Health & Healthcare in London Key Facts September 2006 Overview of LondonвЂ™s Health вЂў вЂў вЂў вЂў вЂў вЂў вЂў вЂў The geography of London LondonвЂ™s population and diversity Health determinants Key lifestyle issues Health inequalities Key health issues Health care use Health care resources LONDONвЂ™S GEOGRAPHY London Boroughs and Acute Trusts вЂў вЂў There are 33 Main Acute Trusts in London There are 31 Primary Care Trusts coterminous with all 32 London Boroughs LONDONвЂ™S POPULATION AND DIVERSITY Key Facts вЂў 7.5 million resident population in Greater London вЂў Highly ethnically diverse with 40% from an ethnic minority group (including White Irish and Other White minority groups) вЂў More than 90 different ethnic groups and 300 different languages spoken вЂў Largest religious groups are Christian, Muslim, Hindu, Jewish, Sikh and Buddhist вЂў Home to many refugees and asylum seekers вЂў Highly mobile (20-40% turnover on GP lists every year) вЂў 1 million daily commuters вЂў 13.1 million tourists every year LONDONвЂ™S POPULATION AND DIVERSITY Population Age Structure вЂў London is relatively young with 16 - 44 years olds accounting for 36.5% of the population compared to England average of 28%. London, 2005 90+ 85-89 80-84 75-79 70-74 вЂў The proportion of people of retirement age is the lowest of all regions (12 %) as wealthier people tend to move out of the Capital at retirement age. 65-69 Males 60-64 Females 55-59 50-54 45-49 40-44 35-39 вЂў Black and minority ethnic populations are relatively younger but are fast growing and ageing. There are large variations in the demographic structure of different ethnic groups. 30-34 25-29 20-24 15-19 10-14 5-9 1-4 <1 Source: ONS population estimates 2005 England average, 2005 Number of people . LONDONвЂ™S POPULATION AND DIVERSITY Population Growth 2200000 2000000 1800000 1600000 1400000 1200000 1000000 800000 600000 400000 200000 0 00-04 '05-15 16-29 30-44 45-64 65-74 75+ 1994 2004 2026 Year Source: GLA population projections вЂў вЂў вЂў вЂў LondonвЂ™s population increased by 550,000 (8%) between 1994 and 2004 LondonвЂ™s population is expected to increase by 600,000 (8%) by 2016, and by 900,000 (12%) by 2026. Only the 16-29 age group is projected to decrease in numbers by 2026 The 45-64 age group will increase by more than 500,000 (36%) by 2026 LONDONвЂ™S POPULATION AND DIVERSITY Number of people in each minority ethnic group, London 2001 Other Ethnic Group вЂў Almost 3 million Londoners are from an ethnic minority group (40% of the population). вЂў 45% of the England & Wales population from an ethnic minority group live in London. вЂў The largest minority ethnic group is White Other followed by Indian, Black African and Black Caribbean. вЂў The Black African group has more than doubled in the last ten years, and the number of Bangladeshis has increased by nearly three quarters since 1991. Chinese Black Other Black African Black Caribbean Asian Other Bangladeshi Pakistani Indian Mixed Other White & Asian White & Black African White & Black Caribbean White Other White Irish 0 100000 200000 300000 400000 500000 600000 700000 Number of people Source: Census 2001 LONDONвЂ™S POPULATION AND DIVERSITY HEALTH DETERMINANTS Health Determinants in London compared to England average This slide shows how London is doing in terms of the main socioeconomic influences on health Deprivation Air quality Poor quality housing вЂў Children in poverty вЂў GCSE achievement вЂў вЂў вЂў Violent crime Older people supported at home England Worst LA England Average England Best LA вЂў GCSE achievement is close to the England average More older people are supported to live at home, but 1/3 pensioners live in poverty. Violent crime is high. Air quality is poor. Over 40% of LondonвЂ™s children are living in poverty, much greater than average. Deprivation, including long term unemployment, is higher than average. HEALTH DETERMINANTS Inequalities in Health Determinants in London вЂў Within London there are wide inequalities in living conditions, and other socio-economic factors that have an influence on health. These inequalities exist between people living in different parts of London, between different ethnic groups, age groups and other groups. вЂў Over half of London boroughs are in the top 30% most deprived boroughs in England, and 24% of boroughs are in the top 10% most deprived, with nearly all boroughs having pockets of deprivation. вЂў Newham, Tower Hamlets and Hackney have some of the highest unemployment rates in the country, whereas other boroughs have rates well below average. вЂў The Bangladeshi population has the highest unemployment rate, and the White British the lowest. вЂў Educational (GCSE) attainment is highest in Chinese children and lowest in Black Caribbean children. вЂў People from a minority ethnic group are more likely to live in an unfit home than the White population. HEALTH DETERMINANTS KEY LIFESTYLE ISSUES Lifestyle influences on health in London compared to England average This slide shows how London is doing in terms of the lifestyle factors that influence health compared to nationally People who smoke вЂ“ Fewer people binge drink. Binge drinking вЂ“ More people eat healthy food. вЂ“ There are fewer obese adults, but London has higher rates of childhood obesity than the rest of England. Healthy eating вЂ“ Smoking levels are average. Obese adults England Worst LA England Average England Best LA KEY LIFESTYLE ISSUES Obesity вЂ“ key facts for London In London every year, obesity accounts for вЂў 4,000 deaths (7% of all deaths) : вЂ“ 300 deaths and 2,700 hospital admissions for cancers вЂ“ 450 deaths and 1,300 hospital admissions for stroke or raised blood pressure вЂ“ 600 deaths and 2,500 hospital admissions for angina or heart attack вЂ“ 250 deaths and 2,400 hospital admissions for diabetes вЂ“ 1,300 hospital admissions for osteoarthritis or gout вЂў Adult obesity is related to social class, and is higher among more deprived populations, particularly for women. вЂў London has higher rates of childhood obesity than the rest of England. KEY LIFESTYLE ISSUES Smoking in London вЂў Smoking is a major cause of cancer, respiratory disease, circulatory and ischemic heart disease. вЂў In London, smoking causes: вЂ“ more than 10,000 deaths each year (1 death/hour) вЂ“ 200 deaths per week among people aged 35 and over in London are attributable to smoking вЂ“ 46,000 hospital admissions and more than 400,000 bed days a year вЂў Smoking costs the NHS in London >ВЈ105 million a year. вЂў Least affluent populations are most likely to smoke. вЂў Highest smoking prevalence is amongst Bangladeshi, Turkish and Irish men. вЂў Over a million Londoners are affected by smoking in the workplace вЂў There are marked social inequalities in smoking rates between the most affluent (who smoke least) and the least affluent who are most likely to smoke. KEY LIFESTYLE ISSUES Percentage of all deaths attributable to smoking in London by PCT, 1998-2002 KEY LIFESTYLE ISSUES Alcohol in London вЂў On average Londoners drink less often and fewer drink above sensible levels compared to the England average. вЂў People on high incomes and the unemployed are most likely to drink above sensible levels and to binge drink. вЂў People from many ethnic minority groups are more likely to be non-drinkers. вЂў More Londoners are dependent alcohol users compared to England. вЂў The death rate due to alcohol in London is higher then nationally. вЂў Alcohol misuse impacts on health care at all levels. вЂў Alcohol consumption contributes significantly to the volume of injuries in London. HEALTH INEQUALITIES Life expectancy and causes of death This slide shows how London is doing in terms of the major killers It is estimated that compared to nationally Life expectancyMale Life expectancyFemale Premature deaths from smoking вЂ“ Premature deaths from heart disease and stroke вЂ“ вЂ“ Premature deaths from cancer Infant deaths вЂ“ Road injuries and deaths England Worst LA England Average England Best LA More people die prematurely from heart disease and stroke. More people are injured or die on the roads per kilometre travelled. Infant mortality, premature deaths from cancer and smoking, and life expectancy are all average in London. However, these figures mask wide inequalities between LondonвЂ™s Primary Care Trusts. HEALTH INEQUALITIES The life expectancy PSA target The PSA target for life expectancy aims to see faster health improvement compared to the average in the вЂњfifth of areas with the worst health and deprivation indicatorsвЂќ вЂ“ The Spearhead PCTs/LAs. The Spearhead LAs are indicated on this map. HEALTH INEQUALITIES Life expectancy in London, 2002-04 вЂў Male Female England 76.6 80.9 London 76.5 81.1 London Spearhead group Source: ONS 74.6 79.9 вЂў вЂў вЂў For males in 2002-2004, life expectancy in England was 76.6. This is very similar to the average for London, but 2.5% higher than in the London Spearhead Group. For females, life expectancy in England was 80.9, 1.3% higher than in the London Spearhead Group. These gaps have to be reduced by 10% for the life expectancy target to be achieved. London as a whole is on track to reach this target, but not all spearhead areas are on track. HEALTH INEQUALITIES Differences in Life Expectancy within a small area in London Travelling east from Westminster, each tube stop represents nearly one year of life expectancy lost Male Life Expectancy 77.7 (CI 75.5-79.9) Canning Town Female Life Expectancy 85.2 (CI 82.2-88.2) Male Life Expectancy 70.7 (CI 69.0-72.5) Westminster London Bridge River Thames Canada Bermondsey Water Female Life Expectancy 78.4 (CI 76.7-80.2) Canary Wharf North Greenwich Waterloo Southwark London Underground 1 Jubilee Line Electoral wards just a few miles apart geographically have life expectancy spans varying by years. For instance, there are eight stops between Westminster and Canning Town on the Jubilee Line вЂ“ so as one travels east, each stop, on average, marks nearly a year of shortened lifespan. 1 Source: Analysis by London Health Observatory using Office for National Statistics data. Diagram produced by Department of Health HEALTH INEQUALITIES Infant mortality rates (deaths < 1 year),1998-2002 вЂў вЂў вЂў вЂў The infant mortality PSA target aims for a reduction in the gap in mortality rate among those with fathers in the вЂњroutine and manualвЂќ groups and the population as a whole. This target is difficult to measure at local levels due to the small number of deaths involved. Within London as a whole the infant mortality rate is falling. There is more than a two fold differential in the infant mortality rates for different London boroughs. This differential can be measured as a proxy for the PSA target. SPECIFIC HEALTH ISSUES IN LONDON Key Facts вЂў вЂў вЂў вЂў вЂў вЂў вЂў London has highest number of new diagnoses of sexually transmitted infections (STI) out of all regions. London has the second highest teenage pregnancy rate out of all regions. London accounts for 57% of HIV infections in the UK. London has significantly higher demand for mental health services than England, and specifically for people with severe Mental Health problems. London has the highest tuberculosis (TB) rate out of all regions and the number of cases per 100,000 population rose from 32 per 100,000 population in 1999 to 48 per 100,000 in 2005. Many diseases such as tuberculosis, diabetes, HIV, renal disease and coronary heart disease are more common in specific ethnic groups who are more commonly resident in London. The prevalence of problem drug use is estimated to be higher in London than average for England. SPECIFIC HEALTH ISSUES - SEXUAL HEALTH Number of newly diagnosed STIвЂ™s reported from genitourinary (GU) clinics in London 1995 - 2003 25000 20000 Chlamydia 15000 Gonorrhoea Herpes 10000 Warts 5000 0 1995 1996 1997 1999 1999 2000 2001 2002 2003 Source: HPA вЂў вЂў вЂў вЂў Chlamydia diagnoses have more than doubled since 1995 and are highest in the young. Syphilis diagnoses have sharply increased in London since 1999. The presence of STIs can facilitate HIV transmission. 68% of people in London obtain an appointment with GU clinics within 48 hours, compared with the target of 100% by 2008. SPECIFIC HEALTH ISSUES - SEXUAL HEALTH HIV - a growing burden in London вЂў London accounts for 57% of infections in the UK. вЂў In 2003 вЂ“ 3190 new infections diagnosed in London. вЂў In 2003 вЂ“ estimated 27% of HIV infections may be undiagnosed (8,600 Londoners). вЂў Nearly all new heterosexual HIV infections have been among Black Africans вЂ“ three quarters acquired in Africa. вЂў Men who have sex with men are the largest group to have acquired infection in this country. вЂў Sharpest increase is in heterosexual transmission. вЂў 2.9% of injecting drug users contacting specialist services in London have HIV infection (higher than elsewhere). SPECIFIC HEALTH ISSUES вЂ“ SEXUAL HEALTH Teenage Pregnancy Source: TPU, DfES, 2006 вЂў Teenage Pregnancy (TP) are all conceptions to women aged <18 years of age. вЂў In 2004 the London TP rate was 48.1/1000 females aged 15-17 compared with 41.5/1000 nationally with the highest number of TP occurring in deprived areas. вЂў Rates have fallen recently in 19 boroughs but large increases in 6 boroughs. SPECIFIC HEALTH ISSUES вЂ“ MENTAL HEALTH Mental Health вЂў вЂў вЂў вЂў Estimated 1 million London residents experienced a common mental health problem during 2003. The most common cause of death of young men under 35 is suicide and London is not on track to meet the suicide target of a 20% reduction in overall suicide rates by 2010. Mental health problems are more prevalent in deprived areas Significantly higher demand for mental health services than England, and specifically for people with severe mental health problems вЂ“ вЂ“ вЂ“ вЂ“ вЂ“ вЂ“ вЂ“ вЂ“ Higher admission rates Higher proportion of inpatients with sever mental illness Higher occupancy rate despite more beds Higher use of forensic beds Highest rate of compulsory admissions Higher crude caseload rates in some community services Highest spend on mental health services Large populations at risk of mental health problems e.g. asylum seekers SPECIFIC HEALTH ISSUES вЂ“ TUBERCULOSIS (TB) London sector TB rate per 100,000 resident population Source: HPA London Regional Unit, 2006 вЂў вЂў вЂў London tuberculosis (TB) rate per 100,000 population rose from 32/100,000 in 1999 to 48/100,000 in 2005. Nationally 70% of newly diagnosed cases in 2004 were among foreign born populations. In London the highest number of new cases occurs among the Asian and Black African populations. G re e n w ic h E a lin g L a m b e th K in g s to n u p o n T h a m e s 100 H a v e rin g B e x le y W e s tm in s te r, C ity o f R ic h m o n d u p o n T h a m e s S u tto n B a rk in g a n d D a g e n h a m M e rto n W a lth a m F o re s t B ro m le y H a m m e rs m ith a n d F u lh a m B a rn e t H a rro w C am den C ro y d o n K e n s in g to n a n d C h e ls e a Source: Compendium of Clinical Indicators R e d b rid g e W a n d s w o rth S o u th w a rk E n fie ld B re n t Is lin g to n L e w is h a m H o u n s lo w H illin g d o n H a rin g e y N ew ham H ackney T o w e r H a m le ts S ta n d a rd is e d M o rta lity R a tio (S M R ) . SPECIFIC HEALTH ISSUES вЂ“ ETHNICITY Mortality from diabetes by London Borough 250 200 150 London E n g la n d 50 0 There are wide inequalities in mortality from diabetes, boroughs with large populations from ethnic minority groups such as Tower Hamlets, Hackney and Newham have the highest rates. HEALTH CARE USE Total QOF points scored for coronary heart disease 2004-05 by PCT in London вЂў вЂў This map shows points achieved under the Quality and Outcomes Framework for PCTs in London in 2004/05. Lighter shaded areas are performing better than others. Source: QPID HEALTH CARE USE Age standardised admission rates by PCT, April 2005-September 2005 K e n s in g to n A n d C h e ls e a W e s tm in s te r C am den B re n t R ic h m o n d A n d T w ic k e n h a m W a n d s w o rth H a rro w H a m m e rs m ith A n d F u lh a m B a rn e t L a m b e th C ro yd o n R e d b rid g e S o u th w a rk Is lin g to n W a lth a m F o re s t K in g s to n H a rin g e y H a ve rin g E a lin g T o w e r H a m le ts H o u n s lo w B a rk in g A n d D a g e n h a m G re e n w ic h B ro m le y C ity A n d H a c k n e y E n fie ld H illin g d o n B e x le y L e w is h a m N ewham 0 5000 10000 15000 20000 A g e s ta n d a rd is e d a d m is s io n ra te Source: Hospital episode statistics 25000 30000 HEALTH CARE USE Healthcare Commission Inpatient Survey 2004 Londoners are less satisfied with the NHS; BME patients are particularly dissatisfied NB risks of Patient Choice. Source: Healthcare Commission Patient Survey Potential Bed days saved based on national mean Top 50 HRGs by Trust Acute Specialist Small Acute London Large Large Medium Acute Multi- Acute London Service London Acute Teaching London 0 RJZ RNJ RAL RRV RJ7 RQN RJ1 RQM RJ5 RF4 RV8 RVL RVR RG2 RGC RJ6 RAX RJ2 RG3 RAS RQX RGZ RKE RAP RNH RC3 RFW RAN RPY RT3 RP4 RP6 HEALTH CARE USE Length of Stay 5,000 10,000 15,000 20,000 25,000 30,000 35,000 40,000 45,000 KingвЂ™s/BartвЂ™s Whipps Cross In 2004-5 there were about 800,000 excess bed days, or 2,100 excess beds, in London hospitals compared to the national mean, with a Reference Cost value of ВЈ216 million. This represents over 13% of all bed days. Most were in acute teaching or small acute trusts. Source: Admitted patient care data for London October 2004 вЂ“ September 2005 HEALTH CARE RESOURCES Wanless underestimates likely growth? While population changes will have some impact on resources and financial stability, this will be largely compensated for by the Resource Allocation Formula, although time lags may cause problems in rapidly growing PCTs. Future pressures on resources will above all be critically dependent on the proportion of GDP allocated to healthcare, and demand for that care. HEALTH CARE RESOURCES 2 0 0 3 -4 & 2 0 0 4 -5 E x p e n d itu re P e r 1 0 0 ,0 0 0 U n ifie d W e ig h te d P o p u la tio n ВЈ 1 4 0 ,0 0 0 ,0 0 0 ВЈ 1 2 0 ,0 0 0 ,0 0 0 ВЈ 1 1 0 ,0 0 0 ,0 0 0 2 0 0 3 -0 4 2 0 0 4 -0 5 ВЈ 1 0 0 ,0 0 0 ,0 0 0 ВЈ 9 0 ,0 0 0 ,0 0 0 n d o tr y y n o u L E C ck la & B N s ee o V al n le te r ex in g D B u o C ir n m ty cs ei L am u G rh re rt o ,N h h at am er & T M & an ch es ss an E tl R u ed M & ts an t en K d ay t w re ir T sh rd o e ir sh p S h ro C n e e t id ta S & e ir es h ff er se m o S M & & et rs h o ys er rc ir o W & s er H se s e e ir sh rd o tf ef er H & W ar s, e y, rd tr n ve C o sh ca an & a ri sh ir b u C fo ed B D h in L N L & s rk o Y m E & N cs t d f O le Is & e ir sh p am H W la E o ll Y A W vo ig n ir g n rk sh su le en in al V P es S W e la y s i lt e cs n T lo ,G h u Y S am & W sh rk o S & ir ex r u ss ea s b W e rr u d n S A b m ey yn ,T o ff u er la ,S u & C & L lk al tr C lk o rf o h rt o N n d n o o L E en S N N am o o n n d d o n o n d o n L o L W W S n ВЈ 8 0 ,0 0 0 ,0 0 0 N S p e n d /1 0 0 ,0 0 0 ВЈ 1 3 0 ,0 0 0 ,0 0 0 The SHA will need to ensure that PCTs in affluent areas reduce demand for healthcare, and that, in order to meet the health inequalities life expectancy target, NHS resources are directed proactively (as their populations will not demand them) to deprived areas and Spearhead PCTs to find new cases of disease and reduce disease risks. SUMMARY OF LONDONвЂ™S KEY HEALTH CHALLENGES вЂў Ethnically diverse population with high mobility and population growth вЂў London as a whole has average mortality rates and life expectancy, however it has high rates of premature mortality from heart disease and stroke, and wide inequalities between boroughs/PCTs вЂў Key lifestyle issues such as obesity, smoking and alcohol are contributing to poor health in LondonвЂ™s more deprived areas вЂў London has high rates of teenage pregnancy and sexually transmitted infections such as HIV вЂў The incidence of tuberculosis is rising and is more common among ethnic minority groups вЂў London has significantly higher than average demand for mental health services, particularly for people with severe mental illness and is not on track to meet the required suicide reduction target. SUMMARY OF LONDONвЂ™S HEALTH CARE CHALLENGES вЂў Primary care services are performing relatively poorly. вЂў Length of stay is excessive in many hospitals. вЂў Londoners are more dissatisfied with the NHS, especially those from BME groups. вЂў 4/5 sectors are overspending, partly because of demanding populations and providers. вЂў NE London has low demand and spending- primary care resources should be proactively developed to reduce inequalities.