Secondary prevention
NHS SoTW
Dr Jackie Gray
Bridging the Gap
• Extending the measured length of
life,
• Improving the measured quality of
life,
• Reducing health inequalities in
terms of the measured health
differential between SoT&W and
England and Wales, and between
small areas within the patch.
NHS SoTW
• S Tyneside
• Gateshead
• Sunderland
The CVD mortality gap
Mortality rates due to all circulatory disease in South
Tyneside and England among people under 75 years
South Tyneside North East England
Age-standardised rate per 100,000
200
180
160
1996 - gap is 18%
140 of England rate
120
2004 - gap is 29% of
100 England rate
80
1995 1997 1999 2001 2003 2005
Source: Clinical and Health Outcomes Know ledge Base
Risk Factor differences
E&W Gat S Tyn Sun
% Obese 21.8 24 24.2 24.1
% 26 33.1 32.9 32.8
Smokers
% Binge 18.2 25 26 26.7
drinkers
Reducing the Gap in Life Expectancy & Mortality*
(Health Inequalities Intervention Tool )
Gat S Tyn Sun
% change in 14.3 15.3 18.3
LE gap
% change in 12.1 14.5 12.2
MR
*Identifying & Managing hypertension + Prescribing statins +
Expanding smoking cessation
NHS SoTW
Commissioning
Executive
NHS SoTW Practice
Cardia Based
c Bridging the Gap
Networ CVD strategy group Commissioni
k ng
Stroke Vascular Arrhythmi Heart
Task Risk Task a Failure
Group Group Task Task Group
Strategic priorities
• Take an overview of the development and
commissioning of CVD services as a programme.
• Ensure that PBC and PCT commissioning and
development of CVD services is co-ordinated..
• To ensure an appropriate balance between the
commissioning of prevention, treatment and care in the
reduction of mortality from CVD.
• Expansion of lifestyle services - £12M investment
• Lead on needs assessment, equity audit, performance
management, an outcomes and evaluation framework.
• Act as a local part of the regional cardiac network.
Hypertensio
Obesity
Improving /
assuring clinical
Communicati
quality &
outcomes *
CHD
Procurement,
contract
management & ons
Population health improvement
investment*
Risk factor modification
CKD
Partnership
Risk assessment
working to
mobilise
community
resources*
CVA
Evaluatio
Health needs
assessment, risk &
PVD
Knowledge
n
management*
DM
Clinical leadership,
engagement &
workforce
managemen
Performanc
development*
Smoking
Public and patient
Lipids
engagement and
empowerment*
e
t
Task groups – priorities
• Vascular risk
• Stroke
• Heart failure
• Arrhythmia
NHS SoTW Workstreams
• Partnership working to mobilise community
resources
• Health needs assessment, risk & knowledge
management
• Improving & assuring clinical quality & outcomes
• Clinical leadership, engagement & workforce
development
• Public & patient engagement & empowerment
• Procurement, contract management &
investment
Vascular Risk task Group
• Systematic vascular risk identification
measurement and management within primary
care supported by community services
– Risk estimation LES
– Social Marketing
– IT systems
– Service models
Participation and coverage
Practices
participating estimate
(%) not done
Sunderland 74 39,000
South Tyneside 90 15,000
Gateshead 94 3,000
Total SOTW 84 57,000
What proportion of the population
are at risk?
% practice populations
0.0 2.5 5.0 7.5 10.0 12.5 15.0 17.5
Sunderland
South Tyneside est. hi risk men
est. hi risk women
actual hi risk men
Gateshead actual hi risk women
Total SOTW
How do actual risks relate to
predictions?
proportion (%) actual risk
>20%
men women All
National prediction** 25.7 11.8
Sandwell project* 2.4
Gateshead* 5.6 3.8 4.7
Prevalence of risk across SoTW
Heart Failure
• Map out the whole patient pathway and develop a standard heart
failure pathway for SoTW
• Review current service provision against the standard SoTW
pathway to identify gaps in the service, areas for development and
improvement and make recommendations for commissioning to
improve and develop services
• Review all local heart failure guidelines and protocols to ensure they
comply with national heart failure guidance & develop a standard
heart failure guidelines for the SoTW area
• Develop competencies for delivery of heart failure service in primary
care, review training for primary care clinicians to support the Les
and make recommendations
• Review current heart failure rehabilitation services and identify areas
for service improvement and development
• Review current palliative care services for patients with heart failure
and identify areas for improvement and development
Arrhythmia
• Map out ideal arrhythmia pathway
• Review current services against the
pathway, and develop recommendations
for future commissioning service
improvement & development
CVA - Early Work Planned
• Development of a local model of provision of TIA
services to reduce stroke incidence
• Assessment of stroke rehabilitation needs
• Work with the Cardiovascular Network to raise
awareness of stroke in our local populations
• Build on initial equity audit to gain an
understanding of health inequalities in relation to
stroke and develop approaches to address
these