Pharmaceutical Needs Assessment January 2011

Transcription

1 Pharmaceutical Needs Assessment January

2 Table of Contents Table of Contents....2 List of Figures (maps and tables)..3 Executive Summary Introduction Context and use for PNAs Process followed in developing the PNA Localities, definition and description Identifying Local Health Needs Population Ethnicity Deprivation Health Inequalities Local Health Problems Coronary Heart Disease Diabetes Hypertention Stroke COPD Sexual Health Mental Health Smoking Obesity/Weight Management Teenage Pregnancy Alcohol Current provision of Pharmaceutical Services Services provided by Community Pharmacies in NHS Hounslow Community Pharmacy funding and payments Community Pharmacy contracts Other Pharmaceutical services providers Community Pharmacy questionnaire Patient Survey GP questionnaire Pharmaceutical services provided, pharmaceutical needs and health needs Future developments in services Shaping the future Exempt applications Conclusions and recommendations Glossary Appendices References 66 2

3 List of figures, maps and tables 4.1 Map of Hounslow Borough highlighting localities and ward boundaries Figure of male resident population in Hounslow s five localities by five year age group Figure of female resident population in Hounslow s five localities by five year age group Figure of Hounslow births and deaths projections Table of the number of community pharmacies per head of population by locality Figure of ethnicity in Hounslow s five localities Table of counts of lower super output area (LSOA) in Hounslow s five localities ranked relative to England using 20 percent quintile of IMD score of Map of Hounslow showing LSOA ranking relative to England using IMD 2007 scores, the localities and ward boundaries are also shown Figure of life expectancy in Hounslow five localities, pooled data Map of Hounslow showing infant mortality rate per 1000 live births at ward level, Table of standardised mortality ratio (SMR) (pooled data ) in Hounslow by locality Figure of prevalence of diabetes by GP practice Map of Hounslow showing admissions due to diabetes in adult resident population Figure of prevalence of hypertension by GP practice Map of Hounslow showing hypertension related admissions in adult population Figure of prevalence of stroke by GP practice Map of Hounslow showing admission rates due to stroke in adult population Figure of prevalence of Chronic Obstructive Pulmonary Disease (COPD) by GP practice Map of Hounslow showing COPD admission rates per 1000 adult population Figure showing sexually transmitted infection diagnosis for Hounslow Table per locality of under 25s tested under National Chlamydia Screening Programme in Hounslow Table of modelled mental heath problem data in 18 to 64 year old adults Map of Hounslow showing number of referrals per 1000 of nought to 19 years old population to tier three mental health services in Hounslow Table of modelled smoking prevalence in Hounslow Figure of percentage of maternities smoking at time of delivery in Hounslow female population Table of rate per 1000 population with a BMI of more than 30 per locality in Hounslow Map showing Hounslow prevalence of childhood overweight and obesity in year six children against a background of child poverty rates Figure showing under 18 conception rates Table of under 18 conception rate per 1000 population

4 Table of directly age standardised rates of admissions for alcohol specific and alcohol related conditions, Hounslow, London and England Figure of directly standardised rates for alcohol specific conditions, per 100,000 population Map of NHS Hounslow Community Pharmacies and GP practices Map of NHS Hounslow Community Pharmacies, Hospital Pharmacies and cross border Community Pharmacies Maps of NHS Hounslow Community Pharmacies by locality detailing the name and address of the pharmacy, phone number and languages spoken. 8.1 Level two stop smoking advisers and prevalence of smokers in NHS Hounslow 8.2 Teenage pregnancy incidence and providers of emergency hormonal contraception in NHS Hounslow. 4

5 Executive Summary The National Health Service (Pharmaceutical services and Local Pharmaceutical services (Amendment) Regulations 2010, which came into force on 24 May 2010 built on the requirements of the Health Act 2009 which placed a duty on all Primary Care Trusts (PCTs) to develop and publish a Pharmaceutical Needs Assessment (PNA). Each PCT must publish a PNA in accordance with these Regulations by 1 February Subject to further regulatory reform, it is anticipated that a process based on the PNA will be used to determine future pharmaceutical service provision and market entry for community pharmacy contract applications in the PCT area. This PNA describes the process in the development of the document and identifies local health needs and problems in the NHS Hounslow area. Public health data is provided on PCT wide, local area committee and ward level and mapped against pharmaceutical services providers. The localities for the purpose of reviewing the provision of pharmaceutical services are based on local area committees. Current pharmaceutical services provided to the area are described and the PNA identifies and maps providers of pharmaceutical services. Out of area providers of pharmaceutical services who dispensed more than 500 prescription items per year which originated in NHS Hounslow, based on data, are also identified. A patient survey, GP questionnaire and community pharmacy questionnaire were undertaken and the results reported upon within the PNA. These results fed into the analysis of the current provision, gaps in provision and suggested future provision of new pharmaceutical services to meet identified local health needs. A draft PNA was consulted upon from 20 September to 19 November A draft report on the consultation was written in December 2010 and comments invited from PNA Project Board members. The consultation report was finalised in January 2011 following comment and the PNA revised in the light of the consultation and report. The consultation report is included in the appendices to the PNA. The following conclusions and recommendations were made; Conclusions Necessary services: current provision 1) The patient survey demonstrated overall satisfaction with the level and quality of service delivery in Community Pharmacies in NHS Hounslow. 2) Pharmaceutical services provided as essential services within the national contractual framework are provided by the 54 community pharmacy contractors within NHS Hounslow with one pharmacy per 4249 resident population. The overall provision across the PCT area is adequate to meet the need for essential pharmaceutical services in the area. The distribution of this provision within the localities defined within the PNA is uneven, with provision in the Cranford and Heston locality per 5000 resident population being less than in the other localities and less than the England average. 3) Community pharmacies, distances selling/internet pharmacies, appliance contractors and other pharmaceutical services providers outside the PCT area which contribute towards meeting the needs for pharmaceutical services in the area as defined by dispensing more than 500 items per year (based on prescribing data for ) from prescriptions which originate within Hounslow PCT, are listed in Appendix 8. Necessary services: future need 1) The PCT has identified the need to redevelop the Heston Centre for Health in order to better meet the health needs of the population in this area. The pharmaceutical needs of the population 5

6 in this area will be considered, with consultation, as part of this redevelopment. Further work would need to be undertaken to determine where and how the population in the area access necessary pharmaceutical services and the adequacy and choice of provision. Other relevant services: gaps in provision 1) In the Heston area there is no provision of the advanced service of medicines use review and no community pharmacy provision of the enhanced services of emergency hormonal contraception, chlamydia screening, smoking cessation, NRT supply, not dispensed scheme or MAR chart production. 2) Although the overall number of providers is in line with locally set targets, there is no provision of needle exchange service in Chiswick, Heston or West Hounslow and no provision of supervised consumption in Heston or West Hounslow. There are no other providers of these services in those areas. Improvements and better access: potential service developments 1) Services which are not currently commissioned from community pharmacies that would meet identified health needs within the population and secure improvements or better access to pharmaceutical services have been identified within the PNA, as have community pharmacy contractors willing to provide such services, if commissioned. Additional conclusions 1) There is a general lack of awareness by GPs of the services offered by community pharmacies. 2) Feedback from the patient survey is that consultations were not always conducted in a private room. The facility of consultation rooms in community pharmacies is a valuable local resource which can be used to the advantage of patients and public. Recommendations 1) Increased integration of community pharmacists into the existing network of providers supporting patients, especially patients with long term conditions including skin conditions. 2) Provision of the means to enable increased working between GPs and community pharmacists, focusing on patient management. 3) Increased integration with local health priorities and support for community pharmacists from Public Health and the PCT in the delivery of the essential services of promotion of healthy lifestyles, self care and signposting. 4) To consider commissioning the full range of local directed services from 100 hour pharmacies in the area. 5) When considering the PCT commissioning intentions for 2011/12 to take into account the responses from the patient survey, GPs and the range of new services community pharmacies in NHS Hounslow would be willing to provide. 6) The PCT to encourage uptake with the provision of MURs, emergency hormonal contraception, chlamydia screening, smoking cessation, NRT supply, not dispensed scheme and MAR chart production in community pharmacies in the Heston area. 7) The PCT to revisit the distribution of providers of needle exchange and supervised consumption services with its partner organisation Central and North West London NHS foundation trust. 6

7 1. Introduction A Pharmaceutical Needs Assessment (PNA) describes local health needs, maps the current providers of pharmaceutical services and documents the services they provide. How pharmaceutical services currently contribute to local health needs and priorities will be illustrated and what could be done further in the future, will be discussed. Pharmaceutical services providers within and around the NHS Hounslow area and who serve patients and public in the area are Community Pharmacies (Chemists), hospitals and walk in centres and clinics both NHS and private. Pharmaceutical services are defined in Regulations (Reference 1) and guidance (Ref. 2). They include advice and the supply of medicines and appliances and are further defined within the essential, advanced and enhanced services of the NHS Community Pharmacy Contractual framework. These services will be described more fully in section seven. 2. Context and use for PNAs The Pharmacy White Paper published in 2008 (Ref. 3) set out a vision for pharmacy, with an emphasis on how further developments in the Community Pharmacy sector could contribute to improving public health. This was specifically with respect to being the first port of call for minor ailments, becoming healthy living centres, providing increased support for long term conditions and the provision of sexual health, vaccination and screening services. Regulations (Ref. 1) which came into force in May 2010, require all Primary Care Trusts (PCTs) to publish a PNA in line with these new regulations, by February A revised assessment is required within three years of the previous publication of a PNA. PCTs may need to publish a supplementary statement or statements during this three year period to explain any local changes or may need to produce a revised assessment, dependant on the scale and nature of the changes. A map which identifies the premises at which pharmaceutical services and dispensing services are provided in the area of the PCT needs to be maintained. The PNA will be used when planning and commissioning new services. It will sit alongside the Joint Strategic Needs Assessment (JSNA) that the Local Authority and PCT publish and will inform the Commissioning Strategy Plan (CSP) of the PCT and future commissioners. Guidance for PCTs relating to PNAs as part of World Class Commissioning was published in January 2009 (Ref. 4) with competencies two, four, five and seven being supported by the PNA process. All PCTs hold a list of providers of pharmaceutical services: Community Pharmacy sole traders or companies who provide NHS Pharmaceutical services to the population and have an NHS contract. When the PCT receives an application to join the list of providers or an application for changes from a current provider, it considers each application in line with national criteria defined in Regulations (Ref. 5). There is a note to the new Regulations which came into force in May 2010 which describes the plan to replace the current control of entry criteria by a process based on the PNA. There will need to be further Regulations passed in order to do this but this is also a use for the PNA which is planned for the future. Summary documents will be able to be prepared from the overall PNA, for example, listing Community Pharmacy services in a format which will be useful for patients, public and clinicians as well as the data being used to update the PCT s website content relating to providers of pharmaceutical services. 7

8 3. Process followed in developing the PNA A paper was presented to the PCT s Executive Director Team in January 2010 to raise awareness of the requirement to produce a PNA, its content and what it would be used for. A lead PCT Director with responsibility for the PNA was identified in April 2010 and a PNA Project Board (membership: Appendix 1, following guidance (Ref. 4)) established in May 2010 which met on six occasions between May and the end of November Meetings were also held between the operational lead and colleagues in public health, communications and engagement during this period. The PNA was added to the PCT s risk register in June 2010 and further papers presented to the PCT Board and Commissioning Executive Committee (CEC) during this period. Additional GP engagement was via a questionnaire (Appendix 2) conducted during a practice based commissioning consortium meeting. A patient survey (Appendix 3) was carried out and a questionnaire sent to all Community Pharmacy contractors (Appendix 4). Further detail about the survey and questionnaires is included in section seven. Letters were sent to all Stakeholders (Appendix 5, defined following guidance (Ref. 4) and local knowledge) giving opportunity for engagement as well as information about the PNA. Additional community pharmacy and Local Pharmaceutical Committee (LPC) engagement was via the Community Pharmacy Steering group and regular newsletter and evening meetings, provided by the PCT. A draft PNA and consultation questions were prepared and presented to the PCT Board in September 2010 and a consultation period undertaken from 20 September to 19 November The persons and organisations consulted with were as defined in Appendix 5 and all members of the public who had responded to the patient survey asking for more information and feedback. A summary report of the patient survey was sent to these individuals and they were also signposted to the consultation. The consultation responses were reported upon in a draft report in December 2010 with comment on the report being invited from PNA Project Board members. Following comments the consultation report was finalised in January 2011 and the PNA revised in the light of this report. The report on the consultation and conclusions reached were agreed by the PCT in January 2011 and the consultation report included in the appendices of the final version of the PNA published on the PCT website by 1 February

9 4. Localities definition and description The localities have been defined based on the Area Committee structure in Hounslow. Hounslow has five Areas, each with its own Council Committee 1. An area committee is made up of councillors and members of the public who are responsible for monitoring local service provision including planning and community leadership. The description and characteristics of the Area Committee is the basis for comparing needs and service provision in this needs assessment. By splitting Hounslow into these localities each area can be described and considered properly; this also helps the addressing of health inequalities. It is for these reasons and on this basis the localities have been defined. The five localities and wards they comprise are: Central Hounslow (Hounslow Central, Hounslow Heath, Hounslow South, Hounslow West) Chiswick (Chiswick Homefields, Chiswick Riverside, Turnham Green) Heston and Cranford (Cranford, Heston Central, Heston East, Heston West) Isleworth and Brentford (Brentford, Isleworth, Osterley &Spring Grove, Syon) West Area (Bedfont, Feltham North, Feltham West, Hanworth, Hanworth Park) 1 Hounslow Community Plan , Hounslow Council, May

10 Locality Profile Localities Characteristics West Hounslow high proportion of residents aged 65 and over highest proportion of children and young people aged 0-19 low-to-average life expectancy for the borough, with the lowest life expectancy in Feltham North, where it is only 76.6 years for females and 73.3 for males highest rates of mortality from cancer highest proportion of White residents (78% in 2008) highest levels of expected prevalence of obesity in adults in the borough and a high proportion of children and young people identified as overweight or obese has two of the three wards (Feltham West and Bedfont) in the borough for the highest teenage conception rates of girls aged fairly high unemployment rates, despite the proximity to the airport Heston & Cranford highest percentage of residents aged 0-5 years fairly high levels of life expectancy, except in Heston West and Heston Central where they are lower than average highest rates of mortality from coronary heart disease except in Hounslow East, where they are very low and about average levels for the borough of early deaths from cancer highest proportion of Asian and other non-white residents in the borough where they comprise a majority (60% in 2008) the largest number of Looked-After Children (93 in ); Central Hounslow highest percentage increase in projected population over the next 5 years highest proportion of residents in the borough aged 65 and over highest rate of births per 1000 population variations between wards in life expectancy, but generally high life expectancy for females, 86.5 years and males 80.5 years in Hounslow South ward high proportion of deaths from coronary heart disease low death rates from cancer but premature death rates from respiratory disease and stroke, which is much higher than the borough average high population of both White residents (47% in 2008) and Asian residents (49% in 2008) predominantly owner-occupied housing of varying age and quality lower than average unemployment the lowest proportion of residents who say they feel safe. Brentford and Isleworth highest percentage increase over the next 5 years in projected population of over 65 s variations between wards in life expectancy, particularly for females, with a difference of 4 years between Isleworth ward (79 years) and Osterley and Spring Grove ward (83.1 years) relatively high premature death rates for cancers but about average for other causes a non-white population of 26.7% in 2008, including a long-established Caribbean community low teenage conceptions in Osterley & Spring Grove a mixed area, ranging from owner-occupied family houses, to new apartments in regenerated neighbourhoods close to the river, to two large Council estates where deprivation is amongst the highest in the borough Chiswick a higher proportion of older people the highest percentage of people aged 85 and over many live on their own the smallest of the five areas (34,066 population in 2009), with the lowest proportion of young people aged 0-19 (11.7%) and the highest percentage of single people in households without children (27%); high life expectancy and premature death rates markedly below average for the borough lowest levels of teenage pregnancy and births in the borough a predominantly affluent and White area (88% in 2008), with some expensive housing but pockets of deprivation too; low unemployment. 10

11 Figure 4.1: Hounslow Borough highlighting localities and ward boundaries. 5. Identifying Local Health Needs 5.1 Population There are approximately 229, 459 people resident in Hounslow. The population is projected to increase by 6.5 percent to 244,200 in 2015 At the end of June 2009 the registered population for GPs in Hounslow was 260,659 people The population aged under five years accounts for around eight percent of the total population in Hounslow compared to 7.3 percent in London. The highest under five population are in West Hounslow at 27 percent followed by Heston & Cranford at 23 percent; and lowest in the Chiswick area. This is projected to remain fairly consistent in 2015 Children and young people nought to 19 years old constitute 26 percent of the whole population. They predominately live in West Hounslow and Heston & Cranford area committees Young girls aged account for three percent of the general resident population with the higher proportion living in West Hounslow at 30 percent and lowest in the Chiswick area The population of over 65 years accounts for 10.7 percent of the population in Hounslow. This age group live predominantly in West Hounslow and with the lowest numbers in Chiswick 11

12 The population over 85 years accounts for one and a half percent of the population in Hounslow. This age group lives predominantly in West and Central Hounslow areas Since 2002 the number of births has increased by 25.7 percent. However it is predicted that by 2019 the births will decrease by two percent. The number of deaths on the other hand is predicted to decrease by 19 percent indicating the population ageing [Figure 5.1.3]. The rate of birth per 1000 is 19 in Hounslow compared to 15 and 12.5 in London and England respectively. Central Hounslow locality has the highest birth at 20 percent and the lowest is in Chiswick at 15.5 percent Appendix 6 shows data about the resident population in five year age group bands in NHS Hounslow s five localities Male Resident Population by Locality in Hounslow 35 % of each age group West Committee Chiswick Committee Heston and Cranford Committee Central Committee Isleworth and Brentford Committee Age in years Figure 5.1.1: Male resident population in Hounslow s five localities by five-year age group. Source of Data: GLA

13 Figure 5.1.2: Female resident population in Hounslow s five localities by five-year age group Source of Data: GLA 2009 Figure 5.1.3: Hounslow births and deaths projections Source: ONS

14 The number of community pharmacies per head of population by locality is shown below in Table Locality Resident Population GP Registered population No. of community Pharmacies Resident Population per Pharmacy Registered GP Population per Pharmacy Central Hounslow Chiswick Heston & Cranford Isleworth & Brentford West Hounslow Table : The breakdown of community pharmacies per locality 5.2 Ethnicity Source: Exeter GP registered population 2008 Figure 5.2.1: Ethnicity in Hounslow s five localities 2008 Based on Exeter mid-2008 there are Black and Minority Ethnic (BME) population constitutes around 35.5 percent of people living in Hounslow; the corresponding figure in London is 31 percent, whereas nationally it was 11.8 percent. 30 percent of the population in Hounslow are from Asian or Asian British ethnic groups with the highest proportion living in Central Hounslow and Heston & Cranford area committees. The corresponding figure in London is 13 percent. Of the nought to 19 years population, around 41 percent are estimated to be from BME [Figure 5.2.1]. 14

15 5.3 Deprivation Hounslow has an average score of percent on the Index of Multiple Deprivation (IMD) 2007 scoring. Hounslow ranks as the 105th most deprived of England s 354 districts (where one is most deprived) and 19th of the 33 London boroughs. Hounslow s IMD 2007 score is 10.6 percent below the London Borough average of 25.96, and 7.2 percent higher than the national average. Fifteen of the 139 LSOA in Hounslow are among the bottom 20 percent of England s most deprived LSOA which is percent of the population. None of Hounslow s wards falls within the least deprived 20 percent nationally. Hounslow Area Committee Most Deprived 20% Central Hounslow Chiswick Heston & Cranford Isleworth & Brentford West Area Total % % % Least Deprived 20% Total Table Counts of Lower Super Output area (LSOAs) in Hounslow s five Committee areas ranked relative to England using 20 percent quintile of IMD Score of 2007 Using a population-weighted average score for each ward, the five most deprived wards in Hounslow are: Hanworth (33.17 percent), Cranford (29.57 percent), Heston West (29.18 percent), Brentford (28.95 percent) and Isleworth (27.24 percent). The least deprived wards in Hounslow are Hounslow South (13.16 percent), followed by Osterley & Spring Grove (15.17 percent), Chiswick Homefields (15.83 percent), Chiswick Riverside (15.97 percent) and Turnham Green (16.81 percent). Central Hounslow has the highest number of the most deprived LSOAs in Hounslow where 25 out of the 35 (71.4 percent) of LSOAs are in the 40 percent most deprived. The map shows differences in deprivation levels in Hounslow based on national quintiles (of the Index of Multiple Deprivation 2007 by Lower Super Output Area). The darkest coloured areas are the most deprived. 15

16 Figure 5.3.2: Map of Hounslow showing LSOA ranking relative to England using IMD2007 scores, the localities and ward boundaries are also shown. 5.4 Health Inequalities 1) Life expectancy Life expectancy at birth is one of the key measures for the health inequalities national target. It is an estimate of the average number of years an individual expected to live if current mortality rates continued to apply. In (latest available data), the life expectancy in Hounslow was 76.6 years for men, and 81.0 years for women. This means that girls born in Hounslow can expect to live 4.4 years longer than boys born at the same time. Life expectancy for both males and females is lower than in London and England averages (Figure 5.4.1). Life expectancy varied considerably across the localities where men experience a shorter average life expectancy than women. Lowest life expectancy was in Feltham North, where it is only 76.6 for females and 73.3 for males. Life expectancy for men living in the least deprived areas within Hounslow is over four years higher than for those living in the most deprived areas reflecting the inequalities in health within the borough. 16

17 Figure 5.4.1: Life expectancy in Hounslow five localities pooled data. Source: Pooled Data, LHO, 2) Infant mortality rate Infant mortality is a measure of all deaths among infants under one year of age, and is considered to be a good general indicator of the health of the population and it is one of two national inequalities targets announced in The link between deprivation and infant mortality is strong, with the most deprived areas broadly correlating to the areas with higher infant mortality rates. The infant mortality rate in Hounslow for the years 2008 was 4.8 deaths per thousand live births, approximately the same rate as the national average and slightly above the regional average of 4.3. Within the wards there were wide variations in rates where Hanworth, Syon and Heston Central experienced higher rates than Hounslow average. This is likely to be a reflection of the higher levels of deprivation in these wards. 17

18 Figure 5.4.2: Map of Hounslow showing infant mortality rate per 1000 live births at ward level

19 6. Local Health Problems Over the last ten years, the rates of deaths from all causes combined and the rates of early deaths from cancer, heart disease and stroke have fallen in Hounslow. However diseases of the circulatory system, remain the leading causes of premature deaths in Hounslow. This is followed by deaths due to all cancers and respiratory diseases. The indirectly standardised mortality ratio (SMR) for all cause all age for Hounslow is higher than for London and England. The rates are also higher in males compared to females (data not shown). The West Hounslow and Isleworth & Brentford localities have SMR higher than Hounslow, the regional and national averages. Deaths in people under 75 years of age gives an indication of years of life lost due to premature death for a disease. Premature deaths due to cancer are lower than both the regional and the national average. However West Hounslow has rate 20 percent higher than the national. Death from respiratory disease is at 13 per 100, 000 in Hounslow compared to 12 in London and England with the deaths in males considerably higher than females (data not shown). Heston Isleworth Mortality Central West Chiswick & & and Births Hounslow Hounslow Cranford Brentford Hounslow London England All age all cause Mortality CHD SMR (Pooled ) <75 Cancer Mortality SMR (Pooled ) Table 6.1: Standardised mortality ratio SMR (Pooled ) in Hounslow by locality. 6.1 Coronary Heart Disease Coronary heart disease (CHD) includes acute myocardial infarction and ischaemic heart disease and is influenced by individual lifestyle factors including smoking, obesity, and lack of physical activity. The most important preventable cause of CHD is smoking where approximately 20 percent of deaths are attributed to smoking. CHD is associated with level of deprivation and certain ethnic minorities. People from the Indian sub-continent have higher death rate from heart disease compared to the average for England and the rates are particularly higher in females. The prevalence of CHD in Hounslow is 2.38 percent compared to 2.26 percent and 3.50 percent in London and England respectively. Mortality in all age groups due to CHD rate in Hounslow is higher than rates for London but similar to the national with rates in males considerably higher than females. The number of deaths under 75 has fallen considerably in the last 10 years however there is a large variation in rates of deaths for CHD under 75 years between localities with the ratio 40 percent higher in Heston & Brentford than the national [Table 6.1]. 19

20 6.2 Diabetes The prevalence of diabetes in Hounslow is about 4.6 percent. Diabetes impacts unequally on population where people from black and minority ethnic (BME) populations are up to six times more likely to develop diabetes. Thus, early identification activities and prevention should be targeted at high risk groups. The prevalence of diabetes in Hounslow is forecasted to increase due to an increase ageing population and the increasing prevalence of obesity. The number of people with diabetes is estimated to increase from 11,365 with a prevalence of 4.4 per cent in 2009 to a prevalence of 6.3 percent by This situation emphasises the need for consistent and intensive primary prevention measures to meet the challenge of obesity and unhealthy lifestyles. Standardised death rates (DSR) from diabetes among males in Hounslow (for all ages and under 75 years) is markedly higher compared to London and England rates. Hounslow has the fourth highest death rate for males and while females have the 7th highest death rate across London. There are no data on diabetes at ward/locality level. The prevalence across GP practices varies considerably ranging from 2.7 percent to 12.6 percent [Figure 6.2.1]. Admissions of people resident in Hounslow to hospital due to diabetes complication could be used as a proxy to reflect the burden of the disease at ward and locality level. The highest admissions are from West Hounslow [Figure 6.2.2]. Figure 6.2.1: Prevalence of diabetes by GP practice 20

21 Figure 6.2.2: Map of Hounslow showing admissions due to diabetes in adult resident population

22 6.3 Hypertension Hypertension (high blood pressure) is the most common long-term condition and an important modifiable risk factor for heart disease, stroke and chronic renal failure. Risk factors for hypertension are obesity, excess dietary salt and heavy alcohol intake. Modelled estimates of prevalence for Hounslow are 51,300 compared to only 29,650 diagnosed (50 percent). The prevalence of hypertension in Hounslow is percent compared to percent for London and percent nationally. Prevalence across GP practices varies considerably ranging from 6.3 percent to 20.5 percent suggesting possible under-diagnosis in some of the GP practices. This mean that a considerable number of local people with hypertension remain undetected, untreated and potentially at risk of stroke and other circulatory diseases. Figure 6.3.1: Prevalence of hypertension by GP practice Mortality from hypertensive disease has continued to rise since the late 1990 s in Hounslow. Premature deaths (dying before the age 75 years) from hypertension are lower than London rates but higher than the national average rate. 22

23 The map [Figure 6.3.2] highlights hypertension related admission rate to hospital. Admissions rates are highest in West Hounslow and Heston& Cranford area committees. Figure 6.3.2: Map of Hounslow showing hypertension related admissions in adult population, Stroke Stroke is a key cause of premature death within Hounslow and the third biggest cause of death locally and nationally. As a disease of the elderly, stroke will affect an increasing number of people as the UK population ages. Stroke is also among the main causes of long term illness and disability. Key risk factors include age, ethnicity and gender. Modifiable risk factors include smoking, lack of exercise, obesity, hypertension, and high cholesterol. It is also predicted that numbers of stroke will rise due to rising obesity and increase of at risk population groups. Hounslow has the same standardised death rate for stroke to London and England however the rates are the highest compared to the local boroughs with the highest male premature mortality rate and the second highest premature female mortality rate. The prevalence of stroke in Hounslow is at one percent compared to 1.6 percent for England. The prevalence varies by GP practice from 0.2 percent to 2.2 percent. 23

24 Figure 6.4.1: Prevalence of stroke by GP practice The map shows admission rates per 1000 adult population for stroke. The highest admission rates are in Osterley & Spring Grove and Brentford wards in Isleworth & Brentford locality followed by Feltham and Hanworth Park in West Hounslow. Figure 6.4.2: Map of Hounslow showing admission rates due to stroke in adult population,

25 6.5 Chronic Obstructive Pulmonary Disease (COPD) COPD is an umbrella term for people with chronic bronchitis, emphysema or both: diseases of the lungs in which the airways become chronically narrowed most commonly due to long term smoking. COPD remains the most common emergency admission among adults in Hounslow ( ) resulting in 484 non elective admissions per 100,000 population. Treatment of COPD involves inhaled medication and advice on smoking cessation. Severe cases may require longterm oxygen therapy or non-invasive ventilation. COPD mortality has steadily declined for men in Hounslow while rates for women increased which supports estimates of an increase in female smoking rates. Mortality rates due to COPD reflect social inequalities with higher mortality in wards with higher deprivation scores. The standardised mortality ratio for COPD in Hounslow is higher at 109 compared to London which is 98 In , there were 2110 patients on the COPD register across GP practices in Hounslow with a prevalence of 0.9 percent compared to a national prevalence of 1.5 percent. Prevalence across GP practices varied widely ranging from 0.2 percent to 2.1 percent, indicating possible underdiagnosis. Figure 6.5.1: Prevalence of COPD by GP practice 25

26 The map [Figure 6.5.2] highlights the admission rate to hospital for COPD. Highest admission rates are in the West Hounslow locality including Hanworth, Feltham East and Bedfont. Brentford ward in the Isleworth & Brentford locality also has high rates of admissions. Figure 6.5.2: Map of Hounslow showing COPD admission rates per 1000 adult population,

27 6.6 Sexual Health The UK has seen a deterioration of sexual health over the past ten years, which is reflected in the growing numbers of sexually transmitted infections (STIs) and teenage pregnancies. STIs can lead to cancer, infertility and death. Late diagnosis and treatment can lead to more people being infected with huge cost to the NHS. Chlamydia is the most common curable STI and often occurs with little or no symptoms. Young people aged years have the highest rise in Chlamydia. Figure shows a summary of selected STIs in Hounslow from 2004 to 2008 with Gonorrhoea and Chlamydia showing increasing numbers. Figure 6.6.1: STI diagnosis for Hounslow In , 19 per cent of under 25s were tested under the National Chlamydia Screening Programme in Hounslow. The prevalence for Hounslow of Chlamydia was 10.4 percent. The highest rate is reported in West Hounslow where 29 percent of under 25 years old tested were positive. Locality Under 25 year old Population Number of Under 25 year olds Tested Percent of the Under 25s (%) Positive for Chlamydia Rate Per 1000 Central Hounslow Chiswick Heston & Cranford Isleworth & Brentford West Hounslow Grand Total Table 6.6.2: Under 25s tested under National Chlamydia Screening Programme in Hounslow

28 6.7 Mental Health One in four people in England and Wales will have some form of mental illness over their lifetime. People at greatest risk of mental health problems include people living in areas of deprivation, people from Black and Minority Ethnic (BME) groups and people who are unemployed, homeless, and refugees and asylum seekers. The true number of people with mental health problems in Hounslow is largely unknown. Current data available usually estimates the prevalence and incidence of mental health by applying national rates to the local population however caution is needed in interpretation of these estimates as these estimates does not take into account local factors such as the ethnicity make up of the population or deprivation levels. The table [6.7.1] below shows the predicted prevalence of common mental illness in population years old. The overall prevalence in Hounslow is similar to London and England average. However it expected that the prevalence will vary between localities because of their different make up. In children and young adults nought to 19 years old most cases are not identified until they need specialised services (tier three services). In 2009/10 the there were 800 new referrals from children resident in Hounslow seen in CHMHS tier three services which was a 10 percent rise from the previous year. The highest proportion came from TW7 and TW13 districts that are areas in South West and Central Hounslow [Figure 6.7.2]. Mental Health - All People Hounslow % London % England % People aged predicted to have a common mental disorder People aged predicted to have a borderline personality disorder People aged predicted to have an antisocial personality disorder People aged predicted to have psychotic disorder Table 6.7.1: Modelled mental health problems in adults. Source :

29 Figure 6.7.2: Map of Hounslow showing number of referrals per 1000 of 0-19 year olds population to tier 3 services in Hounslow Smoking Smoking is the single most important public health problem in England and this is also true locally. It is estimated that Hounslow has more smokers than the average in England. Twenty eight percent of Hounslow s adults were smoking in 2009 as compared with just under a quarter for England. Table shows modelled smoking prevalence in Hounslow s five localities in The highest rates are in West Hounslow at 38 percent followed by Isleworth & Brentford at 36 percent. The percentage of smokers who made contact with Stop smoking services is considerably low across Hounslow. Ward % of Committee population who currently smoke % of Smokers who made contact with Stop Smoking Service (2007/2008) Heston &Cranford Central Hounslow Chiswick Isleworth & Brentford West Hounslow Table modelled smoking prevalence in Hounslow. Source: CACI modelled data

30 Smoking during Pregnancy: Women who smoke during pregnancy have a substantially higher risk of miscarriage than those who do not smoke. Smoking can also cause complications in pregnancy and labour (British Medical Association 2004). The health risks for babies are also substantial. Children born to women who smoke are at risk of low birth weight (weight less than 2500g). Smoking during pregnancy can also increase the risk of death and disease in childhood. In percent of mothers were smoking at time of delivery in Hounslow, compared to 7.2 percent in London and 14 percent in England. Figure 6.8.2: Percentage of maternities smoking at time of delivery in Hounslow female population

31 6.9 Obesity/Weight Management Currently, people being overweight and obese are serious public health issues. Obesity can lead to a wide variety of health problems including an increased risk of CHD, type 2 diabetes, high blood pressure and an increased risk for some cancers. Obesity is also a contributor to health inequalities. Obesity and being overweight are more common in lower socio-economic groups, although the trend is less marked in men than women. Among women there are also important differences between ethnic groups 2. The prevalence of obesity among adults in Hounslow is currently unknown. Modelled rates are usually estimated from national surveys. Table shows modelled obesity (> 30 BMI) in adults per 1000 people in the Hounslow s five localities. These figures are compared to rates of 184 per 1000 population in London and 236 nationally. West Hounslow has the highest rate at 172 followed by Isleworth & Brentford. Chiswick locality has the lowest rate at 115 per 1000 population. Locality Rate per 1000 population with a BMI of >30 Heston & Cranford Central Hounslow Chiswick Isleworth & Brentford West Hounslow Hounslow Total Table 6.9.1: estimated obesity >30 per 1000 population in Hounslow. Source: CACI 2008 Childhood Obesity Overweight and obesity is also a growing and significant problem among children. The National Child Measurement Programme (NCMP) is undertaken annually by the school nursing service, to measure children in reception and year six classes in all Hounslow primary schools. Since the start of the programme there has been slight increase in the proportion of children who are overweight and obese. Hounslow also has worse figures than London and England averages. Figure [6.9.2] shows a map of Hounslow showing the post code of residence of children who are obese and overweight in year six in against a background of the percentage of children living in poverty. Central Hounslow and Brentford & Cranford localities have the highest proportion of overweight children and there is relation to level of poverty. 2 Annual Report of the Chief Medical Officer, London: The Stationery Office,

32 Figure 6.9.2: Map showing Hounslow prevalence of childhood overweight and obesity in year six against a background of child poverty rates,

33 6.10 Teenage Pregnancy Teenage conceptions have been consistently higher in Hounslow than the national average. The latest figure in 2008 showed an overall drop of about 6 percent compared to the previous year and 7.3 percent since the base line set in The percentage of conceptions leading to abortion increased consistently since 1998 to reach 62 percent in 2008 a 20 percent increase. Risk of teenage pregnancy is known to be greater in young women from disadvantage background specifically in terms of education. There is a positive correlation between ward index of multiple deprivation and under 18 conception rates. Thus, the most deprived areas have the greatest number of teenage pregnancies. Figure : under 18 conception rates. Teenage conception varied by localities with highest rates reported in Isleworth & Brentford at 52.1 conceptions per 1000 girls under 18 years of age. The higher rates reported for Chiswick are because the locality hosts a teenage mothers dedicated housing facility which help them into independence. Locality Under 18 Conception Rate per 1000 population ( ) Heston and Cranford Central Hounslow Chiswick Isleworth and Brentford West Hounslow Table : Under 18 Conception Rate per 1000 population ( ).Source: ONS 33

34 6.11 Alcohol The number of hospital admissions for conditions wholly or partially caused by alcohol (alcohol attributable conditions) continues to rise nationally and locally. There was an average increase in admission rates of eight percent a year between 2003/04 and 2008/09 in England. In Hounslow there were 1,137 alcohol attributable admissions in Alcohol specific admissions Alcohol related admissions Observed DSR Observed DSR Hounslow 1, ,137 London 27, England 215, , 641 1,014 Table Alcohol specific admissions and Alcohol related admissions in Hounslow, London and England. source: NI39 Hospital Episodes Statistics (HES) extract, 2007/08. Copyright 2010 Table : Directly Age standardised rates of admissions for alcohol-specific and alcoholrelated conditions, Hounslow, London and England, 2007/08 Figure : Directly standardised rates for alcohol-specific conditions, per 100,000 population,

35 7. Current Provision of Pharmaceutical Services 7.1 Services provided by Community Pharmacies in NHS Hounslow There are 54 Community Pharmacies (CPs) on the Pharmaceutical List of Providers for NHS Hounslow. These are mapped and listed in figure along with the location of NHS Hounslow General Practitioners (GPs). Please note that Community Pharmacies are allocated to PCTs based on postcode, which is why Alisha Pharmacy is outside the area committee boundary. Figure Map of NHS Hounslow Community Pharmacies and GP practices, Community Pharmacies numbered and listed Community Pharmacies Chiswick 1 Pestle and Mortar Central Hounslow 23a Hounslow East Pharmacy West Area 42 Your Local Boots Pharmacy 2 Bedford Park Pharmacy 24 Amin Pharmacy 43 Edwards & Taylor 3 West London Pharmacy 25 Crystal Pharmacy 44 Your Local Boots Pharmacy 4 Churchills Pharmacy 26 Maswell Park Pharmacy 45 Tesco Instore Pharmacy 5 Campbells Chemist 27 Ram Dispensing Chemist 46 Asda Pharmacy 6 ABC Drugstores Ltd 28 Boots the Chemist 47 Your Local Boots Pharmacy 7 Boots the Chemist 29 Asda Pharmacy 48 Boots the Chemist 8 Sainsbury Instore Pharmacy 30 Hounslow Central Pharmacy 49 Tesco Instore Pharmacy 9 Alisha Pharmacy 31 Lloyds Pharmacy 50 Your Local Boots Pharmacy 10 Busbys Pharmacy 32 Herbert & Herbert 51 Rowlands Pharmacy 11 Roxanne's Pharmacy 33 Herbert & Herbert 52 Your Local Boots Pharmacy Isleworth & Brentford 34 Boots the Chemist 53 Your Local Boots Pharmacy 12 B.A. Williams Chemist 35 Shah Pharmacy 13 Alliance Pharmacy 14 Brent Pharmacy Heston & Cranford 36 Brickman Pharmacy 15 Tesco Instore Pharmacy 37 Brickman Pharmacy 16 Osterley Park Pharmacy 38 Bhogal Pharmacy 17 Priyesh Pharmacy 39 Medico Pharmacy 18 A.C. Curd Ltd 40 Beaver Pharmacy 19 Riverside Pharmacy 41 Dunns Chemist 20 Azchem Pharmacy 21 Tesco Instore Pharmacy 22 Jasins Chemist 23 A.C. Curd Ltd 35