Population Based Needs Assessment for Specialised Palliative Care

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

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 2014 2

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

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 2004. 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

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

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

Table 1. Calculated gap between current number of beds and calculated recommended number of beds per CCG. Population Weighted Population Current Number of Specialist Beds @ 20-25 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 329,342 375,388 30 37.5 16 16 14 21.5 47% 57% NHS DARLINGTON CCG 105,584 144,915 11.6 14.5 0 4 12 14.5 100% 100% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 415,706 33.3 41.6 5 11 28 36.6 85% 88% NHS NORTH DURHAM CCG 240,116 301,408 24.1 30.1 7 11 17 23.1 71% 77% TOTAL COUNTY DURHAM AND DARLINGTON 618,578 862,029 69 86 12 26 57 74.2 83% 86% NHS NORTHUMBERLAND CCG 316,278 341,400 27.3 34.1 33 33-6 1.1-21% 3% NHS NORTH TYNESIDE CCG 201,206 254,120 20.3 25.4 19.5 19.5 1 5.9 4% 23% NHS NEWCASTLE NORTH AND EAST CCG 139,067 198,576 15.9 19.9 ^see note ^see note 0% NHS NEWCASTLE WEST CCG 140,025 217,019 17.4 21.7 ^see note ^see note 0% TOTAL NEWCASTLE CCGs 279,092 415,595 33 42 15.5 15.5 18 26 53% 63% NHS GATESHEAD CCG 200,349 301,492 24.1 30.1 8 18 16 22.1 67% 73% NHS SOUTH TYNESIDE CCG 148,164 216,228 17.3 21.6 8 8 9 13.6 54% 63% NHS SUNDERLAND CCG 275,330 427,988 34.2 42.8 14 14 20 28.8 59% 67% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 406,519 32.5 40.7 6 16 27 34.7 82% 85% NHS SOUTH TEES CCG 273,532 419,891 33.6 42 10 10 24 32 70% 76% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 120,872 9.7 12.1 0 0 10 12.1 100% 100% Total Network Population 3,078,520 4,141,523 331 414 142 176.0 189 272 57% 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

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 329,342 375,388 2.6 6.6 3.0 7.5 1.5 7.4 57% 113% 50% 99% NHS DARLINGTON CCG 105,584 144,915 0.8 2.1 1.2 2.9 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD 272,878 415,706 2.2 5.5 3.3 8.3 NHS NORTH DURHAM CCG 240,116 301,408 1.9 4.8 2.4 6.0 COUNTY DURHAM AND DARLINGTON 618,578 862,029 4.9 12.4 6.9 17.2 1.6 12.8 31% 103% 22% 74% NHS GATESHEAD CCG 200,349 301,492 1.6 4.0 2.4 6.0 0.8 4.6 50% 115% 33% 76% NHS NORTHUMBERLAND CCG 316,278 341,400 2.5 6.3 2.7 6.8 1.9 7.6 75% 120% 70% 111% NHS NORTH TYNESIDE CCG 201,206 254,120 1.6 4.0 2.0 5.1 1.2 4.2 75% 104% 59% 83% NHS NEWCASTLE NORTH AND EAST CCG 139,067 198,576 1.1 2.8 1.6 4.0 NHS NEWCASTLE WEST CCG 140,025 217,019 1.1 2.8 1.7 4.3 NEWCASTLE 279,092 415,595 2.2 5.6 3.3 8.3 0.8 9.6 36% 172% 24% 116% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 406,519 2.3 5.7 3.3 8.1 1.7 7.0 75% 123% 52% 86% NHS SOUTH TEES CCG 273,532 419,891 2.2 5.5 3.4 8.4 1.2 7.8 55% 143% 36% 93% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY 152,737 120,872 1.2 3.1 1.0 2.4 0.3 5.2 25% 170% 31% 215% NHS SOUTH TYNESIDE CCG 148,164 216,228 1.2 3.0 1.7 4.3 0.3 3.7 25% 125% 17% 86% NHS SUNDERLAND CCG 275,330 427,988 2.2 5.5 3.4 8.6 0.8 7.3 36% 132% 23% 85% Network 3,078,520 4,141,523 24.6 61.6 33.1 82.8 12.05 77.2 49% 125% 36% 93% Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives 2012 8

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* 1609 1.9+?1* 5.4* 3.1 14.85 107% 274% South Tees Hospitals NHSFT* 1154 1.4+?1* 3.8* 1.7 4 71% 105% South Tyneside Healthcare NHSFT 415 0.5 1.4 0.4 1 80% 71% City Hospitals Sunderland NHSFT 887 1 3 0.6 2 60% 67% North Cumbria University Hospitals FT 605 0.7 2 0.5 2.58 71% 129% Gatheshead NHSFT 517 0.6 1.7 0.5 1 83% 59% Northumbria Healthcare NHSFT 1204 1.4 4 0.6 3.5 43% 88% North Tees and Hartlepool NHSFT 669 0.8 2.2 0.6 2 75% 91% Co Durham & Darlington NHSFT 1131 1.3 3.8 1 3.5 77% 92% Network 8191 6.3 18.1 4.2 15.58 67% 86% Source Commissioning Guidance for Specialist Palliative Care: Helping to deliver commissioning objectives 2012 9

Appendix 1 Calculated gap between current number of beds and calculated recommended number of beds per CCG. Table 4 Unweighted Populations Population Beds @ 20-25 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 329,342 26.3-32.9 16 16 10.3 39.2% NHS DARLINGTON CCG 105,584 8.4-10.6 0 4 8.4 100.0% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 21.8-27.3 5 11 16.8 77.1% NHS NORTH DURHAM CCG 240,116 19.2-24 7 11 12.2 63.5% TOTAL COUNTY DURHAM AND DARLINGTON 618,578 49 62 12 26 37.4 75.7% NHS NORTHUMBERLAND CCG 316,278 25.3-31.6 33 33-7.7-30.4% NHS NORTH TYNESIDE CCG 201,206 16.1-20.1 19.5 19.5-3.4-21.1% NHS NEWCASTLE NORTH AND EAST CCG 139,067 11.1-13.9 ^see note ^see note NHS NEWCASTLE WEST CCG 140,025 11.2-14 ^see note ^see note TOTAL NEWCASTLE CCGs 279,092 22 28 15.5 15.5 6.8 30% NHS GATESHEAD CCG 200,349 16-20 8 18 8 50.0% NHS SOUTH TYNESIDE CCG 148,164 11.9-14.8 8 8 3.9 32.8% NHS SUNDERLAND CCG 275,330 22-27.5 14 14 8 36.4% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 22.7-28.4 6 16 16.7 73.6% NHS SOUTH TEES CCG 273,532 21.9-27.4 10 20 11.9 54.3% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 12.2-15.3 0 0 12.2 100.0% Total Network Population 3,078,520 246-308 142 186.0 104 42.3%

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 16 12 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 33 20 SPC Wansbeck, 4 SPC N Tyne GHSPC Marie Curie & 5SPC St Oswalds NHS NORTH TYNESIDE CCG 19.5 15 SPC N Tyne GH, 2 SPC Marie Curie & 2.5 SPC St Oswalds TOTAL NEWCASTLE CCG 15.5 5.5 SPC St Oswalds & 10 SPC Marie Curie NHS GATESHEAD CCG 18 10 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 10 10 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

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 329,342 49.2% 50.8% 28.4% 46.6% 53.4% 9.6% 40.7% 59.3% NHS DARLINGTON CCG 105,584 48.7% 51.3% 23.9% 45.6% 54.4% 8.3% 39.7% 60.3% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 48.8% 51.2% 25.6% 46.1% 53.9% 8.4% 40.7% 59.3% NHS GATESHEAD CCG 200,349 48.9% 51.1% 24.0% 45.6% 54.4% 8.4% 40.8% 59.2% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 50.9% 49.1% 28.2% 46.3% 53.7% 9.4% 41.5% 58.5% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 48.9% 51.1% 22.3% 45.7% 54.3% 7.6% 40.3% 59.7% NHS NEWCASTLE NORTH AND EAST CCG 139,067 50.4% 49.6% 17.7% 45.5% 54.5% 6.5% 38.6% 61.4% NHS NEWCASTLE WEST CCG 140,025 49.9% 50.1% 20.4% 45.3% 54.7% 7.4% 39.7% 60.3% NHS NORTH DURHAM CCG 240,116 49.1% 50.9% 24.4% 46.0% 54.0% 7.8% 40.6% 59.4% NHS NORTH TYNESIDE CCG 201,206 48.2% 51.8% 24.2% 44.3% 55.7% 8.6% 38.6% 61.4% NHS NORTHUMBERLAND CCG 316,278 48.8% 51.2% 28.0% 46.1% 53.9% 9.2% 41.5% 58.5% NHS SOUTH TEES CCG 273,532 48.7% 51.3% 23.5% 45.8% 54.2% 8.0% 40.5% 59.5% NHS SOUTH TYNESIDE CCG 148,164 48.3% 51.7% 24.7% 44.4% 55.6% 8.9% 37.9% 62.1% NHS SUNDERLAND CCG 275,330 48.6% 51.4% 23.7% 44.6% 55.4% 8.0% 39.5% 60.5% Network (sum of CCGs) 3,078,520 49.0% 51.0% 24.6% 45.7% 54.3% 8.4% 40.2% 59.8% England 53,107,169 49.2% 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

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 3,530 950 26.93% 1,071.68 288.59 NHS DARLINGTON CCG 105,584 1,059 276 26.05% 1,003.31 261.40 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 2,815 851 30.23% 1,031.72 311.86 NHS GATESHEAD CCG 200,349 2,058 631 30.67% 1,027.04 314.95 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 1,285 416 32.38% 841.14 272.36 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 2,614 728 27.85% 920.71 256.42 NHS NEWCASTLE NORTH AND EAST CCG 139,067 1,290 319 24.73% 927.65 229.39 NHS NEWCASTLE WEST CCG 140,025 1,299 345 26.56% 927.65 246.38 NHS NORTH DURHAM CCG 240,116 2,477 671 27.09% 1,031.72 279.45 NHS NORTH TYNESIDE CCG 201,206 2,134 636 29.80% 1,060.60 316.09 NHS NORTHUMBERLAND CCG 316,278 3,290 952 28.93% 1,040.33 301.00 NHS SOUTH TEES CCG 273,532 2,772 855 30.84% 1,013.41 312.58 NHS SOUTH TYNESIDE CCG 148,164 1,693 528 31.19% 1,142.43 356.36 NHS SUNDERLAND CCG 275,330 2,906 789 27.15% 1,055.34 286.57 Network (sum of CCGs) 3,078,520 31,222 8,947 28.66% 1,014.17 290.64 England 53,107,169 465,340 128,958 27.71% 876.23 242.83

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 3,530 950 783.09 2,579 1,720 950 2,671 NHS DARLINGTON CCG 105,584 1,059 276 741.91 783 522 276 798 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 2,815 851 719.86 1,964 1,310 851 2,181 NHS GATESHEAD CCG 200,349 2,058 631 712.09 1,427 952 631 1,583 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 1,285 416 568.77 869 579 416 995 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 2,614 728 664.29 1,886 1,258 728 1,986 NHS NEWCASTLE NORTH AND EAST CCG 139,067 1,290 319 698.27 971 648 319 1,030 NHS NEWCASTLE WEST CCG 140,025 1,299 345 681.27 954 636 345 918 NHS NORTH DURHAM CCG 240,116 2,477 671 752.27 1,806 1,205 671 1,856 NHS NORTH TYNESIDE CCG 201,206 2,134 636 744.51 1,498 999 636 1,635 NHS NORTHUMBERLAND CCG 316,278 3,290 952 739.33 2,338 1,560 952 2,512 NHS SOUTH TEES CCG 273,532 2,772 855 700.83 1,917 1,279 855 2,134 NHS SOUTH TYNESIDE CCG 148,164 1,693 528 786.07 1,165 777 528 1,305 NHS SUNDERLAND CCG 275,330 2,906 789 768.77 2,117 1,412 789 2,201 Network (sum of CCGs) 3,078,520 31,222 8,947 723.53 22,274 14,857 8,947 21,603 England 53,107,169 465,340 128,958 633.40 336,383 224,367 128,958 353,325 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

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 950 798 447 485 485 314 361 675 447 266 352 238 181 NHS DARLINGTON CCG 276 232 130 141 141 91 105 196 130 77 102 69 52 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 851 715 400 434 434 281 323 604 400 238 315 213 162 NHS GATESHEAD CCG 631 530 297 322 322 208 240 448 297 177 233 158 120 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 416 349 196 212 212 137 158 295 196 116 154 104 79 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 728 612 342 371 371 240 277 517 342 204 269 182 138 NHS NEWCASTLE NORTH AND EAST CCG 319 268 150 163 163 105 121 226 150 89 118 80 61 NHS NEWCASTLE WEST CCG 345 290 162 176 176 114 131 245 162 97 128 86 66 NHS NORTH DURHAM CCG 671 564 315 342 342 221 255 476 315 188 248 168 127 NHS NORTH TYNESIDE CCG 636 534 299 324 324 210 242 452 299 178 235 159 121 NHS NORTHUMBERLAND CCG 952 800 447 486 486 314 362 676 447 267 352 238 181 NHS SOUTH TEES CCG 855 718 402 436 436 282 325 607 402 239 316 214 162 NHS SOUTH TYNESIDE CCG 528 444 248 269 269 174 201 375 248 148 195 132 100 NHS SUNDERLAND CCG 789 663 371 402 402 260 300 560 371 221 292 197 150 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 2004. 15

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 2,579 1728 1264 696 928 980 928 980 825 361 851 567 335 NHS DARLINGTON CCG 783 525 384 212 282 298 282 298 251 110 259 172 102 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 1,964 1316 963 530 707 746 707 746 629 275 648 432 255 NHS GATESHEAD CCG 1,427 956 699 385 514 542 514 542 457 200 471 314 185 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 869 582 426 235 313 330 313 330 278 122 287 191 113 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 1,886 1264 924 509 679 717 679 717 604 264 622 415 245 NHS NEWCASTLE NORTH AND EAST CCG 971 651 476 262 350 369 350 369 311 136 320 214 126 NHS NEWCASTLE WEST CCG 954 639 467 258 343 362 343 362 305 134 315 210 124 NHS NORTH DURHAM CCG 1,806 1210 885 488 650 686 650 686 578 253 596 397 235 NHS NORTH TYNESIDE CCG 1,498 1004 734 404 539 569 539 569 479 210 494 330 195 NHS NORTHUMBERLAND CCG 2,338 1567 1146 631 842 889 842 889 748 327 772 514 304 NHS SOUTH TEES CCG 1,917 1284 939 518 690 728 690 728 613 268 633 422 249 NHS SOUTH TYNESIDE CCG 1,165 780 571 314 419 443 419 443 373 163 384 256 151 NHS SUNDERLAND CCG 2,117 1418 1037 572 762 804 762 804 677 296 699 466 275 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 2004. 16

Recorded Place of Death Table 11 Preferred and Actual Place of Death (All Causes) Preferred Place of Death * Place of Death (% Persons, All Ages) 2010-12 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

Table 12 Place of Death Cancer Patients Preferred Place of Death * Actual - Cancer Deaths - 2011 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 2013 18

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

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 201 20

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 72,556 32.3% 32,811 45.2% 36,372 69,183 30.8% NHS Darlington 46,670 15,101 32.4% 6,124 40.6% 6,188 12,312 26.4% NHS Durham Dales, Easington and Sedgefield 120,747 37,940 31.4% 16,750 44.1% 17,392 34,142 28.3% NHS Gateshead 89,154 29,313 32.9% 12,138 41.4% 11,979 24,117 27.1% NHS Hambleton, Richmondshire and Whitby 63,345 18,030 28.5% 9,087 50.4% 11,308 20,395 32.2% NHS Hartlepool and Stockton-on-Tees 119,593 35,378 29.6% 14,960 42.3% 15,593 30,553 25.5% NHS Newcastle North and East 58,356 20,202 34.6% 7,004 34.7% 5,475 12,479 21.4% NHS Newcastle West 58,797 20,135 34.2% 7,701 38.2% 6,637 14,338 24.4% NHS North Durham 103,056 32,067 31.1% 13,743 42.9% 14,586 28,329 27.5% NHS North Tyneside 91,295 30,960 33.9% 12,641 40.8% 11,715 24,356 26.7% NHS Northumberland 138,534 41,406 29.9% 19,407 46.9% 22,463 41,870 30.2% NHS South Tees 116,808 36,443 31.2% 16,081 44.1% 15,975 32,056 27.4% NHS South Tyneside 67,167 23,459 34.9% 9,973 42.5% 8,884 18,857 28.1% NHS Sunderland 119,758 38,096 31.8% 16,075 42.2% 16,242 32,317 27.0% Network (sum of CCGs) 1,418,047 451,086 31.8% 194,495 43.1% 200,809 395,304 27.9% England 22,063,368 6,666,493 30.2% 2,725,596 40.9% 1,851,180 4,576,776 20.7% Source - QS111EW - Household life stage; ONS Crown Copyright Reserved [from Nomis on 21 January 2014] - 2011 21

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 329,342 324 28 54 85 77 40 10 15845 114 NHS DARLINGTON CCG 105,584 65 9 17 27 13 11 2 13719 151 NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 272,878 179 36 73 98 12 5 1 9490 181 NHS GATESHEAD CCG 200,349 126 20 48 66 17 9 1 11385 167 NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 152,737 95 0 2 6 34 20 13 20845 42 NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 283,912 178 33 54 72 51 34 12 14195 153 NHS NEWCASTLE NORTH AND EAST CCG 139,067 85 17 24 31 23 17 7 14968 152 NHS NEWCASTLE WEST CCG 140,025 90 24 38 48 12 6 3 10460 183 NHS NORTH DURHAM CCG 240,116 145 3 22 49 37 25 10 15593 112 NHS NORTH TYNESIDE CCG 201,206 131 8 29 46 35 27 14 15709 118 NHS NORTHUMBERLAND CCG 316,278 197 15 29 46 53 39 18 16707 101 NHS SOUTH TEES CCG 273,532 174 52 70 81 30 11 4 11158 184 NHS SOUTH TYNESIDE CCG 148,164 102 10 40 54 17 11 6 11696 160 NHS SUNDERLAND CCG 275,330 185 29 65 93 19 8 0 11198 166 Network total (sum of CCGs) 3,078,520 2076 284 565 802 430 263 101 13783 22

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 288.59 81 1.54 125 136 36% NHS DARLINGTON CCG 261.40 73 1.72 126 137 37% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 311.86 88 1.86 163 177 77% NHS GATESHEAD CCG 314.95 88 1.79 158 173 73% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 272.36 76 1.20 92 100 0% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 256.42 72 1.73 124 135 35% NHS NEWCASTLE NORTH AND EAST CCG 229.39 64 1.72 111 121 21% NHS NEWCASTLE WEST CCG 246.38 69 1.87 129 141 41% NHS NORTH DURHAM CCG 279.45 78 1.53 120 131 31% NHS NORTH TYNESIDE CCG 316.09 89 1.56 138 151 51% NHS NORTHUMBERLAND CCG 301.00 84 1.48 125 136 36% NHS SOUTH TEES CCG 312.58 88 1.87 164 179 79% NHS SOUTH TYNESIDE CCG 356.36 100 1.76 176 192 92% NHS SUNDERLAND CCG 286.57 80 1.79 144 157 57% Source Methodology taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit 2004. 23

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 783.09 99.6 1.54 153 177 77% NHS DARLINGTON CCG 741.91 94.4 1.72 162 187 87% NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CCG 719.86 91.6 1.86 170 196 96% NHS GATESHEAD CCG 712.09 90.6 1.79 162 187 87% NHS HAMBLETON, RICHMONDSHIRE AND WHITBY CCG 568.77 72.36 1.20 87 100 0% NHS HARTLEPOOL AND STOCKTON-ON-TEES CCG 664.29 85 1.73 146 168 68% NHS NEWCASTLE NORTH AND EAST CCG 698.27 88.8 1.72 153 176 76% NHS NEWCASTLE WEST CCG 681.27 86.7 1.87 162 187 87% NHS NORTH DURHAM CCG 752.27 95.7 1.53 146 169 69% NHS NORTH TYNESIDE CCG 744.51 94.7 1.56 148 170 70% NHS NORTHUMBERLAND CCG 739.33 94.1 1.48 139 160 60% NHS SOUTH TEES CCG 700.83 89.2 1.87 167 192 92% NHS SOUTH TYNESIDE CCG 786.07 100.0 1.76 176 203 103% NHS SUNDERLAND CCG 768.77 97.8 1.79 175 201 101% Source Methodology taken from the National Council for Hospice and Specialist Palliative Care Services model produced by Peter Tebbit 2004. 24