8. PSA AND DSO PERFORMANCE
8.1.23 There are four remaining targets from
previous spending reviews (CSR 1998, SR 2002, and SR 2004), with
six underlying indicators, which have either not been subsumed
into CSR 2007 or not been already met. Performance against
all these targets has been reported as subject to "slippage",
not only in the Departmental Report 2009 (pp. 262-3), but
also the previous year's Departmental Report and the 2008 Autumn
Performance Report. Can the Department state in respect of each
of these four targets what is being done to address this continued
"slippage"? The relative gap in life expectancy at
birth between England as a whole and the fifth of local authorities
with the lowest life expectancy (SR 2002 target 11) has widened
significantly in the period 2005-07, compared to the baseline
data for the period 1997-99 (particularly among women, where
the gap has widened by 12%). Why has there been such a dramatic
widening in the life expectancy gap in this case? Can the Department
supply runs of historical data for CSR 1998 targets 3 and
4, so the Committee can assess long-term trends in progress towards
these targets? (Q114)
Answer
Health inequalities targets—relationship
between spearhead areas and bottom quintile for life expectancy
1. The first ever national health inequalities
targets were introduced in 2001. One was to narrow the gap in
life expectancy at birth between the bottom quintile (the fifth
of local authorities with lowest life expectancy) and the England
average (SR2002 target 11). As part of the Spending Review
in 2004, a target was introduced to narrow the gap in life expectancy
between the fifth of areas with the "worst health and deprivation
indicators" (the spearhead group) and the England average.
New inequalities elements were added to the cancer and cardiovascular
disease mortality targets enabling all these to be based on the
spearhead group rather than separate quintiles.
2. There is considerable overlap between
the bottom quintile areas and the spearhead group. At present,
of the 71 local authorities in the bottom quintiles, for
males 60 are in the spearhead group, and for females, 57 are.
In terms of population, 88% of males, and 87% of females in the
bottom quintile are in the spearhead group. The bottom quintile
changes each year. Adopting the spearhead group allows the Department
to improve delivery for both targets through focused support in
these fixed areas.
Action to meet the inequalities targets
3. NHS expenditure is at record levels and
deprivation is reflected in NHS financial allocations. As deprivation
is a feature of areas in the spearhead group and in the bottom
quintile, allocations on this basis support the SR2004 and
SR2002 life expectancy targets. Health Inequalities: Progress
and Next Steps (2008) announced £34 million additional
spending for health inequalities programmes in 2008-09, including
£19 million to support local communities in disadvantaged
areas working to improve life expectancy and reduce infant mortality
quickly in support of the national target.
4. Health inequalities has been retained
as a key priority for the NHS in the Operating Framework 2009-10.
All age all cause mortality, as a proxy for life expectancy, is
an indicator in both the NHS Operating Framework "Vital
Signs" and the local authority Local Area Agreement National
Indicator Set aligning incentives for the NHS and local government.
5. The Department has identified the interventions
that will impact most on life expectancy and infant mortality
within the target timescale. The Department's focus is to provide
local areas with the targeted support and tools they need to systematically
tackle inequalities with sufficient scale in order to meet the
national target. The key interventions for both the SR2004 spearhead
life expectancy, and the SR2002 lowest quintile life expectancy
targets would be the same.
6. A range of National Support Teams (NSTs)
with an inequalities focus, are providing tailored, intensive
assistance to disadvantaged areas. The NSTs with a particular
role in supporting the inequalities targets are: the Health Inequalities
NST, Infant Mortality NST, Tobacco Control NST, Teenage Pregnancy
NST and Alcohol NST. The Health Inequalities NST has been expanded
enabling it to offer to visit all spearheads by summer 2009 and
the Infant Mortality NST is focusing on the 43 local authority
areas with highest infant mortality rates in routine and manual
groups.
7. The Health Inequalities Intervention
Tools jointly developed by the Association of Public Health
Observatories and the Department of Health, are designed to help
PCTs and local authorities, including spearheads and all areas
in the bottom quintile for life expectancy, to plan and commission
services in order to narrow life expectancy gaps.
8. The Implementation Plan for Reducing
Health Inequalities in Infant Mortality (2007) underpins the
work of the Infant Mortality NST. It identifies the specific interventions
needed to meet the target and promotes effective action, including
through good practice.
Widening gap in life expectancy
9. Life expectancy is at record levels including
in the spearhead group as a whole and in the fifth of local authority
areas with the lowest life expectancy as a whole. However, improvements
have been greater on average in more advantaged areas, meaning
the life expectancy gaps have not narrowed.
10. The reasons for the widening life expectancy
gap are complex and not fully understood. The Department has partitioned
the life expectancy gap between the spearhead group and the average
by age and disease to help understand the drivers. This analysis
was sent to the Health Select Committee in a memorandum entitled
A DH note on widening life expectancy gap between England and
the Spearhead Group on 18 March 2008 as part of
the inquiry into health inequalities. The Department would not
expect to see different results if the age and disease partitioning
was revised with 2005-07 data or if the lowest quintile life
expectancy areas were compared with England. This therefore remains
our best knowledge of what is driving the life expectancy gap.
CSR 1998 accident targets
11. Data showing the age groups and types
of accidents responsible for the slippage against CSR 1998 targets
3 and 4 are provided in tables 114a to 114d.
12. Latest data for 2005-07 (three-year
average) for CSR 1998 target 4 (reduction in the death
rate from accidents) is the same as at the baseline (1995-97),
having increased slightly above the baseline rate in the intervening
years.
13. Despite the slippage, the latest data
show a continuing reduction in accident death rates in age bands
under 15 and 15 to 24 years. Serious accidental
injury rates among children are also continuing to decrease.
14. Based on data to 2005-07, the 65 and
over group continues to account for the main part of the increase
in the death rate from accidents. Falls account for the main part
of the increase in the death rate from accidents in those over
65.
15. Latest data for the financial year 2006-07 for
CSR 1998 target 3 (reduction in the rate of hospital
admission for serious accidental injury) show an increase of 3.1%
from the baseline (1995-96). As before, the 65 and over group
accounts for the main part of the increase in the admission rate.
Falls account for nearly three-quarters of admissions for serious
accidental injury in the 65 and over group, and are a key
factor in the increase in the admission rate.
16. Trend data for CSR 1998 targets
3 and 4 are provided in table 114e.
17. The recently published prevention package
will raise the local focus on older people's prevention services,
for example through improved implementation and quality of services
such as falls where challenges still exist.
18. The National Institute for Health and
Clinical Excellence issued, in 2004, clinical guidelines on the
assessment and prevention of falls in older people; it has also
issued clinical guidelines on the assessment of fracture risk;
and published final guidance on the use of drugs to prevent osteoporotic
fractures in postmenopausal women both as primary and secondary
prevention.
Table 114a
DEATH RATES FROM ACCIDENTS (PER 100,000 POPULATION)
(1) (3)—PROGRESS BY SELECTED AGE GROUPS
|
| Age group | 1995-97
| 2002-04 | 2003-05
| 2004-06 | 2005-07
| % change
1995-97 to
2005-07 (2)
|
|
| Under 15 | 4.1
| 2.9 | 2.7
| 2.6 | 2.4
| -40% |
| 15 to 24 | 17.8
| 15.2 | 14.7
| 14.3 | 14.0
| -22% |
| 25 to 64 | 13.0
| 12.9 | 12.8
| 12.8 | 12.8
| -1% |
| 65 and over | 50.1
| 57.6 | 59.7
| 59.7 | 59.3
| +18% |
|
| Source: |
| Rates calculated by Health Improvement Analytical Team, Department of Health, based on death registrations and population estimates from the Office for National Statistics (ONS).
|
Footnotes:
|
| 1. Death rates are directly age-standardised to allow for change in the age structure of the population (using the European Standard Population as defined by the World Health Organisation). Rates are for all persons, England. Figures are the average of rates for 3 consecutive calendar years.
|
| 2. A percentage change less than 0 is a reduction, greater than 0 is an increase.
|
| 3. 1995-97 data coded used ICD9 (codes E800-E928 exc. E870-E879 used for accidents); 2002-04 to 2005-07 data coded using ICD10 (codes V01-X59 used for accidents).
|
| 4. Data quality: Death registrations data are National Statistics. The coding system for recording cause of death was changed in 2001 (from ICD9 to ICD10), so there may be small discontinuities in the comparison between the data for 1995-97 and later periods (although any effect is not statistically significant for the comparisons presented). The rates are based on the most up to date series of population estimates published by ONS, but population estimates may be revised from time to time.
|
Table 114b
DEATH RATES FROM ACCIDENTS AMONG AGES 65 AND OVER
(PER 100,000 POPULATION) (1) (3)—CONTRIBUTION OF SELECTED
ACCIDENT CATEGORIES
|
| Accident category | 1995-97
| 2002-04 | 2003-05
| 2004-06 | 2005-07
| Change
1995-97 to
2005-07 (2)
|
|
| Land transport | 7.8
| 6.6 | 6.4
| 6.0 | 5.9
| -1.9 |
| Falls | 14.1
| 20.0 | 21.4
| 22.5 | 22.7
| +8.5 |
| Drowning and submersion | 0.4
| 0.4 | 0.4
| 0.4 | 0.4
| 0.0 |
| Smoke, fire and flames | 2.3
| 1.6 | 1.4
| 1.4 | 1.3
| -1.0 |
| Poisoning | 1.1
| 0.8 | 0.8
| 0.9 | 0.9
| -0.2 |
| Other and unspecified incidents | 24.3
| 28.2 | 29.3
| 28.7 | 28.2
| +3.9 |
|
| Source: |
| Rates calculated by Health Improvement Analytical Team, Department of Health, based on death registrations and population estimates from the Office for National Statistics (ONS).
|
Footnotes:
|
| 1. Death rates are directly age-standardised to allow for change in the age structure of the population (using the European Standard Population as defined by the World Health Organisation). Rates are for all persons, England. Figures are the average of rates for 3 consecutive calendar years.
|
| 2. Deaths per 100,000. A change less than 0 is a reduction, greater than 0 is an increase. The changes in each accident category sum to the change in the all accidents rate for ages 65 and over.
|
| 3. 1995-97 data coded used ICD9 (codes E800-E928 exc. E870-E879 used for accidents); 2002-04 to 2005-07 data coded using ICD10 (codes V01-X59 used for accidents).
|
| 4. Data quality: Death registrations data are National Statistics. The coding system for recording cause of death was changed in 2001 (from ICD9 to ICD10), so there may be small discontinuities in the comparison between the data for 1995-97 and later periods (although any effect is not statistically significant for the comparisons presented). The rates are based on the most up to date series of population estimates published by ONS, but population estimates may be revised from time to time.
|
Table 114c
ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY (PER 100,000
POPULATION) (1) (3)—PROGRESS BY SELECTED AGE GROUPS
|
| Age group | 1995-96 (4)
| 2003-04 | 2004-05
| 2005-06 | 2006-07
| % change
1995-96 to
2006-07 (2)
|
|
| Under 5 | 131.7
| 90.2 | 88.3
| 84.3 | 85.2
| -35% |
| 5 to 14 | 120.8
| 77.7 | 76.9
| 71.9 | 65.2
| -46% |
| 15 to 64 | 221.2
| 226.0 | 225.3
| 227.4 | 220.9
| 0% |
| 65 and over | 1,280.2
| 1,460.4 | 1,487.8
| 1,511.9 | 1,471.4
| +15% |
|
| Source: |
| Rates calculated by Health Improvement Analytical Team, Department of Health and National Centre for Health Outcomes Development, based on hospital admissions from Hospital Episode Statistics, The Information Centre for health and social care and population estimates from the Office for National Statistics (ONS).
|
Footnotes:
|
| 1. Admission rates are directly age-standardised rates for all persons, England. Figures are for single financial years.
|
| 2. A percentage change less than 0 is a reduction, greater than 0 is an increase.
|
| 3. ICD10 codes V01-X59, Y40-Y84 used for all accidents.
|
| 4. Figures for 1995-96 are estimates based on trend for subsequent years (due to data quality problems for some areas in 1995-96).
|
| 5. Data quality: Hospital Episode Statistics are compiled from data sent by over 300 NHS Trusts and Primary Care Trusts. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data. Whilst this brings about improvement over time, some shortcomings remain. Serious injury admission figures are adjusted to include estimates of how many injury admission records without a valid cause code relate to unintentional injury. The rates are based on the most up to date series of population estimates published by ONS, but population estimates may be revised from time to time.
|
Table 114d
ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY AMONG AGES
65 AND OVER (PER 100,000 POPULATION) (1)—CONTRIBUTION
OF SELECTED ACCIDENT CATEGORIES
|
| Accident category | 1996-97 (3)
| 2003-04 | 2004-05
| 2005-06 | 2006-07
| Change
1996-97 to
2006-07 (2)
|
|
| Land transport | 52.7
| 48.4 | 49.9
| 49.0 | 45.8
| -6.9 |
| Falls | 942.1
| 1,058.4 | 1,082.4
| 1,098.6 | 1,063.4
| +121.3 |
| Drowning and submersion | 0.1
| 0.2 | 0.3
| 0.1 | 0.2
| +0.1 |
| Smoke, fire and flames | 4.3
| 2.3 | 2.6
| 2.7 | 1.6
| -2.7 |
| Poisoning | 9.7
| 9.6 | 9.2
| 10.8 | 9.5
| -0.2 |
| Other and unspecified incidents | 323.8
| 358.7 | 360.9
| 369.4 | 368.5
| +44.7 |
|
| Source: |
| Rates calculated by Health Improvement Analytical Team, based on hospital admissions from Hospital Episode Statistics, The Information Centre for health and social care and population estimates from the Office for National Statistics (ONS).
|
Footnotes:
|
| 1. Admission rates are directly age-standardised rates for all persons, England. Figures are for single financial years.
|
| 2. Admissions per 100,000. A change less than 0 is a reduction, greater than 0 is an increase.
|
| 3. Comparison is with 1996-97 rather than 1995-96 due to data quality problems for some areas in 1995-96.
|
| 4. Data quality: Hospital Episode Statistics are compiled from data sent by over 300 NHS Trusts and Primary Care Trusts. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data. Whilst this brings about improvement over time, some shortcomings remain. Serious injury admission figures are adjusted to include estimates of how many injury admission records without a valid cause code relate to unintentional injury. The rates are based on the most up to date series of population estimates published by ONS, but population estimates may be revised from time to time.
|
Table 114e
DEATH RATES FROM ACCIDENTS, ALL AGES, ENGLAND (PER 100,000 POPULATION)
AND ADMISSION RATES FOR SERIOUS ACCIDENTAL INJURY (PER 100,000 POPULATION),
ALL AGES, ENGLAND—TIME SERIES
|
Time period
(2) | Accidental injury death rate (1) (4), all ages, England (deaths per
100,000 population)
| Time period
(3)
| Hospital admission rate(1) (5) for
serious accidental injury, all
ages, England (admissions per
100,000 population)
|
|
| 1988-1990 | 18.9
| |
|
| 1989-1991 | 18.7
| |
|
| 1990-1992 | 18.0
| |
|
| 1991-1993(7) | 16.9
| |
|
| 1992-1994 | 16.2
| |
|
| 1993-1995 | 15.7
| |
|
| 1994-1996 | 15.5
| 1995-96(6) | 315.9
|
| 1995-1997 | 15.8
| 1996-97 | 319.3
|
| 1996-1998 | 15.9
| 1997-98 | 314.3
|
| 1997-1999 | 16.0
| 1998-99 | 319.1
|
| 1998-2000 | 15.9
| 1999-2000 | 324.9
|
| 1999-2001 | 15.9
| 2000-01 | 313.4
|
| 2000-2002 | 15.9
| 2001-02 | 312.7
|
| 2001-2003 | 15.9
| 2002-03 | 327.9
|
| 2002-2004 | 15.9
| 2003-04 | 330.1
|
| 2003-2005 | 16.0
| 2004-05 | 332.5
|
| 2004-2006 | 15.9
| 2005-06 | 335.5
|
| 2005-2007 | 15.8
| 2006-07 | 325.8
|
|
| Source: |
| Rates calculated by Health Improvement Analytical Team, Department of Health and National Centre for Health Outcomes Development, based on hospital admissions from Hospital Episode Statistics, The Information Centre for health and social care, and death registrations and population estimates from the Office for National Statistics (ONS).
|
Footnotes:
|
| 1. Rates are directly age-standardised to allow for change in the age structure of the population (using the European Standard Population as defined by the World Health Organisation).
|
| 2. Rolling three calendar year period. Death rates are the average of rates for 3 consecutive calendar years.
|
| 3. Single financial year period. Admission rates for serious accidental injury prior to 1995-96 are not directly comparable with data shown in this table.
|
| 4. Cause of death is identified using the following ICD codes: for 1999 and 2001 onwards, ICD10 V01-X59; for 1995-1998 and 2000, ICD9 E800-E928 excluding E870-E879.
|
| 5. Hospital admissions for accidental injury are identified using ICD10 codes V01-X59, Y40-Y84.
|
| 6. Figures for 1995-96 are estimates based on trend for subsequent years (due to data quality problems for some areas in 1995-96).
|
| 7. There may be discontinuities between data based on 1993 onwards and earlier data due to changes in the process of coding cause of death.
|
8. Data quality:
i. Death registrations data are National Statistics. The coding system for recording cause of death was changed in 2001 from ICD9 to ICD10 (with 1999 deaths being coded using both ICD9 and ICD10 for comparison), so there may be small discontinuities between data based on 1988-1998 and 2000 and data based on 1999 and 2001 onwards (although any effect is known not to be statistically significant for data from 1993). There may also be discontinuities between data based on 1993 onwards and earlier data due to changes in the process of coding cause of death.
ii. Hospital Episode Statistics are compiled from data sent by over 300 NHS Trusts and PCTs. The Information Centre for health and social care liaises closely with these organisations to encourage submission of complete and valid data and seeks to minimise inaccuracies and the effect of missing and invalid data. Whilst this brings about improvement over time, some shortcomings remain. Serious injury admission figures are adjusted to include estimates of how many injury admission records without a valid cause code relate to unintentional injury. The rates are based on the most up to date series of population estimates published by ONS, but population estimates may be revised from time to time.
|
|
