EVESHAM, BREDON, BROADWAY & INKBERROW POPULATION PROFILE Purpose The locality profiles have been produced to – Support shared understanding of the health and care needs and experiences of local people accessing services Provide insights into how people are currently using health services and their outcomes Help to identify opportunities for collaborative working within and across localities These profiles have not been produced for the purposes of performance management. They are intended to support Neighbourhood Team in identifying their priorities for the forthcoming year. Although some of the data might be familiar to you, it is hoped that you will be able to gain a greater insight into the challenges facing the local population when viewing this in the context of a wider data set. This is the first attempt at compiling this data at Neighbourhood Team level. We would expect that as teams have had the opportunity to use this information, we may need to refine the data set over the initial period. If this data proves useful, we will refresh and refine the profiles on an annual basis. It only provides a snapshot across a broad range of indicators, but in producing this, we have compiled a comprehensive data set which we can drill down into as requested. Neighbourhood teams will also be provided with a monthly dashboard of indicators which will demonstrate the performance of their integrated community team. Once the Neighbourhood Teams have identified their priorities for the year, we will provide support in developing a monthly dataset to help you to monitor the effectiveness of any new developments you put in place. Limitations The primary and community care localities are not fully aligned to the local authority area council geographies Public health data, for example, rates of obesity and smoking, is based on council wards whereas the disease prevalence data (QOF) and hospital episode data (SUS) is based on GP registered lists Key for tables Highlighted Data based on local authority population Not highlighted Data based on GP registered lists Patient level data is not matched across different health and care providers so provides limited information around how patients use and move through the system as a whole DEMOGRAPHICS Data sources NHS Digital Number GP practices of Patients Riverside Surgery Registered at a GP Bredon Hill Surgery Practice Barn Close Surgery Merstow Green Medical Practice Abbey Medical Practice Demontfort Medical Centre Grey Gable Surgery Total registered population: 58,951 (July 2017) Black and minority Black and minority ethnic population Number of 65yrs+ living alone ethnic (non-white) population and pensioners living 2.2% 28.5% alone Census 2011 Lower than Worcestershire average – 4.3% Lower than Worcestershire average – 28.7% Census of population Carers provides 20 or more hours unpaid Homelessness (per 1,000 households) 2011 Homelessness care a week applications total 4.3 decisions made: rate 3.8% per 1,000 households Lower than England average – 5.0 15/16 Higher than Worcestershire average – 3.7% EBBI Worcestershire 85+yrs 65-84yrs 25-64yrs 15-24yrs 0-14yrs 0% 10% 20% 30% 40% 50% 60% % Population POPULATION HEALTH Data sources Neighbourhood Team Limiting long term illness or Worcestershire General health bad or very bad data (self-reported) disability (self-reported) Life expectancy PHOF indicator Life expectancy male 81.3 79.7 5.0% 18.7% 2013-15 (3 years pooled data) Council district figure Life expectancy female General health and limiting long 84.6 83.5 Lower than Worcestershire Avg – 5.2% Higher than Worcestershire Avg – 17.9% term illness or disability, Census 2011 – NT level Obese children (Year 6), National Obese children Adults with excess weight Child Measurement Programme (Year 6) (NCMP) 3 years combined data 2014/15 - 2016/17 17.8% 65.4% Obese adults, PHOF indicator 2015/16 (Active Lives Survey) 101 (estimated total) Higher than Worcestershire Avg – 62.4% Council district figure Lower than Worcestershire – 18.8% Healthy eating adults, PHOF Healthy eating adults Percentage of physically active Admissions for alcohol related indicator 2015/16 (Active Lives (self-reported, meeting the Survey) - NT level Smoking prevalence (adults) adults conditions recommended ‘5-a-day’) (self-reported, moderate 150 minutes Smoking Prevalence QOF 15/16 – 16.9% per week) NT level 591 63.8% Lower than Worcestershire Avg – 17.3% Physical activity, 64.2% Higher than Worcestershire Avg – 61.5% Lower than Worcestershire rate - 624 Alcohol admissions PHE Fingertips 15/16 (number of admissions per 100,000 Lower than Worcestershire percentage population – directly standardised – 67.2% rate) NT level Prevalence within total Learning disabilities Mental Health Depression Dementia Asthma COPD population of health conditions QOF 16/17 NT level 0.42% 0.61% 6.65% 0.66% 6.20% 1.88% Higher than Worcestershire Higher than Worcestershire Higher than Worcestershire Higher than Worcestershire Higher than Worcestershire Higher than Worcestershire Avg – 0.29% Avg – 0.50% Avg – 5.87% Avg – 0.56% Avg – 4.22% Avg – 1.29% National Cancer Registration New cancer diagnosis Service14/15 – crude incidence rate per 100,000 pop’n excluding non-melanoma skin cancer 566.5 Lower than Worcestershire rate – 621.1 FINANCE AND UTILISATION OF SERVICES Data sources Data sources Emergency Admission Costs Cost of A&E attendances per Average bed day costs for patients with 5 or Cost of admissions with zero day Business Intelligence, CCG from SUS data per 1000 population 1000 population more admissions during 16/17 per 1000 length of stay per 1000 population Oct 16 – Sept 17 population NT level £142,708 £31,975 £325 £15,680 Lower than Worcestershire Avg - Lower than Worcestershire Avg - Lower than Worcestershire Avg - £370 Lower than Worcestershire Avg - £17,254 £158,945 £33,410 Adult Social Care Residential home packages – spend per head of Nursing home packages – spend per head of Home care packages – spend per head of population 16/17 population 16/17 population 16/17 Awaiting Adult Social Care Data Work Programme Priorities for 2017/18 Improving access to care Integrating primary, community & social care Integrating specialist support Promoting self care & self management Comms & HR, Workforce Governance, £ & IT OD & Culture Estates engagement & role redesign technical support ALLIANCE BOARD PRIORITY 1 IMPROVING ACCESS TO CARE Data sources MORI National GP Patient Ease of getting through to Survey – July 2017 Able to get an appointment to someone at GP surgery on the Convenience of appointment Satisfaction with opening hours NT Level see or speak to someone phone Range based on practices within the NT 79.92% 88.59% 92.01% 80.50% Higher than Worcestershire average Higher than Worcestershire average Lower than Worcestershire average Lower than Worcestershire average NT Range [26.4 – 75.59] NT Range [67.22 – 99.45] NT Range [75.7 -100] NT Range [58.38 – 94.56] Social Care Access A&E attendance and emergency A&E Attendance rates 16/17 Emergency admission rates 16/17 Emergency re-admission rate admission data, rate per 1000 population SUS data NT Level 316 80.90 5.4% Increase in AE attendance rates compared to 15/16 Increase in EA rates compared to 15/16 Higher than Worcestershire Avg – 4.9% End of Life Audits – preferred place of death, primary care Caseloads Waiting times Data is being sourced around NT caseloads for social workers and community teams ALLIANCE BOARD PRIORITY 2 INTEGRATING PRIMARY, COMMUNITY & SOCIAL CARE Data sources CCG Performance Data Emergency admission rate per Emergency admissions – 16/17 data Ambulance call out rate per bed % of ambulance call outs conveyed from SUS, NT Level care home bed Ambulance call out and conveyance 0.71 64% data from WMAS – Oct 16 – Oct 17 – 0.52 NT level Lower than SW average – 0.81 Same as SW average – 64% Higher than SW average – 0.41 Frequent attenders – frequent Patients attending A&E who attenders SUS data re-attend in a 12 month period Total No. 3 or more in a year 10 or more in a year Recovery Beds Utilisation of community Length of stay for patients in a Number of delayed transfers of hospital beds community hospital care in community hospitals % % % Recovery Beds: working with WHCT to get the data split out by GP practice ALLIANCE BOARD PRIORITY 3 INTEGRATING SPECIALIST SUPPORT Data sources National diabetes audit 16/17 Diabetes (type 1) Diabetes (type 2) neighbourhood Achievement of the NICE recommended treatment targets for neighbourhood average average diabetes – BP, cholesterol, HbA1c NT level 21.4% 49.2% Worcestershire average 19.5% Worcestershire average 43.8% Range at practice level 10 - 50% Range at practice level 41.7 – 59.8% QOF 16/17 DM03 – BP DM04 – Cholesterol DM07 – HbA1c Achievement of diabetes QOF indicators – NT level 84.6% 83.9% 77.2% Worcestershire average 81.1% Worcestershire average 82.6% Worcestershire average 74% Range at practice level 79.2 – 91.4% Range at practice level 80 – 85.8% Range at practice level 69.5 – 83.7% Urology admission data - CCG Urinary catheter related performance monitoring data 16/17 UTI admissions 16/17 financial year, with benchmark against admissions 16/17 15/16 data NT Level 163 7 Increase compared to 15/16 Increase compared to 15/16 EMIS Frailty register % >65 population with mild, moderate and severe frailty NT Level Mild Moderate Severe Total ** 13% 8% 5% 26% ** Caveat – there appears to be some discrepancy with how frailty is coded, therefore, this will need to be reviewed next year. Falls data – CCG performance Standardised rate of falls per Standardised rate of fall per 1000 monitoring data 16/17 1000 with fracture without fracture NT Level 4.9 3.2 Higher than Worcestershire Average Higher than Worcestershire Average ALLIANCE BOARD PRIORITY 4 PROMOTING SELF-CARE AND SELF-MANAGEMENT Data sources Flu Vaccination - 25% of practices Flu vaccine update % with highest uptake, or if National 65 and over Change from Target met within the CCG, are shown Surgery SWCCG in GREEN.