Edinburgh Health Information, March 2015 Edinburgh Health Information Key public health issues for Edinburgh Life expectancy has increased steadily in the last ten years in Edinburgh. Edinburgh is more affluent than other parts of Lothian and its population generally has better health. Public policy and the actions of public bodies such as health and social care partnerships need to address shortcomings in determinants of health as well as lifestyle and behavioural factors. There are differences in life expectancy which reflect the social and economic inequalities across the city. There are pockets of poor health throughout the city, often in areas of multiple deprivation. Health is poorest in the East locality, predictably as it is the most deprived of the new Edinburgh localities. Health is the three other localities is broadly similar. The existence and width of health inequalities cannot be attributed to a single clinical or behavioural risk factor. They are the result of social circumstances. Health will improve if people are supported to be physically active, eat and drink healthily and not smoke. However, the drivers of these behaviours are social circumstances such as income, housing, education, employment and transport. As people live longer, they live with chronic conditions. Multimorbidity will become the norm for the Edinburgh population. Preventive actions can ensure people live healthily in their own homes rather than frequenting hospitals and other acute care services. 1
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Edinburgh Health Information, March 2015
Edinburgh Health Information
Key public health issues for Edinburgh
Life expectancy has increased steadily in the last ten years in Edinburgh. Edinburgh is
more affluent than other parts of Lothian and its population generally has better
health.
Public policy and the actions of public bodies such as health and social care
partnerships need to address shortcomings in determinants of health as well as
lifestyle and behavioural factors.
There are differences in life expectancy which reflect the social and economic
inequalities across the city.
There are pockets of poor health throughout the city, often in areas of multiple
deprivation.
Health is poorest in the East locality, predictably as it is the most deprived of the
new Edinburgh localities. Health is the three other localities is broadly similar.
The existence and width of health inequalities cannot be attributed to a single
clinical or behavioural risk factor. They are the result of social circumstances. Health
will improve if people are supported to be physically active, eat and drink healthily
and not smoke. However, the drivers of these behaviours are social circumstances
such as income, housing, education, employment and transport.
As people live longer, they live with chronic conditions. Multimorbidity will become
the norm for the Edinburgh population. Preventive actions can ensure people live
healthily in their own homes rather than frequenting hospitals and other acute care
services.
Edinburgh’s population is increasing. Projections show that in 2037 the percentage
working age population in Edinburgh will still be higher than other Scottish local
authorities.
More GPs, nurses and social care staff will be needed to provide community-based
services that serve the population throughout the lifecourse. Filling these key posts
will be challenging given the current age and career profile of these staff groups.
Edinburgh’s population is ageing. More older people will mean an increase in
absolute demand for health and care.
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Edinburgh Health Information, March 2015
1. Health Inequalities
Life expectancy for a child born in Edinburgh in 2013 was between 78 years and 81 years
depending on its sex.
Life expectancy at birth 2001-2003 2006-2008 2011-2013
Male Female Male Female Male FemaleEast Lothian 75.6 80.1 76.7 81.3 78.5 81.6Edinburgh, City of 74.8 80.1 76.3 81.2 77.6 81.9Midlothian 74.7 78.6 76.4 80.5 77.3 81.7West Lothian 73.5 77.7 75.9 79.2 77.5 80.2Lothian 74.7 79.5 76.3 80.8 77.7 81.6Scotland 73.5 78.8 75.1 79.9 76.9 81.0
Source: NRS Life Expectancy 2001-2013
However, life expectancy, like most measures of health, is directly correlated to
socioeconomic status. More affluent people tend to live longer lives and are more healthy
during their lives. These health inequalities are ‘systematic, unfair differences in the health
of the population that occur across social classes or population groups’. Mortality increases
with greater inequality and there is evidence of pronounced variation in mortality rates in
Edinburgh. People living in the least deprived communities in Edinburgh can expect to live
21 years longer than people living in the most deprived communities: boys born in
Greendykes and Niddrie Mains between 2005 and 2009 had a life expectancy more than 25
years less than girls born in Barnton and Cammo.
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Edinburgh Health Information, March 2015
Highest and lowest l ife expectancy at birth in Edinburgh neighbourhoods, 2005-2009
0
10
20
30
40
50
60
70
80
90
100
Greendykes andNiddrie Mains
New Town West Great JunctionStreet
Barnton andCammo
Neighbourhood (Intermediate Zone)
Life
Expe
ctan
cy (y
ears
)
Male
Female
Figure 1: Highest and lowest life expectancies in Edinburgh, 2005-2009 (Source: NRS Life
Expectancy and Intermediate Zones, 2005-2009)
There are also differences in death rates within localities. The mortality rate in the East
locality is the highest in the city, and is higher than both the Lothian and Scotland average
(see Figure 2). Greater socio-economic disadvantage in the East of the city is the most likely
explanation for the higher death rate in this sector. People living in the most deprived
communities also have poorer physical and mental health throughout their lives (Figure 3).
[1-4] Unsurprisingly, perhaps, people from these communities are most likely to have
unscheduled hospital admissions.[4] Many of these hospitals admissions are potentially
preventable. Although older adults live with many chronic conditions, it is feasible for most
care to be delivered in community settings or at home.[5-9]
Health inequalities usually develop over a lifecourse. Differences in individual experiences
affect people’s health in three main ways:
Differential exposure to environmental, cultural, socio-economic and educational
influences that impact on health.
The psychosocial consequences of differences in social status. There is now strong
evidence that ‘status anxiety’ leads to psychological and physiological changes that
affect health.[10]
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Edinburgh Health Information, March 2015
Accumulation of these effects over the lifecourse. The inequalities in health that are
observed now will reflect not only current status but also differences in experiences at
earlier stages in life. This is why interventions targeting families and the early years are
so important.
Health inequalities can also be attributable to ethnicity, disability or sexuality. Although
overall mortality for people from black and minority ethnic populations is similar or better
than the white Scottish population, there are aspects of health – notably cardiovascular and
diabetes – where access to services and outcomes are worse, particularly for people from
south Asian populations.[11] In part the better health of migrants may be attributable to the
‘healthy migrant effect’ although there is also evidence that this health dividend disappears
for second and third generation minority ethnic residents. Comparisons of population sub-
groups’ health needs to bear in mind that health in Scotland is generally poorer than almost
all other Western European countries.[12, 13]
People experiencing physical disability also tend to have poorer health.[14] Limiting long
term conditions reduce people’s healthy life expectancy ie. the period of life lived in good
health. There is strong evidence that learning disability is associated with very poor health.
[15] There is also very strong evidence of health inequalities associated with social
determinants of health. Low income[16, 17], unemployment and insecure work, [18-29]
homelessness[30-32] and low educational attainment[22, 33-35] have particularly strong
influences.
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Edinburgh Health Information, March 2015
All Cause Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 2: Mortality rates for Edinburgh health and social care localities with comparator geographies (Source: Lothian Analytical Services, 2015)
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Edinburgh Health Information, March 2015
Figure 3: Physical and Mental Health disorders by socioeconomic status[36]
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Edinburgh Health Information, March 2015
The pattern of health inequalities mirrors the distribution of deprivation across Edinburgh. Mortality and morbidity are highest where there is greatest
deprivation
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Edinburgh Health Information, March 2015
But health inequalities are not restricted to areas of multiple deprivation. Research suggests
that up to 50% of people experiencing poor health do not live in the most deprived
communities.
Edinburgh is home to 62% of the Lothian residents who live in Scotland’s most deprived 20%
datazones. Compared to other parts of Lothian, Edinburgh has the highest number of people
living in the least deprived SIMD quintiles as a proportion of local population.
SIMD 2012 share as percentage of local population
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
East Lothian Edinburgh Midlothian West Lothian Lothian
SIMD quintile (1 = Most Deprived)
Perc
enta
ge
SIMD Q1
SIMD Q2
SIMD Q3
SIMD Q4
SIMD Q5
Figure 4: Share of population grouped by SIMD 2012 datazone rankings (Source: NHS
Lothian Public Health and Health Policy, 2014)
Mid-year 2010 populations
Most deprived
SIMD 2012
rankings Least deprived
Area 1 2 3 4 5 Total
East Lothian 3916 19871 20662 35083 17968 97500
Edinburgh 57134 67336 77236 75771 208643 486120
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Edinburgh Health Information, March 2015
Midlothian 5819 22504 20465 18916 13346 81050
West Lothian 24954 49605 37908 29870 29743 172080
Lothian 91823 159316 156271 159640 269700 836750
Scotland 992973
101754
9
105154
8
108527
1
107475
9
522210
0
Health inequalities are not only related to socio-economic position. People who are
disadvantaged by race, migration status, disability, gender and other factors also have
poorer health. The existence and width of health inequalities cannot be attributed to a single
clinical or behavioural risk factor. They are the result of social circumstances and reflect the
underlying distribution of power and resources in the population. The underlying roots of
health inequalities relate to the unfair distribution of power, money and resources. The
social and political forces that maintain this unfair distribution are termed the ‘fundamental
causes’ of health inequalities. These fundamental causes affect the distribution of wider
environmental influences such as the availability of jobs, good quality housing, education
and learning opportunities, access to services, social status. This results in differences in
individual experiences of, for example, discrimination, prejudice, low income, poor
opportunities. This is illustrated in the model below.
Figure 6: Fundamental Causes of Health Inequalities [37]
It is as important to tackle major non-medical causes of ill health, like social isolation,
homelessness and worklessness as it is to tackle the significant individual level factors that
lead to poor health: smoking; high blood pressure; obesity; poor diet; lack of exercise; and
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Edinburgh Health Information, March 2015
excessive alcohol consumption. Tackling health inequalities requires work on prevention as
well as treatment services and mitigation. Making links between health outcomes and work
in policy areas such as planning, housing, education, transport, employability, sport and
leisure will be crucial if population health is going to be improved for the people whose
health is currently worst.
A key role for organisations delivering health and social care is to mitigate and prevent
health inequalities by providing healthcare and health improvement interventions in
proportion to need. High quality, universal healthcare that is available to everyone with no
or minimal cost barriers is in itself important to mitigate and reduce health inequalities. But
within the universal service there are often other barriers that prevent some disadvantaged
groups of people from receiving care. These include physical, social, environmental and
practical barriers such as mismatch between service design and patient need, cultural
differences between patients and staff, low expectations, poor experience, transport costs
and lack of capacity where the need is highest. These all contribute to what is termed the
‘inverse care law’ – that quantity and quality of care may be poorest for those with the
highest needs. There is evidence in Scotland that resources in our poorest communities are
not sufficient for need.[1, 3, 38] The ‘Deep End’ group of general practices serving
populations living in deprived areas has identified the increased workload for these practices
and advocates that practices in deprived areas should have a package of additional support
to meet the health needs of their populations. The package includes additional GP time;
attached specialist workers; link workers to improve joint working with other services
including the third sector. Future health and social care services need to be designed to deal
with the complexities presented by an ageing population, a population that will live with
multiple morbidities. Episodic, disease-focused or client-specific care will not work in future.
More holistic care focusing on what people need rather than services designed to meet the
requirements of health care systems and bureaucracies. [9, 39, 40]
2. Ageing population
In projections to 2037, the increase in the 75 years and over population is notable due to the
relatively small proportion of this group currently. There will be a marked increase in the
absolute number of very old people living the area. Edinburgh will still have a young
population relative to other parts of Lothian and Scotland. It is important to note that
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Edinburgh Health Information, March 2015
current definitions of age, notably the working age population of 16-64 years, may change in
future as changes to pension eligibility, changing work patterns and longer healthy life
expectancy mean that public policymakers need to re-think how and why they think about
services to an older population.[41]
Projected population change within age groupings
-20 0
20406080
100120140160
2017
2022
2027
2032
2037
2017
2022
2027
2032
2037
2017
2022
2027
2032
2037
2017
2022
2027
2032
2037
Children (0-15)
WorkingAges2
PensionableAges2
75+
Age groupings
Pop
ulat
ion
chan
ge East Lothian EdinburghMidlothian West Lothian Lothian
Figure 7: Lothian population projections by age group 2012-2037 (Source: NRS Population
Projections 2012-2037)
Between 2012 and 2037, the number of households in Edinburgh is projected to increase by
88,158 from 224,875 to 313,033, which is an increase of 39%. Edinburgh already has the
highest proportion of single person households in Lothian and this trend continues.
Edinburgh’s proportion of single person households will continue to be above the Scotland
average. Isolation and loneliness are common health determinants for older people. These
are associated with higher all cause mortality for both sexes,[42-44] as well as lifestyle
factors such as poorer dietary intake.[45]
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Edinburgh Health Information, March 2015
2012 2037
Council
area
1
adult
1 adult,
1+
children
2
adults
2+
adults,
1+
children
3+
adults
1
adult
1 adult,
1+
children
2
adults
2+
adults,
1+
children
3+
adults
East
Lothian 31% 6% 32% 22% 8% 36% 8% 32% 19% 6%
Edinburgh,
City of 40% 5% 30% 16% 9% 44% 6% 30% 13% 7%
Midlothia
n 28% 7% 33% 22% 10% 33% 8% 34% 19% 6%
West
Lothian 30% 8% 30% 23% 9% 36% 10% 31% 17% 7%
Scotland 36% 6% 31% 19% 9% 41% 7% 31% 14% 6%
(Source: NRS Population Projections 2012-2037)
The North West Sector contains significantly higher numbers of older people (aged over 75
years
3. Mortality and Morbidity
a. Quality Outcomes Framework (QOF)-- People with Long-term conditions
General Practices record information about specific conditions as part of the nationally
agreed quality outcomes framework. This provides a snap-shot of the total number of
patients with particular conditions, or risk factors. There are limitations to this data, notably
as no patient identifiable information is included to compile the prevalence figures. That
means we are unable to break down the numbers into age groups or by sex. This data is not
available at locality level.
Number of patients and raw prevalence rates for selected long-term conditions: QOF
Figure 9: All Cause Mortality by Edinburgh Locality
Key point: There has been a steady decline in all cause mortality across Edinburgh between 2006/8 and 2011/13. But there are stark differences between
sectors with the East sector having consistently higher death rates.
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Edinburgh Health Information, March 2015
A similar pattern of decline is seen with mortality rates for coronary heart disease, standardised by age and sex. Again, the East sector has the highest death
rates and the North West has the lowest death rates.
17
Edinburgh Health Information, March 2015
All CHD Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 10: All CHD Mortality by Edinburgh Locality
Key point: There has been a steady decline in all Coronary Heart Disease mortality between 2006/8 and 2011/13.
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Edinburgh Health Information, March 2015
There is a slightly different pattern evident for stroke mortality in Edinburgh. Although the East sector has in recent years had the highest mortality rate
from stroke, mortality in South Central is now highest for stroke related deaths. The lowest stroke mortality rate is in South West Edinburgh. All Edinburgh
sectors are close to or below the Scotland rate for stroke mortality.
All Stroke Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 11: All Stroke Mortality by Edinburgh Locality
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Edinburgh Health Information, March 2015
Deaths under the age of 75 years are described as ‘early’ and analysed separately, (in 2006/8 there were 4,627 deaths in Edinburgh, in 2011/13 there were
4,400). Again the East sector has the highest mortality rate and North West has the lowest early mortality rate.
Early (<75) All Cause Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 12: Early all-cause mortality by Edinburgh Locality
Key point: Early mortality in the East sector is above Lothian and Scottish rates. All other Edinburgh sectors have lower early mortality rates than Lothian
and Scotland.
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Edinburgh Health Information, March 2015
We examined the mortality rates in those under 75 years of age by specific cause of death. The standardised mortality rates for cardiovascular disease show
a downward trend in across the time period but again the East sector has the highest mortality (although absolute numbers of deaths are relatively small in
each sector in each three year period).
Early (<75) CHD Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 13: Early CHD mortality by Edinburgh Locality
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Edinburgh Health Information, March 2015
Key point: The standardised mortality rates for cardiovascular disease show a downward trend for people aged less than 75 years between 2006/8 and
2011/13. But mortality rates are highest in the East sector while all other Edinburgh sectors have rates better than the Scotland or Lothian comparator.
22
Edinburgh Health Information, March 2015
Stroke mortality in the under 75 age group shows a similar pattern to stroke mortality across all ages. But absolute numbers of deaths from this cause
among under 75s are low. A summary figure is available on request.
23
Edinburgh Health Information, March 2015
Alcohol mortality involves much smaller numbers making interpretation difficult (there were between 237 and 312 deaths in Edinburgh in each three year
period between 2006/8 to 2011/13). Edinburgh has an alcohol mortality rate above the Lothian rate. The East sector has a markedly higher alcohol
mortality rate. There does appear to be a downward trend in the age standardised rates across Edinburgh. A similar picture is seen when we analyse deaths
caused by liver cirrhosis (again very small numbers, between 196 and 216 across the whole of Edinburgh in each three year period). Liver cirrhosis is
strongly associated with harmful consumption of alcohol.
Research has shown that there is a significant relationship between alcohol-related hospitalisations and alcohol outlet densities.[46, 47] In Scotland,
Edinburgh and Glasgow have the highest number of on-sales and off-sales licenses per datazone – Figure 15 shows the distribution of licensed
premises in Edinburgh. This research shows that alcohol-related death rates in neighbourhoods with the most alcohol outlets are more than double the
rates in those with the fewest outlets. There were 34 alcohol-related deaths per 100,000 people in neighbourhoods with the most off-sales outlets,
compared with 13 per 100,000 in neighbourhoods with the fewest.[46]
Key point: There appears to be a downward trend in the age standardised rates in both localities and across Edinburgh but the city rate is above the Lothian
rate and considerably higher in the East sector. The standardised mortality rates for all alcohol related mortality and liver cirrhosis are based on relatively
small numbers of cases.
24
Edinburgh Health Information, March 2015
All Alcohol Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 14: All Alcohol Mortality by Edinburgh Locality
25
Edinburgh Health Information, March 2015
Figure 15: Total alcohol outlet density by Edinburgh datazone, 2011-2012 (Darker shading is higher density) Source: CRESH, 2014
26
Edinburgh Health Information, March 2015
We analysed the total number of cancer deaths, standardising by age and sex as before. We also looked in more detail at mortality rates for breast, lung
and colorectal cancers. As before the deaths were aggregated into three yearly groupings. Overall there were between 3,490-3,693 deaths from all cancers
in each three yearly grouping across Edinburgh. Lung cancer deaths were between 931 and 972 per 3 yearly grouping; Colorectal between 342-392; Breast
between 219-261. With smaller numbers there will be more background variation in the standardised rates, even when these are aggregated into three
yearly groupings and caution must be used interpreting. Overall, deaths from breast cancer are most affected by smaller numbers in the analysis. Looking at
the overall picture, mortality from breast cancer has generally remained constant over the time period with some fluctuation within sectors. The East sector
has the highest rate of cancer mortality, above Lothian and Scotland rates. The cancer death rate shows some sign of increasing in South West Edinburgh
over the time period.
27
Edinburgh Health Information, March 2015
All Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 17: All Lung Cancer Mortality by Edinburgh Locality
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Edinburgh Health Information, March 2015
Colorectal cancer death rates are again highest in the East sector. There is some suggestion of a slight upward trend in deaths in other sectors across the
city though rates are still below national and Lothian comparators for most areas.
All Colorectal Cancer Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 19: All Breast Cancer Mortality by Edinburgh Locality
Key Point: Edinburgh East has consistently higher cancer mortality levels and fares worse than Scotland and Lothian. There is some suggestion that breast
and colorectal cancers are increasing in other sectors of the city. Overall, all cancer mortality rates seem consistent rather than reducing over the time
period.
31
Edinburgh Health Information, March 2015
Suicide is a leading cause of death among those aged 35 years and under (between 202-278 deaths in each 3 year grouping in Edinburgh between 2006/8
and 2011/13). NHS Lothian issues reports on suicide rates annually and this is broken down by sex at individual local authority level. Changes to coding in
2011 mean that the number of deaths coded as suicide have increased. This means that it is difficult to compare trends before and after 2011 because
different diagnostic categories have been included. Overall, suicide rates in Edinburgh are above the Scotland rate. The East and South Central sectors have
the highest suicide mortality rates whereas North West Edinburgh has a lower rate of deaths from suicide.
All Suicide Mortality - Edinburgh CHP, NHS Lothian and Scotland
Figure 20: All Suicide Mortality by Edinburgh Locality
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Edinburgh Health Information, March 2015
Key point: There has been an apparent increase in the standardised mortality rates from suicide in Edinburgh in recent years. Changes in coding of deaths
will have contributed in part to this rise. Further monitoring will be necessary before any definitive conclusion can be drawn but there is evidence of higher
death rates in Edinburgh East and Edinburgh South Central.
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Edinburgh Health Information, March 2015
4. Health service use in Edinburgh
a. Unplanned inpatient admissions from Edinburgh accounted for just over half of all unplanned admissions in Lothian between 2008/9 and 2012/13. The
admission rate is highest from the Edinburgh East sector. All other sectors are below the Lothian rate. Admission rates per 100,000 people are relatively
stable over the time period.
Unplanned Inpatient Admissions by Edinburgh Sector and CHP with NHS Lothian Total (2008/09 - 2013/14)
6,000
7,000
8,000
9,000
10,000
11,000
12,000
13,000
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Financial Year
Age
-sex
Sta
ndar
dise
d R
ate
per 1
00,0
00 P
opul
atio
n
Edinburgh (East) Edinburgh (North Wes t) Edinburgh (South Central ) Edinburgh (South West) Edinburgh CHP NHS Lothian
Figure 21: Age-standardised Unplanned Inpatient Admissions by Edinburgh Locality
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Edinburgh Health Information, March 2015
It should be noted that unplanned admissions from Edinburgh are among the lowest of the Lothian CHPs and have remained constant over a number of
years.
Unplanned Inpatient Admissions by Lothian CHP with NHS Lothian Total (2008/09 - 2013/14)
6,000
7,000
8,000
9,000
10,000
11,000
12,000
13,000
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Financial Year
Age
-sex
Sta
ndar
dise
d R
ate
per 1
00,0
00 P
opul
atio
n
East Lothian CHP Edinburgh CHP Midlothian CHP West Lothian CHCP NHS Lothian
Figure 22: Age-standardised Unplanned Admission Rates by Lothian CHP
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Edinburgh Health Information, March 2015
Crude admission rates show a consistently higher figure for the most deprived quintile of the population.
Crude Rates per 100,000 Population by SIMD Quintile (City of Edinburgh): 2008/09 - 2012/13
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2008/09 2009/10 2010/11 2011/12 2012/13
1 - Most Deprived 2 3 4 5 - Least Deprived
Figure 23: Crude admission rates by Edinburgh SIMD quintile
Key point: Emergency admission rates have remained consistent over the five years. Deprivation is associated with highest admission rates so Edinburgh
East has most residents being hospitalised in this way. Edinburgh has fewer unplanned hospital admissions than other parts of Lothian.
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Edinburgh Health Information, March 2015
b. Primary Care workforce
Only headcount figures are routinely available for general practitioners working in Scotland
and Edinburgh. This means we are unable to describe the total amount of doctor-time
available within Edinburgh. The number of GPs working in Edinburgh has increased slightly
between 2008/9 and 2012/13. Working practices are changing over time, with increasing
numbers of younger GPs choosing to work less than full-time hours. Increasing population
will place greater pressure on GP services also. We are currently unable to use routine data
to monitor the impact of these changing working practices.
Number of General Practitioners in post by CHP area, 2008-2013
2006 2007 2008 2009 2010 2011 2012
East Lothian CHP 92 89 93 95 96 97 97
Edinburgh CHP 461 476 487 490 495 498 498
Midlothian CHP 86 85 90 95 89 90 91
West Lothian CHCP 144 138 147 148 144 158 155
NHS Lothian 782 787 815 827 821 842 838
Figure 24: GP headcount rates for Lothian
There is a similar difficulty with the information available about the number of practice
nurses. The only routine data source available to us is the NHS Scotland National Primary
37
Edinburgh Health Information, March 2015
Care Workforce Planning Survey in 2007. Only 74% of practices completed the survey and
again, only headcount information is available. Data from the survey is available but likely to
be out of date and of limited value so not included in this summary.
Headcount and wholetime equivalent information is available for community nurses, but
only at NHS Lothian level at present. The total number of community nurses and whole-time
equivalent working have both increased in the last year. This information is available from
the Information and Statistics Division of NHS Scotland.
Figure 25: Community Nurse headcount rate in Lothian
Key point: There is limited routinely information available to describe the primary care
workforce. This is not currently broken down to locality level. Available information suggests
little change in the number of GP’s working in Edinburgh and an increase in the number of
community nurses working in Lothian overall.
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Edinburgh Health Information, March 2015
c. Road Traffic Accidents
The number of emergency admissions following road traffic accidents fluctuates around 200
in Edinburgh. This means small changes can cause large swings in the admission rates.
Overall, emergency admissions following road accidents have stabilised from a high point in
2008/2009.
RTA Emergency Admissions per 10,000 Population by Edinburgh Sector and CHP with NHS Lothian Total (2008/09 - 2013/14)
0
1
2
3
4
5
6
7
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Financial Year
RTA
Adm
issi
ons
per 1
0,00
0 Po
pula
tion
Edinburgh (Eas t) Edinburgh (North Wes t) Edinburgh (South Centra l ) Edinburgh (South West) Edinburgh CHP NHS Lothian
The number of falls resulting in emergency admissions to patients over 75 has increased
slightly over the last five years. Admissions reflect the age profile of the sectors. Crude
admission rates suggest an increase in falls admissions. It is worth noting that this summary
information records the number of episodes, rather than a headcount of the number of
patients who are falling. Further analysis would be necessary to explore whether recent
increases are the result of a small number of ‘frequent fallers’ or an increase in the absolute
numbers of people falling.
Area
Falls Emergency Admissions
Financial Year
2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Edinburgh (East) 245 277 250 260 258 280
Edinburgh (North West) 391 439 420 401 443 457
Edinburgh (South
Central)346 310 335 327 399 362
Edinburgh (South West) 227 226 251 244 268 319
Edinburgh CHP 1,209 1,252 1,256 1,232 1,368 1,418
NHS Lothian 1,980 2,027 2,101 2,143 2,313 2,359
Key point: It appears that there is an increasing trend in admissions of people aged 75 years
or older for falls, but further analysis would be needed to establish whether this is as a result
of a few individuals falling frequently or whether a larger number of individuals are affected.
Dr Dermot Gorman, Martin Higgins, Public Health and Health Policy, NHS LothianDuncan Sage, Lothian Analytical Services, NHS Lothian
31 March 2015
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Edinburgh Health Information, March 2015
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