Download END OF LIFE – SUMMARY OF NEEDS

END OF LIFE – SUMMARY OF NEEDS
(PART OF MARIE CURIE DELIVERING CHOICE REPORT)
(Report was finalised in 2009 as part of Marie Curie Delivering Choice Programme for which
Norfolk County Council and NHS Norfolk are the lead partners.)
Chapter 6: Demography & Epidemiology
Map 1: Map of Norfolk showing the main areas of population
The map above illustrates the primary areas of population within Norfolk. The main areas are:
Norwich and the surrounding area, Kings Lynn and Great Yarmouth, with smaller areas in
Thetford, Dereham and Sheringham.
The Local Authorities are the Councils that govern Norfolk under the guidance of Norfolk
County Council. Both the Great Yarmouth PCT and the Norfolk PCT are served by Social
Services through one Local Authority covering all of Norfolk.
Whilst there are similarities between them all, each Local Authority has a different
demographic, economic and geographic make-up to it, which is illustrated here and detailed
throughout this section.
Map 2: The Local Authorities in the NHS Norfolk area
The Local Authorities are divided into the following geographical areas:
1. Kings Lynn & West Norfolk which covers the urban area of Kings Lynn and the
market towns of Downham Market, Hunstanton and the surrounding rural areas in the
west of Norfolk
2. Breckland which covers the market towns of Dereham, Swaffham, Watton,
Attleborough and Thetford and the surrounding rural areas, and is situated in the
centre of Norfolk
3. South Norfolk which covers the market towns of Diss and Wymondham, along with
the Norwich over-spill in Costessey, in the south of Norfolk and is predominately rural
in nature
4. North Norfolk encompasses the market towns of Fakenham, Holt, Sheringham and
Cromer in the north and is predominately rural in nature and a popular holiday and
retirement destination
5. Broadland which covers the over-spill of Norwich in the north (such as Old Catton)
and to the east of Norwich (such as Thorpe St Andrew) and the rural areas north of the
Norfolk Broads
6. Norwich which covers the urban area of Norwich and the Norfolk Broads.
Population and age distribution:
There are a total of 739,043 people living in Norfolk as of 2006; the breakdown per Local
Authority is thus: Breckland 128,314; Broadland 122,184; Kings Lynn and West Norfolk
142,254; Norwich 129,535; North Norfolk 100,598; South Norfolk 116,158.1
The total population is set to rise 5.3% by 2011 to 840,945. By 2016 this will reach 885,095
and by 2021 this will be 930,412. Even if we assume the population of Norfolk increases
evenly without a disproportionate increase in the elderly population (though all studies point
1
Information from Norfolk Insight, via Norfolk County Council’s website www.norfolk.gov.uk and
www.norfolkinsight.org.uk
towards the UK as a whole having an aging population)2, then that will still mean an increase
of 8,000 people over the age of 65 by 2011 alone. The current services in Norfolk will need to
be more stream-lined and effective to be able to cope with this increase in elderly people as
their health needs will also increase as, generally, people are living longer than they used to
and suffering from more complex illnesses.
The population density of Norfolk is the 10th lowest in the UK at 1.55 persons per hectare (all
figures for this section include the district of Great Yarmouth). However, in reality the rural
areas have a significantly lower density. 38% of the population of Norfolk live in the city of
Norwich and the two towns of Great Yarmouth and Kings Lynn. An additional 18% live in the
market towns with the remainder living in the large rural areas. The Rural and Urban Area
Classification 2004 showed that 46% of Norfolk was classified as either village, hamlet and
isolated dwelling, as shown in the map below.
Map 3: Rural and Urban classification of Norfolk
2
An example of this is via an interactive graphic displaying this via the BBC on
http://news.bbc.co.uk/1/hi/uk/4045261.stm. Information compiled from the Office for National Statistics.
Table 1: Age break-down and population totals
Breckland
Broadland
Kings Lynn &
West Norfolk
North Norfolk
Norwich
South Norfolk
Total
0 to 4
6,509
5,990
5 to 14
15,026
13,766
15-44
46,624
43,245
45-64
34,453
34,427
65-84
22,284
21,593
85+
3,418
3,163
Total Population
128,314
122,184
7,374
4,052
6,663
5,491
36,079
15,897
10,217
12,066
14,079
81,051
48,929
29,752
64,628
39,545
272,723
38,996
29,914
26,458
33,713
197,961
27,334
23,009
16,624
20,400
131,244
3,724
3,654
3,096
2,930
19,985
142,254
100,598
129,535
116,158
739,043
As the above table shows, Kings Lynn & West Norfolk has more people living inside its
boundary than in the other Local Authorities. North Norfolk has the smallest number of people
living inside its boundaries.
These figures demonstrate an increase in people aged over 65 in the coastal areas of Kings
Lynn & West Norfolk and North Norfolk, which is not surprising as there are a lot of retirement
homes around this area and both regions are regarded nationally as being places to retire to3.
North Norfolk in particular also suffers from having poor transport links compared with the
rest of the county. The city of Norwich has a University and subsequently it has a large 15-44
age-group and a younger population overall.
Ethnicity
This information dates from the 2006 survey of Norfolk from the Office for National Statistics.
A small proportion of the BME population of Norfolk is made up of migrant workers, (for 2006
this makes up approx 5% of the total BME population) which may not have been captured by
this survey. The known figures of approved work permits for 2006 are for 910 workers, and in
2005 there were a further 1432 seasonal workers.4 These figures will have changed but
more recent data is not available at the time of writing. These figures do not take into account
any migrant workers who have not registered for permits.
3
Information for top retirement areas (by region) at:
http://www.50connect.co.uk/editors_blog/2008/august/has_britain_lost_its_mojo/recommended_links/the_best_locations_f
or_retirement_living & http://www.telegraph.co.uk/property/retirementproperty/5158696/Top-10-places-forretirement.html & http://www.dailymail.co.uk/news/article-343199/Retirement-sea.html
4
Information taken from Norfolk Insight. For seasonal workers there is no information available for 2006.
Figure 3: Norfolk population composition
Ethnic Population
1%
White British
1%
1%
1%
92%
4%
Asian
Black
Other
3%
Irish
1%
Other White
Mixed
92% of the population in Norfolk is classified as White British, which means there are
approximately 51,000 people of a BME origin in Norfolk as of 2006. The largest BME group is
primarily comprised of Portuguese, East European and Russian residents, making 21,000
people overall. The next largest group encompasses the Asian community (8,000) followed
by those of mixed race (7,000). Whilst Norfolk is not as diverse as other counties in the UK, it
has over 100 languages spoken inside its boundaries and a small but culturally diverse
population who all have different needs and expectations.
Map 4: Concentration of ethnic minorities within Norfolk
The map above illustrates the concentration of BME residents represented as a percentage
of the total population for all ethnicities other than White - British. The areas of higher
concentration levels (marked in red and blue) include the towns of Thetford, Swaffham and
Watton which have large Portuguese communities. Also included are areas of Norwich which
has a large multi-cultural community, and Kings Lynn which has a large Eastern European
community.
The areas in black and grey have the largest concentrations of BME population, and are
located near Thetford and Swaffham. It is likely these areas are higher than others due to a
lower population overall, which increases the percentage numbers of BMEs. The other
significantly higher area is located in and around the University of East Anglia which has a
high number of overseas students.5 For example, the population of University has 14-18% of
the total population comprised of members of the BME communities.
There are a high number of Gypsy & Traveller communities across Norfolk and it is entirely
possible the data for these groups has not been captured by the survey. Primarily the Gypsy
& Traveller community is comprised of both White British and Other White, notably Eastern
European migrant workers. Henceforth this population group will be referred to as Gypsy
Travellers; however although there are commonalities in cultural identity their ethnic identity
may differ. New Age Travellers have been identified separately where possible, as they have
opted for an alternative lifestyle but are not of the same culture.
Figures for the Gypsy Traveller population can be difficult to determine primarily due to the
travelling component to their lifestyle. Other difficulties arise from ethnic classification of
persons for the purpose of demographic data collection as the Gypsy Traveller population are
not included as a separate group.
There are 4 permanent Gypsy Traveller sites within Norfolk and these are:
•
•
•
•
Saddlebow – Kings Lynn
The Splashes- Swaffham
Roundwell- Costessey
Swanton Road- Mile Cross, Norwich
A further new site, Mangreen near Harford Bridges is currently under consultation (January
2009).
These sites are managed day to day by site managers who are usually themselves members
of the travelling community. The site managers, with the support of Norfolk County Council
Gypsy and Traveller Liaison team, sign-post people to specific services within Norfolk as well
as the maintenance and running of the sites themselves. The numbers of people on the
permanent sites can vary and the Gypsy and Traveller Liaison service only count pitches in
their data and not people. The estimates from the service are approximately 200 people
resident at any one time across the 4 permanent site. There is also a permanent site within
Great Yarmouth and the estimated population for this is 50 residents.
There are also 8 unofficial but tolerated sites whereby the landowner has given the travelling
community permission to be resident. These sites tend to house family groups except where
the site is made up of new age travellers.
5
Information produced via the 2001 Census and figures obtained via Norfolk Insight.
Table 2: Estimated number of occupants per unofficial site
All numbers are estimated
Site Name
Type of site
Number
of adults
Costessey – park and ride
Cringleford- Cantley Lane
Seething
Little Plumstead- Hospital site
Thetford- Bridgeham Heath
Earsham
Holt- Letheringsett
Gypsy Traveller
Gypsy Traveller
New Age
New Age
Gypsy Traveller
New Age
new site
10
8
12
12
7
7
unknown
Number of
children
Total
16
6
0
0
1
2
unknown
Total
26
14
12
12
8
9
unknown
81 plus
There are several unauthorised sites and these are mainly situated in West Norfolk and Great
Yarmouth and reportedly chiefly comprise people from Eastern European origin.
Local evidence suggests that the elderly and the ill tend to move into either sheltered
accommodation or into housing association accommodation (which can include sheltered
accommodation) and this is supported by the Sheffield University 2004 report. Norfolk also
has a transient population of Water Travellers but numbers are impossible to collate and
regularly fluctuate.
Deprivation
Wards
Whilst deprivation is not confined to one area of Norfolk, it is notable that the 19 most
deprived wards (the worst 10%) are primarily located in Norwich and Kings Lynn & West
Norfolk, in addition to the urban areas of Thetford and Cromer. Kings Lynn & West Norfolk
and North Norfolk have the next 19 most-deprived wards, with Norwich and the urban area of
Dereham making up the remainder. None of the worst 20% of wards are located in either
Broadland or South Norfolk.
Further detailed analysis indicates that the most deprived wards are located in the following
local authority areas:
Norwich: Mancroft, Mile Cross, Wensum, Bowthorpe, Thorpe Hamlet, Lakenham, Crome
and Catton Grove.
Kings Lynn & West Norfolk: North Lynn, St Margaret’s with St Nicholas, Fairstead,
Gaywood Chase, South and West Lynn, Upwell and Delphe, Walpole, Mershe Lande.
Breckland: Thetford Abbey, Thetford Saxon.
North Norfolk: Cromer Town.
Broadland: None
South Norfolk None
Nearly all of the urban areas of Norwich and Kings Lynn are deprived areas.
Map 5: Map that shows concentration of deprivation in Norfolk.
SOAs
England contains 32,484 Super Output Areas (SOAs). These are geographic and
demographic units that contain on average 1,500 people and are nestled within ward
boundaries to allow comparison between evenly sized populations. Across the Norfolk PCT
there are a total of 188 wards, which makes a total of 468 SOAs throughout the area.
A total of 50 SOAs spread across 18 wards are in the worst 20% nationwide – these are
concentrated in the urban areas of Norwich, Kings Lynn, Thetford and Cromer. The 50 SOAs
represent a total of 10% approx of all SOAs in the Norfolk PCT area. The wards which have
these SOAs within them are not all deprived themselves - for example, in the ward of Town
Close in Norwich only 17% of the SOAs contained are within the most deprived (20%)
nationally. Conversely, the ward of Mile Cross in Norwich is comprised of 100% of these
deprived SOAs. Overall, those SOAs which are amongst the worst nationally encompass
60% of all SOAs in the wards in which they reside. This would seem to indicate that Norfolk is
a diverse area as the difference in deprivation fluctuates within the small area of a ward.
There are some common trends however, which are examined below.
Despite the ease of access to services, it is the urban areas which are the most deprived as
there are no rural wards or SOAs in the 20% worst nationally, and the mainly rural Local
Authority areas of Broadland and South Norfolk have no affected SOAs between them. The
rural area of Breckland has only 2 affected SOAs, both in an urban area, and the same is true
for the 2 affected SOAs in North Norfolk
Table 3: Index of deprivation 2004: Concentration of Deprivation in Norfolk PCT.
Local Authority
Breckland
Broadland
Kings Lynn &
West Norfolk
North Norfolk
Norwich
South Norfolk
No. of
SOAs in
Ward Name
Worst 20%
nationally
Thetford Abbey
3
1
Thetford Saxon
5
1
No SOAs in worst 20%
South & West
3
1
Lynn
St Margaret’s with
3
3
St Nicholas
Fairstead
3
2
Gaywood Close
3
1
North Lynn
4
3
Upwell and
3
3
Delphe
Cromer Town
3
2
Lakenham
6
4
Thorpe Hamlet
5
3
Town Close
6
1
University
5
2
Bowthorpe
5
4
Wensum
7
4
Mile Cross
7
7
Catton Grove
5
2
Mancroft
6
6
Crome
7
3
No SOAs in worst 20%
Totals
89
53
Total Wards in Norfolk
Number of Wards with worse 20% SOAs
Percent of Wards with worse 20% SOAs
Total
SOAs in
Ward
Percent
in Ward
33%
20%
33%
100%
66%
33%
75%
100%
66%
66%
60%
17%
40%
80%
57%
100%
40%
100%
43%
60%
188
19
10%
Mortality, Place of death and Primary cause of death
Mortality and place of death
The annual incidence of deaths is the single most important indicator of palliative care need
in a population since most palliative care arises in the last year of life (Tebbit, 2004). In 2006,
there were a total of 7,907 deaths and for 2007 this was 7,871. The 2008 data will not be
available until October 2009.
Table 4: Deaths per Local Authority and per 100,000 population for 2006 and 2007
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Total Number of Deaths
2006
Deaths
Per 100,000
1407
1326
1621
1290
1161
1102
7907
1097
1085
1140
1282
896
949
1070
% of
Total
Deaths
17.8
16.7
20.5
16.3
14.7
14.0
100.0
2007
Deaths
Per 100,000
1416
1310
1623
1260
1059
1203
7871
1104
1073
1143
1255
821
1037
1054
% of
Total
Deaths
18.0
16.6
20.6
16.0
13.5
15.3
100.0
Based on the data in Table 4 for the calendar years of 2006 and 2007 the actual numbers of
deaths for both years were highest in Kings Lynn & West Norfolk. However examining the
statistic regarding the number of deaths per 100,000 population demonstrates that North
Norfolk has the highest deaths; which is not surprising as it contains the highest elderly
population in Norfolk. Norwich has the smallest number of deaths per 100,000 population and
this too is consistent with it’s having the smallest proportion of elderly residents.
Table 5: Breakdown of deaths across the Norfolk PCT
Deaths in 2006
% of Total Deaths
Deaths in 2007
% of Total Deaths
Home
1772
22.4%
1832
23.3%
Care Home
1607
20.3%
1526
19.4%
Hospice
216
2.7%
223
2.8%
Hospital
4125
52.2%
4127
52.4%
Other
187
2.4%
165
2.1%
Total
7907
100.0%
7871
100.0%
From the table above, we are able to identify that the locality of place of death was consistent
in 2006 and 2007. The only change is that the number of people dying at home has
increased by 1%, whereas the number of people dying in a care home has reduced by 1%.
The “other deaths” category includes data where people died in road traffic accidents for
example. Overall the current system in place shows 42% of people as dying in either at home
or in a care home, with 53% of people dying in hospitals. As there is a negligible change for
2006 and 2007, it is reasonable to assume that the systems in place are consistent in their
application. Once the 2008 data is made available these trends can be analysed to provide
additional data.
Table 6: Place of death on a National basis
2006
England & Wales – Cancer
England & Wales – All Deaths
Norfolk
2007
England & Wales – Cancer
England & Wales – All Deaths
Norfolk
Hospital
55%
68%
53%
Home
22%
19%
22%
Care Home
3%
6%
20%
Hospice
17%
5%
3%
Other
1%
2%
2%
52%
67%
53%
25%
20%
23%
3%
7%
19%
17%
5%
3%
1%
2%
2%
The above table shows where people died across England and Wales in 2006. Based on this,
we can see that Norfolk has a similar number of Home deaths (at 23%), fewer Hospital
deaths (53%) and a considerably higher number of Care Home deaths (20%). This is
consistent with the health distribution across Norfolk, as Norfolk has 5.5 times more care
homes per head of population than the national (England) average.6
For 2007 the results are much the same, with Norfolk having considerably higher deaths in a
Care Home (19%) than the national average; and fewer Hospital deaths (53%) than the
national average. This data can be broken down further in the table below which looks at the
figures for the different Local Authorities within Norfolk
Table 7: Place of death per Local Authority
Total Number of Deaths
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
Deaths at Home
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
6
2006
286
275
377
274
289
271
1772
2006
1407
1326
1621
1290
1161
1102
7907
% of Total Deaths
20.3%
20.7%
23.3%
21.2%
24.9%
24.6%
22.4%
2007
1416
1310
1623
1260
1059
1203
7871
2007
302
275
368
296
264
325
1832
% of Total Deaths
21.3%
21.0%
22.7%
23.5%
24.9%
27.0%
23.3%
The figure for England in 2005 was 0.008 care homes per head, and for Norfolk in 2007 it was 0.044 care homes per head.
Deaths in a Hospice
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
2006
42
39
3
24
66
42
216
% of Total Deaths
3.0%
2.9%
0.2%
1.9%
5.7%
3.8%
2.7%
2007
37
42
2
32
61
49
223
% of Total Deaths
2.6%
3.2%
0.1%
2.5%
5.8%
4.1%
2.8%
Deaths in a Care Home
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
2006
344
308
307
320
134
194
1607
% of Total Deaths
24.4%
23.2%
18.9%
24.8%
11.5%
17.6%
20.3%
2007
362
308
303
272
103
178
1526
% of Total Deaths
25.6%
23.5%
18.7%
21.6%
9.7%
14.8%
19.4%
Deaths in a Hospital
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
2006
705
681
881
642
643
573
4125
% of Total Deaths
50.1%
51.4%
54.3%
49.8%
55.4%
52.0%
52.2%
2007
683
671
913
637
607
616
4127
% of Total Deaths
48.2%
51.2%
56.3%
50.6%
57.3%
51.2%
52.4%
Other Deaths
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
Totals
2006
30
23
53
30
29
22
187
% of Total Deaths
2.1%
1.7%
3.3%
2.3%
2.5%
2.0%
2.4%
2007
32
14
37
23
24
35
165
% of Total Deaths
2.3%
1.1%
2.3%
1.8%
2.3%
2.9%
2.1%
The tables above illustrate the break-down of the total numbers of deaths per local authority
and where the deaths occurred. For example, in North Norfolk in 2007 a total of 637 people
died in Hospital, which is a decrease from 2006.
Using this information, it becomes apparent that most deaths for both 2006 and 2007
occurred in Kings Lynn & West Norfolk. In terms of numbers they also had the most home
deaths, but in terms of percentage of overall deaths, it is Norwich which had the greater
numbers of home deaths for 2006, and South Norfolk for 2007. This information is further
analysed for deaths per 1,000 population in the following and table
Examining the numbers of people who died in hospital, again it is Kings Lynn & West Norfolk
that has both highest numbers and the highest percentage of hospital deaths for both years
and this is evident in the graphs below:
Figure 4: Places of death per Local Authority
Places of death per Local Authority
32
2007 Other
30
2006 Other
14
37
23
23
24
53
35
30
29
22
2007 Hospital
683
671
913
637
607
616
2006 Hospital
705
681
881
642
643
573
362
2007 Care Home
308
344
2006 Care Home
308
37
2007 Hospice
42
42
2006 Hospice
303
307
2
39
3
275
368
2006 Home
286
275
377
10%
20%
30%
40%
42
296
264
274
60%
194
49
66
50%
178
134
61
24
302
103
320
32
2007 Home
0%
272
289
70%
80%
325
271
90%
100%
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
The above graph details numbers of home deaths and indicates that Kings Lynn & West
Norfolk has the highest numbers of people dying at home. South Norfolk has experienced a
large increase in the number of people dying at home in 2007.
The graph illustrates the numbers of hospice deaths; indicating that the numbers of people
dying in hospices from Kings Lynn & West Norfolk are negligible, although the geographical
distance may be a contributory factor. Other limiting factors may be number of beds and the
structure of the health service in Norfolk. There is one inpatient hospice covering Norfolk;
situated in Bury St Edmunds, Suffolk which serves patients from Thetford area of Norfolk.
There is also a Specialist Palliative care inpatient unit situated in Norwich. The third hospice,
near Kings Lynn, is day patient only. Both inpatient units are fairly inaccessible for patients
residing in Kings Lynn & West Norfolk. This is confirmed further by the high numbers of
patients dying in hospices from Norwich and South Norfolk which are very close to one of
these two hospices.
The graph also illustrates the number of care home deaths with the greatest figure occurring
in Breckland. Discounting Norwich, which will have lower deaths due to its younger
population, South Norfolk has a lower number of deaths than the other regions.
Breckland does not have the highest number of care homes in the region; in fact it has about
49 care homes whereas Broadland (at 67), North Norfolk (at 69) and Kings Lynn & West
Norfolk (at 60) all have more care homes. In terms of numbers of care homes where
someone died in 2007, Norwich has only 15 homes, North Norfolk 26, Kings Lynn & West
Norfolk 22 and Breckland has 24.
Broadland has one care home which recorded the greatest number of deaths out of all care
homes accounting for its high figure. Breckland has several large care homes which recorded
high numbers of deaths and the remainder are either equal or slightly above the average
deaths per care home in the other regions.
The graph also shows the amount of people who died in hospital, and indicates that the
occurrence of hospital deaths in Kings Lynn & West Norfolk is higher than any other local
authority. Otherwise, the number of people dying in hospitals has been fairly consistent,
although South Norfolk recorded a fairly large increase in the numbers of people dying in
hospital in 2007 compared with 2006.
Once the 2008 data has been made available these figures can be further analysed to see if
any trends begin to emerge. It will however take several more years worth of data before a
meaningful study can be done on this.
Map 6: Home and Care Home deaths for 2006 by Ward per 1,000 population
The map above evidences those political wards having the highest number of deaths in a
care home and at home per 1,000 population. The reason the figures are presented in this
way is remove the inequities that the greater population density of areas such as Norwich
have, and which would present an unrealistic map if this was not taken into account. As the
map shows, despite a high number of blue areas (5.0 – 9.9 people per 1,000 population)
most of Norfolk has only 3.0 – 4.9 people per 1,000 dying either at home or in a care home,
shown in grey. The grey areas are concentrated around the coastal areas of North Norfolk
where there are a large number of care homes. North Norfolk has a total of 69 care homes
(the highest figure in Norfolk).7 There are also a large number of grey areas located in Kings
Lynn & West Norfolk and in Broadland, both of which have high numbers of care homes (60
and 67 respectively).
Map 7: Home and Care Home deaths for 2007 by Ward per 1,000 population
By 2007 there has been a remarkable amount of change county-wide with a reduction in the
number of people dying in either a care home or at home per 1,000 population. This could
represent a focus on improving certain areas at the expense of others or conversely could be
a result of demographic shift. It is worth noting that nearly all of the northern area of Kings
Lynn and West Norfolk achieves a level of 3.0 people per 1,000 and greater (coloured in
grey, blue or yellow), as does North Norfolk and South Norfolk. Only Breckland and
Broadland still have substantial gaps, though Breckland has more blue areas (5.0 to 9.9) than
it did in 2006. The southern area of Kings Lynn & West Norfolk also has a large amount of
white, which indicates a low level of people dying at home or in a care home.
Once 2008’s data has been received (which is due to be published in October 2009) any
trends can be examined in more detail.
7
Please see the Care Homes section for a map showing the approximate locations of the care homes.
Table 8: Place of death per Local Authority for 2006
Local Authority
Total Population
Total Number of
Deaths
Deaths per 1,000
population
Deaths at Home
Home deaths per
1,000 population
Deaths in a Care
Home
Care Home
deaths per 1,000
population
Deaths in a
Hospital
Hospital deaths
per 1,000
population
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
PCT area
128,314
122,184
142,254
100,598
129,535
116,158
739,043
1,407
1,326
1,621
1,290
1,161
1,102
7,907
11.0
10.9
11.4
12.8
9.0
9.5
10.7
286
275
377
274
289
271
1,772
2.2
2.3
2.7
2.7
2.2
2.3
2.4
344
308
307
320
134
194
1,607
2.7
2.5
2.2
3.2
1.0
1.7
2.2
705
681
881
642
643
573
4,125
5.5
5.6
6.2
6.4
5.0
4.9
5.6
The table above is a breakdown of places of death per Local Authority. From the table, it
would appear that the area where someone lives has an influence on where they die. For
example, in Norwich 5.0 people per 1,000 died in a hospital, whereas in North Norfolk that
figure is 6.4.
Table 9: Place of death per Local Authority for 2007
Local Authority
Total Population
Total Number of
Deaths
Deaths per 1,000
population
Deaths at Home
Home deaths per
1,000 population
Deaths in a Care
Home
Care Home
deaths per 1,000
population
Deaths in a
Hospital
Hospital deaths
per 1,000
population
Breckland
Broadland
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
PCT area
129,935
122,954
143,479
100,779
132,241
117,333
746,721
1,416
1,310
1,623
1,260
1,059
1,203
7,871
10.9
10.7
11.3
12.5
8.0
10.3
10.5
302
275
368
296
264
325
1,832
2.3
2.2
2.6
2.9
2.0
2.8
2.5
362
308
303
272
103
178
1720
2.8
2.5
2.1
2.7
0.8
1.5
2.3
683
671
913
637
607
616
3,933
5.3
5.5
6.4
6.3
4.6
5.3
5.3
As can be seen from the table above, the total number of deaths has fallen slightly in 2007 in
comparison to 2006. Kings Lynn & West Norfolk continues to have the highest number of
people dying in a hospital per 1,000 with 6.4 which is a slight increase from the previous year.
Before October 2006 Norfolk consisted of 6 Primary Care Trusts (PCT) which were
amalgamated to form a single PCT; NHS Norfolk.
Map 8: The Six previous PCT areas
On the map above, the old PCT areas are represented by the black lines and the coloured
areas represent the Local Authority areas.
Chapter 7: Primary Cause of Death and Palliative Care Need
Primary Cause of death
From the table below it is apparent that the primary cause of death across Norfolk (excluding
Great Yarmouth) is from circulatory illnesses followed by cancer and then from respiratory
illnesses. Despite the available data covering only for two years the ratios appear fairly
constant across both of these years. Further data for 2008 and onwards will need to be
collected and analysed in order to determine any overall trends.
Table 10: Primary cause of death across the Norfolk PCT
Norfolk PCT
Circulatory
Respiratory
Cancer
Other
Total
2006
2899
864
2201
1943
7907
%
36%
11%
28%
25%
100%
2007
2818
898
2235
1919
7870
%
37%
11%
28%
24%
100%
There is little change in the primary cause of death across both years, and on both occasions
most people die from circulatory illnesses, followed by respiratory illnesses. This is
consistent with the findings from other Marie Curie Delivering Choice Programmes in different
parts of the country.
This information can be broken down further into the primary causes of death for each Local
Authority area, which has been detailed below:
Table 11: Primary cause of death in the different Local Authorities
Breckland
Circulatory
Respiratory
Cancer
Other
2006
513
164
368
362
%
36
12
26
26
2007
508
159
387
362
Broadland
Circulatory
%
36
11
27
26
2006
%
2007
%
481
36
462
35
Respiratory
Cancer
Other
148
356
341
11
27
26
132
368
348
10
28
27
Kings Lynn & West Norfolk
Circulatory
Respiratory
Cancer
Other
2006
580
188
426
427
%
36
12
26
26
2007
572
209
436
406
%
35
13
27
25
North Norfolk
Circulatory
Respiratory
Cancer
Other
2006
486
129
367
308
%
38
10
28
24
2007
475
147
364
274
%
37
12
29
22
Norwich
Circulatory
Respiratory
2006
454
123
%
39
11
2007
389
122
%
37
11
Cancer
Other
337
247
29
21
294
254
28
24
South Norfolk
Circulatory
Respiratory
Cancer
Other
2006
385
112
347
258
%
36
10
31
23
2007
415
130
386
272
%
34
11
32
23
Palliative Care need
The demand for palliative care services can be estimated in several ways. We have followed
the work of Tebbit (2004), and employed the epidemiological approach to estimate need. Our
estimates are based on data for the calendar years 2006 and 2007.
Epidemiological Approach
As highlighted by Tebbit, the annual incidence of deaths is the single most important indicator
of palliative care need in a population since most palliative care need arises during the last
year of life.
Based on this work the number of patients needing palliative care in the Norfolk PCT area is
6024 and 6010 per year for the two years examined (Table 12).
On average Kings Lynn & West Norfolk has the largest palliative care need and Norwich has
the least palliative care need.
The number of patients with palliative care needs was calculated using the following formula
described by Higginson, 2001.
Number needing palliative care = all cancer deaths plus 67% of all other deaths
Table 12: Need for palliative care based on the number of deaths
2006
2007
Breckland
128,314
368
1039
Those
needing
Palliative
Care
1064
Broadland
122,184
356
970
1006
368
942
999
Kings Lynn & West Norfolk
North Norfolk
Norwich
South Norfolk
142,254
100,598
129,535
116,158
739,043
426
367
337
347
2201
1195
923
824
755
5706
1227
985
889
853
436
364
294
386
2235
1186
896
765
817
5635
1231
964
807
933
Population
Total
Cancer
Deaths
Other
Deaths
6024
Cancer
Deaths
Other
Deaths
387
1029
Those
needing
Palliative
Care
1076
6010
Most symptoms towards the end of life are common regardless of disease. Higginson (1996)
has provided a method of calculating the number of patients that will exhibit a symptom.
Based on that method the number of deaths in each area is multiplied by a symptom
percentage (percentages used are listed in the first column below). The end result is a figure
of the number of patients exhibiting that symptom per area, shown in Table 13
The most prevalent symptom is pain and it is likely that there is a significant need for pain
control followed by breathlessness and a loss of appetite (Table 13).
Table 13 Expected number of patients with symptoms by area
Breckland
Broadland
Cancer
387
368
Kings
Lynn &
West
Norfolk
436
Other
diseases
1029
943
2007 - Cancer & Other diseases
%
Symptoms
North
Norfolk
Norwich
South
Norfolk
364
294
386
1190
898
769
818
Cancer
Pain
84
325
309
366
306
247
324
Other
diseases
Pain
67
689
632
797
602
515
548
Cancer
Trouble with
breathing
47
182
173
205
171
138
181
Other
diseases
Trouble with
breathing
49
504
462
583
440
377
401
Cancer
Vomiting or feeling
sick
51
197
188
222
186
150
197
Other
diseases
Vomiting or feeling
sick
27
278
255
321
242
208
221
Cancer
Sleeplessness
51
197
188
222
186
150
197
Other
diseases
Sleeplessness
36
370
339
428
323
277
294
Cancer
Mental confusion
33
128
121
144
120
97
127
Other
diseases
Mental confusion
38
391
358
452
341
292
311
Cancer
Depression
38
147
140
166
138
112
147
Other
diseases
Depression
36
370
339
428
323
277
294
Cancer
Loss of appetite
71
275
261
310
258
209
274
Other
diseases
Loss of appetite
38
391
358
452
341
292
311
Cancer
Constipation
47
182
173
205
171
138
181
Other
diseases
Constipation
32
329
302
381
287
246
262
Cancer
Bedsores
28
108
103
122
102
82
108
Other
diseases
Bedsores
14
144
132
167
126
108
115
Cancer
Loss of bladder
control
37
143
136
161
135
109
143
Other
diseases
Loss of bladder
control
33
340
311
393
296
254
270
Cancer
Loss of bowel
control
25
97
92
109
91
74
97
Other
diseases
Loss of bowel
control
22
226
207
262
198
169
180
Cancer
Unpleasant smell
19
74
70
83
69
56
73
Other
diseases
Unpleasant smell
13
134
123
155
117
100
106
Map 9: Map of Norfolk showing Local Authority boundaries and the main Hospitals
Map 9 illustrates the two primary acute trusts providing services to this region; the Norfolk &
Norwich University Hospital, which is the primary hospital for this area and the Queen
Elizabeth Hospital in Kings Lynn.
Two additional acute hospitals serve the population of Norfolk but are outside the scope of
this project as they are the James Paget Hospital in Great Yarmouth and the West Suffolk
Hospital in Bury St Edmunds.