What can the NHS do to reduce premature mortality? Professor Sir Mike Richards NHS Health Check National Learning Event April 2013

Transcription

1 What can the NHS do to reduce premature mortality? Professor Sir Mike Richards NHS Health Check National Learning Event April 2013

2 The role of the NHS in reducing premature mortality Overview The scale of the challenge The Domain approach The role of the NHS in promoting health Early diagnosis Better treatment 2

3 3 Global Burden of Disease The Lancet (2013)

4 Age Standardised death rate (per 100,000) USA UK 400 Australia Australia Austria Belgium Canada Denmark Finland France Germany Greece Ireland

5 Major causes of death 2010 in the UK and comparative rankings UK rank/19 1. Ischaemic heart disease Lung cancer Stroke COPD Lower respiratory infections Colorectal cancer 9 7. Breast cancer Alzheimer s 11

6 6 NHS Presentation to [XXXX Company] [Type Date]

7 Living well for longer (March 2013) A call to action to reduce avoidable premature mortality Focus on the 5 big killers Cancer Respiratory Heart disease Liver Stroke Actions needed from 7 Government Individuals PHE LAs NHS Challenge: to avoid nearly 30,000 deaths pa by 2020 in people under 75 years

8 8 Living Well for Longer

9 The NHS Outcomes Framework made simple If you were seriously unwell, what would you be likely to want? To have your life saved To have a good quality of life thereafter To recover quickly To have a good experience of care from the NHS To be treated safely

10 The NHS Outcomes Framework made simple If you were seriously unwell, what would you be likely to want? To have your life saved (Domain 1) To have a good quality of life thereafter (Domain 2) To recover quickly (Domain 3) To have a good experience of care from the NHS (Domain 4) To be treated safely (Domain 5)

11 11 Living Well for Longer

12 Actions to reduce premature mortality: The NHS has important roles in Prevention Earlier diagnosis Improving initial management Improving acute services Preventing recurrence 12

13 Prevention Encouraging healthy lifestyles (related to smoking, obesity, diet, physical activity and alcohol) Referral to appropriate services Smoking cessation Weight management Alcohol Both primary care (e.g. GPs and pharmacies) and secondary care have roles to play NHS Health Check has an important role we need to maximise its effectiveness 13

14 Early diagnosis: The challenge Large numbers of people currently have undiagnosed conditions, for which interventions could reduce risk of premature mortality Hypertension: COPD: Diabetes: Chronic Kidney Disease: 6.8m undiagnosed >1m undiagnosed 850m undiagnosed 840k undiagnosed 14 Some people are wrongly diagnosed (e.g. COPD/asthma) Some people are diagnosed late when they have symptoms of cancer either because of delays in seeking help or delays after seeing a doctor Around 25% of patients with cancer are first diagnosed as emergencies

15 Support for GPs Identifying good and poor practices on the basis of referral rates, conversion rates and detection rates (G. Rubin et al) Providing GPs with feedback on screening uptake, referral practice etc. Decision support tools CAPER approach (W. Hamilton) Q Cancer approach (J. Hippisley Cox)

16 Improving initial management Fewer than 55% of people with diabetes received all 9 care processes in 2010 Only 20% of patients with diabetes achieved all 3 treatment standards (HbA1c, BP and cholesterol) Hypertension is poorly controlled in a significant minority of patients 16

17 Improving acute services Major progress has been made on improving acute services for cardiovascular disease and cancer over the past decade But... the task is not finished e.g. Only 60% of sites provide 7 day Transient Ischaemic Attack services Only 40% of stroke patients receive brain imaging within one hour of admission Some patients who could benefit are not receiving thrombolysis 17

18 Preventing recurrence Ensuring appropriate medication Encouraging physical activity. This has been shown to reduce risk of recurrence in cardiovascular disease and cancer 18

19 Summary Although premature mortality has improved over the past 20 years, we still lag behind most other developed countries New initiatives are needed on prevention, earlier diagnosis, treatment and rehabilitation The NHS has a very important part to play in this 19