High Level Summary of Statistics: Key Trends for Scotland 2006

9. Health & Community Care

Health of Scotland's population

Life Expectancy

Life expectancy, the number of years that a person can expect to live on average, is a single measure of population health which is used to monitor public health, health inequalities, the outcome of health service interventions and to allocate resources.

Life expectancy at birth for Scots continues to improve, and recent trends show a slight narrowing of the gap between males and females to around 5.3 years in 2002-2004 (males now having life expectancy at birth of 73.8 years compared with 79.1 for females). However life expectancy in Scotland remains low compared with most Western European countries. In terms of quality of life, healthy life expectancy at birth (based on Self-Assessed Health) has also increased over the longer term but at a lower rate than the increase in overall life expectancy. The gap between life expectancy and healthy life expectancy is greater for women than for men, suggesting that they spend more years in poor health.

Sources:
1. Data from 1980 to 2000 taken from "Healthy Life Expectancy in Scotland" Report.
2. Data for 2001 - 2003 from GRO(S). Data are provided as 3 year rolling averages and have been plotted against the middle year in this chart.

Publications - Information and Statistics Division
Healthy Life Expectancy in Scotland (Executive Summary) (Published 2004)
Healthy Life Expectancy in Scotland (Full Report), March 2004 (Published 2004)

Mortality Rates

Part of the increase in overall life expectancy stems from the impact of improvements in lifestyle, and in healthcare provision, on reducing premature mortality from the three big killers: cancer, coronary heart disease ( CHD) and stroke.

The overall mortality rate for the under 75s dropped from 507 per 100,000 in 1995 to 412 in 2004. This was largely due to the fall in mortality rates for cancer, CHD and stroke which, when combined, fell from 329 per 100,000 in 1995 to 235 in 2004. This represented a fall from 65% of all deaths to 57% over the period.

Source: General Register Office for Scotland ( GRO(S))
1. Standardised to the European Population

Health Outcome Inequalities

Inequalities in health outcomes are apparent between areas with different levels of deprivation. Premature mortality from cancer and CHD both show a gap between the experience of the most and least affluent.

Source: Analytical Services Health, Scottish Executive

Publication
Inequalities in Health - Report of the Measuring Inequalities in Health Working Group (Published 2004)

Web link
Scottish Public Health Observatory

Diet

The White Paper on health 'Towards a Healthier Scotland' stated that Scotland's diet is a major cause of poor health in the country. The Scottish diet is traditionally high in fat, salt and sugar, and low in fruit and vegetables.

A recent review of dietary progress ¹ has indicated that although some progress has been made towards reducing total fat intake since 1996, there has been no change in the intake of saturated fat, fruit and vegetables, bread, oil rich fish and breakfast cereals. Furthermore the data indicate that there appears to have been an increase in the consumption of non- milk extrinsic sugars (added sugars).

There are marked differences in diet between affluent and deprived areas ². Females in the least deprived areas (30%) are twice as likely to consume the recommended 5 or more portions of fruit and vegetables per day than those in the most deprived areas (13%) according to the Scottish Health Survey in 2003. A similar picture emerges for Males with 26% consuming the recommended levels in the least deprived areas compared with 12% in the most deprived areas. The same pattern is seen when examining Scottish data from the Expenditure and Food Survey.

Other differences detected between most and least deprived areas included higher intakes of wholemeal bread in the least deprived quintile and lowest intakes of non-starch polysaccharide (dietary fibre) intakes in those most deprived. Interestingly there were no differences in the intakes of fat or saturated fat detected between those most and least deprived.

Source: Analytical Services Health, Scottish Executive

Publication
Scottish Health Survey 2003

Reference
1. Wrieden WL, Barton KL, Armstrong J, McNeill G.A Review of Food Consumption and Nutrient Intakes From National Surveys in Scotland: Comparison to The Scottish Dietary Targets. Available on the Food Standards Agency Web site by mid July 2006. http://www.food.gov.uk/scotland/

Obesity

Obesity can reduce people's overall quality of life, it creates a strain on health services and leads to premature death due to its association with serious chronic conditions such as type 2 diabetes, hypertension, and hyperlipidaemia, which are major risk factors for cardiovascular disease. The two major lifestyle factors associated with the growth of obesity are physical inactivity and poor diet.

Body Mass Index is the most commonly accepted measure of general obesity. BMI is defined as weight (kg) divided by height (m ²). Adults are classed as overweight if their BMI is 25 or greater, and obese if their BMI is 30 or greater.

The 2003 Scottish Health Survey estimated that in Scotland around 22% of men and 24% of women were obese. There has been a marked increase in the prevalence of obesity since 1995 when 16% of men and 17% of women were obese.

Almost two-thirds of men (64%) and more than half of women (57%) were overweight (including obese) in 2003.

Source: Scottish Health Survey

Publication
Scottish Health Survey - 2003 results (Published 2005)

Physical Activity

The current recommended levels of activity in terms of health benefits and protection against coronary heart disease are five or more moderate sessions, or three or more vigorous sessions, per week. These measures of activity are therefore based on the intensity, frequency and duration of sessions taken.

The Health Education Population Survey ( HEPS), which samples adults aged 16 to 74 years old in Scotland, has found generally low levels of physical activity in Scotland, with most men and women failing to achieve recommended levels.

For men there has been a slight increase between 1996 and 2004 in the numbers achieving the recommended levels, although there is no definite trend over time. The percentage achieving the recommended levels are consistently higher for men than women.

Source: Health Education Population Survey

Smoking

Smoking remains one of the most damaging factors in Scotland's poor health record. It is estimated that every year 13,000 people in Scotland die prematurely from smoking related diseases including lung cancer, coronary heart disease and stroke.

The percentage of persons aged 16 or more in Scotland who smoke has fallen from 30.4% in 1999 to 26.5% in 2004. In view of this, a new, tougher target has been set for 2010 of 22%.

A target has also been set for those who live in the most deprived areas of 33.2% by 2008. The prevalence of smoking in the most deprived areas has fallen from 42.2% in 1999 to 37.3%in 2004.

There is a further national target to reduce smoking during pregnancy which seeks a reduction in the proportion of women who smoke during pregnancy from 29% to 23% between 1995 and 2005 and to 20% by 2010. The proportion of women smoking during pregnancy in 2004 was 23.8%.

Smoking prevalence is expected to fall further following the introduction of the smoking in public places legislation.

Sources: Scottish Household Survey, ISD Scotland SMR02.

Alcohol

Misuse of alcohol contributes to a wide range of health and social problems, including high blood pressure, liver cirrhosis, pancreatitis, cancer, suicide, accidents, and antisocial behaviours including crime and domestic violence.

In terms of weekly limits, men are advised to drink no more than 21 units of alcohol per week, and women no more than 14 units. Young people in Scotland in the age group 16-24 are more likely to exceed weekly-recommended limits than people in any other age group.

Men are far more likely to consume more than the recommended weekly limit than women with 29% reporting this in 2003 compared to only 17% for women. However, there has been a clear increase over time for women (from 13% in 1995 to 15% in 1998 and 17% in 2003) whereas there has been a reduction in the percentage of men consuming more than the recommended limit (33% in 1995, 34% in 1998 and 29% in 2003).

The Scottish Health Survey 2003 showed a negative relationship between deprivation and alcohol consumption, with people in the least deprived areas most likely to exceed the weekly limits.

Source: Scottish Health Survey

Sexual Health

While teenage conceptions in Scotland are still amongst the highest in Western Europe, there has been some reduction in the rate of teenage conceptions in recent years, from 8.3 per 1,000 in 1991/92 to 7.5 per 1,000 in 2003/04 for 13-15 year olds and from 77.4 per 1,000 to 68.2 per 1,000 for 16-19 year olds.

Since 1996, there has been an upward trend in numbers of diagnoses of sexually transmitted infections ( STIs) in Scotland. There has been a fourfold increase in the incidence of Chlamydia infection in recent years, from 1,770 in 1996 to 7,090 cases in 2004. It has been suggested that some of the increase is related to an increased awareness and to wider application of laboratory tests. There is also thought to be a genuine increase in the level of infection, particularly amongst young people.

Source: Information Services NHS National Health Services Scotland

Web link
Scottish Health Statistics - Sexual Health

Dental Health

Compared with European countries, the dental health of children in Scotland is poor, with substantially higher levels of recorded decay. The overall estimate of obvious decay experience in 5 year olds in Scotland of 2.36 teeth per child is higher than the corresponding value recorded recently for England (1.49), but slightly lower than that recorded for Wales (2.42).

The target set by the Scottish Executive in 1999 in Towards a Healthier Scotland is that 60% of Scottish five year old children will have no obvious decay experience by the year 2010. In 2004, 50.7% of Scottish five year olds fell into this category. The situation varies across Scotland, with the least deprived areas already meeting the target and much higher levels of decay in the most deprived.

Source: Report of the National Dental Inspection Programme of Scotland 2004

Mental Health

People living with chronic disease, especially with mental health problems, is an increasing challenge for society. Depression and anxiety were the 3 ^rd and 4 ^th most common conditions reported in GP consultations in 2003/04. Psychosocial health is measured by the General Health Questionnaire ( GHQ12). This is a widely used standard measure of mental distress and psychological ill-health, consisting of 12 questions on recent concentration abilities, sleeping patterns, self-esteem, stress, despair, depression, and confidence. Overall scores range between 0 and 12. A score of four or more indicates the presence of a possible psychiatric disorder. A score of zero could, in contrast, be considered to be an indicator of psychological well-being.

The proportion of men with high GHQ12 scores has remained constant over time at 13%, while it declined slightly for women, from 19% in 1995 and 1998 to 17% in 2003. However, there is a marked increase in those with zero scores, with men increasing from 60% in 1995 to 68% in 2003 and women increasing from 55% in 1995 to 61% in 2003. In Scotland in 2004 there were 835 suicides (including events of undetermined intent), the same level as in 1994 and 1995. Numbers of suicides showed an upward trend from 1995 up until 2002. They dropped from 899 in 2002 to 794 in 2003. Around three quarters of suicides each year are by males.

There has been a continuous increase in the number of prescriptions for antidepressants - from 1.16 million in 1992/93 to 3.48 million in 2004/05, with a commensurate increase in cost. Estimated daily use of antidepressant drugs by the population aged 15 to 90 increased from 1.9% in 1992/93 to 8.3% in 2004/05.

Source: Scottish Health Survey

Health Service Provision

Health Expenditure

Total expenditure on the NHS in Scotland in 2004/05 was £8bn. Of this, £7bn was spent by the Area Health Boards. Details of this expenditure can be found in the NHS Cost Book.

In 2004/05, 60% of Board expenditure was on hospital care, 13% on community health services and the remaining 27% on family healthcare.

Over half of the total family healthcare expenditure of £1.9 billion was spent on community prescribing costs, one third was spent on primary medical services ( GP practices) and the remainder was on dental and ophthalmic services .

In addition to this NHS expenditure, Local Authorities spent around £1bn on providing community care in 2004/05.

Source: ISD

Web link
Scottish Health Statistics - Costs

Health Workforce

Around 70% of NHS expenditure is on staff. Between 2000 and 2005 there were significant increases in the headcount numbers of all qualified clinical staff: the number of qualified nurses and midwives grew by over 4,600 (11%), the number of consultants increased by almost 500 (16%); the number of dentists grew by 230 (9%), and the number of GPs grew by around 90 (2.5%).

At 30th September 2005 there were 153,996 staff in NHS Scotland. Almost half (43%) are in the Nursing & Midwifery staff group, while management, administration and clerical staff make up 19%.

Source: ISD

Web link
Scottish Health Statistics - Workforce

Patient Contacts

The diagram on the next page illustrates many of the patient contacts that operate throughout the health care system; in primary care, in the community and in hospital. The Executive's policy, set out in 'Delivering for Health', is to provide more treatment outwith the hospital setting, and also to focus on more anticipatory care and better management of chronic illness to shift the balance of care further away from the acute area.

Diagram showing patient contacts for primary care, the community and hospital care

Family Health Service

Family Health Services consists of General Practice, community pharmacies, dentists and ophthalmic services.

A practice team consists of the General Practitioners ( GP) and the disciplines supporting them. Estimates from sample data reveal that there were approximately 27 million face-to-face contacts with practice teams in Scotland in the year ending March 2005. This breaks down to 15.5 million, 6.5 million, 3.5 million and 1.7 million contacts for GPs, practice nurses, district nurses and health visitors respectively.

Source: Practice Team Information ISD

Web links
Scottish Health Statistics:
- Practice Team Information
- Community prescribing
- Dentists
- Opthalmics

Acute Hospital Care

Acute hospitals provide a wide range of specialist care and treatment for patients, for example outpatient consultation, emergency treatment, surgery, diagnostic procedures, and close observation and short-term care of patients with worrying health symptoms. Data on acute hospitals exclude obstetric, psychiatric and long stay care services.

It can be seen from the chart below that emergency inpatient activity was on an upward trend until 2002, and has levelled off since then at around 475,000 patients. In the early 1990's more people were treated as elective inpatients than as day cases, but from 1996 onwards there were more day cases - numbers of which peaked in 2001 - while numbers of elective inpatients continued to drop. The total number of elective inpatient and day case discharges has been falling since 1999.

These recent falls in traditional activity figures result from changes in clinical practice and service delivery. Changing clinical practice has resulted in a reduction in the number of procedures undertaken ( e.g. hysterectomies, insertion of grommets etc). Drug developments ( e.g. troponin for suspected heart attacks) can result in fewer hospital admissions.

Outpatient activity (shown on right hand axis of graph) has also shown a slight fall in recent years. This activity, again, is impacted upon by redesigned services. For example, some return outpatients, where clinically appropriate, are now offered a telephone consultation as an alternative to a clinic appointment. One-stop clinics, in some specialties, increasingly offer a consultation, diagnosis and treatment service all in one visit, where previously this could involve several appointments.

Source: ISD Scotland

Waiting Times

There have been significant reductions in maximum waiting times. For both inpatient/daycases and outpatients the number of patients with a treatment guarantee, those with an Availability Status Code ( ASC), who had been waiting over 6 months had effectively fallen to zero at 31 December 2005. The next target is for maximum waiting time of 18 weeks at 31 December 2007.

Source: ISD Quarterly SMR3 Census

Source: Outpatient Waiting List Census

Web link
Scottish Health Statistics - Acute Activity, Waiting Times and Waiting List

Older People Services

Nearly 73,000 older people in Scotland are now receiving personal care services free of charge. This includes people living in care homes and at home.

Care Homes

There are currently around 32,000 long-stay residents, aged 65+, in Care Homes. Prior to the introduction of the free personal and nursing care policy, the majority of these people were receiving these services for free but self-funders in Care Homes would have had to pay for their entire costs.

There are now 8,900 self-funders in care homes who are benefiting from this policy. These people receive £145 each week for personal care and around two-thirds (5,900 people) receive a further £65 each week for nursing care.

Source: Scottish Executive Health Department, Scottish Care Homes Census

Home Care Services

The number of older people receiving home care services reached a low in 2002 at around 53,600 people. Since the introduction of free personal care it has increased each year to 57,900 in 2005. Over this time we have seen a shift towards more intensive home care provision and an increasing proportion of clients receiving personal care services.

Since July 2002, there has been an increase in the number of people receiving free personal care ( FPC) services at home. The latest figures for September 2005 show that nearly 41,000 people are now benefiting by having personal care services provided without charge at home.

In 2002, 45% of home care clients received personal care services. This has steadily increased each year to reach 68% in 2005.

Source: Scottish Executive Health Department, Home Care Census

Publication
Free Personal and Nursing Care, Scotland 2002-05 (Published 2006)

People with Learning Disabilities

'The Same as You' review of services for people with learning disabilities was published in May 2000 and made 29 recommendations for developing learning disability services setting out a programme for change over 10 years. Since 2000, the number of adults with learning disabilities resident in long-stay hospitals has decreased substantially from over 1,800 in 2000 to just over 480 people in 2005 (a drop of nearly three-quarters). Over the same period the number of adults with learning disabilities in care homes has fallen by nearly a quarter from 3,300 in 2000 to 2,500 in 2005,

At the same time the number of adults with learning disabilities receiving home care services has increased from 1,500 in 2000 to 4,900 in 2005. Over 6,300 adults with learning disabilities now live in their own tenancies, an increase of 2,000 in the two years since this data was first collected in 2003. Although numbers are still small (315 people in 2005) an increasing number of adults with learning disabilities are using direct payments to directly purchase the services they require.

The Same as You? said that the role of day centres should change. Nobody should go to a day centre full-time but should instead get alternative day opportunities for at least part of the week. Over the last three years we have seen a gradual decline in the number of people attending day centres coupled with an increase in the number of adults with learning disabilities getting alternative day opportunities.

Source: Scottish Executive and ISD Scotland

Publication
Adults with Learning Disabilities: Implementation of The Same as You? Scotland 2005 (Published 2006)

Mental Health Services

Scottish Executive policy is that as many people as possible should be treated in the community, avoiding hospital admission or a lengthy stay in hospital unless really necessary. For over a decade the number of hospital beds required for patients with mental illness has continued to decline.

The number of mental health patients resident in hospital for over a year has fallen from over 7,000 in 1991 to under 3,000 in 2001. The number of mental health home care clients rose sharply by 28% in 2004 to almost 3,000, while the numbers of residents in care homes specialising in mental health has remained steady at just over 1,100.

Source: ISD (S)1