Cardiac MCNApril 2007

Tackling Health Inequalities:Keep Well Programme

• Background in Grampian– Evidencing health inequalities locally

• MCN Annual Report

• Keep Well Programme

Tackling Health Inequalities

BACKGROUNDNHSG Framework for reducing health inequalities (2004-2007)

• ‘A pivotal task signalled in our Local Health Plan is the need to action a system-wide approach to tackle health inequalities to increase penetration on addressing health inequalities throughout our business and in conjunction with our partners.’

ABERDEEN CENTRAL

ABERDEEN NORTH

ABERDEEN SOUTH

Population aged 0-15

Population aged 16-64

Population aged 65+

Migration - population inflow in previous year

Migration - population outflow in previous year

Minority ethnic groups

Births

Average age of first-time mothers

Travel to work/study by foot/bike/public transport

Prescriptions (DDDs): anti-depressant related

Prescriptions (DDDs): cardiovascular-related

POPULATION INDICATORS

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Aberdeen City: Area Level Blue Lights

Life expectancy - males

Life expectancy - females

Proportion of 15 year-old boys surviving to 65

Proportion of 15 year-old girls surviving to 65

Deaths

Teenage pregnancies (3 year total)Low birthweight babies (3 year total)

AB25 3AB24 4 AB24 5 AB25 1 AB25 2AB15 5 AB24 1 AB24 2 AB24 3AB10 1 AB11 5 AB11 6 AB15 4

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ABERDEEN CENTRAL

Communities/ Indicators

Are there Health Inequalities in Grampian?EXAMPLE: Aberdeen Central: Area Level

Figure 3bIschaem ic Heart Disease M ortality for Under 75s in G ram pian (2001-05)

by National Quintiles

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20

40

60

80

100

120

140

160

180

200

Q uintiles

SMR

SM R 66.7 90.7 113 150.9 190.2

1 2 3 4 5

Ischaemic Heart Disease Mortality U75s in Grampian (2001-05) by National Quintiles

Ischaemic Heart Disease Mortality U75s 1999-2004 by Local Authority & Scottish Index of Multiple

Deprivation QuintileFigure 4b

Ischaem ic Heart Disease M ortality for Under 75s in Gram pian 2000-04by Council Area & National SIM D Quintile

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50

100

150

200

250

National Quintile

SIMD

Aberdeen City Aberdeenshire M oray

Aberdeen City 58.8 91.2 110.6 143.8 195.5

Aberdeenshire 79 90.5 111.5 166.7 178.2

M oray 75.9 93.3 107.3 113.9 0

1 2 3 4 5

Scottish Index of Multiple Deprivation (SIMD) 2006 Aberdeen City

Domain

SIMD 2006 – Numbers of

Datazones in worst 15%

All Domains 27

Current Income 22

Employment 27

Health 43

Education, skills & training 28

Housing 41

Access to services 10

Crime 59

SIMD 2006 - Local Authority Data

Data Zones in Most Deprived 15% (per 10,000 popn)

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1.0

2.0

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ES Mo Or Sh EL AS SB ED ER Mi P&K An D&G Hi St WL A&B SA Fa Fi AB Ed SL Re EA NA NL Cl WD Du In Gl

SIMD 2006Numbers affected

SIMD 2006 Aberdeen SIMD 2006

No. of Data Zones Population % of Total Population

27 18,027 8.9%

Aberdeenshire

No. of Data Zones Population % of Total Population

6 4,353 1.9%

MCN Annual Report (1)Plans for coming year include:

• ‘…contribute to the targeting of NHS resources to those areas of greatest deprivation.’

• ‘…contribute to prevention of coronary heart disease in the community through working with GP practices. We are involved with several primary care initiatives to improve prevention.’

• ‘….develop improved links with the Community Health Partnerships.’

• ‘…make more use of the information we already collect in the NHS and feed it back to staff….’

MCN Annual Report (2)Related Initiatives

• Scottish Primary Care Collaborative – CHD and Access– Measurable targets….

• Absolute reduction in CHD mortality per year– Improvement measures…

• % of CHD patients on statins• % of CHD patients with last recorded BP below

140/80• Number of recorded CHD deaths

• Patient/Public involvement• Grampian Cardiac Symposium for GPs and Allied

Staff

KEEP WELL PROGRAMME in NHSG

What?Who?How?

With what effect?Where?

With what?Local arrangements?

Starting when?

WHAT? National programme Wave 2 pilot in Aberdeen City to:

• Increase the rate of health improvement in deprived communities;

• Tackle cardiovascular disease and its main risk factors;

• Tackle intermediate clinical risk factors;• Tackle lifestyle risk factors; Tackle life circumstances (eg levels of

income, employment, literacy)• Monitor nationally and locally.

WHO?

• Target 45-64 year olds at risk of preventable serious ill-health.

HOW?• Enhancing primary care services to deliver anticipatory

care;• Identifying and targeting those at risk of preventable

serious ill-health;• Offering appropriate, core, evidence-based interventions

and services;• Delivering through a mix of providers;• Focusing on cardiovascular disease and its main risk

factors;• Incorporating appropriate means of engagement with

different client groups;• Setting clear targets for reach, outcomes and

outputs;• Providing individual monitoring and follow up;• Building on, not replicating, nGMS contract and 2006

Directed Enhanced Services (DES).

WITH WHAT EFFECT?Short term

• Improving REACH: number on risk register; number contacted; number attended; number fully risk assessed.

• Improving UPTAKE: improved access; % receiving clinical interventions; % referred.• Improving COMPLIANCE : % continuing treatment at

follow up.• Improving SERVICE USEAGE: increased prescribing;

increased use of GP practices & local services.

WITH WHAT EFFECT? Medium term

• Reducing CVD risk; Quit rate; smoking; BMI; cholesterol; blood pressure; diabetes management.

• Reducing additional risk factors: Physical activity levels; healthier diet (fruit, veg, fat, salt); alcohol consumption.

• Increasing patient satisfaction: Health-related QoL; quality of contact with GP.

WITH WHAT EFFECT? Long term

(5-10 years post roll out)

• Reducing CVD morbidity and premature mortality in deprived areas;

• Reducing health inequalities.

WHERE?

• In Aberdeen City for the most deprived 15% of population.

• Post pilot, general principles to apply to those ‘at risk through deprivation’ in Grampian.

Flow diagram for identifying Keep Well intervention group

Population aged 45-64 years registered with pilot GP practice

Taking part in secondary prevention programme?

Tailored ‘high risk’ CVD prevention package

Yes No

On CHD/CVD register?

CHD/CVD or diabetespresent?

No

< 20 %

Put on CHD/CVDregister

Yes No Yes

Is participation optimal?

Calculate CVD risk

See Section X Yes No

≥ 20%

Tailored prevention package as applicable

Keep Well intervention group

Maintain/monitor/follow up

WITH WHAT? • Additional resource of 0.5 million per year for

each of 2007-08 and 2008-09.

STARTING WHEN?• Proposal submission 6 June 2007• November 2007

LOCAL ARRANGEMENTS?• Keep Well Group established to engage

relevant parties, in particular GP Practices, in setting up Programme.

Thank you