LOCALITY PROFILE PROFILE FOR WEST MID BEDS LOCALITY 2013 Public Health Evidence & Intelligence Directorate of Public Health
Policy & Document West Mid Beds Locality Profile 2013 (Phase 1) Operational & Management Purpose of Document Multidisciplinary Partnership working To provide information about the health needs of the local population in order to support GP commissioners to develop their commissioning priorities Title West Mid Beds Locality Profile 2013 Authors Co-authors & Contributors Anthony Scanlon, Edmund Tiddeman Dr Annapurna Sen, Malcolm Cox, Jeremy Phillips, Helen Knowles, Jago Kitcat & Dr Sanhita Chakrabarti Special thanks Publication Date May 2013 Dr Alvin Low, Ivel Valley Locality & Dr Peter Parry Okeden, Bedford Locality for their contributions Contact Details Version Email: askpublichealth@nhs.net Directorate of Public Health Bedford Borough Council Borough Hall Cauldwell Street MK42 9AP Version 7 final Review Date April 2014 2 P a g e
1 Foreword This Locality Profile has been designed to support locality GP commissioners develop priorities, assess practice by practice variations, identify inequalities and compliment the JSNA. It brings together granular information about the health needs of the population and in this phase 1 report there is a focus on the major causes of premature mortality. The report has been compiled by the Core Public Health team at Bedford Borough and Central Bedfordshire Councils. The Department of Health has recently published Living Well for Longer which is about reducing avoidable, premature mortality caused by the big killer diseases. Premature Mortality is death aged under 75 years and it is envisioned that England s premature mortality will become the lowest amongst our European peers but it has been shown that we have a long way to go. The Longer Lives report compares overall and specific disease premature mortality from similarly deprived local authorities and shows that Central Bedfordshire is 14 th out of 15 similar local authorities for overall premature mortality. We aim to improve. Within this locality profile report the small area data can provide within-area variation which can be lost in large scale data, which may hide pockets of differing results. It is part of the Director of Public Health s role to have a particular focus on ensuring disadvantaged groups and receiving the attention they need with the aim of reducing health inequalities. Of importance in reducing premature mortality is a focus on lifestyle choices people make such as smoking, poor diet, inactivity and excessive alcohol consumption all which all play their part in determining poor health. On average people with all four of these unhealthy behaviours die fourteen years earlier than those with none of the behaviours. In this locality profile report we also look at health behaviours: smoking, obesity, alcohol and NHS Health Checks. It is intended that subsequent phases of the locality report will concentrate on children and wider determinants of health as well as being an update of phase 1. I am pleased to introduce this locality profile. Dr Sanhita Chakrabarti MRCOG FFPH Assistant Director of Public Health Core Public Health Team Bedford Borough and Central Bedfordshire Councils October 2013 3 P a g e
Contents 1 West Mid Beds Summary 9 2 Aim of the Locality Profiles 12 3 West Mid Beds Locality Patient Profiles 12 4 Demography and Socioeconomic Factors 14 4.1 Population 14 4.2 Ethnicity 16 4.3 Deprivation 17 4.4 Life Expectancy 19 4.5 Mosaic 20 5 Health Behaviour 22 5.1 NHS Health Checks 22 5.2 Smoking 23 5.3 Obesity 26 5.4 Alcohol 27 6 Mortality & Morbidity 28 6.1 Circulatory system 28 6.2 Respiratory Disease: COPD & Asthma 51 6.3 Diabetes 63 6.4 Cancer 76 7 Appendix 1 95 8 Glossary of Terms 96 9 References 98 4 P a g e
Figure 1 West Mid Beds distribution of registered patients 13 Figure 2 Population pyramid for West Mid Beds Locality compared to England Population 14 Figure 3 Ethnicity distributions in West Mid Beds Locality 2011 16 Figure 4 Deprivation scores by Ward 2010 17 Figure 5 Deprivation scores by GP Practice (IMD), 2010 18 Figure 6 Life expectancy at birth for West Mid Beds (2006-2010) 19 Figure 7 West Mid Beds mosaic supergroups 20 Figure 8 Further breakdown of mosaic groups in West Mid Beds 21 Figure 9 NHS Health Checks 22 Figure 10 Smoking Prevalence by GP practice Locality, 2013 23 Figure 11 Stop smoking achievement compared to targets for West Mid Beds locality practices, showing number of 4-week quits, 2012/2013 24 Figure 12 Alcohol Specific & Related hospital admissions, 2012/2013 27 Figure 13 Observed Vs. Estimated prevalence of CHD in West Mid Beds (2011/12) 29 Figure 14 CHD 6 - % Patients with blood pressure <= 150/90 31 Figure 15 CHD 8 - % Patients with total cholesterol 32 Figure 16 CHD 9 - % Patients using aspirin, alternative antiplatelet therapy or anticoagulant, without a contraindication or side effect 33 Figure 17 CHD 10 - % Patients treated with a β blocker, without a contraindication or side effect 34 Figure 19 STROKE 6 - % Patients with blood pressure <=150/90 35 Figure 20 STROKE 7 - % Patients with recorded total cholesterol 36 Figure 21 STROKE 8 - % Patients with total cholesterol <=5mmol/l 37 Figure 22 STROKE 12 - % Patients shown to be non-haemorrhagic with record that antiplatelet drug or anticoagulant is being taken 38 Figure 23 BP 4 - % Patients with total cholesterol <=5mmol/l 39 Figure 24 BP 5 - % Patients in whom the last blood pressure is <=150/90mmHg 40 Figure 25 Emergency Hospital Admissions for CHD, 2011/12 41 Figure 26 Emergency Hospital Admissions for Stroke, 2011/12 42 5 P a g e
Figure 27 Emergency Hospital Admissions for Heart Failure, 2011/12 43 Figure 28 Cardiology outpatients in West Mid Beds, number of patients, 2011/12 47 Figure 29 Cardiology outpatients in West Mid Beds Locality, costs, 2011/12 48 Figure 31 COPD 10 - % patients with FeV1 53 Figure 32 COPD 13 - % patients assessed using MRC dyspnoea score 54 Figure 34 Asthma 10 - % patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status 55 Figure 35 Asthma 9 - % patients with asthma who have had an asthma review 56 Figure 36 Emergency Hospital Admissions for COPD (2011/2012) 57 Figure 37 Emergency Hospital Admissions for Asthma (2011/2012) 58 Figure 38 Thoracic Medicine Outpatients in West Mid Beds Locality, number of patients, 2011/12 60 Figure 39 Thoracic Medicine in West Mid Beds Locality, cost, 2011/12 61 Figure 40 DM 21 - % patients with recorded retinal screening 65 Figure 41 DM 26 - % patients whose HbA1c is <=7.5% 66 Figure 42 DM 30 - % patients whose blood pressure is <=150/90 67 Figure 44 DM 17 - % patients with total cholesterol <= 5mmol/l 68 Figure 45 Emergency hospital admissions for diabetes, 2011/12 (DSR per 100,000 population) 69 Figure 46 Diabetic medicine outpatients in West Mid Beds Locality, number of patients 73 Figure 47 Diabetic medicine outpatients in West Mid Beds Locality, cost 74 Figure 48 Two week wait referrals, 2011/12 79 Figure 49 Two week wait referrals (indirectly standardised), 2011/12 80 Figure 50 Two week referrals- conversion rate, 2011/12 81 Figure 51 Proportion of new cancer cases treated which are Two week referrals 82 Figure 52 Two week referrals: suspected breast cancer, 2011/12 83 Figure 53 Two week referrals: suspected lower GI cancer, 2011/12 84 Figure 54 Two week referrals: suspected lung cancer, 2011/12 85 Figure 55 Two week referrals: suspected skin cancer, 2011/12 86 Figure 56 Emergency hospital admissions for cancers (DSR per 100,000 population) 87 6 P a g e
Figure 57 All Hospital admissions for cancer (DSR per 100,000 population) 88 Figure 58 Medical oncology outpatients in West Mid Beds Locality, number of patients, 2011/12 91 Figure 59 Medical oncology outpatients in West Mid Beds Locality, cost, 2011/12 92 Table 1 Population in West Mid Beds by Age-Group (Registered) 2011/12 14 Table 2 ONS Census 2011 resident population by Parish in West Mid Beds Locality 15 Table 3 Mosaic Supergroups in West Mid Beds Locality 20 Table 4 Outcomes predicted by the QBM for 1,000 quitters over 10 years 25 Table 5 Observed Prevalence of Obesity by GP practices in West Mid Beds, 2012/2013 26 Table 6 Cardio-Vascular Diseases Quality of Care 30 Table 7 Admissions due to Heart Failure (2011/12) 44 Table 8 Admissions due to Myocardial Infarction (2011/12) 44 Table 9 Admissions due to arrhythmia (2011/12) 45 Table 10 Admissions due to IHD (2011/12) 45 Table 11 Admissions due to Angina (2011/12) 46 Table 12 Mortality from CVD, proportion (and number over 10 years), West Mid Beds & Beds CCG, 2006/07 to 2012/13 49 Table 13 Respiratory Diseases Quality of Care 52 Table 14 Inpatient admissions COPD (2011/12) 59 Table 15 Inpatient admissions Asthma (2011/12) 59 Table 16 Respiratory Deaths, proportion (and number per decade) in West Mid Beds and Beds CCG, 2006/2007 to 2012/2013 62 Table 17 Spine Chart for West Mid Beds- Diabetes 64 Table 18 Emergency admissions, Diabetes Type 1 & 2 70 Table 19 Inpatient admissions, Diabetes (E10-E14) 70 Table 20 Diabetic inpatients: Type 1 diabetes (2011/12) 71 Table 21 Inpatient admissions, Diabetes Type 2 (2011/12) 71 Table 22 All Diabetes admissions 2011/12 72 7 P a g e
Table 23 Mortality from diabetes, proportions (and number/10 years) in West Mid Beds and Beds CCG, 2006/2007 to 2012/2013 75 Table 24 Cancer Quality of Care (2011/12) 78 Table 25 Cost: Inpatient cost - All Ages (2011/2012) 89 Table 26 Cost: Inpatient cost All Ages (2011/12) compared against Bedfordshire CCG 90 Table 27 Mortality from cancers, proportion (and number/10 years) for 2006/07 to 2012/13 93 8 P a g e
2 West Mid Beds Summary Population West Mid Beds Locality registered population is 56,906. Ethnically, it has a similar British White proportion to Bedfordshire None of the LSOAs are in the 20% most deprived in Bedfordshire CCG or the 20% of England Health Inequalities Average life expectancy for males in West Mid Beds of 80.2 years is higher than the England figure (78.3 years). For males, five practices are above the BCCG average and one is equal. The gap in life expectancy between the best and worst practices is small at 1.5 years (79.1 to 80.6). For females the gap in life expectancy between practices is smaller at 1.2 years (83.0 to 84.2). Average life expectancy for females in West Mid Beds is 83.7 years, higher than the England figure (82.3 years). For females, all practices have longer life expectancy than the England average Mortality and Morbidity The highest causes of mortality in Ivel Valley are caused by circulatory disease, respiratory disease and cancer: Cardio-vascular diseases It is thought than approximately 930 have undiagnosed coronary heart disease and 8,000 undiagnosed hypertension in West Mid Beds Greensands Medical Surgery practice has a statistically higher emergency admission rates for CHD than the averages for West Mid Beds Dr Morris & Partners has statistically higher rates for cardiology outpatients when compared with the ONS Cluster The mortality rate for CVD for the most deprived 20% LSOAs in Central Bedfordshire is 1,232/100,000 compared to 681/100,000 for the 80% least deprived (2009-12). This applies to one LSOA in West Mid Beds. Respiratory The proportion of CQRS exceptions and incomplete data varies considerably from practice to practice For emergency admission for COPD, Dr Morris & Partners has statistically higher rates than the average for West Mid Beds; there is wide variation Dr Morris & Partners and Greensand Surgery have statistically higher rates for Thoracic medicine outpatients when compared with the ONS Cluster average. The result vary from practice to practice The main causes of premature respiratory death are COPD (48%) and pneumonia (22%) in West Mid Beds 9 P a g e
Diabetes The data suggests there are about 762 patients who have undiagnosed diabetes in West Mid Beds, a quarter of the number of diagnosed diabetics The CQRS indicator for control of blood sugars (DM26) is statistically below the England average Emergency admissions for diabetes varies from practice to practice For diabetic outpatients, Dr Morris & Partners and Oliver Street Surgery have statistically higher rates than the ONS cluster average Cancer The prevalence for Cancers in West Mid Beds is 1,110 (1.95%) compared to 1.8% for England Greensand Surgery has a statistically higher number of two-week wait referrals than the England average Dr Glaze & Partners and Dr Ling & Partners have the suspected cancer that is confirmed (conversion rate) statistically higher than the England average For all admission for cancers, Asplands Medical Centre and Dr Glaze & Partners have statistically higher rates than BCCG average. There is wide variation For medical oncology outpatients, Dr Glaze & Partners, Houghton Close Surgery, Dr Morris & Partners, Oliver Street Surgery and Greensand Surgery have statistically higher rates than the ONS cluster average Smoking, Diet and Exercise Low prevalence for smoking exists in West Mid Beds although one practice had similar levels of smoking than Bedfordshire as a whole. This may be at least part of the reason why West Mid Beds has lower prevalence of COPD If half the quitters in West Mid Beds remain non-smokers in one year (142) around 6 will not get AMI, COPD, lung cancer or stroke that would otherwise have done. This will also save 7 life-years. Additionally, around 35,500 would be saved in health care costs West Mid Beds did achieve their stop-smoking target of 4-weeks quits for 2012/13 by 3 pts. However, Greensand Surgery, Dr Glaze & Partners and Oliver Street Surgery did not achieve the target quits, missing their targets by 36 together For the estimate of adult obesity, Greensand Surgery has a statistically higher rate than BCCG average There are about 11,670 (19%) of adults who binge drink in West Mid Beds (Central Bedfordshire estimate) 10 P a g e
Recommendations Cardio-vascular disease Improve Primary Prevention Identify patients with disease in the population early Increase uptake of NHS Health Checks in the population Improve Quality of care for people with cardiovascular disease by improving blood pressure and cholesterol control Standardise treatment of care for commonly encountered clinical conditions such as Stable and Unstable angina and Heart failure Respiratory disease Maintain the Smoking cessation services Improve quality of care for people with COPD and Asthma in primary care by regular review of management Diabetes Primary Prevention Improving healthy lifestyle in patients with disease by encouraging healthy eating habits and reducing weight Early Diagnosis Increased uptake of NHS Health Checks to improve early diagnosis of patients with latent diabetes as well as people with high risk of developing diabetes Quality in Primary care Improved Glycaemic Control in diabetics in primary care Using standardised protocols to improve care of diabetics in the community Cancer Encouraging more people to quit smoking in areas where prevalence of smokers is high Improving awareness of cancer and increasing early detection and treatment of cancer Improving early diagnosis and treatment of cancer in primary care by improving training in this area Smoking Stop smoking services should be prioritised by all practices Obesity GPs should be encouraged to increase the completeness of the BMI register Patients who are obese need to be referred to the community based obesity services Alcohol Promotion of Healthy lifestyle by primary care clinicians 11 P a g e
3 Aim of the Locality Profiles The aim of the locality profiles is to provide information about the health needs of the local population to support GP commissioners develop their commissioning priorities. This is to compliment the Central Bedfordshire Council JSNA (2012) 1. The objectives of the locality profiles are: To describe the demographic and social characteristic of the local population within the locality and assess variations between areas; To describe the burden of ill health of the local population and assess variations between practices and areas; To describe access to and use of services by locality and assess variations between practices and areas; To assess variations in health needs between practices and areas within the locality, as well as between the CCG and England; To identify GP practices and areas in which improvements would be likely to have a large impact on improving health and reducing inequalities in the CCG; To present the main findings from this work into a clear, concise and accessible report addressing health inequalities. 4 West Mid Beds Locality Patient Profiles General practices that are members of the West Mid Beds Locality Group 6 Registered population within the West Mid Beds Locality (Exeter 2011/12) is 56,906 Registered population (Exeter 2011/12) for males is 28,351 and females is 28,555 West Mid Beds Locality consists of 12 Electoral Wards: Toddington, Cranfield & Marston Moretaine, Flitwick, Houghton Conquest & Hayes, Ampthill, Silsoe & Shillington, Barton-la-Clay, Westoning, Flitton & Greenfield and Aspley & Woburn. 12 P a g e
Figure 1 West Mid Beds distribution of registered patients Source: Exeter 2011/2012 13 P a g e
5 Demography and Socioeconomic Factors 5.1 Population The resident population for West Mid Beds locality is 51,083. Flitwick is the most populous Parish in West Mid Beds with 25% of the population, while both Tingrith and Millbrook Parishes are the least populous with 0.3% each of the population. The locality has a lower proportion of people aged 0-34 years and more above 40 year olds than England. 24% of the population is aged under 20 and 17% of the population is over 65 which is similar to Bedfordshire CCG. Figure 2 Population pyramid for West Mid Beds Locality compared to England Population Table 1 Population in West Mid Beds by Age-Group (Registered) 2011/12 Age Group Female Male Persons 0-4 1,536 1,548 3,084 5-9 1,528 1,648 3,176 10-14 1,659 1,751 3,410 15-19 1,604 1,786 3,390 20-24 1,346 1,530 2,876 25-29 1,329 1,444 2,773 30-34 1,538 1,430 2,968 35-39 1,959 1,771 3,730 40-44 2,264 2,320 4,584 45-49 2,654 2,560 5,214 50-54 2,167 2,265 4,432 55-59 1,816 1,870 3,686 60-64 1,901 1,882 3,783 65-69 1,650 1,648 3,298 70-74 1,166 1,102 2,268 75-79 973 840 1,813 80-84 708 551 1,259 85+ 757 405 1,162 Total 28,555 28,351 56,906 14 P a g e
Table 2 ONS Census 2011 resident population by Parish in West Mid Beds Locality Source: NOMIS: ONS CENSUS 2011 15 P a g e
5.2 Ethnicity Proportionately, West Mid Beds has its largest ethnic group as British White (96%) with Asian (1.7%) as the second. The proportion of West Mid Beds that is not White is similar to Bedfordshire as a whole; the detailed breakdown is shown in Figure 3. Figure 3 Ethnicity distributions in West Mid Beds Locality 2011 Source: NOMIS: ONS CENSUS 2011 16 P a g e
5.3 Deprivation The Index of Multiple Deprivation (IMD) is a Lower Super Output Area a level measure of deprivation. The IMD is made up of seven domains (Crime, Health deprivation & disability, Employment, Education, skills & training, Barriers to housing & services and living environment) each containing a number of indices. An area with a higher IMD score means that it is more deprived 2. In West Mid Beds Locality: Houghton Conquest & Hayes, Toddington and Aspley & Woburn wards had the highest deprivation scores. Bedfordshire is made up of 256 LSOA s with 34 located in West Mid Beds. None of the LSOAs are in the 20% most deprived in Bedfordshire CCG or the 20% of England. Figure 4 Deprivation scores by Ward 2010 Source: Public Health Intelligence Team a An LSOA is an area which has a population of 1,000-3,000. 17 P a g e
To calculate GP practice deprivation scores, LSOA deprivation scores were attributed to patients by the postcode where they live. The value for the practice is the average of its patients. West Mid Beds practices have all practices with lower IMD scores than the Bedfordshire CCG average (Figure 5). Figure 5 Deprivation scores by GP Practice (IMD), 2010 Source: www.localhealth.org.uk/ 18 P a g e
5.4 Life Expectancy Figure 6 shows the life expectancy at birth b. Average life expectancy for males in West Mid Beds of 80.2 years is higher than both the BCCG average (79.1 years) and the England figure (78.3 years). For males, five practices are above the BCCG average and one is equal. The gap in life expectancy between the best and worst practices is small at 1.5 years (79.1 to 80.6). For females the gap in life expectancy between practices is smaller at 1.2 years (83.0 to 84.2). Average life expectancy for females in West Mid Beds is 83.7 years, higher than both the BCCG average (82.6 years) and the England figure (82.3 years). For females, all practices have longer life expectancy than both the BCCG and England averages. Figure 6 Life expectancy at birth for West Mid Beds (2006-2010) Source: www.localhealth.org. b Calculated using practice Life Expectancy from MSOA estimates. The West Mid Beds figures are weighted averages of the practices. 19 P a g e
5.5 Mosaic Mosaic is designed to identify groupings of citizen s behaviour for individuals, households and postcodes. Mosaic classifies all individuals, households or postcodes in the United Kingdom into a set of homogeneous lifestyle types. Table 3 Mosaic Supergroups in West Mid Beds Locality The Mosaic Supergroups were determined based on the postcodes of the patients registered with West Mid Beds practices, the result of which is shown in Figure 7. This shows that Middle Income Families (35%) and Affluent households (35%) are the most common in West Mid Beds followed by Rural and small town inhabitants (13%). The graphic within Table 3 shows that Affluent households and Middle income families are more common in West Mid Beds compared to the England average but other groups, such as Elderly occupants and Social housing tenants are less common. Figure 7 West Mid Beds mosaic supergroups Source: Mosaic Public Sector A further breakdown into 15 groups is shown in Figure 8. This shows that Successful professionals living in suburban or semirural homes are the most common group (31%) and is more common than the England average.. Source: Mosaic Public Sector 20 P a g e
Figure 8 Further breakdown of mosaic groups in West Mid Beds Source: Mosaic Public Sector 21 P a g e
6 Health Behaviour 6.1 NHS Health Checks Results from the NHS Health Checks in Bedfordshire in April 2012 March 2013 show a number of diagnoses for a range of CVD risk factors identified through the NHS Health Check. Of the patients going for a check in West Mid Beds, 5% were put on a High Risk Register, (Figure 9). This corresponds to 109 patients. 553 people with BMI over 30 (obese) and 23 people with newly diagnosed Type 2 diabetes in April 2012 March 2013. Figure 9 NHS Health Checks Source: Public Health Core Team 22 P a g e
6.2 Smoking Smoking remains the main cause of preventable disease and premature death in the UK. In 2012/13, approximately 7,120 (15%) people in West Mid Beds smoked (CQRS c /QMAS). West Mid Beds has a significantly lower smoking prevalence than Bedfordshire CCG, with all but one practice having statistically lower rates than BCCG average (Figure 10). This may be part of the reason why West Mid Beds has low rates of COPD. Figure 10 Smoking Prevalence by GP practice Locality, 2013 Source: CQRS 2013 c CQRS: Calculating Quality Reporting Service 23 P a g e
102 62 56 25 32 7 284 2059 WEST MID BEDS LOCALITY PROFILE 2013 Interventions which can be implemented include referrals to stop smoking service, Making Every Contact Count (MECC), motivational interviewing in primary care and NHS Health Checks. GP practices in West Mid Beds locality helped 284 people stop smoking for at least 4 weeks and West Mid Beds achieved it by three patients (Figure 11). However, Greensand Surgery, Dr Glaze & Partners and Oliver Street Surgery did not achieve the target quits, missing their targets by 36 together. Another 85 people have been helped to stop smoking by a number of services including Children s Centres, schools, and Central Bedfordshire Council. There seems to be a broad negative correlation between high smoking prevalence at practice level and success with the stop smoking service. Figure 11 Stop smoking achievement compared to targets for West Mid Beds locality practices, showing number of 4-week quits, 2012/2013 140% 120% 100% 80% 60% 40% 20% 0% % of Target Achieved Target Source: Quit Manager, Core Public Health 24 P a g e
The Quit Benefits Model (QBM) has been developed to assess the health benefits of stopping smoking in a way that can be quantified. This is broken down in Table 4 and shows that of 1,000 quitters on average 40 will be spared a diagnosis of AMI, COPD, lung cancer and stroke in the first 10 years after quitting, with 47 life-years saved. Also, around 250,000 would be saved in health care costs. There is also good evidence that smoking cessation produces benefits that translate into measureable improvements in health gain within 2 to 5 years. The health benefits for males and females are shown in Table 4 3. In West Mid Beds Locality this means that if half the quitters in one year (142) remain non-smokers around 6 patients will not get AMI, COPD, lung cancer and stroke in the first 10 years after quitting that would otherwise have done. This will also save 7 life-years and a saving of around 35,500 in health care costs. Recommendations: 1. Stop smoking services should be prioritised by all practices Table 4 Outcomes predicted by the QBM for 1,000 quitters over 10 years Category of Benefit Per 1,000 males Per 1,000 females Cases of disease avoided AMI 14 6 COPD 18 20 Lung Cancer 3 3 Stroke 8 7 Any of the above 4 diseases 43 37 Deaths avoided AMI 6 2 COPD 2 1 Lung Cancer 2 2 Stroke 3 4 Any of the above 4 diseases 12 9 Causes other than the above 9 5 Total Deaths 21 14 Life-years saved 57 35 QALYs saved 85 62 The sum may not agree exactly due to rounding Source: Hurley & Matthews, Cost Eff Resour Alloc. 2007 25 P a g e
6.3 Obesity Adult obesity is indicated when an individual s BMI is over 30. It increases the risk of heart disease, diabetes, stroke, depression, bone disease and joint problems. The obesity prevalence recorded by the GPs in West Mid Beds and Bedfordshire CCG as a whole is much lower than the Central Bedfordshire expected prevalence which in 2006-08 was thought to be 24%. 4 Greensands Surgery is statistically higher than the BCCG average. Caution should be taken when interpreting obesity prevalence as GPs only measure the BMI of patients that have come in for a consultation; there is no comprehensive measurement programme. Also, GPs may only measure those who present with symptoms that may be related to over-weight. Table 5 Observed Prevalence of Obesity by GP practices in West Mid Beds, 2012/2013 Source: CQRS 2013 Recommendations: 1. GPs should be encouraged to increase the completeness of the BMI register 2. Patients who are obese need to be referred to the community based obesity services 26 P a g e
6.4 Alcohol 5 Figure 12 shows that West Mid Beds rate is significantly below the Bedfordshire CCG rate for Alcohol Related hospital admissions but statistically similar for Alcohol Specific hospital admissions. Figure 12 Alcohol Specific & Related hospital admissions, 2012/2013 Source: Core Public Health Team Recommendations: 1. Promotion of Healthy lifestyle by primary care clinicians 27 P a g e
7 Mortality & Morbidity Primary Care produces data which shows performance in relation to key QMAS (or, from April 2013, CQRS) indicators within the GP contract. Exception reporting allows for a number of criteria if the patients did not attend for review, for example. This is so that the practices will not be penalised. They are Patient Unsuitable, Informed Dissent, Registration Date, Diagnosis Date and Other if the patient does not fall into a pre-agreed reason for exception. However in order to improve the population health outcomes these indicators need to be seen as a proportion of the whole population with exceptions included. In the CQRS charts throughout this report, results are given by Target Met, Exception Coded and Target Missed. The practices are put in order of deprivation, the most deprived on the left hand side. 7.1 Circulatory system Problems with the circulatory system include Coronary Heart Disease (CHD), Hypertensive heart disease, Heart Failure (HF), arrhythmic heart problems, Myocardial Infarction (MI) and stroke. CHD: The observed prevalence for CHD in West Mid Beds is 3.2%, 66% (2011/2012) of the estimated prevalence. The observed is the actual CHD prevalence as estimated by CQRS. The expected comes from Cardiology Profile published by SEPHO d and estimates the prevalence (Figure 13). It suggests there are still 34% of persons with CHD who are undiagnosed, about 933 (1.6%) people. Lower than expected prevalence may indicate a healthy population or that there is unrecognised CHD in West Mid Beds; the former could be expected considering the low smoking prevalence already noted. d SEPHO: South East Public Health Observatory 28 P a g e
Figure 13 Observed Vs. Estimated prevalence of CHD in West Mid Beds (2011/12) Source: CQRS 2012 Hypertension: The observed prevalence for hypertension in West Mid Beds is 14.3% and the prevalence has been estimated to be 28.3% suggesting half of the hypertensive population is still unidentified (50% of cases are undiagnosed). The gap between recognised and treated hypertension and actual hypertension levels in the community is large. Heart Failure: The observed prevalence for heart failure in West Mid Beds is 0.38%. The prevalence in Bedfordshire CCG has been estimated to be 1.4% in 2008/09 implying there are over half HF cases who are unidentified (about 70% of cases are undiagnosed) Atrial Fibrillation: The observed prevalence for atrial fibrillation in West Mid Beds is 1.6% compared to England 1.5% Stroke: The observed prevalence for stroke in West Mid Beds is 1.6% and the national prevalence has been estimated to be 2.3% which could mean that 28% of strokes are undiagnosed. 29 P a g e
CQRS indicators Table 6 (overleaf) shows the CQRS indicator of the circulatory system (QMAS). It shows key indicators performance in relation to the whole disease registered population. These are broken down in Figure 14-Figure 23. Table 6 Cardio-Vascular Diseases Quality of Care Source: www.apho.org.uk/pracprof 2011/12 30 P a g e
In Figure 14, 38% of the exceptions were classified as Informed Dissent, 23% as Registration Date and 18% as Diagnosis Date Figure 14 CHD 6 - % Patients with blood pressure <= 150/90 Source: CQRS 2013 31 P a g e
Figure 15 CHD 8 - % Patients with total cholesterol Source: CQRS 2013 32 P a g e
Figure 16 CHD 9 - % Patients using aspirin, alternative antiplatelet therapy or anticoagulant, without a contraindication or side effect Source: CQRS 2013 33 P a g e
In Figure 17, 80% of the exceptions were classified as other. Figure 17 CHD 10 - % Patients treated with a β blocker, without a contraindication or side effect Source: CQRS 2013 34 P a g e
In Figure 18, 39% of the exceptions are classified as Diagnosis Date and 28% Patient unsuitable Figure 18 STROKE 6 - % Patients with blood pressure <=150/90 Source: CQRS 2013 35 P a g e
In Figure 19, 69% of the exceptions are classified as patient unsuitable Figure 19 STROKE 7 - % Patients with recorded total cholesterol Source: CQRS 2013 36 P a g e
In Figure 20, 44% were other, 22% diagnosis date, and 22% patient unsuitable Figure 20 STROKE 8 - % Patients with total cholesterol <=5mmol/l Source: CQRS 2013 37 P a g e
In Figure 21, 95% of the exceptions are classified as other Figure 21 STROKE 12 - % Patients shown to be non-haemorrhagic with record that antiplatelet drug or anticoagulant is being taken Source: CQRS 2013 38 P a g e
Figure 22 BP 4 - % Patients with total cholesterol <=5mmol/l Source: CQRS 2013 39 P a g e
In Figure 23, 38% of the exceptions are classified as Diagnosis Date, 28% as Registration Date and 23% as Other Figure 23 BP 5 - % Patients in whom the last blood pressure is <=150/90mmHg Source: CQRS 2013 40 P a g e
Hospital Admissions and Activity 2011/2012 Emergency admission rate (DSR) for CHD, all persons, in West Mid Beds was 148 per 100,000 which is 125 admissions (Figure 24). Greensands Medical Surgery has a statistically higher rate than the average for West Mid Beds. Figure 24 Emergency Hospital Admissions for CHD, 2011/12 Source: SUS Data via MedeAnalytics 41 P a g e
Emergency admission rate (DSR) for Stroke, all persons, in West Mid Beds was 101 per 100,000 which is 94 admissions (Figure 25). Dr Glaze & Partners has a statistically lower rate than the averages for West Mid Beds and BCCG. Figure 25 Emergency Hospital Admissions for Stroke, 2011/12 Source: SUS Data via MedeAnalytics 42 P a g e
Emergency admission rate (DSR) for Heart Failure, all persons, in West Mid Beds was 59 per 100,000 which is 60 admissions (Figure 26). It shows that all practices have a statistically similar results compared to BCCG average. Figure 26 Emergency Hospital Admissions for Heart Failure, 2011/12 Source: SUS Data via MedeAnalytics 43 P a g e
Cost Inpatient cost (2011/2012) There were 66 admissions due to heart failure costing 222,655 with an average cost of 3,374 per admission. Out of which 25 were multiple admissions costing 71,823 with the average cost 2,873/ per admission (Table 7). Table 7 Admissions due to Heart Failure (2011/12) Locality Total Admissions Source: SUS Data via MedeAnalytics There were 37 patients admitted with myocardial infarction (ICD10 I21) that incurred a cost of 155,515 with an average cost of 4,203 and there were 5 multiple admissions with a total cost of 18,230 (Table 8). Table 8 Admissions due to Myocardial Infarction (2011/12) Source: SUS Data via MedeAnalytics DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 234 89 755,437 3,228 112 44 348,691 3,113 Chiltern Vale 91 72 303,041 3,330 39 31 134,211 3,441 Ivel Valley 86 63 279,868 3,254 36 28 123,264 3,424 Leighton Buzzard 50 71 157,089 3,142 24 35 84,207 3,509 West Mid Beds 66 65 222,655 3,374 25 24 71,823 2,873 Bedfordshire CCG 527 76 1,718,091 3,260 236 35 762,195 3,230 Locality Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 115 48 465,586 4,049 27 11 115,789 4,288 Chiltern Vale 101 93 439,243 4,349 18 13 75,597 4,200 Ivel Valley 56 48 234,145 4,181 14 11 51,705 3,693 Leighton Buzzard 38 56 182,153 4,793 8 12 41,718 5,215 West Mid Beds 37 45 155,515 4,203 5 6 18,230 3,646 Bedfordshire CCG 347 56 1,476,641 4,255 72 11 303,039 4,209 44 P a g e
There were 169 patients with arrhythmia (Cardiac Dysrhythmia ICD10 I47-I49) with a cost of 253,629. Moreover, there were 51 multiple admissions with a cost of 79,665 (Table 9). Table 9 Admissions due to arrhythmia (2011/12) Locality Total Admissions Source: SUS Data via MedeAnalytics There were 269 inpatients with IHD costing 904,305 with 66 multiple admissions costing 262,744 (Table 10) Table 10 Admissions due to IHD (2011/12) Source: SUS Data via MedeAnalytics DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 427 204 616,213 1,443 168 79 272,502 1,622 Chiltern Vale 183 183 329,271 1,799 55 54 110,520 2,009 Ivel Valley 205 184 278,937 1,361 55 51 88,864 1,616 Leighton Buzzard 94 174 140,877 1,499 32 57 45,527 1,423 West Mid Beds 169 217 253,629 1,501 51 67 79,665 1,562 Bedfordshire CCG 1,078 195 1,618,927 1,502 361 65 597,078 1,654 Locality Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 897 424 3,177,238 3,542 264 122 1,068,219 4,046 Chiltern Vale 474 461 1,685,901 3,557 152 146 592,402 3,897 Ivel Valley 443 403 1,355,851 3,061 121 103 412,663 3,410 Leighton Buzzard 239 402 822,400 3,441 88 143 352,166 4,002 West Mid Beds 269 334 904,305 3,362 66 81 262,744 3,981 Bedfordshire CCG 2,322 411 7,945,695 3,422 691 118 2,688,195 3,890 45 P a g e
There were 49 admissions from Angina Pectoris costing 83,561 and with an average cost of 1,705. 11 of these were multiple admissions with a total cost of 18,804 (Table 11) Table 11 Admissions due to Angina (2011/12) Locality Source: SUS Data via MedeAnalytics Outpatients Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 137 66 212,333 1,550 51 23 74,843 1,468 Chiltern Vale 71 71 109,208 1,538 28 30 38,342 1,369 Ivel Valley 93 83 126,026 1,355 40 34 48,269 1,207 Leighton Buzzard 27 48 42,012 1,556 10 17 21,396 2,140 West Mid Beds 49 58 83,561 1,705 11 14 18,804 1,709 Bedfordshire CCG 377 67 573,141 1,520 140 25 201,653 1,440 Figure 27 and Figure 28 show the outpatient figures for West Mid Beds by rates and cost e. Dr Morris & Partners is statistically above the ONS Cluster average. e The ONS cluster is calculated using the Central Bedfordshire Council area with Cranfield & Marstone Moretaine 46 P a g e
Figure 27 Cardiology outpatients in West Mid Beds, number of patients, 2011/12 Source: NHS Comparators 47 P a g e
Figure 28 Cardiology outpatients in West Mid Beds Locality, costs, 2011/12 Source: NHS Comparators 48 P a g e
Mortality Table 12 shows the mortality from CVD and the proportion of all deaths and from premature deaths. Overall, in West Mid Beds CVD causes about 31.1% of all deaths. Generally, West Mid Beds and England s rates are close except for AMI for both sexes (West Mid Beds persons: 27.3%, England persons: 16.9%). Table 12 CVD deaths, proportion (yearly average), West Mid Beds & Beds CCG, 2006/07 to 2012/13 Age: All ages West Mid Beds (2007-2011) BCCG (2007-2011) England (2008-2010) Underlying Cause of Death Males Females Persons Males Females Persons Males Females Persons Average number of deaths per year from CVD (ICD10: I) CHD (ICD10: I20-I25) as percentage of all CVD deaths (average number of deaths per year) AMI (ICD10: I21-I22) as percentage of all CVD deaths (average number of deaths per year) HF (ICD10: I50) as percentage of all CVD deaths (average number of deaths per year) Stroke (ICD10: I60-I69) as percentage of all CVD deaths (average number of deaths per year) Other CVD as percentage of all CVD deaths (average number of deaths per year) AMI deaths are also contained within CHD deaths Source: ONS Mortality File 2011/2012 57.2 55.8 113.0 497.8 521.6 1019.4 55.6% (31.8) 27.3% (15.6) 4.5% (2.6) 21.0% (12.0) 18.9% (10.8) 39.8% (22.2) 21.9% (12.2) 5.7% (3.2) 31.5% (17.6) 22.9% (12.8) 47.8% (54.0) 24.6% (27.8) 5.1% (5.8) 26.2% (29.6) 20.9% (23.6) 56.0% (278.6) 27.7% (137.8) 3.8% (19.0) 20.1% (100.2) 20.1% (100.0) 41.1% (214.2) 18.6% (96.8) 6.5% (33.8) 30.3% (157.8) 22.2% (115.8) 48.3% (492.8) 23.0% (234.6) 5.2% (52.8) 25.3% (258.0) 21.2% (215.8) 53.1% 37.3% 45.0% 20.1% 14.0% 16.9% Not available 22.0% 32.7% 27.5% Not available 49 P a g e
Premature CVD Mortality is shown in Error! Reference source not found. below. West Mid Beds and England s rates are close except for AMI for both sexes (West Mid Beds persons: 29.1%, England persons: 22.5%). Table 12: Under 75 years Age: under 75 years West Mid Beds (2007-2011) BCCG (2007-2011) England (2008-2010) Underlying Cause of Death Males Females Persons Males Females Persons Males Females Persons Average number of deaths per year from CVD (ICD10: I) CHD (ICD10: I20-I25) as percentage of all CVD deaths (average number of deaths per year) AMI (ICD10: I21-I22) as percentage of all CVD deaths (average number of deaths per year) HF (ICD10: I50) as percentage of all CVD deaths (average number of deaths per year) Stroke (ICD10: I60-I69) as percentage of all CVD deaths (average number of deaths per year) Other CVD as percentage of all CVD deaths (average number of deaths per year) AMI deaths are also contained within CHD deaths Source: ONS Mortality File 2011/2012 19.2 9.0 28.2 180.4 86.2 266.6 59.4% (11.4) 30.2% (5.8) 0.0% (0.0) 15.6% (3.0) 25.0% (4.8) 40.0% (3.6) 26.7% (2.4) 2.2% (0.2) 26.7% (2.4) 31.1% (2.8) 53.2% (15.0) 29.1% (8.2) 0.7% (0.2) 19.1% (5.4) 27.0% (7.6) 62.9% (113.4) 31.5% (56.8) 1.6% (2.8) 14.5% (26.2) 21.1% (38.0) 45.2% (39.0) 25.3% (21.8) 3.5% (3.0) 23.0% (19.8) 28.3% (24.4) 57.2% (152.4) 29.5% (78.6) 2.2% (5.8) 17.3% (46.0) 23.4% (62.4) 61.0% 43.3% 55.3% 24.6% 18.1% 22.5% Not available 15.1% 25.2% 18.3% Not available For those in West Mid Beds living in the most deprived 20% LSOAs in Central Bedfordshire, the mortality rate from CVD was 1,232 per 100,000 population compared to 681 for the 80% least deprived in the period 2009/10 to 2011/12, 81% higher Recommendations: 1. Improve Primary Prevention 2. Identify patients with disease in the population early Increase uptake of NHS Health Checks in the population 3. Improve Quality of care for people with cardiovascular disease by improving blood pressure and cholesterol control 50 P a g e Public Health 4. Core Standardise Team, Directorate treatment of of Public care for Health, commonly Bedford encountered Borough & clinical Central conditions Bedfordshire such as Stable and Unstable angina and Heart failure
7.2 Respiratory Disease: COPD & Asthma Prevalence of COPD COPD: The observed prevalence for COPD in West Mid Beds is 1.35% (771) (2011/2012) compared to England 1.7%. Asthma: The observed prevalence for Asthma in West Mid Beds is 6.25% (5,344) (2011/2012) compared to England 5.9% 51 P a g e
CQRS indicators Table 13 is of COPD and Asthma indicators from CQRS in West Mid Beds. Four indicators are statistically higher than the England average. Table 13 Respiratory Diseases Quality of Care Source: www.apho.org.uk/pracprof 52 P a g e
In Figure 29, 44% of the exceptions are classified as Informed Dissent, 30% as Patient Unsuitable and 23% as Other. Figure 29 COPD 10 - % patients with FeV1 Source: CQRS 2013 53 P a g e
In Figure 30, 52% of the exceptions are classified as Informed Dissention, 31% as Patient Unsuitable and 15% as Diagnosis Date Figure 30 COPD 13 - % patients assessed using MRC dyspnoea score Source: CQRS 2013 54 P a g e
Asthma 10 is shown in Figure 31 f Figure 31 Asthma 10 - % patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status 100% Asthma 10 - % patients with asthma between the ages of 14 and 19 in whom there is a record of smoking status (during Jan 12 - Mar 13) by GP practice, West Mid Beds High deprivation 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Asplands Medical Centre Dr Glaze & Partners Oliver Street Surgery Greensand Surgery (Ampthill) Dr SJ Morris & Partners Houghton Close Surgery Source: CQRS 2013 Target Met Target Missed f The exception Other has been removed to provide a true reflection of the indicator 55 P a g e
In Figure 32, 71% of the exceptions are classified as Informed Dissent. Figure 32 Asthma 9 - % patients with asthma who have had an asthma review Source: CQRS 2013 56 P a g e
Hospital Admissions & Activity The emergency admission rate for COPD, all persons, in West Mid Beds was 55 per 100,000 which is 51 admissions (Figure 33). Dr Morris & Partners is statistically higher compared to West Mid Beds Locality and Houghton House Surgery, Asplands Medical Centre and Dr Glaze & Partners are statistically lower compared to the BCCG average. Figure 33 Emergency Hospital Admissions for COPD (2011/2012) Source: SUS Data via MedeAnalytics 57 P a g e
The emergency admission rate (DSR) for Asthma, all persons, in West Mid Beds was 58 per 100,000 which is 30 admissions (Figure 34). All practices are statistically similar compared to both the locality and BCCG averages. Figure 34 Emergency Hospital Admissions for Asthma (2011/2012) Source: SUS Data via MedeAnalytics 58 P a g e
Cost Inpatient cost (20112012) In the year 2011-2012, there were 60 COPD (ICD10 J40-J44) admissions that had incurred costing West Mid Beds 141,189 with the average cost of 2,353 per patient admission (Table 14) Table 14 Inpatient admissions COPD (2011/12) Locality Total Admissions Source: SUS Data via MedeAnalytics There were 34 admissions due to Asthma (ICD10 J45-J46) costing 36,175 with an average cost of 1,064 per patient. 8 were multiple admissions costing 8,952 with the average cost 1,119 per patient (Table 15). Table 15 Inpatient admissions Asthma (2011/12) Source: SUS Data via MedeAnalytics DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 202 87 519,987 2,574 101 44 257,255 2,547 Chiltern Vale 195 174 477,595 2,449 110 97 272,271 2,475 Ivel Valley 113 95 291,582 2,580 56 47 145,531 2,599 Leighton Buzzard 102 158 225,415 2,210 48 70 102,654 2,139 West Mid Beds 60 70 141,189 2,353 24 30 52,418 2,184 Bedfordshire CCG 672 109 1,655,768 2,464 339 55 830,129 2,449 Locality Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 211 127 241,106 1,143 75 45 96,569 1,288 Chiltern Vale 71 91 76,368 1,076 32 41 38,257 1,196 Ivel Valley 78 95 90,488 1,160 30 36 43,154 1,438 Leighton Buzzard 36 81 38,878 1,080 22 49 24,966 1,135 West Mid Beds 34 64 36,175 1,064 8 14 8,952 1,119 Bedfordshire CCG 430 101 483,016 1,123 167 39 211,898 1,269 59 P a g e
Outpatients In Figure 35 to Figure 36 the thoracic medicine outpatient g figures for West Mid Beds Locality are given by rates and costs h. Dr Morris & Partners and Greensand Surgery are statistically above the ONS Cluster average. Figure 35 Thoracic Medicine Outpatients in West Mid Beds Locality, number of patients, 2011/12 Source: NHS Comparators g The Treatment Function code 340 (Thoracic/Respiratory Medicine) covers the diagnosis and treatment of disorders of the structures and organs of the chest, especially the lungs. Common respiratory diseases are asthma, COPD, pneumonia and obstructive sleep apnoea h The ONS cluster is calculated using the Bedford Borough Council s area and does not include Cranfield & Marstone Moretaine 60 P a g e
Figure 36 Thoracic Medicine in West Mid Beds Locality, cost, 2011/12 Source: NHS Comparators 61 P a g e
Mortality The top 7 respiratory deaths are shown in Table 16. Bronchitis, Emphysema and COPD account for the biggest proportion of respiratory deaths under 75 years (54 deaths per 10 years) and the second biggest for all ages (167 deaths per 10 years) Pneumonia is the second biggest reason of death in under 75 year olds (24 deaths per 10 years) and the biggest cause of all age respiratory death (193 deaths per 10 years). Table 16 Respiratory Deaths, proportion (yearly average) in West Mid Beds and Beds CCG, 2006/2007 to 2012/2013 West Mid Beds Beds CCG Underlying Cause of Death <75 All ages <75 All ages Pneumonia (ICD10: J12-J18) 21.5% (24) 40.8% (193) 22.4% (221) 36.9% (1594) Bronchitis, Emphysema and COPD (ICD10: J40-J44) 48.1% (54) 35.3% (167) 43.7% (431) 34.6% (1496) Interstitial pulmonary diseases (ICD10: J84) 5.1% (6) 6.0% (29) 9.6% (94) 6.1% (264) Pneumonitis due to food and vomit (ICD10: J690) 7.6% (9) 3.0% (14) 5.5% (54) 4.5% (193) Asthma (ICD10: J45-J46) 2.5% (3) 2.1% (10) 2.6% (26) 2.0% (86) Unspecified acute lower respiratory infection (ICD10: J22) 1.3% (1) 1.5% (7) 1.6% (16) 1.9% (80) Bronchiectasis (ICD10: J47) 5.1% (6) 2.4% (11) 2.3% (23) 1.5% (66) All other respiratory disorders (ICD10: J) 8.9% (10) 8.8% (41) 12.3% (121) 12.5% (540) Total Respiratory (ICD10:J) deaths 100% (113) 100% (473) 100% (987) 100% (4319) Source: ONS Mortality file 62 P a g e
7.3 Diabetes Profile of West Mid Beds Diabetes: The observed prevalence for Diabetes in West Mid Beds is 5.2% (2,398), 75.9% of the estimated prevalence (2011/2012) i. It suggests there are still 24.1% (762) of persons with Diabetes who are undiagnosed Quality of care The CQRS prevalence figure for those aged over 17 is 6.4% (Table 17). The table shows that a number of indicators are statistically above the England rate, including the diabetic prevalence, but DM26 (last HbA1c is below 7.5% in last 15 months) is statistically below. i Yorkshire & Humber Public Health Observatory 63 P a g e
Table 17 Spine Chart for West Mid Beds- Diabetes Source: www.apho.org.uk/pracprof 64 P a g e
In Figure 37, 50% of the exceptions are classified as other, 20% as Informed Dissent and 18% as Diagnosis Date. Figure 37 DM 21 - % patients with recorded retinal screening Source: CQRS 2013 65 P a g e
In Figure 38, 28% of the exceptions are classified as other, 28% as Informed Dissent and 22% as Diagnosis Date. Figure 38 DM 26 - % patients whose HbA1c is <=7.5% Source: CQRS 2013 66 P a g e
Figure 39 DM 30 - % patients whose blood pressure is <=150/90 Source: CQRS 2013 67 P a g e
In Figure 40, 44% of the exceptions were classified as other, 24% as Diagnosis Date and 16% as Informed Dissent. Figure 40 DM 17 - % patients with total cholesterol <= 5mmol/l Source: CQRS 2013 68 P a g e
Emergency Hospital Admissions for diabetes The emergency admission rate (DSR) for primary Diabetes, all persons, in West Mid Beds was 39 per 100,000 which is 26 admissions (Figure 41). Greensands Surgery has no emergency admission and Houghton Close Surgery has statistically lower rates than BCCG. Figure 41 Emergency hospital admissions for diabetes, 2011/12 (DSR per 100,000 population) Source: SUS Data via MedeAnalytics 69 P a g e
Table 18 is of the primary diabetic emergency admissions in West Mid Beds by sex. Caution should be taken when interpreting the table as the numbers are small. Table 18 Emergency admissions, Diabetes Type 1 & 2 Cost Diabetes Type Gender Count Source: SUS Data via MedeAnalytics 2011/12 Inpatient cost (2011/2012) In the year 2011-2012, there were 34 diabetic admissions (ICD10 E10-E14) for both emergency and planned referrals that had incurred West Mid Beds a cost of 74,262 with the average cost of 2,184 per patient admission (Table 19). Table 19 Inpatient admissions, Diabetes (E10-E14) Source: SUS Data via MedeAnalytics Total Tariff (post-mff) Type 1 Female 11 17,644 Male 2 1,304 Type 2 Female 2 4,539 Male 10 32,781 25 56,268 Locality Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 127 68 291,169 2,293 46 24 122,260 2,658 Chiltern Vale 68 81 136,022 2,000 32 40 53,028 1,657 Ivel Valley 61 75 130,318 2,136 32 40 80,804 2,525 Leighton Buzzard 37 84 63,532 1,717 18 43 28,320 1,573 West Mid Beds 34 51 74,262 2,184 19 28 44,805 2,358 Bedfordshire CCG 327 70 695,303 2,126 147 32 329,216 2,240 70 P a g e
There were 16 admissions due to Type 1 Diabetes (ICD10 E10) costing 23,275 with an average cost of 1,455 per patient. 10 were multiple admissions costing 16,390 with the average cost 1,639 per patient (Table 20). Table 20 Diabetic inpatients: Type 1 diabetes (2011/12) Locality Total Admissions Source: SUS Data via MedeAnalytics There were 17 patients admitted due to Type 2 Diabetes (ICD10 E11) that has incurred a cost of 45,867 with an average cost of 2,698 and there were 9 multiple admissions with a total cost of 28,415 Table 21 Inpatient admissions, Diabetes Type 2 (2011/12) Source: SUS Data via MedeAnalytics DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 59 36 64,330 1,090 18 11 21,531 1,196 Chiltern Vale 30 41 37,306 1,244 17 23 20,650 1,215 Ivel Valley 35 48 49,958 1,427 20 28 34,320 1,716 Leighton Buzzard 19 50 25,044 1,318 12 34 17,096 1,425 West Mid Beds 16 28 23,275 1,455 10 17 16,390 1,639 Bedfordshire CCG 159 39 199,912 1,257 77 19 109,986 1,428 Locality Total Admissions DSR per 100,000 Total Cost Cost/Admission Total Multiple Admissions DSR per 100,000 Total Cost Cost/Admission Bedford 66 30 224,334 3,399 27 12 99,280 3,677 Chiltern Vale 34 36 89,088 2,620 12 13 24,745 2,062 Ivel Valley 26 27 80,360 3,091 12 12 46,484 3,874 Leighton Buzzard 17 32 35,980 2,116 6 9 11,224 1,871 West Mid Beds 17 23 45,867 2,698 9 11 28,415 3,157 Bedfordshire CCG 160 29 475,629 2,973 66 12 210,147 3,184 71 P a g e
There were 34 patients admitted due to Diabetes type 1 and 2 (ICD10 E10-11) that has incurred a cost of 74,262. Within this there were 19 multiple admissions with a total cost of 44,805 ( Table 22). Table 22 All Diabetes admissions 2011/12 Source: SUS Data via MedeAnalytics 2011/12 Outpatients Multiple Admissions - No Multiple Admission s - Yes Multiple Admissions - No Multiple Admissions - Yes Tariff (post- MFF) ICD10 Code Primary Diagnosis Total E10 - Type 1 Insulin-dependent diabetes mellitus with ketoacidosis 2 4 1,585 8,703 6 10,288 Insulin-dependent diabetes mellitus with renal complications 2 3,408 2 3,408 Insulin-dependent diabetes mellitus without complications 4 4 5,300 4,279 8 9,579 E11 - Type 2 Non-insulin-depend diabetes mellitus with periph circ comp 6 25,637 6 25,637 Non-insulin-depend diabetes mellitus without complication 4 3,966 4 3,966 Non-insulin-dependent diabetes mellitus with ketoacidosis 2 7,835 2 7,835 Non-insulin-dependent diabetes mellitus with neuro comps 1 487 1 487 Non-insulin-dependent diabetes mellitus with ophthalm comps 1 1 2,011 1,704 2 3,714 Non-insulin-dependent diabetes mellitus with renal comps 1 1 3,641 587 2 4,228 E14 - Other Unspecified diabetes mellitus with ketoacidosis 1 5,120 1 5,120 Grand Total 15 19 29,457 44,805 34 74,262 Figure 42-Figure 43 show the outpatient figures for West Mid Beds Locality by numbers of patients and costs j. Dr Morris & Partners and Oliver Street Surgery have statistically higher rates than the ONS cluster average. j The ONS cluster is calculated using the Bedford Borough Council s area and does not include Cranfield & Marstone Moretaine 72 P a g e
Figure 42 Diabetic medicine outpatients in West Mid Beds Locality, number of patients Source: NHS Comparators 73 P a g e
Figure 43 Diabetic medicine outpatients in West Mid Beds Locality, cost Source: NHS Comparators 74 P a g e
Mortality Table 23 shows the mortality from diabetes, proportions and number of patients over 10 years. These are small numbers so caution should be taken when interpreting the table. Table 23 Mortality from diabetes, proportions (yearly average) in West Mid Beds and Beds CCG, 2006/2007 to 2012/2013 West Mid Beds Beds CCG Underlying Cause of Death <75 All ages <75 All ages Insulin-dependent diabetes mellitus 22.2% (3) 6.7% (3) 6.7% (9) 5.7% (24) Non-insulin-dependent diabetes mellitus 11.1% (1) 50.0% (21) 16.9% (21) 37.4% (159) Unspecified diabetes mellitus 66.7% (9) 43.3% (19) 59.6% (76) 56.9% (241) Total diabetes mellitus 100% (13) 100% (43) 100% (127) 100% (424) Source: ONS Mortality file Recommendations: 1. Primary Prevention Improving healthy lifestyle in patients with disease by encouraging healthy eating habits and reducing weight 2. Early Diagnosis Increased uptake of NHS Health Checks to improve early diagnosis of patients with latent diabetes as well as people with high risk of developing diabetes 3. Quality in Primary care Improved Glycaemic Control in diabetics in primary care 4. Using standardised protocols to improve care of diabetics in the community 75 P a g e
7.4 Cancer The prevalence for Cancers in West Mid Beds is 1.95% (1,110) compared to 1.8% for England. Quality of care 76 P a g e
Table 24 includes the cancer quality of care in West Mid Beds. It shows that the suspected cancer that is confirmed (conversion percentage or rate) is statistically similar to the CCG mean. Too low a conversion rate suggests that the practice is over referring whereas too high suggests that there is a danger of missing a correct referral. 77 P a g e
Table 24 Cancer Quality of Care (2011/12) Source: www.apho.org.uk/pracprof 78 P a g e
As is shown in Figure 44 there is a wide variation between practices for two-week wait referrals rate. Greensand Surgery has statistically higher rates than England. Figure 44 Two week wait referrals, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 79 P a g e
Figure 45 shows the indirectly standardised ratio of two week referrals. Figure 45 Two week wait referrals (indirectly standardised), 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 80 P a g e
Figure 46 is a graph showing the conversion rate by practice. Dr Glaze & Partners and Dr Ling & Partners have statistically higher proportions compared with England. Figure 46 Two week referrals- conversion rate, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 81 P a g e
Figure 47 is the proportion of new cancer cases which are two week referrals. All practices have statistically similar proportions to the England average. Figure 47 Proportion of new cancer cases treated which are Two week referrals Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 82 P a g e
Two week referral with suspected breast cancer is shown in Figure 48. Greensand Surgery and Houghton Close Surgery have statistically higher rate compared with England. Figure 48 Two week referrals: suspected breast cancer, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 83 P a g e
Two week referral with suspected lower GI cancer is shown in Error! Reference source not found.. There is wide variation. Houghton Close Surgery has statistically higher rate than England. Figure 49 Two week referrals: suspected lower GI cancer, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 84 P a g e
Figure 50 shows two week referrals with suspected lung cancer. All the practices have similar results when compared to the England average. Figure 50 Two week referrals: suspected lung cancer, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 85 P a g e
Figure 51 shows two week referrals with suspected lung cancer by practice. Houghton Close Surgery and Oliver Street Surgery have a statistically higher rate than the England average. Figure 51 Two week referrals: suspected skin cancer, 2011/12 Source: Cancer Profile, Cancer Commissioning Toolkit https://www.cancertoolkit.co.uk/ 86 P a g e
Hospital Admissions and Activity The emergency admission rate for Cancers, all persons, in West Mid Beds was 181 per 100,000 which is 142 admissions (Figure 52). Houghton Close Surgery has a statistically lower rate than both the averages for West Mid Beds and BCCG. Figure 52 Emergency hospital admissions for cancers (DSR per 100,000 population) Source: SUS Data via MedeAnalytics 87 P a g e
All admission for Cancers in West Mid Beds, all persons, was 2,102 per 100,000 which is 1,572 admissions (Figure 53). There is wide variation. Asplands Medical Centre and Dr Glaze & Partners have statistically higher rates than West Mid Beds and BCCG averages. Houghton Close Surgery and Oliver Street Surgery have statistically lower rates. Figure 53 All Hospital admissions for cancer (DSR per 100,000 population) Source: SUS Data via MedeAnalytics 2011/12 88 P a g e
Cost In West Mid Beds there were 773 cancer inpatients for all ages that had incurred a cost of 1,147,128 with the average cost of 1,484 for males and 799 patients with average cost of 1,206 for females (Table 25). Table 25 Cost: Inpatient cost - All Ages (2011/2012) Locality Total Admissions Source: SUS Data via MedeAnalytics 2011/12 Male DSR per 100,000 Total Cost Cost/Admission Total Admissions Female DSR per 100,000 Total Cost Cost/Admission Bedford 1,748 1,747 2,694,985 1,542 1,798 1,737 2,807,940 1,562 Chiltern Vale 1,049 2,149 1,339,377 1,277 1,504 3,252 1,862,805 1,239 Ivel Valley 1,110 2,100 1,524,408 1,373 1,093 2,172 1,483,856 1,358 Leighton Buzzard 762 2,924 790,994 1,038 645 2,387 711,122 1,103 West Mid Beds 773 2,071 1,147,128 1,484 799 2,168 963,415 1,206 Bedfordshire CCG 5,442 2,068 7,496,892 1,378 5,839 2,225 7,829,139 1,341 89 P a g e
Table 26 shows the cost of the most common cancers by sex for West Mid Beds and BCCG. Table 26 Cost: Inpatient cost All Ages (2011/12) compared against Bedfordshire CCG West Mid Beds Locality Total Admissions Source: SUS Data via MedeAnalytics 2011/12 Male DSR per 100,000 Total Cost Cost/Admission Total Admissions Female DSR per 100,000 Total Cost Cost/Admission Malignanat neoplasms of digestive organs 121 309 271,501 2,244 95 249 131,612 1,385 Malignant neoplasms, stated or presumed to be primary, of lymphoid, haematopoietic and related tissue 172 486 151,309 880 89 247 70,567 793 Malignant neoplasms of Ill-defined, secondary and unspecified sites 37 93 132,447 3,580 64 168 162,007 2,531 Benign neoplasms 70 214 82,048 1,172 101 327 142,256 1,408 Malignant neoplasm of breast 1 3 2,245 2,245 203 600 191,215 942 Melanoma and other malignant neoplasms of skin 70 140 46,099 659 Bedfordshire CCG Malignanat neoplasms of digestive organs 888 339 1,942,240 2,187 642 217 1,265,367 1,971 Malignant neoplasms, stated or presumed to be primary, of lymphoid, haematopoietic and related tissue 1,255 512 1,143,368 911 684 283 664,051 971 Malignant neoplasms of Ill-defined, secondary and unspecified sites 256 98 666,827 2,605 599 221 970,429 1,620 Benign neoplasms 522 218 545,083 1,044 811 350 1,163,906 1,435 Malignant neoplasm of breast 4 2 8,941 2,235 1,204 491 1,237,013 1,027 Melanoma and other malignant neoplasms of skin 678 234 501,997 740 486 148 357,167 735 Outpatients Figure 54 and Figure 55 show the medical oncology outpatient figures for West Mid Beds Locality by rates and costs k. Dr Glaze & Partners, Houghton Close Surgery, Dr Morris & Partners, Oliver Street Surgery and Greensand Surgery have statistically higher rates compared to the ONS cluster average. k The ONS cluster is calculated using the Bedford Borough Council s area and does not include Cranfield & Marstone Moretaine 90 P a g e
Figure 54 Medical oncology outpatients in West Mid Beds Locality, number of patients, 2011/12 Source: NHS Comparators 91 P a g e
Figure 55 Medical oncology outpatients in West Mid Beds Locality, cost, 2011/12 Source: NHS Comparators 92 P a g e