Published by Surrey County Council on 12/09/2017
Author: Anupama Shaikh
Date Expires: 12/09/2018
The 2017 Health and Care Profiles for Surrey provide an extensive set of information that describes the health and care needs of the population in each CCG area. They describe variation both within CCG areas and between CCGs, Surrey and England, providing a picture of where need is greatest and where resources may need to be focused. Where data are available, they also provide information on trends over time.
The Health and Care Profiles for Surrey for 2017 have changed considerably from previous versions as a result of feedback from users, opportunities provided by new technology and the increasing national policy emphasis on place-based planning. While we continue to provide health and care intelligence based on current Clinical Commissioning Group (CCG) boundaries, we recognise that local partners are increasingly working to different geographies such as Sustainability and Transformation Partnerships (STP) and integrated health and care or family hubs. In anticipation of this, we will now publish all tables, graphs and charts as interactive dashboards using the Tableau© platform and will no longer include illustrations in the narrative reports for each CCG. A move to interactive dashboards will allow us to be more responsive to the transforming health and care landscape and to refresh the dashboards as new data becomes available.
In this profile we start by describing the population in terms of its size, structure and distribution. We also describe the influences on health, sometimes called the ‘wider determinants of health’, including levels of deprivation and the resulting inequalities in health outcomes. This is followed by sections describing health behaviours, the main causes of ill-health and long term conditions, which leads us to the demand and use of social care services and support. Finally we look at the main causes of preventable mortality in the population. We also explain potential implications for the CCG from each of the indicators. The profile should be read in conjunction with the corresponding dataset within the Tableau© dashboards which provide additional information on the indicators and guidance on how to interpret them. We are always interested in feedback, so if you have any comments on this report, please email Anupama Shaikh – Advanced Public Health Intelligence Analyst, on firstname.lastname@example.org.
There are three main sources of information on the number of people living in East Surrey CCG area – resident, registered, and housing constrained populations.
The 2015 resident population of East Surrey CCG was estimated at 182,000 while the GP registered population was less at 178, 239 (April 2015). In 2017 the registered population is 181,742 and the housing constrained population is 184,800.
Around 18% (32,365) of the population are aged 65+ years and this group is projected to increase by 29% (41,700) in 2027.
There were 2,235 live births in 2015 and a third were to mothers over 35 years of age. The East Surrey CCG birth rate for women aged 15-44 years (66 births per 1,000 women) is slightly higher than the Surrey average (63 births per 1,000 women).
Surrey is generally not as ethnically diverse as the rest of England. In East Surrey 8.3% of the population are of non-white ethnic backgrounds compared to 14.6% for England. There are around 288 Gypsy, Roma, and Travellers residing in 72 pitches across seven sites in East Surrey.
Access to a GP or hospital for households without a car can be problematic in East Surrey. In some areas of East Surrey, only 32.2% of households without a car have access to a GP within a reasonable time by public transport or walking, and 1.5% for hospital access.
The proportion of households that experience fuel poverty can be as high as 21.9% in some areas of East Surrey.
The Valuing People report (2001) defined a learning disability as a significantly reduced ability to understand new or complex information and to learn new skills (impaired intelligence) combined with a reduced ability to cope independently (impaired social functioning), which started before adulthood, with a lasting effect on development.
Learning disability prevalence in East Surrey is estimated at under 2.4% (3,545) of the population in 2017. This is projected to increase by 4.9% to 3,718 over the next 5 years.
The index of multiple deprivation (IMD) is an overall measure of multiple deprivation experienced by people living in an area and is calculated for every Lower layer Super Output Area (LSOA), or neighbourhood, in England.
The most deprived small areas (LSOA) in East Surrey CCG are in the ward of Merstham. It is ranked within the most deprived 20% of all LSOAs in England.
Life expectancy (LE) is a measure of how healthy a population is. Differences in life expectancy can show the extent of health inequalities between groups of people.
Residents of East Surrey can expect lower life expectancy than their counterparts in the rest of Surrey. LE is 80.6 years for men and 83.9 for women in East Surrey, compared to 81.2 and 84.5 years respectively for Surrey. At age 65, men in East Surrey can expect to live an additional 19.2 years and women 21.3 years. This is considerably higher than the England average for men (18.6) but is similar for women (21.1). Life expectancy for women in East Surrey at age 65 is significantly lower than the Surrey average of 21.9 years.
There are considerable differences in life expectancy for both men and women at ward level, although with such small areas there is s uncertainty about precise estimates. LE at birth for men ranges from 85.7 years in Felbridge to 76.3 years in Merstham, a difference of 9.4 years. LE at birth for women ranges from 94.4 years in Woldingham to 81.3 years in Westway, a difference of 13.1 years.
Healthy life expectancy at birth
Healthy life expectancy (HLE) is an estimate of the number of years individuals can expect to live in good or very good health, based on a subjective assessment of health. By subtracting healthy life expectancy at birth from overall life expectancy, the number of years people can expect to live in ‘ not good’ health out of their remaining years can be estimated.
Men and women in East Surrey live 84.1% and 82.5% of their lives in ‘good health’ respectively. Men could therefore expect to live 12.8 years of their lives in ‘not good’ health. Although women (83.9 years) live slightly longer than men (80.6 years), the figures show that women spend an average of 14.7 years in ‘not good’ health which is 1.9 years more than men.
Potential years of life lost (PYLL)
Potential years of life lost (PYLL) is a summary measure of premature deaths, i.e. deaths in those under the age of 75, due to causes which have been identified as amenable to prevention or delay through good healthcare.
While all CCGs in Surrey have a PYLL for all conditions significantly lower than that of England, these do indicate the disease areas where the greatest potential gain in improving health through healthcare can be made. In East Surrey, the largest cause of PYLL is respiratory diseases (177.7).
Adult Social Care
Adult social care (ASC) is the provision of support and personal care (as opposed to treatment) to meet needs arising from illness, disability or old age. The majority of people who receive state-funded long-term social care are aged 65 or over and the growth of the older population will pose a significant challenge in meeting the needs and demands on social care in the future.
Overall there are more than 3,000 people receiving adult social care support in East Surrey. Around 15.4% (808) of people aged 85+ years receive social care support compared to just 1% (1.221) of those aged 16-64 years.
Unpaid carers provide considerable support to their families to enable them to remain at home, with potential consequences for their own health.
ASC supports carers through provision of a range of services, including respite care. Some people will be carers in addition to receiving social care support.
There are 800 carers receiving ASC support in East Surrey. Around 1% of people aged 85+ years receive ASC carer support.
Health related behaviours
Smoking is a leading cause of preventable ill-health and death in the UK. In 2014, almost 80,000 deaths were attributable to smoking in England (ONS, 2017), as well as adding significantly to the burden on the NHS of treating smoking-related illness. The government has set an ambitious smoking prevalence target for England of 12% by 2022.
Smoking prevalence in Tandridge is 14.7%, and for Reigate and Banstead is 14.5% (PHE Fingertips, Annual Population Survey) but the estimates for wards show a wide variation, with ward smoking prevalence ranging from 8.6 % in Chaldon to 20% in Redhill East, Horley Central & Whyteleafe wards. (Mosaic estimates)
Across Surrey, 12% of people aged 18 and over smoke, compared to a national average of 15% (2016). Smoking prevalence has been gradually declining year on year. However, smoking rates are much higher among our more deprived communities, having a significant impact on increasing health inequalities by reducing life expectancy in these groups. The smoking rate amongst Surrey residents in routine and manual occupations is 24% (England 27). (PHE Fingertips, Annual Population Survey)
The narrow definition of alcohol related admissions is where the primary reason for admission relates to alcohol. The broad definition is where either the primary or any secondary reason for admission relates to alcohol.
The rate of hospital admission episodes for alcohol related conditions (broad) in East Surrey CCG is 1,800.8 admission episodes per 100,000 population. While this is less than the rate for England (2,138.7 per 100,000), alcohol-related admission episodes in East Surrey have been increasing steadily since 2008/9 and have now surpassed the regional and national rates (2014/15).
Alcohol related mortality is 40.7 deaths per 100,000 population with men experiencing a higher rate of alcohol related mortality compared to womens. (2014)
The proportion of adults estimated to be doing 150+ minutes of physical activity per week in Reigate and Banstead is 55.7%, the second lowest across the 11 Districts and Boroughs and significantly lower than Surrey average (62%). Tandridge has the lowest percentage of adults who do any cycling at least 3 times per week (1.5%), compared to the rest of Surrey (4.8%) and England (4.4%). Tandridge has the lowest percentage of adults who do any cycling at least once per month (11.9%) in Surrey. The percentage for the rest of Surrey is 17.5%.
Diet and Excess Weight
The proportion of the population who, when surveyed, reported that they had eaten the recommended five portions of fruit and vegetables on the previous day in Reigate and Banstead is 58% and in Tandridge is 57%, which is similar to Surrey (57%) and higher than for England (52%).(2015)
The percentage of adults classified as having excess weight in Reigate and Banstead is 63%, and for Tandridge is 63% which is similar to England (65%) but more than the Surrey average at57%(2012-14).
There are 1,037(17.8 %) children in reception year and 1,214 (26.8%) children in year 6 that are classified as overweight or obese in East Surrey. These percentages are lower compared with 22.2% and 33.4% for England respectively (2012/13-2014/15).
The proportion of five year old children free from dental decay in Reigate and Banstead (87.7%) is higher than the proportion for England (75.2 %). There is no data available for Tandridge (2014/15) .
Disease Incidence and Prevalence
Cardiovascular, cancer and respiratory disease are the top three contributing conditions to the life expectancy gap between the most and least deprived populations within Surrey. Long Term Conditions and their effective management is widely recognised to be one of the greatest challenges facing the NHS and Social Care. LTCs can affect many parts of a person’s life, from their ability to work and have relationships to housing and education opportunities.
The standardised incidence ratio of all cancers (94.7) is lower than for England, taking into account the age and sex distribution of the population in East Surrey. Though not significant, East Surrey does have higher than national incidence rates for breast (103.7) and prostate (102.3) cancers when compared to the rest of England.
Long term conditions
GP recorded prevalence is generally the number of people on a GP practice’s disease register as a proportion of the number on the GP practice list. Evidence suggests that a significant proportion of prevalent disease remains undiagnosed.
• The recorded prevalence for hypertension in East Surrey CCG is 12.3% and it is estimated that half of the people with hypertension remain undiagnosed.
• The recorded prevalence for chronic obstructive pulmonary disease (COPD) in East Surrey is 1.4%, lower than that of South East Region (1.7%), with an estimated 22% of people undiagnosed.
• East Surrey has a prevalence of osteoporosis of 0.5% amongst people over 50 years of age, the highest out of all surrey CCGs and higher than the prevalence in South East (0.3%).
• The recorded prevalence for chronic kidney disease in East Surrey CCG is 4.2% which is similar to the South East Region (4.4%), with an estimated 34% of people undiagnosed.
• The recorded prevalence for diabetes mellitus in people aged 17 and over is 5.3% and the estimated prevalence is 7.6%.
In East Surrey there is considerable variation in the standardised hospital emergency admission ratio (SAR) for various conditions between ward areas. Merstham in particular has an SAR of 125.3 for chronic obstructive pulmonary disease (COPD), compared to 100 for England. Significant ward level variation exists in emergency admission ratios for knee replacements from Whyteleafe (24.4), and Godston (169), to Horley East (57.7). Variations also exist for other conditions such as stroke, and myocardial infarction even though they are not as extreme.
Death rates, particularly premature death rates (below the age of 75) are one way to measure the health of the local population, either in comparison to other CCGs or within the CCG. Information on the number of deaths in a year is also necessary to plan for end of life services, including requirements for palliative care.
The mortality rate from all causes for all ages, under 75s and under 65s is significantly lower for all Surrey CCGs than for England. However, there is variation between wards. Chandon has the highest standardised mortality ratio (SMR) for all causes (152.1), stroke (345.5) and circulatory disease (186.9) in East Surrey. With an SMR of 220.2, residents in Portley are more than twice as likely to die from respiratory disease compared to the rest of England.
East Surrey has the highest mortality ratio for respiratory conditions (109.7), significantly higher than the rest of Surrey and England.
The mood and anxiety score is a composite indicator based on the rate of adults suffering from mood and anxiety disorders, hospital episodes data, suicide mortality data and health benefits data. A higher score indicates a higher level of mental ill health in the population.
The score for East Surrey CCG ranges between 0.34 and -1.17. Overall common mental health needs in East Surrey CCG are relatively low compared to England (for England ranges from 3.09 to -2.85). The ward with the highest level of common mental illness is Merstham in Reigate and Banstead (0.34) and the ward with the lowest level is Dormansland and Felcourt in Tandridge (-1.17).
Children’s mental health
The GP prevalence of mental health disorders in children is lower in East Surrey than in England. The estimated prevalence of any mental health disorder for the GP registered population aged 5 to 16 years is 7.8% compared to the national average of 9.2%.
Directly standardised hospital admission rate for self-harm in children and young adults aged 10-24 years in East Surrey (524.8 per 100,000 population) is significantly higher than the national average (430.5). This is the highest rate amongst all Surrey CCGs.
Adult mental health
The estimated prevalence of common mental health disorders is 13.3%. This is lower than the England estimate of 15.6% but is higher than estimates of most other long term conditions such as diabetes and coronary heart disease in East Surrey.
The incidence of depression (first time cases presenting to their GPs) has increased since 2013/14. The proportion of newly diagnosed GP registered patients has nearly doubled from 0.7% to 1.4%.
The incidence of psychosis (severe mental health illness) for people aged 16-64 years (19.3 per 100,000 population) is higher compared to the rate for England (18.1).
The crude rate of people detained under the mental health act in East Surrey (31.9 per 100,000 population) is the highest out of all the Surrey CCGs despite being lower than for England (58.7). The rate of contact with specialist mental health service for adults in East Surrey (2,881.8 per 100,000 population) is significantly higher than the rest of Surrey and England (2,411.3). Total spend on specialist mental health services on East Surrey patients expressed as a rate per person (all ages, weighted for market forces) is £108.8is below the England average (£151.1).
In general there has been a downward trend in suicides in the UK and in Surrey since 2000. Surrey has historically had a lower rate of suicide compared to England. The latest three year average age standardised rate for East Surrey (8.5 per 100,000) shows that mortality from suicide and undetermined injury is lower than for Surrey (9.1) and England (10.1).
In East Surrey CCG, dementia prevalence for all ages and those aged 65 years and over is 0.8% and 4.6% respectively. The estimated dementia diagnosis rate for those aged 65 years and over is 68.2%, which is similar to the national target of 67.9%
Perinatal mental health
Many of the risk factors for mental health illness in women during pregnancy or after childbirth are those associated with mental illness in the general population but some risk factors increase the likelihood of maternal mental health problems. The estimated national prevalence for Adjustment disorders and distress (AD) is 2 per 1,000 deliveries which means there are between 330 to 660 women affected locally. The estimated national prevalence for mild-moderate depressive illness and anxiety (DIA) is 150 in 1,000 deliveries, suggesting there are between 220 to 330 women affected locally.
Improving Access to Psychological Therapies (IAPT)
IAPT services are provided to people with mild to moderate mental health problems, using a stepped care model together with specialist employment support, based on NICE guidelines. The main aims are to provide earlier and appropriate interventions and fewer episodes requiring secondary care and help people to have less time off work and retain and or return to employment.
In East Surrey, the crude referral rate to IAPT(2016/17 Q3) is 602.6 per 100,000 population which is significantly lower than the England average (786.3).
Around 16.4% of those estimated to have anxiety and depression had access to IAPT, which is not significantly different from the national average of 17.2%. Of all referrals to IAPT, about 6.7% did not attend (DNAs) this is significantly lower than the national average (10.2%).
In East Surrey, the average wait from referral to 1st IAPT treatment is 8.1 days which is better than the national average wait of 18.8 days.
The rate of completion of IAPT treatment was 326.1 per 100,000 population. This is not significantly different from the national average (317.3).
Mortality attributable to long-term exposure to fine particulate air pollution (PM2.5) varies across Surrey, ranging from 4.0 in Waverley to 4.9 in Runnymede. Reigate and Banstead (4.6%) has similar rates to England (4.7%) and Tandridge (4.5%) has slightly lower rates. (2015). Partners across East Surrey could begin to work to reduce air pollution and its effects through development of sustainability strategy and evidence based projects such as air alerts and travel initiatives such as increasing active travel and car-pooling.