Programme for Relationships, Intelligence, Metrics and Equality Relationships & Metrics – Baseline Report
Some Context
Birmingham East & North PCT 2007 IMD
Birmingham East & North PCT NHS Services
Common causes of death Standardised mortality rates per 100,000 population
BEN PCT and West Mids SHA Lifestyle Indicators
The Process
High Level Process
Local Context
DFI Dataset Analysis
Broad inequalities identified
Themes identified
Local data analysed
Groupings and measures
The Process • •
Inequalities were looked for across: • Age Groups • Geography • Deprivation To do this the following themes were identified for analysis: • Infant Mortality • Breast Cancer • Tackling Obesity • Childhood Weight Issues • Reducing alcohol harm • Treating drug addiction • Reducing smoking rates • Improving sexual health • Improving mental health • Injuries and Poisonings • All-age all-cause mortality rate per 100,000 population (VSB01) • Mortality rate from all circulatory diseases at ages under 75 (VSB02) • Mortality rate from all cancers at ages under 75 (VSB03) • Mortality rate from causes considered amenable to healthcare (VSC30) • Hospital admissions for alcohol related harm (VSC26) • Hospital admissions by unintentional and deliberate injuries to children and young people (VSC29)
Your Peers •
The Office of National Statistics classifies Primary Care Organisations in England into 7 supergroups and 12 groups based on 2001 Census data.
•
BEN is clustered with 18 other PCTs in the group ‘Centres with Industry,’ within the supergroup ‘Cities and Services.’
•
DFI chose the top 5 peers through OAC classification.
How the data mapped…
All age all cause mortality rate per 100,000 population (VSB01)
Infant Mortality
Childhood Obesity
•Comparison with England •Comparison by ward •Infant Mortality per 1000 deaths •SAR for Pregnancy Conditions •VSC29 - Hospital admissions caused by unintentional and deliberate injuries to children and young people
•Local data mapped to BMI taking adjustment criteria into account •By age •By CAS Ward •By Mosaic™ group •Digestive SAR
Recommended Measures: SAR for Pregnancy Conditions (Quarterly) VSC29 Quarterly Infant Mortality per 1000 deaths (yearly)
Recommended Measures: Severe and moderate malnutrition rates up to Year 6 (quarterly) Overweight and obese rates up to Year 6 (quarterly) Increased sample size/research recommended
Adult Obesity
Alcohol Harm
•SUS data obesity related spells •Comparison Nationally •Comparison with peers •By Ward •By Sex •By Mosaic™ group •Digestive SAR???
•SUS data for alcohol related liver disease per 1000 population •Comparison Nationally •Comparison with peers •By Ward •By Sex •By Mosaic™ group
Recommended Measures: Obesity Related Spells per 1000 population (quarterly) Obesity Related Spells in middle aged women per 1000 population (indicator/priority)
Recommended Measures: Alcohol related liver disease spells per 10,000 population (quarterly) Alcohol related liver disease spells in middle aged women per 10,000 population (indicator/priority)
Smoking
•SUS data SAR for •COPD •Lung Cancer •CVD •Comparison Nationally •Comparison with peers •By Ward •By Sex •By Ward •By Mosaic™ group •VSB03 - Mortality rate from all cancers at ages under 75 per 100,000 population
Recommended Measures: Standardised Admission Rates for COPD, CVD and Lung cancer (quarterly) Recommend focusing on Shard End to begin with (poor for all three conditions) Further analysis with local data underway
Infant Mortality
Infant Mortality per 1000 births by PCT, 2006 BEN PCT Mortality rate is 9 in 1,000 births, the same as Kuwait, Latvia and Bahrain England is 5 in 1,000 births
Worldwide, infant mortality rates are higher among children born to uneducated mothers than those born to mothers with a secondary education. In the Congo, infant mortality is 60 per 1000 live births for educated mothers and 135 per 1000 for the uneducated. In Niger, 260 of every 1000 children born will die before reaching the age of 5. In Portugal, this figure is less than five.
In India, 140 of every 1000 children born to the poorest households die before the age of five. The rate is three times higher than among those born to the richest households, of which 45 of every 1000 will die under five.
Birmingham East & North PCT Infant Mortality, 2006 compared to English Average
Birmingham East & North PCT Infant Mortality, 2006 within Ward
Infant Mortality by Mosaic™ Group 2004-2006
Mosaic™ Group
Three Year Average
Percentage
Ties of Community
24.0
45.0%
Municipal Dependency
9.0
16.9%
Blue Collar Enterprise
6.3
11.9%
Suburban Comfort
4.7
8.8%
Welfare Borderline
3.7
6.9%
Symbols of Success
3.5
4.4%
Happy Families
1.7
3.1%
Grey Perspectives
2.0
1.3%
Unclassified
1.0
1.3%
Urban Intelligence
1.0
0.6%
Grand Total
53.3
-
Sutton Trinity Ward Mosaic™ Distribution
Hodge Hill and Washwood Heath Wards Mosaic™ Distribution
Hodge Hill Ward
Sutton Four Oaks Ward Mosaic™ Distribution
Recommendations, Metrics and Indicators •
Target ‘Ties of the Community’ and ‘Municipal Dependency’ Mosaic™ types with further research and social marketing starting within the Hodge Hill and Washwood Heath wards.
• •
SAR for Pregnancy Conditions (Quarterly) Infant Mortality per 1,000 live births (yearly)
Other possible metrics could include: • Percentage of women who have received a health and social care needs assessment by the 12th week of pregnancy • Antenatal screening uptake • Maternal BMI at booking • Maternal smoking status at booking, by age
Obesity
Obesity Related Admissions per 1000 spells BEN Obesity related admissions is 7.1 per 1,000 spells England is 6.1 per 1,000 spells
Number of spells with a obesity related diagnosis code per 1000 spells BEN PCT Ageband
West Midlands
England
Female
Male
Female
Male
Female
Male
0
0.00
0.00
0.04
0.02
0.01
0.01
1-4
1.52
1.06
0.67
0.72
0.64
0.46
5-9
0.91
4.64
1.90
2.07
1.78
1.83
10-14
10.54
4.10
6.08
7.79
4.87
4.52
15-19
5.11
2.22
3.35
2.18
2.84
2.46
20-24
8.72
1.42
5.46
1.81
3.80
1.53
25-29
6.72
2.01
6.02
2.41
4.64
2.45
30-34
6.38
6.23
7.65
3.98
5.14
4.29
35-39
8.18
6.11
9.72
6.79
7.72
6.45
40-44
16.39
9.83
12.91
8.58
10.14
8.31
45-49
14.54
12.90
12.85
11.79
11.41
10.66
50-54
13.58
8.79
14.53
10.93
12.63
11.75
55-59
15.84
9.56
13.22
9.33
12.34
11.08
60-64
14.13
8.29
10.70
8.73
10.65
9.47
65-69
19.97
8.68
11.81
6.83
10.25
7.50
70-74
8.38
3.48
8.35
5.32
8.36
5.90
75-79
8.92
1.71
6.36
3.15
5.79
3.91
80-84
6.03
1.37
3.16
1.72
3.18
2.08
85-89
1.19
0.58
1.66
0.87
1.63
1.15
90+
2.81
0.00
0.84
0.13
0.74
0.45
Number of spells with an obesity related diagnosis code per 1,000 spells grouped by deprivation Least deprived
Below average
Average
Above average
Most deprived
Ward rate
Acock's Green
0.00
0.00
8.72
1.56
4.45
4.21
Bordesley Green
0.00
0.00
0.00
0.00
7.43
7.37
Erdington
0.00
2.66
4.99
5.69
6.53
5.57
Hodge Hill
0.00
1.45
7.50
10.44
8.06
7.88
Kingstanding
0.00
35.43
15.08
14.30
14.48
15.27
Shard End
0.00
21.28
0.00
13.21
8.97
9.74
Sheldon
41.67
0.00
6.57
7.23
8.52
7.00
South Yardley
0.00
0.00
7.72
5.04
6.29
5.86
Stechford & Yardley North
0.00
0.00
1.68
5.97
9.40
6.56
Stockland Green
0.00
0.00
12.53
10.48
10.66
10.64
Sutton Four Oaks
3.41
1.01
11.47
1.50
0.00
3.59
Sutton New Hall
5.64
2.59
0.96
6.59
13.95
4.18
Sutton Trinity
4.62
2.14
3.32
6.78
4.85
4.17
Sutton Vesey
2.63
5.49
1.62
5.28
0.00
3.69
Tyburn
0.00
24.39
2.92
13.22
11.64
11.39
Washwood Heath
0.00
0.00
0.00
28.04
6.87
7.12
Grand Total
4.03
3.62
5.80
8.60
8.68
-
Ward
Number of spells with an obesity related diagnosis code per 1,000 spells by Ethnicity (Mosaic™ Origins)
Ethnicity Bangladeshi Black African Black Caribbean British Isles Chinese Eastern European Greek/Greek Cypriot Hindi Hispanic Italian Jewish/Armenian Other East Asian Other Muslim Pakistani Sikh Somali Tamil/Sri Lankan Turkish Unknown Western European
Obese 16 4 1 516 10 9 0 22 3 2 0 0 5 240 20 0 0 0 7 6
All Spells 1758 1012 187 67327 812 1516 384 3087 347 685 34 125 407 32991 2697 22 67 58 899 967
Rate per 1,000 9.10 3.95 5.35 7.66 12.32 5.94 0.00 7.13 8.65 2.92 0.00 0.00 12.29 7.27 7.42 0.00 0.00 0.00 7.79 6.20
Recommendations, Metrics and Indicators • • • •
Target women, most likely of British or Pakistani origin and in the more deprived wards (especially Kingstanding, Shard End and Washwood Heath). A targeted campaign for men within certain age ranges is also worth consideration. Obesity Related Spells per 1000 population (quarterly) Obesity Related Spells in middle aged women per 1000 population (indicator/priority)
Alcohol Harm
A dmis s ions for L iver dis eas e, alcohol related per 10,000 population 07/08 4.50
P er 10,000 population
4.00 3.50 3.00 2.50
F emale
2.00
Male
1.50 1.00 0.50 0.00 BE N PCT
W es t Midlands S HA
E ngland
Reducing Alcohol harm Admissions for Alcohol related liver disease per 10,000 population SUS data – April 2007 to March 2008
Ward
Female
Male
Acock's Green
4.92
2.81
Bordesley Green
1.15
2.29
Erdington
1.62
2.44
Hodge Hill
6.40
8.00
Kingstanding
3.91
7.03
Shard End
2.98
3.72
Sheldon
0.00
4.51
South Yardley
4.22
4.92
Stechford & Yardley North
2.32
3.86
Stockland Green
0.89
7.15
Sutton Four Oaks
0.88
1.75
Sutton New Hall
0.00
1.81
Sutton Trinity
4.06
0.81
Sutton Vesey
0.00
5.92
Tyburn
2.62
6.99
Washwood Heath
1.41
0.00
Area
Female
Male
BEN PCT
2.09
3.55
Solihull PCT
0.96
4.06
Wolverhampton PCT
1.42
4.43
Blackburn with Darwen PCT
0.84
8.44
Bradford and Airedale PCT
1.40
4.45
South Birmingham PCT
2.01
3.06
Oldham PCT
0.89
4.64
West Midlands SHA
2.20
4.07
England
1.94
4.11
Reducing Alcohol harm Admissions for Alcohol related liver disease per 10,000 population Analysis by Ethnicity (Mosaic™Origins)
Ethnicity (Mosaic™ Origins) Bangladeshi Black African Black Caribbean British Isles Chinese Eastern European Greek/Greek Cypriot Hindi Hispanic Italian Jewish/Armenian Other East Asian Other Muslim Pakistani Sikh Somali Tamil/Sri Lankan Turkish Unknown Western European
Spells 2 1 0 98 3 4 0 2 1 0 0 0 0 22 5 0 0 0 3 4
Population 9741 1501 650 295210 1092 3117 911 3859 1337 3141 344 2481 4795 44883 4619 802 239 821 553 5583
Rate per 10,000 pop 2.05 6.66 0.00 3.32 27.47 12.83 0.00 5.18 7.48 0.00 0.00 0.00 0.00 4.90 10.82 0.00 0.00 0.00 54.27 7.17
Recommendations, Metrics and Indicators • • • • • •
Target women aged 35-70 living in Acock’s Green, Hodge Hill, South Yardley and Sutton Trinity Target men aged 60-80 living in Hodge Hill The key population ethnicity to target is British and Pakistani Alcohol related liver disease spells per 10,000 population (quarterly) Alcohol related liver disease spells in middle aged women per 10,000 population (indicator/priority) Alcohol related liver disease spells in older men per 10,000 population (indicator/priority)
Smoking
S moking R elated S tandardis ed A dmis s ion R ates 07/08 140 120
S AR
100 80
L ung C anc er C OP D
60
CVD 40 20 0 BE N PCT
W es t Midlands S HA
E ngland
Br ad fo r d
ur n
So
PCT W
Te
ds
gl
T
T
T
T
an
d
A
PC
PC
PC
PC
SH
am
En
an
ld h
tM id l
O
am
hi ng
gh
ac
en
T
T
T
PC
C
PC
ul lP
N
pt on
ar w
m
Bi rm in
es
ut h
al e
D
rh a
wi th
ol ve
Ai re d
kb
d
ac
an
Bl
W
So lih
BE
S AR
S moking R elated S tandardis ed A dmis s ion R ates 07/08
160
140
120
100
80
60
40
20
0 L ung C anc er
C OP D
CVD
R olling 12 Months C OP D by Deprivation 6000 Tariff £k
5000
B ed Days 4000 3000 2000 1000 0 L eas t deprived
B elow average
A verage
A bove average
De priva tion Quintile
Mos t deprived
Smoking related admissions SUS-CDS: April 2007 – March 2008 (Extracted October 2008) Ethnicity Bangladeshi Black African Black Caribbean British Isles Chinese Eastern European Greek/Greek Cypriot Hindi Hispanic Italian Jewish/Armenian Other East Asian Other Muslim Pakistani Sikh Somali Tamil/Sri Lankan Turkish Unknown Western European Grand Total
Smoking 59 44 12 3251 27 78 15 114 9 36 0 7 12 1165 97 0 2 1 37 45 5011
Spells 1759 1012 187 67313 812 1517 384 3086 347 685 34 125 407 32979 2699 22 67 58 899 967 115359
Percentage of Percentage by Spells Ethnicity 3.4% 1.2% 4.3% 0.9% 6.4% 0.2% 4.8% 64.9% 3.3% 0.5% 5.1% 1.6% 3.9% 0.3% 3.7% 2.3% 2.6% 0.2% 5.3% 0.7% 0.0% 0.0% 5.6% 0.1% 2.9% 0.2% 3.5% 23.2% 3.6% 1.9% 0.0% 0.0% 3.0% 0.0% 1.7% 0.0% 4.1% 0.7% 4.7% 0.9% 4.3% -
Smoking related deaths per 100,000 population
BEN
West Midlands
England
Condition
Male
Female
Male
Female
Male
Female
All
286
153
132
56
241
127
CHD
167
86
82
27
154
76
Lung Cancer
77
37
35
19
51
29
COPD
41
30
16
11
37
23
Recommendations, Metrics and Indicators •
British men and Shard End are recommended for consideration as initial focus
•
Standardised Admission Rates for COPD, CVD and Lung cancer (quarterly) Regular local dataset collections where possible
•
Mental health activity
Mental health – Analysis of local data Mental health activity by service and deprivation for BEN residents, July 2007- June 2008 Service Adult Community Substance Misuse Older Adult Adult Home Treatment Adult Assertive Outreach Adult Rehab & Recovery Adult Early Intervention Adult Inpatient Eating Disorders Psychiatric Liaison Working Age Dementia Youth Support Neuropsychiatry Deaf Service Perinatal Psychotherapy Personality Disorders Forensic Men Psychology Not BSMHT Deaf Services
Least Deprived 36.4% 3.8% 29.0% 7.5% 1.3% 1.7% 1.5% 2.2% 10.0% 1.0% 2.3% 0.4% 1.2% 0.5% 0.2% 0.8% 0.1% 0.0% 0.1% 0.0% 0.2%
Below Average 38.7% 7.5% 23.3% 10.4% 4.5% 3.9% 2.6% 2.5% 0.8% 0.2% 0.7% 1.6% 0.7% 0.2% 1.5% 1.1% 0.0% 0.0% 0.0% 0.0% 0.0%
Average 33.8% 10.0% 17.9% 13.2% 6.0% 8.9% 2.3% 3.5% 0.7% 0.9% 0.5% 1.1% 0.6% 0.2% 0.1% 0.2% 0.0% 0.0% 0.0% 0.0% 0.0%
Above Average 35.5% 11.1% 12.4% 10.9% 11.7% 8.4% 2.7% 4.1% 0.2% 0.9% 0.6% 0.3% 0.4% 0.4% 0.1% 0.1% 0.0% 0.1% 0.0% 0.1% 0.0%
Most Deprived 35.8% 17.2% 8.9% 10.9% 8.6% 5.9% 5.3% 3.4% 0.7% 0.8% 0.8% 0.4% 0.4% 0.2% 0.1% 0.1% 0.3% 0.0% 0.0% 0.0% 0.0%
Total 35.7% 13.8% 12.5% 11.0% 8.4% 6.5% 4.0% 3.5% 1.1% 0.8% 0.8% 0.5% 0.5% 0.3% 0.2% 0.2% 0.2% 0.0% 0.0% 0.0% 0.0%
Mental health – Analysis of local data Mental health activity for BEN residents, July 2007- June 2008
Mental health activity for BEN residents by age group and sex, July 2007- June 2008 3,000 2,500
Activity
2,000
Female Male
1,500 1,000 500 0
Age group
Mental health – Analysis of local data Mental health activity by Electoral ward for BEN residents, July 2007- June 2008 Ward
Activity
Rate per 1,000 pop
Stockland Green
4,310
195.5
Erdington
4,090
171.1
Tyburn
3,062
137.5
Kingstanding
3,136
126.7
Washwood Heath
3,153
112.0
Shard End
2,437
95.8
Hodge Hill
2,335
95.0
Stechford & Yardley North
2,265
89.0
South Yardley
1,988
70.9
Sheldon
1,525
70.6
Bordesley Green
2,388
69.6
Sutton Trinity
1,656
68.9
Sutton New Hall
1,326
61.1
Sutton Vesey
1,405
60.9
Sutton Four Oaks
1,267
57.0
Acock's Green
1,328
47.5
Total
37,671
94.3
Mental health – Analysis of local data Mental health activity for BEN residents, July 2007- June 2008 Dominant Ethnicity (Origins) British Isles Pakistani Bangladeshi Eastern European Hindi Unknown Black African Sikh Chinese Hispanic Western European Italian Other Muslim Black Caribbean Greek/Greek Cypriot Turkish Other East Asian Tamil/Sri Lankan Total
Total activity 20,890 11,806 813 717 686 543 461 452 445 287 190 179 80 69 31 11 6 5 37,671
Mosaic ™ group
Total activity
Ties of Community
12,148
Municipal Dependency
5,959
Blue Collar Enterprise
5,668
Welfare Borderline
3,660
Suburban Comfort
2,674
Twilight Subsistence
2,121
Grey Perspectives
1,659
Symbols of Success
1,413
Happy Families
1,056
Urban Intelligence
825
Unclassified
488
Total
37,671
Recommendations, Metrics and Indicators •
Recommendation for further research and local insight
•
Further local data collections and analysis
Next Steps
Next Steps…. • • •
Further analysis as data becomes available Baseline workshop • Comprehensive walkthrough of the data used to date • Development of KPIs Programme KPI sign off
Supporting Materials
A Mosaic™ Tour
Lifestyle group A - "Career professionals living in sought after locations" •
• •
•
•
Symbols of Success people are well set in their careers and their incomes have risen far into upper income tax ranges. Some work for large corporations in senior management positions; some hold respected roles in professional practices; others have built successful enterprises with their own commercial acumen. These are people with busy and complex family lives. Their children are now less time consuming, with more independent lifestyles, but with leisure interests that are likely to be more expensive. This group is mostly white British but is likely to contain significant Jewish, European, Chinese and Indian minorities. Symbols of Success neighbourhoods are concentrated in economically successful regions, notably London and the South East of England, where a high proportion of the workforce is engaged in 'knowledge' industries. These are typically neighbourhoods of choice housing, whether fashionable inner city areas such as Kensington or the New Town area of Edinburgh or prestige outer suburbs. These are well-established neighbourhoods; houses are well built and spacious, with four or more bedrooms, very often built to individual designs at low densities. In this group, status is established by the values associated with the brand rather than by the product category, and by the manner in which the product is accessed and consumed. The air of discretion and 9.2% of BEN Population understatement that is associated with traditional premium brands predominantly in: appeals more than the flamboyance and conspicuous consumption •Sutton Four Oaks associated with the nouveau riche. •Sutton New Hall & •Sutton Vesey
Lifestyle group B - "Younger families living in newer homes" • •
•
•
Happy Families contains people whose focus is on career, home and family. They are mostly young couples, married or living with their partner, raising pre-school and school-age children. This group's educational attainment has enabled them to secure positions in large organisations in either the private or the public sector, with the prospect of future career advancement. These neighbourhoods consist of modern, purpose-built family housing, either detached or semi-detached, on estates with other young families. These estates are often some considerable distance from major commercial centres but an easy driving distance from many potential workplaces, such as major new industrial or office 'parks'. Happy Families neighbourhoods are typically found in areas of rapidly expanding employment, around towns such as Swindon, Northampton and Milton Keynes. Some of the new jobs are in locally grown businesses in new industrial sectors such as information technology, biotechnology or business services. Other jobs are in organisations that are relocating from inner city sites to new green-field office parks; these are close to the motorway network, and within easy reach of potential employees. Happy Families place a high value on material possessions. To some extent, this reflects their life stage, when investing in new homes involves substantial expenditure on appliances. Modern design, the use of high 5.1% of BEN Population technology, and reliability are important consumer values in these predominantly in: neighbourhoods. •Acocks Green •Perry Barr •Sutton New Hall
Lifestyle group C - "Older families living in suburbia"
• •
•
•
Suburban Comfort people have established themselves and their families in comfortable homes in mature suburbs. Children are becoming independent, work is less of a challenge and interest payments on homes and other loans are becoming less burdensome. These people live in inter-war suburbs and work mostly in intermediate level, white-collar occupations, where they are beginning to plan for approaching retirement. They are likely to be married and most have children, who may be at secondary school or university, or grown up and starting families of their own. These neighbourhoods consist mostly of houses built between 1918 and 1970 to meet the needs of a new generation of white-collar office workers. Pleasant but homogenous semi-detached houses are set back from the road in generously sized plots with leafy gardens. Such areas were once on the edge of the city, but they now often form a no-man's land between the high density Victorian inner city and the more modern family estates further out. People in this group value independence and self-reliance, and tend to rely on their own judgment, rather than social or community attitudes, when taking key decisions. Although they expect neighbours to be helpful, they do not necessarily take pride in or get involved with their local community. 'An Englishman's home is his castle' could describe this 14.9% of BEN group's outlook. Population predominantly in: •Sutton Four Oaks •Sutton New Hall & •Sutton Vesey
Lifestyle group D - "Close"Close-knit, inner city and manufacturing town communities" •
•
•
• •
Ties of Community people live in very established rather old-fashioned communities. Traditionally, people in this group married young and had manual jobs in industries such as docks and mines. Today, this group has a younger than average population; many are married or cohabiting and bringing up young children. Social support networks are strong, with friends and relations nearby. These neighbourhoods are often characterised by late nineteenth century housing. Many homes have been improved, and are comfortable if somewhat cramped places to live (usually two rooms and a back extension downstairs, two or three small bedrooms, and a modest rear garden). Originally, such neighbourhoods were within short walking distance of local factories and shops, and many still have access to small corner shops, often owner-managed by recently arrived Asian families. Typically, these neighbourhoods are in former coalfield regions, old steel and shipbuilding towns, and places with docks and chemical plants industries that have been in serious if not terminal decline in recent years. But regional initiatives have attracted footloose industry to new lightindustrial estates and unemployment has fallen; it is lower than in areas where people rent their houses from the local council. To varying degrees, this group has resisted the shift toward individualistic consumption styles. A person's standing in their community is based on the reputation of their family, their personality and their integrity. Conspicuous consumption is out of place.
27.6% of BEN Population predominantly in: •Acocks Green •Perry Barr •Washwood Heath
Lifestyle group E - "Educated, young, single people living in areas of transient populations" • •
•
•
Urban Intelligence people are young, well educated and open to new ideas and influences. They are cosmopolitan in their tastes and liberal in their social attitudes. Few have children. Many are in further education while others are moving into full-time employment. Most do not feel ready to make permanent commitments, whether to partners, professions or to specific employers. As higher education has become internationalised, the Urban Intelligence group has acquired many foreign-born residents, which further encourages ethnic and cultural variety. These neighbourhoods typically occur in inner London and the inner areas of large provincial cities, especially those with popular universities. The growth in student numbers has led to their dispersal from halls of residence into older working class communities and the areas of large Victorian houses that typically surround the older universities. Other inner city areas have also been taken over by recent graduates and young professionals who want to live close to their work and the facilities of the inner city. Demand for flats is outstripping supply, and developers are now building new flats as well as refurbishing older houses, particular in locations close to old canals and docklands. n London, this extends into previously lower middle class suburbs such as Wandsworth and Hammersmith. Outside London, 'dinky' 1.6% of BEN Population developments - new town houses and small flats, often on brownfield predominantly in: sites - cater for this group. In terms of values, this is the most liberal group; it also has the most catholic tastes and the most international •Stockland Green orientation. •Perry Barr •Erdington
Lifestyle group F - "People living in social housing with uncertain employment in deprived areas" •
•
•
•
Welfare Borderline people are struggling to achieve the material and personal rewards that are assumed to be open to all in an affluent society. Few hold down rewarding or well-paid jobs; most rely on the council for their accommodation and on state benefits to fund bare essentials. These neighbourhoods are characterised by small local authority flats, either in high-rise towers or in large mid-rise developments. The group is most common in west central Scotland, which has a tradition of housing families with children in mid-rise and high-rise blocks, but is also common in inner London. There are high levels of social deprivation in these neighbourhoods. Many tenants are in menial, low-paid jobs and many children live in single-parent families or in transient family formations. In London, high proportions of this group are of Caribbean or Bangladeshi descent, or have recently arrived in the country as asylum seekers. In Scotland, this group is also found in 'four in a blocks' - small blocks with two lower and two upper flats, each with its own separate front entrance. The immediate environment often gives an air of neglect and danger. For many, the process of coping with routine tasks can often be a major struggle, and much effort is devoted to the achievement of basic necessities The earnings of these people do not tend to significantly exceed the national minimum wage, and most families qualify for state benefits in some form. Budgets can cope with daily necessities but are 5% of BEN Population often undermined by larger items such as utility bills. predominantly in: Most people do not qualify for a credit card and some do not have a •Yardley current account, which makes cash an important medium of exchange. •Shard End Post offices play a vital role as somewhere to pay bills and to obtain •Erdington benefit payments.
Lifestyle group G - "Low income families living in estate based social housing" •
•
•
Municipal Dependency families lack the funds to buy their own homes and are reliant on local authority housing, which is typically on large, lowrise estates far from the centre of the city. Living in council accommodation, reliant on buses for mobility and on television for entertainment, these people lead particularly passive lives, with far less choice than the better-off groups. These neighbourhoods are generally found in large provincial cities such as Sheffield, Nottingham and Birmingham. Built soon after World War II, they mainly consist of small, two-storey homes, arranged in short terraces, or semi-detached houses with gardens. Built at low densities and with plenty of public open space, these estates were designed to provide a healthier, more attractive living environment for those living in the dilapidated inner cities. And though basic and repetitive in design, these houses are convenient and comfortable. The main problem is poor accessibility - the few retail outlets on the estates are often beyond walking distance, and pubs, schools and community facilities may also be far away. Residual consumers of mass media channels, this group sticks with old, established, mainstream brands. Few make purchases by phone or online, preferring to shop in local stores with friendly staff and discount prices. For this group, balancing the budget is much more important than long-term financial planning. 13.2% of BEN Population predominantly in: •Kingsbury •Shard End •Kingstanding
Lifestyle group H - "Upwardly mobile families living in homes bought from social landlords" •
• •
•
Blue Collar Enterprise people are practical and enterprising, rather than well educated. Many live on council estates where a high proportion of tenants have exercised the right to buy. The lifestyles of this group have improved in recent years. They have become home owners; they may have one or even two cars, putting them in reach of a new range of jobs with higher wages and other incentives; in the more prosperous regions, unemployment has declined, creating a seller's market; their health has improved; the crime rate in these areas has fallen and the environment is generally pleasant. These are low-density estates of terraced or semi-detached housing, usually with a garden. The new owners may have stamped their identity on their homes by fitting new doors and windows, maybe a brick porch, extension or garage, or even a conservatory. Blue Collar Enterprise neighbourhoods tend to occur in small and medium sized towns in the more prosperous Southern and Midland regions. They also crop up in Scotland, which has more of a history of accommodating higher-income families in public housing than England. Highest concentrations occur around the M25 and along other important motorway routes, and in the post-war new towns. These households are increasingly confident in their ability to manage their affairs without support from the state, the wider community, or from immediate family. They value self-reliance, persistence and responsibility 16% of BEN Population predominantly in: at work, taking advantage of opportunities, even with a degree of risk, and enjoyment through consumption. •Stockland Green •Yardley •Kingstanding
Lifestyle group I - "Older people living in social housing with high care needs" • •
•
•
Twilight Subsistence people have reached the late stage in previously independent lives and now require the support of housing and social services departments. Most rely entirely on state benefits for their income. They either rent their homes from the public sector, rather than owning, or use local authority rather than private care homes. This reflects their low levels of savings and incomes; most do not hold any equity, either in their homes or in financial investments and their incomes are likely to be restricted to the basic state pension supplemented by other welfare benefit payments. These neighbourhoods are generally found as pockets within larger areas of council housing. Housing can be found in a number of forms: highrise flats, which are no longer considered suitable for the families for which they were originally built; small enclaves of single-storey units within larger council estates, often specially designed for the needs of elderly residents - for instance, with the provision of ramps and small areas of private garden; dwellings that are part of a more organised complex in which one of the units accommodates the warden; or sheltered accommodation with common sitting and dining rooms. Twilight Subsistence neighbourhoods are dispersed throughout the UK. However, there are larger concentrations in those regions where the 3.4% of BEN Population proportion of the population living in public housing is highest, most predominantly in: notably Scotland and the North East of England. •Stockland Green •Acocks Green •Shard End
Lifestyle group J - "Independent older people with relatively active lifestyles" • • •
•
• •
Grey Perspectives people are retired but still independent, with time on their hands and in reasonably good health. They own and run their own homes and are financially independent. On retirement, they may have swapped their suburban home for a property in a coastal resort or pleasant heritage town or rural village, or in a smart apartment block in the outer London suburbs. This down sizing is likely to have left them with a significant amount of capital. As time elapses, the pensioner population fragments into groups with varying levels of financial security, health, and ability to manage their own homes. It also splits into households populated by couples and single people. Accordingly, some Grey Perspectives will sustain an active lifestyle for longer than others. Some will maintain substantial homes and gardens, while others will survive on modest incomes in estates of seaside bungalows. The more frail and elderly will retreat to the security of a seaside apartment. These neighbourhoods occur in various forms: seaside bungalows, suburban apartments, inner city 'mansion blocks', pretty rural villages, and large blocks on the esplanade looking out to sea. High amenity value, good order and low crime levels are common characteristics of these environments. These people support traditional views, activities and brands, and respond to advertising with clearly stated benefits rather than heavy lifestyle content. They are proud to buy British and appreciate products with a strong regional, heritage or craft-based proposition. They like to purchase faceto-face from people they trust. Grey Perspectives have complex financial needs.
3.6% of BEN Population predominantly in: •Sutton Vesey •Sutton New Hall •Sutton Four Oaks
Vital Signs
Vital Signs •
•
Whilst there doesn’t appear to be any strict guidance on how the vital signs will be measured DFI felt they could again add value here both for the PCT and the Programme and have baselined the following vital signs: • All-age all-cause mortality rate per 100,000 population (VSB01) • Mortality rate from all circulatory diseases at ages under 75 (VSB02) • Mortality rate from all cancers at ages under 75 (VSB03) • Mortality rate from causes considered amenable to healthcare (VSC30) • Hospital admissions for alcohol related harm (VSC26) • Hospital admissions by unintentional and deliberate injuries to children and young people (VSC29) We have done this using ONS death data and SUS data
VSB01 – All age all cause mortality rates per 100,000 population •
Direct age-standardised mortality rates per 100,000 population from all causes at all ages
•
Data source: ONS: death registrations, years 2004-2006
•
Good proxy for life expectancy
•
Implemented in Local Delivery Plans
•
Mandatory indicator in Local Area Agreements
VSB01 - All age all cause mortality rates per 100,000 population Years 2004-2006 BE N PC T S olihull P C T W olverhampton P C T B lac kburn with D arwen P C T B radford and Airedale T eac hing P C T S outh B irmingham P C T O ldham P C T W es t Midlands S HA E ngland
Male 824 740 924 1005 861 860 957 401 724
F emale 548 599 677 713 584 531 727 243 507
VSB02 - Mortality rate from all circulatory diseases at ages under 75 per 100,000 population •
Direct age-standardised mortality rates per 100,000 population aged under 75
•
Deaths from all circulatory diseases, classified by cause of death (ICD 10 I00-I99)
•
Data source: ONS: death registrations, years 2004-2006
•
Circulatory disease is another main causes of premature death
•
Reducing mortality rates will therefore make a significant contribution to increase life expectancy
VSB02 - Mortality rate from all circulatory diseases at ages under 75 per 100,000 population Years 2004-2006 Male BEN PCT Solihull PCT Wolverhampton PCT Blackburn with Darwen PCT Bradford and Airedale Teaching PCT South Birmingham PCT Oldham PCT West Midlands SHA England
Female 157 122 168 177 148 155 198 128 118
68 64 78 86 64 53 94 55 52
VSB03 - Mortality rate from all cancers at ages under 75 per 100,000 population •
Direct age-standardised mortality rates per 100,000 population aged under 75
•
Deaths from all malignant neoplasms, classified by cause of death (ICD 10 C00-C97)
•
Data source: ONS: death registrations, years 2004-2006
•
Cancer is one of the main causes of premature death
•
Reducing mortality rates will therefore make a significant contribution to increase life expectancy
VSB03 - Mortality rate from all cancers at ages under 75 per 100,000 population Years 2004-2006 Male BE N PC T S olihull P C T W olverhampton P C T B lac kburn with D arwen P C T B radford and Airedale T eac hing P C T S outh B irmingham P C T O ldham P C T W es t Midlands S HA E ngland
149 138 171 168 149 161 148 134 130
F emale 110 143 140 138 111 108 154 105 105
VSC30 - Mortality rate from causes considered amenable to healthcare •
Direct age-standardised mortality rates per 100,000 population aged under 75
•
Deaths from a range of causes for specific age groups, including
•
Tuberculosis; Whooping cough; Measles; Malignant neoplasms of colon, skin, breast, cervix, prostate; Influenza; Other infectious diseases.
•
Data source: ONS: death registrations, years 2004-2006
•
Measure is to assess impact of healthcare interventions on mortality rates from causes which are amenable to treatment using those interventions
•
To give an indication of progress against tackling ‘premature’ and ‘preventable’ mortality.
VSC30 - Mortality rate from causes considered amenable to healthcare per 100,000 population Years 2004-2006
BEN PCT Solihull PCT Wolverhampton PCT Blackburn with Darwen PCT Bradford and Airedale Teaching PCT South Birmingham PCT Oldham PCT West Midlands SHA England
Male 173.6 134.7 191.2 194.3 165.9 173.0 209.3 140.1 128.0
Female 104.7 110.0 124.2 120.6 99.8 87.5 147.1 90.8 85.5
VSC26 – Hospital admissions for alcohol related harm per 100,000 population •
Direct age-standardised admission rates per 100,000 population
•
All admissions with considered attributable to alcohol, according to Department of Health review Alcohol-attributable fractions for England
•
Data source: SUS-CDS: April 2007 – March 2008
•
Measure is to assess the impact of prevention interventions i.e. when prevention interventions are improved, hospital admission for specific chronic and acute conditions should slow in the short, medium and long term
VSC26 – Hospital admissions for alcohol related harm per 100,000 population Male
Female
BEN PCT
2161
1170
Solihull PCT
1704
926
Wolverhampton PCT
2357
1059
Blackburn with Darwen PCT
3061
1316
Bradford and Airedale Teaching PCT
2266
1227
South Birmingham PCT
2375
1136
Oldham PCT
2473
1175
West Midlands SHA
2099
1055
England
2059
987
VSC29 - Hospital admissions caused by unintentional and deliberate injuries to children and young people •
Admissions for patients under 19 years with an external cause of morbidity or mortality per 10,000 population
•
All admissions with an external cause of morbidity or mortality in the range ICD10 V01-Y98
•
Excluding X33-X39 and X52 as unlikely to be influenced by Government
•
Important to cross reference with Insight Referral Tool on A&E admissions by Practice for Children and A&E attendance as a wholefrom a demand management and Safeguarding Children’s perspective
•
Data source: SUS, April 2007 – March 2008
VSC29 - Hospital admissions caused by unintentional and deliberate injuries to children and young people April 2007 – March 2008
PCT BEN Solihull Wolverhampton PCT Blackburn with Darwen PCT Bradford and Airedale Teaching PCT South Birmingham PCT Oldham PCT West Midlands England
Males Females per per Total per 10,000 10,000 10,000 PCT Male Female Total pop pop pop 5PG 764 561 1325 151 115 133 TAM 351 235 586 133 95 114 5MV 315 212 527 102 74 88 5CC 370 267 637 167 127 148 737 5NY 1205 1942 169 107 139 5M1 517 410 927 108 88 98 5J5 386 279 665 122 94 108 Q34 9064 6355 15419 131 96 114 83588 56178 139766 132 93 113
Childhood Weight Issues
Childhood Obesity National Child Measurement Programme – 2008
Counts BMI Description Servere malnutrition Moderate malnutrition Mild malnutrition Healthy Overweight Obese Grand Total
Reception Year Six Grand Total Female Male Female Male 7 6 11 11 35 37 47 133 122 339 323 334 478 565 1700 919 1002 922 965 3808 625 676 477 450 2228 138 95 75 55 363 2049 2160 2096 2168 8473
Childhood Obesity – Reception (Aged 4-5 years) Severe malnutrition
Moderate malnutrition
Mild malnutrition
Healthy
Overweight
Obese
Acock's green
0.0%
3.8%
18.9%
28.3%
35.8%
13.2%
Bordesley Green
0.6%
3.0%
9.1%
45.1%
31.1%
11.0%
Erdington
0.0%
1.1%
15.9%
51.1%
29.5%
2.3%
Hodge Hill
0.3%
2.6%
13.8%
44.4%
29.7%
9.1%
Kingstanding
0.4%
3.9%
17.5%
48.4%
24.9%
4.9%
Shard End
0.5%
3.7%
23.5%
50.7%
20.7%
0.9%
Sheldon
0.0%
2.0%
18.6%
52.5%
23.5%
3.4%
South Yardley
0.8%
1.6%
15.8%
44.7%
31.6%
5.5%
Stechford & Yardley North
0.0%
2.1%
18.0%
49.1%
25.4%
5.3%
Stockland Green
0.0%
0.0%
17.4%
41.3%
33.3%
8.0%
Sutton Four Oaks
0.0%
1.3%
12.0%
42.2%
38.7%
5.8%
Sutton New Hall
0.6%
0.6%
10.7%
47.2%
34.0%
6.9%
Sutton Trinity
0.0%
1.4%
14.2%
45.0%
37.2%
2.3%
Sutton Vesey
0.0%
0.6%
12.4%
44.6%
36.2%
6.2%
Tyburn
0.4%
3.5%
18.4%
50.4%
23.8%
3.5%
Washwood Heath
1.0%
2.3%
14.5%
42.6%
33.8%
5.8%
Total
0.3%
2.0%
15.6%
45.6%
30.9%
5.5%
Ward
Childhood Obesity – Year 6 (Aged 10-11 years) Analysis by Ward of Residence Ward
Severe malnutrition
Moderate Mild malnutrition malnutrition
Healthy
Overweight
Obese
Acock's green
0.0%
14.0%
26.3%
42.1%
17.5%
0.0%
Bordesley Green
0.0%
4.1%
24.1%
45.5%
20.7%
5.5%
Erdington
0.0%
4.6%
26.4%
43.7%
22.3%
3.0%
Hodge Hill
0.3%
5.5%
24.4%
45.7%
21.6%
2.4%
Kingstanding
0.7%
7.5%
24.2%
47.1%
18.4%
2.0%
Shard End
0.4%
7.1%
27.6%
46.4%
18.0%
0.4%
Sheldon
1.1%
8.5%
21.6%
42.0%
18.8%
8.0%
South Yardley
0.0%
7.3%
29.3%
40.5%
20.7%
2.2%
Stechford & Yardley North
1.9%
3.8%
30.7%
45.3%
15.1%
3.3%
Stockland Green
0.0%
5.6%
24.4%
43.2%
23.5%
3.3%
Sutton Four Oaks
0.5%
3.1%
15.2%
49.7%
28.3%
3.1%
Sutton New Hall
0.0%
2.5%
18.2%
47.0%
27.8%
4.5%
Sutton Trinity
0.4%
3.5%
16.9%
42.7%
33.7%
2.7%
Sutton Vesey
0.0%
2.8%
23.5%
46.0%
23.9%
3.8%
Tyburn
0.3%
8.2%
28.7%
43.3%
17.1%
2.4%
Washwood Heath
0.3%
7.4%
24.7%
44.5%
19.5%
3.6%
Total
0.5%
6.0%
24.5%
44.3%
21.7%
3.0%
Childhood Obesity - Reception BMI Description Mosaic™ group
Severe Moderate Mild malnutrition malnutrition malnutrition
Blue Collar Enterprise Grey Perspectives Happy Families Municipal Dependency Suburban Comfort Symbols of Success Ties of Community Twilight Subsistence Unclassified Urban Intelligence Welfare Borderline Rural Isolation Grand Total
1 0 0 3 1 0 7 0 0 0 0 0 12
15 0 5 20 5 2 21 3 1 0 3 1 76
114 12 19 121 63 28 153 8 5 3 40 1 567
Healthy
Overweight
Obese
Grand Total
297 26 80 286 219 109 464 28 15 18 117 5 1664
163 19 64 160 162 105 318 9 4 9 73 2 1088
24 4 14 19 33 13 74 3 1 2 13 0 200
614 61 182 609 483 257 1037 51 26 32 246 9 3607
Healthy
Overweight
Obese
46.48% 38.52% 43.83% 45.75% 44.99% 44.58% 45.18% 53.61% 55.77% 56.25% 43.78% 58.82% 45.49%
23.16% 29.51% 28.87% 22.71% 28.94% 35.31% 25.74% 14.43% 17.31% 25.00% 25.36% 23.53% 25.94%
2.66% 8.20% 5.77% 3.43% 5.21% 4.02% 5.40% 3.09% 1.92% 3.13% 3.59% 5.88% 4.33%
BMI Description Mosaic™ group Blue Collar Enterprise Grey Perspectives Happy Families Municipal Dependency Suburban Comfort Symbols of Success Ties of Community Twilight Subsistence Unclassified Urban Intelligence Welfare Borderline Rural Isolation Grand Total
Severe Moderate Mild malnutrition malnutrition malnutrition 0.39% 0.00% 0.00% 0.41% 0.41% 0.17% 0.45% 1.03% 0.00% 0.00% 0.24% 0.00% 0.36%
5.09% 1.64% 3.15% 4.49% 3.68% 1.05% 4.05% 5.15% 1.92% 3.13% 4.31% 5.88% 3.94%
22.22% 22.13% 18.37% 23.20% 16.77% 14.86% 19.19% 22.68% 23.08% 12.50% 22.73% 5.88% 19.93%
Childhood Obesity – Year 6 BMI Description Mosaic™ group
Severe Moderate Mild malnutrition malnutrition malnutrition
Blue Collar Enterprise Grey Perspectives Happy Families Municipal Dependency Suburban Comfort Symbols of Success Ties of Community Twilight Subsistence Unclassified Urban Intelligence Welfare Borderline Rural Isolation Grand Total
4 0 0 2 3 1 2 1 0 0 1 0 14
50 2 7 35 31 4 60 2 0 2 15 0 208
170 15 51 163 101 57 231 14 7 5 55 0 869
Healthy
Overweight
Obese
Grand Total
297 21 87 274 221 146 440 24 14 18 66 5 1613
133 17 46 118 121 97 197 5 5 7 33 2 781
10 6 8 23 18 10 34 0 0 0 2 1 112
664 61 199 615 495 315 964 46 26 32 172 8 3597
Healthy
Overweight
Obese
44.73% 34.43% 43.72% 44.55% 44.65% 46.35% 45.64% 52.17% 53.85% 56.25% 38.37% 62.50% 44.84%
20.03% 27.87% 23.12% 19.19% 24.44% 30.79% 20.44% 10.87% 19.23% 21.88% 19.19% 25.00% 21.71%
1.51% 9.84% 4.02% 3.74% 3.64% 3.17% 3.53% 0.00% 0.00% 0.00% 1.16% 12.50% 3.11%
BMI Description Mosaic™ group Blue Collar Enterprise Grey Perspectives Happy Families Municipal Dependency Suburban Comfort Symbols of Success Ties of Community Twilight Subsistence Unclassified Urban Intelligence Welfare Borderline Rural Isolation Grand Total
Severe Moderate Mild malnutrition malnutrition malnutrition 0.60% 0.00% 0.00% 0.33% 0.61% 0.32% 0.21% 2.17% 0.00% 0.00% 0.58% 0.00% 0.39%
7.53% 3.28% 3.52% 5.69% 6.26% 1.27% 6.22% 4.35% 0.00% 6.25% 8.72% 0.00% 5.78%
25.60% 24.59% 25.63% 26.50% 20.40% 18.10% 23.96% 30.43% 26.92% 15.63% 31.98% 0.00% 24.16%
Recommended Metrics/Indicators • •
Severe and moderate malnutrition rates up to Year 6 (quarterly) Overweight and obese rates up to Year 6 (quarterly)
Additional Programme Dataset
Data theme identified
OMB Permission to analyse
Data gathered
Inequalities Analysis
OMB & SPB Sign Off
Measures Developed