Monday, 19 February 2018 Scrutiny Report Presentation Cardiovascular and Respiratory Health 27th February 2018
Cardiovascular and Respiratory Disease: Local Picture Summary Deaths from all causes under 75 years SMR. Source: ONS 2011-2015
Premature mortality for Cardiovascular and Respiratory Disease Under 75 Mortality Rates (2014 - 16). 200 169.5 180 160 140 120 78.6 100 80 34.2 60 13.8 40 20 0 Cardiovascular Respiratory Communicable diseases Under 75 - preventable England London region Hounslow There were 967 deaths for Number of deaths before the age There was no statistically people under the age of 75 in of 75 in Hounslow (2014 – 2016) significant difference between Hounslow that may have been the premature mortality rates • 393 cardiovascular disease preventable. for Hounslow and London • 163 respiratory disease • 71 communicable disease
Premature mortality, by gender and deprivation (Age Standardised Rate 2014-16) Under 75 mortality by gender Under 75 mortality by deprivation group Most affluent 143.5 45.8 Cardiovascular 102.7 9th 155.4 8th 163.6 28.7 Respiratory 7th 174.9 39.2 6th 188.7 5th 184.8 9.9 Communicable diseases 11.6 4th 204.9 3rd 212.3 138.5 Under 75 - preventable 2nd 222.6 230.4 Most deprived 256.3 0 50 100 150 200 250 0 50 100 150 200 250 Females Males Males have significantly higher under 75 mortality rates than The under 75 mortality for causes that are considered females, in every disease group represented above. preventable is correlated with deprivation across England.
Chronic Obstructive Pulmonary Disorder (COPD) • 3,198 Hounslow residents diagnosed with COPD (true number possibly double) • 86% of COPD deaths smoking related • Around 30,000 smokers in borough
Arial Fibrillation (AF), Hypertension Atrial Fibrillation: • 3181 AF cases on GP registers • Likely to be an underestimate • Diagnosis important Expected Prevalence QoF 2015/16 registrations 4,949 2,916 Hypertension (high blood pressure): • Around 11% in Hounslow have a GP recorded high BP • Estimated that around 20% have high BP • Around 15,000 local people thought to have undetected high BP
Tuberculosis (TB)
Cardiovascular mortality (premature < 75 yrs, all): 2001-2015
Cardiovascular premature mortality (<75 yrs) considered preventable: 2001-2015
Stroke: Early Mortality Trends Hounslow 2004-2014
Respiratory disease premature mortality < 75 yrs: 2001-2015
Respiratory premature mortality <75yrs considered preventable: 2001-2015
Flu vaccination: 2010-2017 (65 yrs +) 2016/17 Hounslow London England Number Rate 19,698 63.4 % 65.1% 70.5%
Flu vaccination (at risk individuals): 2010-2017 2016/17 Hounslow London England Number Rate 12,816 45.1 % 47.1% 48.6%
Lifestyle risk factors to health and wellbeing 80% 70% 60% 50% 40% 30% 20% 10% 0% Smoking at Adult smoking Physically Excess Overweight Flu 5-a-day Overweight or Flu age 15 (14/15) (2016) inactive adults alcohol 10-11 year vaccination (at adherence obese adults vaccination (15/16) consumption (16/17) risk) 16/17 (15/16) (15/16) (aged 65+) (11/14) 16/17 England London Hounslow In Hounslow the main lifestyle conditions negatively impacting health were; Hounslow had a statistically significant higher percentage of inactive adults. • 126,000 adults are overweight There were no other significant • 61,000 adults are inactive differences from the above. • 49,000 adults drink excessive alcohol • 28,000 adults smoke
NHS Health Checks • Statutory Council’s commissioned programme, provided by Hounslow GP practices, aiming at identifying residents at risk of developing cardiovascular diseases, diabetes and kidney disease • All eligible residents aged 40-74 are offered a free health check (one every five years) that includes key measurements of weight, height, blood pressure, pulse, blood tests for cholesterol and blood glucose and questions on lifestyle factors. • Since 2011, Public Health Hounslow has shown great improvements in the uptake of NHS Health Checks programme and now features in the top 10 performing boroughs in the country. The current percentage of eligible people taken up the offer is around 15% per year, which is significantly higher than the national average of 8.50% and London average of 9.8%
NHS Health Check key findings (June 16-July 17) Out of 8837 Health Checks completed from June 16 till July 17: • 4826 females, and 4011 males • 60% were overweight and obese (Body Mass Index of over 25) • 831 patients currently smoked • 1171 patients were at a high risk of cardiovascular disease (Qrisk above 10) • As a result of these health checks 236 patients were diagnosed with Type II diabetes, and 391 patients were diagnosed with hypertension • As part of the health checks, all residents identified at risk of developing heart disease should be offered medications (statins) and referral into community behaviour change programmes i.e. One You Hounslow.
One You Hounslow • Smoking Cessation Service: 1200 smoking quits target • Exercise on Referral for residents with long term conditions or at risk of developing heart disease • Children weight management programme • Universal physical activities • Community outreach events • Digital offer with actively promoting self help tools: Active 10, Couch to 5K, Easy meals, Better points, NHS Smokefree app. • Cook and Eat sessions (Health Checks follow up service) • Social Prescribing for socially isolated residents; engaging in physical activity and befriending activities.
Smoking cessation: working with partners to reduce illicit tobacco supply and use • Illicit tobacco survey showed that 30% offered illicit tobacco, around ½ price, 1/3 from shops • Illicit tobacco cheap, potentially dangerous, sometimes sold to children, ‘pocket money’ prices • Joint work through Hounslow ‘Tobacco Control Alliance (TCA) • Public Health grant support to LBH Trading Standards to highlight dangers of illicit tobacco, identify and crack down on illicit tobacco
Community Blood Pressure Testing Pilot (Sep 2017-Sep 2018) • To complement the NHS Health Check, Hounslow Public Health is piloting a community blood pressure testing project; currently provided by Hounslow and Richmond Community Health Care NHS Trust (HRCH) under the banner One You Hounslow • The programme aims to support improved detection of high blood pressure (an estimated 15,000 people in Hounslow have undiagnosed blood pressure) • There is a particular focus on Feltham and Heston areas, with higher population risk factors • Blood pressure testing is offered during One You Hounslow outreach campaigns and during smoking cessation clinics • From Sep-Dec 17, 314 BP tests were offered, of which 47 were identified with high Blood pressure and they were referred immediately to GPs or urgent care centre
One You Hounslow (Key Outcomes for adults) In 2016/17: • 710 people started the exercise on referral programme, with 65% achieving key outcomes • 2142 residents signed up to receive smoking cessation advice and treatment, of which 1214 people quit smoking for at least 4 weeks. • 5752 residents engaged in physical activity programmes including health walks, dance classes, yoga, pilates, tai chi etc. 73% of residents who were retained in such activities, showed improvement in their physical activity levels and general wellbeing .
Chronic Obstructive Pulmonary Disorder (COPD) Management Services provided Uptake Variations Any issues of concern Out of hospital Spirometry 3096 All practice No areas of concern (adults and children) : This spirometry/ providing the same There is low uptake on is provided by practices to annum service pulmonary rehabilitation. CCG identify/diagnose has expanded the inclusion COPD/asthma patients criteria for referral from April There is some 2018 which will potentially PR : 300 variation across increase the uptake. Pulmonary rehabilitation patients/ GP practices in (PR), home oxygen annum referrals. CCG also updated the BOC assessment (HOS) and HOS : 1000 Hounslow CCG specification to increase the specialist nurse (SN) visits/annum and the providers length of case management of support for COPD patients. SN – 500 working with GP COPD patients by specialist visits/annum Service provided by BOC. practices to reduce nurse which will potentially the variation reduce non – elective admission COPD care by HRCH Adult CCG also working with other community nursing and community partners to improve community matron engagement with patients to attend COPD services
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