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 Health Knowledge Manager 18 February 2015 Bridgette Moess, Commissioning Manager London public health knowledge and intelligence network Jessica Nyman, JSNA Manager
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
JSNA on End of Life Care - process Consultation Service and mapping interviews Policy and Technical evidence document review JSNA
Population and number of deaths
Population Young population Deprived areas (as other London boroughs) Percentage aged 65 years and over 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
Population • Resident LA • Resident CCG • in the country London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Royal Borough of Kensington and Chelsea West London CCG Westminster City Council Central London CCG Queens Park and Paddington
Population • Resident LA • Resident CCG • Registered o Residents who are registered o Registered who are not resident o Residents who are registered elsewhere o Not resident and not registered • in the country London Borough of Hammersmith & Fulham GP GP Hammersmith & Fulham CCG Royal Borough of Kensington and Chelsea West London CCG Westminster City Council Central London CCG Queens Park and Paddington
Population • Resident LA • Resident CCG • Registered • People may die anywhere the country • e anywhere in the country London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Royal Borough of Kensington and Chelsea West London CCG Westminster City Council Central London CCG Queens Park and Paddington
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
Mortality rate Directly standardised mortality rate 1,000 1,200 200 400 600 800 0 Tower Hamlets LB Barking and Dagenham LB Islington LB Newham LB Greenwich LB Lewisham LB Lambeth LB Hackney LB London average Wandsworth LB Southwark LB Social Care Information Centre, 2011-13 Source: Compendium of Population Health Indicators, Health and Hammersmith and Fulham LB Hounslow LB Croydon LB Havering LB Waltham Forest LB Hillingdon LB Ealing LB England average 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
Age at death 100 100% 90 90% Cumulative percentage of deaths 80 80% 70 70% Number of deaths 60 60% 50 50% 40 40% 30 30% 20 20% 10 10% 0 0% 0 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 Age Average number Cumulative percentage of deaths Source: All deaths, Primary Care Mortality Database, 2014
Causes of death Cancer deaths Cardiovascular disease deaths Cold spot – fewer deaths Hot spot – more deaths Source: Deaths by LSOA, Primary Care Mortality Database, 2014
Place of death
Place of death Source: All deaths, Primary Care Mortality Database, 2014
Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% Percentage of all deaths in usual residence 18-28% 29-33% 34-43% 44-51% 52-60% Source: All deaths by wards, Primary Care Mortality Database, 2014
Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% Variation partly explained by: • Care home beds Percentage of all deaths in usual residence Care home beds 18-28% 29-33% 34-43% 44-51% 52-60% Source: All deaths by wards, Primary Care Mortality Database, 2014
Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% 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 Care home beds • Only 7% of the variation can be explained Source: All deaths by wards, Primary Care Mortality Database, 2014
Place of death – by GP practice
Place of death – by GP practice
Place of death – by GP practice Source: Primary Care Mortality Database, 2014
Deaths among hospice patients
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
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
Deaths in hospital
Deaths in hospital – activity before death in hospital Inpatient admissions A&E attendances Outpatient attendances 2 years Month before before Time (months) death death Source: Secondary Uses Service (SUS), deaths in 2014/15, activity in 2 years before death
End of life care JSNA
End of life care JSNA - Recommendations Policy and evidence review Consultation and interviews Service mapping Technical document
End of life care JSNA - Recommendations 1 Policy and • Care planning and co-ordination. evidence review 2 • End of life care as ‘everybody’s business’ Consultation and interviews 3 • Clear strategic leadership Service mapping 4 • Coordinated education and training programme Technical document 5 • Easy access to evidence and information
Find the full JSNA and technical document here: http://jsna.info/endoflifecare Rianne van der Linde rvanderlinde@westminster.gov.uk London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster
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