Welcome and Introduction

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(No Transcript)
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Welcome and Introduction

• Rani Dhir MBE
• Chair
• West Dunbartonshire Community Health Partnership

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Purpose of Event and Wider Context

• Tom Divers
• Chief Executive
• NHS Greater Glasgow and Clyde

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Health Needs Assessment Dr Linda de Caestecker,
Director of Public Health
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Key Results

• The population
• Life expectancy and causes of death
• Health behaviours
• Chronic diseases
• Cancer
• Child health
• Mental health
• Service utilisation
• Conclusions

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West Dunbartonshire population projection 1996
2015, all ages
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Projected percentage change (2004-based)Council
area 2004 - 2024
25
20
15
10
5
0
Percentage change
-5
-10
-15
-20
-25
-30
Fife
Moray
Angus
Falkirk
Stirling
Dumfries
Midlothian
Highland
Inverclyde
Eilean Siar
Galloway
East Lothian
Dundee City
SCOTLAND
Renfrewshire
Argyll Bute
Glasgow City
East Ayrshire
Scottish Borders
West Lothian
Aberdeen City
North Ayrshire
Aberdeenshire
Dunbartonshire
South Ayrshire
Orkney Islands
West
Perth Kinross
East
Dunbartonshire
Shetland Islands
North Lanarkshire
Edinburgh, City of
East Renfrewshire
South Lanarkshire
Clackmannanshire
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Age structure of council areas, 2005 GRO mid-year
( of population under 16, 16-44, 45-64 and 65
years)
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West Dunbartonshire population projection 1996
2015, by age group
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2004 Based Household Population Projections
West Dunbartonshire (Source GROS)
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Demography

• 91,300 population
• 7.67 of NHS Greater Glasgow and Clyde
• Decrease of 4.7 from 95,870 in 1995
• Further 8 predicted decrease by 2024
• Small predicted increase in 65 yrs of 1,556
• 6 increase in number of households

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Scottish Index of Multiple Deprivation

• Whole of Scotland divided into 6505 areas
  datazones of about 769 people
• Multiple deprivation measured by 7
  characteristics current income, employment,
  health, education, geographic access to services,
  housing and crime

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Percentage of West Dunbartonshire, Glasgow City
and NHS Greater Glasgow Clyde residents living
in 5 and 20 most deprived areas of Scotland
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SIMD 2006Datazones in the worst 15 in Scotland
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Male life expectancy at birth (years) West of
Scotland Council Areas vs Scotland 1991-1993 to
2003-2005 Source Office for National Statistics
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Female life expectancy at birth (years) West of
Scotland Council Areas vs Scotland 1991-1993 to
2003-2005 Source Office for National Statistics
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All-cause deaths by council area directly
age/sex standardised rates per 100,000
population, 2005 - GROS
Scotland
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Comparative SMR 2003-2005
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Liver cirrhosis age standardised mortality rates
among men aged 15-74 years in Scotland, NHS
Greater Glasgow and West Dunbartonshire in the
context of maximum, minimum and mean rates for 16
Western European countries.
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Perinatal Deaths West Dunbartonshire
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West Dunbartonshire Health Wellbeing
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Perception of Health Illness

• 69 positive perception
• Less positive than Greater Glasgow (80)

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Dental Health

• 5 of 45-54 year olds with no natural teeth by
  the year 2010
• (Source Towards a Healthier Scotland)

• 9 with no natural teeth
• Compared to 6.6 in Greater Glasgow.

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Health Behaviours - Smoking

• 40 current smokers
• Over half of smokers are heavily addicted
• 20 of 15 year olds are regular smokers

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Health Behaviours - Alcohol

• Health and Wellbeing Survey 34 of men exceed
  the weekly alcohol limit. (25 in Greater
  Glasgow, 27 in Scotland)
• 18 of women exceed the weekly alcohol limit.
  (11 in Greater Glasgow,14 in Scotland).

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Health Behaviours Binge Drinking

• More men (48) than women (28) reported binge
  drinking (Greater Glasgow 39 and 19)

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Health Behaviours Physical Activity

• 47 of respondents had a minimum of 30 minutes
  of physical activity on 5 or more days of the
  week or 20 minutes of strenuous activity on 3 or
  more days of the week (58 in Greater Glasgow).

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Diet, exercise and obesity

• Only 23 are eating 5 fruit and vegetables per
  day
• Average number of portions 3 per day
• 16 with a BMI over 30.

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Overall

• Poorer health and wellbeing than the rest of
  Greater Glasgow
• 106/112 indicators same as or worse than Greater
  Glasgow (mainly worse)
• Greater Glasgow is not great!

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Problem drug use

• 1,185 people with problem drug use in West
  Dunbartonshire (2.2)
• 551 drug injectors in West Dunbartonshire (1.0)
• Glasgow City 3.3 and 1.32
• Scotland 1.84 and 0.67
• Over 20 of 15 year olds responded they had used
  drugs in the last month

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Chronic Diseases
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Diabetes

• Type 1 diabetes is due to inadequate insulin and
  is thought to be infectious in origin and
  influenced by genetics.
• Type 2 diabetes is associated with a resistance
  to insulin related to excess intake of alcohol,
  sugar and calories, too little exercise and
  overweight/obesity.
• There is significant under-diagnosis of Type 2
  diabetes.

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Diabetes

• Diabetes prevalence rising in Scotland, Greater
  Glasgow and WDCHP
• Assumed to be related to the rise in alcohol
  consumption, and overweight/obesity
• WDCHP residents suffer from diabetes more often
  than their Greater Glasgow and Scottish
  counterparts according to primary care
  information (3.6)

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Chronic Obstructive Pulmonary Disease (COPD)

• COPD is the fourth commonest killer in Scotland
  (5 of deaths).
• 80-90 of COPD is caused by smoking.
• Recent study as many as 13 of Britons over 35
  years of age have (salivary or x-ray) evidence of
  COPD and most of these have never been given a
  diagnosis.
• Recent study suggested that 25 of smokers will
  develop COPD.
• Primary Care information shows that WDCHP has a
  17 higher prevalence of COPD (2.1) than does
  Scotland (1.8), in keeping with the higher
  prevalence of smoking.

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Chronic Lower Respiratory Diseases, age
standardised mortality rates Males, all ages
Scotland, NHS Greater Glasgow, Glasgow City and
West Dunbartonshire Council area Directly
standardised to Western European population
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Chronic lower respiratory diseases, age
standardised mortality rates Females, all ages
Scotland, NHS Greater Glasgow, Glasgow City and
West Dunbartonshire Council areaDirectly
standardised to Western European population
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Hospital discharges with chronic lower
respiratory diseases (in first or second diag
position) Age standardised mortality rates, males
NHS Greater Glasgow, Glasgow City and West
Dunbartonshire area Directly standardised to
Western European population
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Hospital discharges with chronic lower
respiratory diseases (in first or second diag
position) Age standardised mortality rates,
females NHS Greater Glasgow, Glasgow City and
West Dunbartonshire area Directly standardised to
Western European population
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Age-standardised incidence of CHD rates per
100,000 for males - Scotland, Greater
Glasgow,West Dunbartonshire and Glasgow City.
1996-2005
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Age-standardised incidence of CHD rates per
100,000 for females - Scotland, Greater
Glasgow,West Dunbartonshire and Glasgow City.
1996-2005
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Age-standardised Acute MI incidence rates per
100,000 for males - Scotland, Greater
Glasgow,West Dunbartonshire and Glasgow City.
1996-2005
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Age-standardised Acute MI incidence rates per
100,000 for females Scotland, Greater
Glasgow,West Dunbartonshire and Glasgow City.
1996-2005
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Age-standardised Cerebrovascular Disease
incidence rates per 100,000 for males - Scotland,
Greater Glasgow, West Dunbartonshire and Glasgow
City. 1996-2005
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Age-standardised Cerebrovascular Disease
incidence rates per 100,000 for females -
Scotland, Greater Glasgow, West Dunbartonshire
and Glasgow City. 1996-2005
n894
n1241
n136
n7003
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Summary of CHD and CVD epidemiology

• Most regions show clear decline for all indices.
• In 2005, for the first time, there were more new
  cases of acute MI and CHD in WD females than WD
  males.
• From 2002, the rate of new cases of acute MI has
  been increasing for WD females.
• CHD incidence rate in WD females in 2005 returned
  to that for 1996.

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Prevalence of chronic conditions from primary
care information

• COPD - 2.1 - lower than GG
• Stroke - 2.2 - higher than GG
• CHD - 4.9 - higher than GG
• Hypertension - 13.5 - higher than GG

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Cancer
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10 most common cancers in men and women,
1998-2002
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Cancer Needs

• Prevention is better than cure
• Reducing cigarette smoking
• Reducing alcohol use
• Reducing obesity
• Increasing physical activity
• Increasing fruit and vegetable intake
• Participation in cervical, breast, and colorectal
  cancer screening programmes

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Child Health
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Proportion of low birth babies (lt2500g)
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of Mothers Smoking During Pregnancy
Provisional data
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of Babies Breast-Feeding at 6 weeks 2002-2005
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Immunisation rates in the West Dunbartonshire
CHP
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Mental Health
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Positive Perception of Mental Health

• 75 of the total sample reported a positive
  perception of mental health
• Less positive than Greater Glasgow (84)

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Prevalence of mental illness from primary care
information

• 0.6 of population
• Lower than GG
• Same as Scotland

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Suicide in males and females, 1980-2005. West
Dunbartonshire, Glasgow City and Scotland
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Service Utilisation
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Use of Health Services

• of respondents who thought it was difficult to
  access health services
• 20 GP appointment
• 10 Hospital appointment
• 4 Dental appointment
• Compared to Greater Glasgow more dissatisfaction
  (exception dental health)

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West Dunbartonshire residents elective activity
to GGC hospitals (selected specialties
2005/2006)
General Medicine
General Surgery
Orthopaedics
VOL
GJH
GGH
SGH
GRI
RAH
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West Dunbartonshire residents emergency activity
to GGC hospitals (selected specialties
2005/2006)
General Medicine
General Surgery
Orthopaedics
VOL
GJH
GGH
GRI
SGH
RAH
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West Dun CHP Rate per 100,000 population of
patients with 3 or more emergency admissions
within 1 year by age group, years ending 31
March 1995-2006 (aged 65) (n236 in 2006)
n58
n57
n48
n40
n33
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Key Messages

• Smoking, drinking and drug misuse are major
  public health problems
• Smoking in pregnancy and low breastfeeding rates
  have major implications for future health
• Need to improve access to smoking cessation and
  problem drinking services
• Oral health, obesity and physical activity must
  be addressed
• More health improvement work needs to be directed
  at women in WD to manage relative increase in
  cases of CHD (including acute MI).
• CHD, stroke, COPD, hypertension and diabetes are
  all more common in WD than Scottish counterparts.
• Priority is to manage chronic diseases in primary
  care

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Health Needs and Health Services
OverviewMeeting Health Needs Role of West
Dunbartonshire Community Health Partnership

• Keith Redpath
• Director
• West Dunbartonshire Community Health Partnership

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Content

• CHP perspective on analysis
• Role of CHP
• Developing a local response

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Key Messages from Needs Assessment

• West Dunbartonshire overall not significantly
  different form the rest of Greater Glasgow and
  Clyde
• But 2nd highest death rate in Scotland
• We also compare poorly across a range of issues
  e.g.
• Too many people smoke
• Too many people drink too much
• Too few people are active enough
• Too many people abuse drugs
• Too many people with poor dental health
• Too many vulnerable people are repeatedly
  re-admitted to hospital
• However, all of these issues are conducive to
  being addressed at local level

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• 90 of patient interaction with the NHS starts
  and ends in Primary Care
• Source Delivering for Health, Scottish
  Executive, November 2005, P. 15.

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• No-one has challenged the case for extending and
  enhancing local health care services to build
  healthier communities
• Hospitals should be our last resort for most
  health care needs, not our first port of call.
• Source Delivering for Health, P. 12.

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• The 90 referred to is in some way the
  responsibility of the CHP
• As a direct provider of
• Community nursing services
• Community-based AHP services such as
  physiotherapy and podiatry
• Community mental health services
• Addiction services

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• The 90 referred to is in some way the
  responsibility of the CHP
• Holding the contractor budgets for
• General Practice
• Dentists
• Optometrists
• Community Pharmacy

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• The 90 referred to is in some way the
  responsibility of the CHP
• As a partner with other related service-providers
  e.g.
• West Dunbartonshire Council
• Voluntary sector
• Other providers
• Carers

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Broader Role for the CHP

• Scheme of establishment states that the CHP will
  be charged with (amongst others)
• Real action on health improvement
• Focusing on the health of the whole population
  not just on services
• Improving the health of our population and
  closing the inequalities gap

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Broader Role for the CHP

• Leading health improvement activity across all
  partners
• Leading Health contribution to the economic and
  physical regeneration of the area
• Ensuring action targeted on the broader
  determinants of ill-health, such as
  unemployment/poor housing/community safety

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• Developing the local response to the needs
  analysis

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Using the CHP Development Plan

• Ensuring that priorities for action are
  identified
• Matching expectations to the available resources
• Continuing the debate on the outcomes

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Chronic Disease and Long-Term Conditions
Management

• Achieving equity across the whole of the area
• Renewed focus on the management of long-term
  conditions with performance and delivery
  monitored nationally

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Using the Community Planning Processes

• Agreeing specific targets and contributions
  across the partners
• Engaging with the wider community on the issues

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Action on Lifestyle Changes e.g.

• Action to tackle levels of smoking
• Action to tackle alcohol abuse
• Action to tackle drug abuse
• Recent announcement of West Dunbartonshire being
  added to 2010 prevention programme

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Repeated Hospital Admissions

• Workshop session later to discuss details
• Examine practice locally
• Approaches of local community services, NHS and
  social care
• Is it levels of ill-health or lack of access to
  services to avoid admission?

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Conclusions

• Highlights areas for priority attention
• Sets an agenda for the CHP to lead
• Supports the need to continue to deliver
  programmes of care through extended primary care
  teams and care models
• Emphasises the continuing importance of using the
  information we have to improve the health status
  of the people of the area

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Reporting Back on Local Health Service
ReviewsReview of Maternity Services

• Deb Den Herder
• Director
• Clyde Acute Services
• NHS Greater Glasgow and Clyde

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Context for Review

• Review of assumptions made in former NHS Argyll
  and Clyde strategy
• Greater Glasgow Maternity Strategy

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Current Configuration of Service in Clyde (est.
2003)

• One consultant-led unit based at Royal Alexandra
  Hospital
• Three Community Midwifery Units, located at
  Inverclyde Royal Hospital, Royal Alexandra
  Hospital and Vale of Leven Hospital

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Role of the Community Midwifery Units

• Community Midwifery Units were intended to
  provide all
• services to women with low and high risk
  pregnancies except
• Inpatient antenatal care
• High risk labour care
• Neonatal special care

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Services Provided in CMU

• Midwife-led antenatal care
• Consultant-led antenatal care via outreach
  clinics
• Day care service (Monday Friday)
• Early pregnancy service (Monday Friday)
• Ultrasound service (Monday Friday)
• SNIPS in liaison with Consultant-led unit (Monday
  Friday)
• Smoking cessation service
• Parent education classes including aqua-natal
• Community midwifery care including home booking
  and home delivery and postnatal care
• Alternative therapies e.g. aromatherapy
• Midwife-managed birthing suite 24/7

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CMU Birth Assumptions of the NHS A C Review

• The proportion of women suitable and choosing to
  deliver in a CMU would be 25
• During labour 10 15 would be transferred
• Numbers based on best evidence (Scotland)
• Anticipated increase in numbers over time as
  increase in confidence in the model grew

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Births at the Vale of Leven CMU Compared to
Predictions

• Predicted births 179 - 210
• Actual births
• 2004 61 births
• 2005 64 births
• 2006 74 births

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West Dunbartonshire Residents Place of Delivery
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Former Greater Glasgow Maternity Services Review
Key Principles

• Developed in 1999, supported by the Professor
  Reid report of October 2003
• Reduces maternity units from three to two with
  closure of Queen Mothers Hospital
• Co-locates Maternity/Adult and Maternity/Paediatri
  c Services
• Southern General is to be new hospital site
• Review now extended to include Clyde

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Clyde CMU Review Process

• Review established December 2006
• Community engagement events January 2007 (two),
  February and March 2007
• Stakeholder participation on review
• Consultation on proposals to commence June 2007

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Reporting Back on Local Health Service
ReviewsReview of Mental Health Services

• David McCrae
• Head of Mental Health and Partnerships
• NHS Greater Glasgow and Clyde

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West Dunbartonshire Mental Health Strategy Group

• West Dunbartonshire/Argyll Bute CHP
• West Dunbartonshire/Argyll and Bute Council
• Local mental health forums
• Carer organisations
• Service user organisations
• Advocacy services
• Voluntary organisations

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Range of NHS Mental Health Services

• Primary Care Mental Health Services
• Psychotherapy
• Integrated Community Mental Health Team
• Assertive outreach
• Early intervention for psychosis
• Crisis Resolution Team including out of hours
• Rehabilitation
• Admission Unit
• IPCU

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Clydebank Lomond Comparison

• Lomond
• Community Mental Health Team (split sites
  non-integrated)
• Rehabilitation (Lochgilphead)
• Admission Unit (Vale of Leven)
• IPCU (Lochgilphead)

• Clydebank
• Primary Care Mental Health Team
• Psychotherapy
• Integrated Community Mental Health Team
• Intermediate Service
• Early intervention for psychosis
• Out of hours service
• Rehabilitation (Gartnavel Royal)
• Admission Unit (Gartnavel Royal)
• IPCU (Gartnavel Royal)

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Work in Progress for 2007

• Lomond
• Psychiatry recruitment
• Psychology recruitment
• Integrated CMHT
• Assertive Outreach
• Crisis Resolution (CHP-wide)
• IPCU pathway changing from Lochgilphead to
  Gartnavel Royal

• Clydebank
• Assertive Outreach
• Crisis Resolution (CHP-wide)

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Next Steps

• Progress discussion regarding funding required to
  access Psychotherapy for all of CHP
• Complete recruitment of Consultant Psychiatrists
  which will enable EMI service to move from
  dementia-only service to older adult model
• Lomond Mental Health Services will be part of the
  ongoing review of Mental Health Services across
  all of Clyde
• Community Engagement events across al of Clyde
  for MH to inform strategy
• West Dunbartonshire Mental Health event 20th
  March 2007, 2.00 4.00 PM at Abbotsford Hotel,
  Dumbarton
• Consultation on Clyde MH Strategy Summer 2007

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Reporting Back on Local Health Service
ReviewsVale of Leven Hospital Unscheduled Care

• Helen Byrne
• Director of Acute Services Planning
• NHS Greater Glasgow and Clyde

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Vale of Leven Hospital Overview of Activity

• 54 beds unscheduled care
• 64 beds rehabilitation
• 21 beds elective care
• 7 beds community midwifery unit
• MAU approximately 5,500 patients
• MIU approximately 8,000 patients
• Outpatients approximately 50,000 patients

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Vale of Leven Hospital Overview of Activity
(continued)

• A E, Surgery and Trauma and Orthopaedic-receivin
  g at RAH
• Currently flows to RAH approximately 5,000 A
  E attendances and 3,700 unscheduled admissions
• 1,700 planned admissions
• Current flows to West Glasgow 2,700 patients
  including tertiary services

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Starting Lomond Integrated Care Model

• New approach across Primary and Secondary Care
• New skills and methods to assess patients
• Bypass of very acutely ill
• Rapid referral and retrieval
• Our of hours
• GPs
• Nurse Practitioners
• Post-acute transfer back to Vale of Leven

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Lomond Integrated Care Progress since April 2006

• Greater Glasgow and Clyde developed proposals to
  fully implement pilot
• Open clinical meeting
• Safety issues raised
• Further discussions
• Vale consultants
• Wider group of consultants
• Consensus not a safe system of work

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Anaesthetics Workstream

• Group established to review Anaesthetic position
• Membership includes
• Anaesthetists from Clyde
• Anaesthetists from Greater Glasgow
• Physicians from Clyde and Greater Glasgow
• CHP/GP involvement

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Key Areas of Work - Anaesthetics

• Review of the current rotas for Greater Glasgow
  and Clyde anaesthetic provision to consider the
  options to allow cover on the VOL site
• Identify the number of patients who have required
  anaesthetic support on site at the VOL, or who
  have been transferred off-site, including details
  of reasons for involvement and time of
  intervention
• Seek new models of working across the United
  Kingdom that could be transferable

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Unscheduled Medical Admissions Workstream

• Established in October 2006
• Membership includes
• Physicians from the Vale/RAH
• Physicians from Greater Glasgow
• West Dunbartonshire and Highland GPs
• Operational management and Acute Planning input

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Future Options for Unscheduled Medical Admissions

• Anaesthetics currently subject to review
• If anaesthetics not sustainable then four
  options
• Option 1 All medical patients access services
  at the Western Infirmary in Glasgow
• Option 2 All medical patients access services
  at the Royal Alexandra Hospital in Paisley
• Option 3 Split the geographic catchment so that
  some medical patients attend the Western and some
  the RAH
• Option 4 Patient and GP choice

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Rehabilitation Workstream

• Established in October 2006
• Membership includes
• Physicians from the Vale/RAH
• Associate Medical Director and Lead Director of
  Rehabilitation (GGC)
• GP/CHP input
• Operational management and Acute Planning input

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Future Options for Rehabilitation

• Option 1 Status quo No service change other
  than as part of ongoing joint-planning
• Option 2 Patients transfer at an early stage in
  the admissions circa one week
• Option 3 Patients transfer at a later stage in
  their admission circa two weeks
• Option 4 Patients transfer near the end of
  their admission

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Progress since October 2006

• Anaesthetics engagement meeting held on 21
  November 2006
• Unscheduled medical admissions engagement
  meeting held on 19 December 2006
• Rehabilitation engagement meeting held on 23
  January 2007

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Next Steps

• Continue detailed work to take forward the three
  streams of work
• Further engagement in May 2007

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Question and Answer Session

• Chaired by Rani Dhir MBE

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Move to Workshop Groups

• A The Factors Driving Change in Acute Hospitals
  Auditorium
• B Emergency Admissions Training Room 1
• C Maternity Services Auditorium Foyer
• D Mental Healthcare Waverley Rooms 1 2
• E Transport and Access to Healthcare Training
  Room 2
• F Local Services provided through West
  Dunbartonshire CHP
• Cameronia Room 1
• G Improving the Health of Local People
  Cameronia Room 2