Data analysis to inform a JSNA on End of Life Care London Boroughs - - PowerPoint PPT Presentation

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Data analysis to inform a JSNA on End of Life Care London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster Andrew Rixom , Senior Public Health Analyst Rianne van der Linde , Public Health Analyst Colin Brodie , Public

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Data analysis to inform a JSNA on End of Life Care

London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster

18 February 2015 London public health knowledge and intelligence network

Andrew Rixom, Senior Public Health Analyst Rianne van der Linde, Public Health Analyst Colin Brodie, Public Health Knowledge Manager Bridgette Moess, Commissioning Manager Jessica Nyman, JSNA Manager

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Outline

JSNA process
Population and number of deaths
Place of death
Deaths among hospice patients
Deaths in hospital
End of Life Care JSNA
Questions and discussion

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JSNA on End of Life Care - process

JSNA

Policy and evidence review Consultation and interviews Service mapping Technical document

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Population and number of deaths

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Population

Young population

(as other London boroughs) Percentage aged 65 years and over

Deprived areas

Index of multiple deprivation, 2015

Westminster Kensington & Chelsea Hammersmith & Fulham

Source: Office for National Statistics, 2008-10, included in End of Life Care profile, 2015; Index of Multiple Deprivation by LSOA, 2015

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Population

Resident LA
Resident CCG
in the country

West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington

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Population

Resident LA
Resident CCG
Registered
Residents who are registered
Registered who are not resident
Residents who are registered elsewhere
Not resident and not registered
in the country

GP GP

West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington

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Population

Resident LA
Resident CCG
Registered
People may die anywhere the country
e anywhere in the country

West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington

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Population

Resident LA
Resident CCG
Registered
People may die anywhere the country
e anywhere in the country
All deaths by LA residents (registered or not registered)

that occurred inside or outside the three boroughs

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Mortality rate

200 400 600 800 1,000 1,200 Tower Hamlets LB Barking and Dagenham LB Islington LB Newham LB Greenwich LB Lewisham LB Lambeth LB Hackney LB Wandsworth LB Southwark LB Hammersmith and Fulham LB Hounslow LB Croydon LB Havering LB Waltham Forest LB Hillingdon LB Ealing LB Merton LB Bexley LB Sutton LB Redbridge LB Enfield LB Brent LB Haringey LB Kingston upon Thames LB Bromley LB Barnet LB Camden LB Richmond upon Thames LB Westminster, City of LB Harrow LB Kensington and Chelsea LB City of London LB

Directly standardised mortality rate

London average England average

Source: Compendium of Population Health Indicators, Health and Social Care Information Centre, 2011-13

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Age at death

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 10 20 30 40 50 60 70 80 90 100

2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 60 62 64 66 68 70 72 74 76 78 80 82 84 86 88 90 92 94 96 98 100 102 104 106 109

Cumulative percentage of deaths Number of deaths Age

Average number Cumulative percentage of deaths

Source: All deaths, Primary Care Mortality Database, 2014

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Causes of death

Cardiovascular disease deaths Cancer deaths

Cold spot – fewer deaths Hot spot – more deaths

Source: Deaths by LSOA, Primary Care Mortality Database, 2014

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Place of death

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Place of death

Source: All deaths, Primary Care Mortality Database, 2014

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Place of death – variation in deaths in usual residence

Percentage of deaths at home or in a care home ranges from 18% to 60%

Source: All deaths by wards, Primary Care Mortality Database, 2014

18-28% 29-33% 34-43% 44-51% 52-60%

Percentage of all deaths in usual residence

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Place of death – variation in deaths in usual residence

Care home beds

18-28% 29-33% 34-43% 44-51% 52-60%

Percentage of all deaths in usual residence Variation partly explained by:

Care home beds

Percentage of deaths at home or in a care home ranges from 18% to 60%

Source: All deaths by wards, Primary Care Mortality Database, 2014

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Place of death – variation in deaths in usual residence

Variation partly explained by:

Care home beds
Higher death rate
Older population
Not significantly associated with median

age at death, cause of death or deprivation

Only 7% of the variation can be

explained Percentage of deaths at home or in a care home ranges from 18% to 60% Care home beds

Source: All deaths by wards, Primary Care Mortality Database, 2014

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Place of death – by GP practice

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Place of death – by GP practice

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Place of death – by GP practice

Source: Primary Care Mortality Database, 2014

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Deaths among hospice patients

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Deaths among hospice patients

Percentage of all deaths that are hospice patients 12-22% 22-30% 30-36% 37-46% 46-72%

Source: Deaths by patients of the three hospices (data provided by hospices) as a proportion of all deaths (Primary Care Mortality Database), Sept 2013 – Aug 2014

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Deaths among hospice patients

2SD of deaths among patients of St Johns hospice 2SD of deaths among patients of Pembridge hospice 2SD of deaths among patients of Trinity hospice

Source: Deaths by patients of the three hospices (data provided by hospices) as a proportion of all deaths (Primary Care Mortality Database), Sept 2013 – Aug 2014

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Deaths in hospital

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Deaths in hospital – activity before death in hospital

Inpatient admissions A&E attendances Outpatient attendances 2 years before death Month before death Time (months)

Source: Secondary Uses Service (SUS), deaths in 2014/15, activity in 2 years before death

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End of life care JSNA

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End of life care JSNA - Recommendations

Policy and evidence review Consultation and interviews Service mapping Technical document

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End of life care JSNA - Recommendations

Policy and evidence review Consultation and interviews Service mapping Technical document

Care planning and co-ordination.

1

End of life care as ‘everybody’s business’

2

Clear strategic leadership

3

Coordinated education and training programme

4

Easy access to evidence and information

5

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London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster

Find the full JSNA and technical document here: http://jsna.info/endoflifecare Rianne van der Linde rvanderlinde@westminster.gov.uk