Scrutiny Report Presentation Cardiovascular and Respiratory Health - - PowerPoint PPT Presentation

Scrutiny Report Presentation Cardiovascular and Respiratory Health 27th February 2018

Monday, 19 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

78.6 34.2 13.8 169.5 20 40 60 80 100 120 140 160 180 200 Cardiovascular Respiratory Communicable diseases Under 75 - preventable

Under 75 Mortality Rates (2014 - 16).

England London region Hounslow

There was no statistically significant difference between the premature mortality rates for Hounslow and London Number of deaths before the age

• f 75 in Hounslow (2014 – 2016)
• 393 cardiovascular disease
• 163 respiratory disease
• 71 communicable disease

There were 967 deaths for people under the age of 75 in Hounslow that may have been preventable.

Premature mortality, by gender and deprivation (Age Standardised Rate 2014-16)

230.4 11.6 39.2 102.7 138.5 9.9 28.7 45.8 50 100 150 200 250 Under 75 - preventable Communicable diseases Respiratory Cardiovascular

Under 75 mortality by gender

Females Males 256.3 222.6 212.3 204.9 184.8 188.7 174.9 163.6 155.4 143.5 50 100 150 200 250 Most deprived 2nd 3rd 4th 5th 6th 7th 8th 9th Most affluent

Under 75 mortality by deprivation group Males have significantly higher under 75 mortality rates than females, in every disease group represented above. The under 75 mortality for causes that are considered 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

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

Expected Prevalence QoF 2015/16 registrations 4,949 2,916

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 Number Rate London England 19,698 63.4 % 65.1% 70.5%

Flu vaccination (at risk individuals): 2010-2017

Hounslow Number Rate London England 12,816 45.1 % 47.1% 48.6%

2016/17

Lifestyle risk factors to health and wellbeing

0% 10% 20% 30% 40% 50% 60% 70% 80% Smoking at age 15 (14/15) Adult smoking (2016) Physically inactive adults (15/16) Excess alcohol consumption (11/14) Overweight 10-11 year (16/17) Flu vaccination (at risk) 16/17 5-a-day adherence (15/16) Overweight or

• bese adults

(15/16) Flu vaccination (aged 65+) 16/17 England London Hounslow

Hounslow had a statistically significant higher percentage of inactive adults. There were no other significant differences from the above. In Hounslow the main lifestyle conditions negatively impacting health were;

• 126,000 adults are overweight
• 61,000 adults are inactive
• 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
• r 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
• utreach 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 (adults and children) : This is provided by practices to identify/diagnose COPD/asthma patients Pulmonary rehabilitation (PR), home oxygen assessment (HOS) and specialist nurse (SN) support for COPD patients. Service provided by BOC. COPD care by HRCH Adult community nursing and community matron 3096 spirometry/ annum PR : 300 patients/ annum HOS : 1000 visits/annum SN – 500 visits/annum All practice providing the same service There is some variation across GP practices in referrals. Hounslow CCG and the providers working with GP practices to reduce the variation No areas of concern There is low uptake on pulmonary rehabilitation. CCG has expanded the inclusion criteria for referral from April 2018 which will potentially increase the uptake. CCG also updated the BOC specification to increase the length of case management of COPD patients by specialist nurse which will potentially reduce non – elective admission CCG also working with other community partners to improve engagement with patients to attend COPD services

Asthma Management

Services provided Uptake Variations Any issues of concern

Asthma Out of hospital contract with primary care Enhanced management of registered asthma patients at their practice (adults and children) Asthma & Wheeze Community Service provided by HRCH (children only) Specialist nurse support for children who has exacerbation and attend UCC/A&E 476 patients reviewed so far out

• f 13441 asthma

patients on Hounslow practice register Around 800 children seen per year Variation practice by practice, due to the contract

• nly being

released in April None identified No specific concerns

• n performance, good

start, hoping the practices will build on activity in 18/19 There is a lack of a fully competent nursing workforce to deliver. The service can be GP led as mitigation. None identified

Tuberculosis (TB) Screening

Services provided Uptake Variations Any issues of concern

Latent TB project: This is to screen the newly registered patients coming from countries with high prevalence of

• TB. Age range :

16-37 Project went live in July 2016 600 patients screened so far Current positive rate : 20% 25 practices have signed up for the project. CCG is including this as primary care wrap around contract from April 2018 which will make it mandatory for all practices to undertake the project. To increase uptake with the practices Public campaign planned to raise awareness amongst patients to get tested for TB/latent TB

Atrial Fibrillation

Services Provided Uptake Variations Any Issues Of Concern

Arrhythmias / monitoring of psychotropic medications / investigation of palpitations ECG – Out of Hospital Out of hospital ECG (adults & children): This service provides local access to electrocardiogram (ECG) recording and interpretation of results for timely diagnosis and management by General Practices to identify/support diagnosis of CVD/ palpitations/ monitor patients 1919 ECG per annum All Localities in Hounslow must

• ffer at least
• ne practice

site for the service Some practices continue to refer to Hospital for ECG and do not use the local

• service. This is

being addressed through Performance management of the contract.

Atrial Fibrillation (AF) / Stroke: AF project in partnership with Chelsea and Westminster Hospital to reduce Strokes Main Aims

• Community-wide approach to increase AF

awareness:

• Increase AF detection in at-risk population

through use of novel technology

• Increase compliance with NICE AF guidance
• Prevention of AF-related strokes
• Target local areas in Hounslow that show

deprivation of AF screening

• Target outreach population in Hounslow

14 community AF screening events were held, with 619 people from the community being screened in areas of Hounslow. Four people were identified as having a possible AF and referred to their GP for further

• consultation. In addition 22

community champions from various community groups including Age UK and Tesco have volunteered to undertake training using the Alivecor ECG device and to continue screening in the community.

CCG and Chelwest are working with GP practices to increase the identification of AF patients. None identified.

Atrial Fibrillation (AF)/ Stroke/ Hypertension

Whole Systems Integrated Care (WSIC) Dashboard development - Development and deployment of a WSIC Hypertension Dashboard (as part of the wider NWL Stroke Prevention Programme) The key objectives, and actions required in order to achieve them:

• Reducing variation in care and improving clinical outcomes for AF and HYP by
• adopting consistent quality standards and guidelines
• providing training and support to healthcare professionals
• sharing knowledge and expertise across the health economy
• Increase detection of both AF and HYP – through targeted and opportunistic case finding
• Improve management of AF and HYP through improved management of known cases
• anti-coagulation for eligible patients, thereby reducing risk of stroke
• reducing blood pressure and thereby reducing AF in the population

NWL opportunity for detection and optimisation of AF & Hypertension

North West London Figures Size of the Prize Stroke Prevention Business Case Undiagnosed hypertension 208,200 204,843 Undertreated hypertension 55,500 22,363 Undiagnosed AF 16,200 14,000 Undertreated AF 5,000 4,500 Estimated CVD risk ≥ 20% not treated with statins 145,000 Not applicable

Heart Failure and Acute Coronary Syndrome

Services Provided Uptake Variations Any Issues Of Concern

Heart Failure (HF) Community Heart Failure Service To provide a consistent and systematic approach to the management

• f chronic HF, through the provision of a seamless community-based

care pathway that involves close liaison with teams across the primary, secondary and social care systems. 1000 HF patients seen per annum. None identified . None identified. Acute Coronary Syndrome / CVD Cardiac Catheter Laboratory at CWFT Aims:

• Enable patients with Acute Coronary Syndrome to receive

diagnostic and therapeutic intervention within 24 hours of presentation as per best-practice guidance

• Ensure appropriate clinical capacity to comply with London

Quality Standards (LQS) such as access to all key diagnostic services for non-urgent patients within 24 hours, 7 days a week

• Eliminate 1-3 day delay for patients seeking cardiac laboratory

services as they wait for a transfer to another Trust

• Shorter travel time and easier access for patients.

2017/18 Total annual activity profile Total Procedure s: 2253 Total Outpatient s: 2407 None identified . None identified.

Cardiac Rehabilitation Service

Services Provided Uptake Variation s Any Issues Of Concern

SF NICE CR phases. full Post-Cardiac Episode (MI, primary or emergency angioplasty and post-cardiac bypass surgery) Cardiac Rehabilitation Service Aims: To reduce the incidence of further cardiac episodes by improving the patients’ level of exercise, lifestyle & dietary management. Objectives

• To ensure that people referred from hospital with a

primary diagnosis of AMI, who meet referral criteria are offered cardiac rehabilitation where clinically indicated

• To reduce the incidence of further cardiac episodes

through increasing levels of exercise, lifestyle and dietary management. 1,624 patients to be seen per annum, Not applicabl e Limited capacity/ resource available to provide full NICE CR phases. (not a concern) Service is contracted for a 6 week waiting time currently patients are seen within 4 weeks of referral. Integrated with the Community HF service, with utilisation of existing nursing resource.