The sheer scale of the Long-Term Conditions (LTCs) challenge for modern healthcare systems means that a shift is needed – away from the ‘medical model’ of illness (which worked efficiently in the 19th and 20th Centuries to bring down mortality and morbidity) towards a model of care which takes into account the expertise and resources of the people with LTCs and their communities. This will help to provide a holistic approach to their care and lives and help them achieve the best outcomes possible.
The Five Year Forward View (FYFV) published by NHS England and its partners (2014) sets out the vision for the future of the NHS. It notes that ’long term conditions are now a central task of the NHS; caring for these needs requires a partnership with patients over the longer term rather than providing single, unconnected “episodes” of care. ’This is particularly important in supporting the increasing numbers of people with more than one long term condition, more commonly known as multimorbidity – helping people with long term conditions to live well, age well and die well.
NHS systems are expected to work with partner organisations to access rigorous and validated population health management capabilities that improve prevention, enhance patient activation and supported self- management for long term conditions, manage avoidable demand, and reduce unwarranted variation in line with the Right Care programme.
The 15 million people in England with long term conditions have the greatest healthcare needs of the population (50% of all GP appointments and 70% of all bed days) and their treatment and care absorb 70% of acute and primary care budgets in England. The barriers to great care for people with long term conditions have been identified by a wide range of reports and reviews, and can best be summed up as failure to provide integrated care around the person:
In 2019 the NHS Long Term Plan was published. This plan aims to support people to live longer, healthier lives through helping them to make healthier lifestyle choices and treating avoidable illness early on. The plan sets out a need for the NHS to work in collaboration with local authorities to deliver joined up care and to focus prevention programmes on reducing smoking, obesity and alcohol intake. This approach will reduce the risk of early ill health and diseases such as cancer, cardiovascular disease, stroke, respiratory disease and mental ill-health.
A significant number of people who are classified as fit with between 1 and 4 long term conditions are being admitted to acute care as an emergency presentation, with an observed growth in the under 65’s.
There is a significant number of unidentified prevalence for hypertension (5,000 people). Other areas where identification needs to be improved include diabetes, coronary heart disease, atrial fibrillation and chronic obstructive pulmonary disease. The figure below compares Richmond to the 10 most similar CCGs in England, demonstrating the detection opportunity if Richmond were performing to the level of its peers.
Source: Right Care data 2017/18
This data is then triangulated with GP practice registers and the figure below shows that there are marked variations in GP registers for hypertension, obesity, diabetes and depression compared to the 10 most similar CCGs.
Source: 2019/20 QOF, NHS Digital
The issue of undetected disease is increasing within Richmond with a demonstrable growth in morbidity between 2018 and 2019 in these conditions (the figure below).
Source: Sollis Clarity 2018/19
People often present with multiple morbidity factors and as the population ages the incidence of multi-morbidity increases. The table below shows the likelihood of a particular long-term condition as multi-morbidity increases, expressed as percentage.
For people with three or more long-term conditions, circa 45% of people are coded with Hypertension, whereas for people with 9+ LTCs, this rises to circa 92% of that cohort.
Source: Sollis Clarity Partners
The presence of multi-morbidity of long-term conditions manifests in multiple ways including a rise in A&E attendances, Non-elective or emergency admissions to hospital, repeated attendance to the GP, a rise in sickness absence and an impact on overall mental wellbeing (the table below).
The information in the table above and the table below shows that it is the presence of multi-morbidity and therefore complexity of a person’s condition that drives higher usage of hospital attendances and the number of bed days once a person is admitted, and not necessarily increased age alone. In all age categories those with a higher number of conditions will attend hospital more frequently and stay longer once admitted.
Within Richmond the identification of long-term conditions is managed by primary care through a suite of locally commissioned services aimed at the detection of specific conditions, there are schemes in place to:
The community provider works to support primary care through the community respiratory and diabetes clinics, and the specialist heart failure nurses to optimise the management of people with long-term conditions and to support education and training for people to manage their own long-term conditions.
Richmond has a predominantly white population, and it is this cohort that has the highest detected prevalence of long-term conditions and specifically within the 15–64 age groups, this information correlates with the age profile of attendance to hospital.
Current services are not as joined up as they need to be which can lead to fragmentation of pathways of care, people not being actively managed or followed up in a timely manner resulting in exacerbation and disease progression.
Richmond’s model of care supports the development of healthy behaviours and lifestyles that enable the population to make choices within a healthy community environment facilitated by the wider determinants of health. It aims to empower people to self-manage any long-term health conditions, maintain independence and an enjoyable lifestyle within the parameters of disease and to prevent the progression of disease into complexity and frailty.
We will underpin our model with the use of technology and work with our partners in health, social care and the voluntary sector to maximise resources and opportunities. The approach is through a framework of Prevent; Detect; Manage; Optimise
To target weight management and support people to make healthy lifestyle choices by maximising the public health offer to the at-risk groups starting early in life to build good habits. Supporting mental health and wellbeing recognising the connectivity between a person’s mental and physical health specifically in relation to stress and anxiety
Develop a service for active opportunistic identification of people at risk of developing a long-term condition or those who are undiagnosed working with community pharmacies/ optometrists etc. Optimise the impact and opportunity for finding people with an undiagnosed long-term condition through existing annual health checks Opportunistic screening of identified cohorts of people who may be hard to reach or vulnerable to developing a long-term condition and may not be picked up through traditional methods of detection.
Develop a model of supported self-management whereby a person with a newly diagnosed long-term condition will be assessed as to their motivation levels, has a care plan developed and then has access to a range of interventions to enable them to self-manage their condition, i.e. information, structured education, buddying, health coaching regular monitoring and social prescribing (the figure below).
Proposed model of care for LTCs
Source: SWLCCG
Obesity is a modifiable risk factor for several long term conditions. Obesity is one of the key behavioural risk factors that the NHS health checks assesses.
Overweight (including obesity) prevalence in adults: In 2022/23, Richmond’s rate was 55.7%, which was the 13th lowest in London, 13.0% lower than the England average and 2.6% lower than the London average. The latest Borough figure for 2022/23 was also 5.8% higher than in 2015/16, in comparison with 4.4% increase in England’s rate in the equivalent time period.
Source: OHID: Public Health Profiles
Obesity in early pregnancy: In 2018/19, Richmond’s rate was 10.9%, which was the 6th lowest in London, 50.5% lower than the England average and 38.6% lower than the London average. Time series data were not available for this indicator.
In 2019/20, Richmond’s rate hospital admissions directly attributable to obesity was 14.0 per 100,000 population, which is the lowest rate in London, 28.9% lower than the England average and 51.7% lower than the London average. The latest Borough figure was also 7.2% higher than in 2013/14, in comparison with a 13.8% increase in England’s rate in the equivalent time period.
Source: NHS Digital. Statistics on Obesity, Physical Activity and Diet.
In this section explores the latest available Richmond-level information on prevention, prevalence, primary care management, hospitalisations, and mortality from cardiovascular conditions. The local coverage and outcomes of the NHS Health Checks, a programme for adults in England aged 40 to 74, is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes and dementia, included in this section. The NHS Health Check helps find ways to lower cardiovascular risk and has a clear role in delivering preventative and personalised solutions to ill-health, and empowering individuals to live healthier and more active lives
Cardiovascular disease (CVD) includes a group of diseases affecting the heart or blood vessels. The list of specific diseases within the CVD classification include coronary heart disease (CHD), myocardial infarction (heart attack), angina, coronary artery diseases and stroke. Primary prevention of CVD requires patients at risk are identified before disease has become established. People with hypertension are at high risk of developing CVD. Controlling blood pressure is therefore a significant factor that protects the patient from developing serious circulatory conditions.
The NHS Health Checks Programme is a mandated service under the Health and Social Care Act 2012. Local Authorities have a legal duty to invite 100% of its eligible population over a 5-year period and deliver at least 50% NHS Health Checks. The annual local targets translate to 20% invitations and 10% NHS Health Checks. The programme is a systematic vascular risk assessment and management programme, aiming to reduce the incidence of heart disease, stroke, diabetes and kidney disease. It is also an opportunity to identify dementia across the population, particularly high risk and vulnerable groups. It helps people to take action to avoid, reduce or manage their risk of developing these conditions It also contributes to the objectives of tackling health inequalities, including socio-economic, ethnic and gender differences.
Office for Health Improvement & Disparities estimates the NHS Health Check Programme could, on average, prevent 1,600 heart attacks and strokes, and save at least 650 lives each year. The programme aims to prevent over 4,000 people a year from developing diabetes, detect at least 20,000 cases of diabetes or kidney disease earlier, allowing individuals to be better managed and improve their quality of life. It achieves this by assessing the top seven risk factors driving the burden of non- communicable disease in England and by providing individuals with behavioural support and, where appropriate, pharmacological treatment.
The NHS Health Checks programme aims to prevent heart disease, stroke, diabetes, and kidney disease and raise awareness of dementia both across the local population and within high risk and vulnerable groups . It also helps people to take action to avoid, reduce or manage their risk of developing these conditions as well as opportunities to make progress in tackling health inequalities, including socio-economic, ethnic and gender inequalities.
The service is available to individuals between 40 and 74 years of age without existing cardiovascular disease (CVD). Invitations can be prioritised for residents who are estimated to have a high CVD risk score (Q-risk) . The aims of the NHS Health Check programme are to offer an NHS Health Check to 20% of the eligible population every year as part of a 5-year rolling programme with an uptake level of 50%:
In Richmond 25 GP Surgeries and 2 pharmacies are contracted to deliver NHS Health Checks. Activity data is automatically extracted from GP surgeries clinical data system Vision Plus and from pharmacies via Pharmoutcomes.
Demographics of service users accessing the service via GP surgeries during 2019/20:
Demographics of service users accessing the service via pharmacies during 2019/20:
The data shows that during 2019/20, females were more likely to access an NHS Health Check than males. The majority of service users (46% GP surgeries, 49% pharmacies) were aged 40–50. The BAME population is slightly overrepresented in comparison with the borough profile for age range. However, there is a data quality issue with ethnicity not being recorded in nearly one third of all consultations.
During 2019/20 the Richmond NHS Health Check programme outcomes included:
Referrals from an NHS Health Check to lifestyle support services during 2019/20 included:
In July 2020, The Department of Health and Social Care (DHSC) asked Public Health England (PHE) to carry out an evidence-based review of the NHS Health Check programme. The review will advise Ministers on how NHS Health Checks can evolve in the next decade to maximise the future benefits of the programme in preventing illness and reducing health inequalities. This may include recommendations on the content of NHS Health Checks, how the programme is delivered and how it links to the wider health and social care system 4.
Cumulative percentage of the eligible population aged 40 to 74 offered an NHS Health Check: In 2018/19 - 22/23, Richmond’s rate was 55.2% (n=35119), which was the 8th lowest in London, 14.7% lower than the England average and 22.0% lower than the London average. The latest Borough figure for 2018/19 - 22/23 was also 28.0% lower than in 2013/14 - 17/18, in comparison with 28.8% decrease in England’s rate in the equivalent time period.
Cumulative percentage of the eligible population aged 40 to 74 offered an NHS Health Check who received an NHS Health Check: In 2018/19 - 22/23, Richmond’s rate was 54.1% (n=18987), which was the 10th highest in London, 27.9% higher than the England average and 12.1% higher than the London average. The latest Borough figure for 2018/19 - 22/23 was also 6.3% higher than in 2013/14 - 17/18, in comparison with 13.2% decrease in England’s rate in the equivalent time period.
Cumulative percentage of the eligible population aged 40 to 74 who received an NHS Health check: In 2018/19 - 22/23, Richmond’s rate was 29.8% (n=18987), which was the 13th lowest in London, 9.1% higher than the England average and 12.5% lower than the London average. The latest Borough figure for 2018/19 - 22/23 was also 23.5% lower than in 2013/14 - 17/18, in comparison with 38.2% decrease in England’s rate in the equivalent time period.
The NHS Health Checks programme provides cardiovascular risk assessments for people between the ages of 40 and 74 years and are an important part of type 2 diabetes prevention and diagnosis. The NHS Health Checks programme includes a diabetes risk assessment or filter, which should lead onto blood testing for those identified at risk. Those people identified with NDH following their blood test should be offered a referral to the NDPP and other lifestyle support services. People identified as having diabetes are managed through the diabetes care pathway through primary care.
In 2019/20, Richmond completed 5187 NHS Health Checks; 23 of these people were diagnosed with diabetes and 59 people were referred to the NDPP. Nationally, it is estimated that Health Checks could prevent 4,000 people a year from developing diabetes 5 and for every 80 – 200 NHS Health Checks, 1 person is diagnosed with type 2 diabetes (1.25%–0.5% of checks) 6. Richmond was lower than this range with 0.44% of checks resulting with a diabetes diagnosis.
Diabetes is a condition where the amount of glucose (a type of sugar) in the blood is too high. There are many types of diabetes including Type 1, Type 2, gestational, and other rarer types of diabetes. Type 1 Diabetes accounts for around 8% of cases, other rarer types of diabetes accounts for 2%, and Type 2 Diabetes accounts for 90%.
Type 1 Diabetes develops when the body is unable to produce insulin. Type 2 Diabetes develops when the body stops producing enough insulin, or the body’s cells stop reacting to the insulin produced. This means sugar builds up in the blood and cannot get into the cells of the body where it is used for fuel.
This section focuses on type 2 diabetes as it is associated with lifestyle factors and can be delayed or prevented through support to change behaviour around lifestyle choices. Other types of Diabetes, such as type 1 diabetes, are not related to lifestyle issues and cannot be prevented.
The number of people developing type 2 diabetes has been increasing globally. Around four million people in the UK have type 2 diabetes and by 2030 it is estimated that there will be more than 5.5 million people with it. This is largely due to the rise in obesity, which is estimated to account for 80–85% of all type 2 diabetes cases in the UK 7. Being overweight or obese is the major modifiable risk factor for type 2 diabetes.
There are many significant impacts on the health and wellbeing of people living with type 2 diabetes in Richmond. Additionally, there are large financial impacts on the NHS and wider social and economic costs due to the rise in type 2 diabetes.
Type 2 Diabetes is a major cause of premature mortality, with around 22,000 people with diabetes dying early each year in England. people with diabetes are more likely to die than their peers of the same age and sex in the general population. In Richmond, the additional risk of death in people with diabetes is 50.9%; for England, the additional risk was 21.8% 8. In England and Wales, people aged 35 to 64 living with type 2 diabetes are up to two times more likely to die prematurely 9.
Those who develop type 2 diabetes are subsequently at greater risk of developing complications from the disease: * CVD including heart attack and stroke – type 2 diabetes leads to an increased risk of CVD. In Richmond, people with diabetes are 164.8% more likely than people without diabetes to have a heart attack, and 62.6% more likely to have a stroke. * Blindness- leading cause of preventable slight loss among people of working age * Nerve damage - most often in legs or feet * kidney disease and failure - diabetes is the leading cause of kidney disease People with diabetes rarely die as a direct result of diabetes. Most die from complications such as heart disease, stroke and kidney failure.
Diabetic foot disease is a potential consequence of the complication of nerve damage and the complication of peripheral vascular disease. Foot problems are the most frequent reasons for hospitalisation amongst people who have diabetes. Latest figures for Richmond show that between 2015/2016 and 2017/2018, there were 325 hospital spells for diabetic foot disease. The median length of stay in hospital was 7 days and the total number of days spent in hospital for diabetic foot disease was 3,359.
Diabetes is one of the leading causes of amputation of the lower limbs. From 2015/2016- 2017/2018 there were 35 minor amputation procedures (removal of toes or feet) performed in Richmond, giving a directly age and ethnicity standardised rate of 18.7 minor amputations per 10,000 population-year. This was not significantly different to the England average. There were only 6 major amputation procedures (above or below the knee amputation) performed, which was not large enough to calculate a robust standardised rate for comparison to England.
People with diabetes are more likely to be admitted to hospital and have longer stays than similar people without the condition. One in six of all people in hospital in England have Diabetes. While Diabetes is often not the reason for admission, they often need a longer stay in hospital, are more likely to be re-admitted, and their risk of dying is higher.
A type 2 diabetes diagnosis can also negatively impact quality of life and social contact, which can have an adverse effect on mental health. people with diabetes are more likely to be diagnosed with Depression. Depression is more prevalent among people living with type 2 diabetes, compared with those who are not. This, as well as many other complications of type 2 diabetes, increases their risk of premature death.
A survey 10 conducted by Diabetes UK also found that:
There is a close association between type 2 diabetes and dementia, in particular Alzheimer’s Disease and Vascular Dementia 11:
In addition to mental health and quality of life, the important social consequences of type 2 diabetes include impacts on individuals’ family life, education and employment. These are wider consequences that are just as important as health outcomes, as they have far-reaching impacts.
Certain Black, Asian and minority ethnic (BAME) groups have a greater chance of developing type 2 diabetes than people from White ethnic groups. The South Asian population living in the UK are up to six times more likely to develop type 2 diabetes than that of the white population. People of African and African-Caribbean descent are three times more likely to have type 2 diabetes than the white population. In Richmond, nearly 22% of people with type 2 diabetes are of ethnic minority origin.
Diabetes treatment currently accounts for around 10 per cent of the annual NHS budget. This is just under £10 billion a year, with 80% spent on managing preventable complications associated with the condition, and 20% on treatment (e.g. primary care and prescribing).
In 2018/19, costs for diabetes drugs for Richmond CCG amounted to £1,778,198.6 12. Diabetes prescriptions made up 12.5% of the total cost of prescribing in England during 2018/19. There are also major indirect costs, such as loss of productivity due to increased death and illness and the need for social care.
People with underlying health conditions, such as Diabetes are at a higher risk of poor outcomes from COVID-19 than people without these conditions. Recent national data reviews show that Diabetes was mentioned on 21% of death certificates where COVID-19 was also mentioned. People with type 2 diabetes are twice as likely to die than people who don’t have Diabetes when in hospital with COVID-19.
BAME groups are also at an increased risk of death from COVID-19. The proportion where Diabetes was mentioned on death certificates was higher in all BAME groups when compared to White ethnic groups and was 43% in the Asian group and 45% in the Black group.
Due to lockdown periods, many people will have been less physically active, have unhealthier diets, and not accessing healthcare and lifestyle services as usual. Some people with non-diabetic hyperglycemia (high risk of Type 2) may now have Diabetes. There may be a greater number of people living with undiagnosed Diabetes following COVID-19.
As people with diabetes can be more vulnerable to becoming seriously ill from COVID-19, it is important to continue to identify people at risk of or living with undiagnosed Diabetes. Prevention work to improve the health and fitness of people, through activities such as exercise, eating well, losing weight and stopping smoking, will help to minimise the health impact of COVID-19. People at high risk of Diabetes should be offered effective support (e.g. Diabetes Prevention Programme) and they should be monitored for progression to Diabetes, which will support early diagnosis.
The risk of type 2 diabetes is about the chance or likelihood of developing type 2 diabetes over a period of time. A person’s level of risk depends on a combination of factors including genetics, which cannot be changed, and preventable lifestyle factors, with risk levels varying over the life course. Risk can be reduced in the universal population through population and community interventions on healthy eating and physical activity throughout pregnancy, infancy, childhood, adulthood. Many people will have low risk for type 2 diabetes by maintaining a healthy lifestyle.
Risk increases with a change in lifestyle factors, such as obesity, as well as with age. People at increased risk are likely to not be aware as they may not have symptoms. Without changes to lifestyle, the risk of type 2 diabetes can progress, leading people to become high risk for developing type 2 diabetes. People are at high risk of developing type 2 diabetes if their blood sugars are raised, but not high enough to be diagnosed with type 2 diabetes. They are also at increased risk of other cardiovascular conditions 13.
The risk factors for being at high risk of type 2 diabetes and developing type 2 diabetes are the same. These factors include:
People at high risk of type 2 diabetes have a greater chance of developing type 2 diabetes in the future. One out of four people with high risk will develop type 2 diabetes in the next 10 years 16.
There are various terms used for high risk of Diabetes including: pre-Diabetes, borderline Diabetes, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), Impaired Glucose Regulation (IGR), or Non-diabetic hyperglycaemia (NDH), which all mean that someone is at high risk of a diagnosis of for developing type 2 diabetes. NDH will be used throughout this Section to mean high risk of type 2 diabetes.
Once people know they are at risk, they can often prevent or delay type 2 diabetes from starting by making healthy changes to their diet and lifestyle. Without lifestyle changes, people with NDH are very likely to progress to type 2 diabetes. Eating healthy foods, incorporating physical activity in daily routines, and maintaining a healthy weight can help bring blood sugar levels back to normal.
A blood test which detects the level of glucose in your blood is needed to make the diagnosis of NDH and type 2 diabetes. An HbA1c blood test is often used and gives an average of how high your blood glucose levels have been over the preceding few months.
NDH is defined as an HBA1c value between 6.0% (42mmol/mol) and 6.4% (47mmol/mol) excluding those who had already been diagnosed with diabetes with an HBA1c value in this range. An HbA1c value of 6.5% (48 mmol/mol) or above is recommended as the blood level for diagnosing Diabetes. A value of less than 48mmol/mol (6.5%) does not exclude Diabetes diagnosed using glucose tests.
Around 16% of the Richmond population are from BAME groups 17. Asian/Asian British is the largest BAME group in Richmond (7.3%). In terms of location, St Margaret’s and North Twickenham had the greatest proportion of the White/White British ethnic group at 88%, while Heathfield had the highest proportion of the BAME ethnic group at 30% (compared to 16% for the Borough). BAME groups are expected to increase to 17.2% by 2030.
Richmond maintains a rank within the 10% least deprived Local Authorities (LAs) in England between 2015 and 2019 and remains the least deprived London borough. In terms of older people, 34% (c. 68,240 residents) of the Richmond population are aged 50 years and over. The number of older people over 65 in the borough of Richmond is expected to increase by 6.5% and number of people over age 85 increasing by 7.1% by 2021. Hampton/Teddington, Heathfield/Whitton, and Kew Gardens are areas with a higher proportion of older people. The most deprived areas in terms of income deprivation affecting older people are Hampton North, Heathfield, Barnes, and North Richmond.
In addition to Hampton and Heathfield, Whitton, Hampton North and Hampton Hill tend to have higher prevalence of heart disease, respiratory disease and other conditions. These areas are also relatively more deprived. Nearly one in three people registered with a GP in Richmond has one or more long-term condition and nearly one in ten has three or more 18.
There are an estimated 15,000 residents 16 years and over (9.6% of population) that have NDH in Richmond. In 2018/19, GP Practices identified around 4,000 of these people (1.3%). This means there could be around 11,000 people who are unaware they are high risk for developing type 2 diabetes.
The figure below provides the demographic breakdown of people in Richmond registered with NDH by their GP Practice. At individual GP practice level, the percent of people identified with NDH varies, ranging from around 0.2% to 6%.
Source: NHS Digital. National Diabetes Audit. 2018/19
At individual GP practice level, the prevalence of diagnosed Diabetes ranges from around 1% to 6%. In 2018/19, there were 5,770 people diagnosed with type 2 diabetes.
Diabetes: QOF prevalence (17+ yrs): In 2022/23, Richmond’s rate was 4.3% (n=8417), which was the 5th lowest in London, 41.7% lower than the England average and 36.8% lower than the London average. The latest Borough figure for 2022/23 was also 17.9% higher than in 2012/13, in comparison with 23.9% increase in England’s rate in the equivalent time period.
The figure below provides the demographic breakdown of people diagnosed with type 2 diabetes.
There is variation in diabetes prevalence across the borough. Diabetes is most prevalent in Heathfield and Whitton, followed by Hampton. This corresponds with having a higher proportion of BAME groups, older people aged 65+, and deprived areas of the borough, which are risk factors for type 2 diabetes (the figure below).
Source: DataRich
It is estimated that 12,553 people in Richmond have diabetes (all types of diabetes). This includes people that have already been diagnosed by their GP and those who have diabetes but do not know it (undiagnosed). Around 55% of people living with diabetes are diagnosed 19. This is lower than the diagnosis rates for England and London, 78% and 71.4% respectively and is the third lowest in London.
Considering the diagnosed prevalence for Type 1 and Type 2 and other diabetes, it is estimated that there are 5,649 people living with undiagnosed diabetes (45%) that are not receiving treatment and are missing out on vital health checks.
As Richmond has a lower prevalence of some of the risk factors for diabetes (e.g. obesity, hypertension), higher prevalence of healthy lifestyle behaviours (e.g. healthy eating, physical activity), and lower prevalence of people with complications related to diabetes (e.g. stroke, CHD), it is a possibility that the observed number of people with undiagnosed diabetes in Richmond is actually lower than the estimated number. There is the caveat with all modelled data, that there are data limitations and a degree of uncertainty associated with these estimates. Nonetheless, the estimates can still be considered indicative, showing that there is still room for improvement in diabetes diagnosis in Richmond.
Some of the undiagnosed cases could be within the more elderly groups. Richmond is one of only six boroughs in London that has more than 30% of its population aged over age 50 years. It also has the highest prevalence of type 2 diabetes (39.9%) in people aged 65 to 79 years old compared with all the other London boroughs. Some of the hidden/undiagnosed diabetes cases could be within the elderly population.
Projections for Diabetes prevalence up to 2035 show an increase in the number of people living with diabetes in Richmond, as well as in London and England at a similar rate. By 2035, it is estimated that 7.8% of people in Richmond will be living with diabetes. This is less than a 1% increase but amounts to a further 3,609 people living with diabetes in Richmond over the next 15 years (the figure below).
Source: Prevalence estimates of Diabetes, Public Health England, 2016
NICE recommends treatment targets for Hba1c (glucose control), blood pressure and serum cholesterol: Target Hba1c reduces the risk of all diabetic complications, target blood pressure reduced the risk of vascular complications and reduced the progression of eye disease and kidney failure and target cholesterol reduced the risk of vascular complications. ‘Meeting all three treatment targets’ is achieved where a patient has HbA1c ≤58mmol/mol, cholesterol <5mmol/L and blood pressure ≤140/80 (the table below).
In 2018/19, 46.4% of people with type 2 diabetes achieved all three treatment targets; this is higher than similar CCGs, STP, and England. Achievement of each treatment target was also higher in comparison. However, there was variation in the achievement between GP Practices, ranging from around 30%-60%.
Source: National Diabetes Audit (NDA) 2018/19
The prevalence of diabetes in people with a learning disability is unknown, but general population data indicate it is around 10% (including Type 1, but in most cases this is type 2 diabetes) 20. Applying this figure to the number of people with learning disabilities in Richmond (695 people with learning disabilities 21) provides a rough estimate of 70 people with learning diabetes that have diabetes. The onset of diabetes is seen at an earlier age for people with a learning disability 22.
People with severe mental illnesses are at substantially higher risk of diabetes compared with the general patient population. People with schizophrenia, psychosis, bipolar depression and anxiety are at double the risk of developing type 2 diabetes 23. In Richmond, 1,896 people were registered with their GP with schizophrenia, bipolar affective disorder and other psychoses, with 64% of patients over age 40 having a record of blood glucose or HbA1c in the preceding 12 months 24.
Current estimates place the number of older people with diabetes resident in care homes at one in four 25. Research has shown that in addition to those with a known diagnosis of diabetes, there are people with undiagnosed diabetes in care homes whose needs for care are not being met.
The estimated NDH prevalence is based on modelled data but does not include confidence intervals. PHOF states a caveat that “with all modelled data, there is a degree of uncertainty associated with these estimates therefore should be considered indicative only.” Additionally, ward level or LSOA breakdown of the data is not available for either data set, making it difficult to interpret this data beyond borough level. Like the estimated NDH prevalence data, estimated Diabetes prevalence is based on modelled data and does not include confidence intervals.
A range of services are available for people at high risk of developing type 2 diabetes and for people diagnosed with type 2 diabetes. The services offer support to people to help prevent type 2 diabetes, as well as help identify people with diabetes early, and ensure quality of care and effective management of their Diabetes.
Much of the management and monitoring of patients at risk of and with type 2 diabetes is undertaken by GPs and members of the Primary Care Team, for example through:
To support the Enhanced Primary Care Diabetes Service of GP Practices, the CCG has partnered with the local GP Federations to focus on quality, support and education for primary care (April 2019-March 2021). This will ensure that all GP Practices have access to the expertise and support to achieve improvements in the delivery of high- quality care for patients with, or at risk of, Diabetes.
The NDPP is an intensive lifestyle support programme for people identified as high risk for developing type 2 diabetes. Individuals are eligible if they are identified by their GP with NDH, defined as having an HbA1c 42 – 47 mmol/mol (6.0 – 6.4%) or a fasting plasma glucose (FPG) of 5.5 – 6.9 mmol/l. The service offers tailored, personalised support to reduce the risk of type 2 diabetes including education on healthy eating and lifestyle, help to lose weight and physical exercise programmes. Local group sessions are delivered in community settings, and a digital option is offered to those declining face-face group sessions. Early outcomes of the Service across England demonstrate that those completing the Programme had a mean weight loss of 3.3 kg and an HbA1c reduction of 2.04 mmol/mol 26.
From June 2018-November 2020, 1,305 of people in Richmond were referred to the service. The table below shows the outcomes of the service.
Source: Richmond NDPP data
Of the people who attended the NDPP Service in Richmond:
Structured education programmes can help adults with type 2 diabetes to improve their knowledge and skills and help to motivate them to take control of their condition and self-manage it effectively. A range of diabetes education programmes exist in London, such as DESMOND and X-PERT. Remote courses such as Oviva are also available for those who prefer digital support.
The table below provides an overview of referrals to Structured Education in 2017 27.
The table below provides an overview of referrals to Diabetes Book & Learn from October 2018-January 2020 for people with type 2 diabetes in Richmond. However, these are rough figures as there have been issues with recording of attendance by providers on the Diabetes Book & Learn platform.
Wherever possible patients with diabetes are treated by their own GP with support from a Diabetes Specialist Nurse allocated to the practice. However, HRCH’s specialist diabetes team can provide specialist care for cases that are too complex to be dealt with by a patient’s GP practice, but not complex enough to warrant hospital admission.
The teams work with the patient to agree outcomes and then produce a care-management plan, which the patient’s GP practice can implement between visits to the specialist clinic. This approach means that patients with diabetes are receiving specialised care for their condition at the most appropriate level and do not have to make unnecessary trips to acute hospitals.
The HRCH diabetes service in Richmond provides:
Having a healthy diet is an important part of living with type 2 diabetes and managing it well. Dietetics can provide individuals with advice and guidance about their diet. Dietetic services are available through Kingston Hospital as well as through St. Georges Hospital based Queen Mary’s Hospital. Additionally, Specialist Diabetes Dietitians are available in the HRCH Diabetes Team and the Beta Cell Diabetes Team at Queen Mary’s Hospital.
Podiatry care is offered to patients with diabetes in Richmond to reduce the risk of lower limb ulceration and early amputation. HRCH Podiatry and Foot Health team are a registered “Any Qualified Provider” (AQP) of routine podiatry care, as well as the only NHS provider for specialist podiatry care to people registered with a Richmond GP. Referrals can be made by a Richmond GP or other health care professional.
Diabetes and Endocrinology departments are mainly accessed by Richmond residents at Kingston Hospital and Queen Mary’s Hospital. The clinical needs of patients referred to this service have a greater complexity or complications. Input may also be required from other specialities, as clinically appropriate.
The specialist nurse led services, provide care for people with diabetes requiring additional support and help with their diabetes management. Consultant led clinics are also provided in their outpatient departments and outreach centres.
Podiatric foot care is offered to patients in Richmond to reduce the risk of lower limb ulceration and early amputation. Healthshare Richmond is the provider of NHS Community Podiatry Services in Richmond. Referrals can be made by a Richmond GP or other Health Care Professionals.
Type 2 diabetes increases the risk of having an eye problem called retinopathy. It is important to have regular eye screening checks for retinopathy. These are different from normal sight tests and specifically look for early signs of damage caused by Diabetes. Eye screening should happen at or around the time of diagnosis and if there are no concerns, then at least once a year after that. If there are signs that damage may be developing, individuals may be offered another check or may be referred to an eye specialist at a hospital.
In 2019, 68.4% of people with diabetes on GP registers had a record of retinal screening in the preceding 12 months. This is lower than London and England (73.7% and 77.3% respectively).
From 2016/17, the National Diabetes Audit has looked at the care of people with Serious Mental Illness, SMI and Diabetes and compared this to the care received by the whole population of people with diabetes. People with SMI and type 2 diabetes are, on average, younger than those with type 2 diabetes who do not have SMI.
NICE provides evidence-based guidance and advice on the prevention, diagnosis and management of Diabetes:
The Diabetes Pathway shows the core components of an optimal Diabetes Service, evidence of the opportunity to reduce variation and improve outcomes and the key evidence-based interventions which the system should focus on for greatest improvement, supported by practice examples from across the NHS
Early diagnosis and treating hypertension significantly reduces the risk of CVD.
Hypertension: QOF prevalence (all ages): In 2022/23, Richmond’s rate was 10.2% (n=24768), which was the 11th lowest in London, 29.0% lower than the England average and 6.2% lower than the London average. The latest Borough figure for 2022/23 was also 2.4% lower than in 2012/13, in comparison with 5.5% increase in England’s rate in the equivalent time period.
CHD: QOF prevalence (all ages): In 2022/23, Richmond’s rate was 2.0% (n=4755), which was the 14th highest in London, 34.2% lower than the England average and 5.8% higher than the London average. The latest Borough figure for 2022/23 was also 1.5% lower than in 2012/13, in comparison with 10.6% decrease in England’s rate in the equivalent time period.
Hospital admissions due to coronary heart disease: In 2022/23, Richmond’s rate was 386.9 per 100,000 (n=690), which was the 15th lowest in London, 0.0% lower than the England average and 0.0% higher than the London average. The latest Borough figure for 2022/23 was also 39.4% lower than in 2003/04, in comparison with 46.2% decrease in England’s rate in the equivalent time period.
Stroke: QOF prevalence (all ages): In 2022/23, Richmond’s rate was 1.3% (n=3112), which was the 8th highest in London, 30.3% lower than the England average and 16.8% higher than the London average. The latest Borough figure for 2022/23 was also 12.6% higher than in 2012/13, in comparison with 8.7% increase in England’s rate in the equivalent time period.
Hospital admissions due to stroke: In 2022/23, Richmond’s rate was 163.7 per 100,000 (n=285), which was the 7th lowest in London, 2.8% lower than the England average and 0.0% higher than the London average. The latest Borough figure for 2022/23 was also 5.1% lower than in 2003/04, in comparison with 6.8% decrease in England’s rate in the equivalent time period.
Mortality rate from stroke, all ages: In 2020 - 22, Richmond’s rate was 39.1 per 100,000 (n=197), which was the 3rd lowest in London, 22.2% lower than the England average and 15.5% lower than the London average. The latest Borough figure for 2020 - 22 was also 59.6% lower than in 2001 - 03, in comparison with 58.6% decrease in England’s rate in the equivalent time period.
Respiratory diseases include asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis and pneumonia. In this section the latest available Richmond-level information on prevalence, hospitalisations and mortality linked to respiratory conditions will be explored. Most of the data presented are published for the registered CCG population (patients registered with Richmond’s GP). In 2019/20 five South West London (SWL) CCGs merged into a single South West London CCG which makes it difficult to distinguish information specific to Richmond. For most CCG indicators the data presented in the chapter is two years old, as the latest 2019/20 and 2020/21 data is only available at SWL CCG level.
COPD (chronic obstructive pulmonary disease) is a diagnostic term that captures a variety of serious lung conditions including chronic bronchitis and emphysema. COPD is usually prevalent in adults over the age of 35 years. COPD is a serious lung disease for which smoking is the biggest preventable risk factor.
COPD: QOF prevalence (all ages): In 2022/23, Richmond’s rate was 1.0% (n=2519), which was the 14th highest in London, 43.6% lower than the England average and 2.0% higher than the London average. The latest Borough figure for 2022/23 was also 5.1% higher than in 2012/13, in comparison with 6.0% increase in England’s rate in the equivalent time period.
Emergency hospital admissions for COPD (35+): In 2019/20, Richmond’s rate was 217.6 per 100,000 (n=215), which was the 2nd lowest in London, 47.6% lower than the England average and 39.2% lower than the London average. The latest Borough figure for 2019/20 was also 16.6% lower than in 2010/11, in comparison with 1.3% increase in England’s rate in the equivalent time period.
Asthma: QOF prevalence (6+ yrs): In 2022/23, Richmond’s rate was 4.8% (n=10872), which was the 16th highest in London, 26.9% lower than the England average and 0.9% higher than the London average. The latest Borough figure for 2022/23 was also 6.2% higher than in 2020/21, in comparison with 2.3% increase in England’s rate in the equivalent time period.
MSK conditions are injuries and disorders that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.). Musculoskeletal conditions are the largest cause of years lived with disability (YLDs), accounting for 17% of all YLDs worldwide 33.
Percentage reporting a long-term Musculoskeletal (MSK) problem: In 2023, Richmond’s rate was 13.1%, which was the 16th lowest in London, 28.8% lower than the England average and 2.3% lower than the London average. The latest Borough figure for 2023 was also 12.9% lower than in 2018, in comparison with 2.1% decrease in England’s rate in the equivalent time period.
Percentage reporting at least two long-term conditions, at least one of which is MSK related: In 2023, Richmond’s rate was 8.5%, which was the 6th lowest in London, 36.9% lower than the England average and 8.7% lower than the London average. The latest Borough figure for 2023 was also 10.8% lower than in 2018, in comparison with 0.0% decrease in England’s rate in the equivalent time period.
% reporting a long term MSK problem who also report depression or anxiety: In 2016/17, Richmond’s rate was 21.5%, which was the 5th lowest in London, 10.8% lower than the England average and 17.0% lower than the London average. The latest Borough figure for 2016/17 was also 19.8% higher than in 2014/15, in comparison with 7.3% increase in England’s rate in the equivalent time period.
Rheumatoid Arthritis: QOF prevalence (16+ yrs): In 2022/23, Richmond’s rate was 0.5% (n=1080), which was the 13th highest in London, 28.2% lower than the England average and 2.5% higher than the London average. The latest Borough figure for 2022/23 was also 7.7% higher than in 2013/14, in comparison with 4.6% increase in England’s rate in the equivalent time period.
Hip fractures in people aged 65 and over: In 2022/23, Richmond’s rate was 510.4 per 100,000 (n=170), which was the 11th highest in London, 8.5% lower than the England average and 1.6% higher than the London average. The latest Borough figure for 2022/23 was also 15.3% lower than in 2010/11, in comparison with 9.3% decrease in England’s rate in the equivalent time period.
People living with mental health problem are more likely to make unhealthy lifestyle choices and twice as likely to smoke 34. Mental health problems often lead to alcohol and substance misuse 35; increasing the risk of obesity, asthma, diabetes, chronic obstructive pulmonary disease (COPD) and cardiovascular disease 36. This section provides an overview of nationally available data on mental health in adults living in Richmond, including GP recorded prevalence of mental illnesses, referral rates to specialist services, admissions to hospital, employment rates, accommodation status and premature mortality rates in adults with mental health problems.
GP Mental Health Registers include patients with a diagnosis of schizophrenia, bipolar affective disorder and other psychoses.
Mental Health: QOF prevalence (all ages): In 2022/23, Richmond’s rate was 0.9% (n=2141), which was the 4th lowest in London, 11.2% lower than the England average and 22.3% lower than the London average. The latest Borough figure for 2022/23 was also 6.9% higher than in 2012/13, in comparison with 18.6% increase in England’s rate in the equivalent time period.
Estimated prevalence of common mental disorders: % of population aged 16 & over: In 2017, Richmond’s rate was 13.2% (n=20430), which was the lowest in London, 21.9% lower than the England average and 31.4% lower than the London average. Time series data were not available for this indicator.
Gap in the employment rate for those who are in contact with secondary mental health services and the overall employment rate: In 2021/22, Richmond’s rate was 70.8 percentage points, which was the 16th highest in London, 2.0% higher than the England average and 0.6% lower than the London average. Time series data were not available for this indicator.
Adults in contact with secondary mental health services who live in stable and appropriate accommodation: In 2020/21, Richmond’s rate was 73.0%, which was the 11th highest in London, 25.9% higher than the England average and 19.7% higher than the London average. The latest Borough figure for 2020/21 was also 13.3% lower than in 2011/12, in comparison with 6.2% increase in England’s rate in the equivalent time period.
Hospital admissions for mental health conditions: In 2022/23, Richmond’s rate was 90.9 per 100,000 (n=40), which was the 3rd highest in London, 12.5% higher than the England average and 47.4% higher than the London average. The latest Borough figure for 2022/23 was also 21.6% higher than in 2010/11, in comparison with 12.3% decrease in England’s rate in the equivalent time period.
Premature mortality in adults with severe mental illness (SMI): In 2020 - 22, Richmond’s rate was 61.5 per 100,000 (n=245), which was the lowest in London, 44.7% lower than the England average and 44.2% lower than the London average. The latest Borough figure for 2020 - 22 was also 4.4% higher than in 2015 - 17, in comparison with 22.6% increase in England’s rate in the equivalent time period.
Sexual health is an important public health issue with health, social and economic impacts that can affect the people across the life course. It is a fundamental aspect of human identity and life experience. Richmond adopts the World Health Organisation’s current working definition of sexual health which is described as:
“A state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.” 37
Poor sexual health can lead to sexually transmitted infections (STIs), HIV and unintended pregnancies which can lead to further long-lasting and costly impacts for both individuals and wider society. However, they can be reduced through safer sex practices such as the use of condoms, regular testing, and access to sexual health and reproductive services 38. Sexual health services currently focus on treatment for sexual health transmitted infections, HIV, unplanned pregnancies as well as prevention.
All new STI diagnoses rate per 100,000: In 2023, Richmond’s rate was 649.1 per 100,000 (n=1265), which was the 6th lowest in London, 7.7% lower than the England average and 55.2% lower than the London average. The latest Borough figure for 2023 was also 6.0% lower than in 2012, in comparison with 16.6% decrease in England’s rate in the equivalent time period.
STIs key findings for Richmond:
MSM are among the largest groups diagnosed with a new STI diagnosis and STI diagnosis is increasing among MSM. BAME communities in Richmond also experience a significantly higher proportion of STI diagnosis compared with the proportion of the population from ethnic groups. The age and gender distribution of new STI diagnoses (Chlamydia, gonorrhoea, herpes, syphilis, warts) in Richmond in 2018 highlights that the largest number of newly diagnosed STI’s are in the 25 to 34-year-old age cohort.
The age and gender distribution of new STI diagnoses (Chlamydia, gonorrhoea, herpes, syphilis, warts) in Richmond residents in 2018 highlights that the largest number of newly diagnosed STI’s are in the 25 to 34-year-old age cohort (as shown in the figure below).
The age and gender distribution of new STI diagnoses (chlamydia, gonorrhoea, herpes, syphilis, warts) in Richmond residents in 2018 highlights that the largest number of newly diagnosed STI’s are in the 25 to 34-year-old age cohort (figure below).
Source: GUMCAD Extracted Feb 2020
People identifying as LGBTQ+ can experience a greater degree of health inequalities, including sexual health 39. National data shows where gender and sexual orientation are known. MSM account for 29% of London residents diagnosed with a new STI in a specialist health clinic. 90% have syphilis and 63% have gonorrhoea. In line with the national picture, the amount of diagnoses of gonorrhoea and syphilis are higher in gay men compared to heterosexual men (figure below).
Source: GUMCAD Sep ’18–Oct ’19
When comparing new diagnosis of STIs by ethnic origin and sexual orientation a larger proportion of white gay/lesbian are newly diagnosed (the figure below).
New STI diagnoses (excluding chlamydia aged under 25) per 100,000: In 2023, Richmond’s rate was 534.6 per 100,000 (n=1042), which was the 7th lowest in London, 2.8% higher than the England average and 56.5% lower than the London average. The latest Borough figure for 2023 was also 5.2% lower than in 2012, in comparison with 8.5% decrease in England’s rate in the equivalent time period.
Genital Chlamydia Trachomatis is the most commonly reported bacterial STI in England. Infection is asymptomatic in at least 70% of women and 50% of men and as a result most infections remain undiagnosed . Untreated chlamydia infection has significant health consequences. It is associated with considerable reproductive morbidity in women including pelvic inflammatory disease, ectopic pregnancy and infertility. In men, complications can include urethritis, epididymitis and Reiter’s syndrome. The chlamydia detection rate is one of the Health Protection indicators within the Public Health Outcomes Framework (PHOF). In 2013 the department of Health set a recommended chlamydia detection rate of ≥2300 per 100.000 population as this indicates high volumes of screening and diagnosis.
Gonorrhoea diagnostic rate per 100,000: In 2023, Richmond’s rate was 130.3 per 100,000 (n=254), which was the 7th lowest in London, 12.7% lower than the England average and 67.2% lower than the London average. The latest Borough figure for 2023 was also 160.6% higher than in 2012, in comparison with 196.9% increase in England’s rate in the equivalent time period.
London is currently witnessing an increase in the rate of Syphilis. In response to the rise, Public Health England has formed a “Syphilis Action Group” to develop and initiate a London wide syphilis action plan. Richmond has been actively involved in the group since its creation in 2019.
Syphilis diagnostic rate per 100,000: In 2023, Richmond’s rate was 19.0 per 100,000 (n=37), which was the 6th lowest in London, 14.0% higher than the England average and 61.7% lower than the London average. The latest Borough figure for 2023 was also 200.5% higher than in 2012, in comparison with 195.7% increase in England’s rate in the equivalent time period.
HIV diagnosed prevalence rate per 1,000 aged 15 to 59: In 2022, Richmond’s rate was 2.1 per 1,000 (n=240), which was the 2nd lowest in London, 11.9% lower than the England average and 60.9% lower than the London average. The latest Borough figure for 2022 was also 7.7% lower than in 2011, in comparison with 19.1% increase in England’s rate in the equivalent time period.
This year 14 adult residents of Richmond were newly diagnosed with HIV. The rate of new HIV diagnosis per 100,000 population among people aged 15 years or above in the borough was 8.9 compared to 20.9 in the rest of London and 8.7 in England. Since 2015, Richmond has seen a 7.3% decrease in new HIV diagnoses. The decrease highlights the success of combination HIV prevention which includes condom provision, pre-exposure prophylaxis (PrEP), expanded HIV testing and prompt initiation of treatment after diagnosis.
In Richmond the E-Service during this period had HIV detection rates for over 24 year olds of non-reactive 7,018 (99.7%) and reactive 21 (0.3%) while the numbers of postal test kits sent out by the newly commissioned SH:24 service totalled 26 with 11 being processed. Most of these kits were requested by people in the 25–34 age group (48.39%) and by males (64.34%). 2 reactive results were produced from those kits processed.
In Richmond the E-Service during this period had HIV detection rates for over 24 year olds of non-reactive 810 (99.6%) and reactive 3 (0.4%) while the numbers of postal test kits sent out by the newly commissioned SH:24 service totalled 5 with 5 being processed. Most of these kits were requested by people in the 25–34 age group (40.48%) and by males (63.16%). No reactive results were produced from those kits processed.
The vast majority (78.0%) of newly diagnosed patients in the borough were put on Antiretroviral treatment (ART) within 91 days of their diagnosis. Successful ART decreases a person’s viral load, significantly reduces the risk of future transmission and transforms HIV from a fatal infection to a chronic but manageable condition. However, between 2016 and 2018, 48.5% of HIV diagnoses were made at a late stage of infection (CD4 count =<350 cells/mm 3). Late diagnosis is the most important predictor of HIV-related morbidity and short-term mortality and is a key component of valuating the success of HIV testing efforts.
Current services In Richmond from Oct 2018 to 19 over 13,000 people accessed a sexual health service for the first time. Access was greater amongst females who represented 58% of attendees (Figure 108) 40.
Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumours, which do not spread. This section presents cancer prevalence (including new diagnoses), hospitalisations and cancer survival rates of Richmond’s patients.
Most of the data presented are published for registered CCG population (patients registered with Richmond’s GP). In the last two years 5 South West London (SWL) CCGs have merged into a single South West London CCG which, starting from year 2019/20, makes it difficult to distinguish cancer information specific to Richmond; for most CCG indicators the data presented in the chapter is 2 years old, as the latest 2019/20 and 2020/21 data is only available at SWL CCG level.
Percentage of cancers diagnosed at stages 1 and 2: In 2018, Richmond’s rate was 58.5% (n=418), which was the 4th highest in London, 7.1% higher than the England average and 4.6% higher than the London average. The latest Borough figure for 2018 was also 3.8% lower than in 2014, in comparison with 1.0% decrease in England’s rate in the equivalent time period.
Premature and preventable cancer mortality can be found in People JSNA Chapter. This section presents mortality from main cancer types including lung, breast and colorectal. There are no mortality indicators for prostate cancer that can be reported. However, the 2012/16 Richmond’s incidence ratio for prostate cancer was 110.8 (n=695), the 13th highest rate in London, and higher than the England average.
Mortality rate from lung cancer, all ages: In 2020 - 22, Richmond’s rate was 32.8 per 100,000 (n=166), which was the 3rd lowest in London, 32.9% lower than the England average and 24.3% lower than the London average. The latest Borough figure for 2020 - 22 was also 44.4% lower than in 2001 - 03, in comparison with 24.9% decrease in England’s rate in the equivalent time period.
Mortality rate from colorectal cancer, all ages: In 2020 - 22, Richmond’s rate was 21.6 per 100,000 (n=110), which was the 11th lowest in London, 16.0% lower than the England average and 5.8% lower than the London average. The latest Borough figure for 2020 - 22 was also 20.0% lower than in 2001 - 03, in comparison with 18.8% decrease in England’s rate in the equivalent time period.
Mortality rate from breast cancer, all ages (Female): In 2020 - 22, Richmond’s rate was 28.8 per 100,000 (n=86), which was the 10th lowest in London, 7.8% lower than the England average and 6.0% lower than the London average. The latest Borough figure for 2020 - 22 was also 33.3% lower than in 2001 - 03, in comparison with 30.7% decrease in England’s rate in the equivalent time period.
Cancer screening coverage: breast cancer: In 2023, Richmond’s rate was 63.8% (n=14667), which was the 6th highest in London, 3.7% lower than the England average and 14.2% higher than the London average. The latest Borough figure for 2023 was also 11.7% lower than in 2010, in comparison with 13.9% decrease in England’s rate in the equivalent time period.
Cancer screening coverage: cervical cancer (aged 50 to 64 years old): In 2023, Richmond’s rate was 72.8% (n=16088), which was the 8th highest in London, 2.1% lower than the England average and 3.1% higher than the London average. The latest Borough figure for 2023 was also 7.7% lower than in 2010, in comparison with 5.4% decrease in England’s rate in the equivalent time period.
Cancer screening coverage: bowel cancer: In 2023, Richmond’s rate was 70.1% (n=21588), which was the 5th highest in London, 2.6% lower than the England average and 10.5% higher than the London average. The latest Borough figure for 2023 was also 22.2% higher than in 2015, in comparison with 25.7% increase in England’s rate in the equivalent time period.
Abdominal Aortic Aneurysm Screening Coverage: In 2022/23, Richmond’s rate was 73.6% (n=781), which was the 12th lowest in London, 6.0% lower than the England average and 2.0% lower than the London average. The latest Borough figure for 2022/23 was also 4.2% lower than in 2013/14, in comparison with 1.2% increase in England’s rate in the equivalent time period.
In 2019, 68.4% of people with diabetes on GP registers had a record of retinal screening in the preceding 12 months. This is lower than London and England (73.7% and 77.3% respectively) 41. This is lower than London and England (73.7% and 77.3% respectively).
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Up to: Joint Strategic Needs Assessment (JSNA)
Updated: 08 July 2024
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