Cardiovascular intelligence pack
CCG: NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG
March 2015 Version 1.2 Contents 1. Introduction 3
2. CVD risk • The narrative 9 • The data 10 3. Stroke • The narrative 33 • The data 34 4. Diabetes • The narrative 47 • The data 48 5. Kidney • The narrative 54 • The data 55 6. Heart • The narrative 65 • The data 66 7. Outcomes 84
8. Appendix 90
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2 CVD Intelligence packs Introduction
3 CVD Intelligence packs This CVD Intelligence Pack has been compiled by the National Cardiovascular Intelligence Network
in collaboration with GPs and nurses in primary care
Dr Matt Kearney Dr Chris Arden
Prof Ahmet Fuat Dr Matt Fay
Dr Yassir Javaid Prof Kamlesh Khunti
Ms Jan Proctor –King Prof Ruth Chambers
Dr Clare Hawley Dr Kathryn Griffith
4 CVD Intelligence packs From Data to Intelligence to Action Why and How to use this CVD Intelligence Pack
Every year in England there are around 150,000 premature deaths. A quarter of premature deaths are due to cardiovascular disease. Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment. High quality primary care is crucial for improving outcomes in CVD because primary care is where much prevention and most diagnosis and treatment is delivered.
This cardiovascular intelligence pack is a powerful resource for stimulating local conversations about quality improvement in primary care. Across a number of vascular conditions, looking at prevention, diagnosis, care and outcomes, the data allows comparison between CCGs and between practices.
This is not about performance management because we know that variation can have more than one interpretation. But patients have a right to expect that we will ask challenging questions about how the best practices are achieving the best and what average or below average achievers could do differently and how they could be supported to perform as well as the best.
The intelligence pack has several sections – CVD prevention and hypertension, stroke and AF, diabetes, kidney and heart disease and heart failure. Each section has one slide of narrative that makes the case and asks some questions. This is followed by data for a number of indicators, each with benchmarked comparison between CCGs and between practices.
Use the pack to identify where there is variation that needs exploring and to start asking challenging questions about where and how quality could be improved. We suggest you then develop a local action plan for quality improvement – this might include establishing communities of practice to build clinical leadership, use of audit tools to get a better understanding of the gaps in care and outcomes, agreeing local protocols and consensus approaches, assessing training and education needs, and exploring new ways of delivering care.
5 CVD Intelligence packs Data and methods
This slide pack compares the clinical commissioning group (CCG) with CCGs in its strategic clinical network (SCN) and England. Where a CCG is in more than one SCN, it has been allocated to the SCN with the greatest geographical or population coverage. The slide pack also compares the CCG to its 10 most similar CCGs in terms of demography, ethnicity and deprivation. For information on the methodology used to calculate the 10 most similar CCGS please go to: http://www.england.nhs.uk/resources/resources-for-ccgs/comm-for-value/
The 10 most similar CCGs to NHS Eastbourne, Hailsham and Seaford CCG are: NHS Fylde & Wyre CCG NHS Lincolnshire East CCG NHS Isle of Wight CCG NHS South Devon and Torbay CCG NHS West Norfolk CCG NHS Great Yarmouth and Waveney CCG NHS North Norfolk CCG NHS North Derbyshire CCG NHS Wyre Forest CCG NHS North Staffordshire CCG
The majority of data used in the packs are taken from the 2013/14 Quality and Outcomes Framework (QOF). Where this is not the case, this is indicated in the slide. All GP practices that were included in the 2013/14 QOF are included. Full source data are shown in the appendix.
For the majority of indicators, the additional number of people that would be treated if all practices were to achieve as well as the average of the top achieving practices is calculated. This is calculated by taking an average of the intervention rates (i.e. the denominator includes exceptions) for the best 50% of practices in the CCG and applying this rate to all practices in the CCG. Note, this number is not intended to be proof of a realisable improvement; rather it gives an indication of the magnitude of available opportunity.
6 CVD Intelligence packs Why Does Variation Matter? A key observation about benchmarking data is that it does not tell us why there is variation. Some of the variation may be explained by population or case mix and some may be “Much variation is unwarranted – unwarranted – we will not know unless we it cannot be explained on the investigate. basis of illness, medical evidence, or patient preference”
The strength of benchmarking lies not in the answers it provides but in the questions it generates for CCGs and Benchmarking is helpful because it highlights practices. variation. Of course it has long been acknowledged that some variation is inevitable in For example: the healthcare and outcomes experienced by 1. How much variation is there in detection, management, patients. exception reporting and outcomes? However, John Wennberg, who has championed 2. How many people would benefit if average performers research into clinical variation over four decades improved to the level of the best performers? and who founded the pioneering Dartmouth Atlas 3. How many people would benefit if the lowest performers of Health Care, concluded that much variation is matched the achievement of the average? unwarranted ie it cannot be explained on the 4. What are better performers doing differently in the way basis of illness, medical evidence, or patient they provide services in order to achieve better outcomes? preference and is accounted for by the 5. How can the CCG support low and average performers to willingness and ability of doctors to offer help them match the achievement of the best? treatment.
There are legitimate reasons for exception-reporting. But ……. Excepting patients from indicators puts them at risk of not receiving optimal care and of having worse outcomes. It is also likely to increase health inequalities. The substantial variation seen in exception reporting for some indicators suggests that some practices are more effective than others at reaching their whole population. Benchmarking exception reporting allows us to identify the practices that need support to implement the strategies adopted by low excepting practices. CVD Prevention and Hypertension
8 CVD Intelligence packs The size of the prevention problem CVD Prevention • 2/3 of people are obese or overweight • 1/3 of people are physically inactive • 20% of people smoke but this rises to over 50% in some communities “The NHS needs a radical upgrade in prevention if it is to be • 5 million people have undiagnosed and untreated hypertension sustainable” • 40% of people with diagnosed hypertension receive 5 year Forward View 2014 suboptimal treatment • Only one in five people whose 10 year CVD risk exceeds 20% receive statins This is because England faces an epidemic of largely preventable non- communicable diseases, such as heart What questions should we ask in our CCG? disease, cancer, Type 2 diabetes and 1. For each indicator how wide is the variation in achievement and exception liver disease. reporting? 2. How many people would benefit if all practices performed as well as the best? 3. How can we support practices who are average or below average to perform
as well as the best in: • Identifying people who are obese, inactive or smokers • Identifying and managing high CVD risk • Identifying and managing high blood pressure • Identifying and managing pre-diabetes 4. What is the quality of brief interventions we offer our patients? The WHO Global Burden of Disease 5. How available are preventive services such as weight management and Study (next slide) shows us that the smoking cessation? leading causes of premature mortality are tobacco, raised blood pressure, obesity, physical inactivity and poor The NHS Health Check is a systematic approach to identifying local diet. The radical upgrade in prevention people at high risk of CVD, offering behaviour change support and early needs population-level approaches. detection of hypertension, CKD, diabetes and pre-diabetes. Modelling But it also needs ongoing behaviour suggests that 75% uptake will lead to substantial reductions in premature change support and medical treatment mortality. for individuals during their repeated What proportion of our local eligible population is receiving the NHS contacts with primary care. Health Check and how effective is their follow up risk factor management in primary care? Source: Murray CJL, Richards MA, Newton JN, et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013;381:99-1020. DOI: http://dx.doi.org/10.1016/S0140-6736(13)60355-4 Hypertension observed prevalence compared to expected prevalence by CCG
Comparison with CCGs in the SCN
NHS Dartford, Gravesham and Swanley CCG 0.61 Graph NHS Medway CCG 0.59 NHS Eastbourne, Hailsham and Seaford CCG 0.58 NHS Swale CCG 0.58 NHS Ashford CCG 0.58 NHS Thanet CCG 0.57 NHS Hastings and Rother CCG 0.57 0.58 ratio of observed to expected NHS Horsham and Mid Sussex CCG 0.57 hypertension prevalence in NHS NHS Surrey Heath CCG 0.56 Eastbourne, Hailsham And Seaford CCG compared to 0.56 in England NHS West Kent CCG 0.56
NHS South Kent Coast CCG 0.56 This suggests that 58% of people NHS Surrey Downs CCG 0.55 with hypertension have been NHS High Weald Lewes Havens CCG 0.55 diagnosed NHS Coastal West Sussex CCG 0.55 NHS North West Surrey CCG 0.54 Note: This slide compares the prevalence NHS Crawley CCG 0.54 of hypertension recorded in QOF in NHS Canterbury and Coastal CCG 0.53 2013/14 to the expected prevalence of NHS Guildford and Waverley CCG 0.52 hypertension taken from the East of England Public Health Observatory NHS East Surrey CCG 0.52 modelled estimates produced in 2011. The NHS Brighton and Hove CCG 0.44 model was developed using data from the 2003-2004 Health Surveys for England England 0.56 and takes into account age, sex, ethnicity, smoking status and deprivation. 0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 ratio of observed to expected
11 CVD Intelligence packs Hypertension observed prevalence compared to expected prevalence by CCG
Comparison with demographically similar CCGs
GraphNHS North Staffordshire CCG 0.61
NHS Wyre Forest CCG 0.60
NHS West Norfolk CCG 0.59
NHS Fylde & Wyre CCG 0.58
NHS North Derbyshire CCG 0.58
NHS Eastbourne, Hailsham and Seaford CCG 0.58
NHS Great Yarmouth and Waveney CCG 0.57
NHS Lincolnshire East CCG 0.57
NHS Isle of Wight CCG 0.56
NHS South Devon and Torbay CCG 0.55
NHS North Norfolk CCG 0.54
0.00 0.10 0.20 0.30 0.40 0.50 0.60 0.70 ratio of observed to expected
12 CVD Intelligence packs Hypertension observed prevalence compared to expected prevalence by GP practice
GP practice CCG
Graph Dr Savvas S & Partner G81012
Dr Palit & Partners G81099
Dr Oezburun G81685
Dr Edwards & Partner G81098
Dr Simmons G81634
Dr Baig & Partners G81008
Dr Pearce & Partners G81059 It is estimated that there are 24,001 Dr Bedford-Turner & Partners G81004 people with undiagnosed Dr Brown R D & Partners G81049 hypertension in NHS Eastbourne, Dr Barnes M H & Partners G81029 Hailsham And Seaford CCG Sovereign Practice G81022
Dr Williams & Partners G81050 GP practice range of observed to
Dr Eyre & Partners G81003 expected hypertension prevalence: 0.32 to 0.72 Dr Brown G C & Partners G81027
Dr Miller & Partners G81056
Dr Adoki & Ptnr Y00080
Park Practice G81104
Dr Verghese & Partners G81002
Dr Barnes J D & Partners G81017
Green Street Clinic G81032
Eastbourne Station Health Centre Y02816
0 0.2 0.4 0.6 0.8 1 ratio of observed to expected
13 CVD Intelligence packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHSGraph Hastings and Rother CCG 81.5% NHS Canterbury and Coastal CCG 81.4% NHS Swale CCG 81.3% NHS South Kent Coast CCG 80.1% NHS Surrey Heath CCG 79.8% NHS West Kent CCG 79.7% NHS Dartford, Gravesham and Swanley CCG 79.7% NHS Crawley CCG 79.4% 33,167 people with hypertension NHS North West Surrey CCG 79.1% (diagnosed)* in NHS Eastbourne, NHS Horsham and Mid Sussex CCG 79.1% Hailsham And Seaford CCG
NHS Thanet CCG 78.8% 26,053 (78.6%) people whose blood NHS East Surrey CCG 78.8% pressure is <= 150/90 NHS Ashford CCG 78.7% NHS Medway CCG 78.6% 2,421 (7.3%) people who are NHS Eastbourne, Hailsham and Seaford CCG 78.6% excepted from optimal control NHS Guildford and Waverley CCG 77.8% NHS High Weald Lewes Havens CCG 77.7% 4,693 (14.1%) additional people NHS Surrey Downs CCG 77.1% whose blood pressure is not <= NHS Coastal West Sussex CCG 76.4% 150/90
NHS Brighton and Hove CCG 76.4%
England 79.2% *Using QOF clinical indicator HYP002 0% 20% 40% 60% 80% 100% denominator plus exceptions
14 CVD Intelligence packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported Graph NHS Isle of Wight CCG 82.6%
NHS Fylde & Wyre CCG 79.9%
NHS North Derbyshire CCG 79.1%
NHS North Norfolk CCG 78.8%
NHS Eastbourne, Hailsham and Seaford CCG 78.6%
NHS Wyre Forest CCG 78.3%
NHS West Norfolk CCG 78.3%
NHS Lincolnshire East CCG 77.7%
NHS Great Yarmouth and Waveney CCG 77.0%
NHS North Staffordshire CCG 77.0%
NHS South Devon and Torbay CCG 74.3%
0% 20% 40% 60% 80% 100%
15 CVD Intelligence packs Percentage of patients with hypertension whose last blood pressure reading (measured in the preceding 9 months) is not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported GraphDr Barnes M H & Partners G81029
Dr Adoki & Ptnr Y00080
Sovereign Practice G81022
Dr Miller & Partners G81056
Dr Brown R D & Partners G81049
Dr Brown G C & Partners G81027
Eastbourne Station Health Centre Y02816 In total, including exceptions, there Dr Eyre & Partners G81003 are 7,114 people whose blood Park Practice G81104 pressure is not <= 150/90 Dr Savvas S & Partner G81012
Dr Simmons G81634 GP practice range: 13.1% to 36.7 %
Dr Pearce & Partners G81059 If all practices were to achieve as Dr Palit & Partners G81099 well as the average of the best Dr Williams & Partners G81050 achieving practices, then an Dr Baig & Partners G81008 additional 1,856 people would have
Dr Oezburun G81685 their hypertension controlled
Dr Barnes J D & Partners G81017
Green Street Clinic G81032
Dr Verghese & Partners G81002
Dr Bedford-Turner & Partners G81004
Dr Edwards & Partner G81098
0% 5% 10% 15% 20% 25% 30% 35% 40%
16 CVD Intelligence packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with CCGs in the SCN Treated No treatment Exceptions reported Graph NHS Swale CCG 72.8% NHS Crawley CCG 71.0% NHS Surrey Heath CCG 70.6% NHS Eastbourne, Hailsham and Seaford CCG 68.4% NHS Surrey Downs CCG 67.3% NHS Horsham and Mid Sussex CCG 65.3% NHS Dartford, Gravesham and Swanley CCG 64.6% NHS West Kent CCG 64.3% 152 people with a new diagnosis of NHS Medway CCG 62.4% hypertension with a CVD risk of 20% NHS Brighton and Hove CCG 61.9% or higher in NHS Eastbourne, Hailsham And Seaford CCG NHS Thanet CCG 61.6%
NHS South Kent Coast CCG 61.1% 104 (68.4%) people who are NHS North West Surrey CCG 59.6% currently treated with statins NHS Coastal West Sussex CCG 58.2% NHS Ashford CCG 57.7% 43 (28.3%) people who are NHS Guildford and Waverley CCG 57.6% excepted from treatment with statins NHS Canterbury and Coastal CCG 51.4% NHS East Surrey CCG 49.0% 5 (3.3%) additional people who are NHS High Weald Lewes Havens CCG 44.6% not currently treated with statins
NHS Hastings and Rother CCG 43.0%
England 64.0% 0% 20% 40% 60% 80% 100%
17 CVD Intelligence packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and treated with statins by CCG Comparison with demographically similar CCGs Treated No treatment Exceptions reported Graph NHS Isle of Wight CCG 68.5%
NHS Eastbourne, Hailsham and Seaford CCG 68.4%
NHS Lincolnshire East CCG 64.5%
NHS South Devon and Torbay CCG 64.1%
NHS North Derbyshire CCG 63.5%
NHS West Norfolk CCG 63.4%
NHS Fylde & Wyre CCG 60.9%
NHS North Norfolk CCG 58.8%
NHS Wyre Forest CCG 58.7%
NHS Great Yarmouth and Waveney CCG 54.1%
NHS North Staffordshire CCG 53.4%
0% 20% 40% 60% 80% 100%
18 CVD Intelligence packs New diagnosis of hypertension who have been given a CVD risk assessment whose CVD risk exceeds 20% and not treated with statins by GP practice
No treatment Exceptions reported GraphEastbourne Station Health Centre Y02816
Dr Barnes M H & Partners G81029
Dr Savvas S & Partner G81012
Dr Verghese & Partners G81002
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Miller & Partners G81056
Dr Oezburun G81685 In total, including exceptions, there are 48 people who are not currently Sovereign Practice G81022 treated with statins Dr Barnes J D & Partners G81017 Green Street Clinic G81032 GP practice range: 0.0% to 100.0 %
Dr Simmons G81634
Dr Bedford-Turner & Partners G81004 If all practices were to achieve as well as the average of the best Dr Palit & Partners G81099 achieving practices, then an Dr Eyre & Partners G81003 additional 30 people would be Dr Pearce & Partners G81059 treated
Park Practice G81104
Dr Baig & Partners G81008
Dr Brown R D & Partners G81049
Dr Edwards & Partner G81098
Dr Adoki & Ptnr Y00080
0% 20% 40% 60% 80% 100% 120%
19 CVD Intelligence packs Percentage of patients with a long term condition whose notes record smoking status in the preceding 12 months by CCG Comparison with CCGs in the SCN Recorded No record Exceptions reported NHSGraph Canterbury and Coastal CCG 95.3% NHS Swale CCG 95.2% NHS Crawley CCG 95.1% NHS Hastings and Rother CCG 94.9% NHS East Surrey CCG 94.7% NHS Dartford, Gravesham and Swanley CCG 94.4% NHS Surrey Heath CCG 94.4% NHS Surrey Downs CCG 94.3% 52,004 people with a long term NHS Horsham and Mid Sussex CCG 94.2% condition in NHS Eastbourne, NHS North West Surrey CCG 94.2% Hailsham And Seaford CCG
NHS South Kent Coast CCG 94.0% 48,274 (92.8%) people whose notes NHS Guildford and Waverley CCG 93.8% record a smoking status NHS Thanet CCG 93.8% NHS Coastal West Sussex CCG 93.7% 419 (0.8%) people who are NHS High Weald Lewes Havens CCG 93.4% excepted from smoking status NHS West Kent CCG 93.4% recording NHS Medway CCG 93.4% NHS Ashford CCG 93.3% 3,311 (6.4%) additional people NHS Brighton and Hove CCG 93.0% whose notes do not record a smoking status NHS Eastbourne, Hailsham and Seaford CCG 92.8%
England 94.6% 0% 20% 40% 60% 80% 100%
20 CVD Intelligence packs Percentage of patients with a long term condition whose notes record smoking status in the preceding 12 months by CCG Comparison with demographically similar CCGs Recorded No record Exceptions reported Graph NHS Fylde & Wyre CCG 95.8%
NHS North Derbyshire CCG 95.6%
NHS Isle of Wight CCG 95.1%
NHS North Norfolk CCG 94.4%
NHS Wyre Forest CCG 94.0%
NHS Great Yarmouth and Waveney CCG 94.0%
NHS Lincolnshire East CCG 94.0%
NHS West Norfolk CCG 93.5%
NHS North Staffordshire CCG 93.1%
NHS Eastbourne, Hailsham and Seaford CCG 92.8%
NHS South Devon and Torbay CCG 91.8%
0% 20% 40% 60% 80% 100%
21 CVD Intelligence packs Percentage of patients with a long term condition whose notes do not record smoking status in the preceding 12 months by GP practice
No record Exceptions reported
Graph Dr Adoki & Ptnr Y00080
Dr Barnes M H & Partners G81029
Dr Brown R D & Partners G81049
Dr Williams & Partners G81050
Park Practice G81104
Dr Eyre & Partners G81003
Sovereign Practice G81022
Dr Miller & Partners G81056 In total, including exceptions, there are 3,730 people whose notes do not Dr Brown G C & Partners G81027 record a smoking status Dr Baig & Partners G81008 Dr Pearce & Partners G81059 GP practice range: 2.8% to 18.2 %
Green Street Clinic G81032
Dr Oezburun G81685 If all practices were to achieve as well as the average of the best Dr Palit & Partners G81099 achieving practices, then an Dr Barnes J D & Partners G81017 additional 1,524 people would have Eastbourne Station Health Centre Y02816 their smoking status recorded
Dr Bedford-Turner & Partners G81004
Dr Verghese & Partners G81002
Dr Simmons G81634
Dr Savvas S & Partner G81012
Dr Edwards & Partner G81098
0% 5% 10% 15% 20%
22 CVD Intelligence packs Percentage of patients with a long term condition who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months by CCG Comparison with CCGs in the SCN Recorded No record Exceptions reported GraphNHS Surrey Downs CCG 96.0% NHS Surrey Heath CCG 95.1% NHS Swale CCG 95.1% NHS Eastbourne, Hailsham and Seaford CCG 94.9% NHS North West Surrey CCG 94.8% NHS Dartford, Gravesham and Swanley CCG 94.6% NHS Canterbury and Coastal CCG 94.5% NHS West Kent CCG 94.4% 6,869 people with a long term NHS South Kent Coast CCG 94.3% condition who are recorded as a NHS Guildford and Waverley CCG 94.0% smoker in NHS Eastbourne, Hailsham And Seaford CCG NHS Coastal West Sussex CCG 94.0%
NHS Medway CCG 93.8% 6,519 (94.9%) people who have a NHS East Surrey CCG 93.6% record of an offer of support and NHS Hastings and Rother CCG 93.6% treatment NHS Horsham and Mid Sussex CCG 93.3% NHS Thanet CCG 93.2% 70 (1%) people who are excepted NHS Crawley CCG 92.5% from an offer of support and NHS Brighton and Hove CCG 92.4% treatment NHS Ashford CCG 92.1% 280 (4.1%) additional people who NHS High Weald Lewes Havens CCG 60.2% have no record of an offer of support and treatment England 93.1% 0% 20% 40% 60% 80% 100%
23 CVD Intelligence packs Percentage of patients with a long term condition who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months by CCG Comparison with demographically similar CCGs Recorded No record Exceptions reported Graph NHS Isle of Wight CCG 96.5%
NHS Wyre Forest CCG 95.7%
NHS Eastbourne, Hailsham and Seaford CCG 94.9%
NHS Fylde & Wyre CCG 94.4%
NHS North Derbyshire CCG 94.3%
NHS West Norfolk CCG 91.1%
NHS North Norfolk CCG 89.8%
NHS Great Yarmouth and Waveney CCG 88.4%
NHS Lincolnshire East CCG 88.1%
NHS South Devon and Torbay CCG 86.5%
NHS North Staffordshire CCG 84.3%
0% 20% 40% 60% 80% 100%
24 CVD Intelligence packs Percentage of patients with a long term condition who are recorded as current smokers who do not have a record of an offer of support and treatment within the preceding 12 months by GP practice
No record Exceptions reported
Graph Dr Adoki & Ptnr Y00080
Dr Brown R D & Partners G81049
Sovereign Practice G81022
Dr Oezburun G81685
Dr Miller & Partners G81056
Eastbourne Station Health Centre Y02816
Dr Savvas S & Partner G81012
Dr Barnes M H & Partners G81029 In total, including exceptions, there are 350 people who have no record Dr Simmons G81634 of an offer of support and treatment Green Street Clinic G81032 Dr Palit & Partners G81099 GP practice range: 0.4% to 34.8 %
Dr Verghese & Partners G81002
Dr Barnes J D & Partners G81017 If all practices were to achieve as well as the average of the best Dr Bedford-Turner & Partners G81004 achieving practices, then an Dr Williams & Partners G81050 additional 234 people would have a Dr Eyre & Partners G81003 record of an offer of support and
Dr Baig & Partners G81008 treatment
Park Practice G81104
Dr Edwards & Partner G81098
Dr Pearce & Partners G81059
Dr Brown G C & Partners G81027
0% 5% 10% 15% 20% 25% 30% 35% 40%
25 CVD Intelligence packs Estimated smoking prevalence (QOF) by CCG
Comparison with demographically similar CCGs
NHS GreatGraph Yarmouth and Waveney CCG 22.2
NHS Lincolnshire East CCG 21.7
NHS West Norfolk CCG 19.9
NHS Wyre Forest CCG 19.6 Prevalence of 17.4% in NHS NHS Isle of Wight CCG 19.5 Eastbourne, Hailsham And Seaford CCG
NHS South Devon and Torbay CCG 19.2
NHS Fylde & Wyre CCG 18.9 Note: It has been found that the proportion of patients recorded as smokers correlates well with IHS smoking prevalence and is a NHS North Staffordshire CCG 18.3 good estimate of the actual smoking prevalence in local areas, NHS North Derbyshire CCG 17.5 http://bmjopen.bmj.com/content/4/7/e00521 7.abstract
NHS Eastbourne, Hailsham and Seaford CCG 17.4 Definition: denominator of QOF clinical indicator SMOKE004 ( number of patients NHS North Norfolk CCG 16.7 15+ who are recorded as current smokers) divided by QOF clinical indicator 0.00 5.00 10.00 15.00 20.00 25.00 denominator of SMOK001 (estimated prevalence % number of patients 15+).
26 CVD Intelligence packs Estimated smoking prevalence (QOF) by GP practice
GP practice CCG
GraphEastbourne Station Health Centre Y02816
Dr Brown G C & Partners G81027
Dr Barnes J D & Partners G81017
Park Practice G81104
Sovereign Practice G81022
Dr Savvas S & Partner G81012
Dr Brown R D & Partners G81049 27,743 people who are recorded as Dr Oezburun G81685 smokers in NHS Eastbourne, Dr Eyre & Partners G81003 Hailsham And Seaford CCG Dr Pearce & Partners G81059 Dr Verghese & Partners G81002 GP practice range: 11.9% to 34.8%
Dr Baig & Partners G81008
Dr Adoki & Ptnr Y00080
Dr Barnes M H & Partners G81029
Green Street Clinic G81032
Dr Miller & Partners G81056
Dr Palit & Partners G81099 Note: This method is thought to be a
Dr Williams & Partners G81050 reasonably robust method in estimating smoking prevalence for the majority of GP Dr Bedford-Turner & Partners G81004 practices. However, caution is advised for Dr Edwards & Partner G81098 extreme estimates of smoking prevalence
Dr Simmons G81634 and those with high numbers of smoking status not recorded and exceptions. 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 prevalence %
27 CVD Intelligence packs Successful smoking quitters at 4 weeks, 2013/14
Comparison with CCGs in the SCN
NHS East Surrey CCG 62.4 Graph NHS North West Surrey CCG 62.4 NHS Surrey Downs CCG 62.4 NHS Surrey Heath CCG 62.4 NHS Guildford and Waverley CCG 61.5 NHS Brighton and Hove CCG 61.0 NHS Ashford CCG 52.1 NHS Canterbury and Coastal CCG 52.1 45.2% successful smoking quitters at NHS Dartford, Gravesham and Swanley CCG 52.1 4 weeks in NHS Eastbourne, NHS South Kent Coast CCG 52.1 Hailsham And Seaford CCG NHS Swale CCG 52.1 compared to 51.3% in England NHS Thanet CCG 52.1 NHS West Kent CCG 52.1 NHS Coastal West Sussex CCG 48.8 NHS Crawley CCG 48.8 NHS Horsham and Mid Sussex CCG 48.8 Note: The local authority indicator, successful smoking quitters at 4 weeks from NHS Medway CCG 46.9 the Health and Social Care Information NHS Eastbourne, Hailsham and Seaford CCG 45.2 Centre, has been used as a basis for NHS Hastings and Rother CCG 45.2 estimating CCG level smoking quitters. NHS High Weald Lewes Havens CCG 45.2 Where more than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been England 51.3 allocated to the CCG and aggregated up to 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 give CCG estimates. percentage
28 CVD Intelligence packs Excess weight (overweight or obese) in adults, 2012
Comparison with CCGs in the SCN
NHS Medway CCG 66.1 Graph NHS Eastbourne, Hailsham and Seaford CCG 65.0 NHS Hastings and Rother CCG 65.0 NHS High Weald Lewes Havens CCG 65.0 NHS Ashford CCG 64.6 NHS Canterbury and Coastal CCG 64.6 NHS Dartford, Gravesham and Swanley CCG 64.6 NHS South Kent Coast CCG 64.6 65.0% of adults with excess weight NHS Swale CCG 64.6 in NHS Eastbourne, Hailsham And NHS Thanet CCG 64.6 Seaford CCG compared to 63.8% in NHS West Kent CCG 64.6 England NHS Coastal West Sussex CCG 64.4 NHS Crawley CCG 64.4 NHS Horsham and Mid Sussex CCG 64.4 NHS Guildford and Waverley CCG 60.9 NHS East Surrey CCG 60.8 Note: Local authority prevalence estimates of excess weight from the Active People NHS North West Surrey CCG 60.8 Survey, Sport England, have been used as NHS Surrey Downs CCG 60.8 a basis for estimating CCG level prevalence NHS Surrey Heath CCG 60.8 estimates of excess weight. Where more NHS Brighton and Hove CCG 49.2 than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the England 63.8 CCG and aggregated up to give CCG 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 estimates. percentage
29 CVD Intelligence packs Percentage of inactive adults, 2013
Comparison with CCGs in the SCN
NHS Medway CCG 33.8 Graph NHS Eastbourne, Hailsham and Seaford CCG 28.0 NHS Hastings and Rother CCG 28.0 NHS High Weald Lewes Havens CCG 28.0 NHS Ashford CCG 26.8 NHS Canterbury and Coastal CCG 26.8 NHS Dartford, Gravesham and Swanley CCG 26.8 NHS South Kent Coast CCG 26.8 28.0% of adults who are inactive in NHS Swale CCG 26.8 NHS Eastbourne, Hailsham And NHS Thanet CCG 26.8 Seaford CCG compared to 28.3% in NHS West Kent CCG 26.8 England NHS Coastal West Sussex CCG 26.3 NHS Crawley CCG 26.3 NHS Horsham and Mid Sussex CCG 26.3 NHS Guildford and Waverley CCG 23.7 NHS East Surrey CCG 23.6 Note: Local authority percentage estimates of inactive adults from the Active People NHS North West Surrey CCG 23.6 Survey, Sport England, have been used as NHS Surrey Downs CCG 23.6 a basis for estimating CCG level percentage NHS Surrey Heath CCG 23.6 estimates of inactive adults. Where more NHS Brighton and Hove CCG 21.6 than one local authority is contained within a CCG, the proportion of the local authority within the CCG has been allocated to the England 28.3 CCG and aggregated up to give CCG 0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 estimates. percentage
30 CVD Intelligence packs NHS Health Check offer and uptake, 2013/14
Comparison with CCGs in the SCN % of people offered an NHS Health check % of people received an NHS Health check of those offered 17.3% of people were Graph NHS Medway CCG 22.6 NHSGraph2 Brighton and Hove CCG 60.3 NHS Eastbourne, Hailsham and offered an NHS Health NHS Ashford CCG 21.4 57.2 Seaford CCG Check in NHS Eastbourne, NHS Canterbury and Coastal CCG 21.4 NHS Hastings and Rother CCG 57.2 Hailsham And Seaford NHS Dartford, Gravesham and NHS High Weald Lewes Havens CCG Swanley CCG 21.4 57.2 CCG compared to 18.4% NHS South Kent Coast CCG 21.4 NHS Medway CCG 50.3 in England NHS Swale CCG 21.4 NHS Coastal West Sussex CCG 44.6 NHS Thanet CCG 21.4 NHS Crawley CCG 44.6 NHS West Kent CCG 21.4 NHS Horsham and Mid Sussex CCG 44.6 57.2% of people received NHS Eastbourne, Hailsham and NHS Guildford and Waverley CCG Seaford CCG 17.3 42.7 an NHS Health Check of NHS Hastings and Rother CCG 17.3 NHS East Surrey CCG 42.2 those offered in NHS NHS High Weald Lewes Havens CCG 17.3 NHS North West Surrey CCG 42.2 Eastbourne, Hailsham And NHS Coastal West Sussex CCG 13.4 NHS Surrey Downs CCG 42.2 Seaford CCG compared to NHS Crawley CCG 13.4 NHS Surrey Heath CCG 42.2 49% in England NHS Horsham and Mid Sussex CCG 13.4 NHS Ashford CCG 34.7 NHS Brighton and Hove CCG 9.3 NHS Canterbury and Coastal CCG 34.7 Note: Local authority indicators NHS Dartford, Gravesham and NHS Health Check offer and NHS Guildford and Waverley CCG 2.4 34.7 Swanley CCG uptake have been used as a NHS East Surrey CCG NHS South Kent Coast CCG 2.0 34.7 basis for estimating CCG level NHS North West Surrey CCG 2.0 NHS Swale CCG 34.7 NHS Health Check offer and NHS Surrey Downs CCG 2.0 NHS Thanet CCG 34.7 uptake. Where more than one NHS Surrey Heath CCG 2.0 NHS West Kent CCG 34.7 local authority is contained within a CCG, the proportion of the England 18.4 England 49.0 local authority within the CCG has been allocated to the CCG 0 5 10 15 20 25 0 10 20 30 40 50 60 70 percentage percentage and aggregated up to give CCG estimates.
31 CVD Intelligence packs Stroke
32 CVD Intelligence packs Stroke Prevention Secondary prevention of stroke For people who have had a stroke anti- It is estimated that if Atrial Fibrillation platelet treatment and good control of blood was adequately treated, around 7000 pressure are key to reducing the risk of a strokes would be prevented and 2100 further stroke lives saved every year.
What questions should we ask in our CCG? Stroke is one of the leading causes of 1. For each indicator how wide is the variation in achievement and premature death and disability. Stroke exception reporting? is devastating for individuals and families 2. How many people would benefit if all practices performed as well and accounts for a substantial proportion as the best? of health and social care expenditure. 3. How can we support practices who are average and below average to perform as well as the best in: • Detection of atrial fibrillation Atrial fibrillation increases the risk of stroke • Management of hypertension in people who have had a by about 6 fold, and strokes caused by AF are previous stroke or TIA often more severe with higher mortality and • Anti-platelet or anti-coagulant treatment in people who greater disability. Anticoagulation substantially have had a previous stroke or TIA reduces the risk of stroke in people with AF.
Despite this, AF is underdiagnosed and under What might help treated. Around 25-30% of people with AF are • Roll out of GRASP-AF to identify people with AF who are undertreated unaware they have the condition and less • Promoting use of electronic templates with decision support tools – than a half of patients are adequately treated CHADS-VASC and HASBLED – many do not receive anticoagulants and of • Roll out of Warfarin Patient Safety Audit Tool to ensure optimal time in those who do, many are undertreated. therapeutic range for people on warfarin • Dissemination of latest evidence on risk-benefit balance for Only 30% of people with known AF anticoagulants including the newer treatments (NOACs) admitted with stroke are on anticoagulant • Ensure appropriate clinical follow up for individuals found to have an treatment at the time of their stroke. irregular pulse during the NHS Health Check Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Comparison with CCGs in the SCN
NHS Ashford CCG 0.88 Graph NHS Eastbourne, Hailsham and Seaford CCG 0.78 NHS Canterbury and Coastal CCG 0.72 NHS West Kent CCG 0.72 NHS South Kent Coast CCG 0.72 0.78 ratio of observed to expected NHS East Surrey CCG 0.71 atrial fibrillation prevalence in NHS NHS Hastings and Rother CCG 0.70 Eastbourne, Hailsham And Seaford CCG compared to 0.65 in England NHS Thanet CCG 0.68
NHS Coastal West Sussex CCG 0.67 This suggests that 78% of people NHS High Weald Lewes Havens CCG 0.67 with atrial fibrillation have been NHS Guildford and Waverley CCG 0.67 diagnosed NHS Crawley CCG 0.66 NHS Dartford, Gravesham and Swanley CCG 0.66 NHS Horsham and Mid Sussex CCG 0.65 Note: This slide compares the prevalence of NHS Brighton and Hove CCG 0.64 atrial fibrillation recorded in QOF in 2013/14 NHS Swale CCG 0.63 to the estimated prevalence of atrial NHS North West Surrey CCG 0.62 fibrillation, taken from National Cardiovascular Intelligence Network NHS Surrey Downs CCG 0.62 estimates produced in 2015. The estimates NHS Medway CCG 0.62 were developed by applying age-sex NHS Surrey Heath CCG 0.58 specific prevalence rates as reported by Norberg et al (2013) to GP population estimates from the Health and Social Care England 0.65 Information Centre. Estimates reported are 0.00 0.20 0.40 0.60 0.80 1.00 adjusted for age and sex of the local ratio of observed to expected population.
34 CVD Intelligence packs Atrial fibrillation observed prevalence compared to expected prevalence by CCG
Comparison with demographically similar CCGs
NHS Eastbourne,Graph Hailsham and Seaford CCG 0.78
NHS South Devon and Torbay CCG 0.74
NHS West Norfolk CCG 0.73
NHS North Derbyshire CCG 0.71
NHS North Staffordshire CCG 0.71
NHS North Norfolk CCG 0.69
NHS Lincolnshire East CCG 0.69
NHS Wyre Forest CCG 0.68
NHS Fylde & Wyre CCG 0.68
NHS Great Yarmouth and Waveney CCG 0.63
NHS Isle of Wight CCG 0.60
0.00 0.20 0.40 0.60 0.80 1.00 ratio of observed to expected
35 CVD Intelligence packs Atrial fibrillation observed prevalence compared to expected prevalence by GP practice
GP practice CCG
Graph Dr Simmons G81634
Dr Eyre & Partners G81003
Dr Savvas S & Partner G81012
Dr Williams & Partners G81050
Dr Palit & Partners G81099
Dr Edwards & Partner G81098
Dr Baig & Partners G81008 It is estimated that there are 1,504 Park Practice G81104 people with undiagnosed atrial Green Street Clinic G81032 fibrillation in NHS Eastbourne, Dr Pearce & Partners G81059 Hailsham And Seaford CCG Dr Barnes M H & Partners G81029
Dr Brown G C & Partners G81027 GP practice range of observed to
Dr Miller & Partners G81056 expected atrial fibrillation prevalence: 0.31 to 1.07 Dr Bedford-Turner & Partners G81004
Dr Barnes J D & Partners G81017
Dr Verghese & Partners G81002
Dr Brown R D & Partners G81049
Sovereign Practice G81022
Dr Adoki & Ptnr Y00080
Dr Oezburun G81685
Eastbourne Station Health Centre Y02816
0 0.2 0.4 0.6 0.8 1 ratio of observed to expected
36 CVD Intelligence packs In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported GraphNHS Surrey Heath CCG 76.8% NHS Medway CCG 76.0% NHS Guildford and Waverley CCG 74.4% NHS Surrey Downs CCG 73.5% NHS Dartford, Gravesham and Swanley CCG 73.0% NHS Ashford CCG 72.6% NHS Swale CCG 72.1% NHS Hastings and Rother CCG 71.7% 3,154 people with atrial fibrillation NHS Eastbourne, Hailsham and Seaford CCG 71.6% with a CHADS2 score > 1 in NHS NHS East Surrey CCG 71.4% Eastbourne, Hailsham And Seaford CCG NHS West Kent CCG 70.9%
NHS South Kent Coast CCG 70.8% 2,258 (71.6%) people treated with NHS Canterbury and Coastal CCG 70.6% anti-coagulation therapy NHS Crawley CCG 69.9% NHS Thanet CCG 69.6% 434 (13.8%) people who are NHS North West Surrey CCG 69.4% exceptions NHS High Weald Lewes Havens CCG 69.3% NHS Coastal West Sussex CCG 66.0% 462 (14.6%) additional people with a NHS Horsham and Mid Sussex CCG 64.9% recorded CHADS2 score > 1 who are not treated NHS Brighton and Hove CCG 58.3%
England 69.1% 0% 20% 40% 60% 80% 100%
37 CVD Intelligence packs In patients with AF with a CHADS2 > 1, the percentage treated with anti-coagulation therapy by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported Graph NHS South Devon and Torbay CCG 73.6%
NHS Eastbourne, Hailsham and Seaford CCG 71.6%
NHS Lincolnshire East CCG 71.1%
NHS North Norfolk CCG 69.8%
NHS North Derbyshire CCG 68.2%
NHS West Norfolk CCG 67.7%
NHS North Staffordshire CCG 67.5%
NHS Wyre Forest CCG 66.2%
NHS Fylde & Wyre CCG 66.1%
NHS Great Yarmouth and Waveney CCG 65.7%
NHS Isle of Wight CCG 64.9%
0% 20% 40% 60% 80% 100%
38 CVD Intelligence packs In patients with AF with a CHADS2 > 1, the percentage not treated with anti- coagulation therapy by GP practice
No treatment Exceptions reported Graph Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Barnes M H & Partners G81029
Eastbourne Station Health Centre Y02816
Dr Verghese & Partners G81002
Dr Savvas S & Partner G81012
Dr Williams & Partners G81050 In total, including exceptions, there Dr Simmons G81634 are 896 people with a recorded Dr Palit & Partners G81099 CHADS2 score > 1 who are not Dr Brown R D & Partners G81049 treated
Dr Eyre & Partners G81003
Park Practice G81104 GP practice range: 12.5% to 43.3 %
Dr Edwards & Partner G81098 If all practices were to achieve as Dr Bedford-Turner & Partners G81004 well as the average of the best Dr Baig & Partners G81008 achieving practices, then an
Dr Barnes J D & Partners G81017 additional 200 people would be treated Sovereign Practice G81022
Dr Pearce & Partners G81059
Green Street Clinic G81032
Dr Adoki & Ptnr Y00080
Dr Oezburun G81685
0% 10% 20% 30% 40% 50%
39 CVD Intelligence packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHSGraph Hastings and Rother CCG 87.9% NHS Swale CCG 87.9% NHS Surrey Heath CCG 86.4% NHS Canterbury and Coastal CCG 86.1% NHS North West Surrey CCG 85.8% NHS Ashford CCG 85.8% NHS East Surrey CCG 85.3% NHS Dartford, Gravesham and Swanley CCG 85.2% 4,841 patients with a history of NHS High Weald Lewes Havens CCG 85.1% stroke or TIA* in NHS Eastbourne, NHS West Kent CCG 85.0% Hailsham And Seaford CCG
NHS Eastbourne, Hailsham and Seaford CCG 84.9% 4,112 (84.9%) people whose blood NHS Thanet CCG 84.9% pressure is <= 150 / 90 NHS Horsham and Mid Sussex CCG 84.8% NHS Crawley CCG 84.7% 293 (6.1%) people who are NHS South Kent Coast CCG 84.6% exceptions NHS Medway CCG 84.5% NHS Guildford and Waverley CCG 84.5% 436 (9%) additional people whose NHS Surrey Downs CCG 84.3% blood pressure is not <= 150 / 90 NHS Brighton and Hove CCG 83.7% NHS Coastal West Sussex CCG 82.7%
England 85.5% *Using the QOF clinical indicator 0% 20% 40% 60% 80% 100% STIA003 denominator plus exceptions
40 CVD Intelligence packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported Graph NHS Fylde & Wyre CCG 86.3%
NHS North Derbyshire CCG 85.3%
NHS Eastbourne, Hailsham and Seaford CCG 84.9%
NHS Great Yarmouth and Waveney CCG 84.9%
NHS Wyre Forest CCG 84.8%
NHS Lincolnshire East CCG 84.4%
NHS North Staffordshire CCG 84.0%
NHS North Norfolk CCG 84.0%
NHS Isle of Wight CCG 84.0%
NHS West Norfolk CCG 83.6%
NHS South Devon and Torbay CCG 81.5%
0% 20% 40% 60% 80% 100%
41 CVD Intelligence packs Percentage of patients with a history of stroke whose last blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported
Graph Dr Barnes M H & Partners G81029
Dr Brown R D & Partners G81049
Dr Adoki & Ptnr Y00080
Park Practice G81104
Sovereign Practice G81022
Dr Miller & Partners G81056
Dr Eyre & Partners G81003 In total, including exceptions, there Dr Brown G C & Partners G81027 are 729 people whose blood Dr Pearce & Partners G81059 pressure is not <= 150 / 90 Dr Edwards & Partner G81098 Green Street Clinic G81032 GP practice range: 5.7% to 29.2 %
Dr Simmons G81634 If all practices were to achieve as Dr Oezburun G81685 well as the average of the best Eastbourne Station Health Centre Y02816 achieving practices, then an Dr Williams & Partners G81050 additional 240 people would have Dr Baig & Partners G81008 their blood pressure controlled
Dr Verghese & Partners G81002
Dr Palit & Partners G81099
Dr Barnes J D & Partners G81017
Dr Savvas S & Partner G81012
Dr Bedford-Turner & Partners G81004
0% 5% 10% 15% 20% 25% 30% 35%
42 CVD Intelligence packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported Graph NHS Crawley CCG 93.4% NHS Thanet CCG 92.7% NHS South Kent Coast CCG 92.6% NHS Hastings and Rother CCG 92.6% NHS Eastbourne, Hailsham and Seaford CCG 92.5% NHS West Kent CCG 91.7% NHS Surrey Heath CCG 91.4% NHS Dartford, Gravesham and Swanley CCG 91.4% 3,447 people with a stroke shown to NHS Canterbury and Coastal CCG 91.2% be non-haemorrhagic, in NHS NHS Horsham and Mid Sussex CCG 91.1% Eastbourne, Hailsham And Seaford CCG NHS North West Surrey CCG 90.8%
NHS Swale CCG 90.7% 3,190 (92.5%) anti-platelet agent, or NHS Coastal West Sussex CCG 90.4% an anti-coagulant is being taken NHS Brighton and Hove CCG 90.4% NHS Ashford CCG 90.2% 177 (5.1%) people who are NHS Medway CCG 89.7% exceptions NHS Guildford and Waverley CCG 89.4% NHS East Surrey CCG 89.2% 80 (2.3%) additional people with no NHS Surrey Downs CCG 88.6% treatment NHS High Weald Lewes Havens CCG 84.8%
England 91.3% 0% 20% 40% 60% 80% 100%
43 CVD Intelligence packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported Graph NHS Eastbourne, Hailsham and Seaford CCG 92.5%
NHS North Derbyshire CCG 92.3%
NHS North Staffordshire CCG 92.3%
NHS West Norfolk CCG 92.1%
NHS Lincolnshire East CCG 91.6%
NHS South Devon and Torbay CCG 91.1%
NHS Wyre Forest CCG 90.9%
NHS Isle of Wight CCG 90.4%
NHS Fylde & Wyre CCG 90.2%
NHS North Norfolk CCG 89.9%
NHS Great Yarmouth and Waveney CCG 89.5%
0% 20% 40% 60% 80% 100%
44 CVD Intelligence packs Percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who do not have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken by GP practice
No treatment Exceptions reported
Graph Dr Miller & Partners G81056
Dr Adoki & Ptnr Y00080
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Pearce & Partners G81059
Green Street Clinic G81032
Dr Baig & Partners G81008
Dr Barnes J D & Partners G81017 In total, including exceptions, there are 257 people with no treatment Dr Barnes M H & Partners G81029
Dr Eyre & Partners G81003 GP practice range: 0.0% to 15.0 % Park Practice G81104
Dr Palit & Partners G81099 If all practices were to achieve as
Dr Simmons G81634 well as the average of the best achieving practices, then an Dr Bedford-Turner & Partners G81004 additional 135 people would be Dr Savvas S & Partner G81012 treated
Dr Verghese & Partners G81002
Dr Brown R D & Partners G81049
Sovereign Practice G81022
Dr Edwards & Partner G81098
Dr Oezburun G81685
Eastbourne Station Health Centre Y02816
0% 2% 4% 6% 8% 10% 12% 14% 16%
45 CVD Intelligence packs Diabetes
46 CVD Intelligence packs Diabetes Prevention and Management
Diabetes is very expensive using up Diabetes is an urgent public health issue. Since 1996 the number of people living with 10% of the NHS budget at around diabetes in England has more than doubled and £10bn per year. It is also often has now reached 3.2 million. Of these, 500,000 preventable. remain undiagnosed.
What questions should we ask in our CCG? 1. For each indicator how wide is the variation in achievement and Type 2 diabetes is often preventable exception reporting? People at high risk of developing type 2 2. How many people would benefit if all practices performed as well diabetes can be identified through the NHS as the best? Health Check and the disease could be 3. How can we support practices who are average and below prevented in 30-60% through appropriate average to perform as well as the best in: behaviour change support. • Detection of diabetes • Delivery of the 8 care processes Complications of diabetes are preventable • Identification and management of ‘pre-diabetes Diabetes is a major cause of premature death and disability and greatly increases the risk of What might help heart disease and stroke, kidney failure, • Practice level performance on delivery of the 8 care processes is amputations and blindness. 80% of NHS measured in the National Diabetes Audit (NDA) spending on diabetes goes on managing these • Promote participation by all practices in the NDA complications, most of which could be prevented. • Obtain and benchmark practice level data from the NDA (this important local data is currently only available on request to There are 8 essential care processes, in CCGs addition to retinal screening, that together substantially reduce complication rates. • Ensure support for patient education, shared management and Despite this, around a third of people with technology enabled support diabetes do not receive all 8 care processes, • Promote uptake of the NHS Health Check to aid detection of and there is widespread variation between diabetes and pre-diabetes CCGs and practices in levels of achievement. • Establish local prevention pathways for the delivery of evidence based interventions to people with ‘pre-diabetes’ Diabetes observed prevalence compared to expected prevalence by CCG
Comparison with CCGs in the SCN
NHS Swale CCG 1.01 Graph NHS Medway CCG 0.99 0.75 ratio of observed to expected NHS Crawley CCG 0.89 diabetes prevalence in NHS NHS Thanet CCG 0.88 Eastbourne, Hailsham And Seaford NHS South Kent Coast CCG 0.87 CCG compared to 0.85 in England NHS Dartford, Gravesham and Swanley CCG 0.87 This suggests that 75% of people NHS Ashford CCG 0.86 with diabetes have been diagnosed NHS Coastal West Sussex CCG 0.83 NHS West Kent CCG 0.82 Note: This slide compares the prevalence of NHS Canterbury and Coastal CCG 0.80 Diabetes recorded in QOF in 2013/14 to the NHS North West Surrey CCG 0.80 expected prevalence of Diabetes taken from NHS Surrey Heath CCG 0.80 the Diabetes prevalence model produced in NHS Horsham and Mid Sussex CCG 0.78 2012.
NHS Hastings and Rother CCG 0.77 The expected prevalence of diabetes is NHS Eastbourne, Hailsham and Seaford CCG 0.75 based on best available data but there is an NHS East Surrey CCG 0.75 element of uncertainty around the figures NHS High Weald Lewes Havens CCG 0.74 especially in smaller areas. A small number of CCGs have a ratio greater than 1. It is NHS Surrey Downs CCG 0.70 unlikely that all people with diabetes will be NHS Brighton and Hove CCG 0.67 diagnosed in any CCG and therefore a ratio NHS Guildford and Waverley CCG 0.67 greater than 1 suggests that the figures are underestimating the true diabetes prevalence in the area. These ratios should be taken as England 0.85 an indication of the comparative scale of 0.00 0.20 0.40 0.60 0.80 1.00 1.20 undiagnosed diabetes rather than absolute ratio of observed to expected figures.
48 CVD Intelligence packs Diabetes observed prevalence compared to expected prevalence by CCG
Comparison with demographically similar CCGs
GraphNHS Lincolnshire East CCG 1.00
NHS North Staffordshire CCG 0.97
NHS West Norfolk CCG 0.97
NHS Wyre Forest CCG 0.94
NHS Great Yarmouth and Waveney CCG 0.91
NHS North Derbyshire CCG 0.89
NHS Fylde & Wyre CCG 0.85
NHS North Norfolk CCG 0.82
NHS Isle of Wight CCG 0.80
NHS South Devon and Torbay CCG 0.76
NHS Eastbourne, Hailsham and Seaford CCG 0.75
0.00 0.20 0.40 0.60 0.80 1.00 1.20 ratio of observed to expected
49 CVD Intelligence packs Diabetes prevalence by GP practice
GP practice CCG
Graph Dr Oezburun G81685
Dr Bedford-Turner & Partners G81004
Dr Pearce & Partners G81059
Dr Baig & Partners G81008
Dr Savvas S & Partner G81012
Park Practice G81104
Dr Barnes M H & Partners G81029 It is estimated that there are 3,185 Dr Eyre & Partners G81003 people with undiagnosed diabetes in Sovereign Practice G81022 NHS Eastbourne, Hailsham And Dr Edwards & Partner G81098 Seaford CCG Dr Brown R D & Partners G81049
Dr Adoki & Ptnr Y00080 GP practice range of observed diabetes: 3.0% to 7.7% Dr Palit & Partners G81099
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Barnes J D & Partners G81017
Dr Simmons G81634
Green Street Clinic G81032
Dr Verghese & Partners G81002
Dr Miller & Partners G81056
Eastbourne Station Health Centre Y02816
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 prevalence %
50 CVD Intelligence packs People with diabetes who had the eight recommended care processes by CCG, 2012/13
Comparison with CCGs in the SCN
NHS South Kent Coast CCG 68.3 Graph NHS Hastings and Rother CCG 68.3 NHS Ashford CCG 67.9 NHS Thanet CCG 67.0 NHS Canterbury and Coastal CCG 66.9 NHS Surrey Heath CCG 65.7 NHS Guildford and Waverley CCG 65.3 NHS Brighton and Hove CCG 59.2 30.4% of people with diabetes had NHS Swale CCG 58.8 the eight recommended care NHS Coastal West Sussex CCG 55.6 processes in NHS Eastbourne, NHS East Surrey CCG 53.1 Hailsham And Seaford CCG NHS Surrey Downs CCG 50.2 compared to 59.5% in England NHS Crawley CCG 50.2 At least 4,143 people did not receive NHS West Kent CCG 48.6 the 8 care processes NHS North West Surrey CCG 46.7 NHS Medway CCG 44.4 NHS Horsham and Mid Sussex CCG 43.8 NHS High Weald Lewes Havens CCG 40.7 NHS Dartford, Gravesham and Swanley CCG 39.5 Note: This slide uses data from the NHS Eastbourne, Hailsham and Seaford CCG 30.4 National Diabetes Audit (NDA)
England 59.5 No data is available for the following
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 CCGs: Camden, Harrogate and rural percentage district, Mid Essex and Southampton
51 CVD Intelligence packs People with diabetes who had eight care processes by GP practice, 2012/13
GP practice CCG
GraphEastbourne Station Health Centre Y02816
Dr Adoki & Ptnr Y00080
Dr Oezburun G81685
Dr Simmons G81634
Park Practice G81104
Dr Palit & Partners G81099
Dr Edwards & Partner G81098
Dr Pearce & Partners G81059 • Practice comparison will show how much potential there is for local Dr Miller & Partners G81056 improvement. Dr Williams & Partners G81050 No data available. Practice level data from the National Diabetes Dr Brown R D & Partners G81049 Audit can only be made available • Practice level data from the National Green Street Clinic G81032 on request by CCGs. Diabetes Audit can only be made
Dr Barnes M H & Partners G81029 available on request by CCGs. To request the data, email Dr Brown G C & Partners G81027 [email protected] Sovereign Practice G81022
Dr Barnes J D & Partners G81017
Dr Savvas S & Partner G81012
Dr Baig & Partners G81008
Dr Bedford-Turner & Partners G81004
Dr Eyre & Partners G81003
Dr Verghese & Partners G81002
0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 percentage
52 CVD Intelligence packs Kidney
53 CVD Intelligence packs Management of Chronic Kidney Disease
Chronic Kidney Disease can Late diagnosis of CKD is common. progress to kidney failure and it Around a third of people with CKD are undiagnosed. More opportunistic testing substantially increases the risk of and improved uptake of the NHS Health heart attack and stroke. Check will increase detection rates.
Chronic Kidney Disease (CKD) is common. What questions should we ask in our CCG? It is one of the commonest co-morbidities and 1. For each indicator how wide is the variation in achievement and affects a third of people over 65. In 2010 it was exception reporting? estimated to cost the NHS around £1.5bn. 2. How many people would benefit if all practices performed as well Average length of stay in hospital tends to be as the best? longer and outcomes are considerably worse: 3. How can we support practices who are average and below approximately 7,000 excess strokes and 12,000 average to perform as well as the best in: excess heart attacks occur each year in people • Detection of CKD with CKD compared to those without. • More systematic delivery of evidence based care Individuals with CKD are also at much higher risk of developing acute kidney injury when they have an intercurrent illness such as pneumonia. What might help • Promote participation by all practices in the National Evidence based guidance from NICE CKD Audit identifies CVD risk reduction, good blood • Obtain and benchmark practice level data from the pressure control and management of National CKD Audit proteinuria as essential steps to reduce the risk • Promote uptake of and follow up from the NHS of cardiovascular events and progression to Health Check to aid detection and management of kidney failure. Despite this there is often CKD significant variation between practices in • Local training and education in the detection and achievement and exception reporting. management of CKD Chronic kidney disease (CKD) observed prevalence (2012/13) compared to expected prevalence (2011) by CCG Comparison with CCGs in the SCN
NHS Dartford, Gravesham and Swanley CCG 1.27 Graph 0.76 ratio of observed to expected NHS Crawley CCG 0.85 CKD prevalence in NHS Eastbourne, NHS Eastbourne, Hailsham and Seaford CCG 0.76 Hailsham And Seaford CCG NHS Brighton and Hove CCG 0.76 compared to 0.7 in England NHS Ashford CCG 0.75 NHS Thanet CCG 0.73 This suggests that 76% of people NHS Medway CCG 0.73 with chronic kidney disease have NHS Swale CCG 0.72 been diagnosed NHS South Kent Coast CCG 0.72 NHS West Kent CCG 0.69 Note: This slide compares the prevalence of NHS High Weald Lewes Havens CCG 0.69 CKD recorded in QOF in 2012/13 to the NHS Canterbury and Coastal CCG 0.68 expected prevalence of CKD produced by the NHS Surrey Heath CCG 0.68 University of Southampton in 2011. A small number of CCGs have a ratio greater than NHS North West Surrey CCG 0.66 1. It is unlikely that all people with CKD will be NHS Horsham and Mid Sussex CCG 0.62 diagnosed in any CCG and therefore a ratio NHS East Surrey CCG 0.62 greater than 1 suggests that the figures are NHS Guildford and Waverley CCG 0.60 underestimating the true CKD prevalence in the area. These ratios should be taken as an NHS Hastings and Rother CCG 0.58 indication of the comparative scale of NHS Coastal West Sussex CCG 0.57 undiagnosed CKD rather than absolute NHS Surrey Downs CCG 0.56 figures.
The QOF 2013/14 data for CKD has a coding England 0.70 issue around episodes which has led to an 0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 underreporting of CKD. Therefore, 2012/13 ratio of observed to expected QOF has been used to ensure accuracy.
55 CVD Intelligence packs Chronic kidney disease (CKD) observed prevalence (2012/13) compared to expected prevalence (2011) by CCG Comparison with demographically similar CCGs
Graph NHS Fylde & Wyre CCG 1.02
NHS Lincolnshire East CCG 0.95
NHS North Derbyshire CCG 0.89
NHS Wyre Forest CCG 0.86
NHS Great Yarmouth and Waveney CCG 0.77
NHS Eastbourne, Hailsham and Seaford CCG 0.76
NHS North Norfolk CCG 0.71
NHS West Norfolk CCG 0.68
NHS South Devon and Torbay CCG 0.66
NHS North Staffordshire CCG 0.65
NHS Isle of Wight CCG 0.55
0.00 0.20 0.40 0.60 0.80 1.00 1.20 ratio of observed to expected
56 CVD Intelligence packs CKD prevalence by GP practice, 2012/13
GP practice CCG GraphDr Bedford-Turner & Partners G81004
Dr Williams & Partners G81050
Dr Baig & Partners G81008
Dr Palit & Partners G81099
Dr Barnes M H & Partners G81029 It is estimated that there are 3,054 Dr Eyre & Partners G81003 people with undiagnosed chronic Vicarage Field Practice G81060 kidney disease in NHS Eastbourne, Dr Savvas S & Partner G81012 Hailsham And Seaford CCG
Dr Edwards & Partner G81098
Sovereign Practice G81022 GP practice range of observed CKD: 0.6% to 12.4% Dr Pearce & Partners G81059
Park Practice G81104
Dr Verghese & Partners G81002
Dr Simmons G81634
Green Street Clinic G81032
Dr Brown G C & Partners G81027
Dr Brown R D & Partners G81049 Note: CCG estimates for the estimated Dr Oezburun G81685 number of people with CKD are based on Dr Miller & Partners G81056 applying a proportion from a resident
Dr Adoki & Ptnr Y00080 based population estimate to a GP
Dr Barnes J D & Partners G81017 registered population. The characteristics of registered and resident populations Eastbourne Station Health Centre Y02816 may vary in some CCGs, and local 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 interpretation is required. prevalence %
57 CVD Intelligence packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2012/13 Comparison with CCGs in the SCN Below 140/85 Not below 140/85 Exceptions reported Graph NHS Swale CCG 75.6% NHS Medway CCG 74.5% NHS Ashford CCG 73.2% NHS North West Surrey CCG 72.8% NHS Brighton and Hove CCG 72.0% NHS Hastings and Rother CCG 71.9% NHS Canterbury and Coastal CCG 71.8% NHS Guildford and Waverley CCG 71.6% 9,839 people with CKD (diagnosed)* NHS Surrey Heath CCG 71.5% in NHS Eastbourne, Hailsham And NHS Crawley CCG 71.1% Seaford CCG
NHS South Kent Coast CCG 70.6% 6,926 (70.4%) people whose blood NHS West Kent CCG 70.4% pressure is <= 140 / 85 NHS Eastbourne, Hailsham and Seaford CCG 70.4% NHS High Weald Lewes Havens CCG 69.8% 772 (7.8%) people who are NHS East Surrey CCG 69.4% exceptions NHS Surrey Downs CCG 69.1% NHS Dartford, Gravesham and Swanley CCG 69.1% 2,141 (21.8%) additional people NHS Thanet CCG 68.9% whose blood pressure is not <= 140 / NHS Horsham and Mid Sussex CCG 68.5% 85
NHS Coastal West Sussex CCG 66.4%
England 71.6% *Using the QOF clinical indicator 0% 20% 40% 60% 80% 100% CKD03 denominator plus exceptions
58 CVD Intelligence packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less by CCG, 2012/13 Comparison with demographically similar CCGs Below 140/85 Not below 140/85 Exceptions reported Graph NHS Isle of Wight CCG 73.0%
NHS Lincolnshire East CCG 72.7%
NHS Great Yarmouth and Waveney CCG 71.7%
NHS Fylde & Wyre CCG 70.7%
NHS Eastbourne, Hailsham and Seaford CCG 70.4%
NHS North Staffordshire CCG 70.2%
NHS North Norfolk CCG 69.8%
NHS West Norfolk CCG 69.7%
NHS Wyre Forest CCG 69.4%
NHS North Derbyshire CCG 68.8%
NHS South Devon and Torbay CCG 66.4%
0% 20% 40% 60% 80% 100%
59 CVD Intelligence packs Percentage of patients on the CKD register whose last blood pressure reading (measured in the preceding 12 months) is not 140/85 mmHg or less by GP practice, 2012/13
Not below 140/85 Exceptions reported GraphEastbourne Station Health Centre Y02816
Dr Adoki & Ptnr Y00080
Dr Barnes M H & Partners G81029
Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Eyre & Partners G81003
Dr Savvas S & Partner G81012 In total, including exceptions, there
Sovereign Practice G81022 are 2,913 people whose blood
Vicarage Field Practice G81060 pressure is not <= 140 / 85
Dr Verghese & Partners G81002 GP practice range: 16.8% to 46.2 % Green Street Clinic G81032 Park Practice G81104 If all practices were to achieve as Dr Edwards & Partner G81098 well as the average of the best
Dr Baig & Partners G81008 achieving practices, then an additional 382 people would have Dr Simmons G81634 their blood pressure controlled Dr Pearce & Partners G81059 Dr Oezburun G81685
Dr Barnes J D & Partners G81017
Dr Palit & Partners G81099
Dr Brown R D & Partners G81049
Dr Bedford-Turner & Partners G81004
0% 10% 20% 30% 40% 50%
60 CVD Intelligence packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2012/13 Comparison with CCGs in the SCN Recorded Not recorded Exceptions reported GraphNHS South Kent Coast CCG 82.2% NHS Hastings and Rother CCG 81.2% NHS Canterbury and Coastal CCG 81.2% NHS Medway CCG 81.2% NHS Eastbourne, Hailsham and Seaford CCG 80.4% NHS Guildford and Waverley CCG 78.7% NHS West Kent CCG 78.1% NHS Thanet CCG 78.1% 9,839 people with CKD (diagnosed)* NHS East Surrey CCG 77.9% in NHS Eastbourne, Hailsham And NHS Surrey Heath CCG 76.8% Seaford CCG
NHS Crawley CCG 76.7% 7,911 (80.4%) people who have a NHS Ashford CCG 76.4% record of a urine albumin: creatinine NHS High Weald Lewes Havens CCG 76.0% ratio test NHS Brighton and Hove CCG 75.9% NHS North West Surrey CCG 74.2% 516 (5.2%) people who are NHS Horsham and Mid Sussex CCG 73.6% exceptions NHS Dartford, Gravesham and Swanley CCG 73.3% NHS Swale CCG 73.1% 1,412 (14.4%) additional people NHS Surrey Downs CCG 72.5% who have no record of a urine albumin: creatinine ratio test NHS Coastal West Sussex CCG 69.7%
England 78.8% *Using the QOF clinical indicator 0% 20% 40% 60% 80% 100% CKD06 denominator plus exceptions
61 CVD Intelligence packs Percentage of patients on the CKD register whose notes have a record of a urine albumin: creatinine ratio test in the preceding 12 months by CCG, 2012/13 Comparison with demographically similar CCGs Recorded Not recorded Exceptions reported Graph NHS North Staffordshire CCG 82.9%
NHS Great Yarmouth and Waveney CCG 80.5%
NHS Eastbourne, Hailsham and Seaford CCG 80.4%
NHS North Derbyshire CCG 80.1%
NHS Isle of Wight CCG 79.9%
NHS Lincolnshire East CCG 79.1%
NHS Fylde & Wyre CCG 78.3%
NHS Wyre Forest CCG 78.2%
NHS West Norfolk CCG 77.1%
NHS North Norfolk CCG 75.0%
NHS South Devon and Torbay CCG 71.9%
0% 20% 40% 60% 80% 100%
62 CVD Intelligence packs Percentage of patients on the CKD register whose notes do not have a record of a urine albumin: creatinine ratio test in the preceding 12 months by GP practice, 2012/13
Not recorded Exceptions reported
Graph Dr Adoki & Ptnr Y00080
Dr Williams & Partners G81050
Dr Eyre & Partners G81003
Dr Oezburun G81685
Dr Barnes J D & Partners G81017
Park Practice G81104
Dr Pearce & Partners G81059
Dr Barnes M H & Partners G81029 In total, including exceptions, there
Dr Miller & Partners G81056 are 1,928 people who have no
Dr Savvas S & Partner G81012 record of a urine albumin: creatinine ratio test Dr Brown G C & Partners G81027
Dr Simmons G81634 GP practice range: 10.8% to 43.6 % Dr Brown R D & Partners G81049 Sovereign Practice G81022 If all practices were to achieve as Dr Verghese & Partners G81002 well as the average of the best
Dr Bedford-Turner & Partners G81004 achieving practices, then an
Dr Baig & Partners G81008 additional 416 people who have a record of a urine albumin: creatinine Eastbourne Station Health Centre Y02816 ratio test Green Street Clinic G81032
Vicarage Field Practice G81060
Dr Edwards & Partner G81098
Dr Palit & Partners G81099
0% 10% 20% 30% 40% 50%
63 CVD Intelligence packs Heart
64 CVD Intelligence packs Management of Heart Disease
Premature death and disability in What questions should we ask in our CCG? people with CHD can be reduced 1. For each indicator how wide is the variation in achievement and exception reporting? significantly by systematic evidence 2. How many people would benefit if all based management in primary care practices performed as well as the best? 3. How can we support practices who are average and below average to perform as well as the best in: Coronary Heart Disease is one of the principal causes of • More systematic delivery of evidence premature death and disability. The key elements of based care for people with CHD management for an individual who already has had a heart attack • Improved detection and management or angina are symptom control and secondary prevention of of heart failure further cardiovascular events and premature mortality. There is robust evidence to support the use of anti-platelet treatment, statins, beta-blockers and angiotensin converting enzyme What might help inhibitors or angiotensin receptor blockers. There is also robust 1. Roll out of GRASP-Heart Failure audit tool evidence to support good control of blood pressure. Each of these that identifies people with heart failure who interventions is incentivised in QOF but variation in achievement are undiagnosed or under treated and exception reporting at practice level shows that there is often 2. Education for health professionals to considerable potential for improving management and outcomes. promote evidence based management of CHD and high quality measurement of Heart failure is a common and an important complication blood pressure of coronary heart disease and other conditions. Again there is 3. Education and training to support delivery good evidence that appropriate treatment including up- of behaviour change interventions for CVD titration of ace inhibitors and beta blockers in heart failure risk reduction in primary care due to LVSD can significantly improve symptom control and 4. Ensure access to rapid access diagnostic quality of life, and improve outcomes for patients. Despite clinics and specialist support for this, around a quarter of people with heart failure are management of angina and heart failure undetected and untreated. And amongst those who are 5. Ensure access to cardiac rehab for diagnosed, there is significant variation in the quality of care. individuals with CHD and heart failure Heart failure prevalence by CCG
Comparison with CCGs in the SCN
NHS Eastbourne, Hailsham and Seaford CCG 1.0 Graph NHS Hastings and Rother CCG 1.0 NHS Coastal West Sussex CCG 0.8 NHS Thanet CCG 0.8 NHS High Weald Lewes Havens CCG 0.7 NHS Swale CCG 0.7 NHS Horsham and Mid Sussex CCG 0.7 NHS Medway CCG 0.7 Prevalence of 1.0% in NHS NHS South Kent Coast CCG 0.6 Eastbourne, Hailsham And Seaford NHS Canterbury and Coastal CCG 0.6 CCG compared to 0.7% in England NHS Crawley CCG 0.6 NHS Ashford CCG 0.6 NHS West Kent CCG 0.6 NHS East Surrey CCG 0.6 NHS Brighton and Hove CCG 0.5 NHS Dartford, Gravesham and Swanley CCG 0.5 NHS North West Surrey CCG 0.5 NHS Surrey Downs CCG 0.5 NHS Guildford and Waverley CCG 0.5 NHS Surrey Heath CCG 0.5
England 0.7
0.00 0.20 0.40 0.60 0.80 1.00 1.20 prevalence %
66 CVD Intelligence packs Heart failure prevalence by CCG
Comparison with demographically similar CCGs
Graph NHS Fylde & Wyre CCG 1.4
NHS North Norfolk CCG 1.1
NHS Lincolnshire East CCG 1.0
NHS Wyre Forest CCG 1.0
NHS Eastbourne, Hailsham and Seaford CCG 1.0
NHS North Derbyshire CCG 1.0
NHS Great Yarmouth and Waveney CCG 1.0
NHS West Norfolk CCG 0.9
NHS Isle of Wight CCG 0.9
NHS South Devon and Torbay CCG 0.7
NHS North Staffordshire CCG 0.7
0.00 0.20 0.40 0.60 0.80 1.00 1.20 1.40 1.60 prevalence %
67 CVD Intelligence packs Heart failure prevalence by GP practice
GP practice CCG
Graph Dr Edwards & Partner G81098
Dr Pearce & Partners G81059
Dr Oezburun G81685
Dr Eyre & Partners G81003
Dr Bedford-Turner & Partners G81004
Dr Williams & Partners G81050
Dr Baig & Partners G81008 1,866 people with diagnosed heart Dr Palit & Partners G81099 failure in NHS Eastbourne, Hailsham Dr Barnes M H & Partners G81029 And Seaford CCG Dr Brown G C & Partners G81027
Dr Miller & Partners G81056 GP practice range: 0.3% to 1.5%
Dr Simmons G81634
Dr Verghese & Partners G81002
Sovereign Practice G81022
Dr Savvas S & Partner G81012
Park Practice G81104
Green Street Clinic G81032
Dr Brown R D & Partners G81049
Dr Barnes J D & Partners G81017
Dr Adoki & Ptnr Y00080
Eastbourne Station Health Centre Y02816
0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 1.6 prevalence %
68 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with CCGs in the SCN Treated No treatment Exceptions reported Graph NHS Crawley CCG 90.9% NHS Guildford and Waverley CCG 90.1% NHS East Surrey CCG 89.9% NHS West Kent CCG 89.9% NHS Eastbourne, Hailsham and Seaford CCG 88.9% NHS Medway CCG 88.5% NHS Dartford, Gravesham and Swanley CCG 87.9% NHS Horsham and Mid Sussex CCG 87.8% 821 people with heart failure with NHS High Weald Lewes Havens CCG 87.1% LVSD in NHS Eastbourne, Hailsham NHS Canterbury and Coastal CCG 86.9% And Seaford CCG
NHS South Kent Coast CCG 86.3% 730 (88.9%) treated with ACE-I or NHS Surrey Heath CCG 86.0% ARB NHS Hastings and Rother CCG 85.9% NHS Swale CCG 85.6% 91 (11.1%) people who are NHS North West Surrey CCG 84.6% exceptions NHS Surrey Downs CCG 83.7% NHS Thanet CCG 83.2% 0 (0%) additional people who are not NHS Brighton and Hove CCG 82.8% treated with ACE-I or ARB NHS Ashford CCG 81.5% NHS Coastal West Sussex CCG 81.3%
England 86.7% 0% 20% 40% 60% 80% 100%
69 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB by CCG Comparison with demographically similar CCGs Treated No treatment Exceptions reported Graph NHS Isle of Wight CCG 90.4%
NHS Fylde & Wyre CCG 89.9%
NHS Wyre Forest CCG 89.4%
NHS North Staffordshire CCG 89.0%
NHS Eastbourne, Hailsham and Seaford CCG 88.9%
NHS Lincolnshire East CCG 87.0%
NHS South Devon and Torbay CCG 85.5%
NHS North Derbyshire CCG 84.9%
NHS West Norfolk CCG 83.7%
NHS North Norfolk CCG 82.4%
NHS Great Yarmouth and Waveney CCG 81.7%
0% 20% 40% 60% 80% 100%
70 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB by GP practice
No treatment Exceptions reported Graph Dr Palit & Partners G81099
Dr Savvas S & Partner G81012
Eastbourne Station Health Centre Y02816
Dr Simmons G81634
Dr Pearce & Partners G81059
Dr Barnes J D & Partners G81017
Dr Williams & Partners G81050 In total, including exceptions, there Dr Baig & Partners G81008 are 91 people who are not treated Dr Barnes M H & Partners G81029 with ACE-I or ARB Park Practice G81104
Dr Eyre & Partners G81003 GP practice range: 0.0% to 25.0 %
Green Street Clinic G81032 If all practices were to achieve as Dr Bedford-Turner & Partners G81004 well as the average of the best Dr Edwards & Partner G81098 achieving practices, then an Sovereign Practice G81022 additional 62 people would be
Dr Verghese & Partners G81002 treated
Dr Brown G C & Partners G81027
Dr Brown R D & Partners G81049
Dr Miller & Partners G81056
Dr Oezburun G81685
Dr Adoki & Ptnr Y00080
0% 5% 10% 15% 20% 25% 30%
71 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with CCGs in the SCN Treated No treatment Exceptions reported GraphNHS North West Surrey CCG 80.8% NHS Swale CCG 79.8% NHS Dartford, Gravesham and Swanley CCG 79.8% NHS Surrey Heath CCG 78.9% NHS Crawley CCG 78.8% NHS Medway CCG 75.8% NHS Thanet CCG 75.7% NHS Coastal West Sussex CCG 75.1% 728 people with heart failure with NHS Guildford and Waverley CCG 74.9% LVSD treated with ACE-I / ARB in NHS Horsham and Mid Sussex CCG 74.6% NHS Eastbourne, Hailsham And Seaford CCG NHS Canterbury and Coastal CCG 74.0%
NHS East Surrey CCG 73.8% 502 (69%) treated with ACE-I / ARB NHS West Kent CCG 72.9% and BB NHS Ashford CCG 71.8% NHS Hastings and Rother CCG 71.8% 180 (24.7%) people who are NHS Brighton and Hove CCG 70.9% exceptions NHS South Kent Coast CCG 69.2% NHS Eastbourne, Hailsham and Seaford CCG 69.0% 46 (6.3%) additional people who are NHS Surrey Downs CCG 68.3% not treated with ACE-I / ARB and BB
NHS High Weald Lewes Havens CCG 63.6%
England 74.3% 0% 20% 40% 60% 80% 100%
72 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are treated with ACE-I / ARB and BB by CCG Comparison with demographically similar CCGs Treated No treatment Exceptions reported Graph NHS Fylde & Wyre CCG 86.4%
NHS North Staffordshire CCG 80.2%
NHS North Derbyshire CCG 74.1%
NHS Lincolnshire East CCG 73.5%
NHS Wyre Forest CCG 72.2%
NHS Great Yarmouth and Waveney CCG 71.3%
NHS Isle of Wight CCG 69.6%
NHS Eastbourne, Hailsham and Seaford CCG 69.0%
NHS West Norfolk CCG 67.7%
NHS South Devon and Torbay CCG 63.3%
NHS North Norfolk CCG 63.1%
0% 20% 40% 60% 80% 100%
73 CVD Intelligence packs Percentage of patients with heart failure due to left ventricular systolic dysfunction (LVSD) who are not treated with ACE-I / ARB and BB by GP practice
No treatment Exceptions reported
Graph Dr Brown R D & Partners G81049
Eastbourne Station Health Centre Y02816
Dr Miller & Partners G81056
Dr Brown G C & Partners G81027
Dr Williams & Partners G81050
Dr Edwards & Partner G81098
Dr Palit & Partners G81099 In total, including exceptions, there Park Practice G81104 are 226 people who are not treated Green Street Clinic G81032 with ACE-I / ARB and BB Dr Bedford-Turner & Partners G81004 Dr Eyre & Partners G81003 GP practice range: 0.0% to 70.0 %
Dr Verghese & Partners G81002 If all practices were to achieve as Dr Barnes M H & Partners G81029 well as the average of the best Dr Baig & Partners G81008 achieving practices, then an Dr Pearce & Partners G81059 additional 82 people would be Sovereign Practice G81022 treated
Dr Simmons G81634
Dr Savvas S & Partner G81012
Dr Barnes J D & Partners G81017
Dr Oezburun G81685
Dr Adoki & Ptnr Y00080
0% 10% 20% 30% 40% 50% 60% 70% 80%
74 CVD Intelligence packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with CCGs in the SCN Below 150/90 Not below 150/90 Exceptions reported NHSGraph Hastings and Rother CCG 91.0% NHS Swale CCG 90.4% NHS Surrey Heath CCG 89.6% NHS Thanet CCG 89.3% NHS Canterbury and Coastal CCG 89.1% NHS West Kent CCG 88.9% NHS Ashford CCG 88.9% NHS South Kent Coast CCG 88.8% 8,156 people with coronary heart NHS North West Surrey CCG 88.8% disease* in NHS Eastbourne, NHS Guildford and Waverley CCG 88.5% Hailsham And Seaford CCG
NHS Dartford, Gravesham and Swanley CCG 88.4% 7,115 (87.2%) people whose blood NHS Horsham and Mid Sussex CCG 88.4% pressure <= 150/90 NHS Crawley CCG 88.2% NHS East Surrey CCG 87.9% 452 (5.5%) people who are NHS Medway CCG 87.9% exceptions NHS High Weald Lewes Havens CCG 87.8% NHS Surrey Downs CCG 87.6% 589 (7.2%) additional people whose NHS Eastbourne, Hailsham and Seaford CCG 87.2% blood pressure is not <= 150/90 NHS Brighton and Hove CCG 86.8% NHS Coastal West Sussex CCG 86.4%
England 88.9% *Using the QOF clinical indicator 0% 20% 40% 60% 80% 100% CHD002 denominator plus exceptions
75 CVD Intelligence packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less by CCG Comparison with demographically similar CCGs Below 150/90 Not below 150/90 Exceptions reported Graph NHS Fylde & Wyre CCG 89.4%
NHS North Derbyshire CCG 89.3%
NHS Isle of Wight CCG 88.4%
NHS Wyre Forest CCG 88.4%
NHS North Norfolk CCG 88.3%
NHS Great Yarmouth and Waveney CCG 87.9%
NHS Lincolnshire East CCG 87.6%
NHS West Norfolk CCG 87.5%
NHS Eastbourne, Hailsham and Seaford CCG 87.2%
NHS North Staffordshire CCG 87.0%
NHS South Devon and Torbay CCG 85.3%
0% 20% 40% 60% 80% 100%
76 CVD Intelligence packs Percentage of patients with CHD whose blood pressure reading (measured in the preceding 12 months) is not 150/90 mmHg or less by GP practice
Not below 150/90 Exceptions reported
Graph Dr Barnes M H & Partners G81029
Dr Brown R D & Partners G81049
Dr Adoki & Ptnr Y00080
Eastbourne Station Health Centre Y02816
Dr Miller & Partners G81056
Sovereign Practice G81022
Park Practice G81104
Dr Brown G C & Partners G81027 In total, including exceptions, there are 1,041 people whose blood Dr Eyre & Partners G81003 pressure is not <= 150/90 Dr Williams & Partners G81050 Dr Baig & Partners G81008 GP practice range: 2.5% to 27.5 %
Dr Pearce & Partners G81059
Dr Savvas S & Partner G81012 If all practices were to achieve as well as the average of the best Dr Verghese & Partners G81002 achieving practices, then an Dr Barnes J D & Partners G81017 additional 459 people would have Dr Palit & Partners G81099 their blood pressure controlled
Dr Edwards & Partner G81098
Dr Bedford-Turner & Partners G81004
Green Street Clinic G81032
Dr Simmons G81634
Dr Oezburun G81685
0% 5% 10% 15% 20% 25% 30%
77 CVD Intelligence packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported NHSGraph Hastings and Rother CCG 93.3% NHS Thanet CCG 92.8% NHS West Kent CCG 92.7% NHS Surrey Heath CCG 92.6% NHS Dartford, Gravesham and Swanley CCG 92.6% NHS Eastbourne, Hailsham and Seaford CCG 92.1% NHS Ashford CCG 91.9% NHS South Kent Coast CCG 91.8% 8,156 people with coronary heart NHS Canterbury and Coastal CCG 91.5% disease* in NHS Eastbourne, NHS Guildford and Waverley CCG 91.5% Hailsham And Seaford CCG
NHS North West Surrey CCG 91.4% 7,508 (92.1%) people with a record NHS Medway CCG 91.4% that aspirin, an alternative anti- NHS East Surrey CCG 91.2% platelet therapy, or an anti-coagulant NHS Crawley CCG 91.1% is being taken NHS High Weald Lewes Havens CCG 91.0% NHS Horsham and Mid Sussex CCG 90.7% 365 (4.5%) people who are NHS Surrey Downs CCG 90.7% exceptions NHS Swale CCG 90.0% NHS Brighton and Hove CCG 90.0% 283 (3.5%) additional people who are not treated NHS Coastal West Sussex CCG 89.8%
England 91.4% *Using the QOF clinical indicator 0% 20% 40% 60% 80% 100% CHD005 denominator plus exceptions
78 CVD Intelligence packs Percentage of patients with CHD with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported Graph NHS Eastbourne, Hailsham and Seaford CCG 92.1%
NHS North Derbyshire CCG 91.8%
NHS Fylde & Wyre CCG 91.6%
NHS Wyre Forest CCG 91.4%
NHS Isle of Wight CCG 91.4%
NHS North Staffordshire CCG 91.2%
NHS North Norfolk CCG 90.6%
NHS Great Yarmouth and Waveney CCG 90.3%
NHS South Devon and Torbay CCG 89.8%
NHS Lincolnshire East CCG 89.4%
NHS West Norfolk CCG 89.3%
0% 20% 40% 60% 80% 100%
79 CVD Intelligence packs Percentage of patients with CHD without a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken by GP practice
No treatment Exceptions reported
Graph Dr Miller & Partners G81056
Dr Adoki & Ptnr Y00080
Dr Brown G C & Partners G81027
Dr Verghese & Partners G81002
Dr Williams & Partners G81050
Dr Pearce & Partners G81059
Dr Edwards & Partner G81098
Green Street Clinic G81032 In total, including exceptions, there are 648 people who are not treated Dr Barnes J D & Partners G81017
Park Practice G81104 GP practice range: 2.5% to 16.4 % Dr Eyre & Partners G81003
Dr Savvas S & Partner G81012 If all practices were to achieve as
Eastbourne Station Health Centre Y02816 well as the average of the best achieving practices, then an Dr Barnes M H & Partners G81029 additional 170 people would be Dr Brown R D & Partners G81049 treated
Dr Baig & Partners G81008
Dr Bedford-Turner & Partners G81004
Dr Palit & Partners G81099
Sovereign Practice G81022
Dr Simmons G81634
Dr Oezburun G81685
0% 5% 10% 15% 20%
80 CVD Intelligence packs The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with CCGs in the SCN Optimal management No treatment Exceptions reported GraphNHS North West Surrey CCG 75.3% NHS Crawley CCG 74.1% NHS Swale CCG 73.7% NHS Surrey Heath CCG 73.1% NHS Medway CCG 72.9% NHS Dartford, Gravesham and Swanley CCG 71.9% NHS Guildford and Waverley CCG 71.1% NHS Hastings and Rother CCG 69.1% 604 people with a history of NHS Horsham and Mid Sussex CCG 68.7% myocardial infarction NHS High Weald Lewes Havens CCG 68.5% 304 (50.3%) people treated with NHS West Kent CCG 68.4% ACEi / ARB aspirin or an alternative NHS South Kent Coast CCG 66.8% anti-platelet therapy, beta-blocker NHS Canterbury and Coastal CCG 66.8% and statin NHS East Surrey CCG 66.2% NHS Surrey Downs CCG 65.9% 295 (48.8%) people who are NHS Brighton and Hove CCG 64.6% exceptions NHS Coastal West Sussex CCG 63.5% NHS Thanet CCG 63.2% 5 (0.8%) additional people who are NHS Ashford CCG 60.6% not on quadruple therapy
NHS Eastbourne, Hailsham and Seaford CCG 50.3%
England 70.2% 0% 20% 40% 60% 80% 100%
81 CVD Intelligence packs The percentage of patients with a history of MI currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by CCG Comparison with demographically similar CCGs Optimal management No treatment Exceptions reported Graph NHS Fylde & Wyre CCG 74.1%
NHS Lincolnshire East CCG 71.0%
NHS Great Yarmouth and Waveney CCG 69.9%
NHS Wyre Forest CCG 69.2%
NHS North Staffordshire CCG 68.1%
NHS North Derbyshire CCG 68.0%
NHS Isle of Wight CCG 66.9%
NHS West Norfolk CCG 65.0%
NHS North Norfolk CCG 62.2%
NHS South Devon and Torbay CCG 61.9%
NHS Eastbourne, Hailsham and Seaford CCG 50.3%
0% 20% 40% 60% 80% 100%
82 CVD Intelligence packs The percentage of patients with a history of MI not currently treated with an ACE-I / ARB, aspirin or an alternative anti-platelet therapy, beta-blocker and statin by GP practice
No treatment Exceptions reported
Graph Dr Adoki & Ptnr Y00080
Green Street Clinic G81032
Eastbourne Station Health Centre Y02816
Dr Barnes M H & Partners G81029
Dr Simmons G81634
Dr Eyre & Partners G81003
Dr Brown R D & Partners G81049
Dr Pearce & Partners G81059 In total, including exceptions, there are 300 people who are not on Dr Miller & Partners G81056 quadruple therapy Dr Williams & Partners G81050 Dr Brown G C & Partners G81027 GP practice range: 0.0% to 96.7 % Sovereign Practice G81022
Dr Bedford-Turner & Partners G81004 If all practices were to achieve as well as the average of the best Park Practice G81104 achieving practices, then an Dr Baig & Partners G81008 additional 168 people would be Dr Edwards & Partner G81098 treated
Dr Palit & Partners G81099
Dr Savvas S & Partner G81012
Dr Barnes J D & Partners G81017
Dr Verghese & Partners G81002
Dr Oezburun G81685
0% 20% 40% 60% 80% 100% 120%
83 CVD Intelligence packs Some data on outcomes for people with cardiovascular disease
84 CVD Intelligence packs Hospital admissions for myocardial infarction for all ages 2002/03 – 2012/13
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England Graph 1,000
900
800
700 In NHS Eastbourne, Hailsham And 600 Seaford CCG, the hospital admission rate for myocardial infarction in 500 2012/13 was 561.4 (1,253 admissions) compared to 575.1 for
400 England Age Age standardised rate 300
200
100
0 2002/032003/042004/052005/062006/072007/082008/092009/102010/112011/122012/13
Source: Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
85 CVD Intelligence packs Hospital admissions for stroke for all ages 2002/03 – 2012/13
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England Graph 200
180
160
140 In NHS Eastbourne, Hailsham And 120 Seaford CCG, the hospital admission rate for stroke in 2012/13 was 155.3 100 (386 admissions) compared to 179.1 for England
80 Age Age standardised rate 60
40
20
0 2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13
Source: Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
86 CVD Intelligence packs Additional risk of complications for people with diabetes, three year follow up, 2012/13
NHS Eastbourne, Hailsham and Seaford CCG England Graph
113.9% Angina 136.8%
56.4% Heart Attack 108.6%
137.6% The risk of a stroke was 48% higher Heart failure 150.0% and the risk of a heart attack was 56.4% higher compared to people 48.0% without diabetes. The risk of a major Stroke amputation was 360.2% higher. 81.3%
360.2% Major amputation 445.8%
550.0% Minor amputation 753.5%
344.6% RRT 293.0%
0% 100% 200% 300% 400% 500% 600% 700% 800% Note: This slide uses data from the National Diabetes Audit (NDA)
87 CVD Intelligence packs Deaths from myocardial infarction, under 75s
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England Graph 90
80
70
60 In NHS Eastbourne, Hailsham And Seaford CCG, the early mortality rate 50 for myocardial infarction in 2010-12 was 37.1 (an average of 66 deaths a 40 year) compared to 45.1 for England
Age Age standardised rate 30
20
10
0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Note: The early mortality rate for 2010-12 is an average of the early mortality rates for 2010, 2011 and 2012. Source: Office for National Statistics (ONS) mortality data 2002 - 2012
88 CVD Intelligence packs Deaths from stroke, under 75s
NHS EASTBOURNE, HAILSHAM AND SEAFORD CCG England Graph 30
25
20 In NHS Eastbourne, Hailsham And Seaford CCG, the early mortality rate for stroke in 2010-12 was 13.7 (an 15 average of 23 deaths a year)
compared to 14.8 for England Age Age standardised rate 10
5
0 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09 2008-10 2009-11 2010-12 Note: The early mortality rate for 2010-12 is an average of the early mortality rates for 2010, 2011 and 2012. Source: Office for National Statistics (ONS) mortality data 2002 - 2012
89 CVD Intelligence packs Appendix
Data sources
• Quality and Outcomes Framework (QOF), 2012/13 and 2013/14, Copyright © 2015, re-used with the permission of the Health and Social Care Information Centre. All rights reserved
• Active people survey, Sport England, 2012 and 2013
• East of England Public Health Observatory modelled estimates 2011
• CKD Prevalence model, G.Aitken, University of Southampton
• Diabetes Prevalence model, National Cardiovascular Intelligence Network
• NHS Stop smoking services Copyright © 2014, Health and Social Care Information Centre
• NHS Health checks, 2013/14
• Norberg J, Bäckström S , Jansson J-H, Johansson L. Estimating the prevalence of atrial fibrillation in a general population using validated electronic health data. Clin Epidemiol 2013 ; 5 475 – 81.
• National Diabetes Audit, 2012/13
• Hospital Episode Statistics (HES), 2002/03 - 2012/13, Copyright © 2015, Re‐used with the permission of The Health and Social Care Information Centre. All rights reserved
• Office for National Statistics (ONS) mortality data 2002 - 2012
90 CVD Intelligence packs About Public Health England
Public Health England exists to protect and improve the nation's health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
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Published March 2015
91 CVD Intelligence packs