Epidemiology & Health Science Team (Public Health)

Commentary regarding the adult health profiles 2012 (new HSCP areas and & Bute CHP) December 2012

For the North & West Unit

This is an accompaniment to the actual measures which should be accessed at: http://intranet.nhsh.scot.nhs.uk/Org/CorpServ/PublicHealth/Epidemiology- HealthSciences/Pages/PublicationsResources.aspx under the section on Health Profiles

It is important that the user of these profiles reads the notes and caveats found with the actual measures

Contents (Commentary) Page

Category 1: Wider Determinants ...... 1 1.1 Population ...... 1 1.2 Ten year population trends (2001 to 2010) ...... 1 1.3 Ten year trend in births from 2001 to 2010 ...... 1 1.4 Population by Urban/rural classification ...... 2 1.5 Population in the most deprived data zones nationally ...... 2 1.6 Population in the most deprived data zones within NHS Highland ...... 2 1.7 Population in the most access deprived data zones within NHS Highland ...... 3 1.8 Populations who are income and employment deprived within NHS Highland ...... 3 1.9 Claimants of incapacity or severe disablement allowance (IBSDA); Job seekers Allowance (JSA) and total Pension credit (PC) claimants ...... 4 1.10 Housing: Single Adult Households; Vacant Dwellings; Second Homes ...... 4 1.11 Housing: Average House sale prices ...... 5 Summary for the wider determinants in respect of the North & West Unit ...... 5

Category 2: Potential for Health Improvement ...... 6 2.1 Life-expectancy at birth ...... 6 2.2 Hospitalisations for avoidable conditions ...... 6 2.3 Early Deaths from Cancer ...... 7 2.4 Smoking prevalence and Smoking Cessation ...... 7 Summary for the potential for health Improvement in respect of the North & West Unit .. 8

Category 3: Health Protection ...... 9 3.1 Screening ...... 9 3.2 Uptake of Flu vaccination ...... 9 Summary for Health Protection in respect of the North & West Unit ...... 10

Category 4: Healthcare ...... 11 4.1 Primary Care disease registers ...... 11 4.2 Disease management ...... 11 4.3 Hospitalisations ...... 12 4.4 Relative Health Need ...... 14 4.5 Older People ...... 14 Summary for Health Care in respect of the North & West Unit ...... 15

Category 1: Wider Determinants

1.1 Population

North & West Operational Unit In terms of total population numbers, this is the smallest of all of the Operational Units at just over 77,500, equivalent to 25% of the total Health Board population estimated for mid-year 2010. The proportion of older people is the highest in the area of where over one quarter (26%) of the population is aged 65 & over compared with the North & West Operational unit and Health Board averages of 21% and 17% respectively. has the youngest population in terms of the proportion of those aged less than 16 years and is similar to the National and Highland HCSP averages. In comparison with the population structure is older overall.

Overall across the units The proportion of the total population of the Health Board residing in each of the units is 46.3% in South & Mid, 28.7% in Argyll & Bute and 25% in the North & West. On average, Argyll & Bute has the oldest population, with 21.7% aged 65 years & over and South & Mid unit the youngest, with 18% aged less than 16 years.

1.2 Ten year population trends (2001 to 2010)

North & West Operational Unit The total population increased by 1.7%, approximately half the increase occurring in the national population of 3.1% over the same period. Across the unit, there was a higher than the national average increase in Lochaber (4.7%) and in Skye & & (3.6%). In contrast, a reduction of nearly 1% occurred in the population of the North, primarily due to Caithness rather than Sutherland which decreased by nearly 2%. The proportion of older people (65 years & over) increased in the operational unit more than that in the national average, particularly that of the very elderly (75 years & over) in which there was nearly a 19% increase.

Overall across the units Over the ten years, the total population in NHS Highland increased by 3.5%, higher than the increase of 3.1% in the Scottish population. The population of the South & Mid unit increased by 8.6%, that of North & West by 1.7%. The population of Argyll & Bute decreased by 2.3%.

1.3 Ten year trend in births from 2001 to 2010

North & West Operational Unit The annual number of births (n = 803 in 2010) and the birth rate per 1000 women aged 15 to 44 years have increased during the ten years by 10% and 25% respectively. The actual rates have tended to be higher than the national average during the same period. The numbers by sub-areas within the Unit are too low to make any valid comparisons between them although the highest rate was recorded in Caithness during 2010.

Overall across the units For the Health Board as a whole, the annual number of births and the birth rate per 1000 women aged 15 to 44 years have increased by 10.7% and 18.9% over the ten year period. These compare with the national increases of 11.9% and 15.8% respectively. The birth rate increased the most in the North & West unit, 25%. The increase in the rate in the South & Mid unit was 18% and in Argyll & Bute the birth rate had increased by 13%. In terms of the

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number of births, the largest increase occurred in the South & Mid unit of 25%, 10% in the North & West unit and a 2% decrease in Argyll & Bute.

1.4 Population by Urban/rural classification

North & West Operational Unit 70% of the population of the Unit live in very remote rural areas (class 8) and 30% in very remote small towns (class 5). Within the unit, the whole population of Sutherland and Skye, Lochalsh & Wester Ross resides in class 8 areas i.e. areas with populations less than 3,000 and with drive times in excess of 60 minutes to the nearest settlement of 10,000 or more. The population in each of Lochaber and Caithness is almost equally divided between class 5 and class 8 areas.

Overall across the units Almost one third (31%) of the population of the Health Board live in very remote and rural areas (settlements of less than 3,000 people and are in excess of a one hour drive time away from settlement of over 10,000) and nearly one quarter (24%) live in other urban areas (settlements of 10,000 to 125,000 people). The units have their own unique profile of urban and rural populations: that of the North & West unit is predominantly (70%) dwellers of very remote and rural areas; that of the South & Mid unit, 40% live in other urban areas (settlements of 10,000 to 125,000 people); that of Argyll & Bute CHP, 40% populate the very remote rural area with a further 20% populating the very remote small towns (settlements of between 3,000 and 10,000 people with a drive time of over one hour to a settlement of over 10,000).

1.5 Population in the most deprived data zones nationally

North & West Operational Unit There are four data zones within the unit which are amongst the 15% most deprived nationally. They are all located in the Caithness district of the North area and are Wick Pultneytown South; Wick South; Wick Hillhead North and Wick South Head. The overall population in these data zones is 2,374 representing just over 10% of the total Caithness district; 7% of the North area and 3% of the N.W Operational Unit populations in 2010.

Overall across the units In terms of the percentage of the population living in the 15% most deprived areas classed nationally, Argyll & Bute has the highest at 7.5%; South & Mid the next at 6.6% and North & West the lowest at 3.2%. In terms of numbers of people residing in the most deprived data zones, South & Mid has the greatest (n = 8,981); Argyll & Bute next (n = 6,244) and North & West the smallest (n = 2,374) in 2010.

1.6 Population in the most deprived data zones within NHS Highland

When the deprivation scores for data zones are distributed within NHS Highland only, as opposed to being part of the national distribution, the following profiles were obtained:

North & West Operational Unit Thirteen data zones in this unit were within the most 15% deprived amongst all those in NHS Highland. This compares to only four data zones within the most 15% deprived amongst all those nationally. They are located in the districts of Caithness (n = 8); Lochaber (n = 3) and Skye, Lochalsh & Wester Ross (n = 2). This compares with the national distribution where all 4 data zones were in the Caithness district. The total resident population within the thirteen data zones (n = 8,934) represented 11.5% of the overall population of the unit. Out of the

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three districts, Caithness had the highest percentage of its population living in the most deprived data zones (21%, 5,210 people).

Overall across the units In terms of the percentage of the population living in the 15% most deprived areas classed within NHS Highland, Argyll & Bute has the highest at 16.6%; South & Mid the next at 15.3% and North & West the lowest at 11.5%. In terms of numbers of people residing in the most deprived data zones, South & Mid has the greatest (n = 22,058); Argyll & Bute next (n = 14,828) and North & West the smallest (n = 8,934) in 2010.

1.7 Population in the most access deprived data zones within NHS Highland

When the access (to basic services- see notes & caveats page within the profiles) deprivation scores for data zones are distributed within NHS Highland only as opposed to being part of the national distribution, the following profiles were obtained:

North & West Operational Unit Thirty one data zones in this unit were within the most 15% access deprived amongst all those in NHS Highland. They are located in the districts of Caithness (n = 6); Sutherland (n=4); Lochaber (n = 6) and Skye, Lochalsh & Wester Ross (n =15). The total resident population within the thirty one data zones (n = 21,712) represented 28% of the overall population of the unit. Out of the four districts, Skye, Lochalsh & Wester Ross had the highest percentage of its population living in the most access deprived data zones (53%, 10,490 people).

Overall across the units In terms of the percentage of the overall populations in the operational units that are accessed deprived, North & West operational unit was the highest at 28%; Argyll & Bute the next at 18.3% and South & Mid the lowest at 5.6%. In terms of numbers of people residing in the most access deprived data zones, North & West has the greatest (n = 21,712); Argyll & Bute next (n = 16,290) and South & Mid the smallest (n = 8,134) in 2010.

1.8 Populations who are income and employment deprived within NHS Highland

These are based on data zone populations and claimants for various allowances and benefits (see notes & caveats page within the profiles).

North & West Operational Unit Overall, 10,470 and 4,795 are income deprived and employment deprived respectively. These equate to 13.4% and 10.3% of the overall population of the unit respectively. The rates of both parameters tend to be higher in the districts of the North area i.e. in Caithness and Sutherland.

Overall across the units The average rates of both income and employment deprivation were similar amongst the three operational units i.e. similar to the NHS Health Board averages of 13% and 10.4%. Both these rates are lower than the national averages of 16.1% and 13% respectively.

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1.9 Claimants of incapacity or severe disablement allowance (IBSDA); Job seekers Allowance (JSA) and total Pension credit (PC) claimants

These are based on a quarterly snap-shot in time with the most up to date at the time of compiling these profiles as at the third quarter (September of 2011).

North & West Operational Unit Overall, 2,360 claimants (aged 16 yrs & over) of IBSDA were recorded amongst the population of the North & West unit, equivalent to a rate of 3.7% amongst the population aged 16 years and over. The highest rate was recorded in the Caithness district of 4.4%.

Overall, 1,280 claimants of JSA were recorded amongst the population of the North & West unit, equivalent to a rate of 2.6% amongst the population aged 16 to 64 years. The highest rate was recorded in the North area with Caithness district at 4.1%. Rates were lower in the West area, average rate of 1.8%.

Overall, 4,260 claimants of PC were recorded amongst the population of the North & West unit, equivalent to a rate of 19.2% amongst the population aged 60 years and over. The highest rate was recorded in the Lochaber district at 21% and lowest in Skye, Lochalsh & Wester Ross at 17.8%.

Overall across the units The average claimant rates for Incapacity or severe disability (IBSD) benefit were similar amongst the three operational units i.e. similar to the NHS Health Board average of 3.7%. These rates are lower than the national average of 4.9%.

The average claimant rates for Job Seekers Allowance (JSA) for each of the three operational units were lower than the national rate (4.1%) with an overall rate for NHS Highland of 2.7%. The rate for Argyll & Bute was the highest at 3.2% and this was due only to a higher than national rate within the district of Bute & , 5%.

With the exceptions of West and East Ross, the claimant rates for Pension Credit (PC) recorded for all districts and localities were lower than the national average of 22.1%. The rate in Inverness West was slightly higher than the national rate (22.7%) and that in East Ross, higher (24.3%).

1.10 Housing: Single Adult Households; Vacant Dwellings; Second Homes

North & West Operational Unit The percentage of all dwellings which are single adult households was 32%, lower than the national average rate of 38%. The rates were higher in Caithness and Sutherland i.e. the North area but these were still lower than the national average.

The rate of vacant dwellings was higher than the national average (4.1% versus 3.0%). The rates for all of the districts were also higher than the national average, with the highest rates recorded in Caithness.

The percentage of second homes was in all districts higher than the national average, overall rate was 6.6% versus the national rate of 1.0%. The highest rates occurred in Sutherland (9.2%) and Skye, Lochalsh & Wester Ross (11.4%).

Overall across the units Overall, nearly one third (32.5%) of all dwellings are single adult households in NHS Highland but this rate is lower than the national average of 38%. The rates in all districts and

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localities are also lower than the national average with the one exception of Inverness West at 38.6%.

Nearly 5,000 dwellings in NHS Highland are vacant (1,500 in and 3,500 in Highland HSCP). The overall rate was however similar to the national average (3.1% versus 3%). The highest rate of vacant dwellings was found in Caithness (5.3%) and Bute & Cowal (4.3%).

There were over 8,500 second homes recorded across NHS Highland, nearly 4,000 of them in Argyll & Bute. The overall rate of 5.4% is 5 times higher than the national average of 1.0%. Argyll & Bute has the highest rate (8.4%). Amongst the sub-areas, Skye, Lochalsh & Wester Ross and Bute & Cowal record the highest rates, both at 11.4%.

1.11 Housing: Average House sale prices

North & West Operational Unit Out of the 20 sub areas (intermediate geographies) of the North & West unit, roughly one half of them recorded higher median house prices in 2010 than the national median (£135,000).The highest prices were mainly in the west, particularly those for Ross & Cromarty South West and North West (medians of £197,000 & £195,000 respectively). The prices in the North were all lower than the national median, with the exception of Sutherland South and Sutherland East which had similar median prices. The house price in East was the lowest at a median value of £68,500 but low prices also pertained to North and West Wick and to Thurso West.

Overall across the units There is a great deal of variation across all of the units with the biggest range from the lowest median price to the highest found in Argyll & Bute (the highest being 3.1 times the lowest). For NHS Highland as a whole, the median price was higher than the national average (£142,500 versus £135,500).

Summary for the wider determinants in respect of the North & West Unit

 Lowest population of all of the units, 25% of the total Health Boards population  Population increased by 1.7% over ten years, less than the average for NHS H  Population increased the most in Lochaber (4.7%) and decreased in the North (Caithness 1.7% decrease)  Number of births and birth rate increased by 10% & 25% respectively over ten years  70% live in very remote rural areas and 30% in very remote small towns  Four data zones in the 15% most nationally deprived, all in the Caithness district making up 3% of the Units population. Using the NHS Highland based distribution Caithness has 21% of its population living in the 15% most deprived areas.  It has the highest percentage (28%) of its population amongst all of the units living in the 15% most access-deprived areas. 53% of the population of Skye, Lochalsh & Wester Ross live in these access-deprived areas.  The proportion of the population which is income or employment deprived is similar to the Health Board average, with higher rates in Caithness and Sutherland.  The rate of claimants for incapacity/severe disablement or job-seekers allowances was highest in Caithness; the rate of pension credit claimants was highest in Lochaber.  Caithness has the highest rate of vacant dwellings (5.3%) in the Health Board.  House prices are lower than the national median (£135,000) in the North except for South and East Sutherland where it is similar. Higher prices are seen in the West, particularly for Ross & Cromarty South West.

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Category 2: Potential for Health Improvement

2.1 Life-expectancy at birth

North & West Operational Unit Within the Unit, the range in life expectancy amongst the intermediate geographies was 71.3 to 80.9 years for males and 76.1 to 84.1 for females. Lowest estimates applied to Fort William North for males (71.3 years) and Wick North for females (76.1 years). In contrast, highest estimates were in Ross & Cromarty South West for males (80.9 years) and Lochalsh for females (84.1 years). These can be compared to the average for the Health Board of 75.7 years for males and 80.5 years for females. On that basis, the life expectancies in two of the intermediate geographies of Wick South and Fort William North were significantly lower and in two of them, Ross & Cromarty South West and Lochaber East & North, significantly higher for male expectancy. For female expectancy, estimates in three of them of Caithness South, Wick South and Wick North were significantly lower and for two of them, South West and Lochalsh significantly higher.

Overall across the units Relative to the average life expectancy of Scotland (males, 74.5 years; females, 79.5 years), those for the Health Board, Highland HSCP and Argyll and Bute are significantly higher, (NHS Highland males, 75.7 years; females, 80.5 years). There was a wide range in estimates for smaller areas with Inverness Merkinch being lower overall for both males (66.0 years) and females (75.1 years). In contrast, Nairn Rural had the greatest life expectancy for both males (83.2 years) and females (87.0 years).

2.2 Hospitalisations for avoidable conditions

North & West Operational Unit Within the Unit, the range in the rates of hospitalisation associated with alcohol conditions amongst the intermediate geographies was 1036 to 2311 per 100,000 population relative to an overall Health Board rate of 1291 per 100,000. Significantly higher rates were in Thurso East, Wick North, Fort William North, Fort William South, Lochaber East & North, Skye North East and Wick South, the latter the highest at 2311 per 100,000. Lowest estimates applied to Sutherland South and Ross & Cromarty South West, the latter being the lowest at 1036 per 100,000.

Within the Unit, the range in the rates of hospitalisation of patients aged 65 years & over due to a fall in the home amongst the intermediate geographies, was 815 to 1867 per 100,000 population relative to an overall Health Board rate of 892 per 100,000. Significantly higher rates were in Wick North and Fort William North, the latter the highest at 1867 per 100,000. The lowest rate applied to Ross & Cromarty South West at 815 per 100,000 but this was not significantly different.

The overall rate of hospitalisation due to drug misuse for the Unit was 66 per 100,000 population significantly lower than the national rate (128 per 100,000). Relative to the health Board average (44 per 100,000), a significantly higher rate applied to Caithness (126 per 100,000) and significantly lower rates to Skye, Lochalsh & Wester Ross and Sutherland, the latter being the lowest at 15 per 100,000.

Overall across the units For admissions due to alcohol, the rates for the Health Board and Highland HSCP were both significantly higher than the national average, 1291, 1289 versus 1088 per 100,000 population respectively. The rate in Argyll & Bute at 1117 per 100,000 was not significantly higher. The highest rates amongst the intermediate geographies in each of the operational

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units were in Wick South, Inverness Merkinch and Oban South and the lowest rates were found in Ross & Cromarty South West, Nairn Rural and Helensburgh North.

For patients aged 65 years & over hospitalised due to a fall in the home, the rates were significantly higher than the Scottish average of 710 per 100,000 population for the health Board (892 per 1000,0000), Highland HSCP (943 per 100,000) and Argyll & Bute (782 per 100,000). The highest rates amongst the intermediate geographies in each of the operational units were in Fort William North, Inverness Muirtown and Dunoon. The lowest rates were found in Ross & Cromarty South West, Ross & Cromarty East and Helensburgh North.

For patients hospitalised due to drug misuse, the rates were significantly lower than the Scottish average of 128 per 100,000 population for the health Board (44 per 100,000), Highland HSCP (41 per 100,000), North & West Unit (66 per 100,000), South & Mid Unit (27 per 100,000 and Argyll & Bute (50 per 100,000). The highest rates amongst the districts in each of the operational units were in Caithness, Inverness West (not significantly higher) and Bute & Cowal. The lowest rates were found in Sutherland, Mid Ross and Mid Argyll, & (not significantly).

2.3 Early Deaths from Cancer

North & West Operational Unit Within the Unit, the range in the mortality rates of those aged under 75 years from cancer amongst the intermediate geographies, was 59 to 185 per 100,000 population relative to an overall Health Board rate of 122 per 100,000. The highest rate was in Wick North (185 per 100,000) but this was not significantly different to the Health Board average. The rate in Skye North West was significantly lower at 59 per 100,000.

Overall across the units For patients aged under 75 years, the death rates due to cancer, were significantly lower than the Scottish average of 135 per 100,000 population for the Health Board (122 per 100,000), Highland HSCP (121 per 100,000). The rate for Argyll & Bute was lower but not significantly (126 per 100,000). The highest rates amongst the intermediate geographies in each of the operational units were in Wick North (not significantly), Inverness Scorguie and Helensburgh East (not significantly). The lowest rates were found in Skye North West, & Strathspey North and Lomond Shore (not significantly).

2.4 Smoking prevalence and Smoking Cessation

Please refer to the notes & caveats on this section, particularly the fact that the prevalence rates are based on a period prior to the legislation on smoking in public places.

North & West Operational Unit The overall prevalence of smoking in the 16 years and over population of the Unit was 25.4% (26.4% males and 24.4% females). These were similar to the overall Health Boards averages of 25.4%, 26.3% and 24.5% respectively. Within the Unit, there were four intermediate geographies with significantly higher rates than the average for the Health Board. These were Lochaber West, Wick South, Fort William North and Fort William South, the latter being the highest at 29.3%. The rates in Fort William South were also the highest for males and females. The lowest rate was in Thurso West (21.4%), and this was also the case for males and females. Other low rates were estimated in Caithness North West and Ross & Cromarty South West.

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The overall uptake rate of the smoking Cessation services for the North & West Unit was the lowest (5.2%) amongst the Units and lower than the Health Board average of 8.8%. However, the proportion of quitters at one month of all attempted quits was the highest (54.3%) amongst the Units and higher than the Health Board average of 48.1%. Amongst the Districts, the highest uptake was in Sutherland (6.9%) and lowest in Skye, Lochalsh & Wester Ross (4.2%). The highest proportion of quitters of the total attempts was in Skye, Lochalsh & Wester Ross (63.6%).

Overall across the units The smoking prevalence rates in persons aged 16 years & over for the Health Board, Highland HSCP and all Operational units including Argyll & Bute were significantly lower than the national average of 27.2%. This also applied to the rates for males (28.1%) and females (26.5%).

Relative to the national average uptake of smoking cessation services of 10.4%, the overall average for the Health Board (8.8%) and for the individual Units, were all lower. The highest uptake rate applied to South & Mid Operational Unit (9.8%) and the lowest in the North & West Operational Unit (5.2%).

In contrast, the proportion of successful quits at one month of those who had made quit attempts was higher for the Health Board (48.1%) and for each of the individual Units than the national average (37.7%). Highest rate amongst the units applied to the North & West where it was 54.3% of those who had attempted a quit. The proportion quit at one month of the estimated total number of smokers was 3.9% for Scotland and for the Health Board, 4.3%. The latter rates are dependent on both the uptake rate of the service and on the effectiveness of the service. The highest applied to the South & Mid Operational Unit (5%) and the lowest to the North & West Operational Unit (2.8%).

Summary for the potential for health Improvement in respect of the North & West Unit

 Relative to the Health Board, the life expectancy in males is lower in Fort William North and Wick South and for females, lower in Caithness South, Wick North and Wick South. Life-expectancy in the West tended to be higher, particularly for Ross & Cromarty South West.  Hospitalisation rate associated with alcohol conditions was highest in Wick South, around twice the Health Board area, and lowest in Ross & Cromarty South West.  Hospitalisation rates due to drug misuse were the highest in Caithness and lowest in Skye, Lochalsh & Wester Ross and Sutherland.  Hospitalisation rates of older people due to a fall in the home were the highest in Wick North and Fort William North and lowest in Ross & Cromarty South West.  Premature deaths from cancer were significantly lower than the Health Board average in Skye North West but higher (not significantly) in Wick North.  The estimated smoking prevalence is lowest in Thurso West and highest in Fort William South.  The uptake rate of smoking cessation services was the lowest amongst all of the units/CHPs at 5.2% but the percentage quitting at one month of all quit attempts made was the highest at 54%.

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Category 3: Health Protection

Please refer to the notes & caveats on this section, particularly the fact that the overall rates do not necessarily reflect any inequalities of screening uptake or immunisation uptake amongst the population.

3.1 Screening

North & West Operational Unit The cervical screening uptake rate was 80.9% overall and there was little variation amongst the districts within the Unit. The highest rate was recorded for the GP Practices in Sutherland (81.7%).

The Breast Screening uptake rate was 81.2% and this was significantly higher than the Scottish (74.9%) and the Health Boards (79.6%) averages. Amongst the districts, the rate in Caithness was significantly higher (82.9%) than the average for the Health Board. The lowest rate was in Lochaber (79.3%) but this was not significantly different to the Health Boards average.

The Bowel Screening uptake rate was 59.1% and this was significantly higher than the Scottish average (54.5%) and the same as that of the Health Board (59.1%). Similar differences applied to males and females. Amongst the districts, the rate in Caithness was significantly higher (61%) and that of Lochaber (56.1%), significantly lower than the average for the Health Board. Similar differences applied to both males and females except the rate in Caithness for uptake amongst males, which was higher but not significantly different.

Overall across the units The average uptake of the cervical screening programme in NHS Highland was 80.4% and this is higher than the national average of 78.7% for 2011/12. A rate of 79.6% applied to Argyll & Bute, which is not significantly different to the national average but lower than the average for the Health Board. The rates for the units in North NHS Highland were just under 81%.

The average uptake rate of the breast screening programme in NHS Highland was 79.6% and this is significantly higher than the national average of 74.9% for 2010/11. The average rates pertaining to each of the Units and Argyll & Bute were significantly higher than the average national rate. Relative to the Health Board, the average for Argyll & Bute (76.1%) was significantly lower whilst the rates for the other units were significantly higher than the Health Boards average.

The average uptake rate of the bowel screening programme in NHS Highland was 59.1% and this is significantly higher than the national average of 54.5% for 2010/11. This was also the case for the rates for males, 55% versus 51% and for females, 63.1% versus 57.9%. Amongst the units, the rates in South & Mid were the highest although the differences were small.

3.2 Uptake of Flu vaccination

North & West Operational Unit The Flu vaccination uptake rate in those aged 65 years & over was 73.4% overall compared to an overall rate of 74.1% for the Health Board. There was little variation amongst the districts within the Unit. The highest rate was recorded for the GP Practices in Caithness (74.4%).

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The flu vaccination rate in those aged under 65 years at risk was 64.2% overall, significantly higher than an overall rate of 60.6% for the Health Board. The rates in Sutherland (69.1%) and in Skye, Lochalsh & Wester Ross (69%) were significantly higher than the Health Board average.

Overall across the units The average uptake rate of the flu vaccine in those aged 65 years & over in NHS Highland was 74.1% 2011/12 and this is significantly lower than the national average of 76.6% for the same period. Amongst the units, the rate in Argyll & Bute was the highest (74.6%) although the differences were small.

The average uptake rate of the flu vaccine in those aged under 65 years at risk in NHS Highland was 60.6% in 2011/12 and this is significantly higher than the national average of 59.7% for the same period. Amongst the units, the rates in North & West Operational unit and in Highland HSCP were also significantly higher than the national average. The rate in the North & West Operational Unit (64.2%) was also significantly higher than the average for the Health Board.

Summary for Health Protection in respect of the North & West Unit

 The uptake rate of cervical screening was similar to the Health Board average. The highest rate was in Sutherland.  The uptake rate of Breast Screening was significantly higher than the Health Board average and was highest in Caithness and lowest in Lochaber - the latter not significantly so.  The uptake rate of Bowel screening was significantly higher than the national average. Relative to the Health Board average, the rates in Caithness were significantly higher and those in Lochaber significantly lower.  Flu vaccination rates in older people were the highest in Caithness but the overall Unit rate was similar to the health Boards.  Flu vaccination rates in younger people at risk was 64%, significantly higher than the average for the Health Board (61%). The rates in Sutherland and in Skye, Lochalsh and Wester Ross were also significantly higher.

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Category 4: Healthcare

4.1 Primary Care disease registers

The notes and caveats particularly apply when interpreting the prevalence of various conditions derived from these registers

North & West Operational Unit The average rate for the Unit was higher than the Health Board average for Asthma (6.2%); Hypertension (16.3%); Diabetes (4.5%); Obesity (10.0%); CHD (5.1%) and Chronic Kidney Disease (4.3%).

Compared to the average crude prevalence rate for the North & West Unit, the rates pertaining to the North area of the unit were notably higher for seven out of the ten conditions covered by the registers. For the other three conditions, Mental Health, Dementia and COPD, the rates were closer to the average rate for the unit. Amongst the seven conditions, higher rates were noted specifically for Caithness as opposed to Sutherland for Asthma (7.0%) and Learning Disabilities (0.5%). Specifically a higher rate applied to Sutherland in relation to Hypertension (18.8%) which was the highest rate recorded across all of the Operational units and sub-areas. In all cases, the average prevalence rate in the West area was lower or similar to the average rate for the unit.

Overall across the units Across the Operational units, highest rates were recorded in the North & West for Asthma, Hypertension, Obesity, CHD and Chronic Kidney Disease and this was due in every case, to higher rates recorded in the North area rather than the West area. The highest rate for Diabetes was recorded in Argyll & Bute which was due to the high rate recorded in the Bute & Cowal locality. The prevalence of Learning Disabilities was highest in the South & Mid unit due to higher rates recorded in both Inverness West and East Ross.

In contrast, across the Operational units, lower rates were recorded in the South & Mid Unit for Hypertension, Diabetes, and CHD and in every case this was due to the lower rates recorded in Inverness East. The lowest prevalence of Obesity was recorded for Argyll & Bute and this was due to the low rate recorded for Bute & Cowal.

4.2 Disease management

North & West Operational Unit The average rate for the Unit tended to be slightly lower or similar to the Health Board average for the uptake of Flu immunisation for patients at high risk due to being on one or more of the registers for CHD or COPD or Diabetes or Stroke (includes TIA). Within the Unit, consistently higher rates of immunisation were recorded in Skye, Lochalsh & Wester Ross. Relatively lower rates pertaining to some of the conditions were recorded in Caithness and Lochaber.

The average percentage of patients with Dementia who have had a review within the last 15 months was higher for the Unit (86.5%) than the Health Board average (81.2%) due to high rates recorded in Sutherland (94.3%) and in Skye, Lochalsh & Wester Ross (93%). Rates in Caithness and Lochaber were lower than the Health Board average at 79.1% and 80.1% respectively.

The average percentage of patients with long-term severe Mental Illness who had a review within the last 15 months was slightly lower for the Unit (93.7%) than the Health Board

Epidemiology & Health Science Team (Public Health) 11 average (94.5%) due to a low rate recorded in Lochaber at 86.5%. Higher than average rates applied to Sutherland (96.2%) and to Skye, Lochalsh & Wester Ross (98.0%).

The average percentage of patients with Diabetes and/or CHD who had been screened for depression in the last 15 months was lower for the Unit (87.5%) than the Health Board average (89.6%) and the lowest amongst all of the Units. The rates pertaining to all of the areas within the Operational unit were lower than the Health Board average except for Sutherland which was higher (91.6%).

The average percentage of patients with a new diagnosis of depression who had an assessment of its severity at the outset of treatment was lower for the Unit (92.7%) than the Health Board average (94.4%) and the lowest amongst all of the Units. The rates pertaining to all of the areas within the Operational unit were lower than the Health Board average except for Sutherland which was higher (95.7%).

The average percentage of the population estimated to be prescribed drugs for anxiety, depression or psychosis was a little higher for the Unit (8.8%) than the Health Board average of 8.5%. Higher percentages (13% ± 1.1%) were noted for the two intermediate geographies of Wick (both North and South) and a lower percentage for Lochalsh (4.3% ± 0.7%).

Overall across the units Across the Operational units, highest rates were recorded in the North & West for the proportion with dementia receiving a review and in the Argyll & Bute for screening in those with CHD or Diabetes. There were no very extreme rates and with the exception of Sutherland, no patterns were apparent in respect of persistently low or high rates for any of the sub-areas. The rates recorded in Sutherland were the highest in the North & West unit for all aspects of disease management other than for flu vaccination. In comparison with Scotland, the overall Health Board averages were similar to national values with two exceptions where it was lower: (1) the severity assessment of newly diagnosed patients with depression (94.4% versus 95.3%) and (2) for the percentage of the population prescribed drugs for anxiety, depression or psychosis (8.5% versus 9.7%).

4.3 Hospitalisations

Note that when a significant difference is noted, this is statistically significant based on the range as defined by the value ± 95% confidence intervals not overlapping with the overall Health Board range defined by its value ± 95% confidence intervals. See caveats for specifications of the data.

North & West Operational Unit Within the Unit, the hospitalisation rate for COPD was significantly higher than the overall NHS Highland rate (116 per 100,000), in the intermediate geography of Lochalsh (213 per 100,000). In contrast, the rate for Sutherland East of 47 per 100,000 was significantly lower.

Within the Unit, the hospitalisation rate for CHD (Coronary Heart Disease) was significantly higher than the overall NHS Highland rate (363 per 100,000) in two of the intermediate geographies: Caithness North East and Wick North, the latter being the highest at 519 per 100,000. In contrast, the rates for two other areas were significantly lower: Fort William North and Lochaber West, the latter with the lowest rate of 219 per 100,000.

Within the Unit, the hospitalisation rate for CVD (Cerebrovasular Disease ) was significantly higher than the overall NHS Highland rate (160 per 100,000) in three of the intermediate geographies: Caithness North East, Caithness South and Thurso East, the latter being the

Epidemiology & Health Science Team (Public Health) 12 highest at 273 per 100,000. In contrast, the rate for one other area was significantly lower: Ross & Cromarty North West at 135 per 100,000.

Within the Unit, the hospitalisation rate for Asthma was significantly higher than the overall NHS Highland rate (713 per 100,000) in eleven of the intermediate geographies: Caithness North East, Caithness North West, Caithness South, Thurso East, Thurso West, Wick North, Wick South, Skye North East, Lochaber East & North, Fort William South and Fort William North, the latter being the highest at 1595 per 100,000). In contrast, there were no areas with significantly lower rates than that of overall NHS Highland.

Within the Unit, the emergency hospitalisation rate was significantly higher than the overall NHS Highland rate (6165 per 100,000) in eight of the intermediate geographies: Caithness South, Thurso East, Wick North, Fort William North, Fort William South, Lochalsh, Skye North East and Wick South, the latter being the highest at 8922 per 100,000. In contrast, there were four areas with significantly lower rates: Sutherland North & West, Lochaber West, Ross & Cromarty South West and Ross & Cromarty North West, the latter with the lowest rate of 4646 per 100,000.

Within the Unit, the Psychiatric hospitalisation rate was significantly higher than the overall NHS Highland rate (311 per 100,000) in two of the intermediate geographies: Fort William South and Wick South, the latter being the highest at 507 per 100,000. In contrast, four out of the eighteen remaining intermediate geographies were associated with significantly lower rates, lowest for Caithness South at 125 per 100,000.

Overall across the units Compared to the national average, the hospitalisation rates for COPD were significantly lower in NHS Highland and the only area for which the rate was significantly higher was Inverness Merkinch.

Compared to the national average, the overall hospitalisation rates for Coronary Heart Disease were significantly higher in NHS Highland and Highland HSCP. In contrast the average rate in Argyll & Bute was significantly lower. Significantly higher rates applied particularly to Inverness Merkinch (nearly twice the Health Board rate), Wick North and Oban South.

Compared to the national average, the overall hospitalisation rates for Cerebrovascular Disease were lower in NHS Highland, Highland HSCP and Argyll & Bute, differences being statistically significant except for the latter. Higher rates which were approximately twice the Health Boards average applied to Inverness Merkinch, Thurso East and Rothesay Town. Amongst the areas, significantly low rates in the order of one half the rate for the Health Board overall applied to North, Helensburgh North, and Ross and Cromarty North West.

Compared to the national average, the overall hospitalisation rates for Asthma was significantly higher for the Health Board and the Highland HSCP. In contrast the overall rate for Argyll & Bute was significantly lower. Particularly high rates, more than twice the Health Board average, applied to Fort William North, and Inverness Merkinch. The lowest rate applied to Whiskey Isles, one fifth of the Health Boards average.

Compared to the national average, Emergency hospitalisation rates were significantly lower for the Health Board, Highland HSCP and Argyll & Bute. Particularly high rates, which were 1.3-1.7 times the Health Board average, applied to Inverness Merkinch, Wick South and Dunoon. The lowest rates applied to Mull, Iona, Coll & Tiree and Black Isle South, approximately 30% lower than the Health Boards average.

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Compared to the national average, the Psychiatric hospitalisation rates were significantly higher for the Highland HSCP and significantly lower for Argyll & Bute. Particularly high rates, which were 1.3-3.7 times the Health Board average, applied to Inverness Merkinch, Wick South and Greater Lochgilphead. The lowest rates applied to Caithness South, Inverness Drakies and Loch Awe.

4.4 Relative Health Need

Read notes & caveats which highlight the various confounders to the interpretation of any differences in the measures of disease rates.

North & West Operational Unit Within the Unit, the rate of patients newly diagnosed with cancer was significantly higher than the overall NHS Highland rate (398 per 100,000), in the intermediate geography of Wick South (513 per 100,000). In contrast, the rate in Skye North East (272 per 100,000) was significantly lower.

Within the Unit, the prevalence rate of diabetes was significantly higher than the overall NHS Highland rate (3.1%), in the intermediate geography of Wick South (4.3%). In contrast, there was one area with a significantly lower rate, Lochalsh at 2.3%.

Overall across the units Compared to the national average (413 per 100,000), the rate of newly diagnosed cancer was significantly lower for the Health Board overall (398 per 100,000) and for Argyll & Bute (381 per 100,000). Significantly higher rates were associated with Wick South, Inverness Muirtown and Inverness Merkinch.

Compared to the national average (3.5%), the prevalence rate of diabetes was significantly lower for the Health Board overall (3.1%), Highland HSCP (3.1%) and for Argyll & Bute (3.0%). Significantly higher rates were associated with Wick South (4.3%) and Inverness Merkinch (5%).

4.5 Older People

North & West Operational Unit Within the Unit, the rate of those aged 65 years & over who have had multiple admissions to hospital was significantly higher than the overall NHS Highland rate (4210 per 100,000), in nine intermediate geographies of Fort William South, Fort William North, Localsh, Skye South, Wick South, Wick North, Thurso East, Caithness North West and Caithness South, the latter being the highest at 6514 per 100,000. In contrast there are four areas with significantly lower rates, Sutherland North & West, Ross & Cromarty South West, Ross & Cromarty North West and Lochaber West, the latter being the lowest at 2782 per 100,000.

The overall rate for the unit of those aged 65 years & over with emergency hospitalisation was significantly higher (27908 per 100,000) than the overall NHS Highland rate (24142 per 100,000), and in two districts, Caithness and Lochaber. The overall rates for the North and the West areas were each significantly higher, 27532 per 100,000 and 28289 per 100,000.

Within the Unit, the profile of patients aged 65 years & over at risk of hospitalisation (SPARRA), had the highest proportion in the 40% & over at risk (8.6%) and in the 60% & over at risk (1.8%) categories in Caithness. The lowest proportion of those at 60% or higher risk was in Sutherland (0.8%). The overall profile for the unit was the highest in both these categories within NHS Highland (7.6% for 40% & over risk and 1.5% for 60% and over risk).

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Overall across the units Compared to the national average (4608 per 100,000), the rate of those aged 65 years & over who have had multiple admissions to hospital was significantly lower for the Health Board overall (4210 per 100,000), Highland HSCP (4190 per 100,000) and for Argyll & Bute (4252 per 100,000). Significantly higher rates were associated with Caithness South (6514 per 100,000), Inverness Merkinch (7382 per 100,000), Campbeltown (6427 per 100,000) and Oban South (6450 per 100,000).

Compared to the national average (25320 per 100,000), the rate of those aged 65 years & over with emergency hospitalisation was significantly lower for the South & Mid operational unit (21420 per 100,000) and for Argyll & Bute CHP (24578 per 100,000, but significantly higher for the North & West operational unit (27908 per 100,000). Significantly higher rates were associated with Caithness (28872 per 100,000) Lochaber (32105 per 100,000) and Mid Argyll Kintyre & Islay (26604 per 100,000).

The proportion of patients categorised as 40% or over at risk of hospitalisation according to SPARRA, was 8% for Scotland as a whole. The equivalent profile for the operational units and for Argyll & Bute CHP, and the HSCP were all lower, the overall profile for the Health Board was 6.5% for this risk category. This also applied for the higher risk category of 60% and over, where the national proportion of 1.8% was higher than the relevant proportions pertaining to each of the units and the CHP, and against the Health Board proportion of 1.2%. Within NHS Highland, the profile with the highest risk of hospitalisation was the North & West Operational Unit with 7.6% being categorised with a 40% and above risk and 1.5% with a 60% and over risk.

Summary for Health Care in respect of the North & West Unit

 The crude prevalence rates of six out of the ten conditions for which there is a primary care disease register were higher for the unit than the overall rates for the Health Board. Comparisons are confounded by any differences in the population structure.  Within the Unit, the crude rates of the conditions were higher in the North area of the unit except for Mental Health, Dementia and COPD for which they were similar. The rates in Caithness were particularly high for Learning Disabilities and Asthma.  Amongst the disease management measures, the rates of review of patients with dementia within the last 15 months were higher than the average for the Health Board. Exceptionally high rates (>93%) were noted in Sutherland and in Skye, Lochalsh & Wester Ross and lower rates in Lochaber and Caithness  Higher rates for the review of patients with long-term severe mental illness were also noted in Sutherland and in Skye, Lochalsh & Wester Ross but lower rates in Lochaber.  Lower rates also noted in Lochaber and Caithness for the flu immunisation rate of those on disease registers  The overall rate of newly diagnosed patients with depression who had received an assessment for severity was lower than the Health Board average and the lowest amongst the units and CHP. The rate in Sutherland was however higher.  The overall rate of screening for depression for those with CHD or Diabetes was lower than the Health Board average and the lowest amongst the units and CHP. The rate in Sutherland was however higher  The hospitalisation rate for COPD was significantly higher in Lochalsh (nearly twice the Health Board average), but in the other areas the rates were lower.  The rates of hospitalisation for CHD were significantly higher in Caithness North East and Wick North.

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 The rates of hospitalisation for CVD were significantly higher in Caithness North East Caithness South and Thurso East.  The rates of hospitalisation due to Asthma in all of the intermediate geographies were either higher or similar to the Health Board average, the highest rate was in Fort William North, over twice the Health Boards average rate.  The rates of emergency hospitalisation were significantly higher in eight of the intermediate geographies, the highest in Wick South which was 50% higher than the Health Board average.  Within the unit, the Psychiatric hospitalisation rate was highest in Wick South, over 50% higher than the Health Board average.  The incidence rate of cancers was significantly higher than the Health Board average in Wick South.  The prevalence rate of Diabetes was significantly higher than the Health Board average in Wick South.  The rate of older people with multiple hospital admissions was higher in nine intermediate geographies, the rate in Caithness South over 50% higher than the Health Board average.  The rates of emergency hospitalisations of older people were higher in all of the districts than the Health Board average, with those for Caithness and Lochaber being significantly higher.  The overall profile for the Unit of older patients at risk of hospitalisation, according to the SPARRA score, had higher proportions in the higher risk categories amongst all of the Units and CHP. Caithness had the highest proportions at risk and Sutherland the lowest.

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