1. 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

2. 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

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

4. Population and number of deaths

5. 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, , included in End of Life Care profile, 2015;
Index of Multiple Deprivation by LSOA, 2015

6. 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

7. 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

8. 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

9. 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

10. Mortality rate
Source: Compendium of Population Health Indicators, Health and Social Care Information Centre,

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

12. 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

13. Place of death

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

15. 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

16. 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

17. 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

18. Place of death – by GP practice

19. Place of death – by GP practice

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

21. Deaths among hospice patients

22. 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

23. 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

24. Deaths in hospital

25. 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

26. End of life care JSNA

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

28. 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

29. Find the full JSNA and technical document here:
Rianne van der Linde
London Boroughs of Hammersmith and Fulham Kensington and Chelsea Westminster