Introduction

This report on health inequalities forms part of the ICB’s response to NHS England’s Statement on Information on Health Inequalities (duty under section 13SA of the National Health Service Act 2006). and details information that the ICB should collect, analyse and publish as part of addressing health inequalities.

It is intended that information within this report should be used by services and boards to inform service improvement and reductions in healthcare inequalities. This includes, but not limited to, using the information to inform:

  • strategy development
  • policy options review
  • resource allocation
  • service design
  • commissioning and delivery decisions
  • service evaluations

The report covers includes ten domains and - where possible - focuses on variables by: sex/gender, age, deprivation and ethnicity. The indicators align to the five priority areas for addressing healthcare inequalities set out in the priorities and operational planning guidance and the Core20PLUS5 approach.

Data has either been sourced from existing anonymised data sources - namely Secondary Uses Service (SUS) data - or tools/dashboards that have been made available via NHS England.

The report provides high-level descriptive analysis only and is intended to help monitor activity - leading to more detailed and robust analysis where appropriate - to further reduce healthcare inequalities.

The ten different domains, and respective indicators, can be navigated using the contents panel on the left. Menu buttons for each variable-type (sex/gender, age, deprivation, ethnicity), where available, can be selected within each section.

1 Elective Recovery

1.1 Size and shape of the waiting list

The data presented below is for all patients still awaiting treatment as of week ending 10th March 2024. The data is for all patients across all treatment services and all referral types (urgent, two-week and routine) combined and is designed to show a high-level summary only that may be indicative of potential inequalities, although this would require further analysis.

Note that there are likely to be different case-mixes within each group whilst the treatment service and referral type are also likely to affect wait times meaning some of the data presented below will be skewed.

Stated gender

Note that due to small numbers, this data has been filtered to include male and female stated genders only.

The above chart shows that female patients have a slightly longer median wait time of 18 weeks compared to male patients (17 weeks). Although the data distributions, visually, look broadly similar, statistical tests identified a significant difference between the two groups.

Age

Note that patients without a valid age have not been included in this data.

The above chart shows that patients in the middle age group (18 to 44 years old) have the longest median wait time of 19 weeks, the youngest (aged 0 to 17 years old) have the shortest median wait time of 16 weeks. The data distributions also show longer tails and more prominent outliers in the 18 to 44 and 45- to 64-year-old age groups.

Statistical tests identified a significant difference between age groups, whilst a further pair-wise test found that the most significant difference was between the 18 to 44 years old age group and the 65 and over age group.

Deprivation

Note that patients without a valid LSOA area of residence are not included in this data. LSOA is required to match to deprivation quintile.

The above chart shows that patients from the most deprived group have a slightly longer median wait time of 19 weeks compared to other groups. The data distributions show there are some outliers waiting more than 65 weeks across all deprivation quintiles, although the two least deprived groups have shorter tails than the most deprived groups.

Statistical tests identified a significant difference between deprivation groups, whilst a further pair-wise test found that the most significant difference was between the most deprived group and the least deprived group.

Ethnicity

Note that the large number of patients with an Unknown ethnicity could potentially skew this analysis. This is indicative of data quality issues with patient ethnicity not always properly captured.

The above chart shows that patients of Asian or of Black ethnicity have longer median wait times of 22 weeks compared to other known ethnic groups who have a median wait time of 18 weeks. The data distributions show there are some outliers waiting more than 65 weeks across all ethnic groups, although some minority ethnic groups have longer tails than the White and Unknown groups . Furthermore, the data distributions for Asian and Black groups show notable peaks at more than 18 weeks.

Statistical tests identified a significant difference between ethnic groups, whilst a further pair-wise test found that the most significant difference was between the White group and the Unknown group. With the Unknown ethnic group removed from the statistical tests, the most significant difference was between the White group and the Asian group.

1.2 Patient waiting more than 18/52/65 weeks

Stated gender

Note due to small numbers in other groups the data has been filtered for Male and Female stated genders only.

The above charts show that whilst the proportion of women waiting more than 18 weeks is significantly higher than for men; at 52 weeks or more and 65 weeks or more there is no significant variation by stated gender.

Age

The above charts show that the proportion of patients aged 18 to 44 waiting more than 18 weeks is significantly higher than for other age groups. There are also a significantly higher proportion of patients aged 18 to 44 and aged 45-64 who are waiting 52 weeks or more, and 65 weeks or more, compared to other age groups.

Deprivation

The above charts show that the proportion of patients from the most deprived group waiting 18 weeks or more is significantly higher than for least deprived groups. There are also a significantly higher proportion of patients from the most deprived group who are waiting more than 52 weeks or more, and 65 weeks or more, compared to other deprivation quintiles.

Ethnicity

The above charts show that the proportion of patients of Asian or of Black ethnicity waiting more than 18 weeks or more is significantly higher than other ethnic groups. There is, however, no further significant variation by ethnic group at 52 weeks or more and 65 weeks or more.

1.3 Elective admissions

Local SUS inpatient has been analysed for the 2023 calendar year on elective admissions for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare admissions by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • Women have a significantly higher rate of elective admissions compared to the overall rate, and the men have a lower rate
  • Elective admissions tend to increase with age
  • Persons from the most deprived quintile have a significantly higher rate compared to the overall rate, whilst the rate is significantly lower for the least deprived quintiles
  • Elective admissions are significantly higher for residents who are of “Other” ethnicity compared to the overall rate

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

1.4 Emergency admissions

Local SUS inpatient has been analysed for the 2023 calendar year on emergency admissions for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare admissions by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • There is no significant variation in emergency admissions rates by stated gender
  • Emergency admissions tend to increase with age, with a notable exception for infants aged 0 to 4 years old
  • The emergency admission rates is significantly higher for residents from the two most deprived groups compared to the overall rate, and significantly lower for the two least deprived groups
  • Emergency admissions are significantly higher for residents who are of “Other” ethnicity compared to the overall rate

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

1.5 A&E attendances

Accident and emergency (A&E) attendance data, derived from SUS, has been analysed for the 2023 calendar year for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare attendances by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • The rate of A&E attendances is significantly higher for women compared to the overall rate, and is lower for men
  • A&E attendances tend to increase with age, with a notable exception for infants aged 0 to 4 years old
  • The A&E attendance rates is significantly higher for residents from the two most deprived quintiles compared to the overall rate, and is significantly lower for those from the least deprived groups
  • A&E attendances are significantly higher for residents who are of “Other” ethnicity compared to the overall rate

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

1.6 Outpatient appointments

Outpatient appointment data, derived from SUS, has been analysed for the 2023 calendar year for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare appointments by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • The outpatient appointment rate is significantly higher for women than the overall rate, and significantly lower for men
  • The rate of outpatient appointments tend to increase with age
  • Outpatient appointment rates are significantly higher for residents from the two most deprived quintiles compared to the overall rate, and significantly lower for the least deprived groups
  • The rate of outpatient appointments is significantly higher for residents who are of “Other” ethnicity compared to the overall rate

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

1.7 Virtual outpatient appointments

The information presented below is take from the NHS Foundry Health Inequalities Improvement Dashboard (HIID) and is based on all virtual outpatients appoints (across all specialties) for a 12 month period up until 23rd November 2023, with data broken down by deprivation and for each ethnic group.

Deprivation

*Source: HIID, NHS Foundry*

Source: HIID, NHS Foundry

The above chart shows that over the past 12 months, the virtual outpatient attendance rate is significantly higher for those from most deprived quintile compared to other groups. Conversely, rates are lowest for those from the least deprived quintile.

Ethnicity

*Source: HIID, NHS Foundry*

Source: HIID, NHS Foundry

The above chart shows that over the past 12 months, the virtual outpatient attendance rate is significantly higher patients from certain ethnic minority groups compared to the White British group.

1.8 Elective activity vs pre-pandemic levels (u18)

Inpatient elective admission data, derived from SUS, has been analysed since 2015 for the registered and resident population within Staffordshire and Stoke-on-Trent aged under 18.

Directly-age standardised rates (using the European Standard Population 2013) have been calculated for stated gender and deprivation (using national deciles of the Index of Multiple Deprivation 2019) for each calendar year to allow for appropriate comparisons over time whilst accounting for differences by age.

Note that although aged 0 to 17 years has been used as the numerator, the denominator is based on the population aged 0 to 19 years old. This is because the European Standard Population 2013 uses incremental five-year age groups.

Trends by ethnicity have not been calculated for this measure as population denominators by ethnicity for each year are not available other than for the 2021 Census year.

Stated gender

The above chart shows that:

  • Under 18 elective admissions have historically been significantly higher for boys than girls
  • There was a big drop in under 18 elective admissions during 2020 which was the beginning of the COVID pandemic
  • Although elective admission rates have since increased, they have increased at a higher rate for boys than for girls
  • Elective admission rates in 2023 remain significantly lower than pre-pandemic levels for both boys and girls

Age

The above chart shows that:

  • Elective admissions amongst the under 18 population have historically been significantly higher for the youngest age group (aged 0 to 4)
  • There was a big drop in under 18 elective admissions for all age groups during 2020 which was the beginning of the COVID pandemic
  • Although elective admission rates have since increased, these have not seen significant year-on-year increases between 2021 and 2023
  • Rates have increased at the highest rate for the under 10s
  • Elective admissions in 2023 remain significantly lower than pre-pandemic levels for all age groups

Deprivation

The above chart shows that:

  • Under 18 elective admissions have historically been significantly higher for children from the most deprived group
  • There was a big drop in under 18 elective admissions during 2020 which was the beginning of the COVID pandemic
  • Although elective admission rates have since increased across all groups, they have increased at a higher rate for the most deprived group
  • Elective admission rates in 2023 remain significantly lower than pre-pandemic levels for both the most deprived and least deprived groups

1.9 Elective activity vs pre-pandemic levels (18+)

Inpatient elective admission data, derived from SUS, has been analysed since 2015 for the registered and resident population within Staffordshire and Stoke-on-Trent aged 18 and over.

Directly-age standardised rates (using the European Standard Population 2013) have been calculated for stated gender and deprivation (using national deciles of the Index of Multiple Deprivation 2019) for each calendar year to allow for appropriate comparisons over time whilst accounting for differences by age.

Note that although aged 18 years and over has been used as the numerator, the denominator is based on the population aged 19 years and older. This is because the European Standard Population 2013 uses incremental five-year age groups.

Trends by ethnicity have not been calculated for this measure as population denominators by ethnicity for each year are not available other than for the 2021 Census year.

Stated gender

The above chart shows that:

  • Elective admissions amongst the 18 and over population have historically been significantly higher for women than men
  • There was a big drop in under 18 elective admissions during 2020 which was the beginning of the COVID pandemic
  • Although elective admission rates have since increased (with a significant year-on-year increases between 2021 and 2023) they have increased at a higher rate for women than for men
  • Elective admission rates in 2023 still remain significantly lower than pre-pandemic levels for both men and women

Age

The above chart shows that:

  • Elective admissions amongst the 18 and over population have historically been significantly higher for oldest age groups (aged 65 and over)
  • There was a big drop in over 18 elective admissions for all age groups during 2020 which was the beginning of the COVID pandemic
  • Elective admission rates have since increased with a significant year-on-year increases between 2021 and 2023 for all age groups
  • Rates have increased at the highest rate for the older age groups (aged 65 and over); most notably for the 80 plus age group
  • Elective admissions in 2023 for the 80 plus age group were in fact significantly higher pre-pandemic levels
  • The younger age groups have seen a more modest post-pandemic increase and rates remain significantly lower than pre-pandemic levels

Deprivation

The above chart shows that:

  • Elective admissions amongst the 18 and over population have historically been significantly higher for the most deprived group
  • There was a big drop in under 18 elective admissions during 2020 which was the beginning of the COVID pandemic
  • Although elective admission rates have since increased (with a significant year-on-year increases between 2021 and 2023) they have increased at a higher rate for the most deprived group than for the least deprived group
  • Elective admission rates in 2023 still remain significantly lower than pre-pandemic levels across all groups

2 Urgent and emergency care

2.1 Emergency admissions (u18)

Local SUS inpatient data has been analysed for the 2023 calendar year on emergency admissions for the registered and resident population aged under 18 within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare admissions by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Note that although aged under 18 has been used as the numerator, the denominator is based on the population aged 19 and under. This is due to the population denominators available by incremental five-year age groups.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • Under 18 emergency admissions are significantly higher for boys when compared to the overall rate and, conversely, are significantly lower for girls
  • Amongst the under 18 age group, emergency admissions are most common in infants (aged 0 to 4 years old)
  • Emergency admissions amongst the under 18 age group are significantly higher for children who live deprived quintile within the ICB, compared to the overall rate, and are significantly lower for children from the two least deprived groups
  • Under 18 emergency admissions are significantly higher for children who are of “Other” ethnicity, compared to the overall rate, and are significantly lower for children of White ethnicity or of Mixed ethnicity

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

3 Respiratory

3.1 Flu vaccinations

The information presented below is take from the NHS Foundry Health Inequalities Improvement Dashboard and is based on data sourced from National Immunisation Management Service (NIMS) for the 2023-24 season and data for week ending 25th March 2024.

Ethnic group and deprivation

*Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)*

Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)

The above chart shows that:

  • Across all deprivation quintiles, flu vaccination rates are higher for the least deprived groups
  • Across all ethnic groups, flu vaccination rates are higher for the persons of White ethnicity
  • Vaccination uptake is highest for persons of White ethnicity and who are in the least deprived group
  • Vaccination uptake is lowest for persons of Asian ethnicity and who are in the most deprived group

Ethnic group and age

*Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)*

Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)

The above chart shows that:

  • Across all ethnic groups, flu vaccination rates tends to increase with age and is highest amongst those aged 70 years old and above
  • Across all ages, flu vaccination rates are higher for the persons of White ethnicity and are lowest for persons of Asian ethnicity
  • Vaccination uptake is highest for persons of White ethnicity and who are in the oldest age group (80 plus)
  • Vaccination uptake is lowest for persons of Black ethnicity and who are in the 20- to 29-year-old age group

Deprivation and age

*Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)*

Flu vaccination uptake by ethnic group and deprivation quintile (Source: HIID, NHS Foundry)

The above chart shows that:

  • Across all age groups, flu vaccination rates are higher for the least deprived groups and lower amongst the most deprived groups
  • Across all deprivation groups, flu vaccination rates tend to be higher higher for older age groups (most notably for the 70 plus age groups) and are lowest amongst the 20-to-29-year-old age group
  • Vaccination uptake is highest for persons in the oldest age group (80 plus) and the least deprived group
  • Vaccination uptake is lowest for persons in the 20-to-29-year-old age group and the least deprived group
  • The biggest differences in uptake between the least deprived and most deprived groups occurs in the 0-to-9-year-old age group

3.2 COVID vaccinations

The charts below shows the latest number of vaccinations (booster dose) by socio-economic groups within the ICB and is based on data derived from COVID-19 Vaccine Equalities Tool within NHS Foundry.

Ethnicity and Deprivation (all ages):

*Source: COVID-19 Vaccine Equalities Tool, NHS Foundry*

Source: COVID-19 Vaccine Equalities Tool, NHS Foundry

The above chart shows that:

  • Amongst the all-age population uptake is generally good with 82% of the population vaccinated
  • Across all ethnic groups, the proportion of the population vaccinated is higher in the least deprived groups with lower uptake in the more deprived communities
  • Across all deprivation groups, uptake tends to be lower amongst ethnic minority groups compared to those of White British or of White Irish ethnicities with uptake most notably lowest for persons of Pakistani ethnicity
  • It should be noted that the age profiles within each deprivation group and within each ethnic group are likely to be different and this may skew some of the above data so caution is advised in its interpretation
Ethnicity and Deprivation (aged 65+):
*Source: COVID-19 Vaccine Equalities Tool, NHS Foundry*

Source: COVID-19 Vaccine Equalities Tool, NHS Foundry

Missing boxes on the chart indicate the size of the cohort is based on a low number and the data has been suppressed.

The above chart shows that:

  • Amongst the population aged 65 plus uptake is generally very good with 97% of the population vaccinated
  • Across all ethnic groups, although uptake is slightly lower amongst the more deprived groups (compared to the least deprived) uptake is still at 93% and 95% for Deciles 1 and 2
  • Across all deprivation groups, although uptake is generally lower amongst the ethnic minority groups = uptake is still at 90% for all but four groups
  • Uptake is lowest most notably for persons of Pakistani ethnicity and is also below 90% for those of Black African, Bangladeshi, Black Caribbean or of White/Black African ethnicities

4 Mental Health

4.1 Overall number of SMI physical health checks

The data presented here relates to people with severe mental illness (SMI) who have had physical health checks in a primary and secondary care setting in the 12 months to the end of the reporting period. The denominator is the number of people on the SMI register and the numerators are the counts of these to have had all of the physical health checks.

Data is broken down by sub-ICB location and the charts below are based on data up to 30th September 2023.

The above chart shows that there is no significant variation in the proportion of health checks, for people with SMI, within the ICB and that levels are similar to that of England.

4.2 Rates of total Mental Health Act detentions

The data below is based on detentions under the Mental Health Act 1983 by ICB. The data is broken down by age group, gender, deprivation and ethnicity for the ICB and presented as crude rates per 100,000 population and is for the 2022/23 reporting period.

Gender

Note that due to small numbers data is only available for male and female

Age

Deprivation

Ethnicity

The above charts show that:

  • There is no significant variation by gender in the rates of Mental Health Act detentions
  • Mental Health Act detentions tends to be higher amongst those aged 18 to 34 and 35 to 49 years old
  • The rate of Mental Health Act detentions is significantly higher for the most deprived groups and, conversely, are lower for those from the least deprived groups
  • The rate of Mental Health Act detentions is significantly higher patients of Black ethnicity, and patients of Asian ethnicity, compared to patients of White ethnicity

4.3 Rates of restrictive interventions

The data below is based on the number of people subject to a restrictive intervention in contact with NHS funded secondary mental health, learning disabilities and autism services. The data is broken down by age group, gender, deprivation and ethnicity for the ICB and presented as crude rates per 100,000 population and is for the 2022/23 reporting period.

Gender

Note that due to small numbers data is only available for male and female

Age

Deprivation

Ethnicity

The above charts show that:

  • Men have a slightly higher rate of restrictive interventions compared to women
  • Rates of restrictive interventions tend to be higher for patients aged 25 to 44 years old (with the exception of the 80 to 84 which is based on a very small sample size)
  • Rates of restrictive interventions tend to be higher for more deprived patients
  • Although data is not available for all ethnic groups; where data is available it appears to show slightly higher rate of interventions for patients of Asian or of Mixed ethnicity compared to patients of White ethnicity

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

4.4 NHS Talking Therapies recovery

The data below is based on NHS Talking Therapies (formerly IAPT) recovery and is for the recovery rate which is defined as the proportion of people who complete treatment who are moving to recovery. The data is broken down by age group, gender, deprivation and ethnicity for the ICB and is for the 2022/23 reporting period.

Gender

Note that due to small numbers data is only available for male and female

Age

Deprivation

Ethnicity

The above charts show that:

  • Men have a slightly higher rate of recovery compared to women
  • Recovery rates tend to be higher for patients in older age groups
  • Recovery rates appear to be higher for patients from the least deprived groups, with lower recovery rates amongst the most deprived
  • Patients from ethnic minority groups appear to have lower recovery rates than patients of white ethnicity

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

4.5 Children and young people mental health access

The data below is based on the number children and young people aged under 18 supported through NHS funded mental health with at least one contact. The data is broken down by age group, gender, deprivation and ethnicity for the ICB and is for the 2022/23 reporting period, presented as a crude rate per 100,000 population aged 0-17.

Gender

Note that due to small numbers data is only available for male and female

Age

Deprivation

Ethnicity

The above charts show that:

  • Rates are similar for boys and girls
  • Rates are highest in the 11 to 15 year old age group
  • Rates appear to be higher for patients from the most deprived groups, with lower rates amongst the least deprived
  • Patients from ethnic minority groups appear to have lower access rates than patients of white ethnicity

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

5 Cancer

5.1 Percentage of cancers diagnosed at stage 1 and 2

The data in this is section is based on new cases of cancers diagnosed at stages 1 and 2 presented as a percentage of all new cases of cancer diagnosed at any known stage (1, 2, 3, and 4) for the following cancer sites: invasive malignancies of lung, oesophagus, colon, rectum, pancreas, invasive melanomas of the skin, breast, uterus, ovary, prostate, testis, kidney, bladder, Hodgkin Lymphoma, larynx, oropharynx, oral cavity, and non Hodgkin lymphoma.

Data is from Office for Health Improvement and Disparities which is derived from NHS Digital’s National Disease Registration Service.

National data shows that patients from the most deprived quintile have lower proportion of cancers diagnosed at Stage 1 and 2 (and a higher proportion with later stage diagnosis) compared to other deprivation groups.

Currently the data at a sub-national level available by deprivation or by other demographics, but it is available at a local authority-level enabling us to look at health inequalities by geography within the ICB-footprint.

Future analytical work by NHS England is planned to make early diagnosis data available at ICB level by deprivation and ethnicity.

area_name value confidence_interval_lower confidence_interval_upper sig
Cannock Chase 51.90% 47.0% 56.7% similar to Eng
East Staffordshire 48.30% 43.7% 52.9% lower than Eng
Lichfield 51.20% 46.4% 55.9% similar to Eng
Newcastle-under-Lyme 51.80% 47.6% 55.9% similar to Eng
South Staffordshire 56.80% 52.7% 60.9% similar to Eng
Stafford 61.00% 57.3% 64.5% higher than Eng
Staffordshire Moorlands 54.70% 50.4% 58.9% similar to Eng
Stoke-on-Trent 54.50% 51.6% 57.3% similar to Eng
Tamworth 51.60% 45.5% 57.6% similar to Eng
Source: Office for Health Improvement and Disparities

The above table shows that eight out of nine local authorities have a similar or better proportion of stage 1 and stage 2 diagnosis compared to England during 2021.

East Staffordshire had a significantly lower proportion of cancers diagnosed at stage 1 and stage 2 compared to England.

Trends by each year since 2013 are presented below:

6 Cardiovascular disease

6.1 Emergency admissions for stroke

Local SUS inpatient data has been analysed for the 2023 calendar year on emergency admissions for stroke (based on IC10-codes I61 to I64) for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare admissions by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • Men have a significantly higher rate of emergency admissions for stroke, compared to the overall rate, and rates are significantly lower for women
  • Emergency admissions for stroke increase by age with highest rates in the oldest age groups.
  • Emergency admissions for stroke are significantly higher for persons from the most deprived group - about 1.5 times higher compared to the overall rate - and are significantly lower for those from the least deprived group
  • Emergency admissions are significantly higher for persons of “Other” ethnicity, compared to the overall rate, and are significantly lower for persons of White ethnicity.

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured. The over-representation of ‘Other’ ethnic category in age-standardised rates could also be indicative of patient ethnicity not always properly captured.

6.2 Emergency admissions for myocardial infarction

Local SUS inpatient data has been analysed for the 2023 calendar year on emergency admissions for myocardial infarction (based on IC10-codes I21 or I22) for the registered and resident population within Staffordshire and Stoke-on-Trent. Age-specific rates have been calculated to compare admissions by age within the ICB. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Age

Deprivation

Ethnicity

The above charts show that:

  • Men have a significantly higher rate of emergency admissions for myocardial infarction, compared to the overall rate and rates are significantly lower for women
  • Emergency admissions for myocardial infarction increase by age with highest rates in the oldest age groups.
  • Emergency admissions for myocardial infarction are significantly higher for persons from the two most deprived groups, compared to the overall rate, and are significantly lower for those from least deprived group.
  • Emergency admissions are significantly higher for persons of Asian ethnicity and persons of Mixed ethnicity, compared to the overall rate, whilst emergency admissions are significantly lower for persons of White ethnicity

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured.

The above charts show that:

  • The proportion of hypertension patients treated to recommended threshold is higher in women than men
  • The proportion of hypertension patients treated to recommended threshold increases with age
  • Hypertension patients from the most deprived groups have a lower proportion treated to the recommended threshold compared to patients from the least deprived groups
  • The proportion of hypertension patients who are treated to the recommended threshold is lower for ethnic minority patients compared to white patients

This measure is based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

6.4 Cholesterol: QRISK 20% of more treated with LLT

The data below is derived from the NHS England’s Cardiovascular Disease Prevention Audit (CVDPREVENT) tool and is based on the percentage of patients aged 18 and over with no GP recorded CVD and a GP recorded QRISK score of 20% or more, on lipid lowering therapy (LLT) (indicator CVDP003CHOL).

The indicator is broken down by sex, aged, deprivation and ethnicity.

Sex

Age

Deprivation

Ethnicity

The above charts show that:

  • There is no significant variation between men and women, who have a QRISK score of 20% or more, treated with LLT
  • Patients treated with LLT is highest in the 40-59 age group and lowest for patients aged 80+
  • The proportion of patients treated with LLT is significantly higher for patients from the most deprived quintiles compared to those from the least deprived group
  • The proportion of patients treated with LLT is significantly higher for patients of Asian ethnicity compared to patients of White ethnicity

This measure is based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

6.5 Atrial fibrillation: treatment with anticoagulants

The data below is derived from the NHS England’s Cardiovascular Disease Prevention Audit (CVDPREVENT) tool and is based on the percentage of patients aged 18 and over with GP recorded atrial fibrillation (AF) and a record of a CHA2DS2-VASc score of 2 or more, who are currently treated with anticoagulation drug therapy (indicator CVDP002AF).

The indicator is broken down by sex, aged, deprivation and ethnicity.

Sex

Age

Deprivation

Ethnicity

The above charts show that:

  • There is no significant variation between men and women, who have atrial fibrillation and a record of a CHA2DS2-VASc score of 2 or more, treated with anticoagulants
  • The proportion of patients treated with anticoagulants is significantly higher for those aged 60 and over compared to younger age groups
  • There is no significant variation by deprivation
  • The proportion of patients treated with anticoagulants is significantly lower for patients of Asian ethnicity compared to patients of white ethnicity

This measure is based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

7 Diabetes

7.1 Type 1 and Type 2 diabetes registrations

The data below is based on the National Diabetes Audit (NDA) 2022-23 and is based on data for by ICB for the NDA 2022-23 audit period (01 Jan 2022 to 31 Mar 2023).

Type 1 and Type 2 registrations are broken down by age, sex, deprivation and ethnicity.

Sex

The above chart show that the proportion of patients registered with diabetes is higher for men than women for both Type 1 and Type 2 diabetes.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. This measure is also based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

Age

The above chart show that the proportion of patients registered with Type 1 diabetes is higher amongst patients age under 40, and lower in older age groups.

In contrast, the proportion of patients with Type 2 diabetes is lowest amongst those aged under 40 and highest for patients aged 40 to 64 and 65 to 79 years old.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Caution is advised in interpreting the above charts.

Deprivation

The above chart show that the proportion of patients registered with Type 1 diabetes is slightly lower amongst the least deprived patients (quintile 5) compared to the most deprived (quintile 1).

Similarly, the proportion of patients with Type 2 diabetes is also slightly lower amongst the least deprived patients (quintile 5), whilst is slightly higher for more deprived patients (quintiles 4 and 5).

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. This measure is also based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

Ethnicity

The above chart show that the proportion of patients registered with Type 1 or Type 2 diabetes is higher for patients of white ethnicity. This reflects the make-up of the ICB population.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. This measure is also based on a crude rate and therefore does not adjust for differences in the age structures within each population which can sometimes skew data. Caution is advised in interpreting the above charts.

7.2 People with T1 and T2 diabetes receiving all 8 care processes

The data below is for the 2022-23 period and taken from NHS England’s National Diabetes Audit Core Annual Dashboard.

Age

Type 1 diabetes:

The above chart show that the proportion of type 1 diabetes patients, who have all 8 care processes completed, tends to increase with age up until 79 years. Those aged 70-79 have the highest rate but the proportion is lower in older age groups, aged 80 and over.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

Type 2 diabetes:

The above chart show that the proportion of type 2 diabetes patients, who have all 8 care processes completed, tends to increase with age up until 79 years. Those aged 70-79 have the highest rate but the proportion is lower in older age groups, aged 80 and over.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

Deprivation

Type 1 diabetes:

The above chart show that the proportion of type 1 diabetes patients, who have all 8 care processes completed, tends to be slightly higher for the least deprived patients (quintiles 4 and 5) and lower for the most deprived patients in quintile 5.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

Type 2 diabetes:

The above chart show that the proportion of type 2 diabetes patients, who have all 8 care processes completed, tends to be slightly higher for the least deprived patients (quintiles 4 and 5) and lower for the most deprived patients in quintile 5.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

Ethnicity

Type 1 diabetes:

The above chart show that the proportion of type 1 diabetes patients, who have all 8 care processes completed, tends to be slightly higher patients of Asian or of Black ethnicity. The proportion is lower for patients of Mixed, Other or of White ethnicity and lowest for patients with unknown ethnicity.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

Type 2 diabetes:


The above chart show that the proportion of type 2 diabetes patients, who have all 8 care processes completed, tends to be slightly higher patients of White or of Black ethnicity. The proportion is slightly lower for patients of Mixed or of Other or ethnicity and lowest for patients with unknown ethnicity.

Note that confidence intervals are not available for these indicators. Some groups will be based on a small sample size, meaning there is an increased risk of variability and uncertainty in these measures. Differences do not necessarily mean there is a significant variation. Caution is advised in interpreting the above charts.

8 Oral health

8.1 Hospital admissions for tooth decay

Local SUS inpatient data has been analysed for the 2023 calendar year on hospital admission for dental caries (based on primary operation F09 or F10 and primary diagnosis codes K021, K025, K028, K029, K040, K045, K046 or K047) for the registered and resident population within Staffordshire and Stoke-on-Trent aged under 10 years old. Indirectly-age standardised rates have been calculated for stated gender, deprivation (using national deciles of the Index of Multiple Deprivation 2019) and main ethnic group; rates are expressed a ratio (observed/expected) and allows for appropriate comparisons within each group whilst accounting for differences by age.

Stated gender

Deprivation

Ethnicity

The above charts show that:

  • There is no significant variation in hospital admission for dental caries between boys and girls
  • Hospital admissions for dental caries are significantly higher for children who live in the 20% most deprived areas nationally within the ICB when compared to the overall rate. In contrast, admissions are significantly lower for children who are from the least deprived group
  • Children of white ethnicity have a significantly lower rate of admissions for dental caries compared to the overall rate.

It should be noted that there are some limitations and caveats around ethnicity. Population denominators for ethnicity and by five-year age band are derived from Census 2021 data. There are known discrepancies related to Unknown ethnicity with much higher numbers within SUS data than we would expect when compared to Census 2021 population denominators. This is indicative of data quality issues with patient ethnicity not always properly captured.

9 Learning disability and autisism

9.1 Learning Disability Annual Health Checks

The data below is based on the learning disabilities health check scheme, which is one of a number of GP enhanced services. It is designed to encourage practices to identify all patients aged 14 and over with learning disabilities, to maintain a learning disabilities ‘health check’ register and offer them an annual health check, which will include producing a health action plan.

Data is broken down by age group (aged 14 to 17, aged 18 and over) for the ICB.

age total ld register completed health checks health checks declined patients not had a health check percent
14 to 17 401 190 7 204 44.6%
18+ 6052 3595 143 2314 55.8%
Source: Learning Disability Health Check Scheme (LDHC) Jan 2024, NHS England. Based on data sourced from GP Extraction Service (GPES) via Calculating Quality Reporting System (CQRS).

The above chart shows that:

  • In the 14-17 year old age group, the ICB has a similar proportion of completed health checks compared to England
  • For patients aged 18 and over, the ICB has a significantly higher proportion of completed heath checks compared to England

9.2 Adult mental health inpatient rates for people with a learning disability and people with autism

The data below is based on the latest monthly statistics on Learning Disabilities and Autism (LDA) patients from the Assuring Transformation (AT) collection and Mental Health Services Data Set (MHSDS), and shows the adult only learning disabilities inpatient rate for the ICB over the last six months:

The above charts show that, over the past six months, Staffordshire and Stoke-on-Trent ICB has had a lower inpatient rates for people with a learning disability.

As of March 2024, Staffordshire and Stoke-on-Trent ICB had the fifth lowest inpatient rate for people with a learning disability out of all 42 ICBs in England.

10 Maternity and neonatal

10.1 Preterm births under 37 weeks

At the time of writing the Maternity Services dataset (MSDS) was not available to the ICB. Data Quality issues were previously identified with the data feed that was made available to the ICB via the CSU. The Development team are currently investigating the issue and will make this available to the ICB in due course.