Intelligence supporting Isle of Barra Health Needs Assessment and St. Brendans Hospital Reprovision

Intelligence supporting Isle of Barra Health Needs Assessment and St. Brendans Hospital Reprovision Public Health Intelligence & Information Services Department

Contents 1. Demographics 3 2. St. Brendan s Hospital Activity utilisation trends and projections 6 3. Barra Population hospital and community morbidity trends 13 4. Long Term Conditions for Barra population 17 5. Main Hospital conditions for Barra population 18 6. Barra Community Health Profile 20 2

1. Demographics a) Barra Population trends Table 1: Isle of Barra Population Estimates by Broad Age Group, 2002-12 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 % Change 0-15 yrs 251 250 252 238 222 227 234 226 196 206-17.9% 16-64 yrs 699 711 696 700 715 720 682 691 690 709 1.4% 65+ yrs 215 220 210 211 215 217 232 242 252 257 19.5% Total 1,165 1,181 1,158 1,149 1,152 1,164 1,148 1,159 1,138 1,172 0.6% Overall there has been a 0.6% increase in population but within this there have been falls in numbers of children compensated by rises in those aged 65+. The most recent 2011 census population estimates the overall population to be higher than the estimates derived in Table 1 above which are 2001 census based as shown below. Table 2: 2011-12 Barra population estimates (2011 census based) 2011 2012 0-15 yrs 260 244 16-64 yrs 753 742 65+ yrs 265 284 Total 1,278 1,270 However, these latest estimates for 2011 and 2012 have not yet been rebased to the sub- Health Board levels for 2002-2010 so cannot be used for trends analysis. Figure below shows that Barra population is very similar in broad terms to that of Western Isles as a whole with both having 22% of population comprised of older people cd(65+) and slightly higher level of children (19%) in Barra compared to Western Isles (17%). Figure 1: 2012 Population Structure of Barra & Western Isles, (2011 census based) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Barra Western Isles 65+ yrs 16-64 yrs 0-15 yrs 3

Figure 2: Proportion of Age Groups as % of Total Population for Community Areas in Western Isles, 2012 (ranked by % aged 65+) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 65+ yrs 16-64 yrs 0-15 yrs In 2012 Barra ranks 8 th largest of 15 communities in Western Isles for older age population proportion. Ranges from 29% in Harris to 14% in Benbecula. b) Barra Population projections There are no nationally available population projections at sub-hb or sub-local Authority area level in Scotland. The following two methods have been utilised which due to the very small numbers at this level of population can produce wide variations in outcomes. The first method is to utilise the POPGROUP software recommended by National Records Scotland (NRS) to apply trends in vital statistics (ie. births/deaths) and migration at small area level (Barra) to baseline population to arrive at a projected figure (see Table 3). This closely follows the same cohort component model used by NRS in producing national and HB/LA population projections although the level of accuracy and variation in outputs is very much dependent on the size of baseline population and inputs/assumptions on births/deaths and migration entered into the model. Table 3: Barra population projections using POPGROUP methodology 2010 baseline estimate 2020 2030 2030 WI No. % Shift % Shift 0-15 yrs 196 241 234 19% -20% 16-64 yrs 690 662 625-9% -19% 65+ yrs 252 312 358 42% 40% Total 1,138 1,214 1,217 7% -6% 4

Comparing the above % shifts to the NRS published projections for Western Isles to 2035 (5 years beyond the POPGROUP calculated projections) shows greater proportionate shifts across all age groups. Applying these same percentage shifts for Western Isles to the Barra baseline population gives an alternative crude forecast (see table 4 below). Table 4: Population projections using WI projected percentage shifts 2010 baseline estimate 2035 2035 WI No. % Shift % Shift 0-15 yrs 196 129-34% -34% 16-64 yrs 690 497-28% -28% 65+ yrs 252 391 55% 55% Total 1,138 1,013-11% -11% However, it is important to note this applies the population cohort changes and assumptions at the Western Isles level to the Barra baseline population and does not therefore reflect demographic trends in Barra that may divert significantly from that of Western Isles as a whole. It may be useful though to consider the % shifts of WI to Barra population when viewing the projections in table 3 that have caveats around small cohort sizes involved that can result in sizeable variations in output. 5

2. St. Brendans Hospital Activity a) Bed occupancy Figure 3: St. Brendan s Daily Occupied Beds 2012-13 St. Brendans Hospital Daily Occupied Bed Count - 01/04/2012 to 31/03/2013 100% % of Total Days Cumulative % of Total Days 80% 60% 40% 20% 0% 0 1 2 3 4 5 % of Total Days 0% 0% 25% 43% 23% 9% Cumulative % of Total Days 0% 0% 25% 68% 91% 100% Beds Occupied 91% of current patient activity would be seen within 4 beds. Improvements in line with national policy to effectively manage hospital lengths of stay and maximise day case provision and in developing anticipatory care planning and selfcare support esp. for patients with long term conditions may impact on the figures on bed utilisation. Figure 4: Daily Bed Occupancy excl. patients who stayed > 20 days (long stay patients) St. Brendans Hospital Daily Occupied Bed Count (-ex. Patients staying > 20 Days) 01/04/2012 to 31/03/2013 100% % of Total Days Cumulative % of Total Days 80% 60% 40% 20% 0% 0 1 2 3 4 5 % of Total Days 36% 41% 15% 7% 0% 0% Cumulative % of Total Days 36% 78% 93% 100% 100% 100% Beds Occupied The above chart presents the daily no. of beds occupied but this time excluding those patients who had a length of stay 20 days or greater. In the absence of long stay coded 6

01-Apr-12 08-Apr-12 15-Apr-12 22-Apr-12 29-Apr-12 06-May-12 13-May-12 20-May-12 27-May-12 03-Jun-12 10-Jun-12 17-Jun-12 24-Jun-12 01-Jul-12 08-Jul-12 15-Jul-12 22-Jul-12 29-Jul-12 05-Aug-12 12-Aug-12 19-Aug-12 26-Aug-12 02-Sep-12 09-Sep-12 16-Sep-12 23-Sep-12 30-Sep-12 07-Oct-12 14-Oct-12 21-Oct-12 28-Oct-12 04-Nov-12 11-Nov-12 18-Nov-12 25-Nov-12 02-Dec-12 09-Dec-12 16-Dec-12 23-Dec-12 30-Dec-12 06-Jan-13 13-Jan-13 20-Jan-13 27-Jan-13 03-Feb-13 10-Feb-13 17-Feb-13 24-Feb-13 03-Mar-13 10-Mar-13 17-Mar-13 24-Mar-13 31-Mar-13 No. Beds Occupied % occupancy beds or patients this was used as a proxy measure for identifying long stay patients to exclude them from the occupancy analysis. Figure 4b shows that excluding such long stay patients the maximum no. of beds occupied in any day during the period was 3 and this was comparatively rarely during the year (7%). 93% of days during the year there were only 2 or fewer beds occupied. b) Occupancy trend Figure 5: St. Brendan s Average Monthly Bed Occupancy, 2012-13 90% 80% 70% 60% Monthly Average Bed Occupancy at St Brendan's 50% 40% 30% 20% 10% 0% Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 2012 2013 Year/Month % occupancy Median Average monthly occupancy levels for latest year have ranged between 78% (Aug-12) and 55% (Mar13) with a general downward trend particularly in the latest period with 7 months at or below the median of monthly levels. Daily occupied bed trends over latest year with 95th and 90 th percentiles are shown in charts below: Figure 6: St. Brendan s Hospital Daily Occupied Beds with Percentile ranges 6 Daily Bed Occupancy at St. Brendan's Hospital, with 90th and 95th Percentiles 5 4 3 2 Daily Beds 95th Percentile 90th Percentile 1 0 7

01-Apr-12 08-Apr-12 15-Apr-12 22-Apr-12 29-Apr-12 06-May-12 13-May-12 20-May-12 27-May-12 03-Jun-12 10-Jun-12 17-Jun-12 24-Jun-12 01-Jul-12 08-Jul-12 15-Jul-12 22-Jul-12 29-Jul-12 05-Aug-12 12-Aug-12 19-Aug-12 26-Aug-12 02-Sep-12 09-Sep-12 16-Sep-12 23-Sep-12 30-Sep-12 07-Oct-12 14-Oct-12 21-Oct-12 28-Oct-12 04-Nov-12 11-Nov-12 18-Nov-12 25-Nov-12 02-Dec-12 09-Dec-12 16-Dec-12 23-Dec-12 30-Dec-12 06-Jan-13 13-Jan-13 20-Jan-13 27-Jan-13 03-Feb-13 10-Feb-13 17-Feb-13 24-Feb-13 03-Mar-13 10-Mar-13 17-Mar-13 24-Mar-13 31-Mar-13 No. Beds Occupied The maximum no. of beds in any day was 5 which occurred on 33 days during the year and therefore 95 th percentile does not fall below 5. The 90 th percentile is 4 beds with further 84 days during year when 4 beds were occupied. It is important to note that a few very long stays during any one year can have a marked impact on the percentiles given the small number of beds involved. The same chart was repeated excluding stays over 20 days in absence of a long stay patient category on the PAS system (chart 7 below). Figure 7: St. Brendan s Hospital Daily Occupied Beds with Percentile ranges (ex. Stays > 20 days) 5 Daily Bed Occupancy (ex. patients with stay >20 days) at St. Brendan's Hospital, with 90th and 95th Percentiles 4 3 2 Daily Occupied Beds Percentile Occupied Beds 95% Percentile Occupied Beds 90% 1 0 This shows the 95 th percentile reduced to 3 beds with 26 days of this level of occupancy during the year. This falls further to 2 beds with additional 56 days occupied excluding beds taken up by patients staying over 20 days. c) Admission activity Table 5: Annual activity at St. Brendans Hospital, 2008/09- Year Inpatient Daycase Total 2008-09 83 20 103 2009-10 99 33 132 2010-11 92 27 119 2011-12 81 18 99 2012-13 87 21 108 Some evidence of a shift downwards in annual activity since peaking in 2009/10 with an overall 18% reduction in total admissions during this period. 8

d) Lengths of stay Table 6: Average length of patient stay at St. Brendans hospital with 5% trimmed average. Year Inpatient Stay Average of lengths of stay (days)* Average Length of Stay Ex. Long stays (days)* 2008-09 700.00 8.43 n/a 2009-10 1139.00 11.51 n/a 2010-11 956 10.39 2.87 2011-12 562 6.94 3.66 2012-13 435 5.00 4.19 * Based on average length of stay rounded up to full day for each episode While admissions have not shown large movements over period and if anything some decrease over peaks the length of stay has shown marked reduction by over half since peak in 2009/10. Inpatient average length of stay has risen from 8.4 to 11.5 days in first 2 years before falling back again beyond baseline to 5.0 days with much reduced activity. Excluding those patients with long stays the average length of stay is affected particularly for those years where overall high average stays were evident. This indicates that the reductions in lengths of stay in latter years has been as result of the reductions in long stay patients. e) Throughput Table 7: Inpatient throughput per bed at St. Brendans Hospital Year Throughput 2008-09 16.6 2009-10 19.8 2010-11 18.4 2011-12 16.2 2012-13 17.4 Throughput is the average no. of inpatients treated per bed and has remained fairly stable over the period. 9

f). Accident and Emergency attendances Table 8 below shows the monthly numbers of A&E attendances excluding planned return visits which are not collated from manual recording systems presently. Table 8: A&E monthly attendances at St. Brendan s Hospital April 2010- March 2013 Month of Attendance All Attendances Reported Attendances (Excluding Planned Returns) A&E 4 Hour Waiting Time Breaches Apr-10 28 28 1 May-10 34 34 1 Jun-10 38 38 0 Jul-10 50 50 0 Aug-10 41 41 0 Sep-10 28 28 0 Oct-10 33 33 0 Nov-10 24 24 2 Dec-10 34 34 1 Jan-11 30 30 0 Feb-11 45 45 2 Mar-11 56 56 0 Apr-11 49 49 0 May-11 43 43 1 Jun-11 46 45 1 Jul-11 113 103 4 Aug-11 63 54 0 Sep-11 61 43 3 Oct-11 24 21 0 Nov-11 27 27 1 Dec-11 43 38 0 Jan-12 20 18 0 Feb-12 47 41 2 Mar-12 32 32 0 Apr-12 48 45 0 May-12 58 45 0 Jun-12 89 83 2 Jul-12 73 73 0 Aug-12 58 56 1 Sep-12 61 49 0 Oct-12 31 28 0 Nov-12 36 32 0 Dec-12 48 42 0 Jan-13 51 32 0 Feb-13 56 47 0 10

Mar-13 33 33 0 g) Projected Inpatient Acute Beds Projections of average available bed requirements have been made which seek to incorporate Barra population projections to 2030 (see table below) from baseline occupied bed rates per capita in. Table 9: Barra Projected Population (2010 based) Age Group Population Estimates/Projections 2012 2020* 2025* 2030* 0-15 yrs 251 241 241 234 16-64 yrs 699 662 646 625 65+ yrs 215 312 337 358 Total 1,138 1,214 1,224 1217 Based on these population projections a number of scenarios have been projected: i) projections based on latest bed utilisation ii) projections based latest bed utilisation ex. Stays over 20 days (in absence of long stay recording) iii) projections based on latest bed utilisation trimmed for 5% outliers with longest stays iv) proposed projections based on Scottish age-specific average length of stays for similar hospital and specialty combination. Table 10: Projection i) Current bed utilisation rate projected Age Group Baseline Activity - OBDs Baseline - Rate/OBDs /1,000 pop. OBD Projections Projected Average Available Beds at average occupancy rates 2012-13 2012-13 2020* 2025 2030 2020 2030 70% 80% 90% 70% 80% 90% 0-15 yrs 2 8 2 2 2 0 0 0 0 0 0 16-64 yrs 74 106 70 68 66 0 0 0 0 0 0 65+ yrs 1078 5014 1564 1690 1795 6 5 5 6 6 6 Total 1154-1636 1760 1863 6 5 5 7 6 6 Table 11: Projection ii) Current bed utilisation (ex. Stays >20 days) projected Age Group Baseline Activity - OBDs (ex.stay> 20 days) Baseline - Rate/ OBDs /1,000 pop. OBD Projections Projected Average Available Beds at average occupancy rates 2012-13 2012-13 2020* 2025 2030 2020 2030 70% 80% 90% 70% 80% 90% 0-15 yrs 2 8 2 2 2 0 0 0 0 0 0 16-64 yrs 74 106 70 68 66 0 0 0 0 0 0 65+ yrs 265 1233 385 415 441 1 1 1 2 2 1 11

Total 341 300 364 486 509 1 1 1 2 2 2 Table 12: Projection iii) Current bed utilisation rates trimmed of 5% longest outlier stays, projected Age Group Baseline Activity - OBDs (Trimmed 5% longest stays) Baseline - Rate/OBDs /1,000 pop. OBD Projections Projected Average Available Beds at average occupancy rates 2012-13 2012-13 2020* 2025 2030 2020* 2030 70% 80% 90% 70% 80% 90% 0-15 yrs 1 4 1 1 1 0 0 0 0 0 0 16-64 yrs 49 70 46 45 44 0 0 0 0 0 0 65+ yrs 909 4228 1319 1425 1514 5 4 4 5 5 5 Total 959 843 1366 1471 1558 5 5 5 6 5 5 Table 13: Projection iv) Current bed utilisation activity applied to Scottish age specific average lengths of stay for GP Other specialties within community hospitals and projected Age Group Baseline Activity - OBDs (expected for Scottish ALoS) Baseline - Rate/OBDs /1,000 pop. OBD Projections Projected Average Available Beds at average occupancy rates 2012-13 2012-13 2020* 2025 2030 2020 2030 70% 80% 90% 70% 80% 90% 0-15 yrs 3 11 3 3 3 0 0 0 0 0 0 16-64 yrs 134 192 127 124 120 1 1 0 1 0 0 65+ yrs 899 4180 1304 1409 1496 5 4 4 5 5 5 Total 1,035 910 1105 1535 1619 4 4 3 6 5 5 Significant variation between projections i, iii and ii since the latter excludes greater no. of stays from the projections. May wish to apply higher length of stay threshold here or to rely upon 5% trim as removing the issue of small number of very lengthy stays skewing data projections. The projections are then modelled for range of possible optimum average occupancy levels rather than actual beds occupied since system will need capacity to flex to meet the peaks and troughs identified in the daily occupancy trends above. The final table is based on Scottish average lengths of stay for same age groups and specialty/hospital combinatoin applied to St. Brendan s Hospital baseline inpatient activity. A further method which would potentially provide more needs based estimates would be to review existing activity at St. Brendans and then to apply the recommended lengths of stay for care groups identified for community hospitals advised as part of a review and good practice guide in England & Wales. These care groups and respective recommended lengths of stay included the following: Sub acute care 5 days Intensive rehabilitation 21 days Specialist stroke 28 days Complex elderly with co-morbidity 42 days Neuro rehabilitation 42 days End of life 5 days 12

Consideration may wished to be give to the value of undertaking this approach with medical input to allocate St. Brendans Hospital activity to the various care groups. 3. Barra Population hospital and community morbidity trends a) Inpatient Activity Trends Table 14: All Barra Resident Activity by Location, 2010-2013 Number of episodes Number of patients Number of episodes Number of episodes Number of patients 2010/11 2011/12 St Brendan's Hospital 109 78 92 64 100 63 Other Western Isles Hospital 96 74 66 49 58 51 Mainland Hospital 278 117 154 97 224 103 Totals 483 269 312 210 382 217 Number of patients Table 15: Emergency & Non Emergency Inpatient Activity (Episodes) by Location, 2010-2013 Nonemergency Admission /transfer Nonemergency Admission /transfer Nonemergency Admission/ transfer Emergency Admission Emergency Admission Emergency Admission 2010/11 2011/12 St Brendan's Hospital 104 5 86 6 94 6 Other Western Isles Hospital 12 84 11 55 3 55 Mainland Hospital 73 205 50 104 58 166 Totals 189 294 147 165 155 227 Table 16: Emergency & Non Emergency Inpatient Activity (Episodes) by Specialty, Non-emergency Emergency Admission Admission/transfer St Brendan's Hospital GP Other than Obstetrics 94 6 Other Western Isles Hospital Cardiology 1 General Medicine 1 General Surgery 16 GP Other than Obstetrics 2 17 Gynaecology 5 Ophthalmology 9 Oral and Maxillofacial Surgery 1 Trauma and Orthopaedic Surgery 6 Mainland Hospital Cardiac Surgery 4 Cardiology 6 9 Clinical Oncology 2 16 Ear, Nose & Throat (ENT) 1 4 Endocrinology & Diabetes 1 Gastroenterology 5 General Medicine 21 22 General Surgery 6 2 General Surgery (excl Vascular, Maxillofacial) 2 6 Geriatric Medicine 9 13

Gynaecology 1 8 Haematology 1 13 Medical Oncology 2 14 Neurology 5 Neurosurgery 3 2 Ophthalmology 2 Paediatrics 2 Plastic Surgery 5 Rehabilitation Medicine 1 Renal Medicine 1 2 Respiratory Medicine 2 6 Trauma and Orthopaedic Surgery 6 12 Urology 2 16 Vascular Surgery 2 Totals 155 227 Table 17: 75+ Emergency Admissions (Episodes) by Location 2010-2013 2010/11 2011/12 St Brendan's Hospital 40 27 33 Other Western Isles Hospital 8 3 1 Mainland Hospital 15 12 14 Totals 63 42 48 Table 18: Proportion of all Episodes by Over/Under 75s age groups by location 2012-13 0-74 75+ 0-74 75+ No. % St Brendan's Hospital 64 36 64% 36% Other Western Isles Hospital 47 11 81% 19% Mainland Hospitals 173 51 77% 23% Totals 284 98 74% 26% b) Day Case Activity Trends Table 19: Day Case Activity (Episodes) by Location 2010 2013 2010/11 2011/12 Other Western Isles Hospital 34 37 28 Mainland Hospitals 99 39 58 Grand Total 133 76 86 c) Outpatient Activity Trends Table 20: New/Return Outpatient Attendances by location, 2010-13 New Return New Return New Return 2010/11 2011/12 St Brendan's Hospital 2 0 2 0 1 0 Other Western Isles Hospital 171 3 116 12 125 5 Mainland Hospital 168 358 122 304 106 323 14

Totals 341 361 240 316 232 328 Table 21: Outpatients by Specialty and Referral Type, New Return St Brendan's Hospital General Medicine 1 0 Other Western Isles Hospital Audiological Medicine 0 1 Child Psychiatry 1 0 Clinical Neurophysiology 3 0 Dermatology 3 0 Diabetes 1 0 Ear, Nose & Throat (ENT) 21 0 General Medicine 11 2 General Surgery 15 0 GP Other than Obstetrics 4 0 Gynaecology 28 2 Ophthalmology 22 0 Trauma and Orthopaedic Surgery 13 0 Urology 3 0 Mainland Hospitals Cardiology 5 8 Clinical Genetics 1 2 Clinical Oncology 4 41 Dermatology 5 11 Diabetes 0 4 Ear, Nose & Throat (ENT) 5 9 Endocrinology 0 6 Endocrinology & Diabetes 1 6 Gastroenterology 0 13 General Medicine 0 3 General Surgery 1 3 General Surgery (excl Vascular, Maxillofacial) 25 35 Gynaecology 0 1 Haematology 0 14 Infectious Diseases 1 5 Medical Oncology 2 25 Neurology 4 9 Neurosurgery 1 1 Obstetrics 5 12 Obstetrics Ante-Natal 2 7 Ophthalmology 8 19 Oral Medicine 1 1 Orthodontics 0 1 Paediatric Surgery 1 0 Paediatrics 0 1 Plastic Surgery 3 9 Rehabilitation Medicine 0 1 Renal Medicine 1 7 Respiratory Medicine 6 9 Rheumatology 4 30 Trauma and Orthopaedic Surgery 12 21 Urology 6 9 Vascular Surgery 2 0 15

Totals 232 328 d) Mental Health activity Table 22: MENTAL HEALTH INPATIENT EPISODES (based on Date of Discharge) no Daycases recorded 2010/11 2011/12 Other WI G1 1 1 G4 2 Mainland G1 1 G3 1 Total 0 5 1 Source: SMR04 Table 23 MENTAL HEALTH OUTPATIENT CLINIC APPOINTMENTS 2010/11 2011/12 St Brendan's G1 2 2 Other WI G21 1 1 Mainland G4 1 1 Total 3 4 1 Source: SMR00 Note: May not include return appointments for mainland hospitals as not mandatory recording. e) Community Health activity Community health service provision in Barra has range of service models from Barra-based to Uist & Barra and Lewis & Harris services which do outreach to Barra as required. The table below provides contact data on the first two service models though the Uist & Barra service is not broken down to Barra resident only. Table 24: Contacts for Community Health services in Barra and Uist & Barra 2010/11 2011/12 Barra Community Nurse 2268 2193 2795 CPN 471 446 183 Health Visitor 664 835 834 CAMHs 2 8 41 Uist & Barra Heart Failure 169 241 220 Macmillan 1501 1361 1806 School Nurse 2354 2416 2290 Stroke Liaison 172 129 65 Substance Misuse 508 583 722 There are range of other services which are based in Lewis & Harris but include a level of service provision in Barra though not possible to quantify which includes the following: Diabetes Nurse MS nurse CA/TV cover for Barra (based in Stornoway) Other services not covered on Barra include: Overnight nurse service 16

Continence/Tissue Viability nurse - awaiting cofirmation of Barra provision 4. Long Term Conditions for Barra population Table25: Disease Prevalence for LTC QOF Primary Care registers QOF register 2 Scotland Raw prevalence rate 1 Western Isles Raw prevalence rate 1 Barra Medical Practice Patients on QOF disease register Raw prevalence rate 1 Asthma 6.10 6.49 81 6.68 Atrial Fibrillation 1.53 2.91 21 1.73 Cancer 2.01 2.64 37 3.05 CHD (Coronary Heart Disease) 4.29 6.06 66 5.45 CKD (Chronic Kidney Disease) 3.23 3.79 72 5.94 COPD (Chronic Obstructive Pulmonary Disease) 2.11 1.78 24 1.98 CVD (Primary Prevention of Cardiovascular Disease) 2.00 3.46 59 4.87 Dementia 0.76 0.98 5 0.41 Depression 1 (of 2): conditions assessed for depression 7.91 9.49 99 8.17 Depression 2 (of 2): new diagnosis of depression 5.31 5.33 29 2.39 Diabetes 4.60 4.52 45 3.71 Epilepsy 0.74 0.79 * * Heart Failure 0.82 1.92 35 2.89 Hypertension 13.78 20.13 244 20.13 Hypothyroidism 3.73 6.26 47 3.88 Learning Disabilities 0.48 0.59 10 0.83 LVD (Left Ventricular Dysfunction) 0.57 1.28 19 1.57 Mental Health 0.87 1.22 13 1.07 Obesity 8.77 11.40 123 10.15 Osteoporosis 0.13 0.12 * * Palliative Care 0.22 0.26 * * Peripheral Arterial Disease 0.88 1.51 20 1.65 "Smoking" (conditions assessed for smoking) 24.53 31.08 381 31.44 Stroke & Transient Ischaemic Attack (TIA) 2.12 2.50 29 2.39 1. Prevalence = number of patients on the specified QOF register, divided by list size, multiplied by 100. Table 26: Long Term Conditions Episodes and Patients (Inpatients only) by Location 2010-2013 Number of Episodes Number of Patients Number of Episodes Number of Patients Number of Episodes Number of Patients 2010/11 2011/12 St Brendan's Hospital 14 11 11 7 14 12 Other Western Isles Hospital 6 3 3 1 0 0 Mainland Hospitals 7 4 11 6 28 10 Totals 27 18 25 14 42 22 17

Table 27: Long Term Conditions Episodes by Location and LTC (Inpatients only) 2010/11 2011/12 St Brendan's Hospital Acute Myocardial Infarction 1 2 2 Asthma 7 4 4 Chronic Obstructive Pulmonary Disease 4 3 5 Diabetes 1 Heart Failure 1 2 3 Other Western Isles Hospital Chronic Obstructive Pulmonary Disease 4 Heart Failure 2 Hypertension 3 Mainland Hospitals Acute Myocardial Infarction 1 2 10 Asthma 4 1 Chronic Obstructive Pulmonary Disease 1 10 Heart Disease 2 6 6 Heart Failure 1 2 Totals 27 25 42 d 5. Main Hospital conditions for Barra population Table 28: Main Diagnostic Conditions (Episodes) by Location (ICD Main Condition Groupings), St Brendan's Hospital Other Western Isles Hospital Mainland Hospital CERTAIN INFECTIOUS AND PARASITIC DISEASES 1 3 CONGENITAL MALFORMATIONS/DEFORMATIONS/CHROMOSOMAL ABNORMALITIES 2 DISEASES OF BLOOD/BLOOD-FORMING ORGANS & DISORDERS INVOLV IMMUNE MECHANISM 4 1 DISEASES OF THE CIRCULATORY SYSTEM 9 6 32 DISEASES OF THE DIGESTIVE SYSTEM 8 17 18 DISEASES OF THE EAR AND MASTOID PROCESS 2 DISEASES OF THE EYE AND ADNEXA 8 2 DISEASES OF THE GENITOURINARY SYSTEM 11 7 13 DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 1 2 12 DISEASES OF THE NERVOUS SYSTEM 1 3 6 DISEASES OF THE RESPIRATORY SYSTEM 18 14 DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 3 3 4 FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES 6 5 6 INJURY,POISONING & CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES 10 3 13 MENTAL AND BEHAVIOURAL DISORDERS 6 1 NEOPLASMS 8 2 64 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM 5 SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS NEC 14 2 26 All Episodes 100 58 224 18

Table 29: Main Diagnostic Conditions (Episodes) by Location (ICD Chapter Groupings), St Brendan's Hospital Other Western Isles Hospital Mainland Hospital CERTAIN INFECTIOUS AND PARASITIC DISEASES 1 3 CONGENITAL MALFORMATIONS/DEFORMATIONS/CHROMOSOMAL ABNORMALITIES 2 DISEASES OF BLOOD/BLOOD-FORMING ORGANS & DISORDERS INVOLV IMMUNE MECHANISM 4 1 DISEASES OF THE CIRCULATORY SYSTEM 9 6 32 DISEASES OF THE DIGESTIVE SYSTEM 8 17 18 DISEASES OF THE EAR AND MASTOID PROCESS 2 DISEASES OF THE EYE AND ADNEXA 8 2 DISEASES OF THE GENITOURINARY SYSTEM 11 7 13 DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE 1 2 12 DISEASES OF THE NERVOUS SYSTEM 1 3 6 DISEASES OF THE RESPIRATORY SYSTEM 18 14 DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE 3 3 4 FACTORS INFLUENCING HEALTH STATUS AND CONTACT WITH HEALTH SERVICES 6 5 6 INJURY,POISONING & CERTAIN OTHER CONSEQUENCES OF EXTERNAL CAUSES 10 3 13 MENTAL AND BEHAVIOURAL DISORDERS 6 1 NEOPLASMS 8 2 64 PREGNANCY, CHILDBIRTH AND THE PUERPERIUM 5 SYMPTOMS, SIGNS AND ABNORMAL CLINICAL AND LABORATORY FINDINGS NEC 14 2 26 All Episodes 100 58 224 Note diagnostic activity data is taken from SMR01 source which has small variation from local Patient Administration System data for sections 2a-e. 19

6. Barra Communith Health Profile Western Isles Community Health Locality Planning Group profiles - February 2014 The Public Health Intelligence Department of NHS Western Isles have produced Community Health Profiles for the Western Isles at Locality Planning Group (LPG) area level. The purpose of these Community Health Profiles is to provide the information that is needed to improve the understanding of local health issues and to take action to improve the health of the local communities. They should assist in assessing planning priorities where measures are shown to be above or below the national level across the islands or in targeting specific local areas for interventions if a particular variation is found within the islands communities. The Profiles compare the status of the population within the LPG areas including Barra across a range of indicators. Comparisons are made between these LPG areas and to the Western Isles and Scottish figures by a series of maps, charts and spine chart for each indicator measure (See example below for Population aged 16-64 years). The Profiles contain 45 indicator areas which have selected according to the following core Domains of Public Health based on the Public Health Outcomes Framework Tool produced in England: Healthcare public health and preventing premature mortality - indicators for tracking progress in reducing numbers of people living with preventable ill health and people dying prematurely Health Improvement - indicators for tracking progress in helping people to live healthy lifestyles and make healthy choices. Health Protection - indicators for tracking progress in protecting the population s health from major incidents and other threats. Improving the wider determinants of public health - indicators to support the tracking of progress in wider factors that affect health and well-being. These Domains are also mapped to the Scottish Public Health Observatory (ScotPHO) domains which they have used in the series of Health and Well Being Profiles they have been producing at Health Board and Community Health Partnership level in recent years (https://scotpho.nhsnss.scot.nhs.uk/scotpho/homeaction.do) Due to the size of the Profiles it is not included here but the profile for Barra locality is available on request from Public Health Intelligence Dept. at NHS Western Isles Health Board Offices or for staff via intranet website http://wihbweb.wi.scot.nhs.uk/publichealth/phi/wihp.html and it is envisaged that public will be able to access from public website in due course. 20

A full list of the Indicator areas and the PH Outcome Domains and ScotPHO domains they represent is provided below. Access to the full Profiling Tool is available from the Public Health Intelligence Dept. at NHS Western Isles. Public Health Outcome Domain ScotPHO Domain 21 Indicator Latest available data Behaviours Prevalence of obesity Behaviours Prevalence of smoking Behaviours Ill Health & Injury Ill Health & Injury Weekly alcohol consumption above recommended limits Well North Average length of stay - non routine admission Average length of stay - routine admissions 2008/09 Ill Health & Injury Emergency admissions Ill Health & Injury Ill Health & Injury Ill Health & Injury Ill Health & Injury Ill Health & Injury Patients hospitalised following a road traffic accident (RTA) Patients hospitalised following a heart attack Patients hospitalised with cerebrovascular disease Patients hospitalised with coronary heart disease (CHD) Potentially preventable admissions (PPAs) Ill Health & Injury Prevalence of asthma Ill Health & Injury Prevalence of cancer Ill Health & Injury Ill Health & Injury Ill Health & Injury Ill Health & Injury Prevalence of cardiovascular disease (CVD) Prevalence of chronic kidney disease Prevalence of chronic obstructive pulmonary disease (COPD) Prevalence of coronary heart disease (CHD) Ill Health & Injury Prevalence of depression Ill Health & Injury Prevalence of diabetes Ill Health & Injury Prevalence of heart failure Ill Health & Injury Prevalence of hydro thyroidism Ill Health & Injury Prevalence hypertension Ill Health & Injury Prevalence of stroke/tia Early deaths from cancer (<75 years) Early deaths from CVD (<75 years) Early deaths from coronary heart disease (CHD) (<75 years) Early deaths from liver disease (<75 years) Local - 2010-2012 National - 2012 Local - 2010-2012 National - 2012 Local - 2010-2012 National - 2012 Local - 2010-2012 National - 2012

Early deaths from respiratory disease (<75 years) Local - 2010-2012 National - 2012 Excess winter deaths Health Improvement Women's & Children's Exclusively breastfed at 6-8 Health week review Health Improvement Women's & Children's Health Low birth weight Health Improvement Women's & Children's Primary 1 children at risk of Health overweight or obese 2011/12 Health Protection Women's & Children's Completed HPV course Health (School year) Health Protection Women's & Children's Completed 5 in 1 immunisation Health at 24 months Health Protection Women's & Children's Uptake of 1 dose of MMR by 24 Health months Health Protection Women's & Children's Uptake of 1 dose of MMR by 5 Health years Health Protection Women's & Children's Uptake of cervical screening Health within the last 5.5 years Wider determinants Population Population aged 15 years Mid-2011 Wider determinants Population Population aged 16-64 years Mid-2011 Wider determinants Population Population aged 65+ years Mid-2011 Wider determinants Population Birth rate 2012 Wider determinants Population Death rate 2012 Wider determinants Wider determinants Wider determinants Population Population Population Population change 2012-2030 (aged 15 years) Population change 2012-2030 (aged 16-64 years) Population change 2012-2030 (aged 65+ years) 2012 (Baseline year) 2012 (Baseline year) 2012 (Baseline year) Martin Malcolm Public Health Intelligence Martin.malcolm@nhs.net 22