Health care

The health care section includes information about:

  • cardiovascular disease (CVD)
  • cancer
  • liver disease
  • NHS health checks
  • respiratory conditions
  • sensory impairment - sight loss

Cardiovascular disease (CVD)

Why this is important

In the UK, cardiovascular disease causes a quarter of all deaths and is the largest cause of premature mortality in deprived areas. Those in the most deprived 10% of the population are almost twice as likely to die as a result of CVD, than those in the least deprived 10% of the population.

Falling mortality rates from heart disease were the main contributor to increases in life expectancy between 2001 and 2016 in England, according to the Health Profile for England. However, since 2011 the rate of increase in life expectancy has slowed for both males and females as improvements in heart disease mortality have plateaued. This highlights the need for a renewed drive to prevent CVD deaths, which still account for 1 in 4 of all deaths in England. (Health Matters: preventing cardiovascular disease, 2019)

In Barnsley, CVD is a major contributor to health inequalities. The age sex standardised mortality for CVD in those aged under 75 is 20% higher than the national average (2016-2018).

In January 2017, the commissioning for Value (CfV) ‘Where to Look Pack’ stated that CVD is the biggest opportunity for the Barnsley health economy when health outcomes and spend are combined. It highlighted high non-elective admissions and associated spend for Cardiovascular Disease.

The Barnsley picture and how we compare

Risk factors

  • Around 1 in 5 adults in Barnsley are smokers (17.4%), according to the national annual population survey (2018). This is significantly higher than the England rate of 14.4%.
  • Almost two-thirds (65.8%) of Barnsley adults are overweight or obese, similar to the national average (62.3%).
  • Latest data (2018/19) indicates that a quarter (24.2%) of Barnsley adults are physically inactive (doing less than 30 minutes of physical activity per week). This is similar to the national rate of 21.4%.
  • Just over a quarter (25.8%) of adults (18+) in Barnsley report drinking over the recommended 14 units of alcohol each week, similar to the England rate of 25.7%.
  • In 2018/19, 15.6% of Barnsley’s GP registered population were recorded on practice registers with hypertension (high blood pressure), significantly higher than the England rate of 14.0%.

Diabetes

  • In 2018/19, 7.7% of Barnsley’s GP registered population aged 17+ (16,201 people) were recorded on practice registers with diabetes, significantly higher than the England rate of 9%.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the fifth-lowest.
  • Rates have increased at each time point since 2009/10.
  • Barnsley’s estimated prevalence of diabetes (diagnosed and undiagnosed) is 8.8% of the practice population (18,512 people). This means that there are an estimated 2,311 people registered on Barnsley GP registers expected to have diabetes, who have not been diagnosed. 
  • Of the people in Barnsley who are registered with Type 2 Diabetes, just over half (56.7%) are male; this reflects the overall England proportion (55.9% male).

Stroke  

Prevalence

  • In 2018/19, 2.2% of Barnsley’s GP registered population (5,712 people) were recorded on practice registers with stroke or transient ischaemic attack (TIA), significantly higher than the England rate of 8%.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the second highest.
  • Rates have remained fairly constant since 2009/10.

Hospital admissions

  • Barnsley’s 2018/19 hospital admissions rate for stroke (258.1 per 100,000) is significantly higher than the England rate of 166.0 per 100,000 and the highest when compared to similar CCGs.
  • The current rate equates to 615 hospital admissions in 2018/19 for Barnsley residents for stroke.
  • At ward level, only one ward (Penistone East) had a lower admission rate than the England average in 2017/18, whilst the rates in Worsbrough, St Helens and Royston wards were more than one and a half times higher.

Mortality

  • Although Barnsley’s rates for under 75 mortality from stroke have fallen over recent years, the 2016/18 rate of 16.0 per 100,000 is still significantly higher than the England rate of 12.8 per 100,000.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the fourth highest.
  • At local level, Worsbrough, Wombwell and Monk Bretton wards have significantly higher mortality rates from stroke than the England average, whilst the rate in Hoyland Milton ward is significantly lower.

Coronary heart disease (CHD)

Prevalence

  • In 2018/19, 4.4% of Barnsley’s GP registered population (11,514 people) were recorded on practice registers with CHD; significantly higher than the England rate of 3.1%.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the second highest.
  • Rates have shown a consistent downward trend since 2009/10.

Hospital Admissions

  • Barnsley’s 2018/19 hospital admissions rate for CHD (663.8 per 100,000) is significantly higher than the England rate of 488.2 per 100,000 and the third highest when compared to similar CCGs.
  • The current rate equates to 1,630 hospital admissions in 2018/19 for Barnsley residents for CHD.
  • At local level, all wards had significantly higher admission rates in 2017/18 than the England average, with the rates in North East, Royston, Darfield, Stairfoot, Dearne North, Wombwell, Cudworth, Worsbrough and St Helens being more than twice as high as England.

Mortality

  • Although Barnsley’s rates for under 75 mortality from CHD have fallen over recent years, the 2016/18 rate of 46.0 per 100,000 is still significantly higher than the England rate of 38.2 per 100,000.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the fifth lowest.
  • The rate has reduced by more than half since 2003/05.
  • At local level, Royston and Penistone East have rates below the England level. The highest rate is in Dearne North.

Heart failure

Prevalence

  • In 2018/19, 1.0% of Barnsley’s GP registered population (2,696 people) were recorded on practice registers with heart failure; slightly higher than the England rate of 9%.
  • Rates have shown a consistent upward trend since 2009/10.

Hospital admissions

  • Barnsley’s 2018/19 hospital admissions rate for heart failure (189.7 per 100,000) is significantly higher than the England rate of 161.5 per 100,000 and the third highest when compared to similar CCGs.
  • The current rate equates to 450 hospital admissions in 2018/19 for Barnsley residents for heart failure.

Kidney 

Prevalence

  • In 2018/19, 4.4% of Barnsley’s GP registered population (9,209 people) were recorded on practice registers with Chronic Kidney Disease (CKD); significantly higher than the England rate of 4.1%.
  • Compared to 10 similar CCGs, Barnsley is ranked 6th
  • Rates have shown a consistent downward trend since 2010/11.

Renal Replacement Therapy (RRT)

  • In 2017, 253 of Barnsley’s GP registered population were receiving RRT, an increase of 20% since 2012.
  • Of the 253 people receiving dialysis, 52.2% had a kidney transplant, 6.7% were receiving home dialysis and 41.1% were receiving hospital dialysis.

Mortality from all CVD 

Under 75 mortality from all CVD  

  • Although Barnsley’s rates for under 75 mortality from CVD have fallen over recent years, the 2016/18 rate of 87.8 per 100,000 is still significantly higher than the England rate of 71.7 per 100,000.
  • Compared to similar local authorities, Barnsley is ranked 8th out of 16 (where 1 is the highest).
  • The rate has reduced by more than half since 2001/03.
  • At local level, there are large geographical differences. Compared to the England average, under 75 mortality rates in Dearne North and St Helens wards are almost twice as high, whilst the rates in Penistone East and Darton West are significantly lower.

Under 75 mortality from CVD considered preventable 

  • In terms of under 75 mortality from CVD that is considered preventable, Barnsley’s 2016/18 rate of 54.5 per 100,000 is significantly higher than the England rate of 45.3 per 100,000.
  • Compared to similar local authorities, Barnsley is ranked 10th out of 16 (where 1 is the highest).
  • The rate has reduced from 141.5 per 100,000 in 2001/03.

Contribution of CVD mortality (all ages) to the gap in life expectancy between Barnsley and England  

  • When considering the life expectancy gap between Barnsley and England in 2015/17, CVD accounted for 22.7% of the gap for men and 20.5% for women. In terms of numbers, this means that during 2015/17, there were 153 more deaths from CVD (95 males, 58 females) than if Barnsley had experienced the same mortality rate as England.

Contribution of CVD mortality (all ages) to the gap in life expectancy between the most deprived quintile and the least deprived quintile of Barnsley

  • When considering the life expectancy gap between the most deprived quintile and the least deprived quintile of Barnsley in 2015/17, CVD accounted for 30.8% of the gap for men and 19.3% for women. In terms of numbers, this means that during 2015/17, there were 190 more deaths from CVD (118 males, 72 females) in the most deprived quintile of Barnsley than if it had experienced the same mortality rates as the least deprived quintile.

Data from:

PHE Cardiovascular Disease Profiles

National General Practice Profiles

PHE Local Health Profiles

Segment Tool

What we're doing and the assets or services we have

A local Health Needs Assessment was completed in 2017 which focussed on risk factors for CVD and the identification and management of heart diseases. Given the marked health inequalities and CVD being largely preventable, the report enabled CVD to have higher strategic priority within the boroughs health and care landscape.

Subsequently, a CVD Programme group was established in 2018 to embed new ways of partnership working and to oversee delivery. Partners represented included; BHNFT, SWYPFT, BMBC, BCCG.

A separate subgroup was also formed which focused on integrated care pathways, beginning with Heart Failure as a test bed for other priority CVD pathways. The group has successfully created a multidisciplinary team which is up and running and has developed a diagnostic pathway for patients with suspected Heart Failure which will be circulated within Primary Care. This pathway will ensure all patients suspected with heart failure have the same diagnostic tests undertaken and the role of the community specialist heart failure nurses to be revised so they have an increased focus on supporting patients with more complex needs.

We understand CVD is strongly associated with health inequalities. People living in the most deprived areas are almost 4 times more likely to die prematurely than those living in the least deprived. To tackle this, Public Health has undertaken a population approach to empower communities within Barnsley to be able to make the healthy choice the easy choice which will lower the risk of CVD. We have worked with Barnsley Hospital to successfully implement the QUIT programme, making it a smokefree site.

Barnsley CCG’s Health Improvement Nurse supports practices with targeted support in order to decrease variation between practices and communities and support the detection and management of high-risk CVD conditions such as atrial fibrillation, high blood pressure and raised cholesterol. This includes the development of practice profiles for each practice including peer comparison data.

Opportunities for improvement or future development

In order to better understand the outcomes from the 2017 Health Needs Assessment, a project group is looking at reviewing the data involved in the pathway for patients presenting with acute coronary syndrome (ACS)/acute MI (AMI). This involves reviewing data from both primary care and secondary care and it will enable focused action across the health care system to improve cardiovascular disease outcomes and inequalities in those outcomes.

Resources and supporting documents

Our area council and ward profiles

Find out more about smoking, excess weight physical activity and NHS health checks



Cancer

Why this is important

Cancer accounts for more than a quarter (27.9%) of all deaths for the people in Barnsley and continues to affect many people in Barnsley who are living with the after effects of having a cancer diagnosis. 

Lung cancer is responsible for the greatest proportion of cancer deaths in Barnsley (24.3% of all male and 25.5% of all female cancer deaths).  72% of lung cancer cases in the UK are caused by tobacco use; the largest contributor to preventable deaths.  For men, bowel cancer is the second largest cause of death, being responsible for 11% of all male cancer deaths.  In women, breast cancer is the second major cause of death from cancer, accounting for 12.9% of all female cancer deaths.

An ageing population and a rise in lifestyle risk factors mean that the number of people being treated with cancer is expected to rise.  Nearly 4 in 10 cancer cases in 2015 were attributable to known risk factors - smoking, alcohol and physical exercise.  Screening rates have improved across Barnsley, however, this is not translating into the improved outcomes that we would expect to see in terms of cancers diagnosed at early stage and 1- and 5-year survival rates.  More work is required to ensure that those who are most at risk are supported to understand that risk and to participate in the programmes.

The Barnsley picture and how we compare

Risk factors

  • Around 1 in 5 adults in Barnsley are smokers (17.4%), according to the national annual population survey (2018). This is significantly higher than the England rate of 14.4%.
  • The proportion of dependent drinkers in Barnsley (1.89%) is significantly higher than the national rate of 1.39%.
  • Barnsley’s 2017/18 rate for hospital admissions for alcohol-related conditions (793 per 100,000 population) is significantly higher than the England rate of 632 per 100,000.
  • Latest data (2017/18) indicates that more than two-thirds (69.7%) of Barnsley adults are overweight or obese; a significantly higher proportion than the national average (62.0%).

Incidence (new cancer cases)

  • In 2016/17, Barnsley’s cancer incidence rate was 513 new cases per 100,000 population; similar to the England rate of 521 per 100,000. In terms of numbers, this equates to 1,334 people on Barnsley GP registers who were diagnosed with cancer in 2016/17.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate was the lowest.
  • In terms of incidence by tumour type, Barnsley has a significantly higher rate than the England average for lung cancer and a significantly lower rate for prostate
  • Large geographical differences exist within Barnsley, with incidence rates (for all cancers) in Dearne South and Dearne North wards being significantly higher than the England average and the incidence rate in Darton West ward being significantly lower.
  • For breast cancer, the incidence rate in Dearne South ward in 2012-2016 was almost one and a half times higher than the England rate.
  • For lung cancer, the incidence rate in St Helens ward in 2012-2016 was almost double the England rate. Only Hoyland Milton, Dodworth, Darton West, Penistone West and Penistone East wards had lower incidence rates than the England average.
  • For prostate cancer, all wards had lower incidence rates than the England average in 2012-2016, with the rates in Darton West, Wombwell, Rockingham, Central, Kingstone and Hoyland Milton being significantly lower.

Prevalence (people with cancer, as recorded on practice disease registers)

  • In 2017/18, 2.7% of Barnsley’s GP registered population were recorded as having a diagnosis of cancer; the same as the England rate. In terms of numbers, this represents just over 7,000 people on Barnsley GP registers who have had a diagnosis of cancer.
  • Compared to 10 similar CCGs, Barnsley’s rate is the second lowest.
  • Rates have increased over recent years (from 1.6% in 2019/10).

Screening

  • Barnsley’s 2017/18 breast screening rate (females, 50-70) of 77.8% is significantly higher than the England rate of 72.1%.
  • Compared to 10 similar CCGs, Barnsley’s rate is the second highest.
  • The current rate is the highest since 2009/10.
  • At GP practice level, screening rates range from 64.5% to 84.0%.

  • Barnsley’s 2017/18 cervical screening rate (females, 25-64) of 76.2% is significantly higher than the England rate of 71.7%.
  • Compared to 10 similar CCGs, Barnsley’s rate is the second highest.
  • However, the current rate is the lowest since 2009/10.
  • At GP practice level, screening rates range from 62.0% to 83.4%.

  • Barnsley’s 2017/18 bowel screening rate (persons, 60-74) of 60.8% is significantly higher than the England rate of 59.6%.
  • Compared to 10 similar CCGs, Barnsley’s rate is the fourth highest.
  • At GP practice level, screening rates range from 47.1% to 70.2%.

Two week wait referrals

  • Barnsley’s 2017/18 rate for two week wait referrals for suspected cancer (2,960 per 100,000 population) is significantly lower than the England rate of 3,263 per 100,000. In terms of numbers, this equates to 7,857 urgent referrals for suspected cancer made for patients registered at Barnsley GP registers in 2017/18.
  • Compared to 10 similar CCGs, Barnsley’s rate is the second lowest.
  • Two week wait referral rates have declined over recent years; the highest rate (3,144 per 100,000) being in 2015/16.
  • At GP practice level, two week wait referral rates per 100,000 range from 1,140 to 5,203.
  • Less than half (44.7%) of patients in Barnsley treated for cancer in 2017/18, were referred through the two week wait referral route; a significantly lower proportion than the England rate of 51.3%.

Emergency presentation

  • Latest data (Jan 2018 - Dec 2018) shows that 22.2% of all malignant cancer diagnoses in Barnsley were diagnosed as an emergency, compared to 18.1% in England overall. Barnsley’s rates have fluctuated since 2013/14, but have been higher than the England average at each time point.
  • Compared to 10 similar CCGs, Barnsley’s Jan-Dec 2018 emergency diagnosis rate is the highest.

Staging

  • Latest staging data (2016/17) shows the percentage of cancers diagnosed at stage 1 or 2 was 48% compared to the national average of 54%.
  • The percentage of cancer diagnosed at Stage 4 was 32% compared to the national average of 27%.
  • If a person is diagnosed at stage 2 for lung cancer, 60% will survive their cancer for a year or more after diagnosis whereas for stage 4 it is only 20%.  
  • For stomach cancer, more than 40% will survive their cancer for 5 years or more compared to being diagnosed at stage 4, which is 5%.

Survival

All cancers

  • More than 7 out of 10 (71.5%) adults (aged 15-99 years) in Barnsley who were diagnosed with cancer (all cancers) in 2016 were still alive one year after diagnosis. However, Barnsley’s 1-year survival rate is significantly lower than the England rate of 72.8%.
  • 1-year survival rates within similar CCGs range from 70.1% to 73.1%.
  • Barnsley’s rates have improved over recent years (from 58.6% in 2001).
  • 1-year survival rates are higher for 55-64 year olds (Barnsley: 77.8%, England: 78.9%) than for 75-99 year olds (Barnsley: 58.9%, England: 60.2%).

Breast cancer

  • Of the adults (aged 15-99 years) in Barnsley diagnosed with breast cancer in 2016, 97.4% were still alive one year after diagnosis; slightly higher than the England rate of 96.9%.
  • Compared to 10 similar CCGs, Barnsley’s 1-year survival rate for breast cancer is the highest.

Bowel cancer

  • Four out of five (80.0%) adults (aged 15-99 years) in Barnsley diagnosed with bowel cancer in 2016 were still alive one year after diagnosis; slightly lower than the England rate of 80.6%.
  • 1-year survival rates for bowel cancer within similar CCGs range from 77.3% to 83.5%.

Lung cancer

  • Less than half (41.4%) of adults (aged 15-99 years) in Barnsley diagnosed with lung cancer in 2016 were still alive one year after diagnosis; slightly lower than the England rate of 41.6%.
  • 1-year survival rates for lung cancer within similar CCGs range from 38.6% to 42.0%.

Patient experience

  • On a scale of 0 (very poor) to 10 (very good), the average rating for Barnsley CCG cancer patients for their overall experience of care in 2018 was 8.9.

Mortality

  • During 2015-2017 in Barnsley, 2,037 people were registered as dying from cancer, accounting for more than a quarter (27.9%) of all deaths.
  • Lung cancer is responsible for the greatest proportion of cancer deaths in Barnsley (24.3% of all male and 25.5% of all female cancer deaths).
  • In men, bowel cancer is the second largest cause of death from cancer, being responsible for 11% of all male cancer deaths.
  • In women, breast cancer is the second major cause of death from cancer, accounting for 12.9% of all female cancer deaths.

Under 75 mortality from cancer

  • Although Barnsley’s rates for under 75 mortality from cancer have fallen over recent years, the 2015/17 rate of 152.4 per 100,000 is still significantly higher than the England rate of 134.6 per 100,000.
  • At ward level, there are large geographical differences. Compared to the national average, under 75 cancer mortality rates in Dearne North, Darfield, Stairfoot, Wombwell, Monk Bretton, St Helens and Central wards are significantly higher, whilst the rate in Penistone East ward is significantly lower.

Under 75 mortality from cancer considered preventable

  • In terms of under 75 mortality from cancer that is considered preventable, Barnsley’s 2015/17 rate of 89.6 per 100,000 is significantly higher than the England rate of 78.0 per 100,000.

Contribution of cancer mortality (all ages) to the gap in life expectancy between Barnsley and England

  • When considering the life expectancy gap between Barnsley and England in 2015/17, cancer accounted for 14.3% of the gap for men and 36.0% for women. In terms of numbers, this means that during 2015/17, there were 175 more deaths from cancer (60 males, 115 females) than if Barnsley had experienced the same mortality rate as England.

Contribution of cancer mortality (all ages) to the gap in life expectancy between the most deprived quintile and the least deprived quintile of Barnsley

  • When considering the life expectancy gap between the most deprived quintile and the least deprived quintile of Barnsley in 2015/17, cancer accounted for 19.2% of the gap for men and 31.6% for women. In terms of numbers, this means that during 2015/17, there were 444 more deaths from cancer (226 males, 218 females) in the most deprived quintile of Barnsley than if it had experienced the same mortality rates as the least deprived quintile.

Data from:

What we’re doing and the assets and services we have 

The Barnsley Cancer Programme aims to improve the whole cancer pathway, from raising awareness, to support at end of life via an integrated approach. The Programme is delivered in partnership between the South Yorkshire, Bassetlaw and North Derbyshire (SYB&ND) Cancer Alliance, NHS Barnsley CCG, Barnsley Hospital NHS Foundation Trust (BHNFT), South West Yorkshire Partnership NHS Foundation Trust (SWPFT), Barnsley Council, Cancer Research UK, Macmillan, NHS England and Be Cancer Safe (Voluntary Action Rotherham) and the public of Barnsley.  

The Barnsley Cancer Programme oversees five key work streams which are listed below with example projects.

Prevention

A key project supporting the prevention of cancer is Be Cancer Safe, a social movement across Barnsley.  The Be Cancer Safe project aims to normalise the conversation about cancer and raise population awareness about cancer signs and symptoms to prevent cancer and increase early diagnosis. The programme focuses on five cancers: breast, bowel, cervical, lung, and prostate. Currently (September 2019) there are over 3,000 Cancer Champions in Barnsley, which the service has helped to create.

Early diagnosis

To support early diagnosis and better outcomes for people living with cancer, I-Heart Barnsley is undertaking an out-of-hours cervical screening pilot at a GP practice in Lundwood.  The service is for local women to fit their cervical screening appointments around their busy schedules. The Lundwood Practice will hold a clinic on a week day evening at 5 and 8pm and Sunday morning, in order to book appointments for women who need an out of hours service or prefer to attend this location.

Best treatment and care 

Linking to best treatment and care, a teledermatology pilot was launched within primary care in June 2019.  The scheme involves photographs of suspect skin lesions being reviewed by consultant dermatologists, who provide clinical assessment, diagnosis and advice to patients and GPs.  The scheme aims to reduce the demand on the skin cancer pathway, improve people experience of having worrying suspected cancer symptoms and reduce the time people need to go for appointments at BHNFT.  

Living with and beyond cancer (LWABC)

LWABC is overseen by BHNFT and includes the recovery package, remote monitoring, health and wellbeing care, stratified follow up pathways and timely re-access to cancer support. Macmillan have funded a fulltime Project Management, Cancer Support Navigators (to support the patients’ journey and to complete regular holistic needs assessments), as well as an anxiety management training programme for Barnsley patients. This includes a regional programme of work streams looking at enabling patients to ‘live well’ after a cancer diagnosis – right up to curative or end of life care, specifically in Colorectal, Urology and Breast cancer.

End of life

To support best care at end of life, SWYPFT have rolled out the Electronic Palliative Care Co-ordination System (EPaCCS) throughout primary care in Barnsley. EPaCCS is a communication tool that enables palliative patients and those closest to them to have their preferences and wishes for their care and subsequent place of death discussed and recorded, to have clear treatment and escalation plans that will guide health and social care providers to deliver the right care, in the right place by the right people.

Opportunities for improvement or future development

The Barnsley Cancer Programme continues to develop initiatives to improve the cancer pathway for Barnsley people. Future developments include increasing easier access to diagnostic tests within the community – a scheme which will enable people to receive diagnostic tests for cancer from a community location rather than a hospital and the straight to test timed pathways which aim for potential cancers to be diagnosed more quickly.

Resources and supporting documentation



Liver disease

Why this is important

The liver is our largest internal organ and it has hundreds of different roles, including the breakdown of food into energy and helping the body get rid of waste products and fight infections - particularly in the bowel. And yet, when your liver is damaged, there are generally no symptoms- until things get serious*

Liver disease is one of the top causes of death in England and people are dying from it at younger ages. Liver disease is largely preventable. Whilst approximately 5% is attributable to autoimmune disorders (diseases characterised by abnormal functioning of the immune system), most liver disease is due to three main risk factors: alcohol, obesity and viral hepatitis. Overall, alcohol-related liver disease accounts for well over a third (37%) of liver disease deaths. And figures show victims of liver disease are getting younger. More than one in 10 of deaths of people in their 40s are from liver disease, most of them from alcohol-related liver disease**.

In Barnsley, liver disease mortality rates have increased consistently throughout recent years and now for the first time across 18 years of comparative data, we have significantly higher rates than the England average.

References

* British Liver Trust website. About The Liver. The Information Standard member organisation. 

** National End of Life Care Intelligence Network website. Deaths from Liver Disease: Implications for end of life care in England.

The Barnsley picture and how we compare

Hospital admissions

  • In 2016/17, the hospital admission rate due to liver disease in Barnsley was 115.1 per 100,000. This is significantly lower than the England rate of 131.2 per 100,000.
  • Out of 16 similar local authorities, Barnsley’s rate was the lowest.
  • In terms of numbers, the rate of 115.1 represents 275 admissions to hospital of Barnsley residents due to liver disease in 2016/17. There were more admissions for men than women (173 compared to 102).

Mortality

(PHOF E06a and Mortality Profile – by gender)

  • Barnsley’s 2016/18 under 75 mortality rate from liver disease (22.2 per 100,000) is significantly higher than the England rate (18.5 per 100,000).
  • Barnsley has the fourth highest rate for liver disease mortality across the 15 areas of Yorkshire and the Humber.
  • The rate for men (30.1 per 100,000) is double that of women (14.5 per 100,000).
  • Rates have increased over recent years (from 12.9 per 100,000 in 2001/03).
  • At ward level (2014/18), under 75 mortality rates from liver disease per 100,000 range from 5.6 in Penistone East to 39.0 in North East ward.

Alcohol-related liver disease

  • Across the Yorkshire and Humber region Barnsley has the fifth highest rate of under 75 mortality from alcohol-related liver disease.
  • Despite having a higher mortality rate for under 75 alcoholic liver disease than the regional and national averages, the rate of hospital admissions for alcoholic liver disease in Barnsley are lower. This suggests that those people suffering with liver disease and ultimately dying in consequence are not being referred or admitted to hospital.

Resources

Public Health England (Liver Disease Profiles)

Public Health Outcomes Framework (E06a)

Public Health Outcomes Framework (Mortality Profile)

NHS Digital – Quality Outcome Framework - the prevalence of liver disease in the borough can be viewed through the Quality Outcomes Framework tool on the NHS Digital site. It also allows you to see data down to GP Practice level for a number of conditions.

Public Health England - Premature mortality visualisation tool - the Longer Lives mortality tool highlights premature mortality across every local authority in England, giving people important information to help them improve their community's health. It includes data for liver disease.

What we're doing and the assets or services we have

We have identified liver disease as a key issue affecting the health and wellbeing of our residents.  We are currently working towards thoroughly understanding the ‘who, when, where and how’. Following this, we will best placed to act with effective action. We are currently working towards:

  • Prioritising a whole systems approach to reducing alcohol consumption and obesity as the key causes of preventable liver disease and early death.
  • Improving awareness, prevention, early detection and treatment of liver disease.
  • Further exploring liver-disease mortality and hospital admission rates
  • Reviewing case studies to help us develop appropriate plans

Resources and supporting documents



NHS health checks

Why this is important

In the UK, high blood pressure, smoking, cholesterol, obesity, poor diet, physical inactivity and alcohol consumption are the top seven causes of preventable death. The Department of Health estimates that the NHS health check programme prevents 1,600 heart attacks and 4,000 people from developing diabetes each year. It also detects 20,000 cases of diabetes or kidney disease earlier each year. Estimates suggest that the programme will pay for itself after 20 years and deliver substantial health benefits.

NHS health checks is a national programme commissioned by councils. Health checks offer people aged 40 to 74 a free check-up of their overall health, every 5 years. The results can tell people whether they are at higher risk of developing certain health problems, such as heart disease, diabetes, stroke and dementia. They help underpin the NHS long-term plan commitments to prevent 150,000 heart attacks, strokes and cases of dementia, and to increase take up of the NHS diabetes prevention programme.

During the check-up the individual’s risk of the above diseases will be assessed; support and advice or treatment will then be offered where necessary about reducing or managing risk. This approach provides a key route into existing lifestyle interventions through well-established pathways to support people to stop smoking, lose weight, be more active and drink within recommended limits as appropriate.

The Barnsley picture and how we compare

  • In 2018/19, almost half (48.1%) of people in Barnsley who were invited for an NHS Health Check took one up; significantly higher than the England rate of 45.9%.

  • Compared to similar authorities, Barnsley is ranked 8th out of 16.

  • The rate of 48.1% equates to 3,693 people in Barnsley who had a Health Check in 2018/19, of which :
    - 14.7% were current smokers
    - 26.3% had a CVD risk higher than 10%
    - 24.0% had high blood pressure
    - 71.2% were an excess weight
    - 24.3% had a high cholesterol ratio
    - 69.3% were classified as active
    - 37.0% were advised to reduce their alcohol intake
  • The more deprived areas had a higher proportion of current smokers and a lower proportion of people classified as active (undertaking more than two and a half hours of physical activity a week).

Data from:

PHE NHS Health Check Profile

What we're doing and the assets or services we have

The provision of NHS health checks is a mandatory requirement for local authorities.

From April 2018 a new provider, Hallcross Medical was commissioned to provide NHS health checks in Barnsley. This resulted in a new service model approach in which the service is provided through a contract with a single provider.

Although GP invitations and involvement remain a key aspect of the health check provision, the new model now offers service outreach in community and business settings. The provider arranges opportunistic checks on eligible patients through workplaces and community events which allows for a more targeted uptake of health checks eg in deprived areas, with men, in routine and manual workforces etc. More recently, our provider has also been able to offer health checks via local pharmacies.

The delivery model specification for this service includes performance monitoring metrics. We hold quarterly contract and performance meetings with our provider where we receive progress reports and discuss their performance and any areas for improvement. We also feedback regionally to Public Health England on a quarterly basis.

Opportunities for improvement or future development

Nationally, the NHS Health Check programme has made progress during the last 10 years. However uptake varies across the country (NHS health check data), the risks identified in a check could be followed up more consistently and evidence is emerging that people could benefit from a more tailored service (for example: Lindbohm, J.V. et al (2019) 5-year versus risk-category-specific screening intervals for cardiovascular disease prevention: a cohort study).

There may also be a case for a particular focus on supporting people through key changes in their life, in particular thinking about future care needs and how they can remain healthy and active in older age.

The government’s green paper ‘advancing our health: prevention in the 2020s’ offers the next opportunity to further shift of focus from cure to prevention. As part of this there will be an opportunity to consider whether changes to the NHS health checks programme could help it deliver even greater benefits. The government will commission an evidence-based review of the programme to maximise the benefits it delivers in the next decade.

Resources and supporting documents



Respiratory conditions

Why this is important

Respiratory conditions are one of the main contributors to reduced life expectancy in both males and females compared to England.

Chronic obstructive pulmonary disease (COPD) is the name for a collection of lung conditions including chronic bronchitis and emphysema. COPD leads to damaged airways in the lungs. This causes the airways to become narrower, making it difficult for air to move in and out of the lungs.

COPD is treatable, but not curable. Identifying and treating COPD early can slow down the decline in lung function, and so lengthen the period of time in which someone can enjoy an active life. The most important intervention for both preventing and treating COPD is not smoking.

Asthma is a common, long-term condition that affects the airways in the lungs. Classic symptoms include breathlessness, tightness in the chest, coughing and wheezing.

Asthma differs from COPD in that restrictions to the airflow are largely reversible, whereas in COPD the restriction is only partially reversible as there is permanent damage to the airways. The goal of treatment for patients with asthma is to be free of symptoms, and able to lead a normal, active life. The causes of asthma are not well understood, so prevention of asthma is not currently possible.

The Barnsley picture and how we compare

Prevalence

Chronic Obstructive Pulmonary Disease (COPD)

  • In 2017/18, 3.2% of the Barnsley population were recorded on GP registers as suffering with COPD; significantly higher than the England rate of 1.9%.
  • Compared to 10 similar Clinical Commissioning Groups (CCGs), Barnsley’s rate is the highest.
  • Rates have increased over recent years (from 2.8% in 2009/10).
  • Large geographical differences exist within Barnsley, with prevalence rates ranging from 0.9% in Penistone to 5.0% in the Dearne.

Asthma

  • In 2017/18, 5.7% of the Barnsley population were recorded on GP registers as suffering with Asthma; significantly lower than the England rate of 5.9%.
  • Compared to 10 similar CCGs, Barnsley’s rate is the lowest.
  • Rates have remained fairly constant since 2009/10, with the 2017/18 rate being the lowest.
  • Geographical variations exist within Barnsley, with prevalence rates ranging from 4.0% to 7.3%.

Smoking prevalence in adults

  • Although the proportion of adult smokers in Barnsley has fallen in recent years, the 2018 rate (17.4%) still remains significantly higher than the England average of 14.4%.

Hospital admissions

Emergency hospital admissions for COPD

  • Barnsley’s 2017/18 rate for emergency hospital admissions for COPD (868 per 100,000) is significantly higher than the England rate of 415 per 100,000.
  • Out of 16 comparator authorities, Barnsley’s rate is the highest.
  • The 2017/18 rate is the highest during the period 2010/11 to 2017/18.
  • At ward level, only two wards (Penistone East and Penistone West) have lower admission rates than the England average. Rates in St Helens and Stairfoot wards are three times higher than the England average.

Hospital admissions for asthma (under 19 years)

  • Barnsley’s 2017/18 rate for hospital admissions for asthma in young people aged under 19 (157 per 100,000) is similar to the England rate of 186.4 per 100,000.
  • Compared to similar authorities, Barnsley’s rate is the fourth lowest.
  • Rates have declined in recent years, and the 2017/18 rate is the lowest during the period 2011/12 to 2017/18.

Emergency admissions for children with lower respiratory tract infections

  • In 2017/18, Barnsley had a significantly higher rate than England of emergency admissions to hospital for children with lower respiratory tract infections (465.3 per 100,000 compared to 403.9 per 100,000).
  • Compared to 10 similar CCGs, Barnsley’s rate is the third highest.
  • The rate was 423.0 in 2013/14 and rates have fluctuated since 2015/16.

Smoking attributable hospital admissions  

  • Barnsley’s 2017/18 rate for smoking attributable hospital admissions (2,753 per 100,000) is significantly higher than the England rate of 1,530 per 100,000.
  • Out of 16 comparator authorities, Barnsley’s rate is the highest.
  • Rates have fluctuated during the period 2009/10 to 2017/18. 

Prevention

Flu vaccine uptake (65+ and <65 at risk)

  • In 2018/19, 72.3% of adults aged 65% received the flu vaccine, similar to the England rate of 72.0%.
  • Just over half (51.5%) of those aged under 65 (at risk) were vaccinated, compared to 48.0% nationally.

Smokers that have successfully quit at 4 weeks (CO validated)

  • The proportion of smokers in Barnsley who successfully quit at 4 weeks (CO validated) (2,301 per 100,000 smokers aged 16+) is significantly better than the national rate of 1,305 per 100,000. Barnsley’s rate of 2,301 represents 799 smokers who successfully quit at 4 weeks in 2018/19.

Mortality

Under 75 mortality from respiratory disease  

  • Although Barnsley’s rates for under 75 mortality from respiratory disease have fallen over recent years, the 2015/17 rate of 41.8 per 100,000 is still significantly higher than the England rate of 34.3 per 100,000.
  • At ward level, there are large geographical differences. Compared to the national average, the rate in Penistone East is significantly lower, whilst in St Helens, the rate is almost double.

Under 75 mortality from respiratory disease considered preventable

  • In terms of under 75 mortality from respiratory disease that is considered preventable, Barnsley’s 2015/17 rate of 20.4 per 100,000 is similar to the England rate of 18.9 per 100,000.
  • Compared to similar authorities, Barnsley’s rate is the second lowest.
  • The current rate is the lowest since 2001/03.

Contribution of respiratory disease mortality (all ages) to the gap in life expectancy between Barnsley and England

  • When considering the life expectancy gap between Barnsley and England in 2015/17, respiratory disease accounted for 16.7% of the gap for men and 17.2% for women. In terms of numbers, this means that during 2015/17, there were 186 more deaths from respiratory disease (107 males, 79 females) than if Barnsley had experienced the same mortality rate as England.

Contribution of respiratory disease mortality (all ages) to the gap in life expectancy between the most deprived quintile and the least deprived quintile of Barnsley

  • When considering the life expectancy gap between the most deprived quintile and the least deprived quintile of Barnsley in 2015/17, respiratory disease accounted for 10.4% of the gap for men and 15.7% for women. In terms of numbers, this means that during 2015/17, there were 103 more deaths from respiratory disease (40 males, 63 females) in the most deprived quintile of Barnsley than if it had experienced the same mortality rates as the least deprived quintile.

Data from

Public Health Outcomes Framework: Indicators 2.14, 4.07i and 4.07ii

PHE Local Tobacco Control Profiles

National General Practice Profiles

PHE Child Health Profiles

PHE Local Health Profiles

Segment Tool

CCG Outcomes Indicator Set

What we're doing and the assets or services we have

Since 2017, respiratory services in Barnsley have undergone a period of clinical transformation involving significant investment. NHS Barnsley Clinical Commissioning Group (CCG) is working in collaboration with Barnsley Hospital NHS Foundation Trust (BNHFT) and South West Yorkshire Partnership Foundation Trust (SWYPFT) to deliver an integrated respiratory service for patients with COPD focusing on exacerbation management, diagnosis, pulmonary rehabilitation and ongoing care with the ambition to improve the quality of life of the Barnsley respiratory patient. The newly established Barnsley REspiratory Assessment and THErapy (BREATHE) Service aims to improve health outcomes and quality of life for people with COPD, and includes Pulmonary Rehabilitation as a key priority. 

An increased proportion of patients having acute exacerbations of respiratory disease and respiratory infections will be supported within the community.  Patients who do require emergency admission for an acute /chronic condition will be reviewed by a Specialist Respiratory Nurse within 24 hours of discharge from hospital, 7 days a week. All patients will have a personalised care plan and for those at high risk of exacerbations, home rescue medications.

Primary Care will be enhanced by specialist respiratory multidisciplinary support which will wrap around the locality hubs, providing specialist respiratory advice and interventions such as pulmonary rehabilitation and long term oxygen assessments.  This includes; a named Respiratory Specialist Nurse aligned to each of the six localities alongside a series of weekly locality based consultant led Respiratory Clinics, one per locality.

The specialist multidisciplinary respiratory team link closely with the neighbourhood nursing teams and intermediate care services in Barnsley who provide rapid response, hospital at home and general rehabilitation.

All patients with COPD will have a personalised care plan including a flare up plan and for those at high risk of exacerbations, home rescue medications.

An increase in the numbers of people having pulmonary rehabilitation will be achieved, with a particular emphasis on ensuring that many more patients who have been admitted to hospital with an exacerbation of COPD receive the intervention.

Patients enter the service through two main routes, either an Emergency Department (ED) attendance of through their GP or practice nurse referring them into the BREATHE Service.  Patients admitted to hospital are assessed by the BREATHE team then, if appropriate, enrolled onto Early Supported Discharge (ESD) and their condition managed in the community until the exacerbation has resolved.

Opportunities for improvement or future development

My COPD app

To support patients to better manage their condition the BREATHE Service will introduce the myCOPD app, available to local areas via the national NHSE Innovation and Technology Tariff. The app is designed to support patients at any stage of the disease. The myCOPD app offers users training techniques for every type of inhaler prescription assessment and identifies if an inhaler medication conflicts with what the patient has been prescribed. It also provides  a self-management plan to help patients understand what medication to take and when.

Pulmonary rehabilitation

A range of actions to improve accessibility and reach of the pulmonary rehabilitation service and improve take up rates is to be introduced. Key activities include; offering a self-referral route into the service, introducing a home based programme of support to patients and reviewing service delivery locations in line with local health need.

Work will continue to review and refine the BREATHE Service Delivery model in line with population health need.

Resources and supporting documents



Sensory impairment - sight loss

Why this is important

Prevention of sight loss will help people maintain independent lives as far as possible.

Research by the Royal National Institute for Blind People (RNIB) suggests that 50% of cases of blindness and serious sight loss could be prevented if detected and treated in time. Whilst this is mainly due to common eye problems such as uncorrected refractive error and untreated cataract, the research implies that the take-up of sight tests is lower than would be expected. This is particularly the case within areas of social deprivation. Low take-up of sight tests can lead to later detection of preventable conditions and increased sight loss due to late intervention.

Prevention of avoidable sight loss is recognised as a key priority for the World Health Organisation’ (WHO) global initiative for the elimination of avoidable blindness by 2020, The Right to Sight. This is also a key priority for Vision UK and a particularly important issue in the context of an ageing population.

Risk of sight loss is heavily influenced by health inequalities, including ethnicity, deprivation and age. Sight loss can increase the risk of depression, falls and hip fractures, loss of independence and living in poverty.

The Barnsley picture and how we compare

The Law Commission report (Adult Social Care, May 2011) recommended that local authorities should maintain a register of blind and partially sighted people (Paragraphs 12.15 - 12.18) and this recommendation has been accepted by Department of Health and Social Care Ministers.  

Completion of a CVI (Certificate of Visual Impairment) by a consultant ophthalmologist, initiates the process of registration with a local authority and leads to access to services. CVI is a patient choice, and in Barnsley we do not incentivise certification, and services are available to all.

  • In 2017/18, the rate for new certifications of visual impairment (CVI) in Barnsley was 63.3 per 100,000. This is significantly higher than the England rate of 41.1 per 100,000. 63.3 equates to 154 people in Barnsley were registered as visually impaired in 2017/18.
  • Out of 16 similar local authorities, Barnsley’s rate was the second highest.
  • Certification rates have increased in recent years.
  • At Area Council level, in 2016/17, rates ranged from 59.9 per 100,000 in South area Council to 115.8 in Central areas.
  • Barnsley’s 2017/18 rates for preventable sight loss due to diabetic eye disease and age related macular degeneration (AMD) are also significantly higher than the England average.

Data from:

What we're doing and the assets or services we have

Our multi-agency Barnsley Vision Strategy Group have a work programme to address prevention of sight loss, support good eye health, and promote independence and social inclusion of those with sight loss. The group have adopted the England Vision Strategy key priorities, refreshed in October 2018; Prevention, Commissioning, Services, Independence, Self Determination, Inclusion.

Barnsley strategy group is being informed by engagement work with Barnsley residents with sight loss (adults, children, young people and parents), local services are actively involved in reviewing what is working well, and where there is value in working together.  The group have also supported a health needs assessment on preventing sight loss and recognises that we still have some work to do to prevent avoidable sight loss in Barnsley, but for those with sight loss our services are working hard to support access to services and CVI.

There are 20 key recommendations that Barnsley Vision Strategy Group will be using to inform and develop their work programme moving forward.

Barnsley Vision Strategy Group 

The strategy group includes the following:

  • Adult service users and parents of children with sight loss
  • Commissioners (Barnsley Council and Barnsley Clinical Commissioning Group)
  • Primary care services (opticians, GPs, and pharmacies)
  • Community services (rehabilitation, sensory, equipment and adaptation)
  • Schools and children’s services (Education Inclusion Service)
  • Voluntary sector services:
    • Barnsley Blind and Partially Sighted Association (BBPSA)
    • Royal National Institute of Blind People (RNIB)
    • Sheffield Royal Society for the Blind (SRSB)
    • Vision Foundation
    • Action for Blind People
    • Barnsley Healthwatch
  • Secondary care services (ophthalmology, eye clinic liaison officer), low vision service, diabetic eye screening service)
  • National England vision strategy regional manager

The group are aiming to have a strategic action plan for 2020 ready by winter 2019.  In the interim, work is ongoing to involve stakeholders, establish links to other local strategies, eg Active in Barnsley, Smoke Free Barnsley, and to develop our local campaign.

Opportunities for improvement or future development

The following Vision Strategy Priorities provide a framework for future developments:

  • Prevention - To improve eye health and prevent sight loss across Barnsley within diverse groups and the wider population.  Our Health Needs Assessment makes 20 key recommendations for implementation of this.

  • Commissioning - To promote effective commissioning strategies across health and social care, supporting an integrated and person-centred pathway.  Sharing and reviewing best practice from other local areas, regionally and nationally.

  • Services - Adults, children, young people and their families have access to the right services, advice and support when eye health and sight loss problems arise.  Services are promoted locally, and Barnsley people know which support to access when a need arises.

  • Independence - Adults, children and young people can learn, relearn or retain key life skills on a continuing basis as driven by their needs with access to appropriate professional support, aids and adaptations including technology, and accessible public transport.

  • Self-determination - To develop and enable face to face and online peer support opportunities and self-help and self-advocacy resources to empower adults, children, young people and their families to achieve their aspirations.

  • Inclusion - To promote inclusive environments and equality of opportunity to enable blind and partially sighted people to fully participate, contribute and live independently.

Resources and supporting documents