Data analysis to inform a JSNA on End of Life Care London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster Andrew Rixom, Senior Public Health Analyst Rianne van der Linde, Public Health Analyst Colin Brodie, Public Health Knowledge Manager Bridgette Moess, Commissioning Manager Jessica Nyman, JSNA Manager 18 February 2015 London public health knowledge and intelligence network

Outline JSNA process Population and number of deaths Place of death Deaths among hospice patients Deaths in hospital End of Life Care JSNA Questions and discussion

JSNA on End of Life Care - process Policy and evidence review Consultation and interviews Service mapping Technical document

Population and number of deaths

Population Young population Deprived areas (as other London boroughs) Percentage aged 65 years and over Deprived areas Index of multiple deprivation, 2015 Westminster Kensington & Chelsea Hammersmith & Fulham Source: Office for National Statistics, 2008-10, included in End of Life Care profile, 2015; Index of Multiple Deprivation by LSOA, 2015

Population Resident LA Resident CCG in the country West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington

Population GP GP Resident LA Resident CCG Registered in the country Residents who are registered Registered who are not resident Residents who are registered elsewhere Not resident and not registered in the country West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington GP GP There are therefore a number of different populations to examine

Population Resident LA Resident CCG Registered People may die anywhere the country e anywhere in the country West London CCG Westminster City Council Royal Borough of Kensington and Chelsea London Borough of Hammersmith & Fulham Hammersmith & Fulham CCG Central London CCG Queens Park and Paddington

Population Resident LA Resident CCG Registered People may die anywhere the country e anywhere in the country All deaths by LA residents (registered or not registered) that occurred inside or outside the three boroughs

Mortality rate Source: Compendium of Population Health Indicators, Health and Social Care Information Centre, 2011-13

Age at death Source: All deaths, Primary Care Mortality Database, 2014

Causes of death Cardiovascular disease deaths Cancer deaths Cold spot – fewer deaths Hot spot – more deaths Source: Deaths by LSOA, Primary Care Mortality Database, 2014

Place of death

Place of death Source: All deaths, Primary Care Mortality Database, 2014

Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% 18-28% 29-33% 34-43% 44-51% 52-60% Percentage of all deaths in usual residence Source: All deaths by wards, Primary Care Mortality Database, 2014

Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% Variation partly explained by: Care home beds 18-28% 29-33% 34-43% 44-51% 52-60% Percentage of all deaths in usual residence Care home beds Source: All deaths by wards, Primary Care Mortality Database, 2014

Place of death – variation in deaths in usual residence Percentage of deaths at home or in a care home ranges from 18% to 60% Variation partly explained by: Care home beds Higher death rate Older population Not significantly associated with median age at death, cause of death or deprivation Only 7% of the variation can be explained Care home beds Source: All deaths by wards, Primary Care Mortality Database, 2014

Place of death – by GP practice

Place of death – by GP practice

Place of death – by GP practice Source: Primary Care Mortality Database, 2014

Deaths among hospice patients

Deaths among hospice patients Percentage of all deaths that are hospice patients 12-22% 22-30% 30-36% 37-46% 46-72% Source: Deaths by patients of the three hospices (data provided by hospices) as a proportion of all deaths (Primary Care Mortality Database), Sept 2013 – Aug 2014

Deaths among hospice patients 2SD of deaths among patients of St Johns hospice 2SD of deaths among patients of Pembridge hospice 2SD of deaths among patients of Trinity hospice Source: Deaths by patients of the three hospices (data provided by hospices) as a proportion of all deaths (Primary Care Mortality Database), Sept 2013 – Aug 2014

Deaths in hospital

Deaths in hospital – activity before death in hospital Inpatient admissions A&E attendances Outpatient attendances 2 years before death Month before death Time (months) Source: Secondary Uses Service (SUS), deaths in 2014/15, activity in 2 years before death

End of life care JSNA

End of life care JSNA - Recommendations Policy and evidence review Consultation and interviews Service mapping Technical document

End of life care JSNA - Recommendations Care planning and co-ordination. 1 End of life care as ‘everybody’s business’ 2 Clear strategic leadership 3 Coordinated education and training programme 4 Easy access to evidence and information 5 Policy and evidence review Consultation and interviews Service mapping Technical document

Find the full JSNA and technical document here: http://jsna.info/endoflifecare Rianne van der Linde rvanderlinde@westminster.gov.uk London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster