1. Trends in the life expectancy at birth relative gap between Spearhead PCTs and England, compared to the national health inequalities target of a 10% reduction between 1995-97 baseline and 2009-11 target, progress at 2004-06 David Merrick Public Health Information Specialist Yorkshire & Humber PHO

2. Summary The following slides show the progress that Yorkshire & Humber Spearhead PCTs have made towards achieving a 10% narrowing of the life expectancy relative gap (England vs Spearhead). Charts are presented that show –life expectancy in England vs Spearhead PCT –life expectancy relative gap between England and the Spearhead PCT with forecast and target up to 2010 LE relative gap forecasts (with 95% confidence interval) were made using Holt’s Exponential Smoothing on data from 1991-93 up to 2004-06. This technique gives more weight to more recent values in the time series. Comparing the forecast with the red target line is a method of assessing the likelihood that the actual LE relative gap will be 10% narrower in 2009-11 than it was in 1995-97, i.e. will the ‘target’ be achieved? The PHO have given each PCT a ‘traffic-light’ that summarises whether the trajectory of observed values is consistent with a 10% narrowing by 2010. This assessment is based upon a visual inspection of the historic values and the forecast and target lines. This PHO assessment is independent of any assessment made by the Department of Health, that may use different criteria for determining the ON/OFF TRACK status of individual PCTs in this respect. An alternative criteria for assigning ON/OFF TRACK status would be a simple comparison of the most recent 2004-06 relative gap with the target line. While this approach is entirely objective and may be applied to a large number of PCTs in an automated way, it ignores trajectory which is likely to reduce predictive performance given the volatility of the relative gap statistic at PCT level. Each set of PCT charts is accompanied by a brief commentary that gives a more detailed justification for the ON/OFF TRACK status that has been assigned.

3. Yorkshire & Humber Spearheads

5. MALES & FEMALES: OFF-TRACK –Both male and female LE has increased year-on-year in both England and Y&H Spearheads since 1991-93. –However, the rate of increase has been greater in England and consequently the relative gap has steadily widened since the baseline year. –The entire forecast interval exceeds the target line which strongly predicts that the 2010 target will not be met.

6. Kingston upon Hull

7. MALES: OFF-TRACK –Male LE has increased year-on-year in England since the 1995-97 baseline, and year-on-year in Hull since 1996-98. –However, the rate of increase has been greater in England and consequently the relative gap has steadily widened since the baseline year. –The entire forecast interval exceeds the target line which very strongly predicts that the 2010 male target will not be met in Hull. FEMALES: OFF-TRACK –Female LE has increased year-on-year in England, whereas the only period of increase in Hull was between 1996-98 and 2001-03, after which LE actually fell. –The combined effect of England LE increases and declining/static Hull LE in the four most recent periods, is a dramatic increase in the observed relative gap to date, which is reflected in the upward forecast. –The entire forecast interval exceeds the target line which very strongly predicts that the 2010 female target will not be met Hull.

8. Barnsley

9. MALES: OFF-TRACK –Male LE has increased year-on-year in both England and Barnsley since 1991-93. –However, the rate of increase was slightly greater in England and consequently the relative gap has steadily widened since the baseline year. –The entire forecast interval exceeds the target line which predicts that the 2010 target will not be met. FEMALES: ON-TRACK –Female LE has increased year-on-year in England. In Barnsley LE increased between 1991- 93 and 2001-03 but has remained fairly static since then. –For most of the period between the 1995-97 baseline and 2001-03, the relative gap was around or well below the target line. However, because female LE in Barnsley has remained static since 2001-03 the relative gap has widened quite sharply. –The ON-TRACK assessment may look slightly optimistic given the recent sharp increase in the relative gap. The 2010 forecast is very close to the targetted 10% narrowing because of the relatively large LE increases up to 2001-03. However, if female LE in Barnsley remains static in 2005-07, it is very likely that the assessment will change to OFF-TRACK.

10. Rotherham

11. MALES: OFF-TRACK –Male LE increased year-on-year in England since 1991-93. Rotherham males experienced similar increases in LE between the 1995-97 baseline and 2000-02. LE decreased slightly between 2000-02 and 2002-04, but then increased between 2002-04 and 2004-06. –Up to 2000-02 the rate of LE increase in Rotherham kept pace with that in England. However because LE decreased between 2000-02 and 2002-04 there was a fairly sharp rise in the relative gap. For the last three data periods the relative gap has been about double the target rate. –The 2010 forecast relative gap is far in excess of the target and it is predicted that the 2010 target will not be met. FEMALES: ON-TRACK –Female LE has increased year-on-year in England since 1991-93. Between 1995-97 and 1999-01 Rotherham LE increased faster than in England. After 1999-01, Rotherham female LE decreased slightly for three successive periods then increased quite sharply in 2003-05 and 2004-06. –Since the baseline year, the observed relative gap has fluctuated around the target line in a cyclical fashion, but in the most recent 2004-06 period the relative gap is just below the target line. –The 2010 forecast is very close to the target and the confidence interval is relatively narrow which is supports the prediction that the 2010 target will be met.

12. North East Lincolnshire

13. MALES: OFF-TRACK –Male LE has increased year-on-year in England since the 1995-97 baseline, and year-on- year in NE Lincolnshire since 1996-98. –However, the rate of increase has been greater in England and consequently the relative gap has steadily widened since the baseline year. –The observed relative gap has been above the target line in every data period since the 1995-97 baseline and the 2010 forecast far exceeds the target. This strongly predicts that the 2010 male target will not be met in NE Lincolnshire. FEMALES: OFF-TRACK –Despite North East Lincolnshire being a Spearhead PCT, female LE was actually greater than in England during the 1995-97 baseline period. This makes it unclear how to assess progress here. The target line displayed on the chart represents a 10% widening of the relative gap in NE Lincolnshire’s favour. –Since the baseline period, female LE in NE Lincolnshire fell in three successive periods, but since then has increased to a level just below LE in England. –The observed relative gap has been above the target line in every data period since the 1995-97 baseline and the entire forecast interval exceeds the target. This strongly predicts that the 2010 female target will not be met in North East Lincolnshire.

14. Doncaster

15. MALES: OFF-TRACK –Male LE has increased year-on-year in both England and Doncaster since 1991- 93. –However, the rate of increase since the 1995-97 baseline has been greater in England and consequently the relative gap has been widened. –The observed relative gap has ‘cycled’ around an increasing trend since 1991-93 and the upward forecast reflects this. Although the lower forecast limit includes the 2010 target, the forecast predicts that the 2010 target is unlikely to be met. FEMALES: ON-TRACK –LE has increased year-on-year in England since 1991-93. Since the 1995-97 baseline, Doncaster LE fell for a single period then increased year-on-year up to latest 2004-06 period. –The relative gap has been below the target line for every period since 1999-01 because female LE has increased at a faster rate in Doncaster than in England. –The observed relative gap has been very stable since 1999-01 and the 2010 forecast is below the target. This suggests that the 2010 target will be met.

16. Bradford

17. MALES: OFF-TRACK –Male LE has steadily increased in both England and Bradford since 1991-93. –The relative gap widened in the two data periods after the baseline and has remained at roughly that level ever since. –The observed relative gap has been above the target line in every data period since the 1995-97 baseline and the 2010 forecast exceeds the target. This predicts that the 2010 male target will not be met in Bradford. FEMALES: OFF-TRACK –Female LE has increased year-on-year in both England and Bradford since 1991-93. –However, the rate of increase has been greater in England and consequently the relative gap has steadily widened since the baseline year. –The entire forecast interval exceeds the target line which strongly predicts that the 2010 target will not be met.

18. Wakefield

19. MALES: OFF-TRACK –Male LE has increased year-on-year in both England and Wakefield since 1991-93. –However, the rate of increase has been slightly greater in England and consequently the relative gap has remained wider than in the baseline year. –The entire forecast interval exceeds the target line which predicts that the 2010 target will not be met. FEMALES: NEAR-TRACK –Female LE has increased year-on-year in both England and Wakefield since 1991-93. –Up to and including 2002-04, observed relative gap was very close to the target line with very little deviation. However, because the 2003-05 and 2004-06 LE increases were smaller in Wakefield than in England, the relative gap has slightly increased in these two latest periods. –The forecast interval includes the 2010 target and until 2003-05 the relative gap was very close to the target line. The observed relative gap trajectory is close to being ON-TRACK but if the very recent trends continue the 2010 target will missed by a small margin.