Population Based Needs Assessment for Specialised Palliative Care

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1 Population Based Needs Assessment for Specialised Palliative Care May 2014 Supportive, Palliative and End of Life Care Group. Northern England Strategic Clinical Networks. 1

2 NHS England Population-Based Needs Assessment: Specialist Palliative Care. Prepared by the Northern England Strategic Clinical Networks Supportive, Palliative & End of Life Care Group Date: May

3 Contents Page Introduction 5 Findings 6 Resource Analysis Specialist palliative care beds 7 Workforce 9 Appendix 1 11 Specialist Palliative Care Beds Appendix 2 23 Epidemiological and demographic data Appendix 3 24 Comparative index of need 3

4 Introduction The Supportive and Palliative Care Peer Review Programme identified the need to undertake a network wide needs assessment of specialised palliative care (SPC) services. The purpose of the Peer Review Measure to undertake a needs assessment was to: ensure equitable access to high quality SPC to the population of the network identify priority areas within the network area identify priorities for service development within a service or locality. In response the Supportive, Palliative and End of Life Group (NSPCG) in consultation with SPC provider organisations, has undertaken this needs assessment. The findings will be shared with Clinical Commissioning Groups in order to: prioritise for service development and /or reconfiguration prioritise for workforce development further develop network operational policies. The assessment includes the populations of North Cumbria, Northumberland, Tyne & Wear, Durham, Darlington, Teesside and the Hambleton and Richmondshire Districts of North Yorkshire. Aim The Needs Assessment is to form the basis of a network wide proposal for the development of specialised palliative care services. Objectives To complete an assessment of the aggregate need of the population Mapping of current services To assess the current services and compare with the needs of the population To Identify service gaps in provision of specialist palliative care To present the collated information to the networks constituent Clinical Commissioning Groups. Methodology With reference to the NICE guidance for the organisation and planning of specialist palliative care services this population based needs assessment follows the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit in This method ensures that the calculated need accurately reflects the populations of the individual CCGs within the Northern England Clinical Network geographical area and adjusts for key issues such as deprivation and incidence of cancer deaths. The Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives (2012) was used to provide the recommendations of resources required. 4

5 Findings For the network overall there is a gap between the existing provision of specialist palliative care and that predicted by the needs assessment. The gap is widened by the higher than average levels of deprivation and deaths from cancer in many parts of North East England and North Cumbria. There is variation in provision of need in different parts of the Region. In broad terms, people in CCG areas north of the river Tyne have access to more specialist palliative care resource than those south of the river Tyne or in North Cumbria. Out of hours specialist advice for professionals is available throughout the region with the exception of County Durham and Darlington. Seven day working throughout the region is very limited. It should be noted that the report uses a nationally accepted approach and information gathering has been supported by all specialist providers in the region. It had been identified that the report does not allow for local variations in model of service, and does not reflect that in some areas there is a greater reliance on specialist community or home services rather than specialist beds. National definitions of specialist beds are clear but it has not been straightforward at network level to clarify the specialist nature of individual units. Locally, commissioners and providers will want to look at whether the beds included in this document meet national criteria and standards. Locally, stakeholders will also want to consider whether the services being delivered for their population are located in the right geographical areas or need to be closer to home. The report is limited to certain specialist services and only includes the provision of specialist nurses, doctors and number of beds. It does not explore provision of specialist Allied Health Professionals services, services for children or out of hour s services. 5

6 Specialist Palliative Care Beds: Gap analysis by CCG. Table 1 shows the calculated maximum gap between the current numbers of dedicated SPC beds compared with the maximum number of SPC beds required per CCG. The methodology adjusts population number by allocating a weighting to adjust for a number of factors. The in depth method and calculation can be found within appendix 2 that includes the epidemiological and demographic data and appendix 3 demonstrating the comparative index of need. 6

7 Table 1. Calculated gap between current number of beds and calculated recommended number of beds per CCG. Population Weighted Population Current Number of Specialist per 250k - Palliative Weighted Population Care beds * Current Number of Beds (all palliative care) ** GAP (current specialist beds vv weighted need ) minimum GAP (current specialist beds vv maimum weighted) maximum GAP (current specialist beds vv maximum weighted ) min max min max NHS CUMBRIA CCG 329, , % 57% NHS DARLINGTON CCG 105, , % 100% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272, , % 88% NHS NORTH DURHAM CCG 240, , % 77% TOTAL COUNTY DURHAM AND DARLINGTON 618, , % 86% NHS NORTHUMBERLAND CCG 316, , % 3% NHS NORTH TYNESIDE CCG 201, , % 23% NHS NEWCASTLE NORTH AND EAST CCG 139, , ^see note ^see note 0% NHS NEWCASTLE WEST CCG 140, , ^see note ^see note 0% TOTAL NEWCASTLE CCGs 279, , % 63% NHS GATESHEAD CCG 200, , % 73% NHS SOUTH TYNESIDE CCG 148, , % 63% NHS SUNDERLAND CCG 275, , % 67% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283, , % 85% NHS SOUTH TEES CCG 273, , % 76% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152, , % 100% Total Network Population 3,078,520 4,141, % 66% Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives 2012 * Specialist palliative care beds are defined in NICE guidance. ** Total number of palliative care beds including those without commissioned palliative medicine consultant support. ^ Newcastle North & East and West CCGs share beds. 7

8 Specialist Palliative Care Consultant and Nurses Required. Workforce Estimations within the Community This table is based on our best understanding of commissioned/funded posts rather than presently occupied posts. Community consultant sessions are all those not attributed to hospitals. This includes inpatient (hospice and palliative care units) and community sessions and any associated supporting professional activity. Community specialist nurse does not include any hospice based (day hospice or inpatient) specialist nurses and may therefore be underestimated. Table 2 Calculated by CCG for Community Care Population Weighted Population Total - Unweighted Need Total - Weighted Need Current Position unweighted need vv Current Position weighted need vv Current Position Consultants Nurses Consultants Nurses Consultants Nurses Consultants Nurses Consultants Nurses NHS CUMBRIA CCG 329, , % 113% 50% 99% NHS DARLINGTON CCG 105, , NHS DURHAM DALES, EASINGTON AND SEDGEFIELD 272, , NHS NORTH DURHAM CCG 240, , COUNTY DURHAM AND DARLINGTON 618, , % 103% 22% 74% NHS GATESHEAD CCG 200, , % 115% 33% 76% NHS NORTHUMBERLAND CCG 316, , % 120% 70% 111% NHS NORTH TYNESIDE CCG 201, , % 104% 59% 83% NHS NEWCASTLE NORTH AND EAST CCG 139, , NHS NEWCASTLE WEST CCG 140, , NEWCASTLE 279, , % 172% 24% 116% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283, , % 123% 52% 86% NHS SOUTH TEES CCG 273, , % 143% 36% 93% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY 152, , % 170% 31% 215% NHS SOUTH TYNESIDE CCG 148, , % 125% 17% 86% NHS SUNDERLAND CCG 275, , % 132% 23% 85% Network 3,078,520 4,141, % 125% 36% 93% Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives

9 Workforce Estimations within the Hospital Trusts Table 3 is based on the Commisioning guidance, stating that one consultant is required per 850 District General Hospital beds and one SPC nurse is required per 300 District General Hospital beds. The guidance also states the requirement of at least one hospital palliative care support team that has a minimum one physician and one nurse with SPC training should be available for a hospital with 250 beds. Some of our hospital trusts have fewer than 850 beds, those trusts and commissioners will want to consider the requirement to have 1WTE specialist physician. It is noted that a large secondary care hospitals and hospitals accepting tertiary referrals and management may need additional SPC professionals, including sub-specialisation roles and provision of additional support and education. This requirement has been included in the table below* Table 3 Calculated by Hospital Trusts Hospital Staffing - Estimated Need Current position Current position vv need Estimated number of beds Consultants Nurse Specialists (SPC) Consultants Nurse Specialists Consultants Nurse Specialists Hospital Trust Newcastle Hospitals NHSFT* ?1* 5.4* % 274% South Tees Hospitals NHSFT* ?1* 3.8* % 105% South Tyneside Healthcare NHSFT % 71% City Hospitals Sunderland NHSFT % 67% North Cumbria University Hospitals FT % 129% Gatheshead NHSFT % 59% Northumbria Healthcare NHSFT % 88% North Tees and Hartlepool NHSFT % 91% Co Durham & Darlington NHSFT % 92% Network % 86% Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives

10 Appendix 1 Calculated gap between current number of beds and calculated recommended number of beds per CCG. Table 4 Unweighted Populations Population per 250k - Unweighted Population 10 Current Number of Specialist Palliative Care beds * Current Number of Beds (all palliative care) ** minimum GAP (current specialist beds vv minimum unweighted ) Percentage GAP (current specialist beds vv minimum unweighted ) min max NHS CUMBRIA CCG 329, % NHS DARLINGTON CCG 105, % NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272, % NHS NORTH DURHAM CCG 240, % TOTAL COUNTY DURHAM AND DARLINGTON 618, % NHS NORTHUMBERLAND CCG 316, % NHS NORTH TYNESIDE CCG 201, % NHS NEWCASTLE NORTH AND EAST CCG 139, ^see note ^see note NHS NEWCASTLE WEST CCG 140, ^see note ^see note TOTAL NEWCASTLE CCGs 279, % NHS GATESHEAD CCG 200, % NHS SOUTH TYNESIDE CCG 148, % NHS SUNDERLAND CCG 275, % NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283, % NHS SOUTH TEES CCG 273, % NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152, % Total Network Population 3,078, %

11 Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives 2012 Table 5 Location of beds by CCG Current Number of Beds ** Location of current beds NHS CUMBRIA CCG SPC beds Eden Valley Hospice & 4 SPCWCH NHS DARLINGTON CCG 4 St Teresa's Hospice NHS DURHAM DALES, EASINGTON AND 3 SPC beds at St Cuthbert's, 2 SPC Beds at Hartlepool, 2 at St 11 SEDGEFIELD CCG Teresa's & 4 at Sedgefield Community Hospital NHS NORTH DURHAM CCG 11 7 SPC at St Cuthbert's, 4 beds at Willowburn NHS NORTHUMBERLAND CCG SPC Wansbeck, 4 SPC N Tyne GHSPC Marie Curie & 5SPC St Oswalds NHS NORTH TYNESIDE CCG SPC N Tyne GH, 2 SPC Marie Curie & 2.5 SPC St Oswalds TOTAL NEWCASTLE CCG SPC St Oswalds & 10 SPC Marie Curie NHS GATESHEAD CCG beds at QE, 6 SPC Marie Curie & 2 SPC St Oswalds NHS SOUTH TYNESIDE CCG 8 St Clare's Hopsice SPC beds NHS SUNDERLAND CCG 14 St Benedict's Hospice SPC beds NHS HARTLEPOOL AND STOCKTON CCG 16 6 SPC Hpool Hospice, 10 beds at Butterwick NHS SOUTH TEES CCG SPC Teesside Hospice NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 0 Total Network Population 186 ** Total number of palliative care beds including those without commissioned palliative medicine consultant support. 11

12 Appendix 2 Epidemiological and demographic data Table 6 Population: Age and Gender Structure All Ages Gender % over 60 years % over 75 years CCG Name Persons % Males % Females Total Males Females Total Males Females NHS CUMBRIA CCG 329, % 50.8% 28.4% 46.6% 53.4% 9.6% 40.7% 59.3% NHS DARLINGTON CCG 105, % 51.3% 23.9% 45.6% 54.4% 8.3% 39.7% 60.3% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272, % 51.2% 25.6% 46.1% 53.9% 8.4% 40.7% 59.3% NHS GATESHEAD CCG 200, % 51.1% 24.0% 45.6% 54.4% 8.4% 40.8% 59.2% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152, % 49.1% 28.2% 46.3% 53.7% 9.4% 41.5% 58.5% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283, % 51.1% 22.3% 45.7% 54.3% 7.6% 40.3% 59.7% NHS NEWCASTLE NORTH AND EAST CCG 139, % 49.6% 17.7% 45.5% 54.5% 6.5% 38.6% 61.4% NHS NEWCASTLE WEST CCG 140, % 50.1% 20.4% 45.3% 54.7% 7.4% 39.7% 60.3% NHS NORTH DURHAM CCG 240, % 50.9% 24.4% 46.0% 54.0% 7.8% 40.6% 59.4% NHS NORTH TYNESIDE CCG 201, % 51.8% 24.2% 44.3% 55.7% 8.6% 38.6% 61.4% NHS NORTHUMBERLAND CCG 316, % 51.2% 28.0% 46.1% 53.9% 9.2% 41.5% 58.5% NHS SOUTH TEES CCG 273, % 51.3% 23.5% 45.8% 54.2% 8.0% 40.5% 59.5% NHS SOUTH TYNESIDE CCG 148, % 51.7% 24.7% 44.4% 55.6% 8.9% 37.9% 62.1% NHS SUNDERLAND CCG 275, % 51.4% 23.7% 44.6% 55.4% 8.0% 39.5% 60.5% Network (sum of CCGs) 3,078, % 51.0% 24.6% 45.7% 54.3% 8.4% 40.2% 59.8% England 53,107, % 50.8% 22.4% 45.7% 54.3% 7.8% 40.5% 59.5% Source Mid-2011 Population Estimates for Clinical Commissioning Groups (CCGs) in England by Single Year of Age and Sex; bases on the results of the 2011 Census. 12

13 Annual Incidence of Deaths and Care Requirements by CCG Table 7 Cancer Mortality Source - The NHS Information Centre for health and social care. Crown Copyright. Source of data: National Statistics (Extracts may only be reproduced by permission.) NCHOD - Mortality from all causes (ICD10 A00-Y99); Mortality from all cancers (ICD10 C00-C97 13 All per 100,000 population (Crude)* Cancer Deaths per 100,000 population (Crude)* CCG Name Population All Deaths Cancer Deaths Cancer as % of Total NHS CUMBRIA CCG 329,342 3, % 1, NHS DARLINGTON CCG 105,584 1, % 1, NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 2, % 1, NHS GATESHEAD CCG 200,349 2, % 1, NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 1, % NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 2, % NHS NEWCASTLE NORTH AND EAST CCG 139,067 1, % NHS NEWCASTLE WEST CCG 140,025 1, % NHS NORTH DURHAM CCG 240,116 2, % 1, NHS NORTH TYNESIDE CCG 201,206 2, % 1, NHS NORTHUMBERLAND CCG 316,278 3, % 1, NHS SOUTH TEES CCG 273,532 2, % 1, NHS SOUTH TYNESIDE CCG 148,164 1, % 1, NHS SUNDERLAND CCG 275,330 2, % 1, Network (sum of CCGs) 3,078,520 31,222 8, % 1, England 53,107, , , %

14 Table 8 Non-Cancer Deaths and Total Numbers Requiring Palliative Care Non-Cancer Deaths per 100,000 population (crude)* Non Cancer Deaths Non Cancer - Palliative Cancer Care Palliative Need Care Need Total Palliative Care Need CCG Name Population All Deaths Cancer Deaths NHS CUMBRIA CCG 329,342 3, ,579 1, ,671 NHS DARLINGTON CCG 105,584 1, NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 2, ,964 1, ,181 NHS GATESHEAD CCG 200,349 2, , ,583 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 1, NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 2, ,886 1, ,986 NHS NEWCASTLE NORTH AND EAST CCG 139,067 1, ,030 NHS NEWCASTLE WEST CCG 140,025 1, NHS NORTH DURHAM CCG 240,116 2, ,806 1, ,856 NHS NORTH TYNESIDE CCG 201,206 2, , ,635 NHS NORTHUMBERLAND CCG 316,278 3, ,338 1, ,512 NHS SOUTH TEES CCG 273,532 2, ,917 1, ,134 NHS SOUTH TYNESIDE CCG 148,164 1, , ,305 NHS SUNDERLAND CCG 275,330 2, ,117 1, ,201 Network (sum of CCGs) 3,078,520 31,222 8, ,274 14,857 8,947 21,603 England 53,107, , , , , , ,325 Source -The NHS Information Centre for health and social care. Crown Copyright. Source of data: National Statistics (Extracts may only be reproduced by permission.) NCHOD - Mortality from all causes (ICD10 A00-Y99); Mortality from all cancers (ICD10 C00-C97 14

15 Prevalence of Problems/Symptoms Table 9 Cancer Patients CCG Name Cancer Deaths Symptom Trouble with Vomiting or Sleeplessness Mental Loss of Const- Loss of Bladder Unpleasant Loss of Bowel Pain Breathing Feeling Sick Confusion Depression Appetite ipation Bedsores Control Control Smell 84% 47% 51% 51% 33% 38% 71% 47% 28% 37% 25% 19% NHS CUMBRIA CCG NHS DARLINGTON CCG NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG NHS GATESHEAD CCG NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG NHS NEWCASTLE NORTH AND EAST CCG NHS NEWCASTLE WEST CCG NHS NORTH DURHAM CCG NHS NORTH TYNESIDE CCG NHS NORTHUMBERLAND CCG NHS SOUTH TEES CCG NHS SOUTH TYNESIDE CCG NHS SUNDERLAND CCG Network (sum of CCGs) 8,947 7,516 4,205 4,563 4,563 2,953 3,400 6,353 4,205 2,505 3,311 2,237 1,700 Source - Expected prevalence of problems taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit

16 Table 10 Non-Cancer Patients CCG Name Non-cancer Deaths Symptom Trouble with Vomiting or Sleeplessness Mental Loss of Const- Loss of Bladder Unpleasant Loss of Bowel Pain Breathing Feeling Sick Confusion Depression Appetite ipation Bedsores Control Control Smell 67% 49% 27% 36% 38% 36% 38% 32% 14% 33% 22% 13% NHS CUMBRIA CCG 2, NHS DARLINGTON CCG NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 1, NHS GATESHEAD CCG 1, NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 1, NHS NEWCASTLE NORTH AND EAST CCG NHS NEWCASTLE WEST CCG NHS NORTH DURHAM CCG 1, NHS NORTH TYNESIDE CCG 1, NHS NORTHUMBERLAND CCG 2, NHS SOUTH TEES CCG 1, NHS SOUTH TYNESIDE CCG 1, NHS SUNDERLAND CCG 2, Network (sum of CCGs) 22,274 14,924 10,914 6,014 8,019 8,464 8,019 8,464 7,128 3,118 7,350 4,900 2,896 Source - Expected prevalence of problems taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit

17 Recorded Place of Death Table 11 Preferred and Actual Place of Death (All Causes) Preferred Place of Death * Place of Death (% Persons, All Ages) Home Hospice Hospital Care Home Hopspital Home Care Home Hospice Darlington CCG 67% 26% 4% 3% 46% 21% 25% 5% Durham Dales, Easington & Sedgefield CCG 67% 26% 4% 3% 51% 24% 19% 2% Gateshead CCG 67% 26% 4% 3% 59% 21% 14% 4% Newcastle North & East CCG 67% 26% 4% 3% 53% 22% 18% 5% Newcastle West CCG 67% 26% 4% 3% 51% 23% 17% 6% North Durham CCG 67% 26% 4% 3% 49% 22% 20% 6% Hartlepool and Stockton-on-Tees CCG 67% 26% 4% 3% 50% 22% 20% 5% Northumberland CCG 67% 26% 4% 3% 54% 21% 21% 2% South Tees CCG 67% 26% 4% 3% 56% 22% 17% 2% South Tyneside CCG 67% 26% 4% 3% 62% 22% 10% 5% Sunderland CCG 67% 26% 4% 3% 57% 23% 14% 4% Cumbria CCG 67% 26% 4% 3% 49% 24% 21% 5% Hambelton, Richmondshire and Whitby CCG 67% 26% 4% 3% 49% 25% 21% 1% North Tyneside CCG 67% 26% 4% 3% 53% 21% 23% 2% * Preferences derived from Local preferences and place of death in regions within England 2010, Cicely Saunders Foundation, August 2011 Source Place of Death All - End of Life Care Profiles 2014 Public Health England 17

18 Table 12 Place of Death Cancer Patients Preferred Place of Death * Actual - Cancer Deaths PCT data ~ Home Hospice Hospital Care Home Home Hospice Hospital Other Darlington CCG 67% 26% 4% 3% 35% 14% 29% 21% Durham Dales, Easington & Sedgefield CCG 67% 26% 4% 3% 32% 15% 28% 26% Gateshead CCG 67% 26% 4% 3% 34% 11% 30% 24% Newcastle North & East CCG 67% 26% 4% 3% 27% 12% 52% 9% Newcastle West CCG 67% 26% 4% 3% 29% 21% 31% 19% North Durham CCG 67% 26% 4% 3% 31% 16% 26% 27% Hartlepool and Stockton-on-Tees CCG 67% 26% 4% 3% 34% 17% 37% 11% Northumberland CCG 67% 26% 4% 3% 34% 17% 37% 11% South Tees CCG 67% 26% 4% 3% 34% 11% 30% 24% South Tyneside CCG 67% 26% 4% 3% 26% 5% 13% 56% Sunderland CCG 67% 26% 4% 3% 31% 6% 34% 30% Cumbria CCG 67% 26% 4% 3% 31% 8% 7% 54% Hambelton, Richmondshire and Whitby CCG 67% 26% 4% 3% 23% 15% 16% 46% North Tyneside CCG 67% 26% 4% 3% 36% 14% 6% 44% * Preferences derived from Local preferences and place of death in regions within England 2010, Cicely Saunders Foundation, August 2011 ~ Source Place of Death Cancer Cancer Commissioning Toolkit September

19 Ethnic Composite and Religion of Population Table 13 Ethnicity Ethnicity White Mixed Asian or Asian British Black or Black British Chinese or Other NHS CUMBRIA CCG 98.5% 0.5% 0.8% 0.1% 0.1% NHS DARLINGTON CCG 96.2% 1.1% 2.1% 0.3% 0.2% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 98.8% 0.5% 0.5% 0.1% 0.1% NHS GATESHEAD CCG 96.3% 0.8% 1.9% 0.5% 0.5% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 97.3% 0.8% 1.3% 0.5% 0.2% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 95.6% 0.9% 2.8% 0.5% 0.2% NHS NEWCASTLE NORTH AND EAST CCG 89.3% 1.5% 6.5% 1.5% 1.2% NHS NEWCASTLE WEST CCG 81.7% 1.6% 12.9% 2.2% 1.7% NHS NORTH DURHAM CCG 97.5% 0.7% 1.4% 0.2% 0.2% NHS NORTH TYNESIDE CCG 96.6% 0.9% 1.9% 0.4% 0.2% NHS NORTHUMBERLAND CCG 98.4% 0.5% 0.8% 0.1% 0.1% NHS SOUTH TEES CCG 93.3% 1.2% 4.3% 0.7% 0.6% NHS SOUTH TYNESIDE CCG 95.9% 0.9% 2.2% 0.3% 0.7% NHS SUNDERLAND CCG 95.9% 0.6% 2.7% 0.5% 0.3% ENGLAND 85.5% 2.2% 7.7% 3.8% 1.0% Source - Table QS211: 2011 Census: Ethnic group (detailed), Middle Layer Super Output Areas (MSOAs) and Lower Layer Super Output Areas (LSOAs) in England and Wales mapped to CCGs 19

20 Table 14 Religion Religion Christian Buddhist Hindu Jewish Muslim Sikh Other None Not Stated NHS CUMBRIA CCG 71.8% 0.3% 0.1% 0.0% 0.3% 0.0% 0.3% 20.3% 6.9% NHS DARLINGTON CCG 67.4% 0.3% 0.3% 0.0% 0.9% 0.3% 0.3% 24.1% 6.4% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 74.0% 0.1% 0.1% 0.0% 0.2% 0.1% 0.3% 19.4% 5.8% NHS GATESHEAD CCG 67.0% 0.2% 0.2% 1.5% 1.0% 0.2% 0.3% 23.9% 5.7% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 71.2% 0.4% 0.4% 0.0% 0.3% 0.0% 0.3% 20.5% 6.9% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 68.8% 0.2% 0.3% 0.0% 1.7% 0.3% 0.2% 22.4% 6.2% NHS NEWCASTLE NORTH AND EAST CCG 55.8% 0.6% 1.0% 0.2% 3.1% 0.4% 0.3% 32.1% 6.5% NHS NEWCASTLE WEST CCG 57.1% 0.6% 1.3% 0.2% 9.4% 0.5% 0.2% 24.6% 6.1% NHS NORTH DURHAM CCG 69.8% 0.3% 0.2% 0.1% 0.6% 0.1% 0.3% 22.6% 6.1% NHS NORTH TYNESIDE CCG 63.8% 0.2% 0.3% 0.0% 0.7% 0.2% 0.3% 28.1% 6.4% NHS NORTHUMBERLAND CCG 68.6% 0.2% 0.1% 0.1% 0.3% 0.2% 0.3% 23.9% 6.4% NHS SOUTH TEES CCG 66.8% 0.2% 0.2% 0.0% 3.8% 0.2% 0.2% 22.2% 6.3% NHS SOUTH TYNESIDE CCG 70.3% 0.2% 0.2% 0.0% 1.9% 0.3% 0.2% 21.1% 5.8% NHS SUNDERLAND CCG 70.3% 0.2% 0.2% 0.0% 1.3% 0.3% 0.2% 21.9% 5.6% ENGLAND 59.4% 0.5% 1.5% 0.5% 5.0% 0.8% 0.4% 24.7% 7.2% Source - LC2107EW - Religion by sex by age; ONS Crown Copyright Reserved [from Nomis on 21 January

21 People Living in Households Table 15 Table 9 - Households Total Households Single Person Households % of Total Pensioners Living Alone (aged > 65) % of Single Households Other All Pensioner Households (Single Family over 65) Total All Pensioner Households % of Total Households NHS Cumbria 224,767 72, % 32, % 36,372 69, % NHS Darlington 46,670 15, % 6, % 6,188 12, % NHS Durham Dales, Easington and Sedgefield 120,747 37, % 16, % 17,392 34, % NHS Gateshead 89,154 29, % 12, % 11,979 24, % NHS Hambleton, Richmondshire and Whitby 63,345 18, % 9, % 11,308 20, % NHS Hartlepool and Stockton-on-Tees 119,593 35, % 14, % 15,593 30, % NHS Newcastle North and East 58,356 20, % 7, % 5,475 12, % NHS Newcastle West 58,797 20, % 7, % 6,637 14, % NHS North Durham 103,056 32, % 13, % 14,586 28, % NHS North Tyneside 91,295 30, % 12, % 11,715 24, % NHS Northumberland 138,534 41, % 19, % 22,463 41, % NHS South Tees 116,808 36, % 16, % 15,975 32, % NHS South Tyneside 67,167 23, % 9, % 8,884 18, % NHS Sunderland 119,758 38, % 16, % 16,242 32, % Network (sum of CCGs) 1,418, , % 194, % 200, , % England 22,063,368 6,666, % 2,725, % 1,851,180 4,576, % Source - QS111EW - Household life stage; ONS Crown Copyright Reserved [from Nomis on 21 January 2014]

22 Socio-Economic Data Table 16 Indices of Deprivation Source Derived from IMD for LSOAs LSOAs in top 10% - Most Deprived LSOAs in bottom 10% - Least Deprivation CCG Rank (based on average of LSOA scores) - n= 211 LSOAs in Average of LSOAs in LSOAs in bottom LSOAs in LSOA Table 10/11 Deprivation Population LSOAs top 20% top 30% 30% bottom 20% Ranks NHS CUMBRIA CCG 329, NHS DARLINGTON CCG 105, NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272, NHS GATESHEAD CCG 200, NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152, NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283, NHS NEWCASTLE NORTH AND EAST CCG 139, NHS NEWCASTLE WEST CCG 140, NHS NORTH DURHAM CCG 240, NHS NORTH TYNESIDE CCG 201, NHS NORTHUMBERLAND CCG 316, NHS SOUTH TEES CCG 273, NHS SOUTH TYNESIDE CCG 148, NHS SUNDERLAND CCG 275, Network total (sum of CCGs) 3,078,

23 Appendix 3 Comparative index of need Table 17 Index of need Cancer Table 12/13 - Index of Comparative Need Cancer Deaths per 100k Index Value Deprivation Modifier Modified Index Value Network Need Index Value Effect on Resource Need NHS CUMBRIA CCG % NHS DARLINGTON CCG % NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG % NHS GATESHEAD CCG % NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG % NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG % NHS NEWCASTLE NORTH AND EAST CCG % NHS NEWCASTLE WEST CCG % NHS NORTH DURHAM CCG % NHS NORTH TYNESIDE CCG % NHS NORTHUMBERLAND CCG % NHS SOUTH TEES CCG % NHS SOUTH TYNESIDE CCG % NHS SUNDERLAND CCG % Source Methodology taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit

24 Table 18 Index of Need - Non Cancer Table 12/13 - Index of Comparative Need Non Cancer Deaths per 100k Index Value Deprivatio n Modifier Modified Index Value Network Need Index Value Effect on Resource Need NHS CUMBRIA CCG % NHS DARLINGTON CCG % NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG % NHS GATESHEAD CCG % NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG % NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG % NHS NEWCASTLE NORTH AND EAST CCG % NHS NEWCASTLE WEST CCG % NHS NORTH DURHAM CCG % NHS NORTH TYNESIDE CCG % NHS NORTHUMBERLAND CCG % NHS SOUTH TEES CCG % NHS SOUTH TYNESIDE CCG % NHS SUNDERLAND CCG % Source Methodology taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit

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