Transcript Linkage of Hospital data and HL1 - IRISS

Health and Homelessness:
the right to the highest
attainable standard of
health?
Katy Hetherington, Programme Manager
[email protected]
Neil Hamlet, Consultant in Public Health, NHS Fife
[email protected]
Our vision and mission
Our Strategy 2012-17:
“A FAIRER HEALTHIER SCOTLAND”
Each stop on the Argyll line travelling East
represents a drop of 2 years in male life expectancy
Male life expectancy
75.8 years
Hillhead
St George’s
Cross
Buchanan
Street
Jordanhill
Hyndland
Partick
Exhibition
Centre
Charing
Cross
Anderston
QUEEN
STREET
Argyll St.
Govan
Ibrox
Cessnock
CENTRAL
St Enoch
Bridgeton
Male life expectancy
61.9 years
Source: McCartney G. Illustrating Glasgow’s health inequalities. JECH 2010; doi
10.1136/jech.2010.120451
What do we mean by health inequalities?
Health inequalities are:
•Unfair differences in health within the population across
social classes and between different populations
These unfair differences:
•Are not random, or by chance, but largely socially
determined
•Are not inevitable.
What causes health inequalities?
Fundamental
causes
Global forces,
political
priorities,
societal values
leading to:
Unequal
distribution of
power, money
and resources
Wider
environmenta
l influences
Individual
experiences
Effects
Economic & work
Economic & work
Physical
Physical
Educ & learning
Educ & learning
Inequalities
in the
distribution
of health and
wellbeing
Social & cultural
Social & cultural
Services
Services
HEALTH
INEQUALITIES
INEQUALITIES
Undo
Prevent
Mitigate
What is most and least effective in reducing
health inequalities?
Least likely to be effective
Interventions reliant on people opting in; information based campaigns; written
materials; messages designed for the whole population; interventions that
involve significant price or other barrier
Most likely to be effective
Structural changes to the environment; legislation, regulatory and fiscal
policies; income support, reduced price barriers; accessibility of public services,
prioritising disadvantaged groups and individuals; intensive support for
disadvantaged population groups; starting young.
Homelessness - a cross-cutting agenda
Third Sector
Agencies
Dental Care
Mental Health
Issues
Community
Alcohol andHealth
Drug
Partnerships
Partnerships
(ADPs)
Council Housing
Departments
Nutrition and diet
Health & Social
Care
Integration
Bodies
Homelessness
Social Work
Foot and skin care
Alcohol Abuse
Substance Misuse
NHS
Acute Services
Registered Social
Landlords
Homelessness - a prevention agenda
Third Sector
Agencies
Family nurturing
(conflict resolution)
Honour and purpose
Alcohol and Drug
Partnerships (ADPs)
Council Housing
Departments
Coping & resilience
Health & Social
Care
Integration
Bodies
Social Work
Education & skills
Income maximisation
Employment
NHS
Outreach Services
Registered Social
Landlords
HSCP
Vol
Sector
NHS
Housing
Homelessness as a public health
issue – ScotPHN Report
•‘Re-energise’ the health and homelessness agenda
•Set it in the current policy context – health and social care, focus on
inequalities, prevention agenda, homelessness policy and legislative
•2005 Health and Homelessness standards
•Discussion and engagement – housing, voluntary sector, SG, academics,
NHS Boards
•Gaps?
•What do we want to recommend to Directors of Public Health?
Severe and multiple disadvantage
•‘Hard Edges’ 2015 – Mapping severe and multiple disadvantage in England
“services still categorise people in separate boxes, defined by simple
issues…different approaches from services and from policy”
•Understanding complex lives – Joseph Rowntree Foundation, 2011
‘There needs to be an integrated response across health, housing
and social care’
•Early childhood experiences – the roots of many people’s experiences lay
within very troubled childhoods.
Linkage of Hospital data
and Homelessness data
in the Kingdom of Fife
Bryan Archibald, Senior Information Officer [email protected]
The Data Sources
Fife Council
• HL1
• National data set for
each homeless
application
• Based on the
application (not the
number of homeless
individuals)
NHS Fife Acute
Hospitals
• eOASIS (patient
administration system)
• SMR data submitted to
ISD (information Services
Division of NHS Scotland)
• Based on Patient Episodes
http://www.scotland.gov.uk/Topics/Statistics/15257/22833
NHS Data (OASIS)
•
•
•
•
•
•
A&E (and Minor Injuries Unit [MIU])
Inpatients & Day cases
Obstetrics
Mental Health Inpatients
Outpatients
Mental Health Outpatients
A&E Attendance by Age Group
Age & Numbers of patients attending A&E
800
Under 20
20 to 29
30 to 39
40 to 49
50 to 64
700
600
500
400
300
200
100
2006
2007
2008
2009
2010
2011
2012
2013
In Patient and Day Case Admissions
Age of patient admitted to hospital
180
160
140
120
100
80
60
40
Under 20
20
20 to 29
30 to 39
40 to 49
50 to 64
2006
2007
2008
2009
2010
2011
2012
2013
So far so good but what does this mean?
• We need a comparator for the homeless
population
• Fife’s ‘securely - housed’ population
• Try to compare by similar age profile
• Started with Fife population 15-64 as our
crude method of ‘standardisation’
• Further refinements planned in
‘standardisation process’
• Aiming to compare ‘apples’ with ‘apples’ by
security of housing as defined by HL1
registration
A&E Attendance Rate per 1,000 Population
Number of attendances at QMH and VHK
1,400
1,200
The value of shared data analysis
1,000
Male
800
Female
600
400
200
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
‘Insecurely Housed’
Fife (Aged 15 - 64)
‘Securely Housed’
Referral From Distribution of A&E Attendances; 2013
Source who referred patient to A&E department
GP
Other Hospital
Self Referral
NHS24
Fife (Aged 15 - 64)
Emergency Services
Abuse ?
HL1
£££
Pragmatic ?
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Age Distribution of A&E Attendances; 2013
Age of patient attending A&E
20 to 29
30 to 39
40 to 49
50 and over
Fife (Aged 15 - 64)
Under 20
HL1
Over 50% are under 30 yrs
Over 80% are under 40 yrs
0%
20%
40%
60%
80%
100%
Patient Multiple Attendance Rate per 1,000 Population
Patients who have attended A&E more than once within specified year
250
Male
Female
200
The
Frequent
Fliers
150
100
50
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
Emergency Admission Rate per 1,000 Population
Patients admitted to hospital as an emergency
300
250
200
150
100
50
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
Multiple Emergency Admission Rate per 1,000 Population
Patients who have been admitted as an emergency more than once in specified year
40
35
30
Revolving
Hospital
Door effect
25
20
15
10
5
2006
2007
2008
2009
2010
HL1
2011
2012
2013
2006
2007
2008
2009
2010
2011
Fife (Aged 15 - 64)
2012
2013
90
30%
75
25%
%
60
20%
Rate
45
15%
30
10%
15
5%
-
0%
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
% of Admissions
Rate per 1,000 Population
Alcohol-related Admissions rate per 1,000 and % of Admissions
Admissions with diagnosis related to alcohol based on ISD definition
Drug Misuse-related Admissions rate per 1,000 and % of Admissions
60
Admissions with diagnosis related to drug misuse based on ISD definition
20%
%
15%
40
Rate
30
10%
20
5%
10
-
0%
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
% of Admissions
Rate per 1,000 Population
50
Emergency Admission Rate relating to Injury & Poisoning per 1,000 Pop
Patients admitted as emergency relating to injury and poisoning (ICD10 codes S00 - T99)
100
90
80
70
60
50
40
30
Clear role for Community
Safety Partnerships ?
20
10
-
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
Obstetric Admission Rate per 1,000 Population
Admission could be for birth, antenatal or postnatal care
450
400
350
300
250
200
150
100
50
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 44)
Age Distribution of Obstetric Admissions; 2013
Age of admitted patient, admission could be for birth antenatal or postnatal care
20 to 24
25 to 29
30 and over
HL1
Fife (Aged 15 - 44)
Under 20
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Psychiatric Admission Rate per 1,000 Population
Admissions to Psychiatric specialty including readmissions,
excludes Learning Disability
120
100
80
The very tip of the mental
distress homeless iceberg
60
Male
Female
40
20
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
% New Outpatient Appointments DNA
New appointments who Did Not Attend
(excludes cancellations by hospital or patient)
40%
35%
•Changed address
•Fearful to open official mail
•Appointment too early
•No money for the bus
•‘it won’t do any good’
30%
25%
20%
Access / Expectation
15%
10%
5%
0%
2006 2007 2008 2009 2010 2011 2012 2013 2006 2007 2008 2009 2010 2011 2012 2013
HL1
Fife (Aged 15 - 64)
What is most and least effective in reducing
health inequalities?
Least likely to be effective
Interventions reliant on people opting in; information based campaigns; written
materials; messages designed for the whole population; interventions that
involve significant price or other barrier
Most likely to be effective
Structural changes to the environment; legislation, regulatory and fiscal
policies; income support, reduced price barriers; accessibility of public services,
prioritising disadvantaged groups and individuals; intensive support for
disadvantaged population groups; starting young.
Making a Difference
On call nurse manager gets a text alert on her
work phone when a homeless person is seen
in Accident and Emergency Dept.
A daily report is now generated listing all the
patients in the hospital at 8am who have a
temporary homeless accommodation
address.
'Houseless and Hungry' by Luke Fildes depicting homeless
paupers queuing outside the casual ward of a London workhouse
“We believe that health and homelessness services can
work better together to ensure that an individual's health
needs are identified and addressed as quickly as possible.
NHS acute services currently bear the brunt of the health
and other complex problems experienced by those who are
homeless. A&E visits per homeless person are four times
higher than that of the general public and over a quarter
of those surveyed had been admitted to hospital in the
previous six months”
Rick Henderson, chief executive of Homeless Link
Meet needs of safety, nurture, belonging and purpose