Annual Patient profile report

December 2016 – November 2017

Cheryl Farmer

Patient Inclusion and Experience Lead

January 2018

Contents

Introduction …… 3

Demographics of local areas:

  • St Helens …… 3
  • Knowsley …… 4
  • Halton …… 4

Section 1: Inpatients:

  • Sex of patients using inpatient services …… 5
  • Age range of inpatients …… 6
  • Ethnicity of inpatients …… 7
  • Religion or belief of inpatients …… 8
  • Marital status of inpatients …… 9

Section 2: Outpatients:

  • Sex of patients using outpatient services …… 10
  • Age range of patients using outpatient services …… 11
  • Ethnicity of patients using outpatient services …… 12
  • Religion or belief of patients using outpatient services …… 13
  • Marital status of patients using outpatient services …… 14

Conclusions …… 14

References …… 15

  1. Introduction

This report looks at the demographics of the patients who have accessed the services the Trust provides during the 12-month period from 1st December 2016 to 30thNovember 2017. It provides information on the demographics of the Trust’s local populations and compares this to the demographics of the patients accessing the Trust’s services. The report looks at both inpatient admissions and outpatient attendances throughout this 12 month period.

The population served by the Trust resides principally in four different local authority areas, St Helens, Knowsley, Halton and Liverpool. The majority of patients (75%) reside in St Helens and Knowsley (50% and 25% respectively). In all areas it is predicted that the elderly population will grow significantly over the next 10 years. This ageing local population is likely to increase the incidence of diseases linked to older age and potentially increase demands on health and social care services across all four local areas as noted below.

  1. Demographics of local areas:

St Helens

The resident population of St.Helens is 177,188 people (Source: 2014 mid-year estimate, ONS). This has remained fairly constant for the past decade; current population projections indicate that there will be a 5% increase of the total population by 2025.

  • Over the next twenty-five years, the number of residents in their 80s is expected to almost double, from 6,700 in 2012 to 12,800 in 2037. The number of residents in their 90s is expected to almost triple from 3,600 to 9,700. This ageing of the local population is likely to increase the incidence of diseases linked to older age and potentially increase demands on health and social care services. (Source: St Helens Joint Strategic Needs Analysis 2015).
  • 49% of the population are male and 51% female
  • 98% of residents in St.Helens answered that their ethnic group was white on the 2011 census.
  • There is limited information on sexuality at a local level; however, applying national survey figures to the local population gives an estimate of 2,274 people aged 16 and over who would define themselves as gay, lesbian or bisexual.
  • In total 22.7% of the St.Helens population have a limiting long term condition. This is higher than the England average at 16.9% (census 2011).
  • Households with disabilities are more likely to experience problems with their housing due to their changing needs, particularly in relation to access and bathing issues, which may prevent safe and continued use of their home. Failure to invest in home adaptations will reduce the potential for disabled people to continue to live independently in their own home and will place additional demands on hospital beds, nursing and residential care (Source St.Helens Joint Strategic Needs Assessment 2015).
  • The local population is expected to become older on average over the coming years, with the mean average age for the Borough increasing from 40.9 years in 2012, to 42.8 years in 2025, and 44.3 years in 2037.

Knowsley

The resident population of Knowsley is 146,400 (Source: UK census data 2014).

  • 47.5% of the local population are male and 52.5% female.

Knowsley hasexperienced a significant increase in its ageing populationand projections for the future anticipate that this population growth amongst the elderly will continue. Currently there are 24,037 adults aged 65 and over living in Knowsley; forecasts predict that by 2030 this figure will have increased to approximately 34,000, the increase in the 80+ age group will be even more significant.This couldintensify the pressures on care services and long term residential carefacilities,given that those aged between 79 and 89 are the most likely to be admitted into long term care.

  • 97.2% of the population in Knowsley declared themselves to be White British and only 2.8% of the population is drawn from BME groups (Source: ONS census 2011).
  • The national GP survey for England (2015) shows that 4% of the population of Cheshire and Merseyside identify as Lesbian, Gay, Bisexual or other.
  • In total 25% of the resident population of Knowsley have stated they have a long term health problem (35751 individuals), with 14% stating their day to day activities are limited a lot and 11% stating their daily activities are limited a little.

Halton

The resident population of Halton is 126,900 (2016), with an increase of 400 since 2015 (Source: Halton Borough Council Population Dashboard).

  • 49% of the population are male with 51% female.
  • As of 2016, 12.0% of Halton’s population were aged 70 and above, whereas, in 2039 Halton’s projected population aged over 70 will represent almost a fifth (19.6%) of the entire population of the are
  • The BME (Black and Minority Ethnic) population of Halton (2.2%) is very small compared to the North West (9.8%) and even more so to England (14.6%).
  • The national GP survey for England (2015) shows that 4% of the population of Cheshire and Merseyside identify as Lesbian, Gay, Bisexual or other
  • According to the 2011 census, there were 26,124 people in Halton with Limiting Long-term Illnesses, which is 20.5% of the population, and higher than the England average of 16.9%. Of these, it is estimated that more than half have a disability.

Section 1: Inpatients – admissions between 01/12/16 and 30/11/17

Total number of inpatients – 114,671

Fig 1. Male v Female inpatients:

Table 1. Sex of patients (inpatients)

Sex of patient (inpatient) / No of admissions
Male / 49,627
Female / 65,044
Grand Total / 114,671

Fig 1 shows that during this time period 57% of inpatients were female compared to 43% male; this figure is much higher than the ratio of male to female residents in the local areas described above.

The main reason for the higher numbers of female than male inpatients will be due to the Trust’s maternity services (delivering mothers) and also it is well documented that women are far more likely to access medical services than men, from primary care through to inpatients.

The Trust has admitted 7,523 more patients than last year (total last year was 107,148), comprising of 3,433 additional male patients and 4,090 additional female patients.

Fig 2. Age range of inpatients:

Table 2. Percentage of inpatients in each age group:

Age
(years) / Number of patients in each age group / % of patients in each age group
0-5 / 5,603 / 4.8
6-10 / 955 / <1
11-15 / 1,047 / <1
16-20 / 3,670 / 3.2
21-25 / 6,152 / 5.3
26-30 / 8,172 / 7.1
31-35 / 7,295 / 6.4
36-40 / 5,605 / 4.9
41-45 / 5,397 / 4.7
46-50 / 6,440 / 5.6
51-55 / 7,473 / 6.5
56-60 / 7,435 / 6.5
61-65 / 7,015 / 6.1
66-70 / 9,009 / 7.8
71-75 / 8,786 / 7.7
76-80 / 9,340 / 8.1
81-85 / 8,007 / 7.0
86-90 / 4,958 / 4.3
91-95 / 1,925 / 1.6
96-100 / 364 / <1
100-105 / 21 / <1
Blank / 2 / <1

Table 2 shows that the first ‘peak’ in inpatient admissions occurs in the 21-35 years age groups (18.8% in total) andincluded in this group will be female patients giving birth in the Trust’s Maternity Unit.

The next peak is seen in the age groups from 51 to 65 years of age (19.1% in total), followed by a significant increase in admissions in the age range from 66 to 85 years of age (30.6%).

Higher incidents of admissions in these older age groups reflect the fact that the UK population is an ageing population. The fact that people are now living longer, a trend which is set to continue, will lead to an increase in the total amount of ill-health and disability in the population. There will be an accompanying change in the nature of ill-health, with a relative shift away from acute illness towards chronic conditions, multi-morbidities, cognitive impairments and long-term frailty as, although people are living longer, they are not living ‘healthier lives’.

In St Helens alone, over the next twenty-five years, the number of residents in their 80s is expected to almost double, from 6,700 in 2012 to 12,800 in 2037. The number of residents in their 90s is expected to almost triple from 3,600 to 9,700, with similar increases in Knowsley and Halton. This ageing of the local population is likely to increase the incidence of diseases linked to older age, which will challenge the way health services are provided to the elderly. Care of the elderly has moved from secondary to primary and community care over recent years, with more reliance on unpaid carers, some of whom will also be elderly and in poor health themselves.

Fig 3. Ethnicity of inpatients:

94% of inpatients during this time period identified as White British (n=107,459), 0.3% as White Irish and 2% any other white background, this figure will include Eastern European patients accessing services in the Trust.

Only 1.66% of patients identified as being from a Black or Minority Ethnic (BME) background or other ethnic group. This figure is slightly lower than the 2% BME people resident in St Helens, Knowsley and Halton.

The remaining 2% are ‘undefined’ (n=2,755), which means that they have not stated their ethnicity or it hasnot been recorded for some other reason eg. there was no code available to assign them to.

These figures are broadly similar to the number of residents in the local populations who identify as being from a Black or Minority Ethnic (BME) background, which shows that people from all ethnic backgrounds are using the Trust’s services in similar numbers to those seen in the local resident communities.

Fig 4. Religion or Belief of inpatients:

The majority of inpatients identified as either Roman Catholic (31%) or Church of England (42%), in line with the fact that 94% of inpatients identified as White British, White Irish or White other. 14% of patients stated they had no religion or were atheist (n=16,427), with 9,781 inpatients (8.5%) ‘undefined’, which again means they have either failed to answer this question or not been asked what their religion or belief is upon admission.

Fig 5. Marital status of inpatients

Section 2 outpatients:attendances between 01/12/16 and 31/11/17

In total there were 455,600 outpatient attendances between 01/12/16 and 31/11/17.

Fig 6: Sex of patients visiting outpatients departments:

Table 3: sex of patients (outpatients):

Sex / Attendances
Male / 192,638
Female / 263,022
Grand Total / 455,660

The overall percentage of male and female outpatients is similar to those seen for inpatients, with a total of 70,384 more females than males accessing outpatient services during this 12 month period.

Fig 6: age range of patients attending outpatients:

Table 4: Percentage of outpatients in each age group:

Age
(years) / Number of patients in each age group / % of patients in each age group
0-5 / 11,468 / 2.5
6-10 / 7,246 / 1.6
11-15 / 7,097 / 1.55
16-20 / 13,058 / 2.8
21-25 / 19,509 / 4.3
26-30 / 25,935 / 5.7
31-35 / 23,860 / 5.2
36-40 / 21,182 / 4.6
41-45 / 23,871 / 5.2
46-50 / 30,379 / 6.6
51-55 / 36,034 / 7.9
56-60 / 36,219 / 7.9
61-65 / 35,199 / 7.7
66-70 / 43,579 / 9.6
71-75 / 39,710 / 8.7
76-80 / 37,510 / 8.2
81-85 / 26,982 / 5.9
86-90 / 12,696 / 2.8
91-95 / 3,658 / <1
96-100 / 447 / <1
100-105 / 21 / <1

Table 4 shows that outpatient visits start to increase at age 40 and over, tailing off over 80 years of age. The table shows that:

  • 11.8% of patients attending an outpatients area were aged 41-50
  • 15.8% of patients attending an outpatients area were aged 51-60
  • 17.3% of patients attending an outpatients area were aged 61-70
  • 16.9% of patients attending an outpatients area were aged 71-80
  • 8.7% of patients attending an outpatients area were aged 81-90

Fig 7: Ethnicity of patients using outpatient services

Similar to the ethnicity of inpatients, 94% of the patients visiting outpatients identified as White British, with 0.3% White Irish and 1.8% White Other. 1.6% identified as being from a Black or other minority ethnic background, with 2.3% undefined, which means they had not stated their ethnicity, it had not been recorded or there was no code available to record it.

These figures are broadly similar to the numbers of residents in the local populations who identify as being from a Black or Minority Ethnic (BME) background, which shows that people from all ethnic backgrounds are using the Trust’s services in similar numbers to those seen in the local resident communities.

Fig 8: Religion or Belief of patients using outpatient services:

The majority of inpatients identified as either Roman Catholic (30.7%) or Church of England (46%) in line with the 94% of patients who used outpatient services identified as White British, White Irish or White other. 10.8% of patients stated they had no religion or were atheist (n=49,556), with 9,781 inpatients (8.8%) ‘undefined’, which again means they have failed to answer this question or not been asked what their religion or belief is. These figures are similar to those seen for inpatients during this period.

Fig 9: Marital status of patients using outpatient services:

Sexual orientation – data is not collected from patients regarding their sexual orientation

Disability status – data is not collected from patients regarding their disability status ie. whether they have a disability and whether their disability is physical, sensory or a mental impairment.

Gender reassignment – data is not collected from patients relating to gender reassignment.

Conclusions:

There are significant gaps in the equality data currently collected by the Trust, in particular information around the disability status and sexual orientation of the patients who are accessing our services.

The Trust is currently in the process of developing a new Patient Access System, phase 1 of the system is due to be in use by the end of April 2018, however, phase 1 does not include the necessary fields to capture the data around disability status or sexual orientation. The Patient Inclusion and Experience Lead will continue to work with the Medway project team in order that the information around disability status and sexual orientation is recorded at the earliest possible date.

Overall, the patients accessing both inpatient and outpatient services appear to be reflective of the local communities the Trust serves in terms of their age, ethnicity and religion or belief. The sex of patients accessing services varied greatly from the percentages of males and females in the local populations. There were far more female patients than males; a significant number of which will have been maternity patients.

References:

ONS – 2014 mid-year population estimates

St Helens Joint Strategic Needs Assessment, 2015

UK Census Data, 2014

Halton Borough Council Population Dashboard, 2016

National GP survey for England, 2015

Future of an Ageing population: Government Office for Science, 2016

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