Dudley Strategy for Tackling Health Inequalities 2010-15

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Percentage performance gapBlood Sugar Control in DiabetesPerformance gaps for optimum blood sugar control in diabetes are high and rangedfrom 16.5% to 51.3% against a Dudley average of 32% and an England average of33.5%. (Figure 8)There is a weak association between deprivation and practice performance withpoorer control being evident for practices in more deprived areas.Figure 8: Blood sugar control (HbA1c< 7.5) (r=0.43,r 2 =19%)4948294046.541.514235447194539362341155036.52082853431.526.521.516.5373174392611210512718 3212 3013 2452 5314474631212564221633380 10 20 30 40 50 60 70Percentage of GP population in most deprived IMD quintileDM20 % Gap Mid Range IMD1 DM20 Dudley Average % Gap DM20 England Average % GapSource: Quality Outcomes Framework disease register 2008/09Primary Care Mortality Data GP Registered PopulationDepartment of Communities & Local Government Indices of Deprivation 2007Cardio-protective PrescribingPractice QOF performance for the prescribing of cardio-protective drugs is alsoextremely varied for all vascular disease/condition registers and was not associatedwith deprivation. QOF performance data does not give detail on whether drugs aretitrated to the optimum levels, only that they are prescribed so giving an insight intoaccess to treatment not equity of treatment outcomes. Dudley‟s averageperformance is similar to the England average - slightly better for all indicators.Performance gaps were much lower for the prescribing of the clot preventing drugs(antiplatelet/anticoagulant).69
Table 4: Range of performance gapDisease/condition registerQOF clinical indicatorPercentagegap rangeDudleyaverageCHD 11 (ACE-I/A2 Antagonist) 0% to 23.1% 10.0% 10.7%Diabetes 15(ACE-I/A2 Antagonist) 0% to 100% 8.3% 10.3%CKD5(ACE-I/ARB) 0% to 100% 13.3% 13.3%Heart Failure 3(ACE-I/ARB) 0% to 20% 7.1% 10.0%CHD10 (Beta blocker) 0% to 46.1% 22.8% 27.5%CHD 9 (aspirin/anti-platelet or anticoagulate)Stroke12 (aspirin/anti-platelet or anticoagulate)AF3 (aspirin/anti-platelet or anticoagulate)Englandaverage0% to 14.5% 5.3% 5.8%0% to 13.5% 4.9% 5.9%0% to 10.6% 5.2% 6.3%Lifestyle Risk Management Service Referrals (LRMS)An important element of chronic disease management and secondary prevention isassessment of the patient‟s lifestyle and referral to LRMS where appropriate.Referral rates/practice were reviewed for physical activity referrals and 4 weeksmoking quitter rates. It was not possible to separate out primary and secondaryprevention referrals.Outcomes for stop smoking services in relation to 4-week quit rates were alsoreviewed to give an indication of the equity of treatment outcomes. Outcomes fromphysical activity referrals are not routinely available.Practice referral rates for physical activity were extremely varied and not related todeprivation. They were also very low across practices ranging from 0 to 16/1,000adult population with a Dudley average of 2.7/1,000. Overall 4 week quit outcomesfor stop smoking were high, ranging from 250 to 721/1,000 referred adult populationwith a Dudley average of 500/1,000. (Figure 9)Practice referral rates for smoking showed a medium positive relationship todeprivation, with practices in deprived areas having higher referral rates. Thismatches need and suggests equitable provision as prevalence of smoking is greaterin areas of higher deprivation. However outcomes across practices were very variedwith practices in deprived areas having lower 4 week quit rates. So although peoplein deprived areas are more likely to be referred, they are less likely to stop smoking.(Figure 10)70
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2010FDudley Strategy forTackling He
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ENDORSEMENT OF THE 2010 - 2015HEALT
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CONTENTSFOREWORD………………
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Standardised Rate per 100,000 Popul
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There were three principles that un
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This work has been built on trustin
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ENSURE A HEALTHY STANDARD OF LIVING
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with, or at high risk of vascular d
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Tackling underage/illegal alcohol c
Page 19 and 20: 2. VISION STATEMENTThe mission stat
Page 21 and 22: tackle health inequalities in the t
Page 23 and 24: These recommendations are addressed
Page 25 and 26: injustice and deprivation impact ne
Page 27 and 28: - Giving priority to pre and post-n
Page 29 and 30: Percentage of live and still births
Page 31 and 32: EYFS Median Scores by National Depr
Page 33 and 34: data which shows us locally what ac
Page 35 and 36: instability. Factors such as job se
Page 37 and 38: Proportion of population claiming J
Page 39 and 40: Data is available for those ALMPs f
Page 41 and 42: Labour market outcomes to date are
Page 43 and 44: achieved through transfer payments,
Page 45 and 46: % share of equivalised incomeA comp
Page 47 and 48: Figure 7 shows the income distribut
Page 49 and 50: Figure 9Proportion of the populatio
Page 51 and 52: Although temperature variations dur
Page 53 and 54: 5. LEADERSHIP AND PARTNERSHIPDudley
Page 55 and 56: A Community Renewal team which coor
Page 57 and 58: 6. COMMUNITY ENGAGEMENTCommunity En
Page 59 and 60: o DMBC sharing their community enga
Page 61 and 62: Transferring power to communitiesNI
Page 63 and 64: Standardised Rate per 100,000 Popul
Page 65 and 66: Secondary Prevention of CVDOptimum
Page 67 and 68: Ratio of obsevred vs. expected prev
Page 69: Performance variation cannot be exp
Page 73 and 74: Conclusions:The general conclusions
Page 75 and 76: 7.2 ACUTE CARDIO-VASCULAR DISEASE (
Page 79: Timely ResponseApproximately 30% of
Page 82 and 83: IMD ScoreRevascularisation Ward Rat
Page 84 and 85: That an increase in access to diagn
Page 86 and 87: Establishing the level of health eq
Page 90 and 91: Timely ResponseTimely access to tre
Page 92 and 93: Continue implementation of current
Page 94 and 95: “reduce smoking during pregnancy
Page 96 and 97: Percentage who currently smokePerce
Page 98 and 99: 1. Stop Smoking Service ProvisionDu
Page 100 and 101: Proportion of clients that have qui
Page 102 and 103: 3. Communication and EducationDSSS
Page 104 and 105: The PCT, Acute Trust, Local Authori
Page 108 and 109: admissions. The following year Dudl
Page 110 and 111: Standardised Rate per 100,00 popula
Page 112 and 113: Netherton &WoodsideHalesowen NorthC
Page 114 and 115: women the Mosaic groups with signif
Page 116 and 117: numbers of alcohol related sexual o
Page 118 and 119: These include:Securing additional i
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The deprivation gap in invasive can
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Age standardised incidence rate rat
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One of the priorities of the Cancer
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Colorectal cancerProstate cancerThe
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and less radical treatment than you
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As more people than ever are surviv
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• Benchmarking of surgery aspirin
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There is a weak correlation between
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7.7 SEASONAL EXCESS DEATHSREDUCING
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Excess Winter Mortality Index (%)Me
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Brockmoor & PensnettSt JamesKingswi
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Percentage uptake of seasonal flu v
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Percentage uptake of seasonal flu v
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The group will establish terms of r
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Standardised Rate per 100,000 popul
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PercentagePercentageFigure 7aMechan
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PercentageFigure 8bMechanism of inj
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Key findings from analysis of morta
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Standardised rate per 100,000 popul
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PercentageFigure 17bMechanism of in
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Key findings from analysis of emerg
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Action plan updated in 2008 to rein
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the minimum standards set out by th
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Further analysis shows that for hyp
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8.2 SOCIAL CAREAdult Social CareSoc
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8.3 TRANSFORMING COMMUNITY SERVICES
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DCS has some key performance target
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8.4 DEVELOPING THE ROLE OF THE VOLU
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at the heart of action to address c
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CHC‟s are trained and supported t
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capacity and confidence of individu
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which it has never done before. The
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centres‟ outreach workers and Hea
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9.1 DUDLEY HEALTH INEQUALITIES HIGH
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RECOMMENDATION ACTIVITY OUTCOMES LE
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Dudley Community Partnership (2005)
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Great Britain. Department of Health
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NHS Dudley and Dudley Metropolitan
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APPENDIX 1 - PERFORMANCE INDICATORS
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Indicator Dudley England Least Most
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APPENDIX 2 - DELIVERY PLANS FOR PRI
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PRIORITY AREA: TOBACCO CONTROLRECOM
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All of these initiatives will requi
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Empower community members toraise a
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Develop an integrated alcoholtreatm
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Offender ManagementRECOMMENDATION A
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PRIORITY AREA: SEASONAL EXCESS DEAT
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APPENDIX 3 - HEALTH INEQUALITIES CH
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PRIORITY ACTIONENGAGEMENT- WORKFORC
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Dudley Strategy for Tackling Health Inequalities 2010-15

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