About the data
How to use Healthier Lives
We’ve created a video tutorial explaining how to get the best out of Healthier Lives. This video shows you how to use the online tool and what the website can tell you about health care in your area.
Interpreting the maps
- Hypertension increases with age and this is important to know in order to interpret some of the maps of prevalence of hypertension and its complications such as stroke and heart disease
- Shades of purple are used on maps for indicators where there is no value judgment on the variation shown (either because it is not statistically robust to do this (including indicators strongly correlated with variables such as age where this cannot be adjusted for) or because of the subject of the indicator)
- Red, amber and green colours are used for maps of indicators where the variation is most likely to be due to good or poor performance over and above demographic factors. Areas that are red or green are statistically significantly different from the average and merit investigation to see if performance could be improved. In the case of GP data, these categories are shown as light blue, amber and dark blue.
There is a 75% difference in detection rates of people with high blood pressure
- This is not related to age of the population or deprivation
- The more people who have a blood pressure recorded in the last 5 years the higher the detection rate – therefore more can be done to find the missing people with hypertension by testing more people for high blood pressure and by testing those at high risk of hypertension more frequently
- The best CCGs (Stoke on Trent, Dudley and Thurrock) identify 63-65% of the people that they are predicted to have with high blood pressure. The lowest CCGs only identify 37% and 39%.
- West Norfolk has the highest prevalence of hypertension at 18% but also has amongst the highest proportion of people aged 65+ (24%); Tower Hamlets has the lowest prevalence of hypertension at 8% but also has the lowest proportion of over 65 year olds in thecountry at 6.1%
- The % estimated detection rate provides a benchmark for detection that takes into account the expected prevalence of hypertension based on age, sex, ethnicity and deprivation. If this value is low check if the % of those over aged 40 years who have a recorded blood pressure is high or not. If it is high it is likely that the model is not sensitive to some local factor; if it is low it is likely that people with hypertension are being missed and are at risk of CVD.
- The CCG with the highest recorded % of patients aged 40+ who have a recorded blood pressure is Newham at 93%; NE Essex and Barking and Dagenham reach 92%. The lowest CCG for this indicator is Central Manchester at 81%
There are wide variations in control of risk factors for high blood pressure
- GP recognised obesity varies from 4.3% in Surrey Downs to 13.8% in Barnsley - these figures are much lower than estimates of obesity in the country; and are lower than 2012/13 figures. Whilst it is not good to have high levels of obesity, higher values can mean good GP care as it means they are recognising obesity. This is important because people who are obese are more likely to develop high blood pressure and therefore should be checked more frequently and provided with support to lose weight and increase physical activity
- the proportion of the population showing healthy eating (5 or more portions of fruit and vegetables a day) varies from 19.4% to 46% of the population (these are estimates based on 2006-8 data, no more recent data are available)
On the whole, blood pressure management could be much better – on average 30% of adults under 80 years are not achieving control to ≤140/90
- BP control to ≤140/90 across people under 80 years with high blood pressure (the level recommended in NICE guidelines) is poor with an average achievement of 70.43%. The lowest achievers missed the target in 39% of cases. Top achieving CCGs achieve control in 93-94% of adults (Lincolnshire West, West Leicestershire, South West Lincolnshire and Leicester City).
- There is also data for the less stringent measure of blood pressure control to ≤150/90 in all adults. Achievement is 79.2% for this target, up almost 2% on the previous year.
There is an unwarranted variation in provision of risk assessments for people diagnosed with hypertension
- For cardio-vascular risk assessment in those newly diagnosed with hypertension the lowest area is missing over 50% of patients; the highest nearly 20%
- For physical activity assessment in patients aged 16-74 with hypertension, achievement ranges from 58.4% to 96.7% between CCGs
Across England there is a 100% variation in the proportion of people with hypertension and high CVD risk who are treated with a statin
- The highest achiever in 2013/14 is Slough at 86% and second is Tower Hamlets at 85%. The lowest in the country is Hastings and Rother on 43% - reasons for this low provision of statins for those at high risk of CVD should be explored.
Controlling blood pressure is done well for those with heart disease and stroke
- Even in the worst area (South Manchester) over 84% of people with heart disease had their blood pressure controlled to ≤150/90 and 80% of those with stroke or TIA achieved this level of control in South Manchester.
- High performers improved further with Tower Hamlets improving from 92% to 93%; City of London and Hackney improved from 89% to 93% achievement of control of BP in those with CHD to ≤150/90 though it is not yet known how well blood pressure is controlled to the NICE target of ≤140/90.
- North East Lincolnshire and City and Hackney were highest for control in those with stroke and TIA at 90% control (89.8 and 89.6% respectively).
Blood pressure control is poor in those with diabetes but is improving in some areas; achievement is poor for hypertension control in those with CKD and there is unwarranted variation – 35-40% are missing the target
- The highest performers in 2013/14 were Slough, Tower Hamlets and Newham achieving 80.3 to 81% control in people with diabetes controlled to ≤140/80. The lowest was Stafford and Surrounds at 64%. The highest achiever for BP control to ≤140/85 in those with chronic kidney disease was 78.4 % in Corby with a low of 65% controlled in Luton. This means that even in the best areas one in four to one in five people with diabetes and kidney disease were not reaching the optimal control of their blood pressure. In the worst areas nearly 35% were missing the target for diabetes and kidney disease
What to do if your area or GP practice is below average – questions to ask
- What is the bigger picture? Does the area as a whole have high deaths rates from cardio-vascular disease? Should it be a priority for the local authority and the CCG. Look at the Longer Lives maps to find this out
- What is the overall picture for the area or practice? Are they red on just one or two indicators or on several?
- Is the area or GP below average just on a few indicators? Are these indicators where the average achievement is high (for example control of BP in CHD and stroke) or where the average is poor such as in detection of blood pressure
- How do they compare to areas with similar deprivation and demography? On the national CCG, LA and GP comparison tables the final column has an option to “find similar” which is identified by taking the mouse to the left of the value
- Is there a problem with one or two practices or most of the practices in the area? Use the GP comparison table. For more information use the GP practice profiles website to find out more.
- What is the role of the Local Authority in relation to deprivation, obesity and other determinants of health - use the risk factor indicators to explore patterns that explain the variation - these change the first column in the comparison table and can be sorted by the triangle in the header
- If you want to generate your own tables and charts download the data for all England CCGs and LAs using the Download data link on the left panel at the bottom on the national comparison table page
What to do if your area or GP practice is above average
- Remember being above average may not be good if the average is low – see the key messages above for indicators where general improvement is required.
Wider work to support you
Public Health England has convened the Blood Pressure System Leadership Board with representatives across national and local government, the health system, voluntary sector and academia.
This group has published in November 2014 Tackling high blood pressure: from evidence into action. This plan is intended to support partners at all levels to focus on the work that will have the biggest impact tackling this condition.
The majority of the data presented in Healthier Lives: High Blood Pressure has been drawn from the Quality Outcomes Framework (QOF), which is based upon general practice records. The QOF data is for the financial year 2013/14. We have not used the more usually published achievement scores, but the intervention rates which look at practices’ performance on all relevant patients without any exception.
This is supplemented with other data sources for individual indicators, as detailed in the call-out boxes:
- Hypertension prevalence modelled estimates (2011, modelling by the former Eastern Region Public Health Observatory, now part of PHE, based on earlier data)
- Hospital Episode Statistics (2012/13)
- Health Survey for England modelled estimates (2011 modelling by National Centre for Social Research, based on earlier data)
- Active People Survey (2013)
- Index of Multiple Deprivation (2010)
The tool will be updated as new data becomes available, at least annually.
More information about individual indicators and definitions can be found in the call-out boxes which appear when an area on the map is clicked.
This data is not new, it has been available in the public domain but this is the first time it’s been published in this form making information easy to access, view and compare.
This data can tell us about:
- What the local prevalence of key risk factors for high blood pressure is – to help us improve prevention
- How many of the missing millions of undiagnosed people with high blood pressure have been found in each area – to help us improve detection
- How well GPs look after people with high blood pressure, including people who also have another condition – to help us improve care
The data covers the whole of England and are broken down by:
- Clinical Commissioning Group
- Local Authority
- Individual General Practices
Why does Healthier Lives present QOF data without taking account of exceptions ?
There are two valid methods to calculate QOF indicators. We have chosen to show the proportion of patients receiving the intervention because:
From a public health perspective we are more interested in the actual proportion of patients receiving the intervention, i.e. the proportion of all patients with this condition who were treated. The HSCIC (QOF FAQs, p.11) states "Percentage of patients receiving the intervention, gives a more accurate indication of the rate of the provision of interventions as the denominator for this measure covers all patients to whom the indicator applies, regardless of exception status."
We consider this to be the better comparable indicator because, while there are very good reasons why a patient might not be treated (such as terminal illness), a generous interpretation of exception rules can also be used to improve practice performance.
The tool is intended to highlight variation and encourage conversation about the causes of variation. We are not suggesting that every practice should, or can, achieve a 100% intervention rate for every indicator - clearly there are patients it would not be desirable to be included - however it is clear that there is unwarranted variation in exception rates and the data is not available for us to make adjustments.
Triangulation with other sources of primary care data such as the National Diabetes Audit (NDA) support this approach. For those QOF indicators which match NDA indicators, a higher degree of correlation was found with intervention rates than with achievement scores, so intervention rates seem a better measure of true performance.