West Midlands Key Health Data 2009/10
CHAPTER ONE: HEALTH GEOGRAPHY
Diane Edwards: West Midlands Cancer Intelligence Unit
Main Body
7: Changes in Heart Attack Admissions since the Smoking Ban
8: Measuring Disability Across the West Midlands
9: Surveillance of Clostridium Difficile in the West Midlands
1.1 Introduction
This chapter draws together a number of changes in organisational arrangements and changes in data provision that might impact on the way public health information is provided for the future. These include NHS West Midlands’ agreement to develop 5 PCT Commissioning Clusters in the region and the start of a consultation process to unite the three Birmingham PCTs into one Birmingham PCT coterminous with its local authority. The recent parliamentary election saw the introduction of new parliamentary constituency boundaries for the UK.
Government initiatives in the name of ‘Making Public Data Public’ resulted in a new web portal (www.data.gov.uk) for access to public sector datasets and a few months later the Ordnance Survey (OS) provided some of its digital mapping data free of charge at OS OpenData. The Office for National Statistics (ONS) has overhauled its coding systems for geographical areas which will form the basis for the future release of area based statistics and it has concluded work to improve its methods for estimating migration in the annual mid-year population estimates.
1.2 New Boundaries
1.2.1 Sub-regional Commissioning Clusterss
NHS West Midlands announced plans to create 5 sub-regional PCT commissioning clusters in March 2010. The Strategic Health Authority was the first to cite a reduction in management costs as a primary reason for doing so but it also expects the move to strengthen joint working on quality and productivity. NHS West Midlands expects this to deliver 30% reduction in management costs by 2014.
Map 1.1: Sub-regional Commissioning Clusters
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1.2.2 Birmingham PCTs
A Transition Steering Group has been established with authority from the boards of the Heart of Birmingham tPCT, the Birmingham East and North PCT and the South Birmingham PCT to ensure the transition to a single commissioning organisation for Birmingham. NHS West Midlands will be responsible for ensuring appropriate consultation is carried out and ensuring that any new organisation is ready to assume its role in April 2011. The aims of the reorganisation are to improve the financial stability of commissioning for Birmingham, lead the NHS in developing for future health needs, shape the local health economy and ensure patient engagement in the planning and commissioning of health services.
The PCTs have since decided to await the outcome of the White Paper ‘ Equity and Excellence: Liberating the NHS’ before they agree a way ahead.
1.2.3 Parliamentary Constituencies
New Parliamentary Constituency boundaries became effective at the date of the General Election - 6th May 2010. The constituency boundaries are described by the ONS in terms of whole Lower Super Output Areas (LSOAs) and lookup tables were published on the Neighbourhood Statistics website - 26th March. There are 650 seats in parliament; 573 seats for England & Wales; 59 for West Midlands, each MP representing approximately 70,000 voters. Although there is no change to the number of seats representing West Midlands between 2001and 2010 the boundaries of the constituencies have changed.
Map 1.2: Parliamentary Constituencies in West Midlands 2001 and 2010
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1.3.3 ‘Making Public Data Public’1
In November 2009 the then Prime Minister Gordon Brown set out his vision for ‘Making Public Data Public’. As a result a new data portal was established under the direction of Sir Tim Berners-Lee and Professor Nigel Shadbolt at www.data.gov.uk. The portal signposts more than 2,500 government datasets that are available for public scrutiny. This resource is expected to be grown by the new coalition government as part of its Big Society2 pledge.
As a further development of opening up public data the UK National Mapping Agency, OS went out to consultation 15th December 20093 to determine views on whether OS data should be provided free of charge, how the data might be funded and the impact this would have on existing licence holders and competitor markets. This consultation closed 17th March 2010 with a government response4 on 31st March. The consultation and government response to it advocated the provision of OS data free of charge. The first data were made available at OS OpenData5 on 1st April 2010.
OS OpenData mapping can be downloaded under licence conditions similar to creative commons and used to disseminate information as long as no financial gain is made from the use of the data. Initially 4 raster datasets, 4 vector datasets and 3 point datasets were supplied. The datasets are provided in a mixture of formats, raster data as tiff files, point data files as comma separated values and vector data in GIS ready formats. Most datasets are available as full Great Britain coverage except the new OS VectorMap District which can be downloaded as individual National Grid Reference squares.
The full list of OS OpenData products can be found at:
https://www.ordnancesurvey.co.uk/opendatadownload/products.html
Many of the OS OpenData products were previously available for one-off purchase or by annual licence for user specified areas and formed a substantial part of the various public sector licensing agreements i.e. Mapping Services Agreement for local government, the Pan Government Agreement for central government and the Digital Mapping Agreement for health organisations. As a result of the OS OpenData initiative there is now pressure to ensure that all public sector organisations have access to a common range of geographic datasets, free of charge at point of use. A working party has been set up to facilitate such a transition and bring cost savings across the public sector. The exact terms of any new agreement are still being considered and are due to come into effect 1st April 2011; it is being referred to as the ‘Public Sector Mapping Agreement’.
1.4 ONS Geography and Populations
1.4.1 ONS Mid-year Population Estimates 2008
These population estimates were published on the 13th May 20106 along with an analysis tool which will compare the estimates for the region with national changes and against the previous year’s estimates. There are also a number of comparator workbooks which look at a number of components of change affecting the estimates e.g. changes over time and changes in quinary age group components.
1.4.2 Improvements to 2008 Migration and Population Statistics7
Over the last 3 years the ONS has carried out a number of improvements in its methods for the inclusion of migration in its population estimation processes. The latest improvements introduce a new methodology for the estimation of internal student migration and better apportionment of international migrants amongst local authorities. Final consultation with local authorities on the effects of the new method came to an end in January 2010 and revised mid-year population estimates 2002-2008 for local authorities were published in May 2010.
ONS provides a useful series of impacts charts8 which provide a breakdown of the effects of the improvements to estimation at region, county and local authority level. At the regional level West Midlands adjustments are minimal, it is the between local authority level adjustments that show the greatest changes. The largest cumulative increases in population estimates for 2002-2008 are in Warwick (+2,500 people) and Birmingham (+2,400). These changes are driven by an increase in student numbers of 2,100 and 3,800 respectively and a change in international migration of +400 in Warwick and -1,400 in Birmingham.
The largest cumulative decreases in population estimates are in Solihull (-1,200) and Redditch (-1,100). Solihull’s changes are due to a reduction in student numbers (-700) and a smaller reduction in international migrants, whereas reductions in Redditch are higher for international migrants (-800) than students (-300).
The largest cumulative percentage increase is in Warwick (11.9%), attributable to increases in student numbers, whilst increases in Rugby and Wolverhampton relate to lower rates of international migrant outflow than previously estimated. The greatest percentage reduction in population estimates for Redditch are attributable to downward adjustments in international migrants yet all other reductions are due to both smaller student populations and fewer international migrants.
Map 1.3: Cumulative percentage change in population estimates in local authorities 2002-2008
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1.4.3 ONS Naming and Coding Policy
The Government Statistical Service will implement its new coding and naming policy on 1st January 2011. The new Register of Geographic Codes (RGC) should then be used in all exchanges of statistics with ONS and in all future published datasets that include codes. The aim of the policy is to adopt a non-hierarchical coding schema for UK geographies on a similar basis to those currently used for LSOAs and MSOAs. The schema will meet modern interoperability standards providing a future-proof coding scheme, negate the need to reuse codes and include metadata and guidance on their presentation and naming conventions. The RGC will apply to the geographic area of each organisation; any organisational name changes with only minor impact to boundaries will not trigger a new code.
The proposed structure of the codes will be based on 9 characters in the format: ANNNNNNNN
ANN will describe the entity or area type eg English Unitary Authority = E06.
NNNNNN will describe the specific instance of that entity eg Portsmouth (000044). The range of the codes is described in Table 1.1.
Table 1.1: Format of Register of Geographic Codes
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The full RGC is available to download at: http://www.ons.gov.uk/about-statistics/geography/policy/coding-and-naming-for-statistical-geographies/index.html
As a result of the RGC two additional fields appeared in the March 2010 National Statistics Postcode Directory and the NHS Postcode Directory as OldCode and NewCode. The old code is the full code required to uniquely describe each geography now and the ‘NewCode’ is the code as it will be under the 9 character RGC schema. The ‘NewCode’ will become operable in January 2011 and replace the ‘OldCode’ in February 2011 postcode directories.
1.4.4 2011 Census
The next, and possibly the last ever census of England and Wales is planned to take place on the 27th March 2011. Census Regulations were laid before Parliament on 4th March 2010 and came into force on 31st March 2010. The Regulations describe the delivery and collection methodology, prescribe the measures to ensure the security of the completed forms and the confidentiality of the data and includes specimens of the questionnaires to be used. Separate Regulations for Wales were laid before the National Assembly for Wales in April 2010.
A number of census rehearsals were carried out in October 2009 to test some of the new methods introduced to improve census return rates. These new approaches include better engagement in communities that have not responded well to previous census and the postal delivery of all household census forms (approximately 25 million) which is dependent on the newly developed national address register. There will be facilities to allow online completion of census forms and a questionnaire tracking system to enable a targeted field follow-up process. 17,000 addresses in Birmingham were invited to join a supplementary rehearsal to test a specific aspect of this new system.
Contracts have been awarded to process census returns and administer the staff training and recruitment process required to support the Census 2011.
The Census aims to provide consistent, joined-up and comparable UK outputs released concurrently with Scotland and Northern Ireland, free at the point of delivery, disseminated using up to date technology, with the ability to generate flexible tables online and provision of appropriate metadata. There will be a common UK statistical disclosure control methodology for census 2011 outputs. It is proposed that changes to output geography will be minimal and limited to less than 5% of output areas with simple mergers and groupings preferable to realignments although some of the worst boundaries may be investigated for alignments to real world objects. The ONS will investigate options for the extension of the central registry of local names for LSOAs and MSOAs. All possible steps will be taken to ensure that a common boundary exists between Scottish and English datasets and a separate set of boundaries reflecting mean-high-water coastline will be released in addition to those to the extent of the realm.
References:
- ‘Making Public Data Public’ : http://www.tso.co.uk/documents/makingpublicdatapublic.pdf
- ‘Building the Big Society’, Cabinet Office News Release, May 2010
- OS Consultation Document: www.communities.gov.uk/documents/corporate/pdf/1411177.pdf
- Government response to OS Consultation:
www.communities.gov.uk/documents/corporate/pdf/1528263.pdf
- OS OpenData available at: www.ordnancesurvey.co.uk/opendata
- ONS MYEs 2008 available at: http://www.statistics.gov.uk/popest
- Details of Migration Statistics Improvement Programme available at:
http://www.ons.gov.uk/about-statistics/methodology-and-quality/imps/mig-stats-improve-prog/comm-stakeholders/improvements-2008-pop-est/index.html - Migration Statistics Improvement Programme Impacts Charts:
http://www.ons.gov.uk/about-statistics/methodology-and-quality/imps/mig-stats-improve-prog/comm-stakeholders/improvements-2008-pop-est/tables-and-charts/index.html