Surrey Downs 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 Surrey Downs CCG area – resident, registered, and housing constrained populations. The 2015 resident population of Surrey Downs CCG was estimated at 287,000 while the GP registered population was higher at 300,967 (April, 2015). In 2017, the GP practice population rose to 306,000 in April 2017. The population aged 65 and over is projected to rise by 21% from 59,600 in 2017 to 72,100 in 2027.
There were 3,098 live births in 2015 with a quarter of them to mothers over 35 years of age. The Surrey Downs CCG birth rate for women aged 15-44 years (64/1,000) is similar to the Surrey average (63/1,000). The older age profile of mothers in Surrey Downs 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. In Surrey Downs, 9.1% of the population are from non-white ethnic backgrounds compared to 14.6% for England. There are an estimated 372 Gypsies, Roma and Travellers residing on 14 traveller sites managed by Surrey County Council. This is an increase compared to previous years’ estimates, due to a new data source that is considered more reliable and the inclusion of sites that are managed by Surrey County Council but that sit just outside the Surrey Downs CCG border.
Access to the GP or hospital for households without a car can be problematic. In some areas of Surrey Downs, only 32.9% of households without a car have access to a GP within a reasonable time by public transport or walking, and 2.8% 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.
In Surrey Downs, the prevalence of learning disability is estimated at under 2.4% (5,608) of the population in 2017. This is projected to increase by 4% to 5,837 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.
In general, Surrey Downs is an affluent area, with over 55% of LSOAs being in the least deprived 20% in England. However, three of the small areas (LSOAs) in the wards of Court, Holmwoods and Ruxley are in the most deprived 30% of all small areas in England. Those living in more deprived areas are more likely to experience worse health.
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 Surrey Downs can expect better life expectancy compared with their counterparts in the rest of Surrey. LE is 81.8 years for men and 85.1 for women in Surrey Downs compared with 81.3 and 84.5 years respectively for Surrey (2010-2012).
At the age of 65, men in Surrey Downs can expect to live an additional 20.1 years and 22.4 for women. This is considerably higher than the England average for both men (18.6) and women (21.1) and the Surrey average for women (22.0 years).
There is a considerable gap in both male and female life expectancy at the ward level (2010-2014). LE at birth for men ranges from 75.6 in Court to 85.8 years in Fetcham East, a difference of 10.2 years. LE for women ranges from 80 in Mickleham, Westhumble and Pixham to 89.7 in Cobham Fairmile, a difference of 9.7 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 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 Surrey Downs live 85.3% and 83.7% of their lives in ‘Good Health’ respectively. Men could therefore expect to live 12.1 years of their lives in ‘not good’ health. Although women (85.1 years) live slightly longer than men (81.8 years), more of this time is spent in ‘not good’ health (13.9 years) compared to men. This, coupled with the expected increase in the population aged over 65, is likely to put increased pressure on health and social care services in the future.
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 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 together that is significantly lower than that of England, these do not indicate the disease areas where the greatest potential gain in improving health through healthcare can be made. Surrey Downs’ PYLL for ischaemic heart diseases is 410.3, similar to other Surrey CCGs but significantly lower than England (667.5).
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.
In Surrey Downs, there are just under 5,000 service users receiving support from ASC in 2017. Around 16.0% (1,525) of people aged 85+ years are current service users. The total number of service users has changed little from 2015 when there were 4,771 adults receiving social care, although the proportion of people aged 85+ who were open to social care has reduced from 20.9% (1,624 individuals).
ASC supports carers through provision of range services, including respite care. Some people will be carers in addition to receiving social care support themselves.
There are almost 1,500 adult carers receive support from ASC in Surrey Downs CCG and 54% of them are of working age (between 18-64 years of age). The actual number of carers in Surrey Downs is likely to be significantly higher, as many will not be known to social care. Previous estimates from census data suggest that approximately 28,000 people are providing at least 1 hour of unpaid care per week in Surrey Downs.
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.
Estimated smoking prevalence in Surrey Downs CCG is 14 % but has significant ward level variation with ward smoking prevalence ranging from 9 % in Nonsuch ward to 25% in Preston ward. These CCG and ward-level estimates are based on Mosaic geodemographic segmentation data and are therefore not directly comparable with the borough and district, Surrey and national estimates that are based on data from the Annual Population Survey (APS).
Smoking rates are much higher among our more deprived communities, e.g. in the wards of Preston (24.6%) and Leatherhead North (22.3%), and among those working in routine and manual occupations, having a significant impact on increasing health inequalities by reducing life expectancy in these groups.(Mosaic data). The smoking rate amongst Surrey residents in routine and manual occupations is 24% (England, 27%).
The narrow definition of alcohol-related hospital 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 definition) in Surrey Downs CCG is 1,601.5 per 100,000 population (all ages, 2014/15). While this is less than the rate for England (2,138.7 per 100,000 population), alcohol-related admission episodes have been increasing steadily since at least 2008/9.
The rate of hospital admissions for alcohol related conditions (narrow definition) in Surrey Downs CCG is 436.3. This is less than the rate for England at 640.8 per 100,000 population. (2014/15)
Alcohol related mortality is 37.6 per 100,000 population (all ages) in Surrey Downs CCG, which is lower than the rate for England at 45.5 per 100,000 population. Since 2008, alcohol related mortality in Surrey Downs has not fallen at the same rate as nationally. Males experienced a higher rate of alcohol related mortality compared to females. (2014)
Health harms from alcohol consumption (such as cardiovascular disease, liver disease and cancer) are usually greater in the more deprived wards of Court, Holmwoods and Ruxley although consumption is usually greater in more affluent areas.
The proportion of adults estimated to be doing 150+ minutes of physical activity per week in Mole Valley is 62%, Epsom and Ewell is 62%, Elmbridge is 66% and Reigate and Banstead is 56%. This is significantly higher than that of England (57%), for Elmbridge, Mole Valley and Epsom and Ewell.
The percentage of adults who do any cycling, at least 3 times per week, in Mole Valley is 4.3%, Epsom Ewell is 3.9%, Elmbridge is 5.2 % and Reigate and Banstead is 3.7%. These estimates are similar to the England (4.4%) and Surrey (4.8%) averages. The percentage of adults who do any walking, at least once per week, in Elmbridge is 87.4%, significantly higher of that of England (80.6%) and Surrey (82.5%) in Epsom and Ewell is 83.2%, Mole Valley is 81.9% and Reigate and Banstead is 82.3% respectively.
Healthy Eating 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 is lowest in Epsom and Ewell (52%), and highest in Reigate and Banstead (58%). Overall Surrey Downs boroughs and districts report similar levels of fruit and vegetable consumption to the rest of Surrey (57%), and higher than the rest of England (52%). (2015) .This indicates that just under half of the population are not consuming sufficient quantities of fruit and vegetables to maintain good health.
The percentage of adults classified as having excess weight (BMI over 25) are highest in Reigate and Banstead (63%) and lowest in Elmbridge (58%). The percentage for England was 65% (2012-14).
Around 16.5 % (1,331) of children in reception year and 24.3 % (1,715) of children in year 6 in Surrey Downs are classified as overweight or obese. These percentages are lower than for England (22.2% for reception and 33.4% for year 6) (2012/13-2014/15); however, there is significant variation between wards.
The proportion of five year old children free from dental decay in Surrey Downs CCG is 82.6 % which is better compared with England at 75.2% (2014/15).
Standardised incidence ratios provide a measure of the number of new cases observed compared with the England population. A ratio higher than 100 indicates more new cases than expected.
Surrey Downs has a higher incidence of prostate (105.9) and breast cancer (107.2) than expected, when compared to the rest of England. The standardised incidence ratio of prostate cancer in Surrey Downs (105.9) is higher than England, but not significantly.
The standardised incidence ratio for breast cancer in Surrey Downs is (107.2), significantly higher than England (100.0). The exact reasons behind this higher incidence ratio are not clear. Breast cancer incidence tends to be higher in more affluent groups, and Surrey Downs is an affluent area, so this may be one explanation. It cannot easily be explained by differences in screening rates that may be identifying more cancers earlier as Surrey overall has similar NHS screening coverage to England. However, it should be noted that screening data specifically for Surrey Downs are not available and NHS breast screening data exclude private screening. Private mammography may possibly be more common due to the area’s affluence. If this were the case then it might lead to a higher screening uptake and therefore higher diagnosis compared with other areas. In addition, many of the risk factors for breast cancer, such as physical inactivity, smoking or excess weight, are less prevalent in Surrey Downs than England. Although alcohol-related hospital admissions are lower in Surrey Downs than England, alcohol consumption is associated with affluence and alcohol is a known risk factor for breast cancer, so this may be a factor. In addition, late or no pregnancy is a known risk factor, so the older maternal age profile for pregnancies in Surrey Downs compared with England may also be contributing to the difference in breast cancer incidence.
The ratios for colorectal and lung cancers are significantly lower than for England (91.1 and 71.6 respectively).
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 practise 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, thereby reducing morbidity and mortality, and their associated costs, downstream. All prevalence figures relate to all ages unless otherwise specified.
- The recorded prevalence for heart failure in Surrey Downs is 0.5%. It is estimated that 58% of people with heart failure remain undiagnosed.
- The recorded prevalence for hypertension in Surrey Downs is 13.8%. It is estimated that 47% of people with hypertension remain undiagnosed.
- The recorded prevalence for atrial fibrillation, a risk factor for stroke, is 1.9%. It is estimated that 33% of people with atrial fibrillation remain undiagnosed.
- The recorded prevalence for chronic obstructive pulmonary disease (COPD) in Surrey Downs is 1.2%. It is estimated that 37% of people with COPD remain undiagnosed.
- Surrey Downs has the lowest recorded prevalence of osteoporosis in those aged 50+ in Surrey (0.2%). This appears to be a reduction from 0.34% reported in the previous profile, which may indicate a drop in recording.
- The recorded prevalence for chronic kidney disease (CKD) in those aged 18+ in Surrey Downs is 3.9%. It is estimated that 44% of people with CKD remain undiagnosed.
- The recorded prevalence for diabetes mellitus in those aged 17+ in Surrey Downs is 5.1%. It is estimated that 34% of people with diabetes remain undiagnosed.
In Surrey Downs CCG the standardised hospital emergency admission ratios for stroke, CHD, COPD and myocardial infarction are significantly lower compared with national rates. Surrey Downs has an emergency admission ratio for myocardial infarction of 70, while East Surrey is 58.5 and Guildford and Waverley is 59.5.
Although admission ratios for the CCG as a whole are generally low, there is variation between wards with some having much higher/lower ratios than for England. This variation information could be used to target preventative interventions and work to identify undiagnosed long term conditions. The highest rates in Surrey Downs are in Molesey South (122.2), Leatherhead North (121.9), Molesey North (118.9) and Preston (114.3), while the lowest rates are in the wards of Fetcham East and Fetcham West (both 50.8).
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. The Surrey Downs ward of Mickleham, Westhumble and Pixham have the highest standardised mortality ratio for cancer in all age groups (134.5).
The mental health section of the health profile covers children’s mental health, common and severe mental health, perinatal and dementia.
Index of deprivation – mood and anxiety disorders.
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 England ranges from 3.09 to -2.85and the Surrey Downs CCG range is from 0.33 to -1.61. Overall common mental health needs in Surrey Downs are relatively low compared with England. The ward with the highest level of common mental illness is Preston in Reigate and Banstead (0.33) and the ward with the lowest level is Oxshott and Stoke D’Abernon in Elmbridge (-1.61).
Children’s mental health
The GP prevalence of mental health disorders in children are is lower in Surrey Downs than in England. The estimated prevalence of any mental health disorder for the GP registered population aged 5 to 16 is 7.4%. This is significantly lower than the national average (9.2%) but similar to other Surrey CCGs.
Adult mental health
The estimated prevalence of common mental health disorders among those aged 16-74 in Surrey Downs in 2014/15 is 13.3% but is higher than estimates of most other long term conditions such as diabetes and coronary heart disease. This is lower than the England estimate of 15.6%.
The incidence of depression (first time cases presenting to their GPs) has increased since 2012/13. The proportion of newly diagnosed GP registered patients has almost doubled from 0.8% to 1.4%. The prevalence of GP-recorded depression in those aged over 18 has also increased in that time to 7.8% in 2015/16. However, the proportion of newly diagnosed patients reviewed 10-56 days after diagnosis is lower in Surrey Downs (57.0%) than England (64.6%) and all other Surrey CCGs (range 65.0-70.7%).
The prevalence of serious mental illness in Surrey Downs in 2015/16 (0.7%) is significantly lower than for England (0.9%). The estimated incidence of psychosis (severe mental illness) per 100,000 population aged 16-64 years is 18.8 (similar to England at 18.1) and the prevalence in those aged 16+ is 0.2% (England 0.4%). However, the annual rate of new cases of psychosis aged 18 years and over served by Early Intervention Teams is significantly lower than England (14.4 vs 26.7 per 100,000 in quarter 4 of 2015/16). The average summary score for GP physical health checks (ie. how well they deliver over six QOF physical health indicators) for patients with serious mental illness is 76.8, which is similar to the England average score of 76. As people with serious mental illness, particularly men, are more likely to die earlier than those without, there is a need to target this group for the identification and support to manage risks to their physical health.
Around 20 per 100,000 people were detained under the Mental Health Act in 2012/13, which is significantly better than the England average (58.7).
The rate of contact with specialist mental health services in Surrey Downs CCG was 2,628 per 100,000 aged 18+ in quarter 4 of 2016/17, which is significantly higher than the England average of 2,441.3.The rate of mental health admissions to hospital is lower in Surrey Downs than the England average (44.1 and 69.8 per 100,000 aged 18+ respectively in quarter 2 of 2014/15); it therefore follows that the discharge rate is also lower in Surrey Downs than in England (50.8 and 69.8 per 100,000 aged 18+ respectively). It is not clear why the discharge rate has been generally higher than the admissions rate over the last 18 months for which data are available.
The age profile of those seeking mental health advice through NHS 111 in 2015 is older in Surrey Downs, with 36.3% of calls being made by those aged 65 years and over (23.5% for England) and only 44.7% made by those aged 18-64, compared to 59.9 in England. The overall rate of calls to NHS 111 regarding mental health was lower in Surrey Downs than England on Monday to Fridays in 2015 (23.4 vs 28.3 per 100,000) and similar over the weekends (43.6 vs 47.0 per 100,000).
Total spend on specialist mental health services on Surrey Downs patients (£101.8 per person) is below the England average (£151.1 per person). The cost of GP prescribing for psychosis and related disorders has more than halved since 2013/14 (to a Net Ingredient Cost of £301.80 per 1,000 registered people in Q4 of 2016/17); however it remains significantly higher than the England average (£215.10 per 1,000) despite the lower prevalence of psychosis in Surrey Downs.
In general there has been a downward trend in suicides in the UK and in Surrey since 2000, although rates in England have been slowly increasing since 2010-12. Surrey has historically had a lower rate of suicide compared with England.
The latest three year average data (2013-15) for Surrey Downs (8.2 age standardised rate per 100,000) shows that mortality rate from suicide and injury undetermined is similar to the Surrey (9.1) and England averages (10.1). Suicide rates in males are also similar to Surrey and national averages.
The GP-recorded dementia prevalence for all ages and those aged 65 years and over is 0.9% and 4.4% respectively. For 65 years and over, this is similar to the Surrey and England averages; however the prevalence for all ages is higher than England.
The estimated dementia diagnosis rate for those aged 65+ in Surrey Downs is 65%, an increase from 56.9% in 2014/15 and 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 Surrey Downs are currently thought to be undiagnosed. Reducing the dementia diagnosis prevalence gap was a local indicator for the Better Care Fund.
Currently 2,666 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 with the national average of 32.1%, a reduction from the estimate of 43% undiagnosed reported in the 2015 health profile for Surrey Downs. Of people diagnosed with dementia, Surrey Downs has the lowest proportion of people whose dementia care plan has been reviewed in the last 12 months of all Surrey CCGs (75.4%); this is also significantly lower than the England average (78.1%). In addition, it has a higher rate of emergency admissions for people with dementia aged over 65 than the Surrey average. However, the mortality rate for people with dementia (aged 65+) is lower than the Surrey average (although not significantly).
Perinatal mental health
Many risk factors for problems with 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.
Due to insufficient data, England prevalence estimates have been applied to the Surrey Downs population to arrive at the estimated numbers of mothers likely to suffer with mental health problems. Estimated national prevalence figures applied to local data suggest that, in Surrey Downs, approximately 445 to 885 women may be affected by Adjustment Disorders and Distress (AD) and between 295 to 445 women may be affected by Mild-Moderate Depressive Illness and Anxiety (DIA) following the birth of their child. Data on other perinatal conditions are shown in the dashboard.
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 or return to employment.
In quarter 3 of 2016/17, the referral rate to IAPT was 529.6 per 100.000 population (crude rate) which is significantly lower than the England average (786.3 per 100,000).
In any one month in 2016/17, between 11.2 and 15.1% of those estimated to have anxiety and depression entered IAPT treatment. This is not significantly different from the national average of 17.2%. Of all referrals to IAPT, about 5.8% did not attend (DNAs) this is better compared with the national average (10.2%).
The mean average wait in days per month from referral to 1st treatment is 9.2 days which is better than the national wait of 18.8 days. This average wait to enter treatment is generally amongst the lowest of the Surrey CCGs. However, the time between 1st and 2nd treatment was 29.9 days, similar to the England average (31.6 days) and the second highest in Surrey.
In quarter 3 of 2016/17, the IAPT treatment completion rate was 294 per 100,000 population. This is not significantly different from the national average (317.3 per 100,000).
Mortality attributable to particulate air pollution varies widely across Surrey. The proportion of all deaths in people aged over 30 years which are due to man-made air pollution in England is 4.6%. Mortality is higher in Epsom and Ewell (4.8%) compared to Mole Valley (4.4%). Partners across Surrey Downs 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.
The Promoting Health and Wellbeing Sub-group of the Surrey Downs Local Joint Commissioning Group, a multi-agency network across health, social care, district and borough councils and the voluntary sector, is taking a collaborative approach to a range of health and wellbeing interventions in Surrey Downs, including proactive identification of residents at risk of developing health and care needs, healthy behaviours and promoting independence and inclusion.
Further information on healthy behaviours support is available on the Healthy Surrey website (https://www.healthysurrey.org.uk/).
This executive summary provides a synopsis of some of the key indicators of relevance to commissioners, clinicians and care providers for the Surrey Downs CCG area.
In summary, Surrey Downs overall is an affluent area, with good health outcomes and relatively low rates of many conditions and unhealthy behaviours; however, this masks some inequalities within the area, with some groups/smaller areas having significantly greater needs or worse outcomes. The data highlight key areas for consideration, including health inequalities, the growing population of those aged over 65, access to services for those without a car, a higher incidence of breast cancer, and significant proportions of people estimated to have long term conditions being undiagnosed.