently die Table 9 Proportion of cancer deaths occurring at hospital, care home, hospice and own home 36 in NHS Greater Glasgow and Clyde by CH(C)P Table 10 Table 10: Most frequent causes of death, Greater Glasgow and Clyde NHS Board 37 area, 2007 by place of death Table 11 Percentage of people aged 65+, income deprived, single person household and from 38 minority ethnic origins in each CH(C)P Table 12 Indices of deprivation - Data zone ranks 40 Table 13 Index of Comparative need - NHS Boards - Cancer related palliative care 43 Table 14 Index of Comparative need - NHS Boards - Non cancer related palliative care 44 Table 15 Index of Comparative need for cancer related palliative care - NHS Greater Glasgow 45 and Clyde CHCP s Table 16 Index of Comparative need for non cancer related palliative care NHS Greater 46 Glasgow and Clyde CHCP s Table 17 Estimated need for cancer and non cancer specialist palliative care beds across NHS 54 Greater Glasgow and Clyde based on NHSGGC Index Value Indices of comparative need Table 18 Estimated Community Clinical Nurse Specialists required across NHS Greater 55 Glasgow and Clyde to provide cancer related and non cancer related palliative care based on NHSGGC Index Value Table 19 Minimum professional resources for community specialist palliative care 56 Table 20 Specialist palliative day care places required in NHS Greater Glasgow and Clyde by 58 CH(C)P Table 21 Hospitals in NHS Greater Glasgow and Clyde Number of in patient beds Admissions, cancer, non cancer and all deaths Table 22 Recommendations for minimum staff for hospital teams 61 Table 23 Table 24 Table 25 Estimated minimum requirements for specialist palliative care hospital teams for cancer related palliative care and current establishment 2009 NHS GGC Number of deaths, beds and death/beds ratio Hospitals - NHS Greater Glasgow and Clyde Summary of Minimum Medical and CNS Requirements for Core Specialist Palliative Care Services for cancer related and non cancer related palliative care, compared to current establishment NHS GGC

6 Executive Summary Introduction Adopting a multi-dimensional approach this Palliative Care Health Needs Assessment examines the cancer related and non cancer related palliative care needs of the 1,192,256 people receiving palliative care services from NHS Greater Glasgow and Clyde, the largest NHS Board in Scotland. A multi dimensional approach - Population based, comparative and stakeholders perspectives The impact that high cancer and non cancer death rates and deprivation have on the demand for palliative care services is estimated using a population based approach developed by Tebbit and utilised in England that examines epidemiological, demographic and socio-economic factors. Considerable diversity is seen in the Community Health (and Care) Partnerships that are responsible for meeting the health needs of the community and managing community based services. There are areas where the population experiences relative affluence and longevity, with growing numbers of older people who live alone. However a striking feature of many communities is the widespread and intense deprivation and the high cancer and non cancer death rates that are experienced by the people who live in NHS Greater Glasgow and Clyde s area. This population based approach was supplemented by a comparative dimension which provides information as to the relative needs of the population in NHS Greater Glasgow and Clyde, identifying that this need is greater than the average need in Scotland. In addition differential needs within NHS Greater Glasgow and Clyde are identified suggesting that the need for palliative care resources may vary from CH(C)P to CH(C)P by as much as +196%. Variation as to where people die was found; people in South West CHCP, South East CHCP, East Renfrewshire, Camglen and West Dunbartonshire are more likely to die in hospital and are less likely to die in a hospice than people in other areas. The stakeholder dimension also provided invaluable information, from the perspectives of health and social care professionals, patient, carers and members of the general public. Respondents to a questionnaire survey (n = 212) and participants in a series of 26 focus groups (n =177) identified a number of issues and priorities. These issues include: meeting the needs of people with nonmalignant conditions, inequalities and gaps in current services, continuity, coordination and communication, the need for education and training and the need to provide person-centred holistic services for patients and families. Key issues: A number of issues are therefore highlighted for further investigation/development. The use of the palliative care register for people with cancer and non malignant conditions is beneficial - the use of a similar approach in care homes and other long term care settings would be beneficial to the frail elderly The implementation of the Liverpool Care Pathway is seen to be beneficial in all care settings if supported by the appropriate education and practice development The exploration of different models for the provision of palliative care for people with non malignant conditions ensuring that a local whole system approach is taken that reflects patients and families experiences of care and is integrated with other strategic developments. Mortality data suggest that priority areas should include chronic lung disease, dementia, cardiovascular disease including stroke, heart failure, frail elderly people with multiple co morbidities Gaps, inequalities and mismatches of service provision have been highlighted o Inequitable provision of a specialist palliative medicine service to West Glasgow, West Dunbartonshire, part of East Dunbartonshire with limited specialist support for Clinical Nurse Specialists in those areas o o A lack of a specialist palliative care service at Vale of Leven hospital Informal palliative medicine provision only is available to Inverclyde Royal and the Western Infirmary / Gartnavel General 6

7 o o o o o There is a relative lack of access to hospice beds, this is significantly experienced in part of West Dunbartonshire, South West Glasgow, South East Glasgow, East Renfrewshire and Camglen particularly when compared to the identified need. Model(s) for provision of specialist palliative care for people with non malignant conditions is the key issue and will require consideration within the range of specialist disease specific care. Potential models for delivering specialist palliative care input to acute beds should particularly explore opportunities to maximize the benefits to be gained from shared care. Unequal access to specialist palliative care nursing advice for care homes a dedicated clinical service is only available in North East Glasgow while an education practice development service is available in Renfrewshire and Inverclyde The Care Homes Medical Practice and Care Homes Nurse Liaison team only support care homes in the former Greater Glasgow Board area The size and composition of specialist hospital palliative care teams requires review as their current establishment does not take account of number of beds, number of cancer and non cancer deaths, deprivation and current best guidance Deprivation and both high cancer and non cancer death rates have an impact on relative need for palliative care services most intense resource need is therefore identified in East CHCP, North CHCP, South West CHCP and Renfrewshire. Current mismatches between the identified need and the size, composition and geographical location of specialist palliative care provision requires further examination. o Inverclyde CHP and part of West Dunbartonshire CHP do not have access to a GP Palliative Care Facilitator The impact of an increasing number of deaths at home on community resources requires to be determined The need for integration of social care, home care, and community nursing services and the relevant funding streams to ensure that these work collaboratively with other services to ensure optimum and person centred care for those with palliative care needs who are at home The need for a range of approaches to support people who wish to be cared for and die at home, where this is possible, for example reviewing and optimising access to o respite services o day services o physiotherapy and occupational therapy o chaplaincy o psychological services o carer support o rapid supported discharge from hospital o carer support services In areas where a rise in the elderly populations, dementia and lone pensioner households is forecast alternative models of care might be explored e.g. alternative care at home packages and alternative models of nursing home provision might be considered Symptom management issues have been highlighted in relation to specific groups of patients for example pain in people with dementia, pain in people with multiple sclerosis, breathlessness and fatigue in people with cancer, heart failure and respiratory disease The need for a comprehensive plan for education and training for health and social care professionals in the acute setting, care homes, community, Out Of Hours, specialists in non malignant conditions, specialist palliative care The need to develop palliative care for those with special needs e.g. surviving children/young adults with life limiting conditions, people with learning disabilities etc Boundary anomalies / differences in the management of different members of the primary care team and out of hours services in the community have been identified in relation to Camglen and Stepps/ Muirhead area 7

8 Palliative Care Health Needs Assessment NHS Greater Glasgow & Clyde Introduction Needs assessment is an essential tool for health care providers to inform the service planning for a defined population. In the context of health care, need may be defined as the ability to benefit from health care (Stevens and Rafferty, 1994) A health needs assessment identifies current and future health and well being needs in light of existing services and strategic and national priorities. Thus a health needs assessment can be defined as a systematic method for reviewing the health needs of a population leading to agreed priorities that will improve health and wellbeing outcomes and reduce inequalities (Department of Health 2007) However, needs assessment is not an exact science and the techniques currently available do not lead to absolute measures of need (National Council for Hospice and Specialist Palliative Care Services, 2004) Nevertheless needs analysis does allow scrutiny of the principal factors that influence palliative care need. It is also important to recognise that within an NHS Board the size of NHS Greater Glasgow and Clyde there will be variations of need within its population where evident these have been highlighted in this report. This palliative care health needs assessment is the first systematic review of the palliative care needs of the population in NHS Greater Glasgow and Clyde. Its purpose is to provide information regarding the palliative care needs of the almost 1.2 million plus people in the NHS Greater Glasgow and Clyde area in light of existing services, highlighting gaps and mismatches in service provision. It will also inform future services planning by identifying priorities for change. It is important to recognise that this palliative care health needs assessment builds on two previous pieces of work; Argyll and Clyde Health Board Health Needs Assessment: Palliative Care (2001) and Greater Glasgow Health Board Health Needs Assessment for Palliative Care (2005). Considerable progress in palliative care services provision has taken place since these reports for example: the recognition of the needs of patients with non-malignant conditions, expansion of hospital specialist palliative care services, clarification of the role of Allied Health Professionals (Allied Health Professionals Project Team, 2004), developments in education provision and improved access to specialist pharmacy advice. This palliative care health needs assessment has a number of key drivers. First, the establishment of NHS Greater Glasgow & Clyde in 2007 with its newly established boundaries means that there is a 8

9 need to review palliative care needs and services across NHS Greater Glasgow and Clyde. Secondly, the requirement in the first National Action Plan for Palliative Care in Scotland Living and Dying Well (2008) that services be planned and delivered based upon identified population need. Thirdly, the report Review of palliative care services in Scotland highlights the need to ensure that services are provided for all who need it regardless of diagnosis and are managed in a way that ensures optimum use of resources (Audit Scotland, 2008). Furthermore, a recent report on palliative care in care homes Better care every step of the way, highlights the important role that care homes play in the provision of general palliative care to our elderly (Care Commission, 2009). Palliative care is defined by World Health Organisation (WHO, 2002) as an approach that improves the quality of life of patients and their families facing the problem associated with lifethreatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care can start from the point of diagnosis of a life-limiting condition and may continue through to bereavement support offered to families after someone has died. This broad definition of palliative care encompasses both generalist and specialist palliative care. Generalist palliative care forms part of the regular care of patients and support for families that is provided in many care settings. It can be provided in the patient s home, a care home or as part of the care provided in a hospital ward. As a result generalist palliative care is part of the work of a wide range of health and social care workers including GP s, hospital consultants, district nurses, social workers, care assistants as well as Allied Healthcare Professionals. Specialist palliative care can also be provided anywhere; in hospices, hospitals, care homes or at home. It focuses on people with complex palliative care needs, such as people needing complex pain management or psychological support. It is provided by professionals who specialise in palliative care; for example, consultants in palliative medicine and clinical nurse specialists in palliative care. Specialist palliative care was developed primarily as a means of providing support to people with cancer nearing the end of life, however now provides care for people at earlier stages of illness, including those with other life limiting illnesses. Palliative care was developed in the 1060 s at the world s first modern hospice, St Christopher s Hospice in London, and became a recognised medical speciality in The number of hospices grew rapidly, with the voluntary sector opening around ten new hospices in the UK each year during the 1980 s. The voluntary sector remains a key provider of specialist palliative care and is increasingly working in partnership with the NHS to plan and deliver services. 9

10 Most people with palliative care needs receive care from generalist providers in their own homes, acute hospitals, long-stay hospitals, community hospitals and care homes. Lead cancer and palliative care GP s and palliative care nurse facilitators, often funded (at least initially) by the voluntary sector, have taken a key role in developing general palliative care in the community. It is important to recognise that the term palliative care is used to denote both the care provided in all care settings mainly by generalists as well as that provided by specialists in palliative care. In this report, where it is necessary to differentiate between generalist palliative care and specialist palliative care, these terms will be used. This palliative care health needs assessment adopts a multi-dimensional approach. It combines examination of population related information, e.g. epidemiological, demographic and socioeconomic factors, with a comparative analysis of the relative palliative care needs of the different populations in NHS Greater Glasgow and Clyde. It also incorporates mapping of the core services requirements against current services. In addition, elicitation of stakeholders perspectives has been undertaken; namely patients, carers and health and social care professionals. The findings from these investigations are combined to identify services issues and gaps and/or mismatches in service provision in order that priorities for service change can be determined. Chapter one provides contextual information regarding the population in NHS Greater Glasgow and Clyde and the current services available. Chapter two presents epidemiological, demographic and socio-economic factors that are most likely to influence the palliative care needs of a population. Chapter three provides evidence of the comparative analysis of palliative care need. This comparative approach utilises mortality and deprivation data to compare the palliative care need of the population of NHS Greater Glasgow and Clyde with other NHS Boards. It also presents a comparison of the needs of different communities within NHS Greater Glasgow and Clyde. In chapter four the assessed need for core palliative care services in NHS Greater Glasgow and Clyde is identified and a comparison to current services is provided. This is followed in chapter five by the provision of a stakeholders dimension that presents the perspectives of health and care professionals, patients, carers and the general public. 10

11 Chapter six provides a synthesis of the key issues arising from the data collected during this palliative care health needs assessment and identifies relevant contextual issues. This report concludes by identifying key issues for future development. 11

12 1. NHS Greater Glasgow and Clyde Population and Services The population being assessed is the 1,192,256 people who live in NHS Greater Glasgow & Clyde and the associated areas of Cambuslang and Rutherglen in South Lanarkshire and the area of Stepps/Muirhead in North Lanarkshire. NHS Greater Glasgow and Clyde has a population of 1,116,040, which is almost a quarter of the population of Scotland, and is the largest NHS Board in Scotland. NHS Greater Glasgow and Clyde covers a geographical area from Greenock in the West to Easterhouse in the East of Glasgow, and from Alexandria near the shores of Loch Lomond in the North West to the Renfrewshire/Ayrshire borders in the South. The resident populations of Cambuslang and Rutherglen, often called Camglen (population 57,076) and the resident population of the Stepps/Muirhead area (population 19,140) are also included in this palliative care health needs assessment for three reasons. First, these populations are served by General Practitioners who are currently contracted to NHS Greater Glasgow and Clyde. Secondly, these resident populations currently use acute services in NHS Greater Glasgow and Clyde. Thirdly, they also use specialist palliative care services in NHS Greater Glasgow and Clyde. Throughout this report when reference is made to the population of NHS Greater Glasgow and Clyde this refers to the population within NHS Greater Glasgow and Clyde s boundary and the resident populations of Camglen and the Stepps/Muirhead area, that is 1,192,256 people, unless otherwise indicated. Serving a population of almost 1.2 million people, health care provision is managed in the community by NHS Greater Glasgow and Clyde s 10 Community Health (and Care) Partnerships. In addition, in Cambuslang and Rutherglen (Camglen) responsibility for the management of community services has partlially been transferred to South Lanarkshire Community Health Partnership, while the Stepps/Muirhead area is part of North Lanarkshire Community Health Partnership. CH(C)Ps hold budgets and contracts for primary care, prescribing, health improvement and promotion and provide primary and community services for their own area, or may host these on behalf of others. CH(C)Ps are intended to deliver structures for integrating health and social care services in order to meet the heath and social care needs of their populations by promoting joint assessment, simplifying access with a stronger focus on vulnerability, early intervention and inclusion. 12

13 It should be noted that the organisational structure of the Community Health Partnerships vary within NHS Greater Glasgow and Clyde. Those that were originally part of Argyll and Clyde Health Board have a slightly different senior management structure from those that were originally part of Greater Glasgow Health Board. Appendix 1 provides a map depicting the geographical areas of NHS Greater Glasgow and Clyde and below Table 1 identifies the current populations of each CH(C)P. Table 1: Population of NHS Greater Glasgow and Clyde by CH(C)P 2007 CH(C)Ps Structure Population Renfrewshire CHP 169,600 West Glasgow CHCP 139,853 East Glasgow CHCP 123,729 South West Glasgow CHCP 117,341 East Dunbartonshire CHP 104,850 South East Glasgow CHCP 101,348 North Glasgow CHCP 99,669 West Dunbartonshire CHP 91,090 East Renfrewshire CHCP 87,480 Inverclyde CHP 81,080 South Lanarkshire (pt) - Camglen CHP 57,076 North Lanarkshire (pt) - Stepps CHP 19,140 NHSGG & C Total 1,192,256 Data Source: Small Area Population Estimates (SAPE) General Register Office for Scotland (GROS) There are significant inequalities in health status and outcomes across the population of Greater Glasgow and Clyde, with poorer health outcomes amongst those who live in deprived areas in particular, but also inequalities and discrimination in relation to age, sex, ethnic origin, disability, faith and sexual orientation. The next section provides a profile of the communities that access specialist palliative care services in NHS Greater Glasgow and Clyde commencing with the CH(C)P with the largest population (Hanlon, Walsh and Whyte, 2006; Glasgow Centre for Population Health, 2008; Scottish Public Health Observatory, 2009). This is followed by a summary of current services. Community Profiles - NHS Greater Glasgow and Clyde Renfrewshire CHP Population: Bordering Ayrshire in the south and the River Clyde in the north, Renfrewshire, is the largest community health partnership, both geographically and in terms of population, with a population of almost 170,000 people. Of the people in Renfrewshire over 18% are children, over 65% are young and middle-aged adults and 16% are older people. There has been a drop, like many other areas, in the size of the overall population in the last ten years (nearly 7,000). 13

14 However, there were rises in the number of middle-aged adults (45-64), up by 2,900, and older people, up by 1,600. The proportion of the population from a minority ethnic community (1.2%) is approximately half the Scottish average. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 73.5 years, slightly lower than the Scottish average, and has risen by about a year in the period to Female life expectancy (78.3 years) has risen by approximately a year in the same period and is still slightly lower than the Scottish average. Comparing different areas of the community, there is a gap in life expectancy across the neighbourhoods of at least 20 years for men and nearly 12 years for women. In a number of neighbourhoods with lower than average life expectancy, life expectancy appears to have remained static or may even have fallen. Some of the highest Scottish emergency hospital admission rates are seen in some of the communities of Renfrewshire CHP. Prosperity/Poverty: Over 25,000 people, 14.9% of the Renfrewshire population, are defined to be income deprived. West Glasgow CHCP Population: West Glasgow with a population of nearly 140,000 people, stretches from Glasgow City Centre to Drumchapel and Yoker and is the community health and care partnership with the second largest population in NHS Greater Glasgow and Clyde. In West Glasgow 14% of the population are children, 72% are young and middle-aged adults and 14% are older people. There has been relatively little change in the size of the overall population in the last ten years. Approximately 1,200 asylum seekers live in the area. The proportion of the population from a minority ethnic community (6.1%) is three times the Scottish average. There are nearly 70,000 households in West Glasgow, of which over 32,000 (46%) are single adult households. Like all other Glasgow City areas it is predicted that in the period from 2002 to 2016 there will be a significant rise in single adult households with no children, such that single adult households with no children will constitute 49% of all households in Glasgow City areas. There are some neighbourhoods in West Glasgow CHCP that have large numbers of old and very old people (80 years plus) e.g. Knightswood and Blairdardie where 21.6% and 22.9% of the local populations, respectively, are aged 65 years and over. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 70.8 years, approximately three years below the Scottish average, and has only risen by about a year in the period to Female life expectancy (77.7 years) has risen by 1.7 years in the same period and is closer to, but still below, the Scottish average. Comparing different areas of the community, there is a gap in life expectancy across the neighbourhoods over 11 years for men and over eight years for women. 14

15 Prosperity/Poverty: There are 28,000 people, 20% of the West CHCP population, defined to be income deprived. East Glasgow CHCP Population: Stretching from Bridgeton to Easterhouse, East Glasgow has a population of almost 124,000 people, of whom nearly 18% are children, 66% are young and middle-aged adults and nearly 16% are older people. There has been a fall of approximately 11,500 in the size of the overall population in the last ten years. The proportion of the population from a minority ethnic community (1.5%) is lower than the Scottish average. Approximately 720 asylum seekers live in the area. There are nearly 60,000 households in East Glasgow, of which over 23,900 (40%) are single adult households. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 68.1 years, one of the lowest rates in Scotland, at over five years lower than the Scottish average. Male life expectancy has risen by less than a year in the period to Female life expectancy (76.0 years) has risen 1.4 years in the same period and is approximately three years lower than the Scottish average. Comparing different areas of the East Glasgow community, there is a gap in life expectancy across the neighbourhoods of over 11 years for men and over 4 years for women. In many neighbourhoods with lower than average life expectancy, life expectancy appears to have remained static or may even have fallen. Emergency admissions and admissions related and attributed to alcohol in East Glasgow CHCP are among the highest in Scotland. Prosperity/Poverty: Over 36,000 people in East Glasgow (30%), almost a third of the population, are defined to be income deprived. South West Glasgow CHCP Population: South West Glasgow, which includes Govan, Cardonald and Pollok has a population of over 117,000 people, of whom over 18% are children, 66% are young and middle-aged adults and over 15% are older people. There has been a small drop of approximately 2,600 in the size of the overall population in the last ten years. Approximately 1,300 asylum seekers live in the area and the proportion of the population from a minority ethnic community (4.5%) is double the Scottish average. There are over 54,200 households in South West Glasgow, of which over 21,000 (40%) are single adult households and 17% are lone pensioner households. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 70.1 years, nearly four years lower than the Scottish average, and has risen by approximately two years in the period to Alongside East Glasgow, male life expectancy in South West Glasgow is among the lowest in Scotland. Female life expectancy (76.7 years) has risen by only a year in the same period and is over two years below the Scottish average. 15

16 Comparing different areas of the community there is a gap in life expectancy across the neighbourhoods of South West Glasgow of nearly nine years for men and nearly seven years for women. Prosperity/Poverty: Over 28,000 people, 24% of the population, are defined to be income deprived. East Dunbartonshire CHP Population: Situated on the North East boundary of NHS Greater Glasgow and Clyde, East Dunbartonshire has a population of nearly 105,000 people, of whom 19% are children, 63% are young and middle-age adults and over 17% are older people. There has been a fall of over 3,800 in the size of the overall population in East Dunbartonshire in the last ten years. However, there have been different trends in different age bands; the number of children has fallen by nearly 3,000 and the number of young adults (16-44) by over 6,000; over the last 10 years the number of middle-aged adults and older people has risen collectively by over 5,400. It is predicted that the size of the population of East Dunbartonshire will decline by 10.5% in the period from 2004 to At the same time it is predicted that the proportion of those over 65 years and those over 80 years of age will increase. The proportion of the population from a minority ethnic community (3.1%) is above the Scottish average. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 77.4 years, 3.5 years higher than the Scottish average, and has risen by 2.4 years in the period to Female life expectancy (80.9 years) has risen by 1.6 years in the same period and is approximately 1.8 years higher than the Scottish average. In Bearsden life expectancy is one of the highest in Scotland. Comparing different areas of East Dunbartonshire, there is a gap in life expectancy across the neighbourhoods of 15 years for men and over 12 years for women. Prosperity/Poverty: Over 7,800 people, 7.4% of the population, are defined to be income deprived. South East Glasgow CHCP Population: Including communities such as the Gorbals, Pollokshields and Castlemilk, South East Glasgow has a population of just over a 101,000 people, of whom nearly 17% are children, 70% are young and middle-ages adults and over 13% are older people. There has been a small drop of approximately 3,500 in the size of overall population in the last ten years. Approximately 690 asylum seekers live in the area and the proportion of the population from a minority ethnic community (11%) is more than five times the Scottish average. This figure of 11% masks large differences between localities within South East Glasgow; the community of Carmunnock has 0.7% of its population from minority ethnic groups as compared to Pollokshields East where almost half (47.8%) of the local population is from minority ethnic groups. 16

17 There are 49,700 households in South East Glasgow, of which over 21,800 (44%) are single adult households, a figure that is predicted to rise. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 71.4 years, 2.5 years lower than the Scottish average, and has risen by approximately 1.7 years in the period to Female life expectancy (78.0 years) has risen by 1.7 years in the same period and is approximately one year lower than the Scottish average. Comparing different areas of the community there is a gap in life expectancy across the neighbourhoods of over 13 years for men and over eight years for women. Alongside East Glasgow, South East Glasgow has one of the highest national rates of hospital admissions, related and attributable to alcohol. Prosperity/Poverty: Over 22,000 people, 22% of the population, are defined to be income deprived. North Glasgow CHCP Population: North Glasgow, which encompasses Springburn, Robroyston and Balornock, has a population of nearly 100,000 people, of whom 17% are children, 68% are young and middle-aged adults and 15% are older people. There has been a small drop in the size of the overall population in the last ten years. Approximately 1,700 asylum seekers live in the area and the proportion of the population from a minority ethnic community (4.6%) is more than double the national average. There are 47,600 households in North Glasgow, of which over 20,000 (43%) are single adult households, a figure that is predicted to rise. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 68.2 years, more than five years lower than the Scottish average, and has only risen by approximately 1.4 years in the period to Female life expectancy (75.4 years) has risen only slightly (by less than a year) in the same period and is nearly four years below the Scottish average. Comparing different areas of the community, there is a gap across the neighbourhoods of over 12 years for male life expectancy and over nine years for women. In some neighbourhoods with lower than average life expectancy, life expectancy appears to have remained static or may even have fallen. Prosperity/Poverty: Nearly 28,000 people, 28% of the population, are defined to be income deprived. West Dunbartonshire CHP Population: Stretching from Dalmuir to west of the southern shores of Loch Lomond, and encompassing communities such as Kilbowie, Dumbarton and Alexandria, West Dunbartonshire has a population of just over 91,000 people, of whom over 18% are children, 66% are young and middle-aged adults and 16% are older people. There has been a fall of over 4,000 in the size of the overall population in the last ten years and this decline in population size is predicted to continue with a 8.7% reduction between 2004 and

18 The proportion of the population from a minority ethnic community (0.7%) is less than half the national average. In the period from 2002 to 2016 it is predicted that the number of single adult households with no children will rise to become 42% of the households in West Dunbartonshire. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 71.1 years, 1.8 years lower than the Scottish average, and has risen by about 0.6 years in the period to Female life expectancy (77.7 years) has risen by nearly a year in the same period and is approximately 2.8 years lower than the Scottish average. Comparing different areas of the community, there is a gap in life expectancy across the neighbourhoods of approximately nine years for both men and women. In a few neighbourhoods with lower than average life expectancy, life expectancy has remained static or may even have fallen. Prosperity/Poverty: Nearly 18,000 people, 19.7% of the population, are defined to be income deprived. East Renfrewshire CHCP Population: On NHS Greater Glasgow and Clyde s southern border and encompassing Giffnock Clarkston and Mearnskirk, East Renfrewshire has a population of approximately 89,000 people, of whom over 20% are children, 62% are young and middle-aged adults and 17% are older people. Unlike other areas in NHS Greater Glasgow and Clyde there has been a rise in the size of the overall population in the last ten years of nearly 2,000. The main reasons for this have been the increases in middle-aged adults (45-64), up by 3,300 in the period, and in older people, up by 2,300. Over the same period the number of young adults (16-44) fell by 3,250 with the number of children dropping slightly also. It is anticipated that a small population increase will continue in the period up to 2014, with a 3% increase from 2004 figures. In addition, in some localities a significant percentage of the population is over 65 years; Netherlee (22.1%), Mearnskirk and South Kirkhill (22.1%) and North Giffnock and North Thornliebank (25.1%). It is also predicted that the largest increase in households in the West of Scotland will occur in East Renfrewshire, with an 11% rise over the period of 2002 to The proportion of the population from a minority ethnic community (3.8%) is nearly double the national average. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 76.5 years, 2.6 years higher than the Scottish average, and has risen by about a year in the period to Female life expectancy (81.3 years) has risen by 1.2 years in the same period and is approximately two years higher than the Scottish average. Comparing different areas of the East Renfrewshire community, there is a gap in life expectancy across the neighbourhoods of over 14 years for men and over 11 years for women. Prosperity/Poverty: In contrast to East Glasgow, East Renfrewshire has a relatively small proportion of the population and (7.5%), over 6,600 people, are defined to be income deprived. 18

19 Inverclyde CHP Population: Inverclyde, the most westerly CH(C)P on the southern shores of the Firth of Clyde is the smallest CHP in terms of population in NHS Greater Glasgow and Clyde, but is one of the larger CH(C)P s geographically. Encompassing, Kilmacolm, Greenock and Wemyss Bay Inverclyde has a population of just over 81,000 people, of whom 18% are children, 65% are young and middle-aged adults and 17% are older people. There has been a drop of 5,500 in the overall population in the last ten years, the largest reduction in population in the West of Scotland. This reduction is anticipated to continue with a predicted decline of 13.6% in the period from 2004 to However it is also expected that the proportion of elderly people (65 years plus) will rise in the period leading to The proportion of the population from a minority ethnic community (0.9%) is half the Scottish average. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 70.9 years, three years lower than the Scottish average, and has risen by 1.6 years in the period to Female life expectancy (77.8 years) has risen by nearly a year in the same period but is still three years lower than the Scottish average. Comparing different areas of the community, there is a gap in life expectancy across the neighbourhoods of over 11 years for men and over 13 years for women. Inverclyde has one of the highest rates of hospital admissions for heart disease in Scotland. Prosperity/Poverty: Over 15,800 people, 19.3% of the population, are defined to be income deprived. Cambuslang and Rutherglen (part of South Lanarkshire CHP) Previously part of Greater Glasgow Health Board, the localities of Cambuslang and Rutherglen, (often referred to as Camglen) have, since the establishment of NHS Greater Glasgow and Clyde been in a process of transition and health care in this area is managed in part by South Lanarkshire CHP. However NHS Greater Glasgow and Clyde also provide community services to this area and the population still access many services in Glasgow. Population: Camglen is situated on the southern shores of the River Clyde between South East Glasgow and East Glasgow. Camglen has a population of just over 57,000, of which 19% are children, 64% are aged between years and approximately 17% are aged 65 years or over. The proportion of the population from a minority ethnic community (1.2%) is less than the Scottish average. The people of Camglen comprise approximately 18% of the population of South Lanarkshire CHP. Life Expectancy and Mortality: For men, life expectancy (at birth) is estimated to be 72.1 years, slightly less than the Scottish average of 73.9 years. Female life expectancy (77.1 years) is two years lower than the Scottish average. 19

20 Prosperity/Poverty: Over 6,000 people, approximately 14% of the population of Camglen, are income deprived. Stepps/ Muirhead area (part of North Lanarkshire CHP) Previously part of Greater Glasgow Health Board, the Stepps/ Muirhead area has, since the establishment of NHS Greater Glasgow and Clyde, been in a process of transition and health care in this area is now managed in part by North Lanarkshire CHP. However NHS Greater Glasgow and Clyde also provide community services to this area and, like Cambuslang and Rutherglen, the population who live in the area around Stepps still access many services in Glasgow. Population: With a population of just over 19, 000 this area comprises 2.2% of the population of North Lanarkshire CHP (total population 323,780). The information provided below is for North Lanarkshire CHP as a whole. Life Expectancy and Mortality: For men in North Lanarkshire CHP, life expectancy (at birth) is estimated to be 72.3 years, over a year lower than the Scottish average. Female life expectancy (77.6 years) is almost two years lower than the Scottish average. Prosperity/Poverty: Approximately 17% of the population of the Stepps/ Muirhead area is income deprived. Community Services in NHS Greater Glasgow and Clyde Primary Care Primary Care is generally regarded as being at the heart of NHS services and is provided by independent contractors - general practitioners, pharmacists, dentists and optometrists often as part of a multi-disciplinary team and alongside multi-agency teams of primary and community care services. Most community services are managed by CH(C)Ps supplemented by some specialist community services managed by a host CH(C)P, Mental Health Partnership or the Acute Division. Around 90% of patients registered with General Practices are in contact with a member of the practice team over the course of a year. From a generalist palliative care perspective in the community setting, professionals who play a key role in the delivery of patient and family care are General Practitioners, District Nurses, Out of Hours medical and nursing services, social work staff and care workers. In NHS Greater Glasgow and Clyde there are approximately 1,000 General Practitioners and 1,100 District Nurses. 20

21 The populations of Camglen and the Stepps/ Muirhead area are served by General Practitioners who are contracted to NHS Greater Glasgow and Clyde and Community Nurses who are employed by NHS Lanarkshire. The populations of these areas have for many years, and continue to, access both acute services and specialist palliative care services in NHS Greater Glasgow and Clyde. In NHS Greater Glasgow and Clyde, community Out of Hours nursing services are managed on either a CH(C)P or a sector basis from a number of locations, mainly health centres, for example north east Glasgow, south Glasgow etc. Greater Glasgow and Clyde Out of Hours Medical Services have recently merged to form NHS Greater Glasgow and Clyde Out of Hours Medical Services which is centrally and separately managed from GP services. Both Out of Hours Nursing Services and Out Of Hours Medical Services in NHS Greater Glasgow and Clyde serve the populations of Camglen and Stepps/Muirhead. Care Homes Some of the population in NHS Greater Glasgow and Clyde are too frail or vulnerable to live at home and as result live in one of 250 plus care homes that exist within the Board s boundaries. Approximately 10,000 people reside in care homes most of which are privately owned, although some care homes work in partnership with social work services and the NHS. These mainly elderly people, but some young disabled, may reside in a residential care home (approximately 3,000). These residential care home residents are supported to live by social care workers and their general palliative care needs are mainly met by their local General Practitioner and Community nurses. Alternatively, many (over 6,000) reside in a nursing care home that employs its own nursing staff who provide twenty-four hour nursing care with medical support from General Practitioners. Additional support is available in some areas. Within the former Greater Glasgow City boundary there is a dedicated Central Medical Practice (6.1 WTE GP s) that, with Assisting Practices, provides General Practice to approximately 3,000 patients in 58 specified care homes. Also, within the previous Greater Glasgow Health Board boundaries there is a Care Home Nurse Liaison Team (12 WTE) providing additional nursing support to 72 specified care homes (with nursing) with approximately 4,400 beds. Two posts within this nurse liaison team are funded by NHS Greater Glasgow and Clyde Managed Care Network for Palliative Care. These community services are currently managed within the Acute Operating Division and are not available in other areas of NHS Greater Glasgow and Clyde. 21