End of Life Supporting Benchmark Tool Yorkshire and the Humber

Date:

June 2012

[email protected] Health Intelligence Specialist Yorkshire and the Humber Quality Observatory

END OF LIFE QUALITY REPORT BENCHMARKING DATA VERSION CONTROL

LOG OF AMENDMENTS/UPDATES DEVELOPMENTS

DATE

NOTES

File created

29/11/2011

Phase 1 benchmarking, future developments funnel plots for GP QOF data and PCT profiles

File populated

Dec'11 - Jan'12

Data added

Updated with latest data

Feb '12-Apr'12

Altered format into 6 sections

Amendments

May-June 2012

Changes made from QA feedback

DEVELOPMENT AREAS Hospital

PLANNED TIMESCALES for next release Dec 2012

Area: Geography and drive times

for next release Dec 2012

Area: Capacity and resources

for next release Dec 2012

DESCRIPTION Additional page for emergency admissions ending in death (see PCT profiles) Additional detail of PCT area and drive times to nearest hospital/hospice etc. Include maps showing spread of care homes and hospices across the region Include information on staff and bed numbers and spend

LOG OF FUTURE PLANS

GUIDANCE NOTES FOR USING THE TOOL PURPOSE This benchmark tool is designed to be used alongside the End of Life Quality Report. It contains a range of additional charts not included in the main report to support further analysis that organisations may wish to undertake. In addition to this tool and the main report, a set of supporting documents have been produced for each of the 6 sections to provide more detail on the indicators used. The tool aims to bring together data from a range of sources to get a picture of end of life care across Yorkshire and Humber.

STRUCTURE The tool is divided into 6 main sections: 1) End of life register - Proportion of people on an end of life register and QOF points achieved 2) Place of death - split by hospital, own home, care home, hospice and other and by age group 3) Deaths in hospital - Length of stay, age and primary diagnosis 4) Cause of death - Cancer, cardiovascular disease (CVD), respiratory disease and other (any cause excluding cancer, CVD and respiratory) 5) Demographics and other - Death rates, life expectancy, deprivation, projections and prevalence of conditions 6) Area - Geography, drive times, capacity and resources

Each section begins with meta data outlining the indicators and how they are constructed and the data sources are list in the appendix. The charts and tables are numbered and referenced in the list of charts and tables. Where a chart or table needs further explanation the following symbol appears with a short note to clarify:

On each page text boxes are included to explain the context, findings and recommendations. The following symbols are used: ˃ Background - explains the context to the indicator ● Findings - what the charts and tables show √ Recommendations based on the data

INTERPRETATION For charts which include confidence intervals, where these overlap there is no significant difference between points, where they do not overlap it is assumed that there is a significant difference between the points. England results are coloured green and regional results red.

USING THE TOOL The tool should be used to supplement the end of life quality report. Its aim is to help understand key issues across the region and within local areas. It does not provide definite answers but rather should be used as a starting point for investigation. It should be triangulated with other local data sources for a fuller picture of end of life within the region and a more detailed understanding of end of life in local areas. The National End of Life Intelligence Network from which some of the data for this tool is sourced is a useful tool which includes data, atlas's, reports, profiles and tools

UPDATES The tool will be updated as new data becomes available (this will vary depending on indicators) and will be published 6 monthly alongside the main report. Additional updates are planned for the next release.

END OF LIFE QUALITY BENCHMARKING TOOL INDEX WORKSHEET EOLReg Metadata EOLReg_1 EOLReg_2

SECTION ONE - EOL REGISTER EOL Register Metadata Palliative Care Prevalence Deaths as a Proportion of EOL Register and QOF Points

INFORMATION This first section focuses on the number of people recorded on end of life registers using the Quality Outcomes Framework (QOF) data sourced from the NHS Information Centre as well as the number of deaths reported in the primary care mortality database. The tool compares PCTs on the proportion of people included on end of life registers versus the proportion expected, as well as QOF points achieved for completing the registers and reviewing the patients every 3 months.

WORKSHEET POD Metadata POD_1 POD_2 POD_3 POD_4 POD_5

SECTION TWO - PLACE OF DEATH Place of Death Metadata Deaths in Hospital Deaths in Own Residence Deaths in Care Homes Deaths in a Hospice Comparisons of Place of Death

INFORMATION

WORKSHEET Hosp Metadata Hosp_1 Hosp_2

SECTION THREE - DEATHS IN HOSPITAL Deaths in Hospital Metadata Length of Stay and Age Primary Diagnosis

INFORMATION

WORKSHEET Cause Metadata Cause_1 Cause_2 Cause_3 Cause_4

SECTION FOUR - CAUSE OF DEATH Cause of Death Metadata Cancer Cardiovascular Disease Respiratory Disease Other

INFORMATION

WORKSHEET Demo Metadata Demo_1 Demo_2 Demo_3 Demo_4 Demo_5

SECTION FIVE - OTHER Demographics and Other Metadata Population proportions and death rates Numbers and proportions of deaths Life Expectancy and Deprivation Death and Population Projections Prevalence of Condition

INFORMATION

WORKSHEET Area Metadata Area_1 Area_2

SECTION SIX - AREA Area Metadata Geography and Drive Times Capacity and Resources

INFORMATION The final section is termed area. At present this is partially complete containing data on PCT ONS classifications and a map of the acute providers for the region. Additional data will be incorporated on the geography of PCTs including size, and maps showing hospices etc., It is anticipated that information on drive times as well as staffing levels, capacity and resources will also be examined.

Section 2 uses Local Authority data from the NEOLCIN on place of death, as well as data from the primary care mortality database to explore place of death trend data by PCT clusters. This section specifically focuses on deaths at home, in care homes, in hospices and in acute trusts. The final part considers home and care home jointly as 'usual place of residence', and compares place of death for each PCT.

The third section concentrates on deaths within hospitals, considering deaths within three time interval groups since admission (0 to 3 days, 4 to 7 days and 8 days or more) and 3 age groups (18-64, 65-84 and 85+ years). Deaths in hospital are also considered by the patients primary diagnosis grouped as Cancer, Cardiovascular Disease (CVD), Respiratory Disease or other.

The fourth section looks at cause of death by Cancer, Cardiovascular Disease (CVD), Respiratory Disease and other using Local Authority data from NEOLCIN. For each condition the proportion of deaths is examined by age group and by place of death (hospital, own residence, care home and hospice).

The fifth section is broadly termed demographic and other data and covers a range of data items. Numbers and rates are deaths are compared by PCT for Yorkshire and Humber, and numbers of death are also split by age group and gender. Deprivation and life expectancy is also considered. This section also looks at the projected number of deaths by PCT cluster as well as the projected population increase. The final part explores the prevalence of key disease types by PCT.

CATEGORY

FIGURE NUMBER

FIGURE TITLE

CATEGORY

FIGURE FIGURE TITLE NUMBER

CATEGORY

FIGURE FIGURE TITLE NUMBER

EOL Register

Chart_1

Prevalence of patients on an EOL register 2010/11

Place of death

Chart_51

% of deaths by place for North Yorkshire and York cluster

Cause of death

Chart_101

% of deaths aged 65-84 with a primary diagnosis of other

EOL Register

Chart_2

Prevalence of patients on an EOL register over 3 years

Place of death

Chart_52

% of deaths by place for South Yorkshire cluster

Cause of death

Chart_102

% of deaths aged 85+ with a primary diagnosis of other

EOL Register

Chart_3

Prevalence of patients on an EOL register in 2010/11 for all PCTs in England

Place of death

Chart_53

% of deaths of all ages dying elsewhere

Cause of death

Chart_103

% of other deaths in hospital

EOL Register

Chart_4

Prevalence of patients on an EOL register out of 1% of expected deaths 2010/11

Place of death

Chart_54

% of deaths by place separating home and care home

Cause of death

Chart_104

% of other deaths in own residence

EOL Register

Chart_5

% of patients on an EOL register out of 1% of expected deaths

Place of death

Chart_55

% of deaths by place combining home and care home

Cause of death

Chart_105

% of other deaths in a care home

EOL Register

Chart_6

Proportion of people on end of life registers compared with actual deaths during 2010/11

Death in hospital

Chart_56

Number of deaths in hospital over 3 years by length of stay

Cause of death

Chart_106

% of other deaths in a hospice

EOL Register

Chart_7

Proportion of QOF points achieved 2010/11

Death in hospital

Chart_57

% of deaths in hospital by length of stay by Trust

Demo and Other

Chart_107

Proportion of males and females in the population by age group

Place of death

Chart_8

% of deaths of all ages dying in hospital

Death in hospital

Chart_58

% of deaths in hospital by length of stay by PCT

Demo and Other

Chart_108

Proportion the population by age group for PCTs

Place of death

Chart_9

% of deaths age 0-64 years dying in hospital

Death in hospital

Chart_59

% of deaths in hospital over 3 years by age band

Demo and Other

Chart_109

Directly age standardised rates for mortality from all causes - all persons

Place of death

Chart_10

% of deaths age 65-84 years dying in hospital

Death in hospital

Chart_60

% of deaths in hospital by age band by Trust

Demo and Other

Chart_110

Directly age standardised rates for mortality from all causes - males

Place of death

Chart_11

% of deaths age 85+ years dying in hospital

Death in hospital

Chart_61

% of deaths in hospital by age band by PCT

Demo and Other

Chart_111

Directly age standardised rates for mortality from all causes -females

Place of death

Chart_12

% of deaths in hospital over 3 years for Airedale, Bradford and Leeds cluster

Death in hospital

Chart_62

% of deaths in hospital by length of stay split by age group

Demo and Other

Chart_112

Proportion of male and female deaths by age group

Place of death

Chart_13

% of deaths in hospital over 3 years for Calderdale, Wakefield and Kirklees cluster

Death in hospital

Chart_63

% of deaths in hospital by age group split by length of stay

Demo and Other

Chart_113

Summary Hospital-level Mortality Indicator (SHMI)

Place of death

Chart_14

% of deaths in hospital over 3 years for Humber cluster

Death in hospital

Chart_64

Number of deaths in hospital over 3 years by primary diagnosis

Demo and Other

Chart_114

Life Expectancy at birth for males

Place of death

Chart_15

% of deaths in hospital over 3 years for North Yorkshire and York cluster

Death in hospital

Chart_65

% of deaths in hospital by primary diagnosis by Trust

Demo and Other

Chart_115

Life Expectancy for males aged 65+

Place of death

Chart_16

% of deaths in hospital over 3 years for South Yorkshire cluster

Death in hospital

Chart_66

% of deaths in hospital by primary diagnosis by PCT

Demo and Other

Chart_116

Life Expectancy at birth for females

Place of death

Chart_17

% of deaths of all ages dying in own residence

Death in hospital

Chart_67

% of Cancer deaths in hospital by length of stay

Demo and Other

Chart_117

Life Expectancy for females aged 65+

Place of death

Chart_18

% of deaths age 0-64 years dying in own residence

Death in hospital

Chart_68

% of CVD deaths in hospital by length of stay

Demo and Other

Chart_118

Projected deaths for Airedale, Bradford and Leeds cluster

Place of death

Chart_19

% of deaths age 65-84 years dying in own residence

Death in hospital

Chart_69

% of Respiratory Disease deaths in hospital by length of stay

Demo and Other

Chart_119

Projected deaths for Calderdale, Wakefield and Kirklees cluster

Place of death

Chart_20

% of deaths age 85+ years dying in own residence

Death in hospital

Chart_70

% of Other deaths in hospital by length of stay

Demo and Other

Chart_120

Projected deaths for Humber cluster

Place of death

Chart_21

% of deaths in own residence over 3 years for Airedale, Bradford and Leeds cluster

Death in hospital

Chart_71

% of deaths in hospital by primary diagnosis split by length of stay

Demo and Other

Chart_121

Projected deaths for North Yorkshire cluster

Place of death

Chart_22

% of deaths in own residence over 3 years for Calderdale, Wakefield and Kirklees cluster

Death in hospital

Chart_72

% of deaths in hospital by length of stay split by primary diagnosis

Demo and Other

Chart_122

Projected deaths for South Yorkshire cluster

Place of death

Chart_23

% of deaths in own residence over 3 years for Humber cluster

Death in hospital

Chart_73

% of deaths in hospital by primary diagnosis split by age band

Demo and Other

Chart_123

Projected deaths for Yorkshire and Humber

Place of death

Chart_24

% of deaths in own residence over 3 years for North Yorkshire and York cluster

Death in hospital

Chart_74

% deaths in hospital by age band split by primary diagnosis

Demo and Other

Chart_124

Population projections up to 2030 by Local Authority

Place of death

Chart_25

% of deaths in own residence over 3 years for South Yorkshire cluster

Cause of death

Chart_75

% of all deaths with a primary diagnosis of cancer

Demo and Other

Chart_125

Prevalence of Coronary Heart Disease

Place of death

Chart_26

% of deaths of all ages dying in a care home

Cause of death

Chart_76

% of deaths aged 0-64 with a primary diagnosis of cancer

Demo and Other

Chart_126

Prevalence of Chronic Obstructive Pulmonary Disease

Place of death

Chart_27

% of deaths age 0-64 years dying in a care home

Cause of death

Chart_77

% of deaths aged 65-84 with a primary diagnosis of cancer

Demo and Other

Chart_127

Prevalence of Cardiovascular Disease

Place of death

Chart_28

% of deaths age 65-84 years dying in a care home

Cause of death

Chart_78

% of deaths aged 85+ with a primary diagnosis of cancer

Demo and Other

Chart_128

Prevalence of Hypertension

Place of death

Chart_29

% of deaths age 85+ years dying in a care home

Cause of death

Chart_79

% of all cancer deaths in hospital

Demo and Other

Chart_129

Prevalence of Stroke

Place of death

Chart_30

% of deaths in a care home over 3 years for Airedale, Bradford and Leeds cluster

Cause of death

Chart_80

% of all cancer deaths in own residence

Demo and Other

Chart_130

Incidence of Cancer

Place of death

Chart_31

% of deaths in a care home over 3 years for Calderdale, Wakefield and Kirklees cluster

Cause of death

Chart_81

% of all cancer deaths in a care home

Place of death

Chart_32

% of deaths in a care home over 3 years for Humber cluster

Cause of death

Chart_82

% of all cancer deaths in a hospice

Place of death

Chart_33

% of deaths in a care home over 3 years for North Yorkshire and York cluster

Cause of death

Chart_83

% of all deaths with a primary diagnosis of cardiovascular disease

EOL Register

Table_1

Prevalence of patients on an EOL register 2010/11

Place of death

Chart_34

% of deaths in a care home over 3 years for South Yorkshire cluster

Cause of death

Chart_84

% of deaths aged 0-64 with a primary diagnosis of cardiovascular disease

EOL Register

Table_2

Prevalence of patients on an EOL register across 3 years

Place of death

Chart_35

% of deaths of all ages dying in a hospice

Cause of death

Chart_85

% of deaths aged 65-84 with a primary diagnosis of cardiovascular disease

EOL Register

Table_3

Prevalence of patients on an EOL register out of 1% of expected deaths 2010/11

Place of death

Chart_36

% of deaths age 0-64 years dying in a hospice

Cause of death

Chart_86

% of deaths aged 85+ with a primary diagnosis of cardiovascular disease

EOL Register

Table_4

Out of 1% of expected deaths, 50% and 75% of patients 2010/11

Place of death

Chart_37

% of deaths age 65-84 years dying in a hospice

Cause of death

Chart_87

% of all cardiovascular deaths in hospital

EOL Register

Table_5

Proportion of people on EOL registers compared with actual deaths during 2010/11

Place of death

Chart_38

% of deaths age 85+ years dying in a hospice

Cause of death

Chart_88

% of all cardiovascular deaths in own residence

EOL Register

Table_6

Proportion of QOF points achieved 2010/11

Place of death

Chart_39

% of deaths in a hospice over 3 years for Airedale, Bradford and Leeds cluster

Cause of death

Chart_89

% of all cardiovascular deaths in a care home

Place of death

Table_7

Significant difference from England average for patients dying in hospital

Place of death

Chart_40

% of deaths in a hospice over 3 years for Calderdale, Wakefield and Kirklees cluster

Cause of death

Chart_90

% of all cardiovascular deaths in a hospice

Place of death

Table_8

Significant difference from England average for patients dying in own residence

Place of death

Chart_41

% of deaths in a hospice over 3 years for Humber cluster

Cause of death

Chart_91

% of all deaths with a primary diagnosis of respiratory disease

Place of death

Table_9

Significant difference from England average for patients dying in a care home

Place of death

Chart_42

% of deaths in a hospice over 3 years for North Yorkshire and York cluster

Cause of death

Chart_92

% of deaths aged 0-64 with a primary diagnosis of respiratory disease

Place of death

Table_10

Significant difference from England average for patients dying in a hospice

Place of death

Chart_43

% of deaths in a hospice over 3 years for South Yorkshire cluster

Cause of death

Chart_93

% of deaths aged 65-84 with a primary diagnosis of respiratory disease

Demo and Other

Table_11

Number of Deaths by PCT

Place of death

Chart_44

% of deaths of all ages by place of death

Cause of death

Chart_94

% of deaths aged 85+ with a primary diagnosis of respiratory disease

Demo and Other

Table_12

Indices of deprivation

Place of death

Chart_45

% of deaths age 0-64 years by place of death

Cause of death

Chart_95

% of all respiratory deaths in hospital

Area

Table_13

PCT ONS Area Classification

Place of death

Chart_46

% of deaths age 65-84 years by place of death

Cause of death

Chart_96

% of all respiratory deaths in own residence

Place of death

Chart_47

% of deaths age 85+ years by place of death

Cause of death

Chart_97

% of all respiratory deaths in a care home

Place of death

Chart_48

% of deaths by place for Airedale, Bradford and Leeds cluster

Cause of death

Chart_98

% of all respiratory deaths in a hospice

Demo and Other

Map_1

Index of muliple deprivation for Yorkshire and Humber

Place of death

Chart_49

% of deaths by place for Calderdale, Wakefield and Kirklees cluster

Cause of death

Chart_99

% of all deaths with a primary diagnosis of other

Area

Map_2

Map of acute trusts for Yorkshire and Humber

Place of death

Chart_50

% of deaths by place for Humber cluster

Cause of death

Chart_100

% of deaths aged 0-64 with a primary diagnosis of other

End of Life Register Metadata Indicator

Construction

Source

Number of patients on an end of life register for 2010-11 as a proportion of GP list size expressed as a prevalence per PCT %

Numerator : Number of patients on a palliative care register in 2010-11 by PCT Denominator: Total number of patients on GP lists by PCT Calculation : Numerator/denominator expressed as a percentage

QOF data 2010-11

Number of patients on an end of life register over 3 years as a proportion of GP list size expressed as a prevalence per PCT %

Numerator : Number of patients on a palliative care register across 3 years by PCT Denominator: Total number of patients on GP lists by PCT Calculation: Numerator/denominator expressed as a percentage

QOF data 2008-09, 2009-10 and 2010-11

Proportion of estimated to expected number of deaths per PCT area in 2010-11

Numerator : Proportion of patients on a palliative care register in 2010/11 Denominator : 1% of GP list (practice list/100) Calculation: Numerator/denominator expressed as a percentage

QOF data 2010-11

Numerator : Number of patients on a palliative care register by PCT 2010/11 Number of people on an end of life register as a proportion of actual Denominator: Number of actual deaths in 2010/11 deaths for 2010-11 Calculation : Numerator/denominator expressed as a percentage

% of QOF points achieved for number of people on an end of life register and number reviewed every 3 months

Numerator : Number of patients on a palliative care register Denominator: Sum of practices multiplied by 3 (3 is the maximum number of QOF points achieved per practice) Calculation: Numerator/denominator expressed as a percentage Numerator : Number of patients on a palliative care register and number of patients reviewed every three months by PCT Denominator: Sum of practices multiplied by 3 (3 is the maximum number of QOF points achieved per practice) Calculation: Numerator/denominator expressed as a percentage

QOF data 2010-11 Primary Care Mortality Database (PCMD) data 201011

QOF data 2010-11

End of Life Register - Palliative Care Prevalence Table_1: Prevalence of patients on an EOL register 2010/11

Table_2: Prevalence of patients on an EOL register across 3 years

Number of Practices

PCT Code PCT Name

Sum of Palliative Care Register

Sum of List Sizes

Palliative Care Prevalence

Figure 1: Prevalence of patients on an EOL register 2010/11

Figure_2: Prevalence of patients on an EOL register across 3 years

PCT Code PCT Name

2008-09

2009-10

2010-11

5JE

BARNSLEY PCT

46

245,420

524

0.21%

5JE

BARNSLEY PCT

0.13%

0.17%

0.21%

5NY

BRADFORD & AIREDALE PCT

81

537,833

1,285

0.24%

5NY

BRADFORD & AIREDALE PCT

0.13%

0.19%

0.24%

5J6

CALDERDALE PCT

28

211,906

380

0.18%

5J6

CALDERDALE PCT

0.10%

0.14%

0.18%

5N5

DONCASTER PCT

44

308,694

494

0.16%

5N5

DONCASTER PCT

0.11%

0.14%

0.16%

5NW

EAST RIDING OF YORKSHIRE PCT

39

315,463

574

0.18%

5NW

EAST RIDING OF YORKSHIRE PCT

0.10%

0.16%

0.18%

5NX

HULL TEACHING PCT

59

288,287

654

0.23%

5NX

HULL TEACHING PCT

0.12%

0.17%

0.23%

5N2

KIRKLEES PCT

72

421,226

700

0.17%

5N2

KIRKLEES PCT

0.08%

0.12%

5N1

LEEDS PCT

113

815,993

1,177

0.14%

5N1

LEEDS PCT

0.11%

TAN

NORTH EAST LINCOLNSHIRE CTP

32

167,466

385

0.23%

TAN

NORTH EAST LINCOLNSHIRE CTP

0.14%

5EF

NORTH LINCOLNSHIRE PCT

21

166,569

174

0.10%

5EF

NORTH LINCOLNSHIRE PCT

5NV

NORTH YORKSHIRE AND YORK PCT

99

802,570

1,540

0.19%

5NV

NORTH YORKSHIRE AND YORK PCT

5H8

ROTHERHAM PCT

40

255,392

722

0.28%

5H8

5N4

SHEFFIELD PCT

92

568,154

1,121

0.20%

5N3

WAKEFIELD DISTRICT PCT

40

351,671

583

0.17%

Q32

YORKSHIRE & HUMBER SHA

806

5,456,644

10,313

ENG

ENGLAND

8,245

55,169,643

92,870

ROTHERHAM PCT

0.28%

ROTHERHAM PCT

BRADFORD & AIREDALE PCT

0.24%

BRADFORD & AIREDALE PCT

NORTH EAST LINCOLNSHIRE CTP

0.23%

NORTH EAST LINCOLNSHIRE CTP

HULL TEACHING PCT

0.23%

HULL TEACHING PCT

BARNSLEY PCT

0.21%

BARNSLEY PCT

0.17%

SHEFFIELD PCT

0.20%

SHEFFIELD PCT

0.13%

0.14% 0.23%

NORTH YORKSHIRE AND YORK PCT

0.19%

0.18%

NORTH YORKSHIRE AND YORK PCT

0.12%

0.09%

0.10%

YORKSHIRE & HUMBER SHA

0.19%

YORKSHIRE & HUMBER SHA

2010-11

0.15%

0.16%

0.19%

EAST RIDING OF YORKSHIRE PCT

0.18%

EAST RIDING OF YORKSHIRE PCT

2009-10

ROTHERHAM PCT

0.13%

0.13%

0.28%

CALDERDALE

5N4

SHEFFIELD PCT

0.10%

0.12%

0.20%

0.18%

CALDERDALE

2008-09

5N3

WAKEFIELD DISTRICT PCT

0.13%

0.14%

0.17%

ENGLAND

0.17%

ENGLAND

0.19%

Q32

YORKSHIRE & HUMBER SHA

0.12%

0.15%

0.19%

0.17%

ENG

ENGLAND

0.10%

0.14%

0.17%

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care

KIRKLEES PCT

0.17%

KIRKLEES PCT

WAKEFIELD DISTRICT PCT

0.17%

WAKEFIELD DISTRICT PCT

DONCASTER PCT

0.16%

DONCASTER PCT

LEEDS PCT

0.14%

LEEDS PCT

NORTH LINCOLNSHIRE PCT

0.10%

NORTH LINCOLNSHIRE PCT

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care

Figure_3: Prevalence of patients on an EOL register in 2010/11 for all PCTs in England

% Patients recorded on an end of life register for all PCTs 2010/11

0

0.0005

0.001

0.0015

0.002

0.0025

0.006

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010 -11

North Lincolnshire (0.10%)

Leeds (0.14%)

Doncaster (0.16%)

England (0.17%)

Kirklees (0.17%) Wakefield (0.17%)

East Riding (0.18%)

0 Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010/11 Table 3: Prevalence of patients on an EOL register out of 1% of expected deaths 2010/11

Sum of List Sizes

0

0.0005

0.001

0.0015

0.002

0.0025

0.003

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2008 -11

● Generally Y&H PCTs are in line with the England average (0.17%). Only North Lincolnshire PCT appears to be significantly below average in the Y&H region (range from the highest in our region 0.28% to the lowest 0.10%). ● For all PCTs in Yorkshire and Humber except for North Lincolnshire, there has been a year on year increase in the prevalence of people on the end of life registers during 2008-09, 2009-10 and 2010-11. ● It is expected that prevalence rates for people on end of life registers should be higher given that 1% of a GP practice population is likely to die on average each year (subject to local variation). Current Y&H results are between 10 -28% of the numbers of people expected to die per GP practice. Whilst we are dealing with relatively small numbers of patients and not al l deaths could be anticipated in advance (i.e. meet the ‘3 trigger criteria’ for inclusion on an EOL register), it is expected that prevalence rates should be higher both regionally and nationally than current data suggests.

0.001

PCT Code PCT Name

0.003

 One of the aims of the end of life strategy is to identify all those people who should be on an end of life register. Inclusi on on an end of life register is linked to better co-ordination and quality of care for patients approaching end of life.  QOF data was used to explore the prevalence of patients per PCT area on an end of life register. This data was examined both as comparative data, as trend data across 3 years and as a proportion of the 1% of patients that die each year on average. Calderdale (0.18%)

Sheffield (0.20%)

0.002

North Yorkshire and York (0.19%)

Barnsley (0.21%)

North East Lincolnshire (0.23%) Hull Teaching (0.23%)

0.003

Bradford and Airedale (0.24%)

Rotherham (0.28%)

0.005

0.004

% Patients recorded on an end of life register across 3 years

% Patients recorded on an end of life register in 2010/11

Figure_4: Prevalence of patients on an EOL register out of 1% of expected deaths 2010/13

Sum of Palliative Care Palliative Care Prevalence Register

Expected deaths per PCT area (1% of GP List Size)

Proportion on register out of expected deaths

5JE

BARNSLEY PCT

245,420

524

0.21%

2,454

21%

5NY

BRADFORD & AIREDALE PCT

537,833

1,285

0.24%

5,378

24%

Proportion of 1% of GP List Size per PCT area on an EOL Register in 2010/11 Proportion on the EOL register ROTHERHAM PCT

28.3%

Proportion of patients not on EOL register 71.7%

BRADFORD & AIREDALE PCT

23.9%

76.1%

23.0%

77.0%

5J6

CALDERDALE PCT

211,906

380

0.18%

2,119

18%

NORTH EAST LINCOLNSHIRE CTP

5N5

DONCASTER PCT

308,694

494

0.16%

3,087

16%

HULL TEACHING PCT

22.7%

77.3%

5NW

EAST RIDING OF YORKSHIRE PCT

315,463

574

0.18%

3,155

18%

BARNSLEY PCT

21.4%

78.6%

5NX

HULL TEACHING PCT

288,287

654

0.23%

2,883

23%

SHEFFIELD PCT

19.7%

80.3%

5N2

KIRKLEES PCT

421,226

700

0.17%

4,212

17%

NORTH YORKSHIRE & YORK PCT

19.2%

80.8%

5N1

LEEDS PCT

815,993

1,177

0.14%

8,160

14%

TAN

NORTH EAST LINCOLNSHIRE CTP

167,466

385

0.23%

1,675

23%

5EF

NORTH LINCOLNSHIRE PCT

166,569

174

0.10%

1,666

10%

YORKSHIRE & HUMBER SHA

18.9%

81.1%

EAST RIDING OF YORKSHIRE PCT

18.2%

81.8%

CALDERDALE PCT

17.9%

82.1%

5NV

NORTH YORKSHIRE & YORK PCT

802,570

1,540

0.19%

8,026

19%

5H8

ROTHERHAM PCT

255,392

722

0.28%

2,554

28%

ENGLAND

16.8%

83.2%

5N4

SHEFFIELD PCT

568,154

1,121

0.20%

5,682

20%

KIRKLEES PCT

16.6%

83.4%

5N3

WAKEFIELD DISTRICT PCT

WAKEFIELD DISTRICT PCT

16.6%

83.4%

Q32

YORKSHIRE & HUMBER SHA

ENG

ENGLAND

DONCASTER PCT

16.0%

84.0%

LEEDS PCT

14.4%

NORTH LINCOLNSHIRE PCT

10.4%

351,671

583

0.17%

3,517

17%

5,456,644

10,313

0.19%

54,566

19%

55,169,643

92,870

0.17%

551,696

17%

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care

The numbers of deaths per annum is on average 1% of the GP list size (this includes expected and sudden deaths). Based on this, the number of people on an EOL register as a proportion of 1% of the total GP list size per PCT area has been calculated.

0%

10%

85.6% 89.6% 20%

30%

40%

50%

60%

70%

80%

90% 100%

Source: Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010-11

 Commissioners should explore data for their area at CCG or GP Practice level to identify outliers. Techniques such as quadran t charts or funnel plots could be useful in supporting this.  GP practice profiles are available on all practices, these provide additional information and context.  Learning can be gained from areas identified as having a higher % of people on an end of life registers, for example what did they do to identify these patients? At the other end of the scale, practices with low prevalence rates may need additional support to set up a register and identify those people in their population are that would benefit from being on an end of lif e register.  Commissioners should also consider comparing their data to their local population demographics to support identification of patients approaching end of life. Factors such as age, ethnicity and deprivation affect prevalence of disease and life expectancy. To take age as an example, areas with older populations may feasibly have higher numbers of people on end of life registers compared with a GP practice population with a younger average age.

Number of deaths as a proportion of EOL Register and QOF Points Achieved Figure 5: % of patients on an EOL register out of 1% of expected deaths

A proportion of sudden deaths are likely to occur each year and these patients could not therefore easily be identified to be added to the EOL register. Based on 1% of the GP list size expected to die each year, the number of deaths if 50% and 75% were recorded on a register has been calculated. 50% could be considered a local target to aim for and 70 -80% the number of deaths on average that could feasibly be identified in advanced out of 1% of deaths per year.

Of the 1% of people expected to die on average per PCT area, the % of those included on an EOL Register % on eol register ROTHERHAM PCT

28.3%

BRAD&AIRE PCT

23.9%

NE LINCS CTP

23.0%

HULL PCT

22.7%

Table 4: Out of 1% of expected deaths, 50% and 75% of patients 2010/11

PCT Code PCT Name

Total GP List Size

Estimated deaths per annum (1% of GP list size)

50% of estimated deaths

75% of estimated deaths

Number patients on an eol register

BARNSLEY PCT

21.4%

SHEFFIELD PCT

19.7%

5JE

BARNSLEY PCT

245,420

2,454

1,227

1,841

524

5NY

BRADFORD & AIREDALE PCT

537,833

5,378

2,689

4,034

1,285

NYY PCT

19.2%

5J6

CALDERDALE PCT

211,906

2,119

1,060

1,589

380

YORKS & HUMBER

18.9%

5N5

DONCASTER PCT

308,694

3,087

1,543

2,315

494

5NW

EAST RIDING OF YORKSHIRE PCT

315,463

3,155

1,577

2,366

574

EAST RIDING PCT

18.2%

5NX

HULL TEACHING PCT

288,287

2,883

1,441

2,162

654

CALDERDALE PCT

17.9%

5N2

KIRKLEES PCT

421,226

4,212

2,106

3,159

700

ENGLAND

16.8%

5N1

LEEDS PCT

815,993

8,160

4,080

6,120

1,177

TAN

NORTH EAST LINCOLNSHIRE CTP

167,466

1,675

837

1,256

385

KIRKLEES PCT

16.6%

5EF

NORTH LINCOLNSHIRE PCT

166,569

1,666

833

1,249

174

WAKEFIELD PCT

16.6%

5NV

NORTH YORKSHIRE AND YORK PCT

802,570

8,026

4,013

6,019

1,540

DONCASTER PCT

16.0%

5H8

ROTHERHAM PCT

255,392

2,554

1,277

1,915

722

5N4

SHEFFIELD PCT

568,154

5,682

2,841

4,261

1,121

LEEDS PCT

14.4%

5N3

WAKEFIELD DISTRICT PCT

Q32

YORKSHIRE & HUMBER SHA

ENG

ENGLAND

351,671

3,517

1,758

2,638

583

5,456,644

54,566

27,283

40,925

10,313

55,169,643

551,696

275,848

413,772

92,870

NORTH LINCS PCT

 Calculating 1% of the GP list sizes per PCT area provides an estimated number of expected deaths each year. Viewing the prevalence of people on an end of life register as a proportion of 1% of the GP list size provides a way of helping to understand the proportion of patients who potentially need to be included on a register.  A local ambition of 50% (out of 1% of the GP Practice population that die on average each year) has been introduced to encourage practices to identify patients approaching end of life and include them on a register. The Gold Standards Framework suggests 10-15% of patients die with little or no warning (i.e. unexpected). Based on research, a marker of 75% has been added to show the approximate proportion of the expected deaths that could potentially have been anticipated.  The proportion of actual deaths per PCT area has been collected from the primary care mortality database, this tells us which patients died in each year. However this data cannot be directly linked to those patients recorded on an end of life register as details of those patients are not available to track. Therefore the information provides an idea of proportions only (i.e. when comparing these 2 items we do not know whether those patients who died during in a particular year corresponded to those on the end of life register for that year).  The % of the maximum points that can be achieved for the palliative care register has been calculated for each PCT area. This includes the % of practices holding a palliative care register for patients at end of life or those thought to need end of life care in the next 12 months, and whether the register is reviewed at least every 3 months.

% not on eol register

10.4% 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Source: Outcomes Quality Quality Outcomes Framework Framework (QOF), The (QOF), NHSThe Information NHS Information Centre for Centre Health forand Health Social andCare Social 2010/11 Care 2010/11

Source: Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010-11

2,271

23%

24%

4,190

31%

5J6

CALDERDALE PCT

211,906

380

2,119

18%

1,839

21%

5N5

DONCASTER PCT

308,694

494

3,087

16%

2,712

18%

5NW

EAST RIDING OF YORKSHIRE PCT

315,463

574

3,155

18%

3,516

16%

5NX

HULL TEACHING PCT

288,287

654

2,883

23%

2,231

29%

5N2

KIRKLEES PCT

421,226

700

4,212

17%

3,515

20%

5N1

LEEDS PCT

815,993

1,177

8,160

14%

6,329

19%

TAN

NORTH EAST LINCOLNSHIRE CTP

167,466

385

1,675

23%

1,557

25%

5EF

NORTH LINCOLNSHIRE PCT

166,569

174

1,666

10%

1,510

12%

5NV

NORTH YORKSHIRE AND YORK PCT

802,570

1,540

8,026

19%

7,727

20%

5H8

ROTHERHAM PCT

255,392

722

2,554

28%

2,443

30%

5N4

SHEFFIELD PCT

568,154

1,121

5,682

20%

4,776

23%

5N3

WAKEFIELD DISTRICT PCT

351,671

583

3,517

17%

3,177

18%

Q32

YORKSHIRE & HUMBER SHA

5,456,644

10,313

54,566

19%

47,793

22%

0.25 0.20

0.15 0.10 0.05

18.9% 21.6%

21%

5,378

16.6% 18.4%

2,454

1,285

19.7% 23.5%

524

537,833

28.3% 29.6%

245,420

BRADFORD & AIREDALE PCT

Proportion of actual deaths

19.2% 19.9%

BARNSLEY PCT

5NY

Proportion of expected deaths

0.30

10.4% 11.5%

5JE

Number of people on an EOL Register as a proportion of both expected deaths (1% of GP population) and actual deaths

0.35

23.0% 24.7%

Palliative Care prevalence as a proportion of actual deaths

14.4% 18.6%

Actual Number of Deaths in 2010/11

16.6% 19.9%

Palliative Care prevalence as a proportion of expected deaths

22.7% 29.3%

Estimated Number of eol deaths per register annum (1% of GP list size)

18.2% 16.3%

Sum of List Sizes

PCT Name

16.0% 18.2%

●

PCT Code

17.9% 20.7%

●

None of the PCTs in figure 5 are achieving the 50% local ambition for the calculated average number of anticipated deaths recoded on an end of life register at present, with 28% being the closest. All PCTs except for East Riding, are showing a higher proportion of prevalence of patients on an end of life register compared to actual deaths rather than expected deaths. This suggests that on average fewer people are dying than the expected 1% for each PCT apart from East Riding. East Riding PCT has a particularly high proportion of older people in the population compared to other PCTs which could explain why this PCT had a higher number of deaths compared to the expected ratio of 1% of GP list size. The proportion of GP practices achieving the maximum QOF points for the completeness of the end of life register ranges from 90.5%-100% across Yorkshire and Humber. The numbers reviewing the register at least every 3 months is more varied across the region and no PCTs reported 100%.

23.9% 30.7%

●

Figure 6: Proportion of people on end of life registers compared with actual deaths during 2010/11

21.4% 23.1%

Table 5: Proportion of people on end of life registers compared with actual deaths during 2010/11

0.00

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010/11 Primary Care Mortality Database (PCMD) extracted Aug 2011

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010-11 and Primary Care Mortality Database (PCMD)

The number of expected deaths on the palliative care register have been compared to the number of actual deaths during 2010/11 as recorded on the primary mortality database. Although these are not directly comparable as we can not track whether the patients who died were on the register, it does gave a sense of proportions. Figure 7: Proportion of QOF points achieved 2010/12 Table 6: Proportion of QOF points achieved 2010/14

PCT Code PCT Name

5JE 5NY 5J6 5N5 5NW 5NX 5N2 5N1 TAN 5EF 5NV 5H8 5N4 5N3 Q32 ENG

BARNSLEY PCT BRADFORD & AIREDALE PCT CALDERDALE PCT DONCASTER PCT EAST RIDING OF YORKSHIRE PCT HULL TEACHING PCT KIRKLEES PCT LEEDS PCT NORTH EAST LINCOLNSHIRE CTP NORTH LINCOLNSHIRE PCT NORTH YORKSHIRE AND YORK PCT ROTHERHAM PCT SHEFFIELD PCT WAKEFIELD DISTRICT PCT YORKSHIRE & HUMBER SHA ENGLAND

% QOF points achieved for palliative care 2010/11 Number of Practices

46 81 28 44 39 59 72 113 32 21 99 40 92 40 806 8,245

PC03 Sum of Points

132 243 84 132 114 171 213 321 93 57 291 120 258 120 2,349 23,667

PC02 Sum of Points

93 219 72 117 102 162 201 294 84 54 288 93 234 117 2,130 21,540

Maximum Points (practice point x 3) 138 243 84 132 117 177 216 339 96 63 297 120 276 120 2418 24735

% of End of Life Register Completed

% Regular meetings to review patients on End of Life Register

95.7% 100.0% 100.0% 100.0% 97.4% 96.6% 98.6% 94.7% 96.9% 90.5% 98.0% 100.0% 93.5% 100.0% 97.1% 95.7%

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010-11

67.4% 90.1% 85.7% 88.6% 87.2% 91.5% 93.1% 86.7% 87.5% 85.7% 97.0% 77.5% 84.8% 97.5% 88.1% 87.1%

Complete register WAKEFIELD PCT ROTHERHAM PCT DONCASTER PCT CALDERDALE PCT BRAD&AIRE PCT

KIRKLEES PCT NYY PCT

EAST RIDING PCT YORKS & HUMBER

NE LINCS CTP HULL PCT ENGLAND BARNSLEY PCT LEEDS PCT

QOF points have been calculated for PC03 - whether the practice has an eol of life register, and PC02 whether the register is reviewed by an MDT at least every 3 months. Three points are awarded for achievement of these . The % of the points achieved has been calculated for both indicators as: points achieved /max points possible (3x list size).

SHEFFIELD PCT NORTH LINCS PCT

3 monthly reviews

100.0% 97.5% 100.0% 77.5% 100.0% 88.6% 100.0% 85.7% 100.0% 90.1% 98.6% 93.1% 98.0% 97.0% 97.4% 87.2% 97.1% 88.1% 96.9% 87.5% 96.6% 91.5% 95.7% 87.1% 95.7% 67.4% 94.7% 86.7% 93.5% 84.8% 90.5% 85.7%

0.00

0.10

0.20

0.30

0.40

0.50

Quality Outcomes Framework (QOF), The NHS Information Centre for Health and Social Care 2010/11

0.60

0.70

0.80

0.90

1.00

 Practices without a register should begin to setup a register. For those practices with registers already in place, they need to work to ensure that reviews are carried out as minimum every 3 months by multi-disciplinary teams. The reviews look at everyone on the end of life register and consider any changes and updates.  The local population and prevalence data should also be triangulated with the QOF points data on palliative care to understand the relationship between these indicators. For example, a PCT may be reporting 100% for having a complete register, but has a low prevalence per population suggesting that potentially not everyone has been identified who needs to be.  As well as having a register in place and reviewing it through MDT at least every 3 months, the quality of the register is also important. For practices with registers in place, the next step would be to examine the quality of end of life registers in terms of accuracy, completeness, frequency of updates and to ensure consistent understanding of when a patient is placed on a register.  Consideration should also be given to which patients have been included on end of life registers. For example cancer patients on average make up 25% of those patients who die per GP Practice, but they account for more than 70% of those patients on an end of life register nationally. The diagnostic breakdown of patients on end of life registers needs to be assessed to help target those patient groups that have not yet been identified.  End of life registers should be used to support advance care planning around themes such as preferred place of care and preferred place of death, DNACPR, etc. Going forward with the roll out of the electronic palliative care co-ordination system, these decisions can be shared across the health system to enable a more joined up approach to end of life.  Consideration should also be given to supporting care homes to develop and roll out palliative care registers.

Place of Death Metadata Indicator

Construction

Source

% of all deaths for persons dying in a hospital for all ages, 0-64 years, 65-84 years and 85+ years

Numerator : Number of patients dying in hospital 2008-10 by LA Denominator: Total number of patients dying in 2008-10 by LA Calculation : Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

% deaths in an acute trust by PCT cluster over 3 years

Numerator : Number of patients dying in hospital over 3 years by PCT cluster Denominator: Total number of patients dying in over 3 years by PCT cluster Calculation: Numerator/denominator expressed as a percentage

Primary Care Mortality Database (PCMD) 2008-2011

% of all deaths for persons dying in usual place of residence for all ages, 0-64 years, 65-84 years and 85+ years

Numerator : Number of patients dying in own residence 2008-10 by LA Denominator: Total number of patients dying in 2008-10 by LA Calculation : Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

% deaths at home by PCT cluster over 3 years

Numerator : Number of patients dying in own residence over 3 years by PCT cluster Denominator: Total number of patients dying in over 3 years by PCT cluster Calculation: Numerator/denominator expressed as a percentage

Primary Care Mortality Database (PCMD) 2008-2011

% of all deaths for persons dying in a care home for all ages, 0-64 years, 65-84 years and 85+ years

Numerator : Number of patients dying in a care home 2008-10 by LA Denominator: Total number of patients dying in 2008-10 by LA Calculation : Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

% deaths in a care home by PCT cluster over 3 years

Numerator : Number of patients dying in a care home over 3 years by PCT cluster Denominator: Total number of patients dying in over 3 years by PCT cluster Calculation: Numerator/denominator expressed as a percentage

Primary Care Mortality Database (PCMD) 2008-2011

Numerator : Number of patients dying in a hospice 2008-10 by LA % of all deaths for persons dying in a hospice for all ages, 0-64 years, Denominator: Total number of patients dying in 2008-10 by LA 65-84 years and 85+ years Calculation : Numerator/denominator expressed as a percentage

% deaths in a hospice by PCT cluster over 3 years

Numerator : Number of patients dying in a hospice over 3 years by PCT cluster Denominator: Total number of patients dying in over 3 years by PCT cluster Calculation: Numerator/denominator expressed as a percentage

Numerator : Number of patients dying per age group by place of death 2008-10 by LA % of all deaths by place of death for all ages, 0-64 years, 65-84 years Denominator: Total number of patients dying 2008-10 by LA for all ages, 0-64, 65-84 and age 85+ and 85+ Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Primary Care Mortality Database (PCMD) 2008-2011

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

% of deaths by place of death for 2008-11 by PCT cluster

Numerator : Number of patients dying by place of death 2008-11 by PCT cluster Denominator: Total number of patients dying 2008-11 by PCT cluster Calculation : Numerator/denominator expressed as a percentage

Primary Care Mortality Database (PCMD) 2008-2011

% of all deaths for persons of all ages dying elsewhere

Numerator : Number of patients dying elsewhere 2008-10 by LA Denominator: Total number of patients dying in 2008-10 by LA Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Numerator : Number of patients dying by place of death 2008-11 for Y&H Proportion of deaths by place of death for 2008-11 for Yorkshire and Denominator: Total number of patients dying 2008-11 by Y&H Humber Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Place of Death - Deaths in Hospital Figure_8: % of deaths of all ages dying in hospital

Figure_9: % of deaths age 0-64 years dying in hospital

% of all deaths for all ages for persons dying in hospital 2008 -10 Kingston upon Hull Doncaster East Riding Calderdale Sheffield Rotherham Barnsley National York Regional Wakefield Kirklees Leeds NE Lincolnshire North Lincolnshire Bassetlaw Selby Hambleton Ryedale Scarborough Harrogate Richmondshire Bradford Craven

East Riding Kingston upon Hull Richmondshire Sheffield Rotherham Kirklees Doncaster Selby Regional Barnsley Calderdale National NE Lincolnshire Leeds Bassetlaw Bradford Wakefield North Lincolnshire York Ryedale Hambleton Scarborough Harrogate Craven

61.6 59.0 57.2 57.0 57.0 57.0 55.1 54.5 54.1 54.1 53.8 53.3 53.3 52.4 52.1 52.1 51.8 51.8 50.4 49.1 48.6 48.5 48.2 41.7 0.0

10.0

20.0

30.0

40.0

50.0

60.0

Figure_10: % of deaths age 65-84 years dying in hospital

% of all deaths for 0-64 years for persons dying in hospital 2008-10

70.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

60.0 57.9 56.2 55.3 54.1 53.9 53.9 52.6 52.4 52.3 51.9 51.5 51.5 51.3 51.2 50.4 50.0 49.2 48.3 47.2 46.8 45.9 45.7 41.5

0.0

80.0

Kingston upon Hull East Riding Doncaster Calderdale Sheffield Rotherham Barnsley National Regional York Kirklees Wakefield Ryedale North Lincolnshire Hambleton NE Lincolnshire Leeds Bassetlaw Harrogate Selby Richmondshire Scarborough Bradford Craven 10.0

20.0

30.0

40.0

50.0

60.0

Figure_11: % of deaths age 85+ years dying in hospital

% of all deaths for 65-84 years for persons dying in hospital 2008-10

70.0

80.0

% of all deaths for 85+ years for persons dying in hospital 2008-10 Kingston upon Hull Doncaster Rotherham Calderdale Sheffield York Leeds Wakefield Barnsley National Regional East Riding Bassetlaw Selby Hambleton North Lincolnshire NE Lincolnshire Kirklees Scarborough Ryedale Harrogate Bradford Richmondshire Craven

63.7 61.2 60.9 60.7 59.8 59.3 57.7 57.1 56.6 56.3 55.9 55.9 55.4 54.9 54.7 54.5 54.5 53.8 53.2 53.1 51.8 51.6 49.9 44.2 0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

0.0

80.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

61.0 58.9 54.8 54.7 54.2 53.8 52.7 52.7 52.7 52.5 51.5 50.8 50.0 49.9 49.8 49.8 49.4 49.3 47.5 45.1 44.5 44.4 40.3 39.3 10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Table_7: Significant difference from England average for patients dying in hospital

85+ none none low none low high low none low high low none low low low high low low none high none none

 Death in hospital is considered the least likely place in general that people would choose to die compared with home, hospic es and care homes. Therefore ensuring that peoples preferences are met involves working to reduce the number of deaths in hospital. This improves quality of care at end of life for the patients and reduces hospital costs on unnecessary a dmissions.  Data on deaths in hospital was examined using data from the NEOLCIN website (originally sourced from ONS) comparing local au thorities on the % of deaths recorded as been in hospital during 2008-10. The charts were split into all ages, 0-64 years, 65-84 years and 85 years+ to look at any differences between age groups.  Charts were also created for each PCT cluster area using data from the primary care mortality database split down into 3 year s (2008/09, 2009/10 and 2010/11).

● ●

● ●

 It is recommended that organisations particularly those with high % of deaths in hospital explore this data in more depth to understand why this is the case. The set up of the hospital may contribute to these scores - for example some organisations have hospice beds within the hospital so these may be coded as deaths in hospital which may partially account f or inflated numbers. Therefore checking coding of palliative care in hospitals and understanding local set up is also important to ensure that the data quality around end of life is high.  Data should also be examined at post code level to determine if patients from certain areas are more likely to die in hospit al. This may suggest capacity issues with hospices or community support at end of life in some areas or may be related to the geography of the region (for example patients in rural areas may be harder to reach and therefore admitted to hospital rather than cared for in the community).

2010/11

0.2

0.2

0.1

0.1

57.5% 57.7% 54.8%

54.1% 53.7% 50.1%

53.6% 54.5% 53.7%

52.7% 52.8% 51.3%

51.3%

52.8%

52.7%

51.5%

52.8%

53.3%

46.5%

47.7%

46.7%

Calderdale

Kirklees

Wakefield

Y&H

0

Brad&Aire

Leeds

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.3

2009/10

2010/11

0.2 0.1

0

2009/10

2008/09

2010/11

0.2

East Riding

Hull

NELincs

North Lincs

Y&H

0

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.1 0

North Yorkshire and York

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

2008/09

0.3

2009/10 2010/11

0.2 0.1

52.7% 52.8% 51.3%

2009/10

0.3

2010/11

2008/09

0.3

57.3% 57.3% 55.3%

2009/10

0.4

0.4

2008/09

% Deaths in an Acute Hospital for South Yorkshire

0.5

0.5

0.4

0.4

0.6

57.8% 57.3% 53.8%

0.5

2008/09

0.3

0.6

52.6% 53.1% 52.8%

0.4

0.6

Figure_16 % of deaths in hospital over 3 years for South Yorkshire cluster

0.7

% Deaths in an Acute Hospital for North Yorkshire and York

55.5% 54.5% 52.6%

0.5

0.7

51.3%

0.5

Figure_15: % of deaths in hospital over 3 years for NYY cluster

% Deaths in an Acute Hospital for Humber

52.8%

0.6

0.7

52.7%

0.6

Figure_14: % of deaths in hospital over 3 years for Humber cluster

% Deaths an Acute Hospital for Calderdale, Wakefield and Kirklees

45.0%

0.7

45.6%

Figure_13: % of deaths in hospital over 3 years for CWK cluster

% Deaths in an Acute Trust for Airedale, Bradford and Leeds

52.7% 52.8% 51.3%

0.7

45.9%

Table of significant differences compared to the England score for deaths in hospital for the different age groups using data from the

Figure_12: % of deaths in hospital over 3 years for Airedale, Bradford and Leeds cluster

Slightly more deaths in hospital seem occur in the 65-84 years age group, but across all age groups the regional and national position is above 50%. The % of patients dying in hospital based on the NEOLCIN data was similar in Yorkshire and Humber to the national position. S ix local authorities had significantly higher proportions of deaths in hospital than the England average (i.e. the confidence intervals did not overlap with the national position on the ‘all ages’ chart). Hull and Sheffield were significant ly higher across all age groups. Thirteen local authorities were significantly lower than the England average. Across the PCT clusters using the PCMD data all of the PCTs in South Yorkshire are above 50% but show a decreasing trend over time (apart from Doncaster). North Yorkshire and Bradford report the lowest % of deaths over the years (below 50%) whereas Hull remains high with over 60% dying in hospital.

52.6% 51.1% 51.1%

65-84 none low low high low high high none low high none low low low low high none low low high none none

53.9% 51.3% 50.1%

0-64 none none none none low none high none low high high none none none none none none low none high none none

61.1% 62.4% 61.4%

All none low low high low high high low low high low low low low low high low low low high none none

51.1% 54.0% 52.9%

Names Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull Kirklees Leeds North East Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

Sheffield

Y&H

0

Barnsley

Doncaster Rotherham

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Place of Death - Death in Own Residence Figure_17: % of deaths of all ages dying in own residence

Figure_18: % of deaths age 0-64 years dying in own residence

Ryedale Hambleton Richmondshire Selby NE Lincolnshire Rotherham Doncaster Wakefield Barnsley National Kirklees Bradford Scarborough Calderdale Regional Leeds Kingston upon Hull Craven Bassetlaw North Lincolnshire Harrogate Sheffield York East Riding

Hambleton Richmondshire Ryedale Craven Selby NE Lincolnshire Scarborough Barnsley Harrogate National Doncaster Rotherham York North Lincolnshire Kingston upon Hull Regional Sheffield Wakefield Calderdale Leeds Bradford Kirklees East Riding Bassetlaw

25.3 24.6 23.5 22.6 20.9 20.6 20.5 20.4 20.4 20.3 20.1 20.1 19.9 19.8 19.8 19.7 19.5 19.3 19.1 19.1 18.8 18.6 17.7 17.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

Figure_19: % of deaths age 65-84 years dying in own residence

% of all deaths 0-64 years for persons dying in their own residence 2008-10

% of all deaths for all ages for persons dying in their own residence 2008-10

35.0

40.0

Richmondshire Hambleton Ryedale Selby Craven NE Lincolnshire National Wakefield Rotherham Kirklees Bradford Scarborough Barnsley Bassetlaw Harrogate Regional Doncaster Leeds Sheffield North Lincolnshire Kingston upon Hull Calderdale East Riding York

37.6 33.9 33.5 33.5 32.9 32.3 32.0 31.7 30.5 30.3 30.1 30.0 29.8 29.8 29.8 29.5 29.5 29.1 29.1 28.3 28.2 27.7 27.3 25.5

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_20: % of deaths age 85+ years dying in own residence

% of all deaths 65-84 years for persons dying in their own residence 2008-10

% of all deaths 85+ years for persons dying in their own residence 2008-10

Ryedale Hambleton Calderdale Selby Rotherham National Doncaster Kirklees Leeds Scarborough Bradford Regional Wakefield Richmondshire Bassetlaw Harrogate Craven NE Lincolnshire Sheffield Barnsley York North Lincolnshire Kingston upon Hull East Riding

28.7 27.7 27.6 26.3 23.7 23.5 22.6 22.6 22.5 22.4 22.3 22.3 22.1 22.0 21.9 21.9 21.6 21.4 20.9 20.8 20.8 20.5 20.4 19.7

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

19.3 15.5 13.1 13.0 13.0 12.7 12.5 12.4 12.4 12.1 11.7 11.7 11.6 11.5 11.3 11.1 11.1 10.8 10.8 10.8 10.7 10.6 10.1 9.9

0.0

40.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Table_8: Significant difference from England average for patients dying in own residence

Names Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull Kirklees Leeds North East Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

All none none none none none none low high low none none low none low high none high none high low none low

0-64 none low low none none none low high none none low low none none none none none none none none none none

65-84 none none none low none none low high none low none low none low high none high none high low none low

 Deaths in own residence is considered the most likely place in general that people would choose to die compared with hospita ls, care homes and hospices for example. As such the health service has a responsibility to support people to die in their own homes wherever possible, thereby improving quality of care at end of life for the patient and avoi ding unnecessary hospital admissions. (Note: care homes are considered separately).  Data on deaths in usual place of residence was examined using data from the NEOLCIN website (originally sourced from ONS) co mparing local authorities on % of deaths recorded as been in the usual place of residence during 2008-10. The charts were split into all ages, 0-64 years, 65-84 years and 85 years+ to look at any differences between age grou ps.  Charts were also created for each PCT cluster area using data from the primary care mortality database split down into 3 year s (2008/09, 2009/10 and 2010/11).

85+ low none low none none none low high low low none none low low none none high none none low none low

● ● ●

The % of patients dying in their own residence based on the NEOLCIN data was lower in Yorkshire and Humber compared to the na tional position. Most areas in North Yorkshire had the highest proportion of deaths at home with the lowest at East Riding and York. The highest proportion of deaths at home is on the 0-64 age group with the lowest in the 85+ age group. Across the PCT clusters the PCMD the data for PCTs generally suggests an increase in the number of deaths at home over the 3 years, particularly Barnsley, Rotherham and North East Lincolnshire .

 Exploration for preferences for place of death should be examined locally, ideally broken down by age group and collected at postcode level where possible. A large enough sample size to make the result more meaningful is recommended (i.e. to be able to detect statistically significant differences between age groups for example). The national su rvey indicated that deaths at home were the first choice for most people. Conducting local surveys or auditing preferences for place of death through advance care planning and the Electronic Palliative Care Co -ordination System (EPaCCS) would be useful in supporting this. Whilst death at home is generally considered the most desirable place of death based on research, this is a proxy measure for the indicator ‘did the patient die in their preferred place of death’. Therefore gathering evidence on local preferences and aiming to meet individual patients preferred choice for place of death is the key factor.  Investigate the feasibility of those people expressing a preference to die at home being able to do so and consider what woul d need to change in the service for this to happen. For example, increasing support for people at home approaching end of life. Can resources be directed to support this?

Table of significant differences compared to the England score for deaths in own residence for the different age groups using data from the NEOLCIN website. Figure_22: % deaths in own residence over 3 years for CWK cluster

2008/09

0.15

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.2

2008/09

0.15

2009/10 2010/11

0.15

2008/09 2009/10

2009/10

0.1

0.1

0.05

0.05

2010/11

0.1

2010/11

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

East Riding

Hull

NELincs

North Lincs

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

North Yorkshire and York

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

20.0% 19.8% 20.9%

19.5% 19.7% 23.6%

18.4% 18.1% 18.4%

19.3% 19.7% 20.5%

0

0

20.0% 20.4% 21.8%

Y&H

20.5%

Wakefield

19.7%

Kirklees

19.3% 19.7% 20.5%

Calderdale

0

18.6% 19.3% 19.3%

19.3% 19.7% 20.5%

Leeds

20.9% 19.8% 20.8%

Brad&Aire

2008/09

0.15

% Deaths at Home for South Yorkshire 0.25

0.05

19.5% 19.9% 21.3%

20.5%

19.7%

19.3%

20.5%

19.9%

18.5%

20.1%

20.9%

20.2%

0.05

0

0.2

2010/11

0.1

20.8% 19.0% 19.7%

2010/11

0.2

2009/10

2009/10

0.1

0.25

19.6% 20.9% 23.4%

2008/09

0.15

% Deaths at Home for Humber 0.25

Figure_25 % of deaths in own residence over 3 years for South Yorkshire cluster

0.3

% Deaths at Home for North Yorkshire and York

19.3%

0.2

0.3

20.8%

0.2

Figure_24: % of deaths in own residence over 3 years for NYY cluster

20.9%

0.25

% Deaths at Home for Calderdale, Wakefield and Kirklees

19.5%

0.25

0.05

Figure_23: % of deaths in own residence over 3 years for Humber cluster

0.3

0.3

% Deaths at Home for Airedale, Bradford and Leeds

18.7% 19.9% 19.5%

0.3

17.8% 16.5% 18.4%

Figure_21 % deaths in own residence over 3 years for Airedale, Bradford and Leeds cluster

Barnsley

Doncaster

Rotherham

Sheffield

Y&H

0

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Place of Death - Deaths in a Care Home* Figure_26: % of deaths of all ages dying in a care home

Figure_27: % of deaths age 0-64 years dying in a care home

% of all deaths for all ages for persons dying a care home 2008-10 Craven Bradford Richmondshire Harrogate East Riding NE Lincolnshire Bassetlaw North Lincolnshire Hambleton Selby Scarborough Barnsley Kirklees Regional York National Ryedale Sheffield Leeds Wakefield Rotherham Calderdale Doncaster Kingston upon Hull

29.1 26.1 25.4 22.6 21.4 21.0 20.4 20.1 19.9 19.6 19.2 18.7 18.6 18.4 18.1 17.8 17.6 17.5 16.2 15.8 15.5 13.9 13.7 13.2 0.0

Bradford Bassetlaw NE Lincolnshire Barnsley Regional North Lincolnshire Richmondshire National Kirklees East Riding Harrogate Leeds Doncaster Craven Hambleton Kingston upon Hull Scarborough Sheffield Rotherham Calderdale Ryedale York Selby Wakefield 5.0

10.0

15.0

20.0

25.0

30.0

Figure_28: % of deaths age 65-84 years dying in a care home

% of all deaths for 0-64 years for persons dying a care home 200810

35.0

40.0

10.0 4.3 3.6 2.8 2.7 2.7 2.6 2.3 2.2 2.1 1.9 1.9 1.9 1.8 1.8 1.7 1.6 1.6 1.5 1.3 1.3 1.3 1.2 1.2

0.0

2.0

4.0

6.0

8.0

10.0

Bradford Craven Richmondshire NE Lincolnshire Bassetlaw North Lincolnshire East Riding Hambleton Barnsley Harrogate Selby Kirklees Regional National Scarborough Wakefield York Leeds Sheffield Doncaster Rotherham Kingston upon Hull Ryedale Calderdale 12.0

% of all deaths 85+years for persons dying a care home 2008-10 Richmondshire Craven Bradford Harrogate East Riding NE Lincolnshire North Lincolnshire Bassetlaw Selby Kirklees Barnsley Scarborough Hambleton Ryedale Regional York National Sheffield Wakefield Leeds Rotherham Calderdale Kingston upon Hull Doncaster

22.2 19.2 16.8 16.3 15.3 15.3 14.7 14.4 14.4 13.9 13.8 13.3 13.2 12.5 11.8 11.7 11.7 11.5 11.5 10.5 10.4 10.2 9.6 9.0

0.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_29: % of deaths age 85+ years dying in a care home

% of all deaths 65-84 years for persons dying a care home 200810

5.0

10.0

15.0

20.0

25.0

30.0

35.0

47.7 46.4 41.8 39.6 37.8 37.7 37.0 36.6 35.7 35.7 35.4 35.1 34.3 34.2 34.0 32.1 32.1 31.9 31.2 30.8 30.2 29.0 26.5 26.2 0.0

40.0

10.0

20.0

30.0

40.0

50.0

60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Table_9: Significant difference from England average for patients dying in a care home

Names Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull Kirklees Leeds North East Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

All high high high low high low high high high low high low high high high low none high high none low none

0-64 none high high low none none none none none none none none high none none low none none none low low low

65-84 high high high low high low high none none low none low high high high low low none none low none none

 Deaths in a care home was also examined . In the context of this section care homes are considered separately to own residenc e in order to see differences between age groups in more detail. Later sections combined these categories into 'own home' as in many cases care homes are considered to be the home of the patient.  Data on deaths in care homes was examined using data from the NEOLCIN website (originally sourced from ONS) comparing local authorities on % of deaths recorded as been in a care home during 2008-10. The charts were split into all ages, 0-64 years, 65-84 years and 85 years+ to look at any differences between age groups.  Charts were also created for each PCT cluster area using data from the primary care mortality database split down into 3 year s (2008/09, 2009/10 and 2010/11).

85+ high high high low high low high none high low high low high high high low none high high none none none

● ● ● ●

The % of patients dying in a care home based on the NEOLCIN data was slightly higher in Yorkshire and Humber compared to the national position, this is significantly higher across all age groups for Bassetlaw, Bradford and North East Lincolnshire and significantly lower for Calderdale and Rotherham. Bradford stands out as having a much higher % of deaths in care homes for the younger age group (age 0 -64) compared to other PCTs and the national and regional average. Deaths in care homes in 0-64 years age group have the lowest proportion and therefore widest confidence intervals, with 65 -84 year olds a higher proportion and 85 years + the highest for all PCTs (ranging from 26 -48%). Across the PCT clusters based on the PCMD the data, the pattern suggests a decrease in the number of deaths in care homes dur ing 2009/10 followed by an increase during 2010/11.

 Review the services in currently in place and identify the gaps between demand for services and availability.  Using information on the expected increases in population (particularly the elderly), the projected numbers of deaths and pre dicted changes to prevalence of diseases, consider likely future demands for services.  Consider the patients perspective as to whether the care home is a temporary respite stay or the persons home. * NOTE: Currently numbers of deaths for Bradford are artificially high in nursing homes and low in hospices due to coding errors in source data . This will be rectified in the next update.

Table of significant differences compared to the England score for deaths in a care home for the different age groups using data from the NEOLCIN website.

Hull

NELincs

North Lincs

Y&H

0.05

0

0 Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

North Yorkshire and York

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

2010/11

18.1% 17.5% 19.1%

East Riding

0.05

2009/10

0.1

16.6% 17.1% 20.0%

Y&H

2010/11

14.6% 15.0% 16.0%

Wakefield

2008/09

0.15

2009/10

19.1%

Kirklees

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.15

17.5%

Calderdale

0

18.1% 17.5% 19.1%

Y&H

20.8% 20.4% 22.1%

Leeds

21.6% 21.4% 21.6%

Brad&Aire

0.05

2008/09

0.1

14.6% 12.5% 12.6%

0

0.1

22.5% 20.8% 21.2%

19.1%

17.5%

18.1%

17.6%

16.0%

16.4%

22.8%

0.05

20.3%

0.05

21.8%

0.1

18.1% 17.5% 19.1%

2010/11

2010/11

16.9% 15.3% 16.5%

2009/10

2010/11

0.1

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.15

2009/10

% Deaths in a Care Home for South Yorkshire

0.2

0.2 2008/09

2009/10

18.7% 18.4% 20.3%

0.15

0.2 2008/09

0.15

0.3

0.25

0.25

18.1%

2008/09

Figure_34 % of deaths in a care home over 3 years for South Yorkshire cluster

% Deaths in a Care Home for North Yorkshire and York

13.8% 12.8% 15.1%

0.25

0.2

0.2

Figure_33: % of deaths in a care home over 3 years for NYY cluster

0.3

% Deaths in a Care Home for Humber

22.0%

0.25

0.25

0.3

14.7% 16.1% 17.1%

Figure_32: % of deaths in a care home over 3 years for Humber cluster

% Deaths in a Care Home for Calderdale, Wakefield and Kirklees

20.4%

Figure_31: % of deaths in a care home over 3 years for CWK cluster

0.3

% Deaths in a Care Home for Airedale, Bradford and Leeds

13.2% 14.2% 14.5%

0.3

21.4%

Figure_30 % of deaths in a care home over 3 years for Airedale, Bradford and Leeds cluster

0

Barnsley

Doncaster Rotherham Sheffield

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Place of Death - Deaths in a Hospice* Figure_35: % of deaths of all ages dying in a hospice

Figure_36: % of deaths age 0-64 years dying in a hospice

% of all deaths for all ages for persons dying in a hospice 2008-10 Scarborough Leeds York Wakefield Calderdale Craven Harrogate North Lincolnshire Bassetlaw Regional Kirklees Rotherham National Sheffield Ryedale Doncaster Barnsley Selby NE Lincolnshire Kingston upon Hull Bradford East Riding Hambleton Richmondshire

9.6 9.0 8.2 7.5 7.2 6.9 6.7 6.1 5.6 5.5 5.4 5.3 5.2 4.9 4.7 4.7 4.3 4.2 3.6 3.3 3.0 2.0 1.5 0.7 0.0

Scarborough Wakefield Craven Leeds Ryedale Calderdale Bassetlaw Kirklees National North Lincolnshire Regional Barnsley Rotherham Selby Doncaster Sheffield NE Lincolnshire Hambleton Kingston upon Hull East Riding Bradford Richmondshire 2.0

4.0

6.0

8.0

Figure_37: % of deaths age 65-84 years dying in a hospice

% of all deaths for 0-64 years for persons dying in a hospice 200810

10.0

12.0

14.7 13.1 13.0 12.9 12.0 11.6 10.5 9.5 9.4 9.0 8.9 8.3 8.2 7.9 7.8 7.0 5.7 5.0 4.6 4.2 3.9 2.2 0.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Scarborough Leeds York Craven Harrogate Calderdale Wakefield North Lincolnshire Bassetlaw Regional Rotherham Kirklees Sheffield National Ryedale Doncaster Selby Barnsley NE Lincolnshire Kingston upon Hull Bradford East Riding Hambleton Richmondshire

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Figure_38: % of deaths age 85+ years dying in a hospice

% of all deaths for 65-84 years for persons dying in a hospice 200810

20.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

% of all deaths for 85+ years for persons dying in a hospice 2008-10 Scarborough Leeds Calderdale York Wakefield Craven Sheffield North Lincolnshire Regional National Harrogate NE Lincolnshire Rotherham Kirklees Doncaster Kingston upon Hull Bassetlaw Bradford Selby Ryedale East Riding Barnsley Richmondshire

12.4 11.4 10.7 10.0 8.5 8.5 8.4 7.7 6.8 6.8 6.8 6.6 6.5 6.4 5.5 5.4 5.3 5.1 4.3 3.9 3.8 2.3 1.5 0.63 0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

4.2 3.4 2.6 2.5 2.4 2.3 2.1 2.0 1.9 1.7 1.5 1.5 1.5 1.5 1.5 1.4 1.2 1.2 1.1 0.8 0.7 0.6 0.21 0.0

1.0

2.0

3.0

4.0

5.0

6.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Table_10: Significant difference from England average for patients dying in a hospice

85+ low none low high none none low

 Deaths in a hospice were also examined. Hospices tended to rate as second to deaths at home for peoples preferences nationally, particularly in the older age groups (see local preferences for place of death report). Data on deaths in hospices was examined using data from the NEOLCIN website (originally sourced from ONS) comparing local authorities on % of deaths recorded as been in a hospice during 2008-10. The charts were split into all ages, 0-64 years, 65-84 years and 85 years+ to look at any differences between age groups.  Charts were also created for each PCT cluster area using data from the primary care mortality database split down into 3 years (2008/09, 2009/10 and 2010/11). ●

none none none high none none low none low high none high high high

● ●

 Given that the national survey indicates that people in the older age groups expressed hospice and their first choice for place of death, more should be done to support people to meet their preferred choice and to identify any potential issues in achieving this.  Hospices could potentially increase in popularity as a place to die if their was more capacity in the regions and more was known/understood about hospice care. It is recommended that local work looks at place of death as a preferred option amongst patients and considers capacity of hospice beds against demand.  Initially more work could be undertaken to promote the role of hospices for patients approaching end of life and this could be discussed with patients in more detail as part of advance planning and EPaCCS. In particular, for patients needing more support towards the end of life and thus who can not be cared for at home and who wish to avoid hospital, this could be a suggested alternative.

Table of significant differences compared to the England score for deaths in a hospice for the different age groups using data from the NEOLCIN website.

* NOTE: Currently numbers of deaths for Bradford are artificially high in nursing homes and low in hospices due to coding errors in source data. This will be rectified in the next update

0.07

0

Brad&Aire

Leeds

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

2009/10

0.04

2010/11

2008/09

0.05

0.07

0.05

2009/10

0.04

2010/11

0.04

2008/09

0.06

2009/10

0.05

2009/10

2010/11

0.04

2010/11

0.03

0.03

0.02

0.02

0.02

0.02

0.01 0

Calderdale

Kirklees

Wakefield

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.01

East Riding

Hull

NELincs

North Lincs

Y&H

0 Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.01

5.9%

0.03

6.2%

0.03

5.7%

5.9%

6.2%

5.7%

8.5%

9.0%

9.7%

7.6%

7.8%

0.01

7.1%

0.02

0.05

6.7%

0.03

0.06

6.4%

2010/11

0.08

0.06 2008/09

0.1

5.9%

0.04

0.09

0.07

5.7% 6.2% 5.9%

2009/10

0.08

0.07

5.8% 6.2% 5.8%

0.05

0.06

0.09

0.08

3.1% 4.2% 3.4%

2008/09

% Deaths in a Hospice for South Yorkshire

% Deaths in a Hospice for North Yorkshire and York

0.09

3.1% 3.2% 4.1%

0.06

% Deaths in a Hospice for Humber

Figure_43 % of deaths in a hospice over 3 years for South Yorkshire cluster

0

0.01

2008/09

0

Barnsley North Yorkshire and York

5.7% 6.2% 5.9%

0.08

0.07

0.1

5.0% 5.4% 4.5%

0.08

Figure_42: % of deaths in a hospice over 3 years for NYY cluster

5.5% 5.8% 3.7%

0.1 0.09

0.1

4.2% 5.6% 4.1%

0.1 0.09

Figure_41: % of deaths in a hospice over 3 years for Humber cluster

% Deaths in a Hospice for Calderdale, Wakefield and Kirklees

4.6% 4.3% 4.1%

Figure_40: % of deaths in a hospice over 3 years for CWK cluster

% Deaths in Hospice for Airedale, Bradford and Leeds

1.9% 2.0% 1.8%

Figure_39 % of deaths in a hospice over 3 years for Airedale, Bradford and Leeds cluster

Deaths in hospices account for 5.5% of deaths in the region. The % of patients dying in a hospice based on the NEOLCIN data was slightly higher in Yorkshire and Humber compared to the national position for all age groups (except 0-64). The confidence intervals around the 0-64 and 85+ age groups in particular are very wide due to small numbers, therefore there is less certainty around the proportion of deaths in hospices/ Trend patterns in the PCT cluster charts vary within clusters and between clusters. Again this data is more volatile due to lower numbers of patients.

5.7% 6.2% 5.9%

65-84 low none low high high low low low high low none high low high low none none high none none high high

6.8% 8.6% 7.7%

0-64 none none low high none low low low high low none high low none low none none high none low high high

4.6% 5.9% 6.7%

All low none low high high low low low high low none high low high low none none high low none high high

6.4% 7.3% 9.5%

Names Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull Kirklees Leeds North East Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

Doncaster Rotherham Sheffield

Y&H

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Comparisons of Place of Death Figure_44: % of deaths of all ages by place of death

Figure_45: % of deaths age 0-64 years by place of death

Hospital

Own Residence

Care Home

Figure_46: % of deaths age 65-84 years by place of death

Place of Death for age 0-64 2008-10

Place of Death for All Persons 2008-10 Hospice

Hospital

Other

Own Residence

Care Home

Hospice

Other

Hospital

Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding Hambleton Harrogate Kingston upon Hull Kirklees Leeds NE Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding of Yorkshire Hambleton Harrogate Kingston upon Hull Kirklees Leeds NE Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

0%

20%

40%

60%

80%

Figure_48: % of deaths by place for Airedale, Bradford and Leeds cluster

Usual Place of Residence

Acute Trust

20%

40%

60%

Figure_49: % of deaths by place for Calderdale, Wakefield and Kirklees cluster

Hospice

80%

100%

Usual Place of Residence

0.6

0.6

0.5

0.5

0.4

0.4

0.3

0.3

0.2

0.2

Place of Death for age 85+ 2008-10

Hospice

Other

Hospital

Acute Trust

Hospice

20%

40%

80%

100%

Usual Place of Residence

Acute Trust

Hospice

Own Residence

Care Home

Hospice

Other

0%

Other

Usual Place of Residence

Acute Trust

40%

60%

80%

100%

Figure_52: % of deaths by place for South Yorkshire cluster

% Deaths by Place 2008-11 for South Yorkshire

% Deaths by Place 2008-11 for North Yorkshire and York

0.7

20%

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_51: % of deaths by place for North Yorkshire and York cluster

% Deaths by Place 2008-11 Humber Other

60%

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_50: % of deaths by place for Humber cluster

% Deaths by Place 2008-11 for Calderdale, Wakefield and Kirklees

Other

Care Home

Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding Hambleton Harrogate Kingston upon Hull Kirklees Leeds NE Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

0%

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

% Deaths by Place 2008-11 for Airedale, Bradford and Leeds

Own Residence

Barnsley Bassetlaw Bradford Calderdale Craven Doncaster East Riding Hambleton Harrogate Kingston upon Hull Kirklees Leeds NE Lincolnshire North Lincolnshire Richmondshire Rotherham Ryedale Scarborough Selby Sheffield Wakefield York

0%

100%

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_47: % of deaths age 85+ years by place of death

Place of Death for age 65-84 2008-10

Hospice

Other

0.6 0.6

Usual Place of Residence

Acute Trust

Hospice

Other

0.6

0.5

0.5

0.4

0.4

0.3

0.3

0.2

0.2

East Riding

Hull

NELincs

North Lincs

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Y&H

3.7%

52.3%

5.9%

38.1%

6.5%

45.5%

3.7%

38.1% 52.3% 5.9%

2.4%

40.1% 51.6% 5.9%

1.8%

42.8% 51.9% 3.5%

2.3%

32.6% 61.7% 3.5%

6.3%

39.1% 52.6% 1.9%

36.8% 53.9% 7.7% 1.6%

38.1% 52.3% 5.9% 3.7% Y&H

Barnsley

Doncaster

Rotherham

Sheffield

Y&H

0

North Yorkshire and York

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

 Whilst the previous sections examined place of death separately, this section combines this data to allow comparisons between place of death by local authority and PCTs .  Combining home and care home together as "usual place of residence" is also considered.

3.4 3.0 2.8 2.6 2.6 2.6 2.6 2.3 2.3 2.2 2.2 2.2 2.2 2.1 2.1 2.0 2.0 2.0 1.9 1.8 1.8 1.7 1.7 1.5 0.0

Wakefield

Figure_54: % of deaths by place separating home and care home

% of all deaths for all ages for persons dying elsewhere 2008-10 Harrogate Craven Bassetlaw Bradford Kirklees North Lincolnshire Wakefield Kingston upon Hull Hambleton Scarborough Doncaster National Regional NE Lincolnshire Sheffield Calderdale Ryedale East Riding Richmondshire Leeds York Selby Rotherham Barnsley

Kirklees

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

38.1% 52.3% 5.9% 3.7%

Calderdale

36.2% 56.7% 5.0% 2.1%

Y&H

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011 Figure_53: % of deaths of all ages dying elsewhere

0.1

36.1% 56.3% 5.0% 2.6%

Leeds

0

34.1% 52.8% 4.6% 8.5%

Brad&Aire

0.1 0

0

0.1

36.7% 54.2% 4.3% 4.8%

0

39.3% 52.7% 5.7% 2.3%

33.8% 56.7% 7.7% 1.8%

0.2

6.3%

0.3

0.1

3.7%

52.3%

5.9%

38.1%

2.1%

52.5%

9.1%

36.3%

3.5%

47.0%

7.5%

42.0%

0.1

0.4

41.7%

0.5

0.04 0.18 Other

● ● ●

Trend patterns in the PCT cluster charts vary within clusters and between clusters. The place of death comparison charts for local authorities allow the proportions to be viewed by age group with hospital deaths dominating all age groups. The comparative charts based on PCMD data for PCT clusters illustrates the proportional gap between usual place of residence (home and care home combined), acute trust, hospices and other. Deaths in hospices and other remains low across all PCTs , however the gap between the highest proportion (hospitals) and own residence varies between clusters.

 Even whilst making every effort to comply with the patients wish to die in their chosen place, it is not always possible to carry this out, for example the patient may be too sick to move and likely to die in transit or it would cause undue pain and discomfort. The level of support required at end of life to keep the patient as comfortable and pain free as possible may mean that death at home for example is not feasible. As such people should be given the best possible care regardless of care setting and it is recommended that care at end of life is reviewed across the different settings to pin point where improvements could be made.  Mapping peoples preferences onto the geography of the region is also crucial to understand how issues such as capacity and drive times may support or hinder a persons chance for having their wishes for place of death met.

Acute Hospice

20.0% 0.52

Home Care Home

0.06

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Figure_55: % of deaths by place combining home and care home

4.0%

0.38

Other Acute 0.52

Hospice Usual Place

0.06

1.0

2.0

3.0

4.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

5.0

6.0 Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Hospital Deaths in Adults Aged 18+ Metadata Indicator

Construction

Source

Number of deaths in hospital over 3 years by length of stay

Number of people in hospital by length of stay per year for Y&H

Hospital Episode Statistics 2008-2011

% of deaths in hospital by length of stay by Trust

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 by Trust Denominator : Total number of patients dying in hospital during 2008-11 by Trust Calculation : Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

% of deaths in hospital by length of stay by PCT

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 by PCT Denominator : Total number of patients dying in hospital during 2008-11 by PCT Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Number of deaths in hospital over 3 years by age group

Number of people in hospital by age group per year for Y&H

Hospital Episode Statistics 2008-2011

% of deaths in hospital by age group by Trust

Numerator : Number of patients dying in hospital aged 18-64, 65-84 and 85+ during 2008-11 by Trust Denominator : Total number of patients dying in hospital during 2008-11 by Trust Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

% of deaths in hospital by age group by PCT

Numerator : Number of patients dying in hospital aged 18-64, 65-84 and 85+ during 2008-11 by PCT Denominator : Total number of patients dying in hospital during 2008-11 by PCT Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of patients dying in hospital in 0-3 days, 4-7 days and 8+ days split by age group for Yorkshire and Humber

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ day for each age group during 2008-11 for Y&H Denominator : Total number of patients dying in hospital during 2008-11 in Y&H Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of patients dying in hospital aged 0-64, 65-84 and 85+ split by length of stay for Yorkshire and Humber

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ day for each age group during 2008-11 for Y&H Denominator : Total number of patients dying in hospital during 2008-11 in Y&H Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Number of deaths in hospital over 3 years by primary diagnosis

Number of deaths in hospital over 3 years by primary diagnosis

Hospital Episode Statistics 2008-2011

% of deaths in hospital by primary diagnosis by Trust

Numerator : Number of patients dying in hospital with a primary diagnosis of cancer, CVD, respiratory disease or other by Trust Denominator : Total number of patients dying in hospital during 2008-11 by Trust Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

% of deaths in hospital by primary diagnosis by PCT

Numerator : Number of patients dying in hospital with a primary diagnosis of cancer, CVD, respiratory disease or other by PCT Denominator : Total number of patients dying in hospital during 2008-11 by PCT Calculation : Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of deaths in hospital over 3 years with a primary diagnosis of cancer by length of stay (PCT)

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 with a primary diagnosis of cancer Denominator: Total number of patients dying in hospital during 2008-11 Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of deaths in hospital over 3 years with a primary diagnosis of CVD by length of stay (PCT)

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 with a primary diagnosis of CVD Denominator : Total number of patients dying in hospital during 2008-11 Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of deaths in hospital over 3 years with a primary diagnosis of respiratory disease by length of stay (PCT)

Numerato r: Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 with a primary diagnosis of respiratory disease Denominato r: Total number of patients dying in hospital during 2008-11 Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of deaths in hospital over 3 years with a primary diagnosis of other by length of stay (PCT)

Numerator : Number of patients dying in hospital in 0-3 days, 4-7 days and 8+ days during 2008-11 with a primary diagnosis of other Denominator : Total number of patients dying in hospital during 2008-11 Calculation : Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Numerator : Number of patients dying in hospital with a primary diagnosis of cancer, CVD, respiratory disease or other for Y&H split Proportion of patients dying in hospital with as primary diagnosis of by length of stay cancer, CVD, respiratory disease or other for Yorkshire and Humber Denominator : Total number of patients dying in hospital during 2008-11 in Y&H split by length of stay Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Proportion of patients dying in hospital within 0-3 days, 4-7 days and 8+ days for Yorkshire and Humber split by primary diagnosis

Numerator : Number of patients dying in hospital within 0-3 days, 4-7 days and 8+ days for Y&H split by primary diagnosis Denominator : Total number of patients dying in hospital during 2008-11 in Y&H Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Numerator : Number of patients dying in hospital with a primary diagnosis of cancer, CVD, respiratory disease or other for Y&H split Proportion of patients dying in hospital with as primary diagnosis of by age group cancer, CVD, respiratory disease or other for Yorkshire and Humber Denominator : Total number of patients dying in hospital during 2008-11 in Y&H split by age group Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Numerator : Number of patients dying in hospital within 0-3 days, 4-7 days and 8+ days for Y&H split by primary diagnosis Proportion of patients dying in hospital aged 0-64, 65-84 and 85+ for Denominator : Total number of patients dying in hospital during 2008-11 in Y&H Yorkshire and Humber split by primary diagnosis Calculation: Numerator/denominator expressed as a percentage

Hospital Episode Statistics 2008-2011

Hospital Data - Length of Stay and Age Figure_56: Number of deaths in hospital over 3 years by length of stay

Figure_57: % of deaths in hospital by length of stay by Trust

Number of deaths over three years grouped by length of stay in hospital from admission to death for Yorkshire and Humber

0 to 3 days

12000

2009-10

Scarborough NLinc and Goole Bradford Barnsley Donc&Basset Rotherham Mid Yorks Harrogate York Hospital Airedale Leeds Cald&Hudd Hull and EY Sheffield

2010-11

10000 8000 6000

11133

11659

12450

4205

4117

4182

7143

7206

7550

4000

0 0 to 3 days

4 to 7 days

8+ days

0%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

2008-09

2009-10

18.1% 17.6% 16.3% 14.0% 13.9% 13.3% 13.1% 12.7% 12.6% 11.5% 10.7% 10.4% 10.4% 8.8%

Bradford

2010-11

12000

Hull and EY Donc&Basset

10000

Sheffield Cald&Hudd

8000

Mid Yorks

NLinc and Goole

6000

Barnsley

Rotherham

4000

Airedale

7851

7905

8072

11428

11851

3202

12702

York Hospital

3226

40%

18-64

Leeds

3408

30%

50%

60%

70%

80%

North Lincs Brad&Aire NE Lincs Doncaster Rotherham Wakefield Barnsley East Riding NYY Yorks & Humber Kirklees Leeds Calderdale Hull Sheffield 90%

Scarborough

0

Harrogate 65-84

85+

0%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

65-84

20%

30%

40%

40%

50%

60%

70%

80%

90%

100%

Proportion of hospital deaths for PCTs grouped by age 2008-11 18-64

50%

60%

70%

80%

90%

17.0% 16.4% 16.1% 14.9% 14.8% 14.3% 14.3% 14.1% 14.1% 13.9% 13.9% 13.9% 13.6% 13.2% 11.4%

Brad&Aire Kirklees Hull North Lincs Doncaster Rotherham NE Lincs Yorks & Humber Wakefield Barnsley Calderdale Leeds East Riding Sheffield NYY

32.1% 29.6% 31.3% 31.9% 35.2% 35.3% 34.4% 34.4% 33.5% 36.7% 40.1% 42.9% 40.8% 43.2% 100%

0%

10%

65-84

85+

50.8% 50.9% 52.4% 51.9% 53.4% 54.6% 53.9% 51.7% 52.8% 53.8% 52.2% 50.9% 51.6% 51.1% 49.5% 20%

30%

40%

32.2% 32.7% 31.6% 33.2% 31.9% 31.1% 31.8% 34.2% 33.2% 32.3% 33.9% 35.2% 34.9% 35.6% 39.1% 50%

60%

70%

80%

90%

100%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

 Reduction in hospital admissions at end of life increases the patients chance of dying in their preferred place of death  Unnecessary admissions are costly, not in the interest of the patient and stop the bed from being used by other patients.

% of deaths in hospital by age group split by length of stay for Yorkshire and Humber

0.6

30%

85+

Figure_63: % of deaths in hospital by age group split by length of stay

% deaths in hospital by length of stay split by age group for Yorkshire and Humber

20%

44.4% 46.3% 46.8% 48.2% 48.0% 49.3% 49.3% 50.2% 49.7% 50.6% 50.6% 52.7% 53.2% 54.3% 56.5%

Figure_61: % of deaths in hospital by age band by PCT

49.8% 52.8% 52.5% 54.1% 51.0% 51.3% 52.6% 52.9% 53.9% 51.9% 49.2% 46.7% 48.9% 48.0%

10%

10%

8+ days

17.7% 19.3% 19.4% 18.9% 19.5% 18.4% 18.4% 17.6% 18.2% 18.0% 18.0% 17.3% 18.0% 17.2% 16.0%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Figure_62: % of deaths in hospital by length of stay split by age group

0%

100%

4 to 7 days

37.9% 34.4% 33.8% 32.9% 32.5% 32.3% 32.3% 32.2% 32.1% 31.4% 31.4% 30.1% 28.8% 28.5% 27.6%

Proportion of hospital deaths for Trusts grouped by age 2008-11

14000

0.6

●

0.5

0.5

0.4

18-64

0.4

0 to 3 days

65-84

0.3

85+ 0.2

● ●

4 to 7 days

0.3

8+ days

●

0 to 3 days

4 to 7 days

8+ days

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

35.4%

33.4%

32.7%

52.0%

51.9%

12.5%

0.1

14.6%

0

16.4%

35.4%

52.0%

12.5%

33.4%

51.9%

14.6%

32.7%

50.9%

0.2 16.4%

0.1

20%

42.9% 45.6% 45.7% 45.9% 47.1% 47.4% 48.9% 49.9% 51.3% 49.8% 52.8% 52.6% 53.2% 55.8%

Figure_60: % of deaths in hospital by age band by Trust

Number of deaths over three years grouped by age band in hospital from admission to death for Yorkshire and Humber

18-64

10%

0 to 3 days

8+ days

19.0% 18.7% 18.8% 18.9% 19.0% 19.2% 18.2% 18.9% 18.0% 20.1% 17.4% 17.9% 17.4% 16.0%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Figure_59: % of deaths in hospital over 3 years by age band

2000

4 to 7 days

38.1% 35.7% 35.6% 35.3% 33.8% 33.4% 32.9% 31.2% 30.8% 30.1% 29.8% 29.5% 29.4% 28.2%

50.9%

2000

Proportion of deaths for PCTs grouped by length of stay in hospital from admission to death 2008-11

Proportion of deaths for Trusts grouped by length of stay in hospital from admission to death 2008-11

14000 2008-09

Figure_58: % of deaths in hospital by length of stay by PCT

0 18-64

65-84

85+

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

●

Approximately 45-55% of patients who die in hospital are in hospital for more than 8 days before death and around one third are in for 0-3 days before death Approximately 50% of the patients are aged 18-64 and around 30-40% are aged 85+ Hospital deaths where the primary diagnosis was respiratory disease account for around one third of hospital deaths and CVD 20-25% and cancer deaths between 10-25% of deaths. Across all PCTs the lowest proportion of deaths for cancer is within 0-3 days and the highest 8 days or more. For CVD the pattern is reversed and the highest proportion of deaths that are within 0-3 days and the lowest 8 or more days. For respiratory diseased the highest proportion of deaths in hospital tends to be within 4-7 days. The 18-64 age group has the lowest proportion of deaths although notably this is much higher for cancer than the other primary diagnosis groups.

Hospital Data - Primary Diagnosis Figure_64: Number of deaths in hospital over 3 years by primary diagnosis

Figure_65: % of deaths in hospital by primary diagnosis by Trust

Number of deaths over three years by primary diagnosis for Yorkshire and Humber

Cancer

9000

Sheffield

2010-11

Cald&Hudd Leeds

7000

Barnsley

6000

Rotherham

5000

Bradford

4000

Donc&Basset NLinc and Goole

Mid Yorks

7404

7728

8470

6585

6206

6648

4569

Scarborough

0

Airedale

CVD

Respiratory

Other

0%

Figure_67: % of Cancer deaths in hospital by length of stay

20%

30%

40%

50%

60%

70%

80%

90%

100%

Y&H

Sheffield

 Trusts and PCTs should examine their local hospital data on patients who died following admission to hospital to dig deeper into the primary diagnosis of the patient. Does it tend to be patients with certain conditions that are admitted? Are there other services which may potentially be more appropriate for the patient?  Are there specific patterns around post codes of admissions? Do certain areas admit more patients? Can work be done with GPs and care homes around services available and appropriateness of referrals. Examining specific geographic areas or locations for sources of admissions (e.g. care homes) may highlight hot spots of high admissions  Further exploration around, ethnicity, living arrangements, co-morbidities, etc should be undertaken.  Patient dying in hospital should be reviewed see whether alternative action to admission could have been undertaken.  Comparisons between hospital sites, specialities and down to consultant teams may also be valuable in understanding the admission criteria for people at end of life and identifying end of life pathways that lead to patients having a good death.  Mapping services and considering bottle necks in the system is a useful way of understanding the end of life pathway and looking for ways to streamline this.  Clear documentation through instruments such as advance care planning and the end of life register are crucial around making the decision as to whether to admit a patient  Similarly clear, co-ordinated documentation could help to speed up the discharge process from hospital – enabling patients to die at home

0.15

Other

Other

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

0 to 3 days

4 to 7 days

8+ days

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

37.2%

47.9%

14.9%

0.1

38.5%

0

0.25

65-84

0.2

Cancer CVD

Respiratory

0.15

Other

Y&H

Sheffield

Wakefield

0.1

51.5%

34.2%

26.6%

18.4%

20.8%

31.6%

30.2%

20.2%

18.0%

34.7%

28.7%

24.6%

0.05

12.0%

34.7% 31.6% 34.2%

0.00%

18-64

85+

0.2

0.1

10.00%

0.3

10.0%

15.00%

Respiratory

38.7%

0.2

0.4

51.1%

4 to 7 days

CVD

0.3

0.5

10.1%

20.00%

Cancer

16.3%

0.25

0.35

59.9%

0 to 3 days

% Deaths in hospital by age band split by primary diagnosis for Yorkshire and Humber 0.4

23.8%

25.00%

Figure_74: % deaths in hospital by age band split by primary diagnosis

% Deaths in hospital by primary diagnosis split by age band for Yorkshire and Humber

0 Cancer

CVD

Respiratory

Other

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

0.05

8.3% 23.4% 31.4% 36.8%

0.6

0.3

8+ days

Across the region there has been a decline in deaths in hospital in 2010-11 for all primary diagnosis except for respiratory disease.

20.3% 20.4% 27.8% 31.4%

0.35

30.00%

28.7% 30.2% 26.6%

Wakefield

NYY

Rotherham

NYY

North Lincs

Leeds

NE Lincs

35.00%

24.6% 20.2% 18.4%

10%

Figure_73: % deaths in hospital by primary diagnosis split by age band

% Deaths in hospital by length of stay split by primary diagnosis for Yorkshire and Humber

0.7

Respiratory

●

8+ days

0.4

12.0% 18.0% 20.8%

0%

100%

28.9% 28.4% 32.2% 31.4% 28.0% 33.9% 35.9% 34.3% 35.4% 37.2% 35.8% 37.9% 36.2% 35.5% 37.5%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Rotherham

North Lincs

Leeds

NE Lincs

Hull

Doncaster

Kirklees

Hull

Kirklees

4 to 7 days

40.00%

CVD

90%

8+ days

Figure_72: % of deaths in hospital by length of stay split by primary diagnosis

% Deaths in hospital by primary diagnosis split by length of stay for Yorkshire and Humber

Cancer

80%

Other

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Figure_71: % of deaths in hospital by length of stay split by primary diagnosis

5.00%

70%

Respiratory 25.2% 28.4% 26.5% 25.0% 32.3% 27.9% 27.3% 27.4% 32.1% 25.6% 29.3% 28.9% 30.3% 28.2% 30.6%

29.6% 14.8% 19.7% 35.9%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Doncaster

Barnsley

Y&H

Sheffield

Rotherham

Wakefield

0.00%

NYY

10.00%

0.00%

NE Lincs

20.00%

10.00%

North Lincs

30.00%

20.00%

Leeds

40.00%

30.00%

Kirklees

40.00%

Hull

4 to 7 days

0 to 3 days

East Riding

8+ days

50.00%

East Riding

60%

Percentage of deaths in hospital by length of stay category for patients with a primary diagnosis of Other (pooled data 2008-11)

50.00%

Doncaster

50%

Cancer CVD 25.7% 20.2% 24.3% 18.9% 23.3% 18.0% 22.5% 21.1% 17.8% 22.0% 17.5% 20.7% 16.6% 20.2% 15.9% 22.5% 15.3% 17.2% 14.1% 23.1% 14.1% 20.8% 13.8% 19.4% 13.8% 19.7% 13.7% 22.6% 12.9% 19.0%

Sheffield Hull Rotherham East Riding Barnsley Yorks & Humber Calderdale Kirklees Doncaster NYY Leeds NE Lincs North Lincs Brad&Aire Wakefield

Figure_70: % of Other deaths in hospital by length of stay

Percentage of deaths in hospital by length of stay category for patients with a primary diagnosis of Respiratory Disease (pooled data 2008-11)

Calderdale

40%

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care Figure_69: % of Respiratory Disease deaths in hospital by length of stay

4 to 7 days

East Riding

Barnsley

Y&H

Sheffield

Wakefield

Rotherham

NYY

NE Lincs

North Lincs

Kirklees

Leeds

0.00%

Hull

10.00%

0.00%

East Riding

20.00%

10.00%

Doncaster

30.00%

20.00%

Calderdale

30.00%

Barnsley

40.00%

Brad&Aire

50.00%

40.00%

Barnsley

30%

0 to 3 days

8+ days

50.00%

Brad&Aire

20%

29.0% 31.1% 33.1% 35.6% 26.4% 34.6% 34.1% 34.3% 36.4% 38.0% 31.3% 37.3% 37.0% 41.0%

Percentage of deaths in hospital by length of stay category for patients with a primary diagnosis of CVD (pooled data 2008 -11)

Brad&Aire

4 to 7 days

0 to 3 days

10%

Proportion of deaths for PCTs by primary diagnosis 2008-11

Other

26.3% 26.5% 28.4% 27.0% 35.3% 30.4% 29.1% 33.5% 30.8% 26.1% 31.1% 31.2% 26.1% 26.3%

Figure_68: % of CVD deaths in hospital by length of stay

Percentage of deaths in hospital by length of stay category for patients with a primary diagnosis of cancer (pooled data 2008 -11) 0 to 3 days

Respiratory

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Brad&Aire

Cancer

Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Calderdale

4921

4903

3923

Harrogate

1000

4127

York Hospital

2000 4161

3000

Calderdale

8000

2009-10

CVD

24.6% 20.1% 20.2% 22.2% 16.7% 21.8% 16.2% 21.1% 16.0% 22.3% 15.5% 19.6% 15.3% 21.5% 15.0% 17.2% 13.5% 19.4% 13.0% 22.8% 12.1% 25.5% 11.8% 19.7% 10.1% 26.8% 9.8% 22.8%

Hull and EY

2008-09

Figure_66: % of deaths in hospital by primary diagnosis by PCT

Proportion of deaths for Trusts by primary diagnosis 2008-11

18-64

65-84

85+

0 Source: Hospital Episode Statistics (HES) The NHS Information Centre for Health and Social Care

Cause of death Metadata Indicator

Construction

Source

Proportion of deaths for cancer 2008-10 (all ages, 0-64, 65-84 and 85+)

Numerator : Number of patients where the cause of death was cancer in 2008-10 by age group Denominator: Total number of patients dying in 2008-10 by age group Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Proportion of deaths for cancer 2008-10 (hospital, usual place of residence, care home, hospice)

Numerator : Number of patients where the cause of death was cancer in 2008-10 by place of death Denominator: Total number of patients dying in 2008-10 by place of death Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Numerator: Number of patients where the cause of death was CVD in 2008-10 by age group Proportion of deaths for CVD 2008-10 (all ages, 0-64, 65-84 and 85+) Denominator: Total number of patients dying in 2008-10 by age group Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Proportion of deaths for CVD 2008-10 (hospital, usual place of residence, care home, hospice)

Numerator: Number of patients where the cause of death was CVD in 2008-10 by place of death Denominator : Total number of patients dying in 2008-10 by place of death Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Proportion of deaths for respiratory disease 2008-10 (all ages, 064-, 65-84 and 85+)

Numerator: Number of patients where the cause of death was respiratory disease in 2008-10 by age group Denominator: Total number of patients dying in 2008-10 by age group Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Numerator: Number of patients where the cause of death was respiratory disease in 2008-10 by place of death Proportion of deaths for respiratory disease 2008-10 (hospital, usual Denominator: Total number of patients dying in 2008-10 by place of death place of residence, care home, hospice) Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Proportion of deaths for other 2008-10 (all ages, 0-64, 65-84 and 85+)

Numerator : Number of patients where the cause of death was other (not cancer, CVD or respiratory disease) in 2008-10 by age group Denominator : Total number of patients dying in 2008-10 by age group Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Proportion of deaths for other 2008-10 (hospital, usual place of residence, care home, hospice)

Numerator: Number of patients where the cause of death was other (not cancer, CVD or respiratory disease) in 2008-10 by place of death Denominator: Total number of patients dying in 2008-10 by place of death Calculation: Numerator/denominator expressed as a percentage

National End of Life Care Intelligence Network (NEOLCIN) 2008-10

Cause of Death - Cancer Figure_75: % of all deaths where the main cause was cancer

Figure_76: % of deaths aged 0-64 where the main cause was cancer

% of all deaths where the main cause was Cancer 2008-10 Doncaster Barnsley Bassetlaw Kingston upon Hull Ryedale Hambleton Rotherham Richmondshire North Lincolnshire Sheffield East Riding Leeds NE Lincolnshire Regional National Selby Wakefield Calderdale York Scarborough Harrogate Kirklees Craven Bradford

% of deaths aged 0-64 where the main cause was Cancer 2008-10

29.3 29.3 29.0 29.0 28.9 28.9 28.8 28.8 28.8 28.4 28.3 28.2 27.8 27.7 27.7 27.6 27.6 27.1 26.9 26.2 26.2 25.8 25.6 25.2

0.0

Craven Ryedale Hambleton Harrogate Richmondshire East Riding Bassetlaw Selby Barnsley York North Lincolnshire Rotherham Scarborough National Sheffield Wakefield Regional Doncaster Calderdale Leeds Kingston upon Hull Kirklees NE Lincolnshire Bradford 5.0

10.0

15.0

20.0

25.0

30.0

35.0

Figure_77: % of deaths aged 65-84 where the main cause was cancer

% of deaths aged 65-84 where the main cause was Cancer 200810

Richmondshire Sheffield Hambleton Barnsley Leeds Rotherham East Riding National NE Lincolnshire Doncaster North Lincolnshire Ryedale York Kingston upon Hull Bassetlaw Regional Selby Harrogate Scarborough Calderdale Wakefield Craven Kirklees Bradford

36.1 35.4 35.1 34.8 34.6 34.6 34.4 34.3 34.3 34.2 33.9 33.9 33.8 33.8 33.7 33.6 33.3 32.6 32.5 32.3 32.3 31.7 31.6 30.6

0.0

5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

0.0

40.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

45.1 45.1 43.8 43.2 42.1 41.6 41.0 40.2 40.0 39.6 39.1 38.7 37.1 36.8 36.5 36.2 36.1 35.7 35.1 34.1 33.6 33.4 32.4 30.1 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset Figure_78: % of deaths aged 85+ where the main cause was cancer

% of deaths aged 85+ where the main cause was Cancer 2008-10 Kingston upon Hull Doncaster Ryedale Sheffield Leeds Bassetlaw North Lincolnshire Rotherham NE Lincolnshire East Riding Regional National Wakefield Hambleton Calderdale Bradford Selby Craven Scarborough York Barnsley Kirklees Harrogate Richmondshire

17.7 17.4 16.3 16.0 15.7 15.4 15.4 15.1 15.1 15.0 15.0 14.9 14.7 14.6 14.5 14.4 14.3 14.3 14.2 14.0 13.8 13.1 13.1 12.8 0.0

5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

 Data on death where the patient had a primary diagnosis of cancer has been examined in more detail . The charts above (figures 75 to 78) look at deaths where the person had a primary diagnosis of cancer by PCT split by age group. ●

Higher proportions of deaths are for the 0-64 and 65-84 age groups from cancer. Regionally Yorkshire and Humber has a similar proportion of deaths compared to the national position overall (this is lower on 0-64 but higher on 65-84 year age group). Barnsley, Doncaster, Rotherham and East Riding are significantly higher than the England average on deaths from cancer for all ages, Bradford, Kirklees, Craven, Harrogate and Scarborough are significantly lower.

 It is recommended that organisations , particularly those with higher proportions of cancer deaths, study their data to understand which age groups resources need to be targeted at to reduce cancer deaths and to put plans in place to support the person at end of life where required.  Organisations should ensure data quality for coding of primary diagnosis.

 Whilst place of death is included in more detail elsewhere, the charts below are looking only as those deaths where the underlying cause of death is listed as cancer during 2008-10.  Place of death is defined as hospital, own residence, care homes and hospices. (Note: care homes is not subsumed into "usual place of residence" for these charts). Charts for "elsewhere" have been excluded due to volatile data from small numbers.  Deaths in the patients own residence is considered the most desirable, particularly over deaths in hospital. ● ●

The highest proportion of deaths from cancer is in hospitals (regionally 42%) followed by own residence , then hospices with the fewest deaths in care homes. Regionally for cancer there are fewer deaths in hospitals and care homes and more in the persons own residence and hospices compared to deaths from any cause for all ages.

 Organisations should review the data for their own region and see how it compares to others as well as to data for place of death for all diagnosis. For patients dying in hospital particularly, organisations should work to ensure that patients with cancer approaching end of life have the opportunity to die at home if they wish.

Figure_79: % of all cancer deaths in hospital

Figure_80: % of all cancer deaths in own residence

% of all deaths for underlying cause of Cancer for persons dying in hospital 2008-10

East Riding Kingston upon Hull Sheffield Richmondshire Ryedale Doncaster Rotherham Selby Hambleton National Regional Calderdale Kirklees Barnsley NE Lincolnshire North Lincolnshire York Bassetlaw Harrogate Leeds Wakefield Bradford Scarborough Craven

% of all deaths for underlying cause of Cancer for persons dying in own residence 2008-10

57.2 55.5 50.5 48.2 47.3 46.9 43.1 43.1 43.0 42.9 42.3 41.5 40.8 40.7 40.0 39.7 38.9 37.2 36.1 35.6 35.2 34.3 34.3 29.4

0.0

Hambleton Richmondshire Selby Ryedale Barnsley NE Lincolnshire Rotherham Bassetlaw Wakefield National Craven Kirklees Doncaster Regional Harrogate Bradford Calderdale Leeds York Sheffield Kingston upon Hull East Riding North Lincolnshire Scarborough

5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 50.0 55.0 60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Scarborough Leeds York Wakefield Calderdale Craven Harrogate North Lincolnshire Kirklees Bassetlaw Regional National Rotherham Sheffield Doncaster Selby Barnsley Ryedale NE Lincolnshire Kingston upon Hull Bradford East Riding Hambleton Richmondshire 10.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

% of all deaths for underlying cause of Cancer for persons dying in a hospice 2008-10

28.9 17.8 16.5 16.3 15.9 13.3 13.1 12.9 12.6 12.5 12.5 11.9 11.6 10.8 10.3 10.2 10.1 9.9 9.8 9.3 9.0 8.9 7.9 5.5 5.0

5.0

Figure_82: % of all cancer deaths in a hospice

% of all deaths for underlying cause of Cancer for persons dying in a care home 2008-10

0.0

0.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_81: % of all cancer deaths in a care home

Bradford NE Lincolnshire North Lincolnshire Craven Bassetlaw Richmondshire Barnsley East Riding Regional Harrogate Hambleton Kirklees National Wakefield Doncaster Leeds Rotherham Scarborough Kingston upon Hull York Calderdale Sheffield Selby Ryedale

38.6 34.6 32.7 32.4 31.7 28.8 28.4 27.9 27.0 26.8 26.5 26.5 26.0 25.7 25.5 25.0 24.1 23.8 23.5 23.5 22.9 22.7 22.6 22.5

15.0

20.0

25.0

30.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

35.0

31.2 29.1 27.3 25.1 24.1 23.6 23.4 19.7 19.2 18.0 18.0 17.3 17.1 16.1 15.2 14.2 13.6 13.1 11.7 10.6 10.4 6.1 4.4 2.3 0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

40.0

Cause of Death - Cardiovascular Disease Figure_83: % of all deaths where the main cause was cardiovascular disease

Ryedale Scarborough Craven Harrogate Hambleton Richmondshire Kirklees East Riding Bradford Selby York NE Lincolnshire Regional National Rotherham North Lincolnshire Leeds Sheffield Wakefield Doncaster Barnsley Calderdale Kingston upon Hull Bassetlaw

% of deaths aged 0-64 where the main cause was CVD 2008-10 Ryedale Selby Bradford Rotherham Wakefield Hambleton Doncaster Craven Barnsley Scarborough Calderdale Regional Sheffield Kirklees Kingston upon Hull East Riding National NE Lincolnshire Leeds North Lincolnshire York Richmondshire Bassetlaw Harrogate

37.3 36.6 35.4 32.9 31.8 31.6 31.0 30.9 30.7 30.4 30.4 30.2 30.0 29.6 29.5 29.4 29.3 29.3 28.9 28.2 28.0 27.9 27.4 27.3 0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_85: % of deaths aged 65-84 where the main cause was cardiovascular disease

5.0

0.0

10.0 15.0 20.0 25.0 30.0 35.0

● ●

40.0 45.0 50.0

Figure_87: % of all cardiovascular deaths in hospital

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

10.0

15.0

20.0

25.0

30.0

35.0

40.0

% of deaths aged 85+ where the main cause was CVD 2008-10 44.2 43.1 40.3 39.7 38.5 38.1 36.7 36.3 36.2 35.2 35.0 35.0 34.7 33.7 33.6 33.5 33.2 33.2 33.0 33.0 32.3 32.0 31.8 31.2

5.0

Rotherham Doncaster Kingston upon Hull Barnsley Calderdale York Wakefield Leeds Sheffield Regional National Kirklees Selby East Riding Bassetlaw North Lincolnshire Bradford NE Lincolnshire Harrogate Hambleton Scarborough Ryedale Craven Richmondshire

% of deaths for underlying cause of CVD for persons dying in own residence 2008-10

63.6 63.5 62.8 62.2 61.1 61.0 60.3 60.0 59.2 58.0 57.9 57.6 57.5 56.5 56.2 54.1 54.0 54.0 53.0 52.3 50.3 50.0 45.9 43.8

0.0

Ryedale North Lincolnshire Hambleton Wakefield Doncaster Bradford Richmondshire Calderdale Leeds NE Lincolnshire Rotherham Kingston upon Hull Selby Regional Kirklees National Scarborough Sheffield Craven Harrogate East Riding Bassetlaw York Barnsley 10.0

20.0

30.0

40.0

50.0

60.0

70.0

Figure_89: % of all cardiovascular deaths in a care home

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Higher proportions of deaths are for older age groups from CVD. Regionally Yorkshire and Humber has a similar proportion of deaths to compared to the national position overall (this is higher on 0-64 and 65-84 but lower for the 85+ years age group). Bradford, Kirklees, East Riding and large parts of North Yorkshire have significantly higher proportions of deaths from CVD than the England average for all age. Barnsley, Doncaster, Bassetlaw, Calderdale and Hull are significantly lower.

 It is recommended that organisations , particularly those with higher proportions of CVD deaths, study their data to understand which age groups resources need to be targeted at to reduce CVD deaths and to put plans in place to support the person at end of life where required.  Organisations should ensure data quality for coding of primary diagnosis.

Richmondshire Craven Scarborough Harrogate Hambleton Ryedale East Riding NE Lincolnshire Bassetlaw Bradford North Lincolnshire Selby York National Kirklees Regional Barnsley Sheffield Leeds Wakefield Calderdale Kingston upon Hull Rotherham Doncaster

10.0

20.0

30.0

40.0

50.0

60.0

70.0

% of deaths for underlying cause of CVD for persons dying in a hospice 2008-10 Scarborough York Leeds Ryedale North Lincolnshire Bassetlaw Wakefield Harrogate Calderdale Regional Sheffield National Rotherham NE Lincolnshire Selby Craven Barnsley Kirklees Doncaster Bradford Kingston upon Hull Hambleton East Riding Richmondshire

31.0 30.8 23.4 23.3 21.6 21.4 21.4 21.0 19.9 19.3 18.8 18.6 17.7 17.5 17.2 17.1 17.1 16.0 14.5 13.5 12.9 12.7 12.2 10.9

0.0 10.0 20.0 30.0 40.0 50.0 60.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

0.0

Figure_90: % of all cardiovascular deaths in a hospice

% of deaths for underlying cause of CVD for persons dying in a care home 2008-10 10.0

25.6 24.2 23.9 23.8 23.6 23.6 23.3 23.3 23.3 23.2 22.8 22.6 22.6 22.4 22.4 22.2 22.2 22.1 20.8 20.3 20.2 19.7 19.0 19.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

 Data on death where the patient had a primary diagnosis of CVD has been examined in more detail . The charts above (figures 83 to 86) look at deaths where the person had a primary diagnosis of CVD by PCT split by age group. ●

Figure_88: % of all cardiovascular deaths in own residence

% of all deaths for underlying cause of CVD for persons dying in hospital 2008-10

5.0

0.0

The highest proportion of deaths from CVD is in hospitals (regionally 58%) followed by own residence , then care home with only a small proportion in hospices. Regionally for people dying with an underlying cause of CVD there are similar proportion for place of death as the national average.

 Organisations should review the data for their own region and see how it compares to others as well as to data for place of death for all diagnosis. For patients dying in hospital particularly, organisations should work to ensure that patients with CVD approaching end of life have the opportunity to die at home if they wish.

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Scarborough Ryedale Craven Harrogate Richmondshire Hambleton East Riding Kirklees NE Lincolnshire York National Selby Regional Leeds Bradford Bassetlaw Sheffield Rotherham Barnsley North Lincolnshire Kingston upon Hull Wakefield Calderdale Doncaster

37.1 35.6 34.5 32.7 32.1 32.0 31.7 31.1 30.5 30.4 30.4 30.3 30.2 30.1 30.1 29.9 29.9 29.4 29.2 29.1 28.6 28.0 27.6 26.8 0.0

22.3 21.5 21.4 20.9 20.7 20.7 20.7 20.5 20.5 20.4 19.8 19.8 19.7 19.7 19.4 19.1 19.0 18.8 18.6 18.2 18.0 17.2 17.0 16.5

Figure_86: % of deaths aged 85+ where the main cause was cardiovascular disease

% of deaths aged 65-84 where the main cause was CVD 2008-10 Ryedale Scarborough Craven Bradford Harrogate Kirklees Richmondshire North Lincolnshire Regional Hambleton Leeds York NE Lincolnshire East Riding Wakefield Selby Rotherham Sheffield National Doncaster Calderdale Kingston upon Hull Barnsley Bassetlaw

 Whilst place of death is included in more detail elsewhere, the charts below are looking only as those deaths where the underlying cause of death is listed as CVD during 2008-10.  Place of death is defined as hospital, own residence, care homes and hospices. (Note: care homes is not subsumed into "usual place of residence" for these charts). Charts for "elsewhere" have been excluded due to volatile data from small numbers.  Deaths in the patients own residence is considered the most desirable, particularly over deaths in hospital.

Figure_84: % of deaths aged 0-64 where the main cause was cardiovascular disease

% of all where the main cause was CVD 2008-10

70.0

1.9 1.0 0.9 0.8 0.8 0.6 0.5 0.5 0.5 0.5 0.4 0.4 0.4 0.3 0.3 0.3 0.3 0.3 0.3 0.3 0.2 0.1 0.1 0.0

-3.0 -2.0 -1.0 0.0 1.0 2.0 3.0 4.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

5.0

Cause of Death - Respiratory Disease Figure_91: % of all deaths where the main cause was respiratory disease

Kingston upon Hull Barnsley Rotherham Calderdale North Lincolnshire Wakefield NE Lincolnshire Bassetlaw Bradford Doncaster Regional Scarborough York East Riding National Craven Kirklees Leeds Selby Ryedale Harrogate Sheffield Richmondshire Hambleton

% of deaths aged 0-64 where the main cause was Respiratory Disease 2008-10

North Lincolnshire Bradford NE Lincolnshire Calderdale Scarborough Kirklees Kingston upon Hull Bassetlaw Rotherham Doncaster Regional York Wakefield Leeds Craven Barnsley National Harrogate East Riding Sheffield Ryedale Selby Richmondshire Hambleton

16.9 16.4 15.7 15.7 15.4 15.2 15.2 14.9 14.7 14.5 14.3 14.0 14.0 13.9 13.9 13.7 13.7 13.7 13.5 13.5 12.6 12.0 11.7 11.7

0.0 5.0 10.0 15.0 20.0 25.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

30.0

10.0

15.0

20.0

●

25.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

30.0

Figure_95: % of all respiratory deaths in hospital

Figure_96: % of all respiratory deaths in own residence

% of all deaths for underlying cause of Respiratory Disease for persons dying in hospital 2008-10

5.0

10.0

15.0

20.0

25.0

30.0

22.0 21.6 20.3 20.1 19.7 19.3 18.8 18.6 18.2 18.1 17.7 17.5 17.5 17.4 17.4 16.9 16.7 16.3 16.2 15.9 15.5 15.4 15.1 15.0

0.0 5.0 10.0 15.0 20.0 25.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Kingston upon Hull Doncaster Calderdale Bassetlaw Wakefield Leeds Sheffield Selby North Lincolnshire National Hambleton Regional Rotherham York East Riding Kirklees Barnsley Scarborough NE Lincolnshire Richmondshire Harrogate Bradford Ryedale Craven

% of all deaths for underlying cause of Respiratory Disease for persons dying in own residence 2008-10

Ryedale Doncaster Rotherham Richmondshire Calderdale Kirklees Kingston upon Hull Selby NE Lincolnshire Hambleton North Lincolnshire Bradford Scarborough Craven Regional York National Wakefield Bassetlaw Leeds Sheffield Barnsley Harrogate East Riding

69.1 68.7 68.4 67.6 67.4 66.9 66.9 66.3 66.0 65.9 65.4 64.8 64.7 64.5 64.0 63.9 63.2 62.8 62.0 61.0 59.5 59.0 56.6 52.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Higher proportions of deaths are for older age groups from respiratory disease . Regionally Yorkshire and Humber has higher proportion of deaths to the national position overall (particularly for the age groups 0-64 and 65-8). Several local authorities have significantly higher proportions of deaths from respiratory disease that the England for all ages, with only Sheffield and parts of North Yorkshire significantly lower.

 It is recommended that organisations , particularly those with higher proportions of respiratory disease deaths, study their data to understand which age groups resources need to be targeted at to reduce respiratory disease deaths and to put plans in place to support the person at end of life where required.  Organisations should ensure data quality for coding of primary diagnosis.  Data suggests that regionally for Yorkshire and Humber respiratory disease is a particular problem which needs to be prioritised.

Craven Bradford Harrogate Ryedale Barnsley Richmondshire East Riding NE Lincolnshire Scarborough Hambleton Regional York Kirklees National Sheffield Selby Rotherham North Lincolnshire Leeds Bassetlaw Wakefield Kingston upon Hull Doncaster Calderdale

Craven Calderdale Scarborough Leeds Harrogate Wakefield National Regional Kirklees Bassetlaw Bradford Kingston upon Hull Ryedale East Riding Rotherham NE Lincolnshire Sheffield Selby Hambleton York North Lincolnshire Doncaster Richmondshire Barnsley

10.0

20.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

% of all deaths for underlying cause of Respiratory Disease for persons dying in a hospice 2008-10

29.6 25.2 24.2 23.3 23.2 22.6 22.1 21.5 19.9 19.6 19.3 19.2 19.1 18.7 18.7 18.3 18.2 18.1 17.6 16.8 16.6 14.4 14.4 14.1 0.0

0.0

Figure_98: % of all respiratory deaths in a hospice

% of all deaths for underlying cause of Respiratory Disease for persons dying in a care home 2008-10

30.0

18.9 16.0 15.9 15.7 15.6 15.2 15.2 15.0 14.7 14.6 14.6 14.6 14.5 14.4 14.4 14.2 14.0 13.8 13.7 13.7 13.2 13.0 12.9 12.9

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_97: % of all respiratory deaths in a care home

 Data on death where the patient had a primary diagnosis of respiratory disease has been examined in more detail . The charts above (figures 91 to 94) look at deaths where the person had a primary diagnosis of respiratory disease by PCT split by age group. ●

The highest proportion of deaths from respiratory disease is in hospitals (regionally 65%) followed by care home, own residence with only a small proportion in hospices. Regionally for people dying with an underlying cause of respiratory disease there is a slightly lower proportion of people dying in hospital and slightly more at home and in care homes.

 Organisations should review the data for their own region and see how it compares to others as well as to data for place of death for all diagnosis. The proportion of deaths in hospital from respiratory disease is very high across the region and nationally. This is potentially a key area to focus on to reduce deaths in hospital overall and to ensure that patients with respiratory disease. approaching end of life have the opportunity to die at home if they wish.

% of deaths aged 85+ where the main cause was Respiratory Disease 2008-10

Kingston upon Hull Barnsley North Lincolnshire Rotherham Wakefield Ryedale NE Lincolnshire Calderdale Scarborough Doncaster Regional National East Riding York Bradford Bassetlaw Leeds Kirklees Hambleton Craven Harrogate Selby Sheffield Richmondshire

17.7 16.8 16.6 15.8 15.4 15.4 15.4 15.3 15.0 15.0 14.3 14.3 14.1 14.0 13.7 13.4 13.3 13.2 12.3 11.9 11.9 11.6 11.5 10.6 5.0

0.0

●

Figure_94: % of deaths aged 85+ where the main cause was respiratory disease

% of deaths aged 65-84 where the main cause was Respiratory Disease 2008-10

0.0

9.6 9.1 9.0 8.7 8.7 8.5 8.1 8.0 7.7 7.7 7.5 7.3 7.2 7.2 6.7 6.6 6.6 6.6 6.5 6.2 5.2 4.5 4.3 4.1

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_93: % of deaths aged 65-84 where the main cause was respiratory disease

Kingston upon Hull Barnsley Calderdale Bassetlaw Wakefield Rotherham Bradford Selby NE Lincolnshire Doncaster Regional North Lincolnshire Kirklees Leeds National Craven East Riding York Scarborough Richmondshire Harrogate Sheffield Ryedale Hambleton

 Whilst place of death is included in more detail elsewhere, the charts below are looking only as those deaths where the underlying cause of death is listed as respiratory disease during 2008-10.  Place of death is defined as hospital, own residence, care homes and hospices. (Note: care homes is not subsumed into "usual place of residence" for these charts). Charts for "elsewhere" have been excluded due to volatile data from small numbers.  Deaths in the patients own residence is considered the most desirable, particularly over deaths in hospital.

Figure_92: % of deaths aged 0-64 where the main cause was respiratory disease

% of all deaths where the main cause was Respiratory Disease 2008-10

30.0

40.0

50.0

60.0

70.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

80.0

3.1 1.5 1.2 1.2 0.9 0.7 0.6 0.6 0.6 0.6 0.6 0.5 0.4 0.4 0.4 0.4 0.4 0.4 0.4 0.3 0.1 0.1 0.0 0.0 0.0

1.0

2.0

3.0

4.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

5.0

Cause of Death - Other (not Cancer, Cardiovascular or Respiratory Disease) Figure_99 % of all deaths where the main cause was other

Sheffield Kirklees Bradford Calderdale National Bassetlaw Leeds York Selby Wakefield Harrogate Regional Doncaster Richmondshire Hambleton East Riding NE Lincolnshire Kingston upon Hull North Lincolnshire Barnsley Rotherham Craven Scarborough Ryedale

% of deaths aged 0-64 where the main cause was other 2008-10

30.3 29.4 29.4 29.4 28.9 28.9 28.8 28.8 28.5 28.3 28.3 28.0 28.0 27.9 27.6 26.9 26.9 26.7 26.5 26.3 26.0 25.3 23.3 20.3 0.0

Leeds NE Lincolnshire Bradford Kingston upon Hull Kirklees Sheffield National Regional Richmondshire Calderdale Doncaster Wakefield York Bassetlaw Selby Scarborough Harrogate North Lincolnshire Barnsley East Riding Rotherham Hambleton Craven Ryedale 5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

0.0

●

●

Figure_103: % of other deaths in hospital

Sheffield Selby Calderdale Bradford Bassetlaw Kirklees Leeds Richmondshire Wakefield York Doncaster Regional National Harrogate Rotherham Barnsley North Lincolnshire Hambleton East Riding NE Lincolnshire Craven Kingston upon Hull Scarborough Ryedale

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

35.7 35.3 35.1 34.7 34.2 34.2 33.9 33.7 33.6 33.4 33.3 32.6 32.5 31.7 31.6 31.6 31.5 31.2 30.8 30.0 29.5 28.0 23.5 21.3 0.0

Kingston upon Hull Doncaster Calderdale Rotherham Barnsley Wakefield NE Lincolnshire Leeds Sheffield National Regional York Scarborough North Lincolnshire Bassetlaw Kirklees Hambleton East Riding Ryedale Harrogate Richmondshire Bradford Selby Craven

% of all deaths for underlying cause of other for persons dying in own residence 2008-10

62.4 62.1 61.4 60.2 58.6 58.0 57.9 57.4 57.1 56.7 56.2 56.1 55.7 55.4 55.3 54.9 54.6 54.4 51.6 50.1 48.7 48.6 47.4 42.5

0.0

Ryedale Selby Scarborough Kingston upon Hull Richmondshire National Hambleton Bradford Leeds Calderdale Kirklees Wakefield Regional Barnsley Doncaster NE Lincolnshire Harrogate Sheffield York Bassetlaw Craven North Lincolnshire Rotherham East Riding 10.0

20.0

30.0

40.0

50.0

60.0

70.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

50.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Higher proportions of deaths are for the 0-64 and 85+ age groups from other. Regionally Yorkshire and Humber has lower proportion of deaths to the national position for all ages (this is mostly the effect of the 65-84 age group). Sheffield is the only local authority with significantly higher proportion of deaths from other compared to the England average, whilst Barnsley, Rotherham, parts of North Yorkshire and all of the Humber area are significantly lower.

 It is recommended that organisations study their data to understand which age groups resources need to be targeted at to reduce deaths and to put plans in place to support the person at end of life where required.  Organisations should ensure data quality for coding of primary diagnosis.

Craven Richmondshire Selby Bradford Harrogate East Riding Bassetlaw North Lincolnshire Sheffield York Hambleton Kirklees Regional NE Lincolnshire Barnsley Ryedale National Rotherham Leeds Scarborough Wakefield Doncaster Calderdale Kingston upon Hull

30.0

Ryedale Scarborough York Craven Leeds Calderdale Kirklees Wakefield Harrogate Regional NE Lincolnshire Barnsley National Sheffield Bradford East Riding Rotherham Selby Bassetlaw North Lincolnshire Kingston upon Hull Hambleton Doncaster Richmondshire

10.0

40.0

50.0

60.0

70.0

80.0

% of all deaths for underlying cause of other for persons dying in a hospice 2008-10

39.5 32.8 32.6 31.4 30.5 29.9 27.1 26.7 26.4 26.3 25.8 25.6 25.2 24.0 23.9 23.9 23.6 23.6 23.1 22.7 22.5 19.6 19.4 16.9 0.0

20.0

Figure_106: % of other deaths in a hospice

% of all deaths for underlying cause of other for persons dying in a care home 2008-10

10.0

10.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_105: % of other deaths in a care home

5.0

19.2 16.6 16.3 15.4 15.3 15.2 15.2 14.9 14.8 14.8 14.3 14.1 13.9 13.9 13.9 13.6 13.4 12.6 12.6 12.5 12.5 12.3 12.3 11.6 0.0

80.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

 Data on death where the patient had a primary diagnosis of other (i.e. not cancer, CVD or respiratory disease) has been examined in more detail . The charts above (figures 99 to 102) look at deaths where the person had a primary diagnosis of other by PCT split by age group. ●

Figure_104: % of other deaths in own residence

% of all deaths for underlying cause of other for persons dying in hospital 2008-10

% of deaths aged 85+ where the main cause was other 2008-10

23.9 23.7 23.5 23.5 22.8 22.7 22.4 22.4 22.3 22.2 21.7 21.6 21.5 21.3 21.0 20.7 20.7 20.6 20.5 20.4 20.3 20.1 19.7 17.6

The highest proportion of deaths from 'other' is in hospitals (regionally 56%) followed by care home, own residence with only a small proportion in hospices. Regionally for people dying with an underlying cause of other there is a similar proportion of people dying in hospital compared to the national position with slightly fewer in own residence and slightly more in care homes.

 Organisations should review the data for their own region and see how it compares to others as well as to data for place of death for all diagnosis.

Figure_102: % of deaths aged 85+ where the main cause was other

% of deaths aged 65-84 where the main cause was other 2008-10

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0 Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

40.1 39.9 39.5 38.8 38.4 37.6 37.6 36.6 36.5 36.5 36.0 35.9 35.0 34.0 33.8 33.8 33.8 33.1 32.8 32.8 32.7 31.4 27.7 27.5

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

Figure_101: % of deaths aged 65-84 where the main cause was other

Hambleton Bassetlaw Harrogate Sheffield National York Calderdale Kirklees Wakefield East Riding Doncaster Regional Selby Bradford Leeds Barnsley North Lincolnshire Kingston upon Hull NE Lincolnshire Craven Richmondshire Rotherham Scarborough Ryedale

 Whilst place of death is included in more detail elsewhere, the charts below are looking only as those deaths where the underlying cause of death is listed as other (i.e. not cancer, CVD or respiratory disease) during 2008-10.  Place of death is defined as hospital, own residence, care homes and hospices. (Note: care homes is not subsumed into "usual place of residence" for these charts). Charts for "elsewhere" have been excluded due to volatile data from small numbers.  Deaths in the patients own residence is considered the most desirable, particularly over deaths in hospital.

Figure_100: % of deaths aged 0-64 where the main cause was other

% of all deaths where the main cause was other 2008-10

20.0

30.0

40.0

50.0

60.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

70.0

80.0

-5.0

-4.0

-3.0

-2.0

-1.0

2.6 2.6 1.8 1.5 1.3 1.1 1.0 0.9 0.9 0.9 0.8 0.8 0.8 0.7 0.7 0.6 0.6 0.5 0.5 0.5 0.5 0.5 0.5 0.3

0.0

1.0

2.0

3.0

Extract from National End of Life Care Intelligence Network (NEOLCIN) Original source ONS Annual Mortality Statistics 2011 and UKACR population dataset

4.0

5.0

Other Metadata Indicator Proportion of males and females in the population by age group

Proportion of the population by age group for PCTs

Construction Numerator : Estimated number of males and females as at 2010 Denominator: Estimated number of people as at 2010 Calculation: Numerator/denominator expressed as a percentage Numerator : Estimated number of males and females as at 2010 Denominator: Estimated number of people as at 2010 Calculation: Numerator/denominator expressed as a percentage

Source NHS Information Centre for Health and Social Care Portal - mid 2010 estimates NHS Information Centre for Health and Social Care Portal - mid 2010 estimates

Death rates from all causes (all persons, males and females)

Directly age-standardised rates fir mortality from all causes oer 100,000 population

Source: DSR NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

Number of Deaths by PCT

Count of death per PCT for 2008-09, 2009-10 and 2010-11

Primary Care Mortality Database (PCMD) 2008-2011

Proportion of deaths by age group

Numerator : Number of male and female deaths in 2008-11 Denominator: Total number of deaths 2008-11 Calculation: Numerator/denominator expressed as a percentage

Primary Care Mortality Database (PCMD) 2008-2011

Summary Hospital-level Mortality Indicator (SHMI)

Calculated summary Hospital-level Mortality Indicator (SHMI)

NHS Information Centre Moratlity Data 2011

Life Expectancy at birth and age 65 for males and females

Calculated life Expectancy at birth and age 65 for males and females

Indices of deprivation 2012

Table of indices of deprication calculated using quintiles

Map of Deprivation for Yorkshire and Humber

Map of Deprivation for Yorkshire and Humber

Projected deaths to 2033 by PCT cluster

Projected deaths to 2033 by PCT cluster

Population projections up to 2030 by Local Authority

Population projections up to 2030 by Local Authority

Prevalence of condition (CHD,. COPD, CVD, Hypertension, stroke)

Prevalence of condition (CHD, COPD, CVD, Hypertension, stroke)

Incidence of all cancers

Incidence of all cancers

NHS Information Centre for Health and Social Care Indicator Portal (NCHOD) NHS Information Centre for Health and Social Care Indicator Portal (NCHOD) YHPHO Wedsire - originally sourced from www.communities.gov.uk 2008-based sub national populations: sub national statistics unit ONS 2008-based sub national populations: sub national statistics unit ONS Disease Prevalence Models - The Network of Public Health Observatories NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

Population proportions and death rates Figure 107: Proportion of males and females in the population by age group

Figure 108: Proportion of the population by age group for PCTs

Examining the age structure of the population Figure 107 shows the proportion of the population for males and females split by age for Yorkshire and Humber and England. The pattern is similar across Yorkshire and Humber and England in that the make and female split is fairly equal in the 0-64 age group, there is proportionally fewer men in the 65-85 age group and considerably fewer males in the 85+ age group

Proportion of the population by age group 0-64

Brad&Aire PCT Hull PCT Leeds PCT Kirklees PCT Sheffield PCT Calderdale PCT Yorks & Humber England avg Wakefield PCT Barnsley PCT Rotherham PCT Doncaster PCT NE Lincs CTP North Lincs PCT Bassetlaw PCT NYY PCT East Riding PCT

65-84

85+

86.6% 86.3% 85.9% 85.1% 84.6% 84.1% 83.6% 83.5% 83.4% 83.1% 82.9% 82.5% 82.2% 81.4% 81.4% 80.7% 79.1% 0%

10%

20%

30%

40%

11.6% 12.0% 12.1% 12.9% 13.3% 13.7% 14.2% 14.2% 14.5% 15.0% 15.0% 15.4% 15.5% 16.2% 16.3% 16.6% 18.2% 50%

60%

70%

80%

90%

Figure 108 compares PCT populations by age group. There are notable differences in the population make up of the PCTs, for example East Riding PCT has the lowest proportion of 0-64 years olds compared to the other PCTs (less than 80%) with the 65-84 and 85+ age groups making up over a fifth of the population (21% compared with less than 15% for Leeds and Bradford for example).

100%

Source Data: NHS Information Centre for Health and Social Care Portal - mid 2010 estimates

Death rates from all causes The charts below look at death rates by PCT area per 100,000 population. Looking at deaths in this way enables the number of deaths from all causes during 2008-10 to be considered compared with the population. The split by males and females show that males have a higher death rate compared to females (see life expectancy charts). Yorkshire and Humber as a region is reporting higher death rates compared to the national average. These death rates cover all causes, so to understand the issues in more detail the death rates for specific causes would need to be examined. This data should be considered alongside data on deprivation. Figure_109: Directly age standardised rates for mortality from all causes - all persons

Figure_110: Directly age standardised rates for mortality from all causes - males

Death rates from all causes by PCT per 100,000 population - All persons (2008-10) Hull PCT

690.2

Barnsley PCT

660.5

Brad&Aire PCT

635.8

Rotherham PCT

634.4

Wakefield PCT

626.5

NE Lincs CTP

623.5

Doncaster PCT

622.8

Kirklees PCT

621.1

Calderdale PCT

604.7

Bassetlaw PCT

601.6

Yorks & Humber

590.9

Sheffield PCT

586.0

North Lincs PCT

585.1

Leeds PCT

580.1

ENGLAND

553.3

East Riding PCT

530.5

NYY PCT

509.3

0

200

400

600

Source: DSR NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

800

Figure_111: Directly age standardised rates for mortality from all causes -females

Death rates from all causes by PCT per 100,000 population Female (2008-10)

Death rates from all causes by PCT per 100,000 population - Male (2008-10)

1000

The relationship between age and end of life care is crucial. Older people are more likely to die and therefore to require planning around managing their end of life care. Therefore places such as East Riding with as older population would expect a higher proportion of deaths within their region and potentially more people on the end of life registers and in nursing homes.

Hull PCT

820.7

Hull PCT

574.8

Barnsley PCT

775.7

Barnsley PCT

570.8

NE Lincs CTP

762.5

Brad&Aire PCT

538.3

Rotherham PCT

758.0

Rotherham PCT

535.8

Doncaster PCT

754.3

Wakefield PCT

534.5

Brad&Aire PCT

754.0

Bassetlaw PCT

524.4

Kirklees PCT

740.1

Kirklees PCT

521.1

Wakefield PCT

734.7

Doncaster PCT

516.4

Calderdale PCT

716.6

Calderdale PCT

512.1

North Lincs PCT

701.1

NE Lincs CTP

509.3

Yorks & Humber

700.5

Yorks & Humber

499.9

Leeds PCT

692.3

Sheffield PCT

499.6

Bassetlaw PCT

692.1

North Lincs PCT

494.7

Sheffield PCT

690.8

Leeds PCT

485.2

ENGLAND

656.0

ENGLAND

467.1

East Riding PCT

626.4

East Riding PCT

452.6

NYY PCT

597.9

NYY PCT

0

200

400

600

Source: DSR NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

800

1000

436.0

0

200

400

600

Source: DSR NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

800

1000

Numbers and proportions of deaths Table_11: Number of Deaths by PCT

Barnsley BradAire Calderdale Doncaster East Riding Hull Kirklees Leeds NE Lincs North Lincs North Yorkshire Rotherham Sheffield Wakefield Yorkshire and Humber

Figure_112a: Proportion of deaths 0-64 years old

2008-09 2,342 4,355 1,914 2,972 3,610 2,487 3,796 6,588 1,762 1,660 7,888 2,660 4,783 3,285 50,102

2009-10 2,367 4,324 1,842 2,882 3,422 2,417 3,638 6,188 1,564 1,562 7,518 2,500 4,855 3,000 48,079

2010-11 2,271 4,190 1,839 2,712 3,516 2,231 3,515 6,329 1,557 1,510 7,727 2,443 4,776 3,177 47,793

Source: Primary Care Mortality Database as at August 2011

Number of deaths by PCT The table above shows a decrease year on year since 2008-09 in the number of deaths in Yorkshire and Humber overall from 50,102 in 2008-09 to 47,793 in 2010-11 (a drop of nearly 5% deaths). There is however variation amongst the PCTs with some increases between years. However the number of deaths in 2010-11 remains lower than in 2008-09. Tracking the number of deaths is useful for resource planning around end of life care.

Figure_112b: Proportion of deaths 65-84 years old

% Proportion of male and female deaths 0-64 years (2008-11) Male

Barnsley

Male

Female

57.7%

Figure_112c: Proportion of deaths aged 85+ years

% Proportion of male and female deaths 85+ years (2008-11)

% Proportion of male and female deaths 65-84 years (2008-11)

42.3%

Female

Male

Barnsley

52.2%

47.8%

Barnsley

32.6%

Female

67.4%

BradAire

61.8%

38.2%

BradAire

50.9%

49.1%

BradAire

34.4%

65.6%

Calderdale

60.0%

40.0%

Calderdale

52.7%

47.3%

Calderdale

33.8%

66.2%

Doncaster

60.7%

39.3%

Doncaster

53.9%

46.1%

Doncaster

36.6%

63.4%

East Riding

58.8%

41.2%

East Riding

54.0%

46.0%

East Riding

35.5%

64.5%

Hull

61.5%

38.5%

Hull

Kirklees

61.3%

38.7%

Kirklees

53.4%

46.6%

55.9%

Hull

44.1%

39.3%

60.7%

Kirklees

32.5%

67.5%

Leeds

61.8%

38.2%

Leeds

52.5%

47.5%

Leeds

34.2%

65.8%

NE Lincs

60.1%

39.9%

NE Lincs

52.7%

47.3%

NE Lincs

35.1%

64.9%

North Lincs

59.9%

40.1%

North Lincs

52.8%

47.2%

North Lincs

North Yorkshire

58.2%

41.8%

North Yorkshire

53.4%

46.6%

North Yorkshire

Rotherham

58.2%

41.8%

Rotherham

54.2%

45.8%

Rotherham

34.3%

65.7%

Sheffield

58.7%

41.3%

Sheffield

54.3%

45.7%

Sheffield

33.8%

66.2% 66.7%

38.8%

Wakefield

60.2%

39.8%

Wakefield

53.5%

46.5%

Wakefield

33.3%

Yorks and Humber

60.1%

39.9%

Yorks and…

53.2%

46.8%

Yorks and…

34.9%

0

0.2

0.4

0.6

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

0.8

0

1

0.2

0.4

0.6

0.8

0

1

61.2%

35.4%

0.2

64.6%

65.1% 0.4

0.6

0.8

1

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Source: Primary Care Mortality Database (PCMD) - data extracted August 2011

Proportion of deaths by age The charts above show the proportions of deaths by male and female for each age group. Many more females die in the 85+ age group compared to men suggesting that women live longer (as supported by the life expectancy charts). This is significant for end of life care planning as the ratio of females outliving men in old age suggests that there potentially there may be a high number of widowed females living either in care homes or in increasing need of end of life care support at home. Figure_113: Summary Hospital-level Mortality Indicator (SHMI)

Summary Hospital-level Mortality Indicator The summary hospital-level mortality indicator - or SHMI, measures two key factors; deaths that occur in hospital and also deaths that occur within 30 days of hospital discharge where the patient had stayed in hospital. SHMI considers how many deaths wold be expected to occur based on the national average, taking into account patient characteristics such as age, sex, diagnosis etc. (See data bite on SHMI for more information).

NHS South Yorkshire and Bassetlaw Barnsley Hospital NHS Foundation Trust (1.06) The Rotherham NHS Foundation Trust (1.02) Doncaster and Bassetlaw Hospitals NHS Foundation Trust (1.02) Sheffield Teaching Hospitals NHS Foundation Trust (0.86)

NHS T he Humber

Figure 113 suggest s that York Teaching Trust, Hull and East Yorkshire Hospitals and Northern Lincolnshire and Goole Trust have a high SHMI ratio indicating that more deaths occurred than would be expected (the points on the chart are outside of the control limits for greater than expected). Sheffield Teaching Trust reported a lower than expected number of deaths.

Northern Lincolnshire and Goole Hospitals NHS Foundation Trust (1.15) Hull and East Yorkshire Hospitals NHS Trust (1.15)

NHS North Yorkshire and York York Teaching Hospital NHS Foundation Trust (1.15) Scarborough and North East Yorkshire Health Care NHS Trust (1.12)

This indicator has been included as many of the deaths that form part of this indicator are likely to be people approaching end of life. Where patients expressed a wish to be cared for and die at home, hospital admission may not have been appropriate. Similarly, regarding place of death, high rates for SHMI have been linked to coding of palliative care and particularly the coding related to beds. For example Hull and East Yorkshire Trust have hospice beds in the acute setting, as these are coded as 'hospital' for place of death this could mean that deaths in hospitals appear higher and it could also potentially inflate the SHMI ratio.

Harrogate and District NHS Foundation Trust (0.94)

NHS Calderdale, Wakefield and Kirklees Mid Yorkshire Hospitals NHS Trust (1.06) Calderdale and Huddersfield NHS Foundation Trust (1.03)

NHS Airedale, Bradford and Leeds Bradford Teaching Hospitals NHS Foundation Trust (0.94) Leeds Teaching Hospitals NHS Trust (0.94)

Whilst only a proportion of the deaths in SHMI may be related to palliative care, it is important that organisations understand the link between SHMI and palliative care.

Airedale NHS Foundation Trust (0.93)

0.8

0.9 Number of deaths less than expected

1

1.1

1.2

Number of deaths greater than expected

Exact Poisson control limts (more conservative) Source: The NHS Information Centre (2011)

Over dispersion control limits (less conservative)

Life Expectancy and deprivation Figure_114: Life Expectancy at birth for males

Figure_115: Life Expectancy for males aged 65+

Life Expectancy at birth for Males 2008-10

Figure_116: Life Expectancy at birth for females

Life Expectancy for Males aged 65+ 2008-10

Figure_117: Life Expectancy for females aged 65+

Life Expectancy for Females aged 65+ 2008-10

Life Expectancy at birth for Females 2008-10

NYY PCT

79.7

NYY

18.8

NYY PCT

83.4

NYY

21.3

East Riding PCT

79.2

East Riding PCT

18.3

East Riding PCT

82.9

East Riding PCT

20.9

Leeds PCT

17.9

ENGLAND

82.57

Leeds PCT

20.6

78.1

Yorks & Humber

17.7

Leeds PCT

82.2

North Lincs PCT

20.5

78

North Lincs PCT

17.7

North Lincs PCT

82.1

ENGLAND

Sheffield PCT

81.8

Yorks & Humber

20.3

ENGLAND

78.58

Sheffield PCT Bassetlaw PCT Leeds PCT

77.9

ENGLAND

17.67

20.31

North Lincs PCT

77.7

Sheffield PCT

17.6

Yorks & Humber

81.8

Yorks & Humber

Sheffield PCT

77.7

20.3

Calderdale PCT

17.6

NE Lincs CTP

81.7

Calderdale PCT

77.1

Calderdale PCT

20.3

Bassetlaw PCT

17.5

Calderdale PCT

81.5

Rotherham PCT

77.1

Doncaster PCT

20.1

Kirklees PCT

17.3

Doncaster PCT

81.4

NE Lincs CTP

20

Brad&Aire PCT

17.3

Kirklees PCT

81.3

Kirklees PCT

19.9

Wakefield PCT

17.2

Bassetlaw PCT

81.3

Doncaster PCT

17.2

Wakefield PCT

81.1

Kirklees PCT

77

Wakefield PCT

77

Barnsley PCT

76.8

Doncaster PCT

76.8

Brad&Aire PCT

76.6

NE Lincs CTP

76.5

Hull PCT

75.7 50

NE Lincs CTP

55

60

65

70

75

80

85

81

Rotherham PCT

16.7

Brad&Aire PCT

80.8

Hull PCT

16.6

Barnsley PCT

80.4

Barnsley PCT

16.6

Hull PCT

80.2

90

Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

Rotherham PCT

17

0

5

10

15

Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

20

25

50

55

Bassetlaw PCT

19.8

Wakefield PCT

19.7

Brad&Aire PCT

19.7

Rotherham PCT

19.5

Hull PCT

19.3

Barnsley PCT 60

65

70

75

80

Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

85

90

19.2

0

5

10

15

20

25

Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

Map_1: Map of Deprivation for Yorkshire and Humber

Life Expectancy The charts above show the life expectancy for each PCT by male and female at birth and also at 65 years old. The key points from the charts are the difference in life expectancy for males and females (females is currently higher). Also the difference between PCTs suggests that more deprived areas tend to have a lower life

Table_12: Indices of deprivation 2012

AREA Barnsley PCT Bassetlaw PCT Bradford and Airedale PCT Calderdale PCT Doncaster PCT East Riding PCT Hull Teaching PCT Kirklees PCT Leeds PCT North East Lincs CTP North Lincolnshire PCT North Yorks and York PCT Rotherham PCT Sheffield PCT Wakefield District PCT

SCORE 28.6 25.0 32.6 23.2 29.8 15.0 37.5 25.2 25.8 29.2 21.8 13.7 28.1 27.4 25.9

RANK 41 69 25 78 35 126 11 65 58 40 84 135 45 49 57

QUINTILE ABOVE AVERAGE DEPRIVATION AVERAGE DEPRIVATION MOST DEPRIVED AVERAGE DEPRIVATION ABOVE AVERAGE DEPRIVATION LEAST DEPRIVED MOST DEPRIVED AVERAGE DEPRIVATION ABOVE AVERAGE DEPRIVATION ABOVE AVERAGE DEPRIVATION AVERAGE DEPRIVATION LEAST DEPRIVED ABOVE AVERAGE DEPRIVATION ABOVE AVERAGE DEPRIVATION ABOVE AVERAGE DEPRIVATION

Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

Table of deprivation rankings per PCT. The data is split into quintiles and coded based on rakings for level of deprivation. Hull and Bradford are the most deprived followed by 7 above average deprivation PCTs, East Riding and North Yorkshire and the least deprived.

Deprivation The table of deprivation highlights Bradford and Airedale PCT and Hull PCT as the most deprived areas in England and East Riding and North Yorkshire and York as the least deprived. The map indicates areas within a PCT that have higher and lower levels of deprivation.

Socioeconomic deprivation is a factor influencing end of life care, for example age and cause of death and even place of death - people living in the most deprived quintiles were found to me more likely to die in hospital (see report 'Deprivation and death: variation in place and cause of death' Feb 2012). A more detailed analysis by postcode areas of PCTs and cause and place of death would be useful to determine the level of influence that deprivation has on end of life care.

Death and population projections Figure_118 Projected deaths for Airedale, Bradford and Leeds cluster

Figure_119 Projected deaths for Calderdale, Wakefield and Kirklees cluster

Projected Deaths to 2033 for Airedale, Bradford and Leeds

Figure_124 Population projections up to 2030 by Local Authority

Population projections up to 2030 by Local Authority

Projected Deaths to 2033 for Calderdale, Wakefield and Kirklees Cluster

8000

8000

7000

7000

6000

6000

5000

2010 Calderdale

4000

North Lincs

162900 175900 187500

Barnsley

14.2%

Calderdale

203000 220200 236700

Bradford

22.1%

Calderdale

16.6%

Barnsley

228100 244700 260600

Doncaster East Riding of Yorks

19.5%

Rotherham

254700 266900 278900

Kingston upon Hull

17.2%

Kirklees

15.5% 22.7%

Hull

266100 290000 311900

Leeds

Doncaster

290400 299300 308500

Wakefield

325700 345400 365900

Wakefield

4000 Bradford and Airedale

3000

3000 2000

2000 Leeds

1000

1000

0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033

0

Source: 2008-based sub national populations: sub national statistics unit ONS

Source: 2008-based sub national populations: sub national statistics unit ONS Figure_120 Projected deaths for Humber cluster

East Riding

341900 374800 408600

Kirklees

409500 441700 473000

Bradford

512900 572700 626000

Sheffield

551500 600900 649400

NYY

800000 862700 927000

Leeds

801600 896200 983700

Figure_121 Projected deaths for North Yorkshire cluster

Projected Deaths to 2033 for Humber Cluster

Projected Deaths to 2033 for North Yorkshire and York

8000 East Riding

7000

NE Lincs

6000

8000

Hull

7000

North Lincs

6000

5000

5000

4000

0

4000

3000

North Yorkshire

3000

2000

Source: 2008-based sub national populations: sub national statistics unit ONS

Source: 2008-based sub national populations: sub national statistics unit ONS

Figure_122 Projected deaths for South Yorkshire cluster

Figure_123 Projected deaths for Yorkshire and Humber

Projected Deaths to 2033 for South Yorkshire Barnsley

8000

Rotherham 6000

Projected Deaths to 2033 for Yorkshire and the Humber

●

60000 50000

Sheffield 40000

●

5000 4000

30000

3000

20000

Yorkshire and The Humber

2000 10000 1000

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 Source: 2008-based sub national populations: sub national statistics unit ONS

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033

0

0

NE Lincolnshire

4.9%

North Lincolnshire

15.1%

NYY

15.9%

Rotherham

200000

400000

9.5%

Sheffield

17.8%

Wakefield

12.3%

600000

800000

1000000

Source: 2008-based sub national populations: sub national statistics unit ONS

Doncaster 7000

6.2%

 Having an idea of the projected deaths going forward is useful for helping the health service to plan, particular around future needs for support at end of life and place of death. Trend data per PCT has been plotted by cluster.  Population projections have also been included as this will also impact on care at end of life as resources will need to be available to support people to improve as well as at end of life.

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033

2033

2032

2031

2030

2029

2028

2027

2026

2025

2024

2023

2022

2021

2020

2019

2018

2017

2016

2015

2014

2013

2012

2011

0

2010

0 2009

1000

% increase from 2010 to 2030

York

2000

1000

2030

NE Lincs

Kirklees

5000

2020

157400 161000 165100

Source: 2008-based sub national populations: sub national statistics unit ONS

The general pattern for Yorkshire and Humber for projected numbers of death shows a decline and then plateau over the next 10 years followed by an increase thereafter. Local differences are evident from the charts, with large increases in number of deaths predicted in 2033 for East Riding and North Yorkshire. All PCTs are expected to experience population increases within the next 10-20 years. Figure 124 shows the expected numbers for 2010, 2020 and 2030 as well as the predicted % increase from 2010 to 2030.

 Organisations should have an understanding of the expected population increase and expected numbers of deaths within their region. Planning for end of life care is dependent on both these factor and even in areas where organisation are achieving high numbers of people dying at home for example, this may become difficult to maintain without planning for future demand on health care services.

Prevalence of Condition

Figure_125 Prevalence of Coronary Heart Disease

Figure_126 Prevalence of Chronic Obstructive Pulmonary Disease

Current and projected prevalence of CHD in the population as a percentage (aged 16+) by PCT

 In addition to considering projected deaths and population increases, in planning for care at end of life it is also useful to understand the expected increases in prevalence of key conditions.  Current and projected data for 2020 is only available for CHD, COPD, hypertension and stroke. Current prevalence data only is available for CHD. Cancer data is available as an incidence rather than prevalence rate. ●

The Humber area tends to have the highest current prevalence rates in the region across the disease groups whereas areas such as Leeds, Sheffield and Bradford have lower rates (note this pattern appears to be different for COPD). All PCTs are predicting an expected increase in prevalence rates by 2020.

Prevalence as at Dec 2011

North Lincs PCT Bassetlaw PCT

NE Lincs CTP East Riding PCT Doncaster PCT Rotherham PCT

Barnsley PCT Wakefield PCT Calderdale PCT Kirklees PCT

England avg Brad&Aire PCT Sheffield PCT NYY PCT Leeds PCT

0

Projected prevalence in 2020

Prevalence as at Dec 2011

Hull PCT Rotherham PCT Kirklees PCT

Leeds PCT Sheffield PCT Brad&Aire PCT

NE Lincs CTP Doncaster PCT Barnsley PCT North Lincs PCT

England avg Bassetlaw PCT Wakefield PCT

Calderdale PCT East Riding PCT NYY PCT

0.02

0.04

0.06

0.08

0.1

Source: Disease Prevalence Models - The Network of Public Health Observatories

The current CHD prevalence rate for the Yorkshire and Humber region ranges from 5.4% to 7.4%. The CHD prevalence rate for England is expected to rise from 5.8% to 6.2%.

Figure_128 Prevalence of Hypertension

Figure_129 Prevalence of Stroke

Prevalence as at Dec 2011

Prevalence as at Dec 2011

Projected prevalence in 2020

North Lincs PCT

Bassetlaw… 33.9% 36.5%

Bassetlaw PCT

North Lincs… 33.8% 36.4% NE Lincs CTP Doncaster…

Rotherham… Barnsley PCT Wakefield…

Calderdale… England avg Kirklees PCT NYY PCT

Hull PCT Brad&Aire… Sheffield PCT

Leeds PCT

East Riding PCT

32.6% 34.8% 32.6% 34.7% 32.3% 34.3% 32.2% 34.6% 32.0% 34.3% 31.8% 33.1% 30.6% 32.3% 30.6% 32.4% 30.5% 34.6% 29.5% 31.0% 29.0% 29.4% 29.0% 30.3% 27.5% 28.0%

0 0.1 0.2 0.3 Source: Disease Prevalence Models - The Network of Public Health Observatories

NE Lincs CTP Doncaster PCT Rotherham PCT Barnsley PCT

Wakefield PCT Calderdale PCT NYY PCT England avg

Kirklees PCT Sheffield PCT Brad&Aire PCT Leeds PCT

0.4

The current hypertension prevalence rate for the Yorkshire and Humber region ranges from 27.5% to 34.8%. The hypertension prevalence rate for England is expected to rise from 30.6% to 32.2%.

0

0 0.01 0.02 0.03 0.04 0.05 0.06 Source: Disease Prevalence Models - The Network of Public Health Observatories

0.07

The current COPD prevalence rate for the Yorkshire and Humber region ranges from 2.6% to 5.3%. The COPD prevalence rate for England is expected to rise from 3.6% to 3.9%.

Hull PCT

435.9

Barnsley PCT

432.8

Doncaster PCT

430.7

Sheffield PCT

413.8

Rotherham PCT

404.1

Calderdale PCT

399.4

Wakefield PCT

396.6

NE Lincs CTP

394.9

Yorks and… 392.4

0.01

East Riding PCT

13.1%

North Lincs PCT

12.9%

Bassetlaw PCT

12.8%

NYY PCT

12.6%

NE Lincs CTP

12.5%

Hull PCT

12.5%

Doncaster PCT

12.4%

Rotherham PCT

12.2%

Barnsley PCT

12.2%

Wakefield PCT

12.0%

Calderdale PCT

11.9%

England avg

11.7%

Kirklees PCT

11.4%

Sheffield PCT

11.1%

Brad&Aire PCT

10.9%

Leeds PCT

Directly age- standardised rates of incidence of cancer per 100,000 population by PCT 2007-09

Projected prevalence in 2020

3.2% 3.4% 3.0% 3.3% 2.9% 3.3% 2.9% 3.1% 2.8% 3.2% 2.8% 3.1% 2.7% 3.0% 2.7% 3.0% 2.7% 3.0% 2.6% 2.8% 2.6% 2.8% 2.5% 2.7% 2.5% 2.8% 2.4% 2.6% 2.3% 2.4% 2.3% 2.3%

Hull PCT

East Riding… 34.8% 37.4%

Projected prevalence in 2020

5.3% 6.3% 5.0% 5.4% 4.7% 5.0% 4.4% 4.5% 4.4% 4.8% 4.3% 4.5% 3.7% 4.2% 3.7% 3.9% 3.6% 3.8% 3.6% 4.0% 3.6% 3.9% 3.5% 4.0% 3.5% 5.4% 3.5% 3.6% 3.3% 3.5% 2.6% 3.2%

10.6%

0

0.05

0.1

0.15

Source: Disease Prevalence Models - The Network of Public Health Observatories

The current CVD prevalence rate for the Yorkshire and Humber region ranges from 10.6% to 13.1%. The CVD prevalence rate for England is 11.7% (no data available for the expected prevalence

Figure_130 Incidence of Cancer

Current and projected prevalence of stroke in the population as a percentage (aged 16+) by PCT

Current and projected prevalence of hypertension in the population as a percentage (aged 16+) by PCT

Current and projected prevalence of CVD in the population as a percentage (aged 16+) by PCT

Current and projected prevalence of COPD in the population as a percentage (aged 16+) by PCT

7.4% 7.9% 7.0% 7.8% 6.9% 7.9% 6.7% 7.4% 6.6% 7.2% 6.6% 7.3% 6.5% 7.2% 6.5% 7.2% 6.3% 7.1% 6.3% 6.7% 6.1% 6.6% 5.8% 6.2% 5.6% 5.8% 5.6% 6.1% 5.5% 6.5% 5.4% 5.4%

Hull PCT

Figure_127 Prevalence of Cardiovascular Disease

0.02

0.03

0.04

Source: Disease Prevalence Models - The Network of Public Health Observatories

The current stroke prevalence rate ranges for Yorkshire and Humber ranges from 2.3% to 3.2%. The stroke prevalence rate for England is expected to rise from 2.5% to 2.7%.

Leeds PCT

392.4

East Riding PCT

388.5

North Lincs PCT

384.5

England avg

380.4

Kirklees PCT

377.4

Brad&Aire PCT

371.2

NYY PCT

362.7

0.0 100.0 200.0 300.0 400.0 500.0 Source: NHS Information Centre for Health and Social Care Indicator Portal (NCHOD)

The regional incident rate for cancer is higher than the England average particularly for Hull, Barnsley and Doncaster. Bradford and North Yorkshire are significantly lower .

 It is recommended that organisations , particularly those with higher proportions of prevalence now, or expecting to have higher prevalence rates by 2020, should study their data in the context of end of life planning.  Linking this data to information around cause of death and end of life registers wold be useful for organisations in understanding where best to focus resources to support people at end of life to have good care and a good death both now and in the future.

Area Metadata Indicator

**SECTION TO BE COMPLETED**

Construction

Source

Geography and drive times Table 13: PCT ONS Area Classifications

Map_2: Map of Acute Trusts for Yorkshire and Humber

PCT

ONS Classification

Barnsley PCT Bassetlaw PCT Bradford and Airedale Teaching PCT Calderdale PCT Doncaster PCT East Riding Of Yorkshire PCT Hull Teaching PCT Kirklees PCT Leeds PCT North East Lincolnshire Care Trust Plus North Lincolnshire PCT North Yorkshire and York PCT Rotherham PCT Sheffield PCT Wakefield District PCT

Manufacturing Towns Manufacturing Towns Centres with Industry Centres with Industry Manufacturing Towns Prospering Smaller Towns Industrial Hinterlands Centres with Industry Regional Centres Manufacturing Towns Manufacturing Towns Prospering Smaller Towns Manufacturing Towns Regional Centres Manufacturing Towns

ONS Area Classification The table above shows the ONS classification each PCT has been given. There are several groups nationally known as clusters which are derived from census data. The clusters each contain PCTs which are considered to have key characteristics common to the population. PCTs often compare themselves to PCTs within their ONS cluster to give a fairer comparison.

**SECTION TO BE COMPLETED** Section to include information related to the following areas: Geography: size of area, urban/rural Drive times: Average ambulance drive times to hospitals/hospices, etc. Maps: hospice locations and care homes

Rationale The make up of an area and drive times could influence both people's preferences for place of death and where they actually die. E.g. a patient may prefer to die in a hospice but as there no hospices within the area this is not considered. This may indicate the need for more hospices within an area? A patient may prefer to die at home but lack of community support in rural areas may mean the patient is admitted to hospital who would prefer to die at home. A patient could potentially have been admitted to hospital and wishes to die at home but distance to home affects the decision to discharge (i.e. the patient is not well enough to survive a 2 hour journey home)

Capacity and Resources

**SECTION TO BE COMPLETED**

Section to include information related to the following areas: Hospitals: number of sites, palliative care staff, bed days ending in death Care homes: number of care homes, number of beds, staff per resident Hospices: number of hospices, number of beds, staff per resident Finance and Commissioning: Total spend on hospital/hospice services per death, predicted future costs for hospital and community

Data Sources: PCT profiles - Indicators related to care homes and spend Workforce data - National Council for Palliative Care (Workforce survey and National Survey of Patient Activity Data), Skills for Health Workforce Functional Analysis Tool Commissioning - National Institute for Health and Clinical Excellence(Commissioning and Benchmark Tool and Guide for Commissioners on End of Life Care report) Finance - End of Life care modelling tools (Cohort, Y&H finance model)

Data Sources SECTION

TITLE

TIME PERIOD

WEBSITE/STORE

LINK

REG_1

Prevalence of people on and end of life register and QOF points

2008-09, 2009-10 and 2010-11

Quality Outcomes Framework (QOF)

http://www.ic.nhs.uk/statistics-and-data-collections/audits-and-performance/the-quality-and-outcomesframework/the-quality-and-outcomes-framework-2010-11 Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

REG_2

Prevalence of people on an end of life register

2008-11

Primary Care Mortality Database

POD_1

Deaths in hospital by age

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

POD_1

Deaths in hospital by PCT cluster

2008-11

Primary Care Mortality Database

POD_2

Deaths in own home by age

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

RELEASE DATE Autumn 2011 Data extracted Aug 2011

PUBLICATION NOTES Published annually Information Centre update online database monthly

Dec-11

Originally sourced from ONS annual mortality statistics

Data extracted Aug 2011

Information Centre update online database monthly

Dec-11

Originally sourced from ONS annual mortality statistics

Dec-11

Originally sourced from ONS annual mortality statistics

Data extracted Aug 2011

Information Centre update online database monthly

Dec-11

Originally sourced from ONS annual mortality statistics

Data extracted Aug 2011

Information Centre update online database monthly

Dec-11

Originally sourced from ONS annual mortality statistics

Data extracted Aug 2011

Information Centre update online database monthly

Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

POD_2

Deaths in own home by PCT cluster

2008-11

Primary Care Mortality Database

POD_3

Deaths in a care home by age

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

POD_3

Deaths in a care home by PCT cluster

2008-11

Primary Care Mortality Database

POD_4

Deaths in a hospice by age

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

POD_4

Deaths in a hospice by PCT cluster

2008-11

Primary Care Mortality Database

POD_5

Deaths by place

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx Extract taken from database August 2011 - http://www.ic.nhs.uk/services/population-geographyinformation/demographics-and-statistics/primary-care-mortality-database

POD_5

Deaths by place by PCT cluster

2008-11

Primary Care Mortality Database

POD_5

Deaths elsewhere by age

2008-10 pooled data

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

Dec-11

Originally sourced from ONS annual mortality statistics

Hosp_1

Deaths in hospital by length of stay and age

2008-09, 2009-10 and 2010-11

Hospital Episode Statistics (HES)

Extract taken from HES Feb 2012

Deaths in hospital by primary diagnosis

2008-09, 2009-10 and 2010-11

Aggregated to comply with information governance rules

Hosp_2

Hospital Episode Statistics (HES)

Extract taken from HES Feb 2012

Data extracted Feb'12

Cause_1

% deaths by age and % deaths by place where cause of death 2008-10 pooled data was cancer % deaths by age and % deaths by place where cause of death 2008-10 pooled data was CVD % deaths by age and % deaths by place where cause of death 2008-10 pooled data was respiratory disease

Originally sourced from ONS annual mortality statistics Originally sourced from ONS annual mortality statistics Originally sourced from ONS annual mortality statistics

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

Dec-11

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

Dec-11

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

Dec-11

Cause_4

% deaths by age and % deaths by place where cause of death 2008-10 pooled data was other (not cancer, CVD or respiratory disease)

National End of Life Care Intelligence Network (NEOLCIN) http://www.endoflifecare-intelligence.org.uk/end_of_life_care_profiles/local_authority_profiles.aspx

Dec-11

Originally sourced from ONS annual mortality statistics

Demo_1

Proportion of males and females split by age group

Mid 2010

Estimates of resident population (2001 Census based):

https://indicators.ic.nhs.uk/webview/

Jan-12

Previously NCHOD

Demo_1

Proportion of the population by age group

Mid 2010

Estimates of resident population (2001 Census based):

https://indicators.ic.nhs.uk/webview/

Jan-12

Previously NCHOD

Demo_1 Demo_2 Demo_2

Death rates from all causes Number of deaths Proportion of male and female deaths

2008-10 2008-11 2008-11

https://indicators.ic.nhs.uk/webview/ Extract taken from database August 2011 Extract taken from database August 2012

Jan-12

Previously NCHOD

Demo_2

Summary Hospital-level Mortality Indicator (SHMI)

2010/11

http://www.yhpho.org.uk/resource/view.aspx?RID=118970

Jan-12

Data from Information Centre 2011

Demo_3 Demo_3

Life expectancy at birth Life expectancy age 65

1991-93 to 2008-10 2000-02 to 2008-10

Mortality from all causes pooled data 2008-10 Primary Care Mortality Database Primary Care Mortality Database Summary Hospital-level Mortality Indicator (SHMI) Data Bites Issue 4 Life expectancy at birth Life expectancy at age 65

https://indicators.ic.nhs.uk/webview/ https://indicators.ic.nhs.uk/webview/

Jan-12 Jan-12

Previously NCHOD Previously NCHOD

Demo_3

Indices of deprivation

2008

Indices of Deprivation 2010 (Local Authority, Primary Care Organisation and County summaries):

https://indicators.ic.nhs.uk/webview/

Jan-12

Based on ONS data

http://www.yhpho.org.uk/default.aspx?RID=110329

2011

Produced by YHPHO

Cause_2 Cause_3

Demo_3

Map of deprivation

2010

Index of multiple deprivation 2010 for Yorkshire and Humberside

Demo_4

Projected deaths

2009-2033

2008-based subnational population projections

Demo_4

Projected population

2010, 2020, 2030

2008-based subnational population projections

Demo_5 Demo_5

Cardiovascular disease (CVD) Chronic Heart Disease (CHD)

Dec 2011 Dec 2011

Network of Public Health Observatories Network of Public Health Observatories

http://www.ons.gov.uk/ons/rel/snpp/sub-national-population-projections/2008--basedprojections/index.html http://www.ons.gov.uk/ons/rel/snpp/sub-national-population-projections/2008--basedprojections/index.html http://www.apho.org.uk/DISEASEPREVALENCEMODELS http://www.apho.org.uk/DISEASEPREVALENCEMODELS

Demo_5

Chronic Obstructive Pulmonary Disease (COPD)

Dec 2011

Network of Public Health Observatories

http://www.apho.org.uk/DISEASEPREVALENCEMODELS

Dec 2011

Demo_5

Hypertension

Dec 2011

Network of Public Health Observatories

http://www.apho.org.uk/DISEASEPREVALENCEMODELS

Dec 2011

Demo_5

Stroke

Dec 2011

Dec 2011

Incidence of all cancers (DSR)

2007-09 pooled data

Network of Public Health Observatories NHS Information Centre for Health and Social Care Indicator Portal

http://www.apho.org.uk/DISEASEPREVALENCEMODELS

Demo_5

https://indicators.ic.nhs.uk/webview/

Jan-12

Previously NCHOD

Area_1

ONS Area Classification

Version 4 - based on 2001 NHS Information Centre for health and Social Care Portal https://indicators.ic.nhs.uk/webview/ census

Jan-11

Previously on NCHOD, sourced from ONS

Area_1

Index of Multiple Deprivation 2010 Yorkshire and Humberside map

May 2011

May 2011

Image of map used

Yorkshire and Humber Public Health Observatory

http://www.yhpho.org.uk/resource/view.aspx?RID=110329

Jan-11 Jan-11 Dec 2011 Dec 2011

ONS publication, latest updated March 2012 for 2010=based subnational populations

Predicted prevalence data for 2020 was published Oct/Nov 2008