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									Enclosure 9

Subject Report From Date of Meeting AIM OF REPORT
To inform the Board of progress in Walsall towards local targets related to the ‘Our Healthier Nation’ strategy. This includes mortality targets for cardiovascular disease, cancer and suicide, subsequently adapted as Public Service Agreement (PSA) targets, and mortality targets for accidents. Progress in reducing inequalities between Walsall mortality rates and average rates in England are also reported.

Our Healthier Nation: Targets and Monitoring Data, Walsall 10 Years On Dr Sam Ramaiah, Director of Public Health Thursday 21 May 2009

Walsall tPCT adopted local targets in 2001 for reducing mortality from circulatory disease, cancer, suicides and accidents, in order to take forward ‘Our Healthier Nation’ in Walsall. These targets took account of the need to reduce health inequalities between Walsall and other districts in England. Relative to the baseline period 1995-97, achievement of the mortality targets in this report will reduce Walsall annual deaths from these causes by 391 by the year 2010. The report includes recently published data up to 2007 and shows trends from 1995 up to 2007, together with comparisons of Walsall with West Midlands and national (England) data. Performance monitoring data is presented for the triennium 2005-07 as the main measure of progress against the baseline period 1995-97. After ten years of the fourteen year strategy period, annual deaths in Walsall have reduced by a total of 272 in the four priority areas. This represents about 70% of the number of lives which will be saved if all the targets are achieved by 2010. Trend performance since 1995 suggests that Walsall is on track to achieve the headline mortality targets for circulatory disease. The local trends data suggests that the cancer target may be marginally underachieved and the mental health (suicide) target seems unlikely to be achieved. The ambitious target for accidental deaths (42% reduction) may also be difficult to achieve. The Walsall mortality rate for all circulatory disease in people under 75 has fallen by 42% since 1995-97, saving 209 lives per year. Despite this good progress, the Walsall reduction is marginally less than achieved nationally and the Walsall mortality rate is therefore 25% higher than the national rate. Elimination of this inequality gap would save an additional 56 lives per year in Walsall. The report also examines progress separately for CHD and Stroke in people under 65 and in people 65-74 years old. Prevention, treatment and care in Walsall is driven by standards in the National Service Framework, the Quality and Outcomes Framework, and guidelines from the National Institute for Health and Clinical

Walsall Teaching Primary Care Trust

Excellence. Cancer mortality in the under 75s in Walsall has fallen by almost 14% since 1995-97, saving 53 lives per year. However, as the national reduction over the period was over 18%, the Walsall inequalities gap has widened to a rate 12% higher than the national average. Reducing the Walsall rate down to the national rate would save an additional 41 lives per year in Walsall. Progress is also examined separately for lung cancer and for breast cancer. All the progress in reducing lung cancer mortality in Walsall so far has been among men, with mortality rates for women unchanged over the ten years. There is therefore concern that the Walsall target may be achieved without a major reduction in the lung cancer mortality rate in women. The Walsall mortality rate for breast cancer in women of screening age 50-69 years has fallen by 13% since 1995-97 but the national rate has fallen faster. Prevention, treatment and care in Walsall is driven by local strategies to implement the national cancer plan and guidelines from the National Institute for Health and Clinical Excellence. The Walsall suicide rate in 2004-06 has increased by 16% since 1995-97, However, the number of deaths is relatively small and any changes therefore result in substantial fluctuations in mortality rates. In 2004, the number of suicide deaths increased to the highest level in the decade (30 deaths) but subsequently fell to 16 deaths in 2006, increasing again to 18 deaths in 2007. Achievement of the 2010 target requires a consistent reduction to no more than 13 deaths per year. A suicide prevention strategy and action plan is currently being implemented, with a dedicated coordinator in post. £70,000 was invested during 2007-08 on a range of suicide prevention measures, including work with vulnerable communities. The Walsall mortality rate from accidents has decreased by 29% since 1995-97, resulting in 11 fewer deaths per year than a decade ago. In contrast, the national mortality rate has changed little since 1995-97. Consequently death rates in Walsall are now 15% lower than nationally (30% lower for Walsall women). The ambitious year 2010 target may nevertheless be difficult to achieve, requiring a further 18% reduction in accident mortality over the remaining 4 years. Appendix 1 provides a linear extrapolation of 1993-2007 data through to 2010 for each target. Appendix 2 highlights Walsall’s progress in reducing health inequalities relative to the national averages for men and for women over the period to 2005-07. Appendix 3 maps the wide variation across the West Midlands for the target indicators. For example, for all circulatory disease under 75 years the range of the mortality rate across the West Midlands is from 63.8 (Herefordshire) to 131.6 (Heart of Birmingham), with Walsall at 98.9. For cancer under 75 years the range of the mortality rate is from 104.8 (Herefordshire) to 140.0 (Stoke-on-Trent), with Walsall at 129.9. In contrast, Walsall has the lowest mortality rate in the West Midlands for deaths from accidents. An Addendum investigates the increase in CHD mortality among the under 65s in Walsall during 2006 and 2007, which is highlighted as an area of concern in the main report. Provisional mortality data for 2008 shows a substantial reduction and a return to the previous downward trend.


Walsall Teaching Primary Care Trust

That the Board receives the report. The report is compiled annually to highlight areas of good progress towards targets as well as areas of concern where targets are unlikely to be met and/ or where inequality gaps are widening. It is recommended that the report is used to inform the ongoing development of strategies targeting circulatory disease, cancer, mental health and accidents.

Board Action Required (please tick)

Approval [  ]

Assurance [ ]

IMPLICATIONS Priorities (please tick) Comment - Health Service not Illness Service [ ] Evidence-based Excellence [ ] - Alliances the Key to Success [ ] - Listening to Local People [ ] - True Choices, Accessible Services [ ] - Hitting the Hard Targets [ ] Target for reducing suicide may not be Risks

achieved, and cancer and accident mortality targets may be marginally underachieved. Attention is also drawn in the report to increasing or persisting inequalities (including gender) relative to national mortality rates

Resource Environment Equality Impact Assessment Engagement (eg PPI, Clinical, NonClinical)

See risks above

Legal Timescales and Implementation

Review Key Standard(s) for Better Health WCC Competency Author Director Checked (Initials) Date Received by Board Secretary

The report presents results for 10 years into the strategy (to 2005-07). The final target year is 2010, for which performance will be measured by 2009-2011 data The next report will be compiled in 2010, when data for 2008 becomes available C5a, C18, C22a, C22c, C23 2, 3, 4, 5,6

Graham Fee SR 6.5.09

Walsall Teaching Primary Care Trust


Walsall Teaching Primary Care Trust

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