1 ANNUAL PUBLIC HEALTH REPORT 2011 Extending life in Islington Harriet Murrell Public Health Strategist. on behalf of Islington’s Public Health team

2  To look at what more could be done to improve population health outcomes, and particularly early death, in people aged living with long term conditions in Islington.  Four main sections: –Description of the burden of ill-health from long term conditions –Finding the undiagnosed –Lifestyles and behaviour change in those with long term conditions –Management and care of long term conditions in primary care  Case for change and recommendations on what more could be done to reduce early deaths and other outcomes in people living with long term conditions. Purpose and outline

3 High quality information to inform commissioning and service delivery Demographics Diagnoses Assessments Exceptions Medications 5 tables 37 practices 215,000 registered patients 120,000 read codes 35,000,000 rows of anonymised data

4 Long term conditions in Islington: key areas for public health action

5 Factors impacting on the prevalence of long term conditions

6 SETTING THE SCENE: THE BURDEN OF ILL-HEALTH FROM LONG TERM CONDITIONS IN ISLINGTON

7 Causes of death:

8 Numbers of long term conditions Number of diagnosed long term conditions by condition, Islington’s registered population (18+), March 2011

9 People living with multiple conditions Number of diagnosed long term conditions per person aged years, Islington’s registered population, March 2011

10 Comorbidity and order of diagnosis

11 Conditions with higher prevalence in deprived areas Odds ratios and numbers of people diagnosed with long term conditions by type of condition and local deprivation quintiles, Islington’s registered population aged 18-74, March 2011

12 This section looks at which lifestyle risk factors are important in contributing to the development of long term conditions in Islington with comparisons to early deaths. It also looks at differences by deprivation. LIFESTYLES AND THE DEVELOPMENT OF LONG TERM CONDITIONS

13 Contribution of lifestyle risk factors to long term conditions and early death Contribution of lifestyle risk factors to the prevalence of and early deaths from diagnosed long term conditions, Islington’s registered population aged 18-74, March 2011

14 Smoking prevalence by ethnicity Indirectly standardised ratio of smoking prevalence in those with diagnosed long term conditions by ethnic group, Islington’s registered population aged 18-74, March 2011

15 Current lifestyle risk factors Indirectly standardised prevalence of smoking, obesity and high and increasing risk drinking* among people with a diagnosed long term condition, Islington’s registered population aged 18-74, March 2011 *Increasing risk drinking is defined as usual consumption of between 22 and 50 units of alcohol per week for men, and between 15 and 35 units of alcohol per week for women. High risk drinking is defined as usual consumption of over 50 units of alcohol per week for men, and over 35 units of alcohol per week for women (APHO, 2010)

16 Diabetes and obesity Indirectly standardised diagnosed prevalence of type II diabetes by BMI classification in adults aged 18-74, Islington registered population, March 2011

17 Smoking and COPD Current smoking status by MRC breathlessness scale in people aged years diagnosed with COPD, Islington’s registered population, March 2011

18 Missed opportunities to help to close prevalence gaps, better manage conditions, and to reduce early deaths. SYSTEMATIC TARGETING OF THE POPULATION ‘AT RISK’ USING COST- EFFECTIVE INTERVENTIONS

19 Follow-up of people with a high blood pressure reading but no diagnosis

20 NHS Health Checks and Cardiovascular risk assessments Excludes Partnership Primary Care Centre because the clinical system uses Framingham CVD rather than QRisk2

21 Depression screening Number and percentage of people with at least one diagnosed long term condition (excluding chronic depression and psychotic disorders) that have a record of screening for depression or PHQ9 questionnaire, Islington’s registered population aged 18-74, March 2011

22 Smoking advice offered to those with COPD Smoking advice offered to people aged with diagnosed COPD by MRC breathlessness scale, Islington’s registered population, March 2011

23 Prescribing Percentage of eligible populations aged years prescribed antihypertensives or statins in 2010/11, March 2011

24 EXAMPLES OF SUCCESSES

25  In 2010/11, Islington had the fourth highest rate of quits among all London boroughs, at 1,232 per 100,000 persons aged 16+.  There were a total of 5,940 attempts to quit with the Islington Stop Smoking Service, an increase on the 2009/10 figure (5,339).  The total number of quitters was 2,225, which exceeded the target number for this year (2,218).  Most quits (95%, 2,115) were achieved among GPs.  Only three Islington GP practices achieved lower quit rates per 1,000 practice population than the previous year. Five practices achieved a significantly higher rate.  Quit rates were significantly higher among the most deprived 20% of persons living in Islington than the least deprived 20%. Smoking quits in Islington, 2010/11

26 Overview of Health Checks in Islington, 2010/11  6,455 Health Checks (HCs) were carried out in Islington in 2010/11 in persons aged between 35 and 74, and with no previous relevant diagnosis.  7,637 HCs were offered (15% of the eligible population).  Most HCs were carried out at GP practices (62%, n=3,992), followed by the community outreach programme (27%, n=1,742) and pharmacies (n=721 HCs, 11%).  Islington was the only PCT in the NCL sector to achieve the target number of Health Checks delivered, and one of 8 PCTs in London to achieve this target. Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74; Health Smart (May 2011); TeleHealth Solutions (June 2011).

27 New diagnoses following Health Checks, 2010/11 Source: EMIS (June 2011), NHS Health Checks in persons aged 35-74, Islington registered population.

28 Time period Recorded prevalence Expected prevalence Undiagnosed prevalence Number% % 2010/112,9661.6% 3.7% 3,7502.1% 2009/102,6511.4%4,2402.3% 2008/092,5791.4%4,1602.3% Increase in diagnosed COPD  453 new diagnoses in the LES target population (patients aged >35, who were current smokers or ex-smokers) between April 2010 and March  The overall recorded prevalence has increased by 0.2 percentage points, thus reducing the gap of between expected and recorded prevalence by 13%.

29 Next Steps

30 Determining health and wellbeing priorities Strategic fit (Must do’s; political influence) Numbers of people affected by the issue and effect on health and wellbeing and health inequalities Projected future position if no action taken Benchmarking – how do we compare to other areas Resource impact or cost to the community Local views

31 Current approaches to evidence in Islington The JSNA has been developed in two formats; a short version and a long version publicly available on the NHS Islington internet site PH intelligence pages contain quantitative data (NHS only) LBI webpages include top-line “borough statistics” Other information and performance reporting within internal systems, held by individual teams within different organisations Other evidence available from a range of different external organisations (e.g. PH observatories, NHS IC, Local Communities and Government

32 Summary “factsheets” Health profiles; strategies; evidence summaries from literature reviews “Raw” quantitative data; RSS feeds to PubMed Islington Evidence Hub Would include different types and levels of evidence to try and meet wide-ranging need for information – people can drill down for the level they require At a top-level: summary “factsheets” (e.g. Health Islington: the Facts; ward profiles; develop others for key themes); overarching performance metrics At bottom-level: access to spreadsheets with population counts

33 Relationship with the Islington Health and Wellbeing Board The evidence provided through the Joint Strategic Needs Assessment and other documents will support the work of the Islington Health and Wellbeing Board by clarifying the health and wellbeing needs of the local population. Understanding the needs of the local population is important for informing the health and wellbeing priorities for the borough which in turn will influence strategy and commissioning decisions.