Transcript Projected acute hospital demand in South East London

Projected acute hospital demand
in South East London
Meic Goodyear
Queen Mary University of London &
South East London Public Health Network
August/September 2005
Background to South East London (1)
• Six PCTs – Bexley, Bromley, Greenwich,
Lambeth, Southwark, Lewisham
• All coterminous with London Boroughs
• 120 Wards
• ca. 1.5 Million residents
Background to South East London (2)
• Overlapping geographies:
- Inner/Outer London
Inner (Lambeth, Southwark, Lewisham)
Outer (Bexley, Bromley Greenwich)
- London Sub Regions:
South (Bromley)
East (Bexley, Greenwich, Lewisham)
Central (Lambeth, Southwark)
- Thames Gateway Zones
Background to South East London (3)
• Population:
–
–
–
–
Ethnically diverse
Highly mobile in most parts
Areas of significant deprivation
Growing Fast!
Hospitals in South East London
• Each PCT hosts a General or Teaching
Hospital
• Lambeth’s & Southwark’s are managed as a
single provider trust
• Policy decision: no new hospitals to be built
Hospitals most used by South East Londoners
"Source: 2001 Census Output Area Boundaries. Crown copyright 2003. Crown copyright material is reproduced with the permission of the Controller of HMSO"
Questions and issues
• What will be the expected demand for
hospital usage over the period to 2016?
• How to develop existing facilities
• Where to put new facilities
(diagnostic/treatment centres etc)?
• Conflicting pressures
- historical rise in demand year on year
- Government policies to move services to community
and restrict growth of emergency admissions
Data Sources – patient activity
• Inpatient utilisation: each PCT provided files of patient
(“consultant episode”) data annually from 2000. Data from
the national HES database was used for standardisation
• Outpatient utilisation: although this data is exchanged
nationally, not all PCTs keep it available, so for the
moment outpatients are assumed to follow the same
patterns and flows as inpatients
• Typically there are 4-5 times as many outpatient
attendances as inpatient episodes
• A&E data not suitable for use, and not easily to hand so
not included in study
Data Sources – reference
• Standard NHS codes reference files
• NHS Postcodes file
• Ordnance Survey codepoint/addresspoint
Method(1)
•
•
•
•
•
Establish baseline and assume constant rates
Determine baseline usage patterns
Work at lowest convenient geographical level
Apply to best available population projections
Investigate mismatch between existing provision
and need (assuming total baseline meets total
need, but not necessarily in the right places)
Method(2)
•
•
•
•
Baseline: Average 2000-2002 activity
Apply to 2001 Census to get rates
Work at Ward level
Ward/provider flows where there is reasonable
year-to-year consistency (90-95% of totals)
• 95% confidence intervals to handle uncertainty
• Ward centroid – provider distances as the crow
flies by Pythagoras from geocodes; driving
distance from Infomap software using shortest
journey time as preference
Projected population growth SEL 2001 – 2016
per NELSHA/SELSHA “Blue Book”
Projected population growth SEL 2001 – 2016
per GLA Scenario 8.1
South East London SHA
Lambeth
Southw ark
Lew isham
Greenw ich
Bexley
Bromley
Total population
Increase from previous
Total increase 2001 - 2016
2001
2006
2011
2016
274,200
294,002
310,777
326,509
251,060
266,030
284,414
302,925
254,886
264,041
274,435
284,426
217,805
231,956
241,047
246,616
218,757
221,610
225,150
228,671
296,218
301,810
309,283
316,390
1,512,926 1,579,448 1,645,106 1,705,536
66,522
65,658
60,429
192,610
Projected population growth - 2001 – 2016
Comparison GLA v Blue book by PCT
Gr eenwi ch
B r o ml e y
Bexl ey
235,000
340,000
230,000
320,000
225,000
300,000
280,000
270,000
260,000
250,000
220,000
GLA
280,000
GLA
GLA
240,000
BB
2 15 , 0 0 0
BB
BB
260,000
230,000
2 10 , 0 0 0
240,000
205,000
220,000
2 10 , 0 0 0
200,000
200,000
200,000
2001
2006
2 0 11
2 0 16
220,000
2001
L a mb e t h
2006
2 0 11
2001
2 0 16
2 0 11
2 0 16
So u t h w a r k
Lewi sham
340,000
2006
320,000
290,000
280,000
320,000
300,000
270,000
300,000
280,000
260,000
280,000
GLA
250,000
GLA
BB
240,000
BB
GLA
260,000
260,000
BB
240,000
230,000
240,000
220,000
220,000
220,000
2 10 , 0 0 0
200,000
200,000
200,000
2001
2006
2 0 11
2 0 16
2001
2006
2 0 11
2001
2 0 16
So u t h E a s t L o n d o n
1, 7 5 0 , 0 0 0
1, 7 0 0 , 0 0 0
1, 6 5 0 , 0 0 0
1, 6 0 0 , 0 0 0
GLA
1, 5 5 0 , 0 0 0
BB
1, 5 0 0 , 0 0 0
1, 4 5 0 , 0 0 0
1, 4 0 0 , 0 0 0
1, 3 5 0 , 0 0 0
2001
2006
2 0 11
2 0 16
2006
2 0 11
2 0 16
Thames Gateway “Zones of Change”
"© Crown Copyright/database right 2007. An Ordnance Survey/EDINA supplied service."
TG Zones do not observe borough or ward boundaries
"Source: 2001 Census Output Area Boundaries. Crown copyright 2003. Crown copyright material is reproduced with the permission of the Controller of HMSO"
Which population projections?
• GLA: by year, by age in years and 5-year age band, by
Borough and ward. Includes data from Housing Capacity
Study (HCS).
Only part of TG development included, where that was
included in the HCS.
Issued in late 2003. Initially informed no TG included,
subsequently this was corrected.
No other ward-based projections are available so use these,
with appropriate caveats, and revise calculations when
these are updated.
Linking patients to geography
Patient data
– postcode,
NHS hosp;
PCT;GP &
practice
codes
NHS Postcode
file/ Ordnance
Survey: NHS
links to Postcode
& geocoding
Aggregate
at ward level
Analyse by
Ward-provider
Flows, distance,
travel
Prince’s Ward, Lambeth (randomly chosen example)
"Source: 2001 Census Output Area Boundaries. Crown copyright 2003. Crown copyright material is reproduced with the permission of the Controller of HMSO"
Outputs of Analysis (1)
Annual totals with 95% CIs by age band
Lambeth Prince's ward, projected admitted episodes, by age band,
2001-2016
3500
3500
3000
3000
2500
2500
f 75-84
2000
2000
e 65-74
1500
1500
1000
1000
95% CI
episodes
g 85+
d 45-64
c 15-44
b 5-14
a 0-4
500
500
20
16
20
15
20
14
20
13
20
12
20
11
20
10
20
09
20
08
20
07
20
06
20
05
20
04
20
03
20
02
0
20
01
0
year
Lambeth
Prince's Ward
year
Age range
a 0-4
b 5-14
c 15-44
d 45-64
e 65-74
f 75-84
g 85+
All ages
95% CI
All ages Lower 95% CI
All ages Upper 95% CI
2001
227
84
1066
754
319
314
140
2906
216
2798
3014
2002
226
86
1032
764
312
321
133
2874
213
2767
2980
2003
234
86
1052
775
318
311
141
2918
216
2810
3026
2004
247
86
1067
790
323
314
145
2974
220
2864
3084
2005
259
88
1083
805
325
309
157
3024
224
2912
3136
2006
268
90
1093
836
315
311
166
3078
227
2964
3191
2007
273
93
1097
870
310
308
173
3123
230
3008
3238
2008
278
97
1096
905
310
305
178
3169
233
3053
3286
2009
283
101
1099
932
310
300
188
3212
236
3094
3330
2010
287
102
1107
965
308
297
188
3254
239
3134
3373
2011
292
105
1111
1001
308
294
189
3299
243
3178
3420
2012
295
105
1113
1026
313
291
191
3335
245
3213
3458
2013
299
107
1115
1054
309
296
185
3364
247
3240
3487
2014
302
110
1111
1083
302
302
186
3395
249
3271
3520
2015
305
112
1112
1099
305
304
185
3422
250
3297
3548
2016
307
113
1121
1098
315
296
189
3440
252
3314
3566
Outputs of Analysis (2)
Standardised Episode Ratio (SER)
Age range
a 0-4
b 5-14
c 15-44
d 45-64
e 65-74
f 75-84
g 85+
All ages
SER
0.79
0.85
0.89
1.53
0.95
1.00
1.22
1.03
lower 95% CI higher 95% CI
0.69
0.90
0.68
1.06
0.84
0.95
1.42
1.64
0.85
1.06
0.89
1.12
1.03
1.44
0.99
1.06
Standardised to England population
using HES data 2000-2002 average rates
Outputs of Analysis (3)
Ward-provider flow proportions
3 year
average
fraction
76.7%
7.1%
3.8%
1.6%
1.5%
0.7%
0.8%
0.8%
7.0%
provider
RJ1
RJZ
RV4
RQM
RV501
RJZ33
RV502
RRV
provider name
GUY'S AND ST THOMAS' NHS TRUST
KING'S COLLEGE HOSPITAL NHS TRUST
COMMUNITY HEATH SOUTH LONDON
CHELSEA AND WESTMINSTER HEALTHCARE NHS TRUST
ST THOMAS'S HOSPITAL (MENTAL HEALTH UNIT)
KINGS COLLEGE DENTAL HOSPITAL
THE LAMBETH HOSPITAL
UNIVERSITY COLLEGE LONDON HOSP NHS TRUST
Others
Journeys at current patterns
• Admitted patients in South East London
travel ca 4,000,000 person Kms per year to
and from their admissions
• Assuming similar patterns for outpatients,
total annual travel to and from hospitals in
South East London will be in the 20-25
million kilometres
Naïve assumption
• For environmental and for convenience of
patients, wherever possible,
patients should be treated at the hospital
nearest their homes
(most would choose this assuming equal quality of care)
“Excess distance”
• Calculate total current travel distances
• Calculate minimum travel distances on the
basis of all journeys being to/from hospital
nearest to home (ward centroid of patient’s
address)
• Excess distance is the difference between
these
South East London Admitted Patients:
Fraction of mileage to hospitals other than the
shortest journey
"Source: 2001 Census Output Area Boundaries. Crown copyright 2003. Crown copyright material is reproduced with the permission of the Controller of HMSO"
Excess distance (2)
"Source: 2001 Census Output Area Boundaries. Crown copyright 2003. Crown copyright material is reproduced with the permission of the Controller of HMSO"