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Food poisoning

There is a large burden of illness associated with food borne infections each year. While notifications of illness by GPs (NOIDs) only represent the tip of the iceberg, Campylobacter clearly remains the most common food poisoning organism in England. Environmental Health Officers follow up many cases of food poisoning each year to ensure that any common sources of infection are identified and risks minimised to reduce the risk of outbreaks occurring

Incidence of Food Poisoning notifications in 2013

Viral Gastroenteritis

Common viruses that cause diarrhoea and vomiting illnesses include Norovirus, Rotavirus and a range of other viruses. Infections are often mild and healthy adults and children often recover quickly and do not require hospital treatment but outbreaks in care homes and hospitals can result in more severe illnesses in vulnerable groups of people and are very costly for health services every year. Community Infection Control Services and Acute Trusts work together to try and minimise the spread of infections in conjunction with regular advice to the public each year to avoid hospital visits in particular if people are unwell.

 Confirmed and suspected outbreaks of viral gastroenteritis in york by setting 2013

Hepatitis C and chronic liver disease

Illness associated with Hepatitis C continues to rise in the UK with injecting drug use remaining the biggest risk factor for infection. Many cases of chronic infection are not diagnosed until late on and work is ongoing to prevent new infections, to increase awareness of infection, to increase testing and diagnosis and to ensure that diagnosed individuals are able to access treatment and care

Project burden of chronic liver disease from 2010 to 2015

Tuberculosis (TB)

York has a low burden of infection with TB in comparison to large urban centres like London, Birmingham and Manchester but all cases of infectious TB require early diagnosis, treatment and public health action and follow up by community TB services to ensure preventable spread to others is avoided. Late diagnosis and completion of treatment remain key components of the Chief Medical Officer’s targets for TB.

Percentage of TB cases treated

HIV

People living with HIV can expect a near normal lifespan and better clinical outcomes if they are diagnosed promptly. Earlier treatment must be combined with a substantial increase in the frequency of HIV testing among groups most affected. Successes in treatment outcomes have led to a large increase in the numbers of people requiring ongoing care.

Numbers accessing HIV-related care and HIV prevalence rates in York:

 Rate of Care access per 100,000

Vaccine preventable disease

Data is only currently available for the boundaries of the Primary Care Trust prior to the reorganisation of services in April 2013. Vaccination with the Measles Mumps and Rubella vaccine (MMR) dropped considerably across the UK from the early 2000s onwards before recovering. Unfortunately this contributed successive years of susceptible children to enable a large national level outbreak to emerge towards the end of 2012 and resulted in an MMR ‘catch up’ campaign in April 2013. Data still indicates that MMR uptake rates are below the level required to prevent outbreaks occurring and there is a gap between the rate of vaccination with the primary childhood immunisations and MMR.

Percentage of Children immunised with second MMR by their fifth birthday

Difference between second dose MMR1 and DTaP/IPV

MMR1 = Measles Mumps Rubella vaccine given at 13 months

MMR2 = Measles Mumps Rubella vaccine given from 3 years of age

DTP/IPV = Diptheria Tetanus Pertussis and Polio vaccine given at 3 years

Screening

Screening is the process of identifying and testing individuals who are at high risk of developing a disease, or have the early stages of a disease but have no symptoms. The aim is to intervene early and improve the longer-term outcomes for individuals and communities. Screening programmes running in North Yorkshire and York are both cancer and non-cancer screening programmes. The cancer screening programmes commissioned achieve universally high Quality Assurance performance monitoring.

Non-cancer screening

Antenatal screening

All pregnant women should be offered information to help them decide whether or not they wish to participate in the antenatal screening programme. The tests included in the programme include a screening test for Down's syndrome that meets agreed national standards and an ultrasound scan between 18 weeks and 20 weeks and 6 days gestation to check for physical abnormalities in the unborn baby.

Newborn screening

All parents of newborns should receive information about the newborn screening programme. The programme includes a bloodspot test (also known as a heel prick) for several genetic disorders, congenital hypothyroidism and sickle cell disease. This test is taken between five and eight days after birth (Public Health England). In addition, all parents of newborn children should be offered a hearing screen for their child within 2 weeks of birth.

Abdominal Aortic Aneurysm screening

An abdominal aortic aneurysm is a swelling of the large blood vessel at the back of the stomach. This swelling can cause the wall of the blood vessel to become stretched and in some cases the swelling can burst requiring emergency surgery and in some cases leading to death. This condition is more common in men and if identified early enough, surgery can be performed to reduce the risk of rupture.

The programme will invite all men for screening during the year they turn 65, although men aged over 65 years will be able to self-refer for screening. Men who have an aneurysm detected through screening will be offered treatment or monitoring depending on the size of the aneurysm. The programme has not yet been fully implemented across North Yorkshire and York, but will be completed by March 2013.

Cancer screening

Breast screening

The plot in the figure below illustrates the trend in uptake of breast screening by eligible women aged 50-70 years within the historic Primary Care Trust (PCT) boundary and in England. The plot shows that NHS North Yorkshire and York have consistently screened a greater proportion of the eligible population than the England rate. However the general trend appears to be downwards with fewer screened in 2009-2010 than in 2002-2003, although the trend for England is similar (NHS Information Centre).

Breast screening uptake by women aged 50-70 years in NHS North Yorkshire and York

Source: The Health and Social Care Information Centre. Copyright © 2011

The incidence of breast cancer in York for 2007-2009 was not significantly different to the England rate at 120 breast cancers per 100,000 of the population aged under 75 years (NHS Information Centre, 2012). Similarly the death rate associated with breast cancer in York for 2008-2010 was not significantly different to the England rate at 17 deaths per 100,000 of the population aged under 75 years (NHS Information Centre, 2012). In spite of these rates being similar to the England rate, the downward trend in the uptake of breast screening should be a cause for caution.

Cervical Screening

25-64 years

For the period 2012-2013, 80.4% of the eligible population in NHS North Yorkshire and York were screened. This was higher than the England rate for the same period (78.3%) and higher than the regional rate of 79.8%. The rate was slightly lower than the previous figures for 2011-2012 and has reduced from 80.6% of the eligible population in NHS North Yorkshire & York. National rates also reduced slightly from 78.6% and regional rates reduced slightly from 80% of the eligible population in 2011-2012 (Health & Social Care Information Centre, 2013).

25 – 49 years

For the period 2012-2013, 74.9% of the eligible population in NHS North Yorkshire and York were screened. This was higher than the England rate for the same period (71.5%) and higher than the regional rate of 74.1%. The rate was lower than the previous figures for 2011-2012 and has reduced from 76.6% of the eligible population in NHS North Yorkshire & York. National rates also reduced from 73.5% and regional rates reduced from 76% of the eligible population in 2011-2012 (Health & Social Care Information Centre, 2013).

50-64 years

For the period 2012-2013, 78.7% of the eligible population in NHS North Yorkshire and York were screened. This was higher than the England rate for the same period (77.5%) and higher than the regional rate of 78%. The rate remained similar to previous figures for 2011-2012 reduced from 78.6% of the eligible population in NHS North Yorkshire & York. National rates also remained similar to previous figures of 77.8% and similar to regional rates which were 78.2% of the eligible population in 2011-2012 (Health & Social Care Information Centre, 2013).

The incidence of cervical cancers in York for the period 2007-2009 was significantly lower than the England rate for the same period at 5.44 cervical cancers per 100,000 of the population aged under 75 years (NHS Information Centre, 2012).

However, the death rate for cervical cancer for 2008-2010 was not significantly different to the England rate for the same period at 1.7 deaths per 100,000 women aged under 75 years (NHS Information Centre, 2012). The death rate for cervical cancer was not significantly different to the England rate.

Bowel Cancer Screening

Colorectal cancers are the third most common cancers in the UK after breast and lung and in the region of 100 new cases of colorectal cancer are diagnosed each day. Almost three-quarters of colorectal cancer cases occur in people aged 65 and over (National Institute for Health and Care Excellence, 2011) and given the projected population changes for the City of York this is likely to have an impact on future planning. The NHS bowel cancer screening programme is being implemented locally and offers screening every two years to all men and women aged 60 to 69 years. Local data on the performance of the screening programme is not currently available, but it is envisaged that it will inform future iterations of the Joint Strategic Needs Assessment.

The incidence rate for the rolling period 2007-2009 was 32 new colorectal cancers per 100,000 of the population. This was not significantly different to the rate for the period 2006-08, nor was it significantly different to the England rate for the same period (NHS Information Centre, 2012). The death rate attributed to colorectal cancer of 10 deaths per 100,000 of the population for the period 2008-2010 was also not significantly different to the England rate for the same period. However, the incidence rate presented here relates to clinically apparent cancers in the majority of cases. When the results of the first cycle of the bowel screening programme are available it would be expected that the incidence rate would initially rise.

Health Checks

The NHS Health Check is for adults in England between the ages of 40 and 74. Its aim is to give the person and their GP a clearer picture about the person’s health, and help the person take action to reduce risk of heart disease, stroke, type 2 diabetes and kidney disease (NHS).

The total population in England who were eligible to have a health check in 2013-2014 was just over 15.3 million people.

Just over 2 million people were offered a health check (13.2% of the eligible population).

Just over 973,000 people received a health check (6.4% of the eligible population).

More than half of the population who were offered a health check did not receive one (48.1% of people who were offered a health check received one).

Health check information for England in 2013-2014.

Total eligible population 2013-2014 15,308,022
Number of people who were offered a NHS Health Check 2,022,063 (13.2%)
Number of people that received a NHS Health Check 973,093 (6.4%)
Percentage of people that received an NHS Health Check of those offered 48.10%

Source:  NHS Health Check

In York, the total population who were eligible to have a health check in 2013-2014 was 55,311 people.

8,337 people were offered a health check (15.1% of the eligible population).

3,649 people received a health check (6.6% of the eligible population).

More than half of the population who were offered a health check did not receive one (43.8% of people who were offered a health check received one).

Health check information for York in 2013-2014.

Total eligible population 2013-2014 55,311
Number of people who were offered a NHS Health Check 8,337 (15.1%)
Number of people that received a NHS Health Check 3,649 (6.6%)
Percentage of people that received an NHS Health Check of those offered 43.80%

Source:  NHS Health Check

At present we are unable to break down these numbers to see if any groups within the population are less likely to attend, for instance what is the uptake by men of working age? What is the uptake in people with disabilities? Therefore it is recommended that further analysis be undertaken so that efforts to increase uptake are appropriately targeted.

References

This page was last updated on 20 April 2015
This page will be reviewed by 20 April 2016