Places most at risk of death during pandemic revealed in new index

The Centre for Progressive Policy (CPP) launches a local area risk rating to identify which local authorities and Clinical Commissioning Groups (CCG) face the highest threat to life during the Covid-19 pandemic.

CPP’s analysis goes beyond the number of confirmed cases to look at the existing health of the population as well as the quality of the health and social care systems locally, to show that different areas will be better or worse equipped to deal with the surge in cases (table below).

Places at high risk

• The West Midlands is the new immediate battleground against covid-19. It has a relatively high number of cases and an even higher level of systemic vulnerability.
• Big cities like Liverpool, Nottingham and Manchester could be next. Currently they have relatively low caseloads, but all have a high level of systemic vulnerability.

• Adult social care has been largely overlooked during this crisis, but a poor performing sector in places like Middlesbrough, Barnsley and the Wirral could exacerbate pressures on the rest of the healthcare system.

By updating the ranking in real time on a weekly basis, the index is designed to indicate how policy makers can best direct resources – targeting those healthcare systems likely to struggle the most due to the combination of a high case load and a high level of existing system vulnerability.

Key findings:

• Protective factors such as the existing health of the population and the mortality rate from treatable conditions need to be taken into account. While much of the recent focus has been on London, CPP’s analysis shows that many local areas in the West Midlands are facing a very stark challenge. Walsall, Wolverhampton, Sandwell, Dudley and Birmingham are all in the top 14 most risky local areas.
  
• While much of the focus has rightly been on the NHS, finding ways to support enhanced capacity in the adult social care sector will be another crucial way of coping with the surge in cases. In Barnsley for instance, which has a moderate-to-high case load (ranked 53 out of 149 local authorities), the adult social care sector is likely to be particularly vulnerable given the prevalence of low ratings from the Care Quality Commission.
  

• The risk rating identifies the places where public health restrictions are particularly important to save lives. For instance, in Walsall, healthy life expectancy is just 56.4 years of age – significantly below the age set by government for self-isolation (age 70 and older). Ensuring that those who have pre-exiting conditions self-isolate, irrespective of age, and social distancing is fully observed will be critical to avoiding greater pressure on Walsall’s health and social care sector and saving lives.

On publishing the index, Ben Franklin, Head of Research, Centre for Progressive Policy, said,

“To ensure that health services across the country receive all the support they need to fight the pandemic, it is important to keep in mind that some local areas will be less able to cope because the existing stock of health in their population is lower, or the healthcare system is already less effective at treating common conditions.

CPP’s index highlights these high-risk local areas taking into account both the rising case numbers as well as other crucial measures of systemic risk facing local health systems. Only by taking both into account will resources be properly allocated.”

The table below reveals the 50 local authorities (and related CCGs) that are facing the highest level of risk to life from Covid-19 and indicates where resources are most needed. This risk rating will be updated in real time on a week by week basis as the Covid-19 case numbers rise and fall.

1. The report can be found online at https://www.progressive-policy.net/publications/covid-19-local-area-risk-rating
2. The risk rating is based on the indicators referred to in the report (Table 1; The indicators)). Data for the indicators is assigned to an upper tier local authority (UTLA) and its relevant CCG(s). To normalise the data, each of the 149 local authorities is ranked against each indicator, ranking 1 if it has the highest level of risk (i.e. highest cases per 100,000 people) and 149 if it has the lowest level of risk (i.e. lowest cases per 100,000). In determining weightings for the indicators, we seek to strike a balance between accounting for the systemic vulnerability of local areas on the one hand, and the present reality of rising covid-19 cases on the other. Since we are particularly interested in providing a forward look at health systems most at risk for the duration of the crisis, the systemic indicators make up the largest proportion of the risk rating – accounting for 75% of the overall rating (25% weighting for the prevalence of covid-19). We partially base the weights for each of the four systemic indicators, on their relative ability to explain variation in local authority age-standardised mortality rates (ASMR). The assumption being that if all places have the same number of covid-19 cases, mortality will be higher in those areas that already suffer from higher death rates.
3. CCGs marked with an asterisk are not the only CCG linked to that area. Lancashire has NHS Chorley and South Ribble CCG, NHS East Lancashire CCG, NHS Fylde and Wyre CCG, NHS Morecambe Bay CCG and NHS West Lancashire CCG. Cumbria has NHS Morecambe Bay CCG and NHS North Cumbria CCG. Staffordshire has NHS Cannock Chase CCG, NHS East Staffordshire CCG, NHS North Staffordshire CCG, NHS South East Staffordshire and Seisdon Peninsula CCG and NHS Stafford and Surrounds CCG.
4. Rationale behind the indicators: The objective is to capture both the prevalence of the virus, as well as the strength of local characteristics and institutions that can support local health resilience in the face of the surge. To capture the prevalence of the virus in a local area, we use the laboratory confirmed case load per 100,000 people. This has several limitations including that it only measures the number of cases within hospitals and depends on the resourcing and ability of NHS staff to administer tests for patients with symptoms which may itself differ by area and trust. But it is the best official and timely data currently available.
5. About CPP: The Centre for Progressive Policy is a think tank committed to making inclusive economic growth a reality. By working with national and local partners, our aim is to devise effective, pragmatic policy solutions to drive productivity and shared prosperity in the UK. Inclusive growth is one of the most urgent questions facing advanced economies where stagnant real wages are squeezing living standards and wealth is increasingly concentrated. CPP believes that a new approach to growth is needed, harnessing the best of central and local government to shape the national economic environment and build on the assets and opportunities of place. The Centre for Progressive Policy is fully funded by Lord David Sainsbury, as part of his work on public policy.
6. For more information on the Centre for Progressive Policy, please see www.progressive-policy.net or follow @CentreProPolicy
7. For interview requests contact Thomas Hauschildt, Communications Manager, Centre for Progressive Policy: THauschildt@progressive-policy.net