1. South West Public Health Observatory Assessing the seasonal impact of tourism on emergency hospital admissions in the South West Roy Maxwell, Caroline Trotter, Davidson Ho, Mark Dancox, Paul Brown, Julia Verne

2. South West Public Health Observatory Tourism in the South West The South West region is the most popular destination for domestic visitors (estimated 23m domestic visits in 2003: mixture of business, family, holiday etc.) Within the region, Devon and Cornwall are the most popular counties (estimated 11.3m domestic visits in 2003) Coastal areas are a big tourist attraction (39% of visits were to the seaside in 2003) Visitor numbers to the region are highest in the summer source: www.swtourism.co.uk

3. South West Public Health Observatory Tourism and Health Large increase in the number of visitors may lead to increased pressure on health care resources Important to quantify impact of tourism on health care for service planning and provision

4. South West Public Health Observatory Data sources HES - hospital admissions Emergency admissions only –elective admissions unlikely to occur on holiday Analysis by month of admission Tourist = ‘non-resident’ –GOR of residence –Distance between place of residence and hospital

5. South West Public Health Observatory Seasonal pattern of emergency admissions in the South West Data source: Hospital Episode Statistics

6. South West Public Health Observatory Seasonal pattern of emergency admissions in the South West – non residents Data source: Hospital Episode Statistics

7. South West Public Health Observatory Region of residence versus distance from home Resident status People from the surrounding regions may be closest to a SW hospital People from Bristol may be tourists in Cornwall Distance from home Arbitrary cut-off point People further away from home more likely to be ‘tourists’

8. South West Public Health Observatory Detailed analysis Two largest hospital Trusts in region examined in more detail Gloucestershire Hospitals NHS Foundation Trust –Area of low tourist activity (7% of South West tourism) Royal Cornwall Hospitals Trust –High tourist activity (Cornwall 2 nd most popular county)

9. South West Public Health Observatory Courtesy of Lynne Kirkham Location of Royal Cornwall and Gloucestershire Foundation Trust hospitals

10. South West Public Health Observatory Gloucestershire versus Cornwall Total emergency admissions, 2002/03 Data source: Hospital Episode Statistics

11. South West Public Health Observatory Gloucestershire versus Cornwall Emergency admissions, 2002/03 Data source: Hospital Episode Statistics

12. South West Public Health Observatory Characteristics of ‘tourist’ emergency admissions in Cornwall, 2002/03, Age Data source: Hospital Episode Statistics

13. South West Public Health Observatory Characteristics of ‘tourist’ emergency admissions in Cornwall, 2002/03 (2) Chapter Data source: Hospital Episode Statistics

14. South West Public Health Observatory Discussion Impact of tourism on emergency admissions is variable within region In Cornwall, peak ‘tourist’ admissions coincide with peak tourism activity Is the increase in admissions proportional to the increase in population? –Risky behaviours or healthy tourists? What it the cost of emergency tourist admissions to the NHS Trust? What is the cost to the resident population?

15. South West Public Health Observatory Next steps Seasonal analysis for all hospital Trusts in the region Impact of tourism on primary care and A&E