March 2018 CCG localities profile for Hertfordshire 2017-18
Purpose
This report presents key population and health data for the ten NHS Clinical Commissioning Group (CCG) localities in Hertfordshire. It includes current and future population structures as well as rates of selected emergency hospital admissions, premature mortality and recorded disease prevalence. The data builds a picture of each CCG locality relative to others across the county and to its respective CCG. It is intended to provide clinical commissioners with an overview of key indicators of health needs and health service demand in each locality area and is an update to the 2016 report.
Key messages
There is considerable variation in health outcomes across Hertfordshire’s CCG localities, with rates of avoidable emergency admissions for acute and chronic conditions in localities with the highest rates double that of those with the lowest rates. The same is true for children admitted as an emergency for asthma, diabetes, epilepsy or lower respiratory tract infections, as well as premature mortality from respiratory disease and potential years of life lost from cerebrovascular disease. Rates of emergency admissions for children with lower respiratory tract infections have seen a statistically significant increase over the last three years across Hertfordshire’s two main CCGs, whilst rates of emergency re-admissions within 30 days have decreased. Hypertension (13%), obesity (8-9%) and depression (8-9%) have the highest prevalence of the GP QOF registers, in line with national trends.
Authors
This profile was created by Claire Tiffany (Senior Public Health Analyst, Hertfordshire County Council), with input from David Hodson (Head of Information, NHS East and North Hertfordshire CCG) and Julia Lisk (Public Health & Programmes Information Lead, NHS Herts Valleys CCG). It was reviewed by David Conrad (Consultant in Public Health, Hertfordshire County Council).
www.hertshealthevidence.org.uk 1 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Contents Introduction ...... 3 Clinical Commissioning Group (CCG) localities in Hertfordshire ...... 3 About the data ...... 4 Summary: NHS East and North Hertfordshire CCG localities ...... 6 Summary: NHS Herts Valleys CCG localities ...... 9 Population ...... 11 NHS East and North Hertfordshire CCG registered population ...... 11 NHS Herts Valleys CCG registered population ...... 15 CCG resident population projections ...... 18 Deprivation ...... 19 GP recorded (QOF) disease prevalence Tartan Rug ...... 21 Emergency admissions and mortality Tartan Rug ...... 22 Emergency admissions ...... 23 Avoidable emergency admissions (acute and chronic) ...... 23 Acute conditions that should not require hospital admission ...... 24 Unplanned hospitalisation for chronic ambulatory care sensitive conditions...... 25 Emergency re-admissions within 30 days ...... 26 Children with asthma, diabetes and epilepsy ...... 27 Children with lower respiratory tract infection ...... 28 Mortality ...... 29 Potential years of life lost (PYLL) from causes considered amenable to healthcare ...... 29 Potential years of life lost (PYLL) from ischaemic heart disease ...... 30 Potential years of life lost (PYLL) from neoplasms ...... 31 Potential years of life lost (PYLL) from cerebrovascular disease ...... 32 Potential years of life lost (PYLL) from respiratory diseases ...... 33 Premature mortality from cancer...... 34 Premature mortality from cardiovascular disease ...... 35 Premature mortality from respiratory disease ...... 36 Premature mortality from liver disease ...... 37
www.hertshealthevidence.org.uk 2 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Introduction Clinical Commissioning Group (CCG) localities in Hertfordshire Clinical Commissioning Groups (CCGs) are NHS organisations responsible for planning, designing and buying health services on behalf of their local populations. Hertfordshire has two main CCGs: NHS East and North Hertfordshire CCG and NHS Herts Valleys CCG. Both CCGs consist of smaller geographical areas called ‘localities’ based on the registered populations of groups of GP practices. There are ten CCG localities in total, only three of which (Dacorum, St Albans and Harpenden, Stevenage) are coterminous with Hertfordshire’s ten local authority districts as shown in Figure 1.
NHS East and North Hertfordshire CCG Localities: CCG encompasses the areas covered by: • Lower Lea Valley • Broxbourne Borough Council • North Hertfordshire • East Hertfordshire District Council • Stevenage • North Hertfordshire District Council* • Stort Valley and Villages • Stevenage Borough Council • Upper Lea Valley • Welwyn Hatfield Borough Council • Welwyn Hatfield *except for the Royston area which is covered by NHS Cambridgeshire and Peterborough CCG
NHS Herts Valleys CCG Localities: CCG encompasses the areas covered by: • Dacorum • Dacorum Borough Council • Hertsmere • Hertsmere Borough Council • St Albans and Harpenden • St Albans City & District Council • Watford and Three Rivers • Three Rivers District Council • Watford Borough Council
Figure 1: CCG localities and local authority districts in Hertfordshire (Royston is not included in ENHCCG)
www.hertshealthevidence.org.uk 3 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Introduction
About the data Summaries of key findings for each of the CCG localities have been provided followed by a detailed breakdown of the data. Data are presented on population, deprivation, emergency admissions, mortality and Quality and Outcomes Framework (QOF) prevalence data for each CCG and for each CCG locality. GP practice level QOF prevalence tartan rugs for Hertfordshire’s two main CCGs are available from the data tools and reports section of www.hertshealthevidence.org .
Methodology and definitions
Populations: All indicators in this report use GP registered populations, except for the population projection estimates which use the resident populations. Registered populations are based on the location of the GP practice, whilst resident populations are based on where people live.
Directly age-standardised rates (DSR): Differences in hospital admissions and deaths between CCG localities will be partly due to the differences in the underlying population age structure. DSRs have been used to allow comparisons between localities with different demographic characteristics by controlling for the differences in the underlying population. The DSR for a locality is the number of admissions or deaths per 100,000 population that would occur in a ‘standard reference population’ if that standard population had the age-specific rates (based on 5-year age-bands) of the population of interest. This report uses ONS mid-year estimates for England as the reference population.
Confidence Intervals (CIs): CIs are a measure of the statistical precision of a value (for example mortality rates) and show the range of uncertainty (caused by sample size and random variation) around the value. Calculations based on smaller sample sizes tend to result in wider CIs. The wider the CI the greater the uncertainty in the value. In public health, the conventional practice is to use 95% CIs. This represents the probability that the interval includes the true value. CIs are presented on the charts as bars or whiskers extending above and below the value. They are important to consider when interpreting data and comparing areas or trends to assess whether differences are ‘real’ or statistically significant. If the CIs around a figure do not overlap with the interval around another then we can be certain that there is a statistically significant difference between the data points. If the CI around a figure overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two figures.
Potential Years of Life Lost (PYLL): PYLL from causes considered amenable to healthcare measures the number of years of life lost per 100,000 registered patients from conditions which are usually treatable. ONS 2014-based life expectancies have been used to calculate the PYLL in this report.
Quality and Outcomes Framework (QOF) GP recorded prevalence: The percentage of patients with selected diseases (cardiovascular, respiratory, mental health and neurology, musculoskeletal, high dependency and other long-term conditions) or obesity, as recorded on the practice disease register. QOF prevalence percentages are crude because they are not adjusted to account for patient age distribution or other factors that may differ between general practices. It can be difficult to interpret QOF registers as they are based on recorded rather than actual prevalence so may under-report certain groups or diseases. QOF registers may also reflect different coding practices and case finding priorities.
www.hertshealthevidence.org.uk 4 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Introduction
‘Tartan Rugs’: Tartan rugs are colour coded data tables which allow quick comparison of a large number of indicators against a comparator area, in this case the respective CCG.
Each tartan rug comes with a key to help interpret the data. Cell colour is determined by statistical significance. Significance in this sense is a measure of whether any difference is statistically meaningful, rather than a subjective judgement. This involves colouring cells according to whether their confidence intervals, the margin of error associated with the value of the indicator, overlap the confidence intervals of the comparator area.
Areas where the confidence intervals overlap with the comparator area are said to be ‘Not Significantly Different’. Where confidence intervals do not overlap, higher or lower values can be judged to be ‘Significantly Better’ or ‘Significantly Worse’. Value judgements are not ascribed to the QOF indicators; for example, recorded instances of diabetes could be seen to be better because they are high (suggesting few unrecorded cases of diabetes) or because they are low (suggesting few cases of diabetes). In these cases, the terms ‘Significantly Higher’ or ‘Significantly Lower’ are used. The QOF tartan rug is based on 95% CIs using the Wilson method. This may differ from methodologies used elsewhere and on Public Health England data tools.
It is important to note that interventions should not be planned simply based on the colour of a cell in the rug in relation to a particular indicator but should also take into account the ability of an intervention to make a difference, current priorities in the area and associated factors which may affect the indicator. While an area may not be significantly different than the comparator area for a particular indicator, a robust intervention here could make more of an impact than a weak intervention on an indicator which is significantly worse.
Data Sources - Deaths (Local analysis using Primary Care Mortality Database, based on year of registration) - Emergency hospital admissions (Local analysis of Secondary Uses Service (SUS) data) - GP registered populations (NHS Digital) - Index of Multiple Deprivation 2015 (Ministry of Housing, Communities & Local Government) - Population Estimates and Projections (ONS) - QOF GP recorded prevalence (NHS Digital)
Methodological changes from 2016 report - Emergency admission rates are directly standardised against the England Mid-Year Estimate (previously European Standard Population) - NHS Herts Valleys CCG used different software to analyse hospital admissions - Life expectancies updated from 2012 to 2014 for Potential Years of Life Lost (PYLL)
www.hertshealthevidence.org.uk 5 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Summary: NHS East and North Hertfordshire CCG localities
Of the six CCG localities in NHS East and North Hertfordshire CCG, Stevenage experienced the poorest outcomes across the selected emergency hospital admission and mortality indicators, whilst Upper Lea Valley experienced the best. Welwyn Hatfield experienced statistically significant worsening in 7 out of 15 of the admission and mortality indicators, the most across the CCG localities. Lower Lea Valley has the highest deprivation levels but sits in the middle in terms of the selected outcomes.
CCG rates of emergency admissions for children with lower respiratory tract infections and potential years of life lost (PYLL) from respiratory diseases have both seen statistically significant increases over time, whilst emergency re-admissions within 30 days, PYLL (overall), PYLL from ischaemic heart disease and PYLL from cancer (neoplasms) have all decreased.
Hypertension (13.4%), obesity (9.0%) and depression (8.7%) have the highest prevalence of the 20 GP QOF registers, in line with national trends. Stevenage has the highest GP recorded prevalence of obesity and depression.
The tartan rugs on page 21 and 22 summarise each of the indicators at locality level compared to the CCG. Written high level summaries for each CCG locality are given below.
Lower Lea Valley
• The population age structure is similar to the CCG. Lower Lea Valley has the highest level of overall deprivation in the CCG. 20% of children under 16 live in low income families and 16% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally similar to or lower than the CCG average, with four of the 20 indicators statistically significantly higher and six lower than the CCG average (see page 21). The hypertension and rheumatoid arthritis registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Dementia and epilepsy have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with two out of 15 statistically significantly worse (see page 22). The rate of potential years of life lost (PYLL) from respiratory diseases has increased statistically significantly over time.
North Herts
• The population age structure is older than the CCG average. 13% of children under 16 live in low income families, whilst 13% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators vary when compared to the CCG average, with nine of the 20 indicators statistically significantly higher and five lower than the CCG average (see page 21). The coronary heart disease, stroke/ TIA, asthma, dementia and mental health registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Depression and rheumatoid arthritis have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with five out of 15 statistically significantly worse (see page 22).
www.hertshealthevidence.org.uk 6 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Summary: NHS East and North Hertfordshire CCG localities
Stevenage
• The population age structure is younger than the CCG average. 20% of children under 16 live in low income families, whilst 15% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators vary when compared to the CCG average, with six of the 20 indicators statistically significantly higher and six lower than the CCG average (see page 21). The chronic obstructive pulmonary disease, obesity, diabetes, palliative care, depression and epilepsy registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Atrial fibrillation, cancer, chronic kidney disease and osteoporosis have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally statistically significantly worse than the CCG average (10 out of 15 indicators) with the remainder showing no statistically significant difference (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), acute and chronic conditions (considered avoidable) combined, children with lower respiratory infections and rates of potential years of life lost (PYLL) from respiratory diseases have increased statistically significantly over time.
Stort Valley and Villages
• The population age structure shows a slightly higher proportion of people in their 40s. Stort Valley and Villages has the lowest level of overall deprivation in the CCG, however 8% of children under 16 live in low income families and 10% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators vary when compared to the CCG average, with six of the 20 indicators statistically significantly higher and eight lower than the CCG average (see page 21). The heart failure, cancer, chronic kidney disease, learning disability and osteoporosis registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Stroke/ TIA, chronic obstructive pulmonary disease, obesity, diabetes and palliative care have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average, with only one out of 15 statistically significantly worse (see page 22). Rates of potential years of life lost (PYLL) from cerebrovascular disease have increased statistically significantly over time.
Upper Lea Valley
• The population age structure is older than the CCG average. 11% of children under 16 live in low income families, whilst 11% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally similar to the CCG average, with two of the 20 indicators statistically significantly higher and four lower than the CCG average (see page 21). The atrial fibrillation register has the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Mental health has the lowest prevalence of the CCG’s localities and is statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average (see page 22).
www.hertshealthevidence.org.uk 7 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Summary: NHS East and North Hertfordshire CCG localities
Welwyn Hatfield
• The population age structure is younger than the CCG average. 16% of children under 16 live in low income families, whilst 14% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally similar to or below the CCG average, with one of the 20 indicators statistically significantly higher and seven lower than the CCG average (see page 21). The coronary heart disease, hypertension and asthma registers have the lowest recorded prevalence of the CCG’s localities as well as being statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally similar to the CCG average, although seven out of 15 are statistically significantly worse (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), acute and chronic conditions (considered avoidable) combined, children with lower respiratory infections and rates of overall potential years of life lost (PYLL), PYLL from cerebrovascular disease, cancer (neoplasms) and respiratory diseases have increased over time.
www.hertshealthevidence.org.uk 8 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Summary: NHS Herts Valleys CCG localities
Of the four CCG localities in NHS Herts Valleys CCG, Watford and Three Rivers experienced the poorest outcomes across the selected emergency hospital admission and mortality indicators, whilst St Albans and Harpenden experienced the best. Watford and Three Rivers has the highest overall level of deprivation.
CCG rates of emergency admissions for acute conditions (considered avoidable), emergency admissions for children with lower respiratory tract infections and potential years of life lost (PYLL) from cerebrovascular and respiratory diseases have all seen statistically significant increases over time, whilst emergency re-admissions within 30 days, PYLL from ischaemic heart disease and premature mortality from cardiovascular disease have all decreased.
Hypertension (12.5%), obesity (8.1%) and depression (8.4%) have the highest prevalence of the 20 GP QOF registers, in line with national trends. Dacorum has the highest GP recorded prevalence for these indicators.
The tartan rugs on page 21 and 22 summarise each of the indicators at locality level compared to the CCG. Written high level summaries for each CCG locality are given below.
Dacorum
• Overall, the population age structure is similar to the CCG. 13% of children under 16 live in low income families, whilst 12% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally similar to or higher than the CCG average, with 10 of the 20 indicators statistically significantly higher than the CCG average (see page 21). The hypertension, peripheral arterial disease, obesity, depression, osteoporosis and rheumatoid arthritis registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are similar to or better than the CCG average (see page 22).
Hertsmere
• Overall, the population age structure is similar to the CCG. 13% of children under 16 live in low income families, whilst 14% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally higher than the CCG average, with 14 of the 20 indicators statistically significantly higher and one lower than the CCG average (see page 21). The atrial fibrillation, coronary heart disease, heart failure, stroke/ TIA, chronic obstructive pulmonary disease, cancer, chronic kidney disease, palliative care and dementia registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with two out of 15 statistically significantly worse (see page 22).
www.hertshealthevidence.org.uk 9 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Summary: NHS Herts Valleys CCG localities
St Albans and Harpenden
• The population age structure shows higher proportions of 5-14 and 40-49 year olds compared to the CCG average. St Albans and Harpenden has the lowest level of overall deprivation in the CCG, however 8% of children under 16 live in low income families and 10% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally lower than the CCG average, with one of the 20 indicators statistically significantly higher and 14 lower than the CCG average (see page 21). The asthma register has the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Coronary heart disease, heart failure, hypertension, peripheral arterial disease, stroke/ TIA, chronic obstructive pulmonary disease, obesity, chronic kidney disease, diabetes, palliative care, dementia, depression, learning disability and osteoporosis have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average, with only one out of 15 indicators statistically significantly worse (see page 22). Rates of overall potential years of life lost (PYLL) and PYLL from cancer (neoplasms) and respiratory diseases have increased statistically significantly over time.
Watford and Three Rivers
• The population age structure is younger than the CCG average, with a higher proportion of 25-34 year olds. Watford and Three Rivers has the highest level of overall deprivation in the CCG. 12% of children under 16 live in low income families and 14% of older people aged 60 or over experience income deprivation. • QOF prevalence indicators are generally similar to the CCG average, with three of the 20 indicators statistically significantly higher and two lower than the CCG average (see page 21). The diabetes and learning disability registers have the highest recorded prevalence of the CCG’s localities as well as being statistically significantly higher than the CCG average. Atrial fibrillation and cancer have the lowest prevalence of the CCG’s localities and are statistically significantly lower than the CCG average. • Rates of selected emergency hospital admission and mortality indicators are generally worse than the CCG average (eight out of 15 indicators), with the remainder similar to or better than the CCG (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), children with lower respiratory infections and rates of potential years of life lost (PYLL) from cerebrovascular diseases have increased statistically significantly over time.
www.hertshealthevidence.org.uk 10 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population
The following charts are based on GP registered populations as at 1st October 2017 taken from Open Exeter, published by NHS Digital.
NHS East and North Hertfordshire CCG registered population
• In October 2017 NHS East and North Hertfordshire CCG had a registered population of 595,000.
• Compared to Hertfordshire’s registered population NHS East and North Hertfordshire CCG has a slightly higher proportion of 20-24 year olds.
Upper Lea Valley locality has the largest population with 124,795 people, 21% of the total CCG population, whilst Lower Lea Valley has the lowest at 75,679 (13%).
Stevenage locality has the highest proportion of under 5s (6.4%) and under 20s (24.4%), whilst North Herts locality has the highest proportion of over 65s (18.7%), and over 85s (2.6%) as shown in Table 1 below.
Table 1: Population breakdown of NHS East and North Hertfordshire CCG and localities, Oct 2017 All ages Under 5s Under 20s 65 and overs 85 and overs AREA No No % No % No % No % Lower Lea Valley 75,679 4,696 6.2 18,338 24.2 12,633 16.7 1,709 2.3 North Herts 115,954 6,539 5.6 26,514 22.9 21,728 18.7 3,066 2.6 Stevenage 96,007 6,179 6.4 23,446 24.4 13,549 14.1 1,876 2.0 Stort Valley and Villages 61,324 3,188 5.2 14,548 23.7 10,147 16.5 1,341 2.2 Upper Lea Valley 124,795 6,876 5.5 28,707 23.0 23,131 18.5 2,847 2.3 Welwyn Hatfield 121,237 7,029 5.8 28,502 23.5 18,030 14.9 2,733 2.3 ENHCCG TOTAL 594,996 34,507 5.8 140,055 23.5 99,218 16.7 13,572 2.3 Data source: Open Exeter, NHS Digital
www.hertshealthevidence.org.uk 11 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population: NHS East and North Hertfordshire CCG localities
Lower Lea Valley locality has a similar population structure to the CCG.
Compared to the CCG North Herts locality has a lower proportion of people in their 20s.
www.hertshealthevidence.org.uk 12 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population: NHS East and North Hertfordshire CCG localities
Compared to the CCG Stevenage locality has: • a higher proportion of under 10s and 25-34 year olds. • a lower proportion of 65-79 year olds.
Compared to the CCG Stort Valley and Villages locality has: • a higher proportion of 10-14 and 40-49 year olds. • a lower proportion of under 5s, 20- 24 and 30-34 year olds.
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CCG localities profile for Hertfordshire 2017-18 March 2018
Population: NHS East and North Hertfordshire CCG localities
Compared to the CCG Upper Lea Valley locality has: • a higher proportion of 65-74 year olds. • a lower proportion of 20-34 year olds.
Compared to the CCG Welwyn Hatfield locality has: • a higher proportion of 15-29 year olds (University of Hertfordshire is based in this locality). • a lower proportion of 45-54 and 65-74year olds.
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CCG localities profile for Hertfordshire 2017-18 March 2018
Population
NHS Herts Valleys CCG registered population
• In October 2017 NHS Herts Valleys CCG had a registered population of 641,800.
• NHS Herts Valleys CCG has a similar population structure to Hertfordshire’s registered population. The largest difference is a slightly lower proportion of 20-24 year olds.
Watford and Three Rivers locality has the largest population with 212,415 people, 33% of the total CCG population, whilst Hertsmere has the lowest at 105,334 (16%).
Watford and Three Rivers and Dacorum localities haves the highest proportion of under 5s (6.2%), whilst St Albans and Harpenden locality has the highest proportion of under 20s (25.4%). Hertsmere locality has the highest proportion of over 65s (17.4%), and over 85s (2.6%) as shown in Table 2 below.
Table 2: Population breakdown of NHS Herts Valleys CCG and localities, Oct 2017 All ages Under 5s Under 20s 65 and overs 85 and overs AREA No No % No % No % No % Dacorum 167,499 10,322 6.2 39,678 23.7 27,638 16.5 3,915 2.3 Hertsmere 105,334 6,156 5.8 25,046 23.8 18,321 17.4 2,730 2.6 St Albans and Harpenden 156,521 9,576 6.1 39,759 25.4 24,215 15.5 3,261 2.1 Watford and Three Rivers 212,415 13,256 6.2 51,670 24.3 31,245 14.7 4,419 2.1 HVCCG TOTAL 641,769 39,310 6.1 156,153 24.3 101,419 15.8 14,325 2.2 Data source: Open Exeter, NHS Digital
www.hertshealthevidence.org.uk 15 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population: NHS Herts Valleys CCG localities
Compared to the CCG Dacorum locality has a higher proportion of 60-64 year olds.
Compared to the CCG Hertsmere locality has a lower proportion of 40-44 year olds.
www.hertshealthevidence.org.uk 16 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population: NHS Herts Valleys CCG localities
Compared to the CCG St Albans and Harpenden locality has: • a higher proportion of 5-14 and 40- 49 year olds. • a lower proportion of 20-34 year olds.
Compared to the CCG Watford and Three Rivers locality has a higher proportion of 25-34 year olds.
www.hertshealthevidence.org.uk 17 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Population
CCG resident population projections 2014 based Office of National Statistics (ONS) population projections, below, show changes over the next ten years based on the CCG area people live in (the resident population). Population projections are available at local authority district level but not at GP practice or CCG locality level.
NHS East and North Hertfordshire CCG resident population is projected to increase by ten per cent over the next ten years to an estimated 626,100 in 2027. The largest increases are in the older age groups, with 24,700 (25%) more people aged 65 or over in 2027 compared to 2017 and 3,200 (62%) more people aged 90 or over as shown in Table 3 and population pyramid (right). Not all age groups are predicted to increase. A decrease of 7% is predicted for people in their 20s and 10% for those aged 50-54. Table 3: Population Projections, NHS East and North Hertfordshire CCG, 2017 to 2027
Age 2017 2027 Increase Increase group (No.) (No.) (%) All ages 569,900 626,100 56,200 9.9% 0-4 35,800 38,100 2,300 6.4% 0-19 138,500 154,700 16,200 11.7% 20-64 333,600 349,200 15,600 4.7% 65+ 97,500 122,200 24,700 25.3% 85+ 14,600 19,900 5,300 36.3%
NHS Herts Valleys CCG resident population is projected to increase by ten per cent over the next ten years to an estimated 663,700 in 2027. The largest increases are in the older age groups, with 23,500 (24%) more people aged 65 or over in 2027 compared to 2017 and 3,200 (53%) more people aged 90 or over as shown in Table 4 and population pyramid (right). Not all age groups are predicted to increase. A decrease of 8% is predicted for people in their 20s and 3% for those aged 50-54. Table 4: Population Projections, NHS Herts Valleys CCG, 2017 to 2027
Age 2017 2027 Increase Increase group (No.) (No.) (%) All ages 601,300 663,700 62,400 10.4% 0-4 40,400 43,100 2,700 6.7% 0-19 152,300 173,000 20,700 13.6% 20-64 349,000 367,400 18,400 5.3% 65+ 99,900 123,400 23,500 23.5% 85+ 15,700 20,800 5,100 32.5%
www.hertshealthevidence.org.uk 18 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Deprivation
The Indices of Multiple Deprivation (IMD) 2015 are used to identify the most deprived areas across England. They combine several indicators covering a range of economic, social, health and housing issues into a single deprivation score. There are also supplementary indices for income deprivation among children (IDACI) and older people (IDAOPI). Each Lower Super Output Area (LSOA), a sub-ward geography averaging approximately 1,500 people, in England has an IMD score, allowing the identification of small pockets of deprivation. IMD scores are a relative measure of deprivation. They can be used to identify if one area is more deprived than another but not by how much. A higher score represents a higher level of deprivation. IMD, IDACI and IDAOPI scores have been calculated for CCG locality populations by taking a population-weighted average of the IMD scores for each LSOA in which the given practices have registrations.
General Practice IMD scores are available from Public Health England’s General Practice profiles (https://fingertips.phe.org.uk/profile/general-practice) and an interactive map of local deprivation is available from: https://www.hertfordshire.gov.uk/microsites/herts-insight/home.aspx (note: this website is maintained by Hertfordshire County Council’s Community Information & Intelligence Unit).
NHS East and North Hertfordshire CCG • Lower Lea Valley locality has the highest level of multiple deprivation (IMD), income domain affecting children (IDACI) and income domain affecting older people (IDAOPI) within the CCG (Table 5). • NHS East and North Hertfordshire CCG has five LSOAs in England’s most deprived quintile (fifth) for multiple deprivation (IMD) representing 1.5% of the resident population. Two are in Lower Lea Valley (Broxbourne 013C and 013D), two are in Stevenage (Stevenage 008D and 009A) and one is in North Herts (North Hertfordshire 009C). • In NHS East and North Hertfordshire CCG around 15% of children under 16 live in low income families and13% of older people aged 60 or experience income deprivation.
NHS Herts Valleys CCG • Watford and Three Rivers locality has the highest level of multiple deprivation (IMD), and income domain affecting children (IDACI) within the CCG, whilst Hertsmere is the highest for income domain affecting older people (IDAOPI) as shown in Table 3. • NHS Herts Valleys CCG has four LSOAs in England’s most deprived quintile (fifth) for multiple deprivation (IMD) representing 1.1% of the resident population. Two are in Watford and Three Rivers (Watford 009B; Three Rivers 012D), one is in Dacorum (Dacorum 008D) and one is in Hertsmere (Hertsmere 006C). Hertsmere 006C and Three Rivers 012D are also in England’s most deprived decile (10%). • In NHS Herts Valleys CCG around 12% of children under 16 live in low income families and 12% of older people aged 60 or experience income deprivation.
www.hertshealthevidence.org.uk 19 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Deprivation
Table 5: CCG locality level IMD 2015 scores, ranks and proportion living in England’s most deprived fifth (in order of most deprived locality within CCG) IMD 2015 Most deprived national quintile CCG and CCG localities Score CCG Herts No of No of % of Rank[1] Rank[1] LSOAs people[2] people[2] NHS East & North Hertfordshire CCG 13.3 - - 5 8,432 1.5% Lower Lea Valley 18.5 1 1 2 3,815 5.2% Stevenage 17.4 2 2 2 3,260 3.8% Welwyn Hatfield 13.4 3 3 - - - North Herts 12.7 4 6 1 1,357 1.2% Upper Lea Valley 10.1 5 8 - - - Stort Valley & Villages 7.7 6 9 - - - NHS Herts Valleys CCG 11.5 - - 4 6,698 1.1% Watford & Three Rivers 13.2 1 4 2 3,645 1.8% Hertsmere 13.0 2 5 1 1,700 1.9% Dacorum 12.0 3 7 1 1,353 0.9% At Albans & Harpenden 7.7 4 10 - - - Data Source: Ministry of Housing, Communities & Local Government; [1] A ranking of 1 denotes the most deprived locally; [2] ONS MYE 2015
Table 6: CCG locality level Income Deprivation Affecting Children Index (IDACI) 2015 and Income Deprivation Affecting Older People Index (IDAPOI) 2015 scores and ranks (in order of most deprived locality by IDACI within CCG) IDACI 2015 IDAOPI 2015 CCG and CCG localities Score[2] CCG Herts Score[2] CCG Herts (%) Rank[1] Rank[1] (%) Rank Rank NHS East & North Hertfordshire CCG 14.5 - - 13.0 - - Lower Lea Valley 20.0 1 1 15.8 1 1 Stevenage 19.6 2 2 15.2 2 2 Welwyn Hatfield 15.7 3 3 14.0 3 4 North Herts 13.3 4 4 12.6 4 6 Upper Lea Valley 10.6 5 8 10.5 5 8 Stort Valley & Villages 7.6 6 10 9.9 6 9 NHS Herts Valleys CCG 11.5 - - 12.4 - - Dacorum 13.0 1 5 11.7 3 7 Hertsmere 12.9 2 6 14.1 1 3 Watford & Three Rivers 12.2 3 7 13.9 2 5 At Albans & Harpenden 8.1 4 9 9.9 4 10 Data Source: Ministry of Housing, Communities & Local Government; [1] A ranking of 1 denotes the most deprived locally; [2] Percentage experiencing income deprivation
www.hertshealthevidence.org.uk 20 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
GP recorded (QOF) disease prevalence Tartan Rug
Average QOF prevalence for the two CCGs is generally lower than nationally. Hypertension, obesity and depression have the highest prevalence locally and nationally. NHS East and North Hertfordshire CCG: North Herts has the highest number of QOF registers (9 out of 20) statistically significantly higher than the CCG average whilst Stort Valley and Villages has the highest number statistically significantly lower (8 out of 20). Lower Lea Valley has the highest recorded prevalence of hypertension (14.5%, 10,972 patients), whilst Stevenage is highest for obesity (11.4%, 8,467 patients) and depression (10.6%, 7,862 patients). NHS Herts Valleys CCG: Hertsmere has the highest number of QOF registers (14 out of 20) statistically significantly higher than the CCG average whilst St Albans and Harpenden has the highest number statistically significantly lower (14 out of 20). Dacorum has the highest recorded prevalence of hypertension (13.4%, 22,364 patients), obesity (9.6%, 12,256 patients) and depression (9.7%, 12,665 patients).
www.hertshealthevidence.org.uk 21 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions and mortality Tartan Rug
NHS East and North Hertfordshire CCG: Stevenage has the highest number of indicators (10 out of 15) statistically significantly worse than the CCG average whilst Upper Lea Valley has the highest number statistically significantly better (9 out of 15). NHS Herts Valleys CCG: Watford and Three Rivers has the highest number of indicators (8 out of 15) statistically significantly worse than the CCG average whilst St Albans and Harpenden has the highest number statistically significantly better (10 out of 15).
www.hertshealthevidence.org.uk 22 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Avoidable emergency admissions (acute and chronic) In 2016/17 there were 11,455 avoidable emergency admissions for acute and chronic conditions in ENHCCG and 10,296 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 11045 1928 1892 1964 11681 2042 2005 2079 11445 1987 1950 2024 Lower Lea Valley 1344 1800 1705 1899 1370 1849 1752 1949 1275 1729 1635 1827 North Herts 2453 2058 1977 2141 2631 2225 2140 2312 2682 2223 2139 2309 Stevenage 2018 2325 2223 2429 2288 2629 2521 2740 2304 2647 2539 2758 Stort Valley & Villages 921 1615 1512 1723 958 1669 1565 1779 769 1341 1248 1440 Upper Lea Valley 2044 1678 1606 1753 2004 1644 1573 1718 1869 1516 1448 1587 Welwyn Hatfield 2265 2011 1928 2096 2430 2157 2071 2245 2546 2247 2160 2336 HVCCG 9834 1621 1589 1654 9973 1653 1620 1685 10296 1685 1652 1718 Dacorum 2576 1604 1542 1667 2547 1586 1525 1649 2718 1673 1611 1738 Hertsmere 1378 1291 1223 1361 1415 1329 1260 1400 1425 1329 1261 1401 St Albans & Harpenden 2042 1407 1346 1470 1958 1355 1295 1416 2049 1409 1348 1472 Watford & Three Rivers 3838 1980 1917 2044 4053 2113 2048 2180 4104 2094 2030 2160 Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (Hertsmere) Inter CCG locality 1,341 per 100,000 - 1,329 per 100,000 - range* 2,647 per 100,000 2,094 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 1928 - 1987 per 100,000 1621 - 1685 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 23 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Acute conditions that should not require hospital admission In 2016/17 there were 7,509 avoidable emergency admissions for acute conditions in ENHCCG and 6,794 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG, although HVCCG has experienced a statistically significant increase over time.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 7214 1257 1228 1286 7649 1335 1306 1366 7509 1301 1272 1331 Lower Lea Valley 850 1136 1061 1215 845 1135 1060 1215 820 1107 1033 1186 North Herts 1615 1360 1294 1428 1745 1481 1412 1553 1728 1438 1371 1508 Stevenage 1342 1525 1444 1610 1501 1696 1610 1784 1530 1729 1642 1818 Stort Valley & Villages 553 968 889 1053 614 1067 984 1155 492 858 783 937 Upper Lea Valley 1376 1138 1079 1200 1299 1075 1017 1135 1237 1013 957 1072 Welwyn Hatfield 1478 1299 1233 1367 1645 1443 1374 1515 1702 1491 1420 1564 HVCCG 6170 1010 984 1035 6237 1026 1000 1052 6794 1107 1081 1134 Dacorum 1581 981 934 1031 1584 981 933 1031 1754 1080 1030 1132 Hertsmere 869 809 756 865 905 846 792 903 966 901 845 960 St Albans & Harpenden 1323 903 854 953 1265 869 821 918 1410 962 912 1013 Watford & Three Rivers 2397 1220 1171 1270 2483 1279 1229 1331 2664 1350 1299 1403
Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (Hertsmere) Inter CCG locality 858 per 100,000 - 901 per 100,000 - range* 1,729 per 100,000 1,350 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 1,257 – 1,301 per 100,000 1,010 – 1,107 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 24 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Unplanned hospitalisation for chronic ambulatory care sensitive conditions In 2016/17 there were 3,936 avoidable emergency admissions for chronic conditions in ENHCCG and 3,502 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 3831 671 650 692 4032 706 685 728 3936 685 664 707 Lower Lea Valley 494 664 607 726 525 713 654 777 455 622 566 682 North Herts 838 698 651 747 886 743 695 794 954 785 736 837 Stevenage 676 799 740 862 787 933 869 1001 774 918 854 986 Stort Valley & Villages 368 647 582 716 344 602 540 670 277 484 428 544 Upper Lea Valley 668 540 500 582 705 569 528 613 632 503 464 544 Welwyn Hatfield 787 712 663 764 785 713 664 765 844 756 705 809 HVCCG 3664 612 592 632 3736 627 607 647 3502 577 558 597 Dacorum 995 622 584 662 963 605 567 644 964 594 557 632 Hertsmere 509 481 440 525 510 483 442 527 459 429 390 470 St Albans & Harpenden 719 504 468 543 693 486 450 524 639 447 413 484 Watford & Three Rivers 1441 760 721 801 1570 834 793 877 1440 744 706 784 Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (Hertsmere) Inter CCG locality 484 per 100,000 - 429 per 100,000 - range* 918 per 100,000 744 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 671 - 685 per 100,000 612 - 577 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 25 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Emergency re-admissions within 30 days In 2016/17 there were 9,173 emergency readmissions within 30 days in ENHCCG and 8,940 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG, with both CCGs experiencing statistically significant decreases over time.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 9579 1667 1634 1701 9422 1644 1610 1677 9173 1587 1555 1620 Lower Lea Valley 1036 1388 1305 1476 1004 1357 1274 1443 1001 1354 1271 1440 North Herts 2202 1825 1749 1903 2187 1833 1757 1912 2153 1776 1702 1853 Stevenage 1799 2103 2006 2203 1919 2259 2158 2363 1764 2048 1952 2147 Stort Valley & Villages 878 1544 1443 1650 676 1165 1079 1257 713 1233 1144 1328 Upper Lea Valley 1635 1326 1263 1392 1623 1309 1245 1374 1576 1255 1194 1319 Welwyn Hatfield 2029 1807 1729 1888 2013 1794 1715 1874 1966 1747 1670 1827 HVCCG 9443 1566 1535 1598 8734 1457 1427 1488 8940 1476 1446 1507 Dacorum 2354 1475 1416 1537 2152 1339 1283 1397 2260 1401 1344 1460 Hertsmere 1455 1369 1299 1441 1458 1378 1308 1451 1472 1380 1311 1453 St Albans & Harpenden 1895 1319 1260 1380 1684 1186 1129 1244 1732 1214 1157 1273 Watford & Three Rivers 3739 1941 1879 2005 3440 1811 1750 1873 3476 1795 1736 1856 Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (St Albans & Harpenden) Inter CCG locality 1,233 per 100,000 - 1,214 per 100,000 - range* 2,048 per 100,000 1,795 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 1667 - 1566 per 100,000 1587 - 1476 per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 26 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Children with asthma, diabetes and epilepsy In 2016/17 there were 321 emergency admissions for under 19s with asthma, diabetes or epilepsy in ENHCCG and 357 in HVCCG. Rates are similar in ENHCCG and HVCCG.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 319 243 217 271 358 272 244 302 321 242 217 271 Lower Lea Valley 39 222 158 304 51 289 215 380 30 170 115 243 North Herts 67 266 206 338 69 276 215 349 63 247 190 316 Stevenage 71 321 251 405 93 423 341 518 76 340 268 426 Stort Valley & Villages 30 220 148 314 40 288 205 392 34 256 177 359 Upper Lea Valley 48 178 131 236 56 209 158 271 55 206 155 268 Welwyn Hatfield 64 249 192 318 49 191 141 252 63 239 183 306 HVCCG 314 217 194 243 318 216 193 241 357 239 215 265 Dacorum 82 223 177 277 78 208 165 260 107 283 232 342 Hertsmere 50 212 158 280 33 139 95 195 33 138 95 194 St Albans & Harpenden 66 177 137 226 63 165 127 212 59 151 115 195 Watford & Three Rivers 116 245 203 294 144 299 252 352 158 321 273 376 Variation NHS ENHCCG NHS HVCCG (Lower Lea Valley) (Hertsmere) Inter CCG locality 170 per 100,000 - 138 per 100,000 - range* 340 per 100,000 321 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 243 - 242 per 100,000 217 - 239 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 27 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Emergency admissions
Children with lower respiratory tract infection In 2016/17 there were 436 emergency admissions for under 19s lower respiratory tract infections in ENHCCG and 488 in HVCCG. Rates are similar in ENHCCG and HVCCG and both have seen a statistically significant increase over time.
2014/15 2015/16 2016/17 Count Value CI Lower CI Upper Count Value CI Lower CI Upper Count Value CI Lower CI Upper ENHCCG 346 270 242 300 374 291 262 322 436 339 308 372 Lower Lea Valley 37 212 149 292 53 304 228 398 46 267 195 356 North Herts 90 367 295 451 67 273 212 347 81 328 260 407 Stevenage 60 261 199 336 106 462 379 559 97 423 343 516 Stort Valley & Villages 30 241 163 344 15 119 67 197 23 188 119 281 Upper Lea Valley 62 245 188 314 67 263 204 334 79 312 247 389 Welwyn Hatfield 67 262 203 332 66 256 198 326 110 421 346 508 HVCCG 388 269 243 297 392 271 245 299 488 335 306 366 Dacorum 129 350 292 416 117 316 261 378 119 319 264 381 Hertsmere 50 221 164 291 51 225 168 296 68 295 229 375 St Albans & Harpenden 96 263 213 321 103 283 231 343 115 316 261 380 Watford & Three Rivers 113 234 193 281 121 249 207 297 186 380 327 438 Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (Hertsmere) Inter CCG locality 188 per 100,000 - 295 per 100,000 - range* 423 per 100,000 380 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 270 - 339 per 100,000 269 - 335 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 28 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Potential years of life lost (PYLL) from causes considered amenable to healthcare In 2016 there were 9,981 potential years of life lost (from 409 deaths) from causes considered amenable to healthcare in ENHCCG and 9,976 (from 427 deaths) in HVCCG. Rates in ENHCCG are statistically significantly higher than HVCCG, although they have seen a statistically significant decrease since 2012.
2012 2013 2014 2015 2016 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 10694 1919 1883 1956 9890 1723 1689 1757 10650 1862 1827 1898 10729 1870 1835 1906 9981 1727 1693 1761 Lower Lea Valley 1176 1626 1534 1722 1314 1776 1681 1875 1177 1605 1514 1700 1368 1823 1727 1922 1181 1623 1532 1719 North Herts 2284 1984 1903 2067 2021 1729 1654 1807 2184 1843 1766 1923 2007 1709 1635 1786 2001 1671 1598 1746 Stevenage 2038 2441 2335 2550 1894 2159 2062 2260 1944 2202 2104 2304 2220 2531 2425 2639 1842 2126 2029 2226 Stort Valley & Villages 1186 2011 1897 2130 930 1582 1482 1688 1284 2227 2106 2353 995 1709 1604 1819 939 1538 1441 1641 Upper Lea Valley 2391 1901 1825 1979 1866 1444 1379 1511 1934 1482 1416 1550 2336 1816 1743 1892 1675 1298 1237 1362 Welwyn Hatfield 1620 1599 1522 1680 1865 1779 1699 1862 2127 2073 1985 2164 1801 1727 1647 1809 2343 2169 2082 2259 HVCCG 9983 1719 1685 1753 9810 1653 1621 1686 10814 1790 1756 1824 9926 1656 1623 1689 9976 1654 1622 1687 Dacorum 2997 1914 1845 1984 2511 1569 1508 1632 2813 1706 1643 1771 2562 1584 1523 1646 2548 1554 1494 1616 Hertsmere 1772 1794 1711 1879 1432 1425 1352 1501 1627 1604 1527 1684 1818 1811 1729 1896 1974 1937 1852 2025 St Albans & Harpenden 1705 1201 1145 1260 2398 1683 1616 1752 2513 1697 1630 1765 2447 1659 1593 1726 2131 1457 1396 1521 Watford & Three Rivers 3509 1905 1842 1970 3469 1828 1768 1891 3861 2029 1964 2094 3100 1639 1582 1699 3324 1723 1664 1783 Variation NHS ENHCCG NHS HVCCG (Upper Lea Valley) (St Albans & Harpenden) Inter CCG locality 1,298 per 100,000 - 1,457 per 100,000 - range* 2,169 per 100,000 1,937 per 100,00 (Welwyn Hatfield) (Hertsmere) Change in CCG rate** 1,919 - 1,727 per 100,000 1,719 - 1,654 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 29 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Potential years of life lost (PYLL) from ischaemic heart disease On average in 2014-2016 there were 3,115 potential years of life lost (from 149 deaths) from ischaemic heart disease in ENHCCG per year and 2,693 (from 128 deaths) in HVCCG. Rates in ENHCCG are statistically significantly higher than HVCCG. Both CCGs have seen statistically significant decreases since 2012-2014, although much sharper in HVCCG.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 9580 584 573 596 9477 574 563 586 9478 568 557 580 9466 563 552 574 9345 551 539 562 Lower Lea Valley 1296 604 572 638 1143 531 501 563 1066 493 463 523 1138 524 494 555 1333 611 579 645 North Herts 2205 640 614 668 2196 641 615 669 2330 675 648 703 2041 592 567 619 1771 502 479 526 Stevenage 1630 692 658 726 1851 765 730 801 1752 706 673 740 1894 730 697 764 1902 746 713 781 Stort Valley & Villages 800 464 432 497 671 392 363 423 761 438 407 471 672 393 363 424 794 451 420 483 Upper Lea Valley 1819 485 463 507 1865 495 473 518 1945 513 491 537 1959 510 488 533 1744 449 428 471 Welwyn Hatfield 1830 623 595 653 1751 587 560 616 1624 540 514 567 1762 580 553 608 1801 582 555 610 HVCCG 9406 549 538 561 9279 537 526 548 8381 481 471 492 8075 460 450 470 8079 457 447 468 Dacorum 3005 639 616 662 2731 577 555 599 2437 511 491 532 2172 451 432 471 2242 462 443 482 Hertsmere 1516 522 496 549 1524 515 490 542 1319 442 418 466 1244 414 391 438 1323 439 415 463 St Albans & Harpenden 2014 489 468 511 2089 503 481 525 1907 449 429 470 1942 455 435 476 1694 396 377 415 Watford & Three Rivers 2871 536 517 556 2934 544 524 564 2719 505 486 524 2717 498 479 517 2820 509 490 528 Variation NHS ENHCCG NHS HVCCG (Upper Lea Valley) (St Albans & Harpenden) Inter CCG locality 449 per 100,000 - 396 per 100,000 - range* 746 per 100,000 509 per 100,00 (Stevenage) (Watford and Three Rivers) Change in CCG rate** 584 - 551 per 100,000 549 - 457 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 30 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Potential years of life lost (PYLL) from neoplasms On average in 2014-2016 there were 3,391 potential years of life lost (from 137 deaths) from neoplasms in ENHCCG per year and 3,434 (from 137 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG with ENHCCG showing a statistically significant decrease between 2010-12 and 2014-16.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 10903 652 640 664 9875 584 573 596 9959 583 571 594 9758 567 556 579 10172 588 576 599 Lower Lea Valley 1438 684 650 721 1435 671 636 706 1317 610 577 644 1366 618 586 652 1024 463 435 493 North Herts 2155 626 600 653 1770 510 487 535 1713 479 457 502 2014 569 545 595 2271 639 613 666 Stevenage 1966 781 747 817 1824 717 684 751 1916 736 703 770 1856 713 681 746 1936 730 697 763 Stort Valley & Villages 1031 588 552 625 1073 602 567 640 984 556 521 592 831 467 435 500 867 485 453 518 Upper Lea Valley 2429 639 614 665 2089 544 521 568 2178 560 537 584 1903 487 466 510 1879 479 458 502 Welwyn Hatfield 1883 613 586 642 1684 548 522 575 1851 596 569 624 1788 573 546 600 2195 692 663 722 HVCCG 9573 547 536 558 9617 548 537 559 9872 554 543 565 10594 590 579 602 10301 566 555 577 Dacorum 2734 575 553 597 2677 563 542 585 2708 561 540 583 2818 583 561 605 2852 578 557 599 Hertsmere 1638 559 532 587 1483 502 477 528 1501 502 477 528 1724 576 549 604 1740 576 550 604 St Albans & Harpenden 2333 536 514 558 2410 560 537 583 2285 530 508 552 2805 638 614 662 2776 621 598 645 Watford & Three Rivers 2868 527 508 547 3047 556 536 576 3378 596 575 616 3247 568 549 588 2933 504 486 523 Variation NHS ENHCCG NHS HVCCG (Lower Lea Valley) (Watford and Three Rivers) Inter CCG locality 463 per 100,000 - 504 per 100,000 - range* 730 per 100,000 621 per 100,00 (Stevenage) (St Albans & Harpenden) Change in CCG rate** 652 - 588 per 100,000 547 - 566 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 31 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Potential years of life lost (PYLL) from cerebrovascular disease On average in 2014-2016 there were 1,187 potential years of life lost (from 53 deaths) from cerebrovascular disease in ENHCCG per year and 1,206 (from 55 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG, with HVCCG experiencing a statistically significant increase in rates between 2010-12 and 2014-16.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 3324 204 197 211 3678 222 215 230 4145 247 240 255 4260 253 246 261 3560 211 204 218 Lower Lea Valley 458 215 196 236 479 215 197 236 398 170 154 188 352 153 137 170 248 109 95 123 North Herts 658 190 176 205 684 197 182 212 781 220 205 236 749 212 197 228 738 208 194 224 Stevenage 573 240 221 261 702 294 272 317 761 314 291 337 807 328 306 352 525 215 197 234 Stort Valley & Villages 389 223 201 246 358 206 185 228 572 335 308 364 715 418 388 450 758 435 404 467 Upper Lea Valley 734 195 181 210 783 207 192 222 825 217 203 232 779 205 191 220 588 154 142 167 Welwyn Hatfield 513 177 162 193 672 228 211 246 809 276 257 296 858 286 267 306 702 236 219 254 HVCCG 3319 191 184 197 3657 209 202 216 3655 209 202 216 3466 199 192 206 3619 205 198 211 Dacorum 988 212 199 226 1104 234 220 248 914 194 181 207 915 195 182 208 774 164 153 176 Hertsmere 770 263 245 283 825 281 263 301 750 253 235 271 584 201 185 218 770 254 237 273 St Albans & Harpenden 600 137 126 148 692 160 148 172 752 174 162 187 780 185 173 199 515 126 115 137 Watford & Three Rivers 962 173 162 185 1036 185 174 197 1239 223 210 236 1187 211 199 223 1561 275 261 289 Variation NHS ENHCCG NHS HVCCG (Lower Lea Valley) (St Albans & Harpenden) Inter CCG locality 109 per 100,000 - 126 per 100,000 - range* 435 per 100,000 275 per 100,00 (Stort Valley and Villages) (Watford and Three Rivers) Change in CCG rate** 204 - 211 per 100,000 191 - 205 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 32 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Potential years of life lost (PYLL) from respiratory diseases On average in 2014-2016 there were 908 potential years of life lost (from 39 deaths) from respiratory diseases in ENHCCG per year and 968 (from 41 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG with both experiencing statistically significant increases between 2010-12 and 2014-16.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 2011 121 116 126 1833 110 105 115 1807 106 102 111 2213 130 125 136 2723 159 153 165 Lower Lea Valley 112 52 43 62 165 78 66 91 141 66 55 78 275 125 111 141 408 189 171 208 North Herts 505 144 132 158 432 123 112 135 449 129 117 141 417 121 110 133 489 140 128 153 Stevenage 338 145 130 162 374 156 141 173 386 147 133 163 512 198 181 216 497 196 179 215 Stort Valley & Villages 188 112 96 129 288 178 158 200 346 202 181 224 332 190 170 211 264 145 128 164 Upper Lea Valley 552 143 131 155 339 88 79 98 286 73 65 82 335 85 76 95 487 125 114 137 Welwyn Hatfield 316 105 94 117 234 75 66 86 198 66 57 76 342 115 104 128 578 186 171 202 HVCCG 2377 139 133 144 2559 148 142 153 2722 154 148 160 2573 144 139 150 2905 162 156 168 Dacorum 702 154 142 165 602 132 121 143 559 119 109 129 543 112 103 122 688 140 129 151 Hertsmere 489 168 154 184 484 164 150 180 484 162 148 178 404 137 124 152 539 180 165 196 St Albans & Harpenden 232 58 51 67 265 65 58 74 499 117 107 128 518 119 109 130 613 139 128 150 Watford & Three Rivers 953 172 161 183 1208 214 202 226 1180 207 195 219 1107 194 182 206 1065 186 175 198 Variation NHS ENHCCG NHS HVCCG (Upper Lea Valley) (St Albans & Harpenden) Inter CCG locality 125 per 100,000 - 139 per 100,000 - range* 196 per 100,000 186 per 100,00 (Stevenage) (Watford and Three Rivers) Change in CCG rate** 121 - 159 per 100,000 139 - 162 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 33 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Premature mortality from cancer On average there were 558 premature deaths per year from cancer in ENHCCG and 556 in HVCCG between 2014 and 2016. Rates are similar in ENHCCG and HVCCG.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 1720 115 110 121 1737 116 110 121 1744 115 110 121 1704 112 107 118 1674 110 105 115 Lower Lea Valley 233 120 105 137 238 123 108 139 231 119 104 135 242 124 108 140 210 108 94 123 North Herts 348 110 99 122 345 109 98 121 331 104 93 116 359 113 101 125 355 111 99 123 Stevenage 257 119 105 135 272 125 110 141 294 133 118 150 289 132 117 149 298 136 121 152 Stort Valley & Villages 159 103 87 120 167 108 92 125 158 101 86 118 146 93 78 109 149 93 79 110 Upper Lea Valley 380 110 100 122 356 103 92 114 371 106 96 117 347 98 88 109 343 96 86 107 Welwyn Hatfield 343 127 114 142 359 133 119 147 359 131 118 146 321 118 105 131 319 116 104 130 HVCCG 1660 108 103 113 1673 108 103 113 1652 106 101 111 1697 108 103 113 1667 105 100 111 Dacorum 444 106 96 116 438 104 94 114 429 100 91 110 440 102 92 112 449 103 93 113 Hertsmere 300 113 101 127 298 112 99 125 295 110 98 123 301 112 100 125 281 104 92 117 St Albans & Harpenden 364 97 87 108 370 98 88 109 352 93 83 103 387 102 92 112 391 103 93 113 Watford & Three Rivers 552 115 106 125 567 118 108 128 576 118 109 129 569 117 107 127 546 111 102 121
Variation NHS ENHCCG NHS HVCCG (Stort Valley & Villages) (Dacorum/ St Albans & Harpenden) Inter CCG locality 93 per 100,000 - 103 per 100,000 - range* 136 per 100,000 111 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 115 - 110 per 100,000 108 - 105 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 34 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Premature mortality from cardiovascular disease On average there were 274 premature deaths per year from cardiovascular disease in ENHCCG and 268 in HVCCG between 2014 and 2016. Rates are similar in ENHCCG and HVCCG with HVCCG showing a statistically significant decrease between 2010-12 and 2014-16.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 898 60 56 64 903 60 56 64 901 60 56 64 894 59 55 63 821 54 50 58 Lower Lea Valley 116 59 49 71 114 58 48 70 101 51 41 62 103 52 42 63 104 53 43 64 North Herts 199 63 55 72 199 63 55 72 198 62 54 71 181 57 49 66 163 51 43 59 Stevenage 151 71 60 83 169 79 67 92 164 75 64 88 162 73 62 85 151 68 57 80 Stort Valley & Villages 74 48 37 60 69 44 35 56 79 51 40 63 79 51 40 64 79 50 40 63 Upper Lea Valley 192 56 48 64 187 54 47 62 199 57 50 66 197 56 49 65 172 49 42 56 Welwyn Hatfield 166 62 53 72 165 61 52 71 160 59 50 69 172 63 54 73 152 55 47 65 HVCCG 911 59 56 63 901 58 55 62 878 56 53 60 817 52 49 56 804 51 47 54 Dacorum 262 63 55 71 263 63 55 71 250 59 52 67 223 52 45 59 215 50 43 57 Hertsmere 166 63 54 74 157 59 50 69 155 58 49 68 141 52 44 62 155 57 48 67 St Albans & Harpenden 189 51 44 59 186 50 43 58 170 45 39 53 173 46 39 53 146 38 32 45 Watford & Three Rivers 294 61 54 68 295 61 54 68 303 62 55 70 280 57 50 64 288 58 51 65
Variation NHS ENHCCG NHS HVCCG (Upper Lea Valley) (St Albans & Harpenden) Inter CCG locality 49 per 100,000 - 38 per 100,000 - range* 68 per 100,000 58 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 60 - 54 per 100,000 59 - 51 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 35 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Premature mortality from respiratory disease On average there were 131 premature deaths per year from respiratory disease in ENHCCG and 116 in HVCCG between 2014 and 2016. Rates are similar in ENHCCG and HVCCG.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 347 24 21 26 336 23 20 25 344 23 21 26 357 24 21 26 394 26 24 29 Lower Lea Valley 35 18 13 25 42 22 16 29 41 21 15 29 54 28 21 36 56 29 22 38 North Herts 75 24 19 30 69 22 17 27 73 23 18 29 77 24 19 30 79 25 20 31 Stevenage 54 26 19 33 61 29 22 37 63 29 22 37 74 34 27 43 81 37 29 46 Stort Valley & Villages 25 17 11 25 27 18 12 26 29 19 13 27 25 16 10 24 31 20 14 29 Upper Lea Valley 86 25 20 31 74 22 17 27 75 22 17 27 60 17 13 22 66 19 14 24 Welwyn Hatfield 72 28 22 35 63 24 19 31 63 24 18 31 67 25 20 32 81 30 24 37 HVCCG 319 21 19 24 337 22 20 25 338 22 20 25 334 22 20 24 348 23 20 25 Dacorum 89 22 18 27 75 19 15 23 82 20 16 25 79 19 15 24 88 21 17 26 Hertsmere 69 26 21 33 78 30 24 37 71 27 21 34 68 26 20 33 67 25 20 32 St Albans & Harpenden 55 15 11 20 63 18 13 22 64 18 14 22 64 18 13 22 63 17 13 22 Watford & Three Rivers 106 22 18 27 121 26 21 31 121 25 21 30 123 26 21 31 130 27 22 32
Variation NHS ENHCCG NHS HVCCG (Upper Lea Valley) (St Albans & Harpenden) Inter CCG locality 19 per 100,000 - 17 per 100,000 - range* 37 per 100,000 27 per 100,00 (Stevenage) (Watford & Three Rivers) Change in CCG rate** 24 - 26 per 100,000 21 - 23 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 36 [email protected]
CCG localities profile for Hertfordshire 2017-18 March 2018
Mortality
Premature mortality from liver disease On average there were 68 premature deaths per year from liver disease in ENHCCG and 65 in HVCCG between 2014 and 2016. Rates are similar in ENHCCG and HVCCG.
2010-12 2011-13 2012-14 2013-15 2014-16 CI CI CI CI CI CI CI CI CI CI Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper ENHCCG 192 13 11 15 194 13 11 15 190 12 11 14 181 12 10 13 203 13 11 15 Lower Lea Valley 24 12 8 18 26 13 9 19 31 16 11 22 30 15 10 21 30 15 10 21 North Herts 42 13 10 18 43 13 10 18 41 13 9 17 37 11 8 16 37 11 8 16 Stevenage 29 13 9 19 25 11 7 16 22 9 6 14 28 12 8 18 31 14 9 20 Stort Valley & Villages 15 10 5 16 13 8 4 14 12 8 4 13 17 10 6 17 22 13 8 20 Upper Lea Valley 31 9 6 13 38 11 8 15 37 10 7 14 35 10 7 14 45 12 9 17 Welwyn Hatfield 51 19 14 24 49 18 13 23 47 17 12 22 34 12 8 17 38 13 9 18 HVCCG 191 12 10 14 191 12 10 14 185 11 10 13 184 11 10 13 194 12 10 13 Dacorum 49 11 8 15 50 11 8 15 50 11 8 15 52 12 9 16 51 12 9 15 Hertsmere 23 9 5 13 24 9 6 13 29 10 7 15 35 12 9 17 35 12 9 17 St Albans & Harpenden 43 11 8 14 44 11 8 15 35 9 6 12 34 9 6 12 34 9 6 12 Watford & Three Rivers 76 15 12 19 73 14 11 18 71 14 11 18 63 12 9 15 74 14 11 18
Variation NHS ENHCCG NHS HVCCG (North Herts) (St Albans & Harpenden) Inter CCG locality 11 per 100,000 - 9 per 100,000 - range* 15 per 100,000 14 per 100,00 (Lower Lea Valley) (Watford & Three Rivers) Change in CCG rate** 13 per 100,000 12 per 100,000 * latest time period; ** between first and last time period
Increasing/ getting worse Decreasing/ getting better No significant change
www.hertshealthevidence.org.uk 37 [email protected]