Profile of Leeds West Clinical Commissioning Group (CCG)

Profile of Leeds West Clinical Commissioning Group (CCG) Leeds West Why make this profile? These profiles aim to support CCGs in ensuring they are commissioning effective care in relation to the needs of their population. Different data sets - from lifestyles to long term conditions to hospital admissions and premature mortality - enable CCGs to consider how to improve care for their population. The addition of data on age profile, ethnicity, deprivation and population segmentation will help CCGs decide where and how to target proactive care and increase equitable access for their population. Comparisons with the rest of Leeds, variations across the CCG, and deprived parts of Leeds enable benchmarking. For broader impacts on health these profiles should be read alongside the published MSOA profile for the practice area. On a micro level these profiles will also support practices in caring for their patients. This report is in two parts. Part 1 is about the people registered at the practices that belong to Leeds West CCG. Part 2 is about the geographical footprint which Leeds West CCG is responsible for. Part 3 is about the Leeds West CCG localities. Part 1. The people registered with practices belonging to Leeds West CCG Demographics Leeds West CCG member practices 2 Population profile 3 GP recorded ethnicity 4 Acorn and Health Acorn 5 GP data Coronary heart disease 7 Chronic obstructive pulmonary disease Diabetes 8 Smoking Cancer 9 Obesity All GP data for Leeds West 10 Admissions Inpatient emergency admissions by age band 11 Outpatient first attendances by age band 12 Emergency admissions: respiratory, circulatory, cancer 13 Mortality Early deaths: all causes, respiratory, circulatory, cancer 16 Alcohol admissions 20 Part 2. Leeds West CCG area by footprint. Demographics Matching data to Leeds West CCG 21 MSOAs that are used in this report to represent this CCG 22 Population profile 23 GP recorded ethnicity 24 Pupil demographics 25 Neighbourhood Index 26 Two sample neighbourhood Index sheets 27 Levels of deprivation 29 Life expectancy Life expectancy 2008-10 30 Mortality Mortality rates 2006-10 (under 75s) 31 Part 3. Leeds West CCG localities GP data 33 Emergency admissions: respiratory, circulatory, cancer 39 Early deaths: all causes, respiratory, circulatory, cancer 42 This profile is designed to be viewed in colour. Colours have been chosen with Deuteranope and Protanope type colour vision deficiency in mind. Unfortunately the profile will not reproduce well in black and white. Maps: Ordnance Survey PSMA Data, Licence Number 100050507 (c) Crown Copyright 2011. All rights reserved December 2012 1 of 47

Part 1. Profile of the Leeds West CCG practice population Practices in this report Cluster B86001 Morley Health Centre Oval B86003 Armley Medical Centre Triangle B86004 Highfield Surgery Kite B86011 Hillfoot Surgery Pentagon B86014 Robin Lane Medical Centre Kite B86015 Manor Park Surgery Triangle B86017 Craven Road Medical Practice Rectangle B86018 Pudsey Health Centre Kite B86024 Priory View Medical Centre Oval B86025 Hyde Park Surgery Rectangle B86028 The Surgery Kite B86030 Burton Croft Surgery Kite B86038 Yeadon Health Centre Kite B86041 Vesper Road Oval B86044 New Croft Surgery Kite B86047 Rawdon Surgery Pentagon B86050 Calverley Medical Centre Pentagon B86051 Silver Lane Surgery Pentagon B86052 Park Road Medical Centre Kite B86057 Windsor House Surgery Pentagon B86058 Sunfield Medical Centre Kite B86060 Thornton Medical Centre Oval B86064 Leigh View Medical Centre Pentagon B86065 Moor Grange Oval B86067 The Dekeyser Group Practice Pentagon B86068 The Abbey Medical Centre Kite B86069 Burley Park Medical Centre Rectangle B86071 Whitehall Surgery Pentagon B86074 Fieldhead Kite B86086 Laurel Bank Surgery Rectangle B86094 The Gables Pentagon B86101 Gildersome Health Centre Kite B86104 The Highfield Medical Centre Triangle B86109 Kirkstall Lane Medical Centre Rectangle B86110 Leeds Student Medical Practice Rectangle B86655 Beech Tree Medical Centre Oval B86672 Hawthorn Surgery Pentagon B86678 Drighlington Medical Centre Pentagon 0 Practice clusters The Yorkshire and Humber Public Health Observatory clustered GP practices in England into ten classification groups in February 2011. The groups are designed to bring together practices with similar characteristics. The practices are listed with their cluster here. The following variables were used to group practices: age structure, percentage of practice population from Asian or Black ethnic groups, deprivation score for practice population (IMD 2007), rural classification. More information about these groupings at: www.yhpho.org.uk/resource/view.aspx?rid=104087 Square Practices With a smaller than average list size, a high percentage of the population aged under 15 years old and fewer aged 65 years or older. A very high proportion of the population from Asian ethnic groups and a higher than average proportion from Black ethnic groups and very high levels of deprivation. Circle Practices Have a high percentage under 15 years. Very high percentage of Black population and higher than average Asian population. High deprivation. Triangle Practices Practices with a high percentage of children (under 15 years old) and very high levels of deprivation. Rectangle Practices Practices with a very low percentage of people under 15 years and a lower proportion of older people (65 years and older). An above average proportion of the population from Asian and Black ethnic groups. Oval Practices Practices with a higher percentage of older people (aged 65 years and older) and slightly higher levels of deprivation. Pentagon Practices Practices with an average proportion of the population in younger and older age groups and generally low deprivation. Hexagon Practices Located in towns or urban fringe settlements with low deprivation and few people from Asian and Black ethnic groups. Octagon Practices Practices with a high percentage of the population aged 65 years and older and low levels of deprivation. Kite Practices Practices with large average list sizes, an average proportion of the population under 15 years old, a higher proportion aged 65 years and older and low levels of deprivation. Crescent Practices Located in villages, hamlets and isolated settlements with a small average list size and a higher proportion of the population aged 65 years and older. Few people from Asian and Black ethnic groups and low levels of deprivation. Some practices are not in clusters. December 2012 2 of 47

Population profile January 2012 Population of this CCG (living in Leeds): All: 351,789 Male: 174,285 Female: 177,504 Leeds West Population of Leeds West living in the Deprived Quintile* Additional population of this CCG (living outside Leeds) is 7,513 The Leeds resident population (not just those registered with a practice which is a member of a Leeds CCG) is 813,653. The total combined populations (living anywhere) of people registered with Leeds GPs is 821,660. There are small numbers of people in addition to this whose address is unknown. 7% of the Leeds West registered population live in the Deprived Quintile. This represents 15% of the entire Deprived Quintile population. Population of Leeds by CCG: Proportion of Leeds resident population: Leeds North 194,093 23.9% Leeds West 351,789 43.2% Leeds South East 255,953 31.5% No consortia 1,044 0.1% CCG practice populations compared to Leeds and the deprived quintile. CCG patients Leeds Deprived Quintile 85+ 80-84y 75-79y 70-74y 65-69y 60-64y 55-59y 50-54y 45-49y 40-44y 35-39y 30-34y 25-29y 20-24y 15-19y 10-14y 5-9y 0-4y Female Male 15% 10% 5% 0% 5% 10% 15% This chart compares the CCG population to Leeds and the Deprived Quintile. Historically population charts are shaped like a pyramid. The base is wide and each age band above is narrower as there are proportionately fewer people in the older age groups. In modern western societies population pyramids are now typically narrower at the base due to a decline in the birth rate. The Leeds profile is shown in outline and follows the expected pattern for a modern western population but with a larger than usual proportion of people in the university student age groups. The blue bars in this pyramid represent the CCG registered population. The orange dots represent the age structure of the Deprived Quintile population for comparison. Leeds West CCG has the largest population of the three CCGs with over 40% of the Leeds population. It has a far greater number of 15-29 year olds due the high proportion of students. The remaining population is fairly evenly distributed across all the age bands in line with Leeds average. There is a slightly lower number of under 14s than the Leeds average. *Deprived Quintile - see glossary Practice locations for this CCG. The coloured area is the combined contracted areas of these practices. December 2012 3 of 47

GP recorded Ethnicity This data compares the ethnicity of the CCG practice adult populations, as recorded by practices in Q1 2012/13, with the Leeds GP registered adult population over the same period. The 'White British' category is not included in the chart as it usually dominates the data to such an extent that all other ethnic groups are hidden. By omitting 'White British' we can use a scale that uncovers detail in the smaller ethnic groups. Leeds West Leeds registered White British 57.7% 55.3% CCG Leeds Other white background 5.6% 6.8% Pakistani or British Pakistani 1.3% 2.2% Black African 1.0% 1.9% Indian or British Indian 1.5% 1.8% Other Asian Background 1.3% 1.4% Other Ethnic Background 0.9% 1.0% Chinese 1.2% 0.8% Black Caribbean 0.2% 0.5% Other Black Background 0.2% 0.5% White Irish 0.4% 0.4% Bangladeshi or British Bangladeshi 0.1% 0.4% Mixed white and Black African 0.3% 0.4% Mixed white and Black Caribbean 0.3% 0.4% Other mixed background 0.3% 0.3% Mixed white and Asian 0.3% 0.3% 0% 2% 4% 6% 8% Leeds West Leeds registered Not Recorded (75,720) 22.2% 21.5% Not Stated (8,866) 2.6% 2.5% Unknown (8,634) 2.5% 1.5% The CCG practice population differs from the Leeds pattern of ethnicity, with smaller proportions of the 'Other white background', 'Pakistani or British Pakistani' and 'Black African' ethnic groups. This comparison is complicated by the fact that nearly a quarter of the Leeds registered population has no ethnicity recorded. This highlights the importance of improving data recording so that we can get the maximum information from the data available. Census data will give us a Leeds-wide picture of ethnicity when it is released, however it cannot be exactly broken down to a practice / CCG level. We know that the ethnic mix in Leeds is changing quickly. and so the census will not be a reliable benchmark for long. December 2012 4 of 47

Acorn summary Leeds West Acorn is a nationwide population segmentation tool. It combines geography with demographics and lifestyle information, helping our understanding of where people live and their underlying characteristics and behaviour. This sheet compares the January 2012 population of this CCG with the whole GP registered population of Leeds in terms of Acorn groups. For instance 23.1% of this CCG's population are in the 'Hard-Pressed' category, compared to 27.6% of the Leeds population. Acorn categories Patients Leeds Wealthy Achievers 45,095 12.8% 126,216 15.7% Urban Prosperity 70,299 20.0% 110,925 13.8% Comfortably Off 103,135 29.3% 222,357 27.7% Moderate Means 43,082 12.2% 109,543 13.6% Hard-Pressed 81,125 23.1% 221,941 27.6% Unclassified or unknown 9,053 2.6% 11,898 1.5% Acorn groups Wealthy Executives 16,533 4.7% 51,244 6.4% Affluent Greys 5,677 1.6% 18,740 2.3% Flourishing Families 22,885 6.5% 56,232 7.0% Prosperous Professionals 8,808 2.5% 20,563 2.6% Educated Urbanites 28,655 8.1% 45,666 5.7% Aspiring Singles 32,836 9.3% 44,696 5.6% Starting Out 24,765 7.0% 41,752 5.2% Secure Families 52,247 14.9% 123,078 15.3% Settled Suburbia 21,309 6.1% 43,952 5.5% Prudent Pensioners 4,814 1.4% 13,575 1.7% Asian Communities 2,363 0.7% 21,498 2.7% Post Industrial Families 11,255 3.2% 22,525 2.8% Blue Collar Roots 29,464 8.4% 65,520 8.2% Struggling Families 49,410 14.0% 136,544 17.0% Burdened Singles 21,807 6.2% 59,434 7.4% High Rise Hardship 7,450 2.1% 20,923 2.6% Inner City Adversity 2,458 0.7% 5,040 0.6% Unclassified or unknown 9,053 2.6% 11,898 1.5% Health Acorn groups 0% 50% 0% 50% Healthy 158,769 45.1% 279,212 34.8% Possible Future Concerns 89,917 25.6% 219,824 27.4% Future Problems 45,038 12.8% 153,272 19.1% Existing Problems 50,536 14.4% 140,972 17.6% Unclassified or unknown 7,529 2.1% 9,600 1.2% 0% 50% The CCG population is very diverse with above the Leeds average for both the 'Urban Prosperity' and 'Comfortably Off' categories, which if added together make up over 49% of the CCG's population. 23% of the population is in the 'Hard Pressed' category, compared to 27.7% of the Leeds population. This CCG has lower rates of 'Existing Problems' and a high rate of 'Healthy' compared to the city average. 26.5% of the CCG population compared to 28.2% of Leeds are in the 'Possible Future Concerns' category. For more information about Acorn, including the characteristics of the categories, groups and types listed here, visit http://www.caci.co.uk/acorn-classification.aspx and http://www.caci.co.uk/healthacorn.aspx December 2012 5 of 47

General information about the GP data Collecting the GP data. NHS Leeds runs a quarterly collection of data from GP systems, forming a picture over time of conditions recorded by GPs across Leeds. The automated data collections note the most recent occurrences of specific disease codes in each patient's record as defined by the Quality Outcomes Framework (QOF). This routine data collection gives Leeds a much greater level of detail than standard QOF data and is a result of the trusting relationship we have developed with practices. Rates and prevalence are calculated with the date-relevant GP registered populations for those practices that partook in the data collection. Cancer. The main risk factors for cancer are: growing older, smoking, sun, ionising radiation and chemicals, some viruses, family history of cancer, alcohol, poor diet, lack of physical activity, or being overweight. Behaviours like smoking, poor diet, over consumption of alcohol and lack of physical activity are likely to be higher in more deprived communities. As educational attainment is lower in deprived communities, some people may be less familiar with early signs of cancer and less able to use a complicated system of care to their benefit. As a result some cancer patients present late which reduces the chances of curative treatment. Life expectancy for people with cancer is lower in more deprived communities despite a range of risk factors which suggest many cancers are potentially preventable. Coronary heart disease (CHD). Prevalence identified via the GP systems is often under recorded compared to the real prevalence in an area. The modelled prevalence for Leeds overall is 5.3% compared to a recorded prevalence of 3.5%. CHD has a close association with deprivation as well as key lifestyle factors such as smoking, being overweight and excessive alcohol use. There is now a focus on systematic early diagnosis, via the NHS Health Check, offered to all those between the ages of 40 and 74. The purpose being that those people who are at high risk of CHD are managed appropriately. From a recent cardiovascular disease mortality audit within Leeds we know that being on a register such as the NHS Health Check has a positive effective on increasing both life expectancy and quality of life. Chronic obstructive pulmonary disease (COPD). A disease of the lungs and a key cause of premature mortality in Leeds. It is associated with deprivation and smoking. COPD is often identified late, reducing options for management to improve quality of life or to slow down the progression of the disease. Prevalence identified from GP systems is often under recorded, the modelled prevalence for Leeds is 4.5% compared to a recorded prevalence of 1.7% Diabetes. Diabetes consists of type 1 and 2. Type 2 is the most common and is strongly associated with obesity, other lifestyle factors, particular population groups and deprivation. From modelled estimates from the Association of Public Health Observatories, the prevalence in Leeds would be around 6.7% (within a range of 4.8-10%). The recorded prevalence on GP systems for Leeds overall shows 3.6-3.9%. Smoking. The use of tobacco is the primary cause of preventable disease and premature death. It is not only harmful to smokers but also to the people around them through the damaging effects of second-hand smoke. Smoking rates are much higher in some social groups, including those with the lowest incomes. These groups suffer the highest burden of smoking-related illness and death. This is the single biggest cause of inequalities in death rates between the richest and poorest in our communities. Levels of smoking have fallen since the 1960s but the decline has stopped and may be reversing. Obesity. The latest Health Survey for England data shows that nearly 1 in 4 adults, and over 1 in 10 children aged 2-10, are obese and the trend is set to increase. Obesity can have a severe impact on people s health. Around 10% of all cancer deaths among non-smokers are related to obesity. The risk of coronary artery disease and type 2 diabetes directly increases with increasing levels of obesity e.g. levels of type 2 diabetes are about 20 times greater for people who are very obese. These diseases shorten life expectancy. It is eating and physical activity habits that are primarily responsible for maintaining a healthy body weight. These are impacted by significant external influences such as environmental and social factors (e.g. changes in food production, motorised transport and work/home lifestyle patterns) contributing to the trend of increasing body weight. December 2012 6 of 47

Coronary heart disease (CHD) / chronic obstructive pulmonary disease (COPD) Source: NHS Leeds GP data audits, quarterly 2009-12 CHD age standardised rates (DSR) per 100,000 4,000/ 3,500/ 3,000/ 2,500/ 2,000/ CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 2,925 2,905 2,888 2,863 2,849 2,840 2,820 2,791 2,780 2,744 2,736 2,719 2,973 2,962 2,934 2,912 2,899 2,885 2,876 2,854 2,832 2,810 2,795 2,777 3,628 3,631 3,589 3,590 3,597 3,625 3,566 3,563 3,449 3,411 3,394 3,433 The CHD DSR for the CCG is marginally lower than the Leeds average. CHD is the major cause of premature death and disability in the UK. There are many modifiable risk factors, address these factors and the evidence is that we can have a considerable impact on the quality of life. Of the practices that comprise this CCG, The Highfield Medical Centre has the highest CHD DSR of 3,813 per 100,000 while Burton Croft Surgery has the lowest CHD DSR with 1,903. COPD age standardised rates (DSR) per 100,000 3,000/ 2,500/ 2,000/ 1,500/ 1,000/ CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 1,372 1,385 1,393 1,392 1,411 1,426 1,421 1,436 1,452 1,448 1,457 1,457 1,469 1,481 1,482 1,475 1,495 1,514 1,542 1,537 1,542 1,551 1,566 1,567 2,669 2,697 2,713 2,711 2,743 2,760 2,813 2,825 2,809 2,831 2,855 2,920 The COPD age standardised rate for the CCG is marginally lower than the Leeds average. Of the practices that comprise this CCG, Armley Medical Centre has the highest COPD DSR of 2,669 per 100,000 while Burton Croft Surgery has the lowest COPD DSR with 623. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts.these rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. December 2012 7 of 47

Diabetes / smoking Source: NHS Leeds GP data audits, quarterly 2009-12 Diabetes age standardised rates per 100,000 6,000/ 5,500/ 5,000/ 4,500/ 4,000/ 3,500/ 3,000/ this CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 3,129 3,153 3,184 3,209 3,255 3,286 3,318 3,325 3,360 3,361 3,386 3,407 3,345 3,378 3,399 3,441 3,489 3,541 3,628 3,600 3,635 3,646 3,680 3,708 4,753 4,835 4,827 4,910 5,031 5,131 5,186 5,220 5,165 5,148 5,275 5,314 The diabetes age standardised rate for the CCG is lower than the Leeds average. Of the practices that comprise this CCG, Hyde Park Surgery has the highest diabetes DSR of 6,610 per 100,000 while Park Road Medical Centre has the lowest diabetes DSR with 2,178. Smoking age standardised rates per 100,000 33,500/ 31,500/ 29,500/ 27,500/ 25,500/ 23,500/ 21,500/ CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 22,340 22,261 21,909 21,825 21,821 21,777 22,221 22,323 22,528 22,244 22,333 22,226 23,268 23,213 23,039 22,982 22,922 22,793 23,089 23,112 23,154 23,054 23,135 23,057 33,989 33,989 33,720 33,601 33,589 33,422 33,950 34,123 34,187 34,117 34,148 34,113 The smoking age standardised rate for the CCG is lower than the Leeds average. Of the practices that comprise this CCG, Whitehall Surgery has the highest smoking DSR of 33,634 per 100,000 while Park Road Medical Centre has the lowest smoking DSR with 13,286. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts.these rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. December 2012 8 of 47

Cancer / obesity (BMI>30) in the 16+ population Source: NHS Leeds GP data audits, quarterly 2009-12 Cancer age standardised rates per 100,000 2,500/ 2,400/ 2,300/ 2,200/ 2,100/ 2,000/ 1,900/ 1,800/ 1,700/ 1,600/ 1,500/ this CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 2,067 2,102 2,097 2,108 2,132 2,169 2,192 2,211 2,208 2,243 2,274 2,288 2,045 2,063 2,069 2,088 2,116 2,147 2,181 2,199 2,205 2,233 2,261 2,283 1,805 1,821 1,834 1,849 1,874 1,925 1,950 1,965 1,969 1,969 1,994 2,047 The DSR for cancer for this CCG is comparable to the Leeds average. Of the practices that comprise this CCG, Drighlington Medical Centre has the highest cancer DSR of 3,364 per 100,000 while Armley Medical Centre has the lowest cancer DSR with 1,611. Obesity age standardised rates per 100,000 26,000/ 25,000/ 24,000/ 23,000/ 22,000/ 21,000/ 20,000/ 19,000/ this CCG Leeds registered Deprived Quintile Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2009/10 2010/11 2011/12 19,500 19,530 19,497 19,671 19,776 19,803 19,936 20,072 20,313 20,188 20,255 20,372 20,581 20,587 20,572 20,831 20,925 20,887 21,020 21,130 21,250 21,202 21,309 21,407 25,081 25,104 25,214 25,340 25,498 25,445 25,603 25,726 25,863 25,863 25,863 25,876 Obesity DSR for this CCG is slightly lower than the Leeds average. Obesity rates are calculated against those patients who have a BMI recorded and includes only the most recent recording - whenever it was made. Of the practices that comprise this CCG, Beech Tree Medical Centre has the highest obesity DSR of 22,558 per 100,000 while New Croft Surgery has the lowest obesity DSR with 18,799. Due to the variations in deprivation across this CCG's population, we need also to take note of the evidence available at practice level when exploring need. note: chart scales vary to reveal maximum detail, be careful with visual comparisons between charts.these rates are calculated from the data provided by the practices of this CCG, they include patients who may live outside Leeds. In these charts, the 95% confidence intervals are always shown for the CCG as error bars. Confidence intervals for Leeds and the Deprived Quintile are also shown, but only if they are significantly different to that of the CCG. This data is collected from practices quarterly and therefore only contains records where patients are presenting. Certain population groups are known to present late or not at all. Deprived Quintile: This is a slightly different measure of deprivation. The Deprived Quintile is the most deprived fifth of all MSOAs in Leeds. 'Deprived Leeds' as used elsewhere refers to the LSOAs in Leeds which are in the 10% most deprived in England - a more exact definition, but GP audit data is restricted to MSOA level and cannot be resolved to the finer level of detail LSOAs offer. December 2012 9 of 47

All GP recorded data for this CCG Source: NHS Leeds GP data audits, quarterly 2009-12 Age standardised rates per 100,000 for this CCG only GP recorded conditions for this CCG, are displayed in the table below for the last two years. The quarter four data is used in the chart to compare change between years. CHD COPD Diabetes Smoking Cancer Obesity Q1 2,849 1,411 3,255 21,821 2,132 19,776 Q2 2,840 1,426 3,286 21,777 2,169 19,803 Q3 2,820 1,421 3,318 22,221 2,192 19,936 Q4 10-11 2,791 1,436 3,325 22,323 2,211 20,072 Q1 2,780 1,452 3,360 22,528 2,208 20,313 Q2 2,744 1,448 3,361 22,244 2,243 20,188 Q3 2,736 1,457 3,386 22,333 2,274 20,255 Q4 11-12 2,719 1,457 3,407 22,226 2,288 20,372 Changes in age standardised rates between quarter 4 in 2010/11 and quarter 4 2011/12 5% 4% 3% 2% 1% 0% -1% -2% -3% -4% % change -5% CHD COPD Diabetes Smoking Cancer Obesity CCG -2.6% 1.4% 2.5% -0.4% 3.5% 1.5% Leeds -2.7% 2.0% 3.0% -0.2% 3.8% 1.3% Deprived quintile -3.6% 3.4% 1.8% 0.0% 4.2% 0.6% Most notable is the rising rate obesity in this CCG compared to both Leeds as a whole and the Deprived Quintile. December 2012 10 of 47

Inpatient emergency admissions note: chart scales vary considerably to reveal detail in each age group Source: HES data Emergency admissions 0-14 years Rate per 100,000 population 2008 2009 2010 2011 CCG 5,661 6,501 8,356 10,634 Leeds 6,129 6,797 8,331 10,660 registered Leeds registered this CCG 2008 2009 2010 2011 11,000/ 10,000/ 9,000/ 8,000/ 7,000/ 6,000/ 5,000/ Emergency admissions 15-65 years Rate per 100,000 population CCG 6,122 6,526 6,612 6,733 Leeds 7,040 7,792 7,598 7,526 registered 2008 2009 2010 2011 8,000/ 7,500/ 7,000/ 6,500/ 6,000/ Emergency admissions 65+ years Rate per 100,000 population CCG 27,730 28,994 29,600 30,456 Leeds 27,650 28,449 29,803 30,283 registered 2008 2009 2010 2011 32,000/ 30,000/ 28,000/ 26,000/ 24,000/ Emergency admissions all ages Rate per 100,000 population CCG 8,986 9,349 9,809 10,178 Leeds 10,127 10,446 10,842 11,083 registered 2008 2009 2010 2011 12,000/ 11,000/ 10,000/ 9,000/ 8,000/ For 0-14 years the rate for the CCG is increasing markedly, which reflects the direction for Leeds. For 15-65 years the rate for the CCG is slowly increasing which is different to the decreasing rate for the city (although only for one year; we would need to see this year's result to ascertain whether the trend for the city is continuing). For 65 + years the rates for the CCG and Leeds are comparable and are both rising. For all ages the CCG rate, although lower than the rate for Leeds, is rising at a similar rate. All specialty and case types: Inpatient Emergency - Accident and Emergency Dept / Inpatient Emergency - Bed Bureau / Inpatient Emergency - Consultant Outpatient Clinic / Inpatient Emergency / General Practitioner / Inpatient Emergency - Other. Rates are calculated against practice populations from January in-years. Membership of CCG projected as of April 2012. Years are calendar years. "Leeds" is all Leeds registered patients. December 2012 11 of 47

Outpatient first attendances note: chart scales vary considerably to reveal detail in each age group Source: HES data Outpatient first attendances 0-14 years Rate per 100,000 population 2008 2009 2010 2011 CCG 17,084 17,746 17,935 21,197 Leeds 17,227 18,412 18,651 22,186 registered Leeds registered this CCG 2008 2009 2010 2011 23,000/ 21,000/ 19,000/ 17,000/ 15,000/ Outpatient first attendances 15-65 years Rate per 100,000 population CCG 19,976 24,415 26,615 31,179 Leeds 21,860 26,723 28,856 33,968 registered 2008 2009 2010 2011 38,000/ 33,000/ 28,000/ 23,000/ 18,000/ Outpatient first attendances 65+ years Rate per 100,000 population CCG 52,939 69,629 73,211 82,171 Leeds 53,062 71,280 74,598 85,109 registered 2008 2009 2010 2011 87,000/ 82,000/ 77,000/ 72,000/ 67,000/ 62,000/ 57,000/ 52,000/ Outpatient first attendances all ages Rate per 100,000 population CCG 24,001 29,462 31,611 36,237 Leeds 25,606 31,705 33,736 39,186 registered 2008 2009 2010 2011 39,000/ 34,000/ 29,000/ 24,000/ This CCG had a total of 125,719 first outpatient attendances in the 2011 calendar year. This represents 40.7% of all first outpatient attendances in Leeds, whereas the CCG registered population makes up 42.8% of the Leeds registered population. For 0-14 years the rate for the CCG is lower than the rate for Leeds but both are rising at a similar rate. For 15-65 years the rate for the CCG is lower than the rate for Leeds but both are rising at a rapid rate. For 65+ years the rate for the CCG is lower than the rate for Leeds but both are demonstrating a similar pattern. For all ages the rate for the CCG is lower than the rate for Leeds Outpatient attendance: Attendances are sums of first attendances per practice, aggregated to CCG level using membership of CCG projected as of April 2012. Practice populations used to calculate rates are from January in-years. Years are calendar years. "Leeds" is all Leeds registered patients. December 2012 12 of 47

Emergency hospital admissions for respiratory problems Emergency respiratory admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all Leeds registered patients and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG 1,400/ 1,300/ 1,200/ 1,100/ 1,000/ 900/ 800/ 700/ 600/ Deprived Leeds Leeds registered 2002 / 2006 All emergency admissions (respiratory) 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 716 715 710 719 751 1,230 1,202 1,188 1,234 1,285 788 781 773 793 823 In the chart to the right, practices are ranked by their most recent DSR for respiratory admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'The Highfield Medical Centre' with 1,235, and the lowest is 'Burton Croft Surgery' with a DSR of 458. 3,000/ 2,500/ 2,000/ 1,500/ 1,000/ 500/ 0/ All practices ranked by Q4 2006-2010 admissions 2002 / 2006 2003 / 2007 Male admissions 2004 / 2008 2005 / 2009 2006 / 2010 1,400/ 1,300/ 1,200/ 1,100/ 1,000/ 900/ 800/ 700/ 600/ 1,400/ 1,300/ 1,200/ 1,100/ 1,000/ 900/ 800/ 700/ 600/ 2002 / 2006 Female admissions 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 842 833 824 839 863 Leeds registered 733 729 723 747 782 763 760 753 755 786 CCG 668 670 666 682 715 1,318 1,281 1,252 1,264 1,295 Deprived Leeds 1,149 1,131 1,132 1,216 1,285 The emergency hospital admissions due to respiratory disease for West Leeds CCG is below that of Leeds, and well below that of Deprived Leeds. It has been slowly climbing at more or less the same rate as Leeds. Both male and female DSRs for emergency admissions due to respiratory problems are below the Leeds rate. Both are following a similar slow upward trend to Leeds. Interestingly, Deprived Leeds is showing a relatively steep rise for female admissions which is not reflected in the Leeds or CCG rates though. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 13 of 47

Emergency hospital admissions for circulatory problems Emergency circulatory related admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all Leeds registered patients and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG 1,050/ 950/ 850/ 750/ 650/ 550/ 450/ 350/ 250/ Deprived Leeds Leeds registered 2002 / 2006 All emergency admissions (circulatory) 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 504 477 460 447 440 916 865 789 727 660 575 544 507 479 451 In the chart to the right, practices are ranked by their most recent DSR for circulatory admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'The Highfield Medical Centre' with 734, and the lowest is 'Burton Croft Surgery' with a DSR of 271. Male admissions 2,500/ 2,000/ 1,500/ 1,000/ 500/ 0/ All practices ranked by Q4 2006-2010 admissions Female admissions 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 1,050/ 950/ 850/ 750/ 650/ 550/ 450/ 350/ 250/ 1,050/ 950/ 850/ 750/ 650/ 550/ 450/ 350/ 250/ 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 698 660 614 587 559 Leeds registered 453 429 402 372 343 655 627 602 584 570 CCG 358 331 320 312 310 1,027 959 882 833 769 Deprived Leeds 799 768 691 614 543 Emergency admission DSRs for circulatory disease within the West CCG population have been slowly falling. The Leeds rate has been dropping slightly faster meaning West CCG and Leeds are currently very similar. The Deprived Leeds DSR has been falling much more quickly but is still well above the CCG and Leeds. Male emergency admissions within West Leeds CCG are falling and currently very similar to those of Leeds. For women in West Leeds CCG the rate is levelling off and for now still below that of Leeds. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 14 of 47

Emergency hospital admissions for cancer Emergency cancer related admission age standardised rates per 100,000 (DSR) for the under 75s in this CCG are averaged in five year bands. They are compared with the same data for all Leeds registered patients and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG Deprived Leeds 290/ 270/ 250/ 230/ 210/ 190/ 170/ 150/ Leeds registered 2002 / 2006 All emergency admissions (cancer) 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 189 189 188 179 180 225 229 229 225 227 186 188 189 182 185 In the chart to the right, practices are ranked by their most recent DSR for cancer admissions, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Laurel Bank Surgery' with 252, and the lowest is 'Kirkstall Lane Medical Centre' with a DSR of 85. Male admissions 400/ 350/ 300/ 250/ 200/ 150/ 100/ 50/ 0/ All practices ranked by Q4 2006-2010 admissions Female admissions 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 290/ 270/ 250/ 230/ 210/ 190/ 170/ 150/ 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 209 208 206 195 194 Leeds registered 166 169 174 172 178 222 216 209 192 191 CCG 159 165 169 169 172 257 264 261 249 246 Deprived Leeds 194 195 197 200 208 290/ 270/ 250/ 230/ 210/ 190/ 170/ 150/ Emergency hospital admissions due to cancer are more or less constant with small fluctuations following the Leeds DSR pattern. Deprived Leeds shows similar DSR patterns but of a higher amount. DSRs for male and female cancer admissions from West Leeds CCG are very similar to those for Leeds. In both cases the DSR for Deprived Leeds is higher. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 15 of 47

Early deaths from all causes All cause mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG is compared with the same data for all Leeds registered patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG Deprived Leeds 650/ 600/ 550/ 500/ 450/ 400/ 350/ 300/ 250/ 200/ 150/ Leeds registered 2002 / 2006 All cause mortality, under 75s. DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 300 286 272 260 247 492 479 472 460 450 305 294 284 274 266 In the chart to the right, practices are ranked by their most recent all cause mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Vesper Road' with 413, and the lowest is 'Leeds Student Medical Practice' with a DSR of 2. 2,000/ 1,800/ 1,600/ 1,400/ 1,200/ 1,000/ 800/ 600/ 400/ 200/ 0/ All practices ranked by Q4 2006-2010 mortality DSR 2002 / 2006 Male under 75 mortality DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 650/ 600/ 550/ 500/ 450/ 400/ 350/ 300/ 250/ 200/ 150/ 2002 / 2006 Female under 75 mortality DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 378 361 346 331 323 Leeds registered 237 229 223 219 211 373 350 334 316 301 CCG 231 226 213 206 195 608 599 584 563 550 Deprived Leeds 371 354 356 352 344 650/ 600/ 550/ 500/ 450/ 400/ 350/ 300/ 250/ 200/ 150/ All cause mortality for under 75s within the population of Leeds West CCG is slightly below that of Leeds and declining at a similar rate. The DSR for Deprived Leeds is also falling gently, but is much higher than this CCG and Leeds. The male, and the female CCG DSRs are following the Leeds rate closely as it slowly falls, with the male rate being higher than that of females. In both cases Deprived Leeds has a much higher DSR than the CCG. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 16 of 47

Early deaths from lung disease Respiratory mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG is compared with the same data for all Leeds registered patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG Deprived Leeds 100/ 90/ 80/ 70/ 60/ 50/ 40/ 30/ 20/ 10/ 0/ Leeds registered 2002 / 2006 Respiratory mortality, under 75s. DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 28 25 23 22 21 56 53 52 53 52 29 27 27 26 25 In the chart to the right, practices are ranked by their most recent respiratory mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Vesper Road' with 45, and the lowest is 'Leeds Student Medical Practice' with a DSR of 0. 100/ 90/ 80/ 70/ 60/ 50/ 40/ 30/ 20/ 10/ 0/ All practices ranked by latest respiratory mortality DSR 2002 / 2006 Male under 75 mortality DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 100/ 90/ 80/ 70/ 60/ 50/ 40/ 30/ 20/ 10/ 0/ 2002 / 2006 Female under 75 mortality DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 35 32 31 30 31 Leeds registered 24 22 22 22 20 34 29 27 26 26 CCG 22 21 19 19 17 65 64 62 62 63 Deprived Leeds 46 42 43 45 42 100/ 90/ 80/ 70/ 60/ 50/ 40/ 30/ 20/ 10/ 0/ Mortality for under 75s from lung disease within Leeds West CCG is falling at the same rate as, and slightly below that of Leeds. The Deprived Leeds DSR is much higher. The male CCG mortality DSR is slightly below that of Leeds and following a similar trajectory. For women in Leeds West the rate is well above that of Leeds. For males the CCG is far below the Deprived Leeds DSR, for women though the Deprived Leeds DSR is much lower and closer to that of the CCG. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 17 of 47

Early deaths from heart disease Circulatory mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG is compared with the same data for all Leeds registered patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. 250/ 200/ 150/ 100/ 50/ Circulatory mortality, under 75s. DSR 0/ Relevant CCG Deprived Leeds Leeds registered 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 86 81 77 73 67 145 140 135 129 125 89 84 79 75 71 In the chart to the right, practices are ranked by their most recent circulatory mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Kirkstall Lane Medical Centre' with 129, and the lowest is 'Leeds Student Medical Practice' with a DSR of 2. 250/ 200/ 150/ 100/ 50/ 0/ All practices ranked by latest circulatory mortality DSR Male under 75 mortality DSR 250/ 250/ Female under 75 mortality DSR 200/ 200/ 150/ 150/ 100/ 100/ 50/ 50/ 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 0/ 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 125 118 109 103 98 Leeds registered 54 51 49 48 45 122 115 108 101 92 CCG 53 50 48 47 43 200 196 186 175 171 Deprived Leeds 89 83 82 81 77 0/ Circulatory disease within West Leeds CCG is falling steadily and matching the Leeds DSR closely. Deprived Leeds is following the same trend but at a far higher rate. Male and female circulatory disease mortality in West Leeds CCG match their Leeds equivalents very closley. However the male DSR is so much higher in general than female that the female Deprived Leeds DSR is below that of the male Leeds and CCG DSRs. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 18 of 47

Early deaths from cancer Cancer mortality in the under 75s. Standardised rates per 100,000 are averaged in five year bands. The CCG is compared with the same data for all Leeds registered patients, and the most deprived fifth of Leeds. Some Leeds registered patients live outside Leeds but if registered at Leeds practices they are included in the data. Relevant CCG Deprived Leeds 190/ 170/ 150/ 130/ 110/ 90/ 70/ 50/ Leeds registered 2002 / 2006 Cancer mortality, under 75s. DSR 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 121 117 114 108 106 161 160 162 159 161 119 116 114 111 110 In the chart to the right, practices are ranked by their most recent cancer mortality for under 75s, those in this CCG are shown as blue. Averages for Leeds, the CCG, and Deprived Leeds are overlaid as black, blue and orange horizontal lines respectively. The practice in this CCG with the highest DSR is 'Vesper Road' with 167, and the lowest is 'Park Road Medical Centre' with a DSR of 51. 300/ 250/ 200/ 150/ 100/ 50/ 0/ All practices ranked by latest cancer mortality DSR Male under 75 mortality DSR Female under 75 mortality DSR 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 190/ 170/ 150/ 130/ 110/ 90/ 70/ 50/ 2002 / 2006 2003 / 2007 2004 / 2008 2005 / 2009 2006 / 2010 133 128 126 121 120 Leeds registered 105 105 104 102 100 135 129 126 119 116 CCG 108 108 103 99 97 184 182 179 175 175 Deprived Leeds 138 139 145 143 147 190/ 170/ 150/ 130/ 110/ 90/ 70/ 50/ The cancer mortality DSR for West Leeds CCG is falling very slowly and almost exactly the same as Leeds overall. Deprived Leeds is much higher than this CCG. The male and female cancer DSRs are falling and have always matched those of Leeds. Neither the male or female DSRs are very close to their respective Deprived Leeds counterparts. Source: Hospital Episode Statistics (HES), GP registered. 95% confidence interval error bars are always shown for the practice, but only for the other lines if they do not overlap the practice error bars. This reduces overlaps making the chart easier to read, and only highlights the points where something is significantly different to the practice. December 2012 19 of 47

Alcohol admissions 2010-2011 All Leeds practices are ranked below by alcohol specific and attributable admissions. Practices that are a member of this CCG are highlighted in blue. Leeds (black line) and CCG rate (blue line) are included for comparison. Rank charts show combined male and female admissions; the bar charts alongside compare the CCG data for both genders against Leeds. Alcohol specific admissions Directly age standardised rates per 100,000 4,000/ 4,000/ 3,500/ 3,500/ 3,000/ 3,000/ 2,500/ 2,500/ 2,000/ 2,000/ 1,500/ 1,500/ 1,000/ 1,000/ 500/ 500/ 0/ Practices ranked by all specific admissions 0/ All Males Females CCG per 100,000 663 860 460 Leeds per 100,000 641 841 436 All practices Practices in this CCG Leeds CCG Alcohol attributable admissions* Directly age standardised rates per 100,000 4,000/ 4,000/ 3,500/ 3,000/ 3,000/ 2,500/ 2,000/ 2,000/ 1,500/ 1,000/ 1,000/ 500/ 0/ Practices ranked by all attributable admissions 0/ All Males Females CCG per 100,000 1,892 2,350 1,469 Leeds per 100,000 1,847 2,328 1,398 Within Leeds there are two practices (not in this CCG) with extremely high attributable admission rates. They are not shown in entirety in the charts as the required scale would make all other practices too hard to see. These practices also have the highest rates of specific admissions in Leeds. The misuse of alcohol is associated with a wide range of chronic health conditions such as liver disease, hypertension, some cancers, impotence and mental health problems. It has a direct association with accidents, criminal offending, domestic violence and risky sexual behaviour. It also has hidden impacts on educational attainment and workplace productivity. For this CCG, the 'Manor Park Surgery' and 'Hyde Park Surgery' practices had the highest attributable and specific admissions DSR respectively. The practice with the lowest specific and attributable admissions was the 'Leeds Student Medical Practice'. Source: SUS admissions, NWPHO alcohol admissions fractions. *Attributable admissions are calculated, not counted. For more information see www.nwph.net/nwpho/publications/alcoholattributablefractions.pdf December 2012 20 of 47

Part 2. Matching data to Leeds West CCG. CCGs have a geographical footprint covering an area of Leeds, the boundaries of which reach to the outer edges of the city, and internally meet each other, leaving no part of Leeds without CCG 'ownership. Each electoral ward is allocated to a particular CCG as shown on the map below. Wards allocated to CCGs Most health data in this report comes from the practices that are members of this CCG. Some data though isn't available in this form, so another way is needed to allocate it to a specific CCG. The data is available by small chunks of land called Middle Super Output Areas (MSOAs) and so the CCG is allocated MSOAs that match as closely as possible the wards it is responsible for. An MSOA is attributed to a ward if the geographical centre of the MSOA falls within the ward area. The map below shows the MSOAs allocated to CCGs on that basis. The two maps are very similar. Part 2 of this report uses MSOAs to calculate data for the CCG areas as opposed to data from the CCG practice population (which was in part 1). These MSOAs are listed overleaf. CCG boundaries have also been defined by smaller geographical areas called LSOAs (Lower Super output Areas) as part of the NHS Commissioning Boards national process. Data in this report is not available at LSOA level. MSOAs allocated to CCGs About MSOAs (Middle Super Output Areas): These are geographic areas designed to improve the reporting of small area statistics in England and Wales. There are 108 MSOAs in Leeds. MSOAs are built from groups of Lower Super Output Areas (LSOAs). The minimum population of an MSOA is 5,000 and the mean is 7,200 (when originally generated). December 2012 21 of 47

The MSOAs that are used in this report to represent Leeds West CCG MSOA code E02002337 E02002338 E02002339 E02002343 E02002348 E02002350 E02002355 E02002356 E02002357 E02002362 E02002365 E02002368 E02002372 E02002373 E02002374 E02002375 E02002378 E02002380 E02002381 E02002383 E02002384 E02002385 E02002387 E02002388 E02002391 E02002392 E02002395 E02002396 E02002397 E02002400 E02002405 E02002407 E02002408 E02002409 E02002410 E02002412 E02002422 E02002424 E02002425 E02002431 E02002433 E02002434 E02002435 E02002436 E02002437 MSOA name Hawksworth Village, Tranmere Park Guiseley Yeadon - Henshaws, Southway, Westfields Rawdon North Ireland Wood, Lawnswood Horsforth - Brownberries, West End West Park and Weetwood Horsforth, New Road Side, Stanhopes and Rawdon South Horsforth Central Hawksworth Wood Far Headingley Calverley, Farsley North South Headingley Headingley Central Kirkstall Broadleas, Ganners, Sandfords Hyde Park,Woodhouse Bramley Whitecote Stanningley, Rodley Hyde Park, Burley Little London, Sheepscar Burley Bramley Bramley Hill Top, Raynville and Wyther Park Farsley South Little Woodhouse and Burley Thornbury Upper Armley Swinnow Armley, New Wortley Pudsey - Waterloos, Tyersals, Westroyds Farnley Pudsey Central, Littlemoor Gamble Hill, Moorside Upper Wortley New Farnley,Lower Wortley Churwell East Gildersome and Morley Springfields Drighlington and West Gildersome Morley East Morley West Middleton Heritage Village, Robin Hood S, Lofthouse and Thorpe Morley - Bruntcliffe, Howley Parks and Tingley East Ardsley West Ardsley December 2012 22 of 47

Population profile Population (of the area this CCG is responsible for), registered with any GP in January 2012. ALL: 347,564 Male: 173,051 Female: 174,513 The Leeds resident population registered with any GP in January 2012 was 813,654. Of the 347,564 people living in this CCG area, 22,701 or 6.5% live in the most deprived fifth of Leeds. Population pyramid for Leeds resident population, registered with any GP in January 2012 Leeds West CCG has the largest population of the three CCGs with over 40% of the Leeds population. It has a far greater number of 20-29 year olds due to the high proportion of students. The remaining population is fairly evenly distributed across all the age bands in line with Leeds averages. Demographic profiles at MSOA level vary greatly. For example the MSOA Hawksworth Village, Tranmere has a marked older population; Armley, New Wortley has a higher population of young children and adults in their late 20s and 30s; Burley has an extremely dissimilar profile to Leeds because the majority of the population is within the 20-40 age range (due to the student population). 85+ 80-84y 75-79y 70-74y 65-69y 60-64y 55-59y 50-54y 45-49y 40-44y 35-39y 30-34y 25-29y 20-24y 15-19y 10-14y 5-9y 0-4y Female Male 15% 10% 5% 0% 5% 10% 15% This CCG Leeds This chart shows the Leeds population and that of this CCG area. Historically population charts are shaped like a pyramid. The base is wide and each age band above is narrower as there are proportionately fewer people in the older age groups. In modern western societies the pyramids are now typically narrower at the base due to a decline in the birth rate. The Leeds profile is shown in outline and follows the expected pattern for a modern western population with an increase in the proportion of people in the university student age groups. The blue bars in this pyramid represent the total GP registered population of the ward area the CCG is responsible for (when converted into MSOAs), regardless of which CCG the patient is registered with. December 2012 23 of 47

GP recorded Ethnicity This data compares the ethnicity of people in the CCG responsible area, as recorded by Leeds practices in the first quarter (Q1) of 2012/13 with the ethnicity of the Leeds GP registered population as a whole. The 'White British' category is not included in the chart as it usually dominates the data to such an extent that all other ethnic groups are hidden. By omitting 'White British' we can use a scale that uncovers detail in the smaller ethnic groups. Leeds West White British 57.5% 55.3% Leeds registered Other White Background 6.1% 6.8% Pakistani or British Pakistani 1.3% 2.2% Black African 1.3% 1.9% Indian or British Indian 1.6% 1.8% Other Asian Background 1.3% 1.4% Other Ethnic Background 1.0% 1.0% Chinese 1.2% 0.8% Black Caribbean 0.3% 0.5% Other Black Background 0.3% 0.5% White Irish 0.4% 0.4% Bangladeshi or British Bangladeshi 0.0% 0.4% Mixed - White and Black African 0.3% 0.4% Mixed - White and Black Caribbean 0.3% 0.4% Other Mixed Background 0.3% 0.3% Mixed - White and Asian 0.3% 0.3% 0% 2% 4% 6% 8% Leeds West Leeds registered Not Recorded (69,066) 21.3% 21.5% Not Stated (8,495) 2.6% 2.5% Unknown (8,304) 2.6% 1.5% The ethnicity of the Leeds West CCG area population is broadly similar to the Leeds pattern of ethnicity (this takes into account the 'White British' category that is not shown on the chart, as well as the 'Not Recorded' and 'Not Stated' categories). This comparison is complicated by the fact that nearly a quarter of the Leeds registered population has no ethnicity recorded. This highlights the importance of improving data recording so that we can get the maximum information from the data available. Census data will give us a Leeds-wide picture of ethnicity when it is released, and later this will be available at MSOA level, allowing us to calculate figures for CCG responsible areas. We know that the ethnic mix in Leeds is changing rapidly and so the census will not be a reliable benchmark for long. December 2012 24 of 47

January 2012 School Census, language and ethnicity Pupils on roll in this area: 40,347 Pupils on roll in Leeds: 105,550 Top five recorded languages: in this area in Leeds Index 0 100 200 English 35,255 87.4% 87,689 83.1% 105 Urdu 618 1.5% 2,629 2.5% 61 Panjabi 562 1.4% 1,395 1.3% 105 Other than English 482 1.2% 1,399 1.3% 90 Arabic 354 0.9% 710 0.7% 130 Others 2,355 5.8% 9,966 9.4% Chart: Proportions of top five languages in this area compared to Leeds CCG Leeds English Urdu Panjabi Other than English Arabic 0% 25% 50% 75% 100% Top five recorded ethnicities: in this area in Leeds Index 0 100 200 White British 32,285 80.0% 76,078 72.1% 111 Non-Kashmiri Pakistani 1,137 2.8% 4,307 4.1% 69 Black African 785 1.9% 3,629 3.4% 57 Indian 751 1.9% 2,194 2.1% 90 Any Other Ethnic group 576 1.4% 1,415 1.3% 106 Others 4,666 11.6% 17,405 16.5% Chart: Proportions of top five ethnicities in this area compared to Leeds CCG Leeds White British Non-Kashmiri Pakistani Black African Indian Any Other Ethnic group 0% 25% 50% 75% 100% The annual School Census provides information on the ethnicity and first language of pupils who live in and go to school in Leeds. In total, there are 24 ethnic categories and over 170 different first languages. This profile summarises the top five of each in the area and compares these to the city averages (N.B. the 'top five' has been set as a threshold because in most areas the numbers below this are very small). While this data is specific to school children it is representative of the wider population. It provides valuable additional information on the make-up of the area and complements the population profile derived from analysis with Origins software of the GP registered population. Source: January 2012 School Census. (Totals will be slightly less than roll total as it is not a statutory requirement to collect ethnicity and language data for pupils below the statutory school age). Index: see glossary for details (Leeds = 100) December 2012 25 of 47

Neighbourhood Index The City Council has worked with partner organisations to develop a 'Neighbourhood Index' for the city, which provides the Council and its partners with a robust evidence base by which to plan service interventions and to begin to identify and guide resources into the areas of greatest need. It contributes to a more sophisticated understanding of the problems and issues facing local communities and the people in those communities, and provides a framework to benchmark progress in key neighbourhoods and communities. The Neighbourhood Index is a tool which brings together a wealth of information that paints a broad picture of an area and helps to describe local conditions. It is a multiple domain and indicator based system that seeks to measure outcomes rather than activities and inputs, and which can be used to measure the general 'health' and the relative success of neighbourhoods across the city. The aim has been to provide a framework for the exchange, analysis and sharing of information amongst partners / project deliverers / local communities that: can consistently gather, collate, analyse and present information about neighbourhoods can identify areas of need and analyse relevant data on the critical issues facing target neighbourhoods provides an agreed mechanism for reporting progress in neighbourhoods, and target areas in particular, and monitors success in meeting targets. The Index is constructed from 27 indicators that have been grouped into the following seven domains, then combined into a domain score and rank, and then into a single Neighbourhood Index score and rank: Economic Activity Low Income Education Health Community Safety Environment Housing The Neighbourhood Index is run yearly and the sample profiles overleaf represent the third year of the Index. Comparing profiles from different years allows us to see how conditions in an area have changed over time. The information contained in the Neighbourhood Index provides a contextual background for the more detailed health and wellbeing data contained in the Neighbourhood Profiles. The Neighbourhood Index looks at Middle Super Output Areas (MSOAs), included here are two of the many MSOA within this CCG area. They have been chosen to display the breadth of conditions within the CCG area but may not necessarily represent the absolute extremes. For further information please contact Jacky Pruckner, Business Transformation Team, Leeds City Council. Email: jacky.pruckner@leeds.gov.uk or telephone: 0113 2476394. December 2012 26 of 47

E02002400: Armley, New Wortley Leeds Index Economic Activity 100 Area 90 Community Safety 80 City 70 Education Community Safety 60 Low Income 50 Leeds Neighbourhood Index Domain Summary Environment 40 30 20 Health 10 0 2012 Rank Score Leeds Housing -10 Diff. -20 Score Economic Activity 14 28.56 68.40-39.84 Low Income Low Income 4-9.67 54.08-63.74 Education Housing Housing Health 10 10 47.00 30.59 63.28 54.35-16.28-23.76 Economic Activity Environment 15 63.83 83.09-19.26 Education 14 28.53 61.42-32.89-80 -60-40 -20 0 20 40 60 80 Community Safety 2 52.67 81.08-28.40 Leeds Index 5 7.92 58.15-50.23 The area is located in the Inner West and is adjacent to the City Centre. The populated area is bounded by the canal to the north and Tong Road to the south and stretches Environment Health Key Statistics Profiled Area Leeds M.D. across from New Wortley to Armley Moor Top. The River Aire and the Leeds / Liverpool Number Rate Number Rate Canal run through this area. Population 2010 MYE 8,705 798,769 Households Liable for Council Tax BME Population 3,637 1,146 14.72% 323,495 77,482 10.83% The age breakdown broadly reflects the averages for the city. The area has a diverse ethnic population with 15% of people coming from BME communities. Foundation Stage Key Stage 2 44 46 48.35% 65.71% 4,787 5,231 58.70% 73.00% 40% of households are renting from the local authority (through an ALMO) and 37% are in Key Stage 4 21 33.87% 3,986 53.40% owner-occupation. Terraced housing accounts for 58% of the stock and purpose built Persistent Absenteeism 51 13.75% 2,343 6.30% flats for a further 25%. 92% of properties are classified in Council Tax Band A. NEET (Nov - Jan Average) 29 13.89% 1533 7.00% Crimes Against the Person 508 N/A 24,651 N/A Key services located in the area include: St Bartholomews C of E Primary, Castleton Acquisitive Property Crime 776 N/A 44,609 N/A Primary, Armley Primary, Holy Family Catholic Primary, Strawberry Lane Community Environmental Crimes 211 N/A 10,588 N/A Centre, Armley and Tong Road Post Offices, and Armley Mills. Community Disorders 816 N/A 41,363 N/A Average Purchase Price 81,097 N/A 180,530 N/A Price / Income Ratio 5.60 N/A 6.06 N/A Housing Turnover 785 20.42% 48,339 14.12% Empty Homes (90+ days) 280 7.28% 20,131 5.88% Children in Workless Households 601 39.91% 27,113 20.16% Households Receiving In-Work Benefits 413 11.36% 18,637 5.76% 60+ Households In Receipt of Benefits 490 13.47% 33,388 10.32% Court Payment Orders 502 N/A 23,401 N/A 0.0% Least Successful 0.1% Job Seekers' Allowance 620 10.27% 25,029 4.71% 4.8% 0.5% Incapacity Benefit 610 10.11% 30,645 5.77% 0.0% 1.1% Lone Parent Income Support 190 3.15% 7,950 1.49% 40.1% 6.9% Circulatory Disease Mortality N/A 121.82 N/A 72.84 48.9% 17.2% Cancer Mortality N/A 180.73 N/A 111.16 6.2% Average 39.5% Low Birthweight N/A 9.52 N/A 7.69 0.0% 33.0% Adult Social Care 90 N/A 9,069 N/A 0.0% Most Successful 1.7% Profiled Area Leeds M.D. Faith (2001 Census) Fly Tipping 114 N/A 2,503 N/A Profiled Area Leeds M.D. Number Rate Number Rate The pie charts represent the weighted proportions of Graffiti (2010/11 data) 42 N/A 3,141 N/A Christian 4,647 59.63% 492,656 68.87% individual indicators falling into each band Waste Issues 90 N/A 5,191 N/A Buddhist 9 0.12% 1,603 0.22% Profiled Area Leeds M.D. Hindu 47 0.60% 4,189 0.59% Ethnicity (2001 Census) Adult Social Care Profiled Area Leeds MD Number Rate Number Rate Jewish 16 0.21% 8,233 1.15% Community Based Service Users Number Rate Number Rate White British 6,638 85.28% 637,872 89.17% Muslim 520 6.67% 21,385 2.99% Learning Disabilities 12 N/A 1,518 N/A Irish 110 1.41% 8,532 1.19% Sikh 87 1.12% 7,601 1.06% Mental Health 26 N/A 1,596 N/A Black Caribbean & White 91 1.17% 4,577 0.64% Physical Disablilty 45 N/A 5,646 N/A Black African & White 11 0.14% 867 0.12% Profiled Area Leeds MD Supplementary Health Information Other Reasons 7 N/A 309 N/A Asian & White 27 0.35% 2,541 0.36% Number Rate Number Rate Indian 135 1.73% 12,296 1.72% CHD Prevalance N/A 3.09% N/A 3.55% Age (2010 M.Y.E.) Profiled Area Leeds MD Pakistani 455 5.85% 15,064 2.11% Smoking Prevalance N/A 37.76% N/A 22.71% Number Rate Number Rate Bangladeshi 14 0.18% 2,531 0.35% Children 1,506 17.30% 134,493 16.84% Black Caribbean 69 0.89% 6,737 0.94% Profiled Area Leeds MD Disability (2001 Census) Working Age 6,036 69.34% 531,036 66.48% Black African 16 0.21% 2,404 0.34% Number Rate Number Rate Older People 1,163 13.36% 133,240 16.68% Chinese 26 0.33% 3,468 0.48% Limiting Long-Term Illness 1,762 22.62% 128,647 17.98% This product includes mapping data licensed from Ordnance Survey with the permission of HMSO Crown copyright and/or database right 2012. All rights reserved. License number 100019567 December 2012 27 of 47

E02002356: Horsforth, New Road Side, Stanhopes and Rawdon South Leeds Index Economic Activity 100 Area 90 Community Safety 80 City 70 Education Community Safety 60 Low Income 50 Leeds Neighbourhood Index Domain Summary Environment 40 30 20 Health 10 0 2012 Rank Score Leeds Housing -10 Diff. -20 Score Economic Activity 98 94.33 68.40 25.93 Low Income Low Income 96 87.66 54.08 33.58 Education Housing Housing Health 84 85 76.63 83.23 63.28 54.35 13.35 28.88 Economic Activity Environment 91 97.86 83.09 14.77 Education 106 103.03 61.42 41.61-80 -60-40 -20 0 20 40 60 80 Community Safety 85 95.64 81.08 14.56 Leeds Index 99 94.51 58.15 36.36 The area is located in the Outer North West. This area stretches from the edge of Apperley Bridge in the west and the Newlays area of Horsforth in the east. Also included is Environment Health Key Statistics Profiled Area Leeds M.D. south Rawdon and the Victorias in Horsforth. Number Rate Number Rate Population 2010 MYE Households Liable for Council Tax 7,719 3,206 798,769 323,495 The population is predominantly White British and the age breakdown shows a slightly higher than average proportion of older people. BME Population 377 4.96% 77,482 10.83% Foundation Stage Key Stage 2 76 53 90.48% 85.48% 4,787 5,231 58.70% 73.00% 82% of households are in owner-occupation. Semi-detached housing accounts for 47% of the stock, terraced housing for 23% and detached properties a further 17%. 80% of Key Stage 4 56 86.15% 3,986 53.40% properties are classified in Council Tax Bands B-E. Persistent Absenteeism 7 2.06% 2,343 6.30% NEET (Nov - Jan Average) 8 4.20% 1533 7.00% The area contains part of the Leeds City College, Horsforth Newlaithes Junior School, Crimes Against the Person 71 N/A 24,651 N/A Featherbank Infants School, Rawdon St Peter's C of E Primary School, Horsforth Acquisitive Property Crime 259 N/A 44,609 N/A Cemetery and Police Station. Environmental Crimes 43 N/A 10,588 N/A Community Disorders 140 N/A 41,363 N/A The area contains part of Horsforth Hall Park, Ashdown Lodge Pre-Prep School and Average Purchase Price 233,371 N/A 180,530 N/A Woodhouse Grove School. Price / Income Ratio 7.33 N/A 6.06 N/A Housing Turnover 374 11.29% 48,339 14.12% Empty Homes (90+ days) 168 5.07% 20,131 5.88% Children in Workless Households 41 3.06% 27,113 20.16% Households Receiving In-Work Benefits 53 1.65% 18,637 5.76% 60+ Households In Receipt of Benefits 232 7.24% 33,388 10.32% Court Payment Orders 78 N/A 23,401 N/A 0.0% Least Successful 0.1% Job Seekers' Allowance 84 1.76% 25,029 4.71% 0.0% 0.5% Incapacity Benefit 110 2.30% 30,645 5.77% 0.0% 1.1% Lone Parent Income Support 15 0.31% 7,950 1.49% 0.0% 6.9% Circulatory Disease Mortality N/A 32.14 N/A 72.84 1.4% 17.2% Cancer Mortality N/A 88.72 N/A 111.16 29.2% Average 39.5% Low Birthweight N/A 6.28 N/A 7.69 63.0% 33.0% Adult Social Care 97 N/A 9,069 N/A 6.4% Most Successful 1.7% Profiled Area Leeds M.D. Faith (2001 Census) Fly Tipping 16 N/A 2,503 N/A Profiled Area Leeds M.D. Number Rate Number Rate The pie charts represent the weighted proportions of Graffiti (2010/11 data) 6 N/A 3,141 N/A Christian 5,719 75.51% 492,656 68.87% individual indicators falling into each band Waste Issues 10 N/A 5,191 N/A Buddhist 3 0.04% 1,603 0.22% Profiled Area Leeds M.D. Hindu 33 0.44% 4,189 0.59% Ethnicity (2001 Census) Adult Social Care Profiled Area Leeds MD Number Rate Number Rate Jewish 10 0.13% 8,233 1.15% Community Based Service Users Number Rate Number Rate White British 7,227 95.04% 637,872 89.17% Muslim 23 0.30% 21,385 2.99% Learning Disabilities 10 N/A 1,518 N/A Irish 52 0.68% 8,532 1.19% Sikh 25 0.33% 7,601 1.06% Mental Health 19 N/A 1,596 N/A Black Caribbean & White 13 0.17% 4,577 0.64% Physical Disablilty 62 N/A 5,646 N/A Black African & White 6 0.08% 867 0.12% Profiled Area Leeds MD Supplementary Health Information Other Reasons 6 N/A 309 N/A Asian & White 34 0.45% 2,541 0.36% Number Rate Number Rate Indian 57 0.75% 12,296 1.72% CHD Prevalance N/A 3.68% N/A 3.55% Age (2010 M.Y.E.) Profiled Area Leeds MD Pakistani 3 0.04% 15,064 2.11% Smoking Prevalance N/A 13.55% N/A 22.71% Number Rate Number Rate Bangladeshi 0 0.00% 2,531 0.35% Children 1,342 17.39% 134,493 16.84% Black Caribbean 17 0.22% 6,737 0.94% Profiled Area Leeds MD Disability (2001 Census) Working Age 4,777 61.89% 531,036 66.48% Black African 3 0.04% 2,404 0.34% Number Rate Number Rate Older People 1,600 20.73% 133,240 16.68% Chinese 46 0.60% 3,468 0.48% Limiting Long-Term Illness 1,107 14.57% 128,647 17.98% This product includes mapping data licensed from Ordnance Survey with the permission of HMSO Crown copyright and/or database right 2012. All rights reserved. License number 100019567 December 2012 28 of 47