Projected acute hospital demand in South East London

Meic GoodyearQueen 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 8.1South East London SHA 2001 2006 2011 2016

Lambeth 274,200 294,002 310,777 326,509Southw ark 251,060 266,030 284,414 302,925Lew isham 254,886 264,041 274,435 284,426Greenw ich 217,805 231,956 241,047 246,616Bexley 218,757 221,610 225,150 228,671Bromley 296,218 301,810 309,283 316,390Total population 1,512,926 1,579,448 1,645,106 1,705,536Increase from previous 66,522 65,658 60,429Total increase 2001 - 2016 192,610

Projected population growth - 2001 – 2016 Comparison GLA v Blue book by PCT

South E as t London

1, 350, 000

1, 400, 000

1, 450, 000

1, 500, 000

1, 550, 000

1, 600, 000

1, 650, 000

1, 700, 000

1, 750, 000

2001 2006 2011 2016

GLA

BB

B ex l ey

200, 000

205, 000

210, 000

215, 000

220, 000

225, 000

230, 000

235, 000

2001 2006 2011 2016

GLA

BB

B r oml ey

200, 000

220, 000

240, 000

260, 000

280, 000

300, 000

320, 000

340, 000

2001 2006 2011 2016

GLA

BB

G r eenwi c h

200, 000

210, 000

220, 000

230, 000

240, 000

250, 000

260, 000

270, 000

280, 000

2001 2006 2011 2016

GLA

BB

Lambeth

200, 000

220, 000

240, 000

260, 000

280, 000

300, 000

320, 000

340, 000

2001 2006 2011 2016

GLA

BB

Lewi s ham

200, 000

210, 000

220, 000

230, 000

240, 000

250, 000

260, 000

270, 000

280, 000

290, 000

2001 2006 2011 2016

GLA

BB

Southwar k

200, 000

220, 000

240, 000

260, 000

280, 000

300, 000

320, 000

2001 2006 2011 2016

GLA

BB

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

Aggregateat 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)

Lambeth Prince's Wardyear

Age range 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016a 0-4 227 226 234 247 259 268 273 278 283 287 292 295 299 302 305 307b 5-14 84 86 86 86 88 90 93 97 101 102 105 105 107 110 112 113c 15-44 1066 1032 1052 1067 1083 1093 1097 1096 1099 1107 1111 1113 1115 1111 1112 1121d 45-64 754 764 775 790 805 836 870 905 932 965 1001 1026 1054 1083 1099 1098e 65-74 319 312 318 323 325 315 310 310 310 308 308 313 309 302 305 315f 75-84 314 321 311 314 309 311 308 305 300 297 294 291 296 302 304 296g 85+ 140 133 141 145 157 166 173 178 188 188 189 191 185 186 185 189All ages 2906 2874 2918 2974 3024 3078 3123 3169 3212 3254 3299 3335 3364 3395 3422 344095% CI 216 213 216 220 224 227 230 233 236 239 243 245 247 249 250 252All ages Lower 95% CI 2798 2767 2810 2864 2912 2964 3008 3053 3094 3134 3178 3213 3240 3271 3297 3314All ages Upper 95% CI 3014 2980 3026 3084 3136 3191 3238 3286 3330 3373 3420 3458 3487 3520 3548 3566

Annual totals with 95% CIs by age bandLambeth Prince's ward, projected admitted episodes, by age band,

2001-2016

0

500

1000

1500

2000

2500

3000

3500

year

ep

iso

de

s

0

500

1000

1500

2000

2500

3000

3500

95% CI

g 85+

f 75-84

e 65-74

d 45-64

c 15-44

b 5-14

a 0-4

Outputs of Analysis (2)Standardised Episode Ratio (SER)

Age range SER lower 95% CI higher 95% CIa 0-4 0.79 0.69 0.90b 5-14 0.85 0.68 1.06c 15-44 0.89 0.84 0.95d 45-64 1.53 1.42 1.64e 65-74 0.95 0.85 1.06f 75-84 1.00 0.89 1.12g 85+ 1.22 1.03 1.44All ages 1.03 0.99 1.06

Standardised to England populationusing HES data 2000-2002 average rates

Outputs of Analysis (3)Ward-provider flow proportions

3 year average fraction provider provider name

76.7% RJ1 GUY'S AND ST THOMAS' NHS TRUST7.1% RJZ KING'S COLLEGE HOSPITAL NHS TRUST3.8% RV4 COMMUNITY HEATH SOUTH LONDON1.6% RQM CHELSEA AND WESTMINSTER HEALTHCARE NHS TRUST1.5% RV501 ST THOMAS'S HOSPITAL (MENTAL HEALTH UNIT)0.7% RJZ33 KINGS COLLEGE DENTAL HOSPITAL0.8% RV502 THE LAMBETH HOSPITAL0.8% RRV UNIVERSITY COLLEGE LONDON HOSP NHS TRUST7.0% 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"