March 2018 CCG localities profile for Hertfordshire

Transcription

1 March 2018 CCG localities profile for Hertfordshire Purpose This report presents key population and health data for the ten NHS Clinical Commissioning Group (CCG) localities in Hertfordshire. It includes current and future population structures as well as rates of selected emergency hospital admissions, premature mortality and recorded disease prevalence. The data builds a picture of each CCG locality relative to others across the county and to its respective CCG. It is intended to provide clinical commissioners with an overview of key indicators of health needs and health service demand in each locality area and is an update to the 2016 report. Key messages There is considerable variation in health outcomes across Hertfordshire s CCG localities, with rates of avoidable emergency admissions for acute and chronic conditions in localities with the highest rates double that of those with the lowest rates. The same is true for children admitted as an emergency for asthma, diabetes, epilepsy or lower respiratory tract infections, as well as premature mortality from respiratory disease and potential years of life lost from cerebrovascular disease. Rates of emergency admissions for children with lower respiratory tract infections have seen a statistically significant increase over the last three years across Hertfordshire s two main CCGs, whilst rates of emergency re-admissions within 30 days have decreased. Hypertension (13%), obesity (8-9%) and depression (8-9%) have the highest prevalence of the GP QOF registers, in line with national trends. Authors This profile was created by Claire Tiffany (Senior Public Health Analyst, Hertfordshire County Council), with input from David Hodson (Head of Information, NHS East and North Hertfordshire CCG) and Julia Lisk (Public Health & Programmes Information Lead, NHS Herts Valleys CCG). It was reviewed by David Conrad (Consultant in Public Health, Hertfordshire County Council). 1

2 Contents Introduction... 3 Clinical Commissioning Group (CCG) localities in Hertfordshire... 3 About the data... 4 Summary: NHS East and North Hertfordshire CCG localities... 6 Summary: NHS Herts Valleys CCG localities... 9 Population NHS East and North Hertfordshire CCG registered population NHS Herts Valleys CCG registered population CCG resident population projections Deprivation GP recorded (QOF) disease prevalence Tartan Rug Emergency admissions and mortality Tartan Rug Emergency admissions Avoidable emergency admissions (acute and chronic) Acute conditions that should not require hospital admission Unplanned hospitalisation for chronic ambulatory care sensitive conditions Emergency re-admissions within 30 days Children with asthma, diabetes and epilepsy Children with lower respiratory tract infection Mortality Potential years of life lost (PYLL) from causes considered amenable to healthcare Potential years of life lost (PYLL) from ischaemic heart disease Potential years of life lost (PYLL) from neoplasms Potential years of life lost (PYLL) from cerebrovascular disease Potential years of life lost (PYLL) from respiratory diseases Premature mortality from cancer Premature mortality from cardiovascular disease Premature mortality from respiratory disease Premature mortality from liver disease

3 Introduction Clinical Commissioning Group (CCG) localities in Hertfordshire Clinical Commissioning Groups (CCGs) are NHS organisations responsible for planning, designing and buying health services on behalf of their local populations. Hertfordshire has two main CCGs: NHS East and North Hertfordshire CCG and NHS Herts Valleys CCG. Both CCGs consist of smaller geographical areas called localities based on the registered populations of groups of GP practices. There are ten CCG localities in total, only three of which (Dacorum, St Albans and Harpenden, Stevenage) are coterminous with Hertfordshire s ten local authority districts as shown in Figure 1. NHS East and North Hertfordshire CCG Localities: CCG encompasses the areas covered by: Lower Lea Valley Broxbourne Borough Council North Hertfordshire East Hertfordshire District Council Stevenage North Hertfordshire District Council* Stort Valley and Villages Stevenage Borough Council Upper Lea Valley Welwyn Hatfield Borough Council Welwyn Hatfield *except for the Royston area which is covered by NHS Cambridgeshire and Peterborough CCG NHS Herts Valleys CCG Localities: CCG encompasses the areas covered by: Dacorum Dacorum Borough Council Hertsmere Hertsmere Borough Council St Albans and Harpenden St Albans City & District Council Watford and Three Rivers Three Rivers District Council Watford Borough Council Figure 1: CCG localities and local authority districts in Hertfordshire (Royston is not included in ENHCCG) 3

4 About the data Introduction Summaries of key findings for each of the CCG localities have been provided followed by a detailed breakdown of the data. Data are presented on population, deprivation, emergency admissions, mortality and Quality and Outcomes Framework (QOF) prevalence data for each CCG and for each CCG locality. GP practice level QOF prevalence tartan rugs for Hertfordshire s two main CCGs are available from the data tools and reports section of Methodology and definitions Populations: All indicators in this report use GP registered populations, except for the population projection estimates which use the resident populations. Registered populations are based on the location of the GP practice, whilst resident populations are based on where people live. Directly age-standardised rates (DSR): Differences in hospital admissions and deaths between CCG localities will be partly due to the differences in the underlying population age structure. DSRs have been used to allow comparisons between localities with different demographic characteristics by controlling for the differences in the underlying population. The DSR for a locality is the number of admissions or deaths per 100,000 population that would occur in a standard reference population if that standard population had the age-specific rates (based on 5-year age-bands) of the population of interest. This report uses ONS mid-year estimates for England as the reference population. Confidence Intervals (s): s are a measure of the statistical precision of a value (for example mortality rates) and show the range of uncertainty (caused by sample size and random variation) around the value. Calculations based on smaller sample sizes tend to result in wider s. The wider the the greater the uncertainty in the value. In public health, the conventional practice is to use 95% s. This represents the probability that the interval includes the true value. s are presented on the charts as bars or whiskers extending above and below the value. They are important to consider when interpreting data and comparing areas or trends to assess whether differences are real or statistically significant. If the s around a figure do not overlap with the interval around another then we can be certain that there is a statistically significant difference between the data points. If the around a figure overlaps with the interval around another, we cannot say with certainty that there is more than a chance difference between the two figures. Potential Years of Life Lost (PYLL): PYLL from causes considered amenable to healthcare measures the number of years of life lost per 100,000 registered patients from conditions which are usually treatable. ONS 2014-based life expectancies have been used to calculate the PYLL in this report. Quality and Outcomes Framework (QOF) GP recorded prevalence: The percentage of patients with selected diseases (cardiovascular, respiratory, mental health and neurology, musculoskeletal, high dependency and other long-term conditions) or obesity, as recorded on the practice disease register. QOF prevalence percentages are crude because they are not adjusted to account for patient age distribution or other factors that may differ between general practices. It can be difficult to interpret QOF registers as they are based on recorded rather than actual prevalence so may under-report certain groups or diseases. QOF registers may also reflect different coding practices and case finding priorities. 4

5 Introduction Tartan Rugs : Tartan rugs are colour coded data tables which allow quick comparison of a large number of indicators against a comparator area, in this case the respective CCG. Each tartan rug comes with a key to help interpret the data. Cell colour is determined by statistical significance. Significance in this sense is a measure of whether any difference is statistically meaningful, rather than a subjective judgement. This involves colouring cells according to whether their confidence intervals, the margin of error associated with the value of the indicator, overlap the confidence intervals of the comparator area. Areas where the confidence intervals overlap with the comparator area are said to be Not Significantly Different. Where confidence intervals do not overlap, higher or lower values can be judged to be Significantly Better or Significantly Worse. Value judgements are not ascribed to the QOF indicators; for example, recorded instances of diabetes could be seen to be better because they are high (suggesting few unrecorded cases of diabetes) or because they are low (suggesting few cases of diabetes). In these cases, the terms Significantly Higher or Significantly Lower are used. The QOF tartan rug is based on 95% s using the Wilson method. This may differ from methodologies used elsewhere and on Public Health England data tools. It is important to note that interventions should not be planned simply based on the colour of a cell in the rug in relation to a particular indicator but should also take into account the ability of an intervention to make a difference, current priorities in the area and associated factors which may affect the indicator. While an area may not be significantly different than the comparator area for a particular indicator, a robust intervention here could make more of an impact than a weak intervention on an indicator which is significantly worse. Data Sources - Deaths (Local analysis using Primary Care Mortality Database, based on year of registration) - Emergency hospital admissions (Local analysis of Secondary Uses Service (SUS) data) - GP registered populations (NHS Digital) - Index of Multiple Deprivation 2015 (Ministry of Housing, Communities & Local Government) - Population Estimates and Projections (ONS) - QOF GP recorded prevalence (NHS Digital) Methodological changes from 2016 report - Emergency admission rates are directly standardised against the England Mid-Year Estimate (previously European Standard Population) - NHS Herts Valleys CCG used different software to analyse hospital admissions - Life expectancies updated from 2012 to 2014 for Potential Years of Life Lost (PYLL) 5

6 Summary: NHS East and North Hertfordshire CCG localities Of the six CCG localities in NHS East and North Hertfordshire CCG, Stevenage experienced the poorest outcomes across the selected emergency hospital admission and mortality indicators, whilst Upper Lea Valley experienced the best. Welwyn Hatfield experienced statistically significant worsening in 7 out of 15 of the admission and mortality indicators, the most across the CCG localities. Lower Lea Valley has the highest deprivation levels but sits in the middle in terms of the selected outcomes. CCG rates of emergency admissions for children with lower respiratory tract infections and potential years of life lost (PYLL) from respiratory diseases have both seen statistically significant increases over time, whilst emergency re-admissions within 30 days, PYLL (overall), PYLL from ischaemic heart disease and PYLL from cancer (neoplasms) have all decreased. Hypertension (13.4%), obesity (9.0%) and depression (8.7%) have the highest prevalence of the 20 GP QOF registers, in line with national trends. Stevenage has the highest GP recorded prevalence of obesity and depression. The tartan rugs on page 21 and 22 summarise each of the indicators at locality level compared to the CCG. Written high level summaries for each CCG locality are given below. Lower Lea Valley The population age structure is similar to the CCG. Lower Lea Valley has the highest level of overall deprivation in the CCG. 20% of children under 16 live in low income families and 16% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally similar to or lower than the CCG average, with four of the 20 indicators statistically significantly higher and six lower than the CCG average (see page 21). The hypertension and rheumatoid arthritis registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Dementia and epilepsy have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with two out of 15 statistically significantly worse (see page 22). The rate of potential years of life lost (PYLL) from respiratory diseases has increased statistically significantly over time. North Herts The population age structure is older than the CCG average. 13% of children under 16 live in low income families, whilst 13% of older people aged 60 or over experience income deprivation. QOF prevalence indicators vary when compared to the CCG average, with nine of the 20 indicators statistically significantly higher and five lower than the CCG average (see page 21). The coronary heart disease, stroke/ TIA, asthma, dementia and mental health registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Depression and rheumatoid arthritis have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with five out of 15 statistically significantly worse (see page 22). 6

7 Summary: NHS East and North Hertfordshire CCG localities Stevenage The population age structure is younger than the CCG average. 20% of children under 16 live in low income families, whilst 15% of older people aged 60 or over experience income deprivation. QOF prevalence indicators vary when compared to the CCG average, with six of the 20 indicators statistically significantly higher and six lower than the CCG average (see page 21). The chronic obstructive pulmonary disease, obesity, diabetes, palliative care, depression and epilepsy registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Atrial fibrillation, cancer, chronic kidney disease and osteoporosis have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally statistically significantly worse than the CCG average (10 out of 15 indicators) with the remainder showing no statistically significant difference (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), acute and chronic conditions (considered avoidable) combined, children with lower respiratory infections and rates of potential years of life lost (PYLL) from respiratory diseases have increased statistically significantly over time. Stort Valley and Villages The population age structure shows a slightly higher proportion of people in their 40s. Stort Valley and Villages has the lowest level of overall deprivation in the CCG, however 8% of children under 16 live in low income families and 10% of older people aged 60 or over experience income deprivation. QOF prevalence indicators vary when compared to the CCG average, with six of the 20 indicators statistically significantly higher and eight lower than the CCG average (see page 21). The heart failure, cancer, chronic kidney disease, learning disability and osteoporosis registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Stroke/ TIA, chronic obstructive pulmonary disease, obesity, diabetes and palliative care have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average, with only one out of 15 statistically significantly worse (see page 22). Rates of potential years of life lost (PYLL) from cerebrovascular disease have increased statistically significantly over time. Upper Lea Valley The population age structure is older than the CCG average. 11% of children under 16 live in low income families, whilst 11% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally similar to the CCG average, with two of the 20 indicators statistically significantly higher and four lower than the CCG average (see page 21). The atrial fibrillation register has the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Mental health has the lowest prevalence of the CCG s localities and is statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average (see page 22). 7

8 Summary: NHS East and North Hertfordshire CCG localities Welwyn Hatfield The population age structure is younger than the CCG average. 16% of children under 16 live in low income families, whilst 14% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally similar to or below the CCG average, with one of the 20 indicators statistically significantly higher and seven lower than the CCG average (see page 21). The coronary heart disease, hypertension and asthma registers have the lowest recorded prevalence of the CCG s localities as well as being statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally similar to the CCG average, although seven out of 15 are statistically significantly worse (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), acute and chronic conditions (considered avoidable) combined, children with lower respiratory infections and rates of overall potential years of life lost (PYLL), PYLL from cerebrovascular disease, cancer (neoplasms) and respiratory diseases have increased over time. 8

9 Summary: NHS Herts Valleys CCG localities Of the four CCG localities in NHS Herts Valleys CCG, Watford and Three Rivers experienced the poorest outcomes across the selected emergency hospital admission and mortality indicators, whilst St Albans and Harpenden experienced the best. Watford and Three Rivers has the highest overall level of deprivation. CCG rates of emergency admissions for acute conditions (considered avoidable), emergency admissions for children with lower respiratory tract infections and potential years of life lost (PYLL) from cerebrovascular and respiratory diseases have all seen statistically significant increases over time, whilst emergency re-admissions within 30 days, PYLL from ischaemic heart disease and premature mortality from cardiovascular disease have all decreased. Hypertension (12.5%), obesity (8.1%) and depression (8.4%) have the highest prevalence of the 20 GP QOF registers, in line with national trends. Dacorum has the highest GP recorded prevalence for these indicators. The tartan rugs on page 21 and 22 summarise each of the indicators at locality level compared to the CCG. Written high level summaries for each CCG locality are given below. Dacorum Overall, the population age structure is similar to the CCG. 13% of children under 16 live in low income families, whilst 12% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally similar to or higher than the CCG average, with 10 of the 20 indicators statistically significantly higher than the CCG average (see page 21). The hypertension, peripheral arterial disease, obesity, depression, osteoporosis and rheumatoid arthritis registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Rates of selected emergency hospital admission and mortality indicators are similar to or better than the CCG average (see page 22). Hertsmere Overall, the population age structure is similar to the CCG. 13% of children under 16 live in low income families, whilst 14% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally higher than the CCG average, with 14 of the 20 indicators statistically significantly higher and one lower than the CCG average (see page 21). The atrial fibrillation, coronary heart disease, heart failure, stroke/ TIA, chronic obstructive pulmonary disease, cancer, chronic kidney disease, palliative care and dementia registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally similar to or better than the CCG average, with two out of 15 statistically significantly worse (see page 22). 9

10 Summary: NHS Herts Valleys CCG localities St Albans and Harpenden The population age structure shows higher proportions of 5-14 and year olds compared to the CCG average. St Albans and Harpenden has the lowest level of overall deprivation in the CCG, however 8% of children under 16 live in low income families and 10% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally lower than the CCG average, with one of the 20 indicators statistically significantly higher and 14 lower than the CCG average (see page 21). The asthma register has the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Coronary heart disease, heart failure, hypertension, peripheral arterial disease, stroke/ TIA, chronic obstructive pulmonary disease, obesity, chronic kidney disease, diabetes, palliative care, dementia, depression, learning disability and osteoporosis have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally better than or similar to the CCG average, with only one out of 15 indicators statistically significantly worse (see page 22). Rates of overall potential years of life lost (PYLL) and PYLL from cancer (neoplasms) and respiratory diseases have increased statistically significantly over time. Watford and Three Rivers The population age structure is younger than the CCG average, with a higher proportion of year olds. Watford and Three Rivers has the highest level of overall deprivation in the CCG. 12% of children under 16 live in low income families and 14% of older people aged 60 or over experience income deprivation. QOF prevalence indicators are generally similar to the CCG average, with three of the 20 indicators statistically significantly higher and two lower than the CCG average (see page 21). The diabetes and learning disability registers have the highest recorded prevalence of the CCG s localities as well as being statistically significantly higher than the CCG average. Atrial fibrillation and cancer have the lowest prevalence of the CCG s localities and are statistically significantly lower than the CCG average. Rates of selected emergency hospital admission and mortality indicators are generally worse than the CCG average (eight out of 15 indicators), with the remainder similar to or better than the CCG (see page 22). Rates of emergency admissions for acute conditions (considered avoidable), children with lower respiratory infections and rates of potential years of life lost (PYLL) from cerebrovascular diseases have increased statistically significantly over time. 10

11 Population The following charts are based on GP registered populations as at 1 st October 2017 taken from Open Exeter, published by NHS Digital. NHS East and North Hertfordshire CCG registered population In October 2017 NHS East and North Hertfordshire CCG had a registered population of 595,000. Compared to Hertfordshire s registered population NHS East and North Hertfordshire CCG has a slightly higher proportion of year olds. Upper Lea Valley locality has the largest population with 124,795 people, 21% of the total CCG population, whilst Lower Lea Valley has the lowest at 75,679 (13%). Stevenage locality has the highest proportion of under 5s (6.4%) and under 20s (24.4%), whilst North Herts locality has the highest proportion of over 65s (18.7%), and over 85s (2.6%) as shown in Table 1 below. Table 1: Population breakdown of NHS East and North Hertfordshire CCG and localities, Oct 2017 All ages Under 5s Under 20s 65 and overs 85 and overs AREA No No % No % No % No % Lower Lea Valley 75,679 4, , , , North Herts 115,954 6, , , , Stevenage 96,007 6, , , , Stort Valley and Villages 61,324 3, , , , Upper Lea Valley 124,795 6, , , , Welwyn Hatfield 121,237 7, , , , ENHCCG TOTAL 594,996 34, , , , Data source: Open Exeter, NHS Digital 11

12 Population: NHS East and North Hertfordshire CCG localities Lower Lea Valley locality has a similar population structure to the CCG. Compared to the CCG North Herts locality has a lower proportion of people in their 20s. 12

13 Population: NHS East and North Hertfordshire CCG localities Compared to the CCG Stevenage locality has: a higher proportion of under 10s and year olds. a lower proportion of year olds. Compared to the CCG Stort Valley and Villages locality has: a higher proportion of and year olds. a lower proportion of under 5s, and year olds. 13

14 Population: NHS East and North Hertfordshire CCG localities Compared to the CCG Upper Lea Valley locality has: a higher proportion of year olds. a lower proportion of year olds. Compared to the CCG Welwyn Hatfield locality has: a higher proportion of year olds (University of Hertfordshire is based in this locality). a lower proportion of and 65-74year olds. 14

15 Population NHS Herts Valleys CCG registered population In October 2017 NHS Herts Valleys CCG had a registered population of 641,800. NHS Herts Valleys CCG has a similar population structure to Hertfordshire s registered population. The largest difference is a slightly lower proportion of year olds. Watford and Three Rivers locality has the largest population with 212,415 people, 33% of the total CCG population, whilst Hertsmere has the lowest at 105,334 (16%). Watford and Three Rivers and Dacorum localities haves the highest proportion of under 5s (6.2%), whilst St Albans and Harpenden locality has the highest proportion of under 20s (25.4%). Hertsmere locality has the highest proportion of over 65s (17.4%), and over 85s (2.6%) as shown in Table 2 below. Table 2: Population breakdown of NHS Herts Valleys CCG and localities, Oct 2017 All ages Under 5s Under 20s 65 and overs 85 and overs AREA No No % No % No % No % Dacorum 167,499 10, , , , Hertsmere 105,334 6, , , , St Albans and Harpenden 156,521 9, , , , Watford and Three Rivers 212,415 13, , , , HVCCG TOTAL 641,769 39, , , , Data source: Open Exeter, NHS Digital 15

16 Population: NHS Herts Valleys CCG localities Compared to the CCG Dacorum locality has a higher proportion of year olds. Compared to the CCG Hertsmere locality has a lower proportion of year olds. 16

17 Population: NHS Herts Valleys CCG localities Compared to the CCG St Albans and Harpenden locality has: a higher proportion of 5-14 and year olds. a lower proportion of year olds. Compared to the CCG Watford and Three Rivers locality has a higher proportion of year olds. 17

18 CCG resident population projections Population 2014 based Office of National Statistics (ONS) population projections, below, show changes over the next ten years based on the CCG area people live in (the resident population). Population projections are available at local authority district level but not at GP practice or CCG locality level. NHS East and North Hertfordshire CCG resident population is projected to increase by ten per cent over the next ten years to an estimated 626,100 in The largest increases are in the older age groups, with 24,700 (25%) more people aged 65 or over in 2027 compared to 2017 and 3,200 (62%) more people aged 90 or over as shown in Table 3 and population pyramid (right). Not all age groups are predicted to increase. A decrease of 7% is predicted for people in their 20s and 10% for those aged Table 3: Population Projections, NHS East and North Hertfordshire CCG, 2017 to 2027 Age group 2017 (No.) 2027 (No.) Increase Increase (%) All ages 569, ,100 56, % ,800 38,100 2, % , ,700 16, % , ,200 15, % , ,200 24, % ,600 19,900 5, % NHS Herts Valleys CCG resident population is projected to increase by ten per cent over the next ten years to an estimated 663,700 in The largest increases are in the older age groups, with 23,500 (24%) more people aged 65 or over in 2027 compared to 2017 and 3,200 (53%) more people aged 90 or over as shown in Table 4 and population pyramid (right). Not all age groups are predicted to increase. A decrease of 8% is predicted for people in their 20s and 3% for those aged Table 4: Population Projections, NHS Herts Valleys CCG, 2017 to 2027 Age group 2017 (No.) 2027 (No.) Increase Increase (%) All ages 601, ,700 62, % ,400 43,100 2, % , ,000 20, % , ,400 18, % , ,400 23, % ,700 20,800 5, % 18

19 Deprivation The Indices of Multiple Deprivation (IMD) 2015 are used to identify the most deprived areas across England. They combine several indicators covering a range of economic, social, health and housing issues into a single deprivation score. There are also supplementary indices for income deprivation among children (IDA) and older people (IDAOPI). Each Lower Super Output Area (LSOA), a sub-ward geography averaging approximately 1,500 people, in England has an IMD score, allowing the identification of small pockets of deprivation. IMD scores are a relative measure of deprivation. They can be used to identify if one area is more deprived than another but not by how much. A higher score represents a higher level of deprivation. IMD, IDA and IDAOPI scores have been calculated for CCG locality populations by taking a population-weighted average of the IMD scores for each LSOA in which the given practices have registrations. General Practice IMD scores are available from Public Health England s General Practice profiles ( and an interactive map of local deprivation is available from: (note: this website is maintained by Hertfordshire County Council s Community Information & Intelligence Unit). NHS East and North Hertfordshire CCG Lower Lea Valley locality has the highest level of multiple deprivation (IMD), income domain affecting children (IDA) and income domain affecting older people (IDAOPI) within the CCG (Table 5). NHS East and North Hertfordshire CCG has five LSOAs in England s most deprived quintile (fifth) for multiple deprivation (IMD) representing 1.5% of the resident population. Two are in Lower Lea Valley (Broxbourne 013C and 013D), two are in Stevenage (Stevenage 008D and 009A) and one is in North Herts (North Hertfordshire 009C). In NHS East and North Hertfordshire CCG around 15% of children under 16 live in low income families and13% of older people aged 60 or experience income deprivation. NHS Herts Valleys CCG Watford and Three Rivers locality has the highest level of multiple deprivation (IMD), and income domain affecting children (IDA) within the CCG, whilst Hertsmere is the highest for income domain affecting older people (IDAOPI) as shown in Table 3. NHS Herts Valleys CCG has four LSOAs in England s most deprived quintile (fifth) for multiple deprivation (IMD) representing 1.1% of the resident population. Two are in Watford and Three Rivers (Watford 009B; Three Rivers 012D), one is in Dacorum (Dacorum 008D) and one is in Hertsmere (Hertsmere 006C). Hertsmere 006C and Three Rivers 012D are also in England s most deprived decile (10%). In NHS Herts Valleys CCG around 12% of children under 16 live in low income families and 12% of older people aged 60 or experience income deprivation. 19

20 Deprivation Table 5: CCG locality level IMD 2015 scores, ranks and proportion living in England s most deprived fifth (in order of most deprived locality within CCG) IMD 2015 Most deprived national quintile CCG and CCG localities Score CCG Rank [1] Herts Rank [1] No of LSOAs No of people [2] % of people [2] NHS East & North Hertfordshire CCG , % Lower Lea Valley , % Stevenage , % Welwyn Hatfield North Herts , % Upper Lea Valley Stort Valley & Villages NHS Herts Valleys CCG , % Watford & Three Rivers , % Hertsmere , % Dacorum , % At Albans & Harpenden Data Source: Ministry of Housing, Communities & Local Government; [1] A ranking of 1 denotes the most deprived locally; [2] ONS MYE 2015 Table 6: CCG locality level Income Deprivation Affecting Children Index (IDA) 2015 and Income Deprivation Affecting Older People Index (IDAPOI) 2015 scores and ranks (in order of most deprived locality by IDA within CCG) IDA 2015 IDAOPI 2015 CCG and CCG localities Score [2] (%) CCG Rank [1] Herts Rank [1] Score [2] (%) CCG Rank Herts Rank NHS East & North Hertfordshire CCG Lower Lea Valley Stevenage Welwyn Hatfield North Herts Upper Lea Valley Stort Valley & Villages NHS Herts Valleys CCG Dacorum Hertsmere Watford & Three Rivers At Albans & Harpenden Data Source: Ministry of Housing, Communities & Local Government; [1] A ranking of 1 denotes the most deprived locally; [2] Percentage experiencing income deprivation 20

21 GP recorded (QOF) disease prevalence Tartan Rug Average QOF prevalence for the two CCGs is generally lower than nationally. Hypertension, obesity and depression have the highest prevalence locally and nationally. NHS East and North Hertfordshire CCG: North Herts has the highest number of QOF registers (9 out of 20) statistically significantly higher than the CCG average whilst Stort Valley and Villages has the highest number statistically significantly lower (8 out of 20). Lower Lea Valley has the highest recorded prevalence of hypertension (14.5%, 10,972 patients), whilst Stevenage is highest for obesity (11.4%, 8,467 patients) and depression (10.6%, 7,862 patients). NHS Herts Valleys CCG: Hertsmere has the highest number of QOF registers (14 out of 20) statistically significantly higher than the CCG average whilst St Albans and Harpenden has the highest number statistically significantly lower (14 out of 20). Dacorum has the highest recorded prevalence of hypertension (13.4%, 22,364 patients), obesity (9.6%, 12,256 patients) and depression (9.7%, 12,665 patients). 21

22 Emergency admissions and mortality Tartan Rug NHS East and North Hertfordshire CCG: Stevenage has the highest number of indicators (10 out of 15) statistically significantly worse than the CCG average whilst Upper Lea Valley has the highest number statistically significantly better (9 out of 15). NHS Herts Valleys CCG: Watford and Three Rivers has the highest number of indicators (8 out of 15) statistically significantly worse than the CCG average whilst St Albans and Harpenden has the highest number statistically significantly better (10 out of 15). 22

23 Emergency admissions Avoidable emergency admissions (acute and chronic) In 2016/17 there were 11,455 avoidable emergency admissions for acute and chronic conditions in ENHCCG and 10,296 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 1,341 per 100,000-2,647 per 100,000 (Stevenage) (Hertsmere) 1,329 per 100,000-2,094 per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 23

24 Emergency admissions Acute conditions that should not require hospital admission In 2016/17 there were 7,509 avoidable emergency admissions for acute conditions in ENHCCG and 6,794 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG, although HVCCG has experienced a statistically significant increase over time. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 858 per 100,000-1,729 per 100,000 (Stevenage) (Hertsmere) 901 per 100,000-1,350 per 100,00 (Watford & Three Rivers) Change in CCG rate** 1,257 1,301 per 100,000 1,010 1,107 per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 24

25 Emergency admissions Unplanned hospitalisation for chronic ambulatory care sensitive conditions In 2016/17 there were 3,936 avoidable emergency admissions for chronic conditions in ENHCCG and 3,502 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 484 per 100, per 100,000 (Stevenage) (Hertsmere) 429 per 100, per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 25

26 Emergency admissions Emergency re-admissions within 30 days In 2016/17 there were 9,173 emergency readmissions within 30 days in ENHCCG and 8,940 in HVCCG. Rates are statistically significantly higher in ENHCCG compared to HVCCG, with both CCGs experiencing statistically significant decreases over time. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 1,233 per 100,000-2,048 per 100,000 (Stevenage) (St Albans & Harpenden) 1,214 per 100,000-1,795 per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 26

27 Emergency admissions Children with asthma, diabetes and epilepsy In 2016/17 there were 321 emergency admissions for under 19s with asthma, diabetes or epilepsy in ENHCCG and 357 in HVCCG. Rates are similar in ENHCCG and HVCCG. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Lower Lea Valley) 170 per 100, per 100,000 (Stevenage) (Hertsmere) 138 per 100, per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 27

28 Emergency admissions Children with lower respiratory tract infection In 2016/17 there were 436 emergency admissions for under 19s lower respiratory tract infections in ENHCCG and 488 in HVCCG. Rates are similar in ENHCCG and HVCCG and both have seen a statistically significant increase over time. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers 2014/ / /17 Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 188 per 100, per 100,000 (Stevenage) (Hertsmere) 295 per 100, per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 28

29 Mortality Potential years of life lost (PYLL) from causes considered amenable to healthcare In 2016 there were 9,981 potential years of life lost (from 409 deaths) from causes considered amenable to healthcare in ENHCCG and 9,976 (from 427 deaths) in HVCCG. Rates in ENHCCG are statistically significantly higher than HVCCG, although they have seen a statistically significant decrease since ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Upper Lea Valley) 1,298 per 100,000-2,169 per 100,000 (Welwyn Hatfield) (St Albans & Harpenden) 1,457 per 100,000-1,937 per 100,00 (Hertsmere) Change in CCG rate** 1,919-1,727 per 100,000 1,719-1,654 per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 29

30 Mortality Potential years of life lost (PYLL) from ischaemic heart disease On average in there were 3,115 potential years of life lost (from 149 deaths) from ischaemic heart disease in ENHCCG per year and 2,693 (from 128 deaths) in HVCCG. Rates in ENHCCG are statistically significantly higher than HVCCG. Both CCGs have seen statistically significant decreases since , although much sharper in HVCCG. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Upper Lea Valley) 449 per 100, per 100,000 (Stevenage) (St Albans & Harpenden) 396 per 100, per 100,00 (Watford and Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 30

31 Mortality Potential years of life lost (PYLL) from neoplasms On average in there were 3,391 potential years of life lost (from 137 deaths) from neoplasms in ENHCCG per year and 3,434 (from 137 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG with ENHCCG showing a statistically significant decrease between and ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Lower Lea Valley) 463 per 100, per 100,000 (Stevenage) (Watford and Three Rivers) 504 per 100, per 100,00 (St Albans & Harpenden) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 31

32 Mortality Potential years of life lost (PYLL) from cerebrovascular disease On average in there were 1,187 potential years of life lost (from 53 deaths) from cerebrovascular disease in ENHCCG per year and 1,206 (from 55 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG, with HVCCG experiencing a statistically significant increase in rates between and ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Lower Lea Valley) 109 per 100, per 100,000 (Stort Valley and Villages) (St Albans & Harpenden) 126 per 100, per 100,00 (Watford and Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 32

33 Mortality Potential years of life lost (PYLL) from respiratory diseases On average in there were 908 potential years of life lost (from 39 deaths) from respiratory diseases in ENHCCG per year and 968 (from 41 deaths) in HVCCG. Rates are similar in ENHCCG and HVCCG with both experiencing statistically significant increases between and ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Upper Lea Valley) 125 per 100, per 100,000 (Stevenage) (St Albans & Harpenden) 139 per 100, per 100,00 (Watford and Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 33

34 Mortality Premature mortality from cancer On average there were 558 premature deaths per year from cancer in ENHCCG and 556 in HVCCG between 2014 and Rates are similar in ENHCCG and HVCCG. ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Stort Valley & Villages) 93 per 100, per 100,000 (Stevenage) (Dacorum/ St Albans & Harpenden) 103 per 100, per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 34

35 Mortality Premature mortality from cardiovascular disease On average there were 274 premature deaths per year from cardiovascular disease in ENHCCG and 268 in HVCCG between 2014 and Rates are similar in ENHCCG and HVCCG with HVCCG showing a statistically significant decrease between and ENHCCG Lower Lea Valley North Herts Stevenage Stort Valley & Villages Upper Lea Valley Welwyn Hatfield HVCCG Dacorum Hertsmere St Albans & Harpenden Watford & Three Rivers Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Count Value Lower Upper Variation NHS ENHCCG NHS HVCCG Inter CCG locality range* (Upper Lea Valley) 49 per 100, per 100,000 (Stevenage) (St Albans & Harpenden) 38 per 100, per 100,00 (Watford & Three Rivers) Change in CCG rate** per 100, per 100,000 * latest time period; ** between first and last time period Increasing/ getting worse Decreasing/ getting better No significant change 35