NHS Next Steps Review Initial Briefing Materials on Staying Healthy

1
NHS Next Steps Review Initial Briefing
Materials on Staying Healthy
CONFIDENTIAL
Draft
3 October 2007
2
Introduction to this regional briefing

• This briefing is intended to act as an
  introductory overview for the clinical group
• It reviews the current situation in this clinical
  area across the West Midlands, outlines selected
  parts of a case for change, and provides some
  examples
• This briefing is intended as the start of a wider
  process and as a helpful dialogue
• It aims to be fully consistent with the NHS West
  Midlands strategy document Investing for Health
  which also provides useful material in this
  clinical area

Purpose
Fit with national briefing materials

• The Department of Health (DH) has produced a
  separate introductory briefing that covers
• Key national facts and figures on this clinical
  area
• An overview of the evidence base on good practice
  in this area
• National or international case studies of
  successful work
• We have designed this regional briefing to avoid
  overlap with the DH materials, by focusing on
• Presenting the regional situation
• Starting to develop the case for change
• Putting forward some local examples of good
  practice or innovation

• This document points out some significant
  variations across the West Midlands and compares
  the West Midlands with other regions
• Understanding the root causes of regional
  variations can help identify best practices and
  improve outcomes across the health economy
• In a region such as the West Midlands, variations
  in practice or outcomes are typically not caused
  by resource availability
• Understanding what really drives this variation
  is likely to surface a number of improvement
  opportunities that can be taken forward by the
  clinical group

Interpreting regional variation
3
Introduction to this regional briefing (cont.)

• The document therefore contains the following
  parts
• Current situation across all clinical areas The
  challenges facing the West Midlands health
  services as a whole, across all clinical areas
• Current situation in this clinical area The
  starting point for this clinical area
  specifically, covering questions such as access,
  investment, inequalities and outcomes
• Case for change Selected issues with current
  common practice in the West Midlands
• Vision for the future Examples of successful
  work in the West Midlands to date, and some
  questions on the future path of services that
  your group may wish to consider.

Structure of this document
Further development

• NHS West Midlands intends this to be the start of
  a dialogue
• In particular, if you believe that some analyses
  in this document are misleading or incorrect,
  then we would welcome it if you would provide us
  with more appropriate, up-to-date or accurate
  information

4
Contents

• Executive summary
• Current situation
• Challenges facing the West Midlands health system
• Current situation in Staying Healthy
• Case for change
• Vision for the future

5
Executive summary Staying Healthy

• The West Midlands health system faces 7
  challenges outlined in Investing for Health
  widening inequalities, variability in quality and
  safety, services that are difficult to navigate,
  low public confidence, too little prevention, low
  return on investment, and cost pressures
• Within Staying Healthy we note that
• Life expectancy in the West Midlands is close to
  the national average
• Significant variations are seen by local
  authority and very wide variations by ward,
  which are correlated with deprivation
• Social drivers for health vary widely and may
  explain some of these differences
• Performance on smoking and drinking is in line
  with the English average but could be improved
  and obesity and diabetes are real issues
• West Midlands region does mostly well at
  screening and immunisation, though again there
  are some important differences within the region
• Financial pressures and competing priorities
  meant that most PCTs did not allocate full value
  of Choosing Health monies to public health and
  health promotion

Current situation
Case for change

• We identify three aspects of the case for change
  in the West Midlands
• GPs are vital to successful Staying Healthy
  interventions, but the most needy areas have too
  few GPs and practices are frequently too small
• Prevention initiatives can have poor access and
  variable success rates and relevant data are not
  always measured
• Obesity is a major and rising issue for the
  region, but the appropriate range of
  interventions is unclear and insight into the
  problem is patchy

Vision for the future

• Examples of good practice and innovation exist in
  the region, such as choice in smoking cessation
  approaches, local innovations such as LifeCheck
  to address the need for accessible health
  information, and using Health Trainers to target
  deprived communities with personalised lifestyles
  advice and access to services
• There are therefore several questions about the
  future direction for the clinical group to
  consider, including
• What are the key issues for you?
• What goals should be prioritised?
• What best practices/innovations have you seen?
  Are there barriers to implementing them?
• What is your vision for the future?

6
Contents

• Executive summary
• Current situation
• Challenges facing the West Midlands health system
• Current situation in Staying Healthy
• Case for change
• Vision for the future

7
The West Midlands health system faces 7 challenges
Challenge
1
Outcomesand quality
Widening inequalities
Despite improvements in overall health status,
inequalities in health have widened
2
There remains an unjustifiable variability in the
quality and safety of services and individual care
Variability in quality and safety
3
Patientfocus
We do not always help patients to navigate the
system
Difficult to navigate
4
Low public confidence
The public, our customers have little
confidence that their local NHS will get better
5
Too little prevention
We are not achieving enough in prevention
Investmentfocus
6
We spend substantial amounts of resources on
clinical activities where there is little return
on investment in terms of improved health, or
where there are more cost-effective alternatives
Low return on investment
7
Cost
The rate of cost pressures arising from doing
more of the same outstrips any conceivable rate
of increased funding
Cost pressures and opportunity costs
Source Investing for Health
8
Inequalities in health are significant
471
1
Deprivation index (IMD)
Standardised years of life lost per 10,000
population
200305 pooled
2004 ward-based figures
Warwickshire
Worcestershire
Shropshire
South Staffs
Herefordshire
Solihull
North Staffs
Telford Wrekin
Dudley
West Mids average
Coventry
Walsall
Wolverhampton
Stoke on Trent
Sandwell
S Birmingham
Heart of Birmingham
Birmingham E N
England average
Standardised YLL rate is the number of years
of life lost divided by the age-standardised
resident population aged under 75 years. The
age-standardised rate is the rate of events that
would occur in a standard population if that
population were to experience the age-specific
rates of the subject population Source National
Centre for Health Outcomes Development
9
and have widened in recent years
1
Gap between highest and lowest life expectancy,
West Midlands, years
84
Female highest
82
3.8 years
80
Female lowest
3.3 years
78
Male highest
76
4.9 years
74
4 years
Male lowest
72
19911993
9294
9395
9496
9597
9698
9799
982000
9901
200002
0103
0204
20032005
Source National Centre for Health Outcomes
Development
10
There remains an unjustifiable variability in the
quality and safety of services and individual care
90
2
STROKE EXAMPLE
Equal to or above national average
Below national average
2006 audit
Patients treated in a stroke unit,
Emergency brain scan within 24 hours of stroke,
Screening for swallowing disorders within 24
hrs of admission,
Trust (Site)
Burton Hospitals
Dudley Group of Hospitals
George Eliot
Good Hope Hospitals
Heart of England
Hereford Hospitals
Mid Staffordshire General Hospitals
Royal Wolverhampton Hospitals
Sandwell and W Birmingham (City Hospital)
Sandwell and W Birmingham (Sandwell District
Hospital)
Shrewsbury Telford Hospital
University Hospital Birmingham
South Warwickshire General Hospitals
N/A
100
South Worcestershire PCT
University Hospital North Staffordshire North
Staffords
UH Coventry and Warwickshire (St Cross Rugby)
UH Coventry and Warwickshire (Walsgrave Hospital)
Walsall Hospitals
Worcestershire Acute Hospitals (Alexandra H,
Redditch)
Worcestershire Acute Hospitals (Worcester Royal
Hospital)
62
66
42
National average
International evidence indicates maximum of 3
hours is preferred
England, Wales and Northern Ireland Source T
he National Sentinel Audit of Stroke 2006,
February 2007
11
We do not always help patients to navigate the
system
129
3
are serious in the West Midlands and result in
high emergency admissions rates
Issues with providing joined-up care for asthma
Standardised emergency hospital admissions for
asthma, 2004. Average admission rate 100

• In England
• 1 in 4 people with asthma are not offered or do
  not have a routine asthma review
• More than three-quarters of all adults and
  children with asthma (82 and 75 respectively)
  do not have written personal asthma action plans
• 12 of people who had experienced an asthma
  attack requiring emergency care do not know what
  to do during an asthma attack, and 16 do not
  know what to do after an attack
• People who do not have a written personal asthma
  action plan are four times more likely to have an
  asthma attack requiring hospital treatment than
  those with a plan

East
South East
South West
London
East Midlands
North East
West Midlands
Yorkshire andHumberside
North West
Source The Asthma Divide, Asthma UK, 2007
12
The public, our customers have little
confidence that their local NHS will get better
32
4
Thinking about the health services in your area,
do you expect them to . . .?
dont know
. . . get much better
. . . get much worse
11
2
. . . get better
29
. . . get worse
. . . stay about the same
Source Ipsos MORI Survey for NHS West Midlands
August and September 2006 3,555 responents
13
We are not achieving enough in prevention
18
5
Smoking cessation success rate
Women smoking during pregnancy
06/07, of people who set a quit date who
successfully stopped smoking
2005/06, of births
Telford And Wrekin
Shropshire County
Birmingham E N
South Birmingham
South Staffordshire
Heart Of Birmingham
Worcestershire
Solihull Care
Coventry
West Mid Avg
Dudley
Herefordshire
North Staffordshire
Warwickshire
Walsall
Stoke On Trent
Wolverhampton City
Sandwell
National average
53
15.9
Source The Information Centre for Health and
Social Care, Healthcare Commission Annual Health
Check
14
We continue to spend substantial amounts of
resources on clinical activities where there is
little return on investment in terms of improved
health, or where there are more cost-effective
alternatives
121
6
Improvement opportunity from bringing
standardised surgery rate for 5 procedures down
to that of lowest quartile
Relative level of surgery
HRG cost, annualised, 000
Actual vs. expected rate
105
Warwicks
109
S Staffs
91
Worcs
118
S Bhm
109
Sandwell
83
Bhm E N
81
Coventry
89
Solihull
69
H of Bhm
Total opportunity for five procedures in 13 PCTs
9.5m
64
Wolverhampton
79
Shropshire
68
Dudley
75
Telford Wrekin
Four PCTs excluded owing data quality or lack
of data supplied Myringotomy, hysterectomy,
lower back surgery, tonsillectomy, and dilation
and curettage. Selected because evidence-based
thresholds for when the surgery is likely to be
effective are sometimes ignored Given the
PCTs population base. 100 expected, under 100
lower than expected, over 100 higher than
expected. Figures are across all five procedures,
and so a PCT with under 100 overall can
nonetheless have savings potential as it is over
100 in one or more procedures. Source NHS
Better Care, Better Value Indicators
15
The rate of cost pressures arising from doing
more of the same outstrips any conceivable rate
of increased funding
9
7
PCT allocations, W Midlands
Annual growth rate, nominal

• Cost of inpatient activity in the region has
  grown at around 10 annually in recent years
• This has been manageable given the significant
  funding increases seen since the release of the
  NHS Plan
• In the future the funding settlement is likely to
  be tighter and so similar rates of activity
  increase will not be sustainable

5
Cost of inpatient activity, W Midlands
Annual growth rate, nominal
10
10
99/0005/06
05/0611/12
Assumes 2.5 real increase above GDP
deflator Assumes continuation of historical
rate of activity growth of 6 p.a. and 4 p.a.
tariff inflation Source DH HES
16
Contents

• Executive summary
• Current situation
• Challenges facing the West Midlands health system
• Current situation in Staying Healthy
• Case for change
• Vision for the future

17
This section sets the context for Staying Healthy
in the West Midlands

• Life expectancy in the West Midlands is close to
  the national average

18
Life expectancy in the West Midlands at an
aggregated level is close to the national average
0
200305
Male life expectancy, years
Female life expectancy, years
SHA
South Central
South West
East of England
South East Coast
East Midlands
London
West Midlands
Yorkshire The Humber
NW
North East
76.6
80.9
England average
Source NCHOD statistics
19
However, within the region there are significant
variations between local authorities (1/2)
76.8
Life expectancy male, years, 200305
74.8
1. Birmingham
77.6
2. Bridgnorth
3. Bromsgrove
77.8
75.5
4. Cannock Chase
75.4
5. Coventry
76.2
6. Dudley
76.2
7. East Staffordshire
77.6
8. Herefordshire
76.8
9. Lichfield
77.7
10. Malvern Hills
76.1
11. Newcastle-under-Lyme
77.5
12. North Shropshire
13. North Warwickshire
76.5
24
14. Nuneaton and Bedworth
76.1
25
11
15. Oswestry
77.9
16. Redditch
76.6
15
12
17. Rugby
76.7
23
74.4
18. Sandwell
7
77.3
19. Shrewsbury and Atcham
78.5
20. Solihull
28
19
77.8
21. South Shropshire
4
9
77.2
22. South Staffordshire
22
23. Stafford
77.4
29
31
27
2
24. Staffordshire Moorlands
76.9
21
18
73.7
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
78.5
14
27. Tamworth
77.7
34
20
76.6
28. Telford and Wrekin
5
3
17
29. Walsall
75.7
16
30. Warwick
78.0
30
10
31. Wolverhampton
75.1
32
8
33
32. Worcester
77.2
78.6
33. Wychavon
26
76.8
34. Wyre Forest
80.2
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
20
However, within the region there are significant
variations between local authorities (2/2)
86.2
Life expectancy female, years, 200305
80.1
1. Birmingham
81.8
2. Bridgnorth
81.3
3. Bromsgrove
80.2
4. Cannock Chase
80.6
5. Coventry
80.8
6. Dudley
80.6
7. East Staffordshire
82.4
8. Herefordshire
80.3
9. Lichfield
10. Malvern Hills
81.5
11. Newcastle-under-Lyme
81.1
12. North Shropshire
81.3
13. North Warwickshire
80.5
24
14. Nuneaton and Bedworth
80.0
25
11
15. Oswestry
81.9
16. Redditch
80.5
15
12
17. Rugby
80.3
23
18. Sandwell
79.4
7
81.9
19. Shrewsbury and Atcham
82.6
20. Solihull
28
19
82.4
21. South Shropshire
4
9
81.1
22. South Staffordshire
22
82.0
23. Stafford
29
31
27
2
81.0
24. Staffordshire Moorlands
21
18
79.1
25. Stoke-on-Trent
13
6
1
81.9
26. Stratford-on-Avon
14
80.3
27. Tamworth
34
20
80.8
28. Telford and Wrekin
5
3
17
80.7
29. Walsall
16
82.9
30. Warwick
30
10
80.0
31. Wolverhampton
32
8
33
81.2
32. Worcester
82.5
33. Wychavon
26
81.3
34. Wyre Forest
86.2
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
21
. . . as well as within each local authority
71

• Female life expectancy in Coventry by ward, years

82
Earlsdon
81
Bablake
81
Lower Stoke
80
Sherbourne
79
Cheylesmore
79
Wainbody
79
Westwood
79
Whoberley
77
Holbrook
77
Radford
77
Wyken
77
Upper Stoke
76
Binley Willenhall
76
Woodlands
Longford
75
74
Foleshill
72
Henley
St. Michaels
71
Source Office for National Statistics Annual
Mortality Extracts
22
These differences are closely correlated with
deprivation
11
Wards in Dudley

• Standardised mortality, all causes
• 19992003, (National Average 100)

Index of multiple deprivation 2000
Note r2 0.59 Source Neighbourhood
Statistics.gov.uk, Office of National Statistics
23
Social drivers for these differences include
income deprivation . . .
10.8
of residents on means-tested benefits, 2003
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
3.3
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
24
. . . homelessness . . .
9.1
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
0
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
25
. . . and the percentage of children in
low-income households
17.4
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
5.2
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
26
Much of the region performs worse than the
English average at GCSE results
38
England average
W Mids average
Children achieving 5 A-C grades at GCSE, 2004,
Solihull
Shropshire
Herefordshire
Worcestershire
Warwickshire
Birmingham
Dudley
Staffordshire
Telford Wrekin
Wolverhampton
Coventry
Stoke-on-Trent
Walsall
Sandwell
51
53
Source Choosing Health for the West Midlands,
West Midlands Public Health Group, 2006
27
Transport, especially access to a car, is one
root cause of health inequalities

• Around 653,000 households in the West Midlands
  region have two or more cars but there are also
  households with no car
• For example, 38 of the population in Birmingham
  do not have access to a car, compared with just
  135 households in Stratford-upon-Avon
• This may also reflect the greater need of
  households in rural areas for cars to access
  education, employment and leisure activities
• An example of access to goods and services that
  has a significant bearing on health inequalities
  is access to food that is nutritious, healthy and
  affordable
• Many people without cars face difficulties in
  buying a reasonable range of quality foods at
  affordable prices
• Research in the West Midlands into food access
  has shown that people who need to shop locally
  owing to mobility or transport difficulties have
  fewer choices of food and an even greater cost to
  pay
• It should be noted however that car journeys are
  less likely to enable to occupants to increase
  their physical activity levels for better health

Source Choosing Health for the West Midlands,
West Midlands Public Health Group, 2006
28
as is housing

• Levels of overcrowding in housing are associated
  with poor physical and mental health, and vary
  across the West Midlands region
• According to the 2001 census, 9.6 of houses in
  Birmingham were overcrowded, compared with 2.7
  in Bromsgrove
• Across the region, people from black and ethnic
  minority communities are on average over six
  times more likely to be in housing that is
  overcrowded than white households
• According to the English House Condition Survey,
  as many as 39 of the dwellings in the West
  Midlands region do not meet the Decent Homes
  Standards (i.e., are cold, damp, with inadequate
  heating and/or without adequate toilet
  facilities)
• Homeless people have poor life expectancies,
  similar to parts of the developing world, yet
  homelessness remains an issue in the region
• Steady rate of around 25,000 applications per
  year
• Disproportionately high homelessness rates
  amongst black and ethnic minority communities

Source Choosing Health for the West Midlands,
West Midlands Public Health Group, 2006
29
It is important to prioritise Staying Healthy
issues when considering progress against
interventions and outcomes
FOR DISCUSSION
Issues in Staying Healthy can be prioritised by
their importance and our ability to address them
EXAMPLE
High
Breast feeding
Questions to consider
Diet
Smoking

• How should different activities on Staying
  Healthy be prioritised?
• How does this prioritisation vary between
  segments?
• How do we ensure that evidence-based approaches
  and methodologies are used to address these
  areas?
• How can partners in other sector best be involved?

Exercise
Importance
Drinking
Sexual health
Low
Low
High
Ability to address
Measured by quality-adjusted life years
(QALYs) or similar metrics Source Team analysis
30
Performance on smoking across the region is in
line with or somewhat better than the English
average but needs to be improved
25.2
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
15.5
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
31
The same is true for binge drinking
16.1
Adults who binge drink, , modelled estimates
from the Health Survey for England, 2007
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
14. Nuneaton and Bedworth
15. Oswestry
16. Redditch
17. Rugby
18. Sandwell
19. Shrewsbury and Atcham
20. Solihull
21. South Shropshire
22. South Staffordshire
23. Stafford
24. Staffordshire Moorlands
25. Stoke-on-Trent
26. Stratford-on-Avon
27. Tamworth
28. Telford and Wrekin
29. Walsall
30. Warwick
31. Wolverhampton
32. Worcester
33. Wychavon
34. Wyre Forest
8.8
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
32
Issues with drug misuse generally in line with
the national average, except for the Birmingham
area and Stoke
7.6
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
1.3
No significance calculated for lower-tier
authorities Source Community Health Profiles
2007, APHO and Department of Health team analysis
33
Healthy eating is more mixed, with large
differences between most and least deprived areas
23.8
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
38.1
Five portions or more of fruit and vegetables
per day Source Community Health Profiles 2007,
APHO and Department of Health team analysis
34
The same is largely true of adults who take
physical activity
10.7
Physically active adults, , 200506
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
17.2
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
35
Performance on obesity is poor in most areas
25.1
Prevalence of obesity, , modelled estimates from
the Health Survey for England, 2007
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
14.6
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
36
This is mostly correlated with diabetes prevalence
3.7
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
2.1
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
37
Wide variations in deaths from smoking across the
region . . .
195.8
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
147.6
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
38
. . . also in early deaths from heart disease and
stroke . . .
44.9
Early deaths from heart disease and stroke,
directly age-standardised rate per 100,000
population under 75, 2003-05
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
44.9
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
39
. . . and early deaths from cancer
81.6
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
81.6
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
40
Teenage pregnancies are concentrated in local
authorities with larger numbers of poor children
40.5
Teenage pregnancies rate, crude rate per thousand
female population aged 1517, 200204
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
12.8
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
41
People feel in poor health in the Birmingham
area, Coventry, Telford and Stoke, and in good
health in most other areas
7.2
Adults feeling in poor health, directly
age-standardised , 2001
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
4.2
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
42
Wide variations in hospital stays due to alcohol
across the region
200.9
Hospital stays due to alcohol, directly age- and
sex-standardised rate per 100,000 population,
2005/06
1. Birmingham
2. Bridgnorth
3. Bromsgrove
4. Cannock Chase
5. Coventry
6. Dudley
7. East Staffordshire
8. Herefordshire
9. Lichfield
10. Malvern Hills
11. Newcastle-under-Lyme
12. North Shropshire
13. North Warwickshire
24
14. Nuneaton and Bedworth
25
11
15. Oswestry
16. Redditch
15
12
17. Rugby
23
18. Sandwell
7
19. Shrewsbury and Atcham
28
20. Solihull
19
21. South Shropshire
4
9
22. South Staffordshire
22
23. Stafford
29
31
27
2
24. Staffordshire Moorlands
21
18
25. Stoke-on-Trent
13
6
1
26. Stratford-on-Avon
14
34
27. Tamworth
20
5
28. Telford and Wrekin
3
17
29. Walsall
16
30. Warwick
30
10
32
31. Wolverhampton
8
33
32. Worcester
33. Wychavon
26
34. Wyre Forest
85.6
Source Community Health Profiles 2007, APHO and
Department of Health team analysis
43
West Midlands does mostly better than national
average at achieving breast cancer screening
coverage
83
West Midlands average
England average
South Worcestershire
Wyre Forest
Herefordshire
East Staffordshire
Rugby
Redditch and Bromsgrove
Cannock Chase
Staffordshire Moorlands
North Warwickshire
Dudley South
South Warwickshire
Solihull
South Western Staffordshire
Newcastle-Under-Lyme
Shropshire County
North Birmingham
South Stoke
North Stoke
Dudley Beacon and Castle
South Birmingham
Walsall Teaching
Coventry Teaching
Wednesbury and West Bromwich
Rowley Regis and Tipton
Wolverhampton City
Oldbury and Smethwick
Telford and Wrekin
Burntwood, Lichfield and Tamworth
Eastern Birmingham
Heart Of Birmingham Teaching
78
76
Source NHS Information Centre
44
The same is true for cervical cancer screening
also
70
West Midlands average
England average
Burntwood, Lichfield and Tamworth
Staffordshire Moorlands
East Staffordshire
Shropshire County
Cannock Chase
South Western Staffordshire
South Warwickshire
Herefordshire
Newcastle-Under-Lyme
Solihull
Dudley South
South Stoke
North Stoke
North Birmingham
Telford and Wrekin
North Warwickshire
Redditch and Bromsgrove
Walsall
Dudley Beacon and Castle
Rugby
Wolverhampton City
South Birmingham
Heart Of Birmingham Teaching
Wyre Forest
Eastern Birmingham
Wednesbury and West Bromwich
Rowley Regis and Tipton
South Worcestershire
Oldbury and Smethwick
Coventry
70
72
Source NHS Information Centre
45
Variation in immunisation rates between PCTs can
be up to 10 percentage points
65
West Midlands average
England average
Proportion of those in relevant age group
immunised against key diseases,
Over 65s, Oct 2005Jan 2006



Children, by 2nd birthday, 200506
Diphtheria
Tetanus
MMR
Influenza
Former PCT
99
Staffordshire Moorlands
99
92
74
99
Newcastle-Under-Lyme
99
92
76
98
Redditch and Bromsgrove
98
88
76
98
Rugby
98
90
75
97
South Stoke
97
91
76
97
Cannock Chase
97
86
74
97
North Stoke
97
91
75
97
Dudley South
97
88
73
97
82
79
97
South Warwickshire
97
Burntwood, Lichfield and Tamworth
97
90
72
97
Shropshire County
97
86
76
97
85
72
97
South Western Staffordshire
96
87
74
96
Telford and Wrekin
96
Walsall
96
85
75
Heart of Birmingham Teaching
96
96
92
77
Wyre Forest
95
95
82
79
Solihull
95
95
84
75
East Staffordshire
95
95
88
70
North Warwickshire
95
95
83
74
North Birmingham
95
95
84
72
South Birmingham
95
95
86
73
Wednesbury and West Bromwich
95
95
80
67
Oldbury and Smethwick
94
94
81
67
Rowley Regis and Tipton
94
94
83
72
94
84
75
Dudley Beacon and Castle
94
93
81
73
Eastern Birmingham
94
Herefordshire
94
94
82
78
South Worcestershire
92
92
79
76
92
81
73
Wolverhampton City
92
91
79
71
91
Coventry
94
95
85
84
75
74
94
95
By pre-2006 PCT Source COVER HPA
46
Over half of PCTs spent less than their Choosing
Health allocation on public health and health
promotion
40
Choosing Health allocation 2006/07 and 2007/08, m
Sandwell
2.7
Heart of Birmingham
2.3
Stoke on Trent
2.0
Wolverhampton City
2.1
South Staffordshire
3.6
North Staffordshire
1.1
Herefordshire
1.1
Shropshire County
1.7
South Birmingham
2.6
Telford and Wrekin
1.0
Coventry
2.4
Walsall
2.1
Solihull
1.0
3.1
Birmingham East and North
1.9
Dudley
Note Not available for Warwickshire and
Worcestershire Source West Midlands analysis
47
Contents

• Executive summary
• Current situation
• Challenges facing the West Midlands health system
• Current situation in Staying Healthy
• Case for change
• Vision for the future

48
This section highlights 3 areas as part of a case
for change in the West Midlands

• GPs are vital to successful Staying Healthy
  interventions, but the most needy areas have too
  few GPs and practices are frequently small

• Prevention initiatives can have poor access and
  variable success rates and relevant data are not
  always measured

• Obesity is a major and rising issue for the
  region, but the appropriate range of
  interventions is unclear and insight into the
  problem is patchy

49
GPs are key to many interventions but the West
Midlands has fewer per head than the national
average
60
England average
Practitioners per 100,000 population, 30
September 2006, headcount
South West
North East
Yorkshire and the Humber
South Central
London
East Of England
South East Coast
North West
West Midlands
East Midlands
65
Excluding retainers and registrars Source NHS
Workforce Statistics NHS Information Centre
50
Wide variation in GP numbers by PCT
52
West Midlands average
England average
Practitioners per 100,000 population, 30
September 2006, headcount
South Birmingham
78
Herefordshire
77
Shropshire County
71
Worcestershire
70
67
Solihull Care Trust
66
Heart of Birmingham Teaching
Sandwell
65
64
Coventry Teaching
61
Dudley
60
Telford Wrekin
59
Birmingham East North
59
Warwickshire
59
Stoke on Trent
57
South Staffordshire
56
North Staffordshire
56
Wolverhampton City
52
Walsall Teaching
63
65


Excluding retainers and registrars Source NHS
Workforce Statistics NHS Information Centre
51
The literature indicates that there are
advantages to larger GP practices
Area of care
Summary of evidence
Reference

• Primary care management of CHD, hyper-tension and
  stroke

• Significantly higher average QOF scores found for
  high caseload vs low caseload practices in some
  areas (inverse relationship not found in any
  area)71.4 vs. 88.6 for referral of patients
  with newly diagnosed angina for exercise testing
  and/or specialist assessment
• 73.3 vs. 89.3 for patients whose CHD and LVD
  diagnosis confirmed by echocardiogram
• 63.4 vs. 86.0 for referral for confirmation by
  MRI/CT scan of patients with newly diagnosed
  presumptive stroke

• Saxena, Car, Eldred, Soljak, Majeed, BMC Health
  Services Research, Practice size, caseload,
  deprivation and quality of care of patients with
  CHD, hypertension and stroke in primary care
  national cross-sectional study, 2007 (27 June),
  7(1), 96

• Quality (QOF) attainment across all areas

• Median QOF score for smallest practices
  significantly lower than largest practices
  944.1 vs. 970.4 due to lower attainment on the
  organisational domain 172.0 vs 179.0
• 40 higher CHD mortality for smallest practices
  vs. largest practices despite no difference in
  CHD prevalence

• Wang, ODonnell, Mackay, Watt, Brit J Gen
  Practice, Practice size and quality attainment
  under the new GMS contract a cross-sectional
  analysis 2006 (Nov), 56, 532, 830-835

• Consultation length and practice size
• Consultation length and quality of care in
  angina, asthma and diabetes

• Mean consultation length of 7.6 mins in smallest
  practices vs. 11.2 mins in largest practices
• Longer consultations associated with higher
  quality scores in all areas gt67 in asthma,
  gt21 in diabetes, gt17 in angina

• Campbell, Ramsay, Green, Brit J Gen Practice,
  Practice size impact on consultation length,
  workload and patient assessment of care, 2001,
  51, 469, 644-50
• Campbell et al, BMJ, Identifying predictors of
  high quality care in English general practice,
  2001 323, 784-7

Left Ventricular Dysfunction Source Team
analysis
52
However, West Midlands GP partnerships tend to be
smaller than elsewhere in England
0
GP partnerships in the West Midlands by size, 30
September 2006, of all partnerships
13
9
7
8
6
4
3
5
2
10
1
12
11
Practitioners in partnership
England average
21
1
17
13
13
11
8
6
4
3
1
1
0
Source NHS Information Centre
53
There is also wide variation in list sizes per
practice within PCTs
Smallest
Largest
Top quartile
Bottom quartile
Practice list size by PCT, West Midlands 2006/07
, people
Primary Care Trust
Herefordshire
Worcestershire
Solihull
North Staffordshire
Shropshire County
Warwickshire
Telford and Wrekin
South Birmingham
South Staffordshire
Coventry Teaching
Dudley
Sandwell
Stoke on Trent
Birmingham East North
Wolverhampton City
Walsall
0
5,000
10,000
15,000
20,000
25,000
Practice list size
Source NHS West Midlands analysis
54
This section highlights 3 areas as part of a case
for change in the West Midlands

• GPs are vital to successful Staying Healthy
  interventions, but the most needy areas have too
  few GPs and practices are frequently small

• Prevention initiatives can have poor access and
  variable success rates and relevant data are not
  always measured

• Obesity is a major and rising issue for the
  region, but the appropriate range of
  interventions is unclear and insight into the
  problem is patchy

55
Prevention is a critical part of the pathway for
many diseases, including stroke . . .
Initial diagnosis
Immediate treatment
Rehabili-tation
Prevention
Managed primary care
Active treatment of TIA

• Reduced salt intake
• Smoking cessation
• Physical activity
• Weight management
• Reduced binge drinking

• Early investigation and treatment with aspirin
  and possible carotid end-arcterectomy

• CT scan within 3 hours
• Assessment by a neurologist

• High quality ongoing rehabilitation on stroke
  unit
• Continuation into community based services

• Thrombolysis for eligible patients
• Early assessment by speech therapist and
  physiothera-pist
• Early treatment on stroke unit

• Early identification and treatment of
  hypertension and atrial fibrillation
• Regular treatment and drug therapy (e.g.,
  aspirin)
• Link to support groups

Source Clinical evidence review team analysis
56
. . . and also COPD
Outpatientcare
Acute episode
Intermediate care
Prevention
Diagnosis
Ongoingmanage-ment

• Screening to identify those at risk
• Smoking cessation and public health initiatives/
  campaigns

• Triage call centre and patient database
• Exercise in referral and other healthy living
  care
• Telephone supported self-care
• Pulmonary rehabilitation
• Care manage-ment for severe patients

• Clinics in the community
• Forces on moderate/severe patients

• Intermediate care nurses trained in COPD

• Emergency care gatekeeper
• Reduced LOS via developing links to GPwSIs,
  intermediate care and social care
• Facilitated discharge

• Screening to identify those likely to have COPD
• Mobile clinics to identify patients
• Diagnostic testing with GPwSI specialist nurse

Source Clinical evidence review team analysis
57
Successful prevention is also more
resource-efficient than secondary care
196
2006/07,
Smoking cessation vs. Thoracic Medicine
Health Trainers vs. Diabetic care
Expert patients programme vs. Asthma spell
Smoking cessationservice
209 (per 4-week quartile)
426 (per patient episode)
Health Trainersservice
Expert patients programme
271 (perpatient completing)
Thoracic Medicine (first outpatients)
Diabetic care (first outpatients)
Asthma without CC (non-elective)
196 (per appointment)
241 (per appointment)
1,138 (per spell)
Source NHS West Midlands analysis based on
2006/07 tariff Stapleton J. Cost effectiveness
of NHS Smoking Cessation Services, 2001 BBCHA
data
58
There are however serious gaps in provision
Example COPD
Example Stroke

• Issues include
• Variations in smoking cessation performance
• Poor access for some groups to smoking cessation
  support
• Lack of joined-up activity (in NHS and beyond) on
  salt intake reduction

• Issues include
• Limited specific screening
• Similar issues on smoking cessation as for stroke

• Issues in
• Access
• Success rates
• Data availability

Source Team analysis
59
Smoking cessation services are reaching 68 of
the target group
50
Smokers attending Stop Smoking Services in the
West Midlands, 2004/05,
4559
3544
60
1834
Age
Estimated using Lifestyle Survey 2005 smoking
prevalence data Source West Midlands Stop
Smoking Services Regional Equity Profile,
February 2006
60
There is unmet demand for lifestyle risk
prevention services
34,615
Estimated unmet demand and activity for selected
interventions, 2005/06
Unmet demand
Activity
Waiting lists and times more tolerated for
lifestyle risk prevention than acute interventions
Thousand people/spells
Thousand people/spells

• Acute waiting lists and times receive
  considerable political and operational attention
• Regarded as unacceptable that patients should
  have to wait an undue amount of time to receive
  an intervention that is known to be both
  effective and efficient
• Although more than 600,000 people in the West
  Midlands wish to stop smoking, only 71,000
  received help from the NHS in 2005/6
• Similar patterns can be observed for other
  lifestyle risk prevention services.
• Such a pattern would not be regarded as
  acceptable for say, hip replacements or pure tone
  audiometry

Smokingcessation
600
71
Audiology puretone audiometry
29
65
MagneticResonance Imaging
11
96
Trauma Orthopaedics
26
99
ENT
35
Source NHS West Midlands analysis
61
Some PCTs are unable to offer 48-hour GUM access
41
GUM attendees offered an appointment within 48
hours, May 2007,
Telford and Wrekin
Walsall
Shropshire
South Birmingham
Heart of Birmingham Teaching
South Staffordshire
Birmingham East and North
Coventry Teaching
Sandwell
Solihull
Wolverhampton city
Worcestershire
Warwickshire
Dudley
Herefordshire
North Staffordshire
Stoke on trent
Source HPA
62
Smoking cessation services are less effective
amongst the young and the most deprived
60
Proportion of clients attending Stop Smoking
Services in the West Midlands who had
successfully quit at 4 weeks, 2004/05,
By IMD deprivation quintile, males
By age
Most deprived
1834
3544
2
3
4559
4
60
Most affluent
Source West Midlands Stop Smoking Services
Regional Equity Profile, WM PHO, February 2006
63
Correct measurement is important but recording
rates of lifestyle risks vary enormously
98
Cases with lifestyle risk recorded, West
Midlands, 2006, of cases
Of adult GP registrants
Of maternities
Smoking status
Breast feeding initiation
Smoking at time of delivery
BMI
Physical activity
Unknown
Diet
Estimate Source NHS West Midlands analysis
64
And not all smoking cessation participants are
followed up, especially amongst the young and the
most deprived
13
Proportion of West Midlands Smoking Cessation
Services clients with an unknown quit status,
2004/05,
By IMD deprivation quintiles, males
By age
Most deprived
1834
3544
2
3
4559
4
60
Most affluent
Source West Midlands Stop Smoking Services
Regional Equity Profile, WM PHO, February 2006
65
This section highlights 3 areas as part of a case
for change in the West Midlands

• GPs are vital to successful Staying Healthy
  interventions, but the most needy areas have too
  few GPs and practices are frequently small

• Prevention initiatives can have poor access and
  variable success rates and relevant data are not
  always measured

• Obesity is a major and rising issue for the
  region, but the appropriate range of
  interventions is unclear and insight into the
  problem is patchy

66
Studies show obesity is linked to multiple
factors but the evidence base is still evolving
2
Summary of strength of evidence on factors that
might promote or protect against weight gain and
obesity (adapted from