Using evaluations to improve population health in Sandwell

Ranked second-lowest in the country on the 2022 ‘cost-of-living vulnerability index‘ Sandwell, in the West Midlands, has one of the highest levels of deprivation across England. With residents described as being worse off than in other parts of the country, and facing substantial health challenges, life expectancy is significantly lower than the national average. So how do healthcare decision makers find the right areas to focus on, to reduce inequalities and improve population health?

The Health Economics Unit (HEU) was commissioned to evaluate healthcare data from Sandwell and provide recommendations to prevent ill-health and improve health outcomes in the future.

Using data to understand population needs

The expert HEU team focused on the prevalence of long-term conditions (LTCs), hospital activity, health outcomes, and health management in Sandwell, England between 2019-2023. Data from the Quality and Outcomes Framework and Secondary Uses Service was analysed, along with the Office for National Statistics mortality and population data, screening data and vaccination data.

The team found that obesity was the most prevalent LTC, followed by hypertension, diabetes, depression, and non-diabetic hyperglycaemia. The prevalence of obesity, diabetes, hypertension, coronary heart disease and chronic kidney disease was also higher when compared to regional and national averages.

There were fewer hospital admissions, and shorter lengths of stay and emergency department (ED) visits in Sandwell than in other areas of the country but higher rates of readmission and mortality following LTC admissions.

In terms of ED visits, the highest rates were for patients with chronic obstructive pulmonary disease while hospital stays and readmissions were highest for patients with cancer. Mortality rates for cancer were also the highest of all LTCs.

Despite having a relatively younger population, dementia appears to be a key driver for ED attendance and mortality rates in Sandwell, reinforcing the need for high-quality care and early diagnosis. Additionally, we suspect a high prevalence of depression may also be driving the high rates of mental health ED attendances.

The HEU team found that mortality rates in Sandwell were higher than the national average for England but comparable to the Midlands.

Coverage rates for several key vaccinations, including routine childhood vaccines, HPV and meningococcal ACWY vaccines, and flu vaccinations were way below national and international targets. Screenings for bowel cancer, breast cancer, cervical cancer, abdominal aortic aneurysm, and chlamydia were also lower than the national average. Low screening coverage may partially explain the poor health outcomes observed in patients with cancer in Sandwell.

Data-led decisions to improve healthcare

Based on current projections, the prevalence of LTCs is likely to persist and possibly even worsen by 2030.

The HEU team recommend addressing these largely preventable but high impact chronic conditions (obesity, hypertension, diabetes, and non-diabetic hyperglycaemia) through implementing targeted public health interventions. This may include risk stratification, public education campaigns, and incentives to promote healthier behaviours.

Sandwell also faces significant challenges in terms of mental health care, particularly regarding dementia. Earlier diagnosis and prevention measures are, therefore, needed.

The HEU team also recommend implementing measures to improve the uptake of vaccinations and screening (early detection) programmes, the current low rates of which are likely contributing to Sandwell’s poor health outcomes.

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