Dudley Strategy for Tackling Health Inequalities 2010-15

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Standardised Rate per 100,000 PopulationStandardised Rate per 100,000 PopulationFigure 53500Directly Standardised Admission Rates from All admissions All CVD byPercentage of GP population in the Most Deprived IMD 2007 QuintileBoth Sexes, All Ages, 200830005325004840Correlationcoefficient0.502200015001000523012120107423 433162 3135618 3214 4938444751462124 17192613 4384592852527392322361141 34 291550DSRDudley averageMid range IMD 13750000% 10% 20% 30% 40% 50% 60% 70% 80%Percentage of GP population in most deprived IMD quintileSource: Secondary Users Service (SUS) Hospital AdmissionsPrimary Care Mortality Data GP Registered PopulationDepartment of Communities & Local Government Indices of Deprivation 2007Figure 6:1800Relationship between Directly Standardised Admission Rates from Alladmissions CHD and Expected Disease Prevelance by GP PracticeBoth Sexes, All Ages, 2008Correlation coefficient = -0.253160014001200100080060040020000.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%Expected DiseasePrevalence (%)Source: Secondary Users Service (SUS) Hospital AdmissionsPrimary Care Mortality Data GP Registered PopulationQuality and Outcomes Framework 2008/0977
Timely ResponseApproximately 30% of patients who die of MI do so before reaching hospital. For theremainder, their prognosis is dependent on the time it takes to restore blood flow tothe ischaemic myocardium. The earlier reperfusion is achieved, the greater thebenefit. Mortality is twice as high in patients treated 4-6 hours after the onset ofsymptoms as it is in patients treated within 1-2 hours. Therefore, it is imperative thatpatients suffering an MI should receive medical attention as quickly as possible (BHF,2006).Timely access to treatment for AMI is dependent on:o Public knowledge and awareness of signs, symptoms and speed ofresponseo Emergency response timeso Access to timely diagnostics and treatment - reperfusionPublic knowledge and awareness of the symptoms and need to call 999 is low in thegeneral population and pre-hospital delays are greater in older people, women,deprived, ethnic groups and patients with pre-existing conditions. Currently there areno national or local awareness campaigns running.Emergency reperfusion for Dudley patients is delivered by a tertiary level PrimaryPCI service for STEMI MI at the Heart and Lung Centre at New Cross Hospital(NCH) Wolverhampton. The Black Country is one of the first to roll out this service,with coverage across England currently at only 25% (MINAP, 2009). National goodpractice standards for PPCI have been set of 90 minutes between arrival atinterventional centre and reopening of artery (door to balloon) and 150 minutes fromcall for help to reopening of the artery (call to balloon). Door to balloon times aredependant on speed of access to diagnostics and treatment within the hospital andcall to balloon time incorporates ambulance response times and triage via otheradmission routes as well as hospital efficiency. Performance at NCH for 2008/9 wasclose to the average for England (Table 1).Table 1: Speed of Access Measures for PPCI (Source MINAP data 2009)PPCI measures ( door to balloon) (call to balloon)New cross hospital 82% 77%England average 84% 79%Source MINAP data 2009Door to balloon times are specifically influenced by the method of admission.Routine data analysis at New Cross shows a mean average door to needle time for999 ambulance admissions directly to the heart and lung centre as 67.8 minutescompared to 83.1 minutes for other admission methods e.g. via self presentation atNew Cross A&E. 28% of patients entered the pathway by the self presentation route.This reiterates the need for public awareness campaigns.Acute MI is dealt with as a Category A call with a target response time of 8 minutes.Weekly Category A response times for the WMAS during 09/10 ranged frombetween 55% to 85% with an average of 72.3%.78
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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
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2. VISION STATEMENTThe mission stat
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tackle health inequalities in the t
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These recommendations are addressed
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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 and 70: Performance variation cannot be exp
Page 71 and 72: Table 4: Range of performance gapDi
Page 73 and 74: Conclusions:The general conclusions
Page 75 and 76: 7.2 ACUTE CARDIO-VASCULAR DISEASE (
Page 77: Standardised Rate per 100,000 Popul
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
Page 122 and 123: The deprivation gap in invasive can
Page 124 and 125: 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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