North West Surrey Place-Based Profile
Published by Surrey County Council on 11/10/2017
Author: Anupama Shaikh
Date Expires: 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, at firstname.lastname@example.org .
There are three main sources of information on the number of people living in the North West CCG area – resident, registered, and housing constrained populations.
The 2015 resident population of North West Surrey CCG was estimated at 343,000 while the GP registered population was higher at 362,662 (April 2015). In 2017 the GP registered population has risen to 370,000 (2017). When constraints relating to projected housing availability are taken into account for projecting population increases, it is estimated the population will increase to 364,600 by 2027. The number of those aged 65 and over is projected to rise by 21% from 62,500 in 2017 to 75,600 in 2027.
There were 4,484 live births in 2015. A third were to mothers over 35 years of age. The North West Surrey CCG birth rate for women aged 15-44 years (70/1,000) is higher than the Surrey average (63/1,000). The older age profile of mothers in North West Surrey may increase the proportion of pregnancies and births that experience complications compared with national rates.
Surrey in general is not as ethnically diverse as the rest of England but North West Surrey CCG is the most diverse of the Surrey CCGs with 12.5% of the population from a non-white ethnic background as follows; Indian (2.7%), Mixed/multiple ethic group (2.4%), Pakistani (2.1%) and other Asian (3.1%). There are around 544 Gypsy Roma Travellers in North West Surrey residing in 136 pitches spread across 25 sites.
Access to GPs or hospitals for households without a car can be problematic. Only 36.2% of such households are within reasonable travel time if using public transport or walking to get to their GP practice and the corresponding figure for hospital access is as low as 6.8%
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 North West Surrey CCG is estimated at under 2.4% (6,683) of the population in 2017. This is projected to increase by 3.6% to 6,920 over the next 5 years (2022).
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.
North West Surrey is largely affluent with 105 out of 214 (49%) LSOAs in the least deprived 20% in England. The most deprived small area (LSOA) in North West Surrey CCG is in Maybury and Sheerwater. It is ranked within the most deprived 20% of all LSOAs in England. People living in more deprived areas typically experience poor health outcomes.
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 North West Surrey can expect below average life expectancy compared to their counterparts in Surrey. LE is 80.6 years for men and 83.9 for women in North West Surrey CCG compared to 81.3 and 84.5 for men and women in Surrey respectively (2010-2012). Women can expect to live an additional 3.3 years more than men.
At age 65 men and women in North West Surrey CCG can expect to live an additional 19.3 years and 21.6 years respectively. This is more than the England average for both men (18.6) and women (21.1) but is lower than the Surrey average.
There is a considerable variation in both male and female life expectancy at ward level. LE at birth for men ranges from 74.8 in Weybridge North to 87.6 years in Ashford. For women, LE at birth ranges from 79.8 in Weybridge North to 92.5 in Walton Ambleside.
Healthy life expectancy
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 from overall life expectancy, the number of years people can expect to live in poor health out of their remaining years can be estimated.
Men and women in North West Surrey live 84.3% and 82.2% of their lives in ‘good health’ respectively. Men could therefore expect to live 12.7 years of their lives in ‘not good’ health. Although women (83.9 years) live slightly longer than men (80.6 years), women spend an average of 14.9 years in ‘not good’ health which is 2.2 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 75, due to causes of death 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
Similar to all of the Surrey CCGs, North West Surrey has the highest rate of PYLL for Cancer compared to other conditions.
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.
There are more than 6,000 people receiving social care support in North West Surrey. Around 18.5% (1,801) of people aged 85 and over currently receive support.
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. The number of people with caring responsibilities are expected to increase.
Just under 2,000 carers currently receive support in North West Surrey CCG and 1% of them are of working age (between 18-64 years of age). Around 1.3% of people aged 85 and over are carers receiving ASC support. The actual number of carers in North West Surrey is likely to be higher as many will not be known to social care.
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). Additionally, smoking-related illness adds significantly to the burden on the NHS.
The government has set an ambitious smoking prevalence target for England of 12% by 2022.
Smoking prevalence in the district & boroughs within North West Surrey CCG show a variation from 12.2% (in Elmbridge) to 18.6% (in Spelthorne). Also, there are significant variations between wards, ranging from 9 % in Pyrford, to 23% in Maybury and Sheerwater and 24% in Stanwell North.
Across Surrey, 12% of people aged 18 and over smoke, compared to a national average of 15% (2016). Smoking prevalence has gradually declined year on year. However, smoking rates are much higher among the 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% compared to 27% for England.
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 admissions episodes for alcohol related conditions (broad definition) in North West Surrey CCG is 1,795 per 100,000 population. This rate has risen steadily since 2008/09 and is higher than the 2014/15 rate for the rest of Surrey (1,755) and the South East region (1,708).
In North West Surrey CCG alcohol related mortality is 32.2 per 100,000 population which is lower than the rate for England at 41.3 per 100,000 population. Men experienced a higher rate of alcohol related mortality compared to women (2014). The number of alcohol-related deaths are usually higher in more deprived groups.
In Spelthorne, the proportion of adults estimated to be doing 150+minutes of physical activity per week is 54% which is significantly lower compared with Surrey (62%) and the lowest out of all the District and Boroughs in Surrey. The percentage of adults who do any walking for at least 10 minutes a day 5 times per week in Spelthorne is 37.7%, which is significantly lower than England (50.6%) and Surrey (49.8%).
Healthy Eating and Excess Weight
The proportion of the population within North West Surrey CCG who, when surveyed in 2015, reported that they had eaten the recommended 5 portions of fruit and vegetables on the previous day varied between the levels reported for England and Surrey. These were as follows:
Spelthorne (50%), Runnymede (54%), Woking (57%) and Elmbridge (57%) compared with Surrey (57%) and England (52%).
The percentage of adults classified as having excess weight in North West Surrey is the highest in Spelthorne (63%) and Runnymede (62%) and the lowest in Elmbridge (58%). These percentage are slightly less than that for England (65%) (2012-14).
There are 18.8 % (2,069) of children in reception year and 29.3 % (2,564) of children in year 6 in North West Surrey that are classified as overweight or obese. Those children who are overweight or obese are putting their current and future health at risk. (2014/15)
The proportion of five year old children free from dental decay in North West Surrey CCG is 79.3 % which is slightly more than the proportion for England at 75.2 % (2014/15).
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 (LTC) 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 educational opportunities.
North West surrey has significantly higher standardised incidence ratio (ISR) for colorectal cancer (107.6) compared with the rest of England. The incidence of lung cancer in North West Surrey was 85.4, significantly lower than that for England. Egham Hythe and Egham Town are the wards in North West Surrey with a high ratio of incidence of lung cancer, respectively 137.6 and 137.8.
Long term conditions
GP recorded prevalence is the number of people on the practice’s disease register expressed as a proportion of the number on the 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 and so indicates the potential to find and treat people at an earlier stage of the disease.
Within North West Surrey CCG, the proportion of undiagnosed people is estimated at 30% for atrial fibrillation, 55% for heart failure, and 50% for hypertension. The recorded prevalence for these conditions is 1.7%, 0.5%, and 12.6% respectively.
Diagnostic gaps also exists for other conditions such as chronic obstructive pulmonary disease (32%) and chronic kidney disease (44%).
Considerable variation exists in rates of diagnosis amongst the GP practices in North West Surrey.
The standardised hospital emergency admission ratios (adjusted for age) for stroke, coronary heart disease (CHD), chronic obstructive pulmonary disease (COPD) and myocardial infarction (MI) are significantly lower in North West Surrey compared to nationally. However, amongst the Surrey CCGs, North West Surrey also shows the highest emergency admission ratio for stroke (93.6), myocardial infarction (87) and COPD (67).
There is significant variation in emergency admission ratios for different conditions at the ward level indicating a need to focus on the causes of these health inequalities.
Death rates 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. Number of deaths also affects the size of the local population.
North West Surrey has the highest standardised mortality ratio for cancer (94.9) within Surrey when compared to England. Mortality among the under 75s from cancer is also higher in North West Surrey compared with other CCG areas in Surrey. Significant variation exists at ward level; for example, all age cancer mortality is high in Kingfield and Westfield (124.4), and low in St Georges Hill, Horsell East and Woodham and Ashford Town (68.4) when compared to nationally.
The mental health section of the health profile covers children and adult mental health, access to psychological therapies and dementia.
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 IMD 2015 common mental illness score for North West Surrey ranges from -1.18 to 0.10, and for England from -2.85 to 3.09. Overall common mental health needs in North West Surrey are relatively low compared to England. Hersham North (0.10) has the highest level of common mental illness, and St George’s Hill (-1.18) the lowest.
Children’s mental health
The recorded prevalence of mental health disorders in children is lower in North West Surrey CCG than in England. The estimated prevalence of any mental health disorder for GP registered population aged 5 to 16 is 7.9%. This is significantly lower than the national average of 9.2%.
Adult mental health
The estimated prevalence of common mental health disorders is 13.2%. This is lower than the England estimate of 15.6% but higher than the recorded prevalence of other LTC such diabetes mellitus.
The incidence of depression (first time cases presenting to their GPs) has increased from 0.8% to 1.0% since 2013/14.
The incidence of psychosis (severe mental health illness) in adults is 12.8 per 100,000 compared to 26.7 for England. The average achievement score for GP health checks for patients with psychosis is 77.7 which is higher than the England average score of 76.
The rate of people detained under the mental health act, is 24.7 per 100,000, which is significantly lower than the England average (58.7). The rate of contact with specialist mental health service for adults in North West Surrey was 2,665 per 100,000 which is significantly higher than the England average of 2,441. The discharge rate from mental health hospitals for North West Surrey registered patients (39.5 per 100,000 population) is lower than that for England (69.8).
The demand for mental health advice through NHS 111 was significantly more in North West Surrey CCG (262.4 per 100,000 population) compared to the National average (235.6).
Total spend on specialist mental health services on North West Surrey CCG patients (£129.7) is below the England average (£151.1).
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.
The current quarter’s (2016/17 Q3) referral rate to IAPT is 507.2 per 100.000 population (crude rate) which is significantly lower than the England average (786.3).
The mean average wait in days per month from referral to 1st treatment is 10.5 days which is better than the national wait of 18.8 days.
Those who completed treatment in the quarter (2016/17 Q3) was 252.6 per 100,000 population. This is below the national average (317.3).
In general there has been a downward trend in suicides in the UK, although rates in England have been slowly increasing since 2010-12, and in Surrey since 2000. Surrey has historically had a lower rate of suicide compared to England.
The latest three year average data for North West Surrey CCG shows there were 100 deaths from suicide and undetermined injury, a rate of 11.1 per 100 000 persons, which is higher than the rate for Surrey (9.1 per 100 000) and England (10.1 per 100,000). The rate for women in North West Surrey (7.4) is higher compared to that for Surrey (5.6) and significantly higher than for England (4.7).
The GP-recorded dementia prevalence for all ages and those aged 65 years and over are 0.8% and 4.6% respectively, which is similar to Surrey and England.
The estimated dementia diagnosis rate for those aged 65 years or older in North West Surrey is 65%. This is not significantly different to the national target of 67.9%. The estimated rate describes the rate of recorded diagnoses per person estimated to have dementia, therefore approximately 35% of people with dementia in North West Surrey are thought to be undiagnosed. Reducing dementia diagnosis prevalence gap was a local indicator for the Better Care Fund.
Currently 2,794 residents have been diagnosed with dementia. Estimates of expected levels of dementia in the population indicate that 35% of the residents with dementia remain undiagnosed compared to the National average of 32.1%.
Perinatal mental health
Many of these risk factors for Perinatal Mental Health are 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 630 to 1,260 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 420 to 630 women affected locally.
Mortality attributable to particulate air pollution varies widely across Surrey but is highest in North West Surrey. North West Surrey also exceeds the England average. The proportion of all deaths in people over 30 years of age which are due to man-made air pollution is 4.9% for Runneymede, and 4.8% for both Spelthorne and Elmbridge compared to 4.6% for England. Partners cross North West Surrey 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.