Guildford and Waverley Place-Based Profile
Published by Surrey County Council on 11/10/2017
Author: Anupama Shaikh
Expires on: 11/10/2019
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 the Guildford and Waverley CCG area – resident, registered and housing-constrained populations. The 2015 resident population of Guildford and Waverley CCG was estimated at 206,000 while the GP registered population was higher at 220,804 (April 2015). The housing-constrained population is 210,700 in 2017 and the registered population has risen to 225,000 (April 2017).
About 20% (41,296) of the registered population are 65 years or older, of whom 3% (6,594) are aged 85 years or older. Compared to the other CCGs, there is a greater proportion of young adults in Guildford and Waverley CCG, likely due to the location of Surrey University. While the population below the age of 65 years is projected to remain relatively stable over the coming 10 years, the population aged 65 years and older is projected to go up from 40,600 in 2017 to 48,200 in 2027.
There were 2,085 live births in 2015. A third were to mothers over 35 years of age. The Guildford & Waverley CCG birth rate for women aged 15-44 years (53 births per 1,000 women) is less than the Surrey average (63 per 1,000 women).
Surrey in general is not as ethnically diverse as the rest of England. In Guildford and Waverley CCG 7.2% of the population are from non-white ethnic backgrounds compared to 14.6% for England. Although numerically relatively small, one of the significant minority ethnic groups in Guildford and Waverley CCG is the Gypsy, Roma, and Travellers group with around 824 residing in 206 pitches across 36 traveller sites in Guildford and Waverley CCG.
Access to the GP or hospital for households without a car can be problematic. In some areas of Guildford and Waverley CCG, only 17% of households without a car have access to a GP within a reasonable time by public transport or walking, and 4% for hospital access.
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 Guildford and Waverley CCG is estimated at under 2.4% (4,218) of the population in 2017. This is projected to increase by 3.3% to 4,357 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 G&W are in the ward of Westborough, which are ranked within the most deprived 20% of all LSOAs in England.
Health status and health inequalities
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 Guildford and Waverley CCG can expect better life expectancy than their counterparts in Surrey. LE is 82.6 years for men and 85.1 for women in Guildford and Waverley compared to 81.3 and 84.5 respectively for Surrey. At age 65 men in G&W can expect to live an additional 20.2 years, and 22.6 years for women. This is considerably higher than the England average for both men (18.6) and women (21.1). Within Surrey, Guildford and Waverley CCG has the highest LE at age 65 for both men and women.
There are considerable differences between wards in life expectancy for both men and women, although with such small areas there is uncertainty about the precise estimate. LE at birth for men ranges from 76.6 years in Stoke to 87.6 years in Godalming Holloway, a difference of almost 10 years. LE at birth for women ranges from 78.8 years (Stoke) to 90.7 years (Blackheath and Wonersh), a difference of 11.9 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 Guildford and Waverley CCG live 85.5% and 83.8% of their lives in ‘good health’ respectively. Men could therefore expect to live 11.9 years of their lives in ‘not good’ health. Although women live slightly longer than men, they spend an average of 13.8 years in ‘not good’ health, almost two years more than men. The years spent in ‘not good’ health are likely to be periods of high demand on health and social care.
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 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 Guildford and Waverley CCG, the largest cause of PYLL is cancer (607 years), followed by ischaemic disease (383 years), cerebrovascular (175 years) and respiratory (98).
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 about 3,590 service users receiving support from ASC in Guildford and Waverley CCG. Just under one fifth of people aged 85 and over (1,221) receive support from social care. Amongst those aged between 18 and 65 years, a similar number (1,177) received support as those aged 85+ years but this represents a much smaller proportion of the population (1%).
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 1,300 carers receiving ASC support in G&W, which represents 0.8% of the adult population. About 3% of those aged 75 or over are carers receiving ASC 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 treating smoking-related illness. The government has set an ambitious smoking prevalence target for England of 12% by 2022. While the overall estimated smoking prevalence in Guildford and Waverley CCG is 16%, there are some wards which are already below the national target for 2022 (e.g. 9.2 % in Blackheath and Wonersh). However, smoking rates are much higher among more deprived communities in Guildford and Waverley, which has a significant impact on increasing health inequalities by reducing life expectancy in these groups. The smoking prevalence is highest in Westborough (25%), one of the most deprived wards in Guildford and Waverley. (Mosaic estimates)
The smoking rate amongst Surrey residents in routine and manual occupations is 24% (England, 27%). Efforts to reduce smoking across G&W should focus on those areas or groups where prevalence is highest. (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 Guildford and Waverley CCG is 1,757.1 per 100,000 population. While this is less than the rate for England at 2,138.7 per 100,000 population (2014/15), alcohol-related admission episodes have been increasing steadily since at least 2008/9. Admission episodes specifically related to alcohol, i.e. all causally attributable to alcohol consumption, have been increasing in G&W at an apparent faster rate than Surrey, the South East or England, particularly in women. Currently, alcohol-related mortality is 32.2 per 100,000 population in G&W, 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 Guildford is 65.4% and 69.4% in Waverly. While this is significantly higher than that of England (57%) and Surrey (62%), it does mean that close to one third of the population do not meet the recommended levels of physical activity to maintain their health and independence. Estimates of the proportion of the population which is inactive (i.e. less than 30 minutes of physical activity per week) are 19.6% for Guildford and 18.6% for Waverley. Combining these two indicators suggests that relatively few of those who are not hitting the recommended target are undertaking any kind of physical activity.
Diet and Excess Weight
The proportion of the population who, when surveyed, reported that they had eaten the recommended 5 portions of fruit and vegetables on the previous day in Guildford and Waverley is 62%, which is higher than for Surrey (57%) and England (52%) (2015). Again, this indicates that almost one-third of local residents are not consuming sufficient fruit and vegetables for their health.
The percentage of adults estimated as having excess weight in Guildford is 57 % and 60% in Waverley, similar to the Surrey proportion but less than for England 65 %.( 2012-14)
There are 17.5 % (1,016) of children in reception year and 23.8 % (1,067) of children in year 6 in Guildford and Waverley that are classified as overweight or obese. (2012/13-2014/15) Almost one-fifth of 11 years olds in G&W have an unhealthy weight sufficient to put their current and future health at risk.
The proportion of five year old children free from dental decay in Guildford and Waverley CCG is 83.6 % which is more than the proportion for England at 75.2 %. (2014/15)
Disease Incidence and Prevalence
Cardiovascular Disease, 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. Long term conditions can affect many parts of a person’s life, from their ability to work and have relationships to housing and education opportunities.
The incidence of all cancers in Guildford and Waverley CCG is similar to but lower than the national cancer incidence, taking into account the different age and sex profile of Guildford and Waverley. However, specific cancer sites vary – Guildford and Waverley CCG has a significantly lower overall standardised incidence ratio (ISR) for lung cancer (59.7) compared to the rest of England (100) while individual wards such as Westborough have a high incidence (111.9). This variation in rates relates to the variation in smoking prevalence. Guildford and Waverley CCG overall has a slightly higher rate of breast cancer (105) compared to England (100), again with substantial variation within the CCG area.
Long term conditions (LTC)
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 diagnosis gap gives an indication of how many people in the local population are undiagnosed but may have that condition and so indicates the potential to find and treat people at an earlier stage of the disease.
The different cardiovascular diseases are the most common long term conditions in Guildford and Waverley CCG. Around 12.5% of the population have been diagnosed with hypertension, 2.5% with Coronary Heart Disease, 2.0% with Atrial Fibrillation, 1.4% with Stroke or Transient Ischaemic Attack, 0.5% with heart failure and 0.4% with Peripheral Arterial Disease. About 4.5% of the population of Guildford and Waverley CCG have been diagnosed with diabetes and 3.3% with chronic kidney disease. The diagnosis gap between those diagnosed and the expected prevalence of specific diseases varies: over 50% of those with hypertension, chronic kidney disease or heart failure are potentially undiagnosed. Over one third of those with diabetes may be undiagnosed. Individual practices vary substantially in the level of diagnosis gap for different conditions.
The prevalence of respiratory disease is also significant, with 5.7% of the population diagnosed with asthma and 1.2% with chronic obstructive pulmonary disease. About one-third of those with chronic obstructive pulmonary disease (COPD) may be undiagnosed.
In Guildford and Waverley CCG there is considerable variation in standardised hospital emergency admission ratios (SAR) between wards, indicating a need to focus on the causes of these health inequalities. In particular, Stoke has an SAR of 135 for emergency admissions due to CHD compared to 100 for England, while Whitley and Hambledon has a standardised rate of 27.6. Similar variation exists for COPD, while differences between wards for hip fractures are not so 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.
As might be expected, the highest standardised mortality rate for circulatory disease is in Stoke, but the variation between wards for premature mortality rates is not as stark as for emergency admission rates. Shamley Green and Cranleigh North have the highest mortality rate in Surrey for cancer in people under 75 years of age (171.9).
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 Guildford and Waverley range is from 0.09 to -1.76 for overall common mental health needs in Guildford and Waverley CCG, it is relatively low compared to England (3.09 to -2.85). The ward with the highest level of common mental illness is Stoke (0.09) and the ward with the lowest level is Clandon and Horsely (-1.76).
Children’s mental health
The GP prevalence of mental health disorders in children is lower in Guildford and Waverley CCG than in England. The estimated prevalence of any mental health disorder for the GP registered population aged 5 to 16 is 7.4%, compared to the national average of 9.2%
Adult mental health
The estimated prevalence of common mental health disorders is 12.8%. 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 G&W. 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 0.8% to 1.3%.
The incidence of psychosis (severe mental health illness) per 100,000 population aged 18+ years per year is 19.4 (England, 26.7). The prevalence in those aged 16+ is 0.2% (England, 0.4%). The average achievement score for GP health checks for patients with psychosis is 74.1%, slightly lower than the England average score of 76%.
The rate of people detained under the mental health act is 27.4 per 100,000 population, which is significantly lower than the England average for detention (58.7). The rate of contact with specialist mental health service for adults in G&W was 2,417 per 100,000, similar to the England average (2411.3 per 100,000). The discharge rate in England is significantly better than for Guildford and Waverley CCG, at 69.8 and 50.5 per 100,000 adult population respectively.
The demand for mental health advice through NHS 111 made by those aged 65 years and over was greater in G&W (27.8%) than the national average (23.5%).
Total spend on specialist mental health services on Guildford and Waverley CCG patients (£127) is 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 data for Guildford and Waverley CCG (7.6 age standardised rate per 100 000) shows that mortality rate from suicide and injury undetermined is similar to the Surrey (9.1) and England average (10.1).
Perinatal mental health
Many of the risk factors for Perinatal Mental Health 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 in 1,000 which means there are between 325 to 650 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 325 women affected locally.
Improving Access to Psychological Therapies (IAPT)
Improving Access to Psychological Therapies (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.
The (2016/17 Q3) crude referral rate to IAPT is 654.9 per 100.000 population which is significantly lower than the England average (786.3).
In the month (March, 2017) about 16.5% of those estimated to have anxiety and depression had access to IAPT. This is not significantly different from the national average of 17.2%. Of all referrals to IAPT, about 6.2% did not attend (DNAs), better than the national average (10.2%). The mean average wait in days per month from referral to 1st treatment is 12.9 days which is better than the national wait of 18.8 days.
The rate of those completing treatment in the same quarter was 310.5 per 100,000 population. This is not significantly different from the national average (317.3).
Mortality attributable to particulate air pollution varies widely across Surrey. The proportion of all deaths in people aged over 30 years of age which are due to man-made air pollution is higher in Guildford (4.4%) compared to Waverley (4.0%) , but less than for England (4.6%). Partners across Guildford and Waverley CCG could begin to work to lower 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.