Surrey-Context-Key-Challenges

Wellbeing and indicators of quality of life

Please follow the link or explore the ‘Economic and other indicators’ page of the Surrey population tableau dashboard below.

The Office for National Statistics looks at a variety of indicators to assess quality of life and wellness. Within this are survey questions focusing on self-reported wellness.

• When rating anxiety on a scale of 0 – 10 (0 being no anxiety, 10 being high anxiety), Tandridge and Woking reported the least anxiety (2.7) and Spelthorne the most (4.3)

• When rating the feeling that things done in life are worthwhile on a scale of 0 – 10 (0 being not at all, 10 being completely), Runnymede has the highest rating (8.3) and Waverley the lowest (7.5)

• When rating happiness on a scale of 0 – 10 (0 being low, 10 being high), Woking had the highest rating (8.3) and Guildford had the lowest (7.1)

• When rating life satisfaction on a scale of 0 – 10 (0 being low, 10 being high), Runnymede has the highest rating (8.0), Reigate and Banstead and Spelthorne had the lowest (7.2)

Nationally and in Surrey average ratings of well-being have deteriorated across all indicators in the year ending March 2021, continuing a trend that was seen across most indicators in the previous period, but even more sharply, and which notably takes place during the COVID-19 pandemic.

Proportion in good health

Please follow the link or explore the ‘proportion of population in good health’ page of the Surrey population tableau dashboard below.

In the census, people were asked to self-report on their health status. The share of the population in good health deteriorates as people age. However, evidence shows this happens earlier and at a faster rate for men and women living in the most deprived areas compared to the least deprived areas (The Health Foundation).

Surrey has a higher proportion of people who report being in good or very good health than England at all ages. The lowest proportion is seen in those ages 65 and older (65.8%), however this is still significantly higher than the same age group nationally (58.0%).

The biggest difference between males and females in Surrey is seen in the 16 to 24 age group, at 92.9% and 94.6% respectively.

Ratio of house price to earning

Please follow the link or explore the ‘housing affordability’ page of the Surrey place tableau dashboard below.

Overall, housing affordability has been decreasing in Surrey since 2002. Median earnings have increased but not at the same rate as house prices. This means people in Surrey are likely to spend longer renting and for those that are able to become homeowners, this is likely to be later in life.

Economy

Please follow the link or explore the ‘economy’ page of the Surrey place tableau dashboard below.

Employment and unemployment

Employment status can affect health outcomes through multiple means including but not exclusively, access to and affordability of healthcare,

In Surrey 73.6% of the population are economically active and 2.8% of those who are economically active are unemployed. Just over a quarter (26.4%) of the population are economically inactive, of which 2% are long term sick or disabled and 12.9% are retired. Runnymede has the highest proportion of economically inactive people (28.4%), and Spelthorne the lowest (24.5%).

The highest number of people on universal credit is in Spelthorne, and the lowest is in Waverley. In 2023, there were 3,604 (15.2%) of 16-17 year olds in Surrey not in education, employment or training (or unknown).

Personal debt

Those with personal debt are more likely to be in poor health due to stress, health-harming behaviours and less access to disposable income to engage in healthy behaviours. Equally when in poor health, debt management can become increasingly difficult.

Average personal debt (unsecured loans) per person aged 18+ in Surrey is £641.20. This is highest in Elmbridge and lowest in Guildford. Being in debt is linked to mental ill-health [3].

Further details on economy in relation to employment in Surrey is provided in the Overview of people (young people out of work) section of this chapter.

Fuel poverty

Data on fuel poverty is available by filtering the ‘deprivation’ page of the Surrey place tableau dashboard to ward level and selecting the fuel poverty indicator.

Fuel poverty in England is measured using the Low-Income Low Energy Efficiency (LILEE) indicator. Under this indicator, a household is considered to be fuel poor if:

• they are living in a property with a fuel poverty energy efficiency rating of band D or below

and

• when they spend the required amount to heat their home, they are left with a residual income below the official poverty line

There are 3 important elements in determining whether a household is fuel poor:

• household income

• household energy requirements

• fuel prices

The latest fuel poverty statistics were created by the Department for Business, Energy & Industrial Strategy using 2023 data. Overall, the South East had a lower proportion of households in fuel poverty (9.6%) compared to England (13.0%).

Subregional statistics were last produced using 2022 data and so may not represent the current levels of fuel poverty.

In subregional analyses, Surrey had smaller proportions of households in fuel poverty (8.3%) than the English average (13.1%) in 2022. All districts and boroughs have seen an increase in fuel poverty, likely associated with rising fuel cost seen in 2022 and the ongoing wider cost of living crisis. Waverley had the highest proportion of households in fuel poverty at 9.34 per cent alongside Guildford with 9.01%, Tandridge 8.95% and Mole Valley 8.85% in fuel poverty . Surrey Heath had the smallest percentage of households in fuel poverty at 6.75 per cent.

At LSOA level, the proportion of households in fuel poverty ranges by 16.43 percentage points from 2.65% in 001F Reigate and Banstead to 19.08% in 002F Runnymede. In Surrey, 24 LSOAs have a higher percentage of households in fuel poverty than the national average. Further detail on fuel poverty in Surrey is available on Surrey-i: Fuel poverty and related statistics

Attainment in children eligible for free school meals

The Free School Meals indicator shows attainment for children eligible for free school meals. Attainment is measured via the Average Attainment 8 measure which is calculated by adding together a student’s highest scores across eight government approved qualifications (including GCSEs and the English Baccalaureate or EBacc). Pupils are at the end of Key Stage 4 (KS4) aged 15-16 and attending state-funded schools in England.

Free school meals (FSM) does not relate to pupils who actually received free school meals but those who are eligible to receive free school meals. Pupils not eligible for free school meals or unclassified pupils are described as ‘All other pupils’.

Most areas in Surrey have a similar average attainment score to England (39.1), except for Surrey Heath (29.7) and Mole Valley (29.3), which are below the England average, while Elmbridge and Epsom & Ewell have scores just above the England average.

Figure 7: Average attainment score among children eligible for FSM (2020/21)

Attainment score data can be found on Fingertips

Children’s education and development of skills are important for their own wellbeing and for that of the nation as a whole. Learning ensures that children develop the knowledge and understanding, skills, capabilities and attributes that they need for mental, emotional, social and physical wellbeing now and in the future. Children with poorer mental health are more likely to have lower educational attainment and there is some evidence to suggest that the highest level of educational qualifications is a significant predictor of wellbeing in adult life; educational qualifications are a determinant of an individual’s labour market position, which in turn influences income, housing and other material resources.

Educational attainment is influenced by both the quality of education children receive and their family socio-economic circumstances. Being on FSM is considered to be a good indicator of socio-economic disadvantage in the UK [5]. Young people in the UK are usually eligible for free school meals (FSM) if their parents or carers are on a low income or in receipt of certain benefits. Children on FSM perform relatively poorly in educational attainment compared to counterparts without FSM [6].

Overview of people in Surrey

In 2020, a series of rapid needs assessments (RNAs) were carried out as part of the Surrey Covid-19 Community Impact Assessment to understand the impacts of the pandemic on key population groups that were identified as having different types of vulnerabilities. Hundreds of community members, people working in frontline services, volunteer and community organisations took part in this process through interviews, focus groups and surveys. The findings from the RNAs formed the basis of the priority population groups incorporated into the Surrey Health and Well-being Strategy and each group will have their own refreshed JSNA chapter.

Please follow the link below to view the Priority Populations in Surrey Tableau dashboard: JSNA Priority Populations 2026 This dashboard provides high level estimates of the number and proportions of people within each of the priority populations in Surrey. The data definitions and further details about each indicator can be shown by hovering over the values shown in the dashboard.

This section gives a high-level overview of each of the priority populations of identity named in the Surrey Health and Wellbeing Strategy as well as other identified population groups. On average people in this groups experience poorer than average health access, experience and/or outcomes.

Some JSNA chapters are currently being updated and where an existing JSNA chapter has been published, a link is provided to take you to the full chapter. Links are also provided to the relevant RNAs.

The below are HWB strategy / surrey Heartlands Integrated care strategy priority populations

Adults with learning disabilities and adults with autism

In 2019/20 the number of adults diagnosed with learning disabilities in Surrey was 5,616 (0.4%).

In 2021 the number of people in Surrey Heartlands CCG who self-reported having a learning disability was 1.1%.

An Adults and Children with Learning Disabilities Rapid Needs Assessment Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

A JSNA chapter on people with learning disabilities has been published with high level insights on this topic. A further chapter on Neurodiversity is also planned.

Children and young people with additional needs and disabilities

In Surrey 4,565 (2.86%) children in school have Special Educational Needs (SEN).

An Adults and Children with Learning Disabilities Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

A JSNA chapter on children and young people with additional needs and disabilities has been developed and provides high level insights on this topic.

Young people out of work

Please follow the link or explore the relevant indicators on the ‘economy’ page of the Surrey place tableau dashboard below.

A Young people out of work Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

Looked after children and People with care experience

In 2021 there were 996 children in care in Surrey (38 per 10,000 of the population under 18 years old).

Surrey’s aim to enable the system of support to realise better outcomes for children and young people is outlined in the Sufficiency Strategy for Looked After Children, Care Leavers and Children on the Edge of Care 2020-2025.

People with long term health conditions, disabilities or sensory impairment

Please follow the link or explore the Long term disease tableau dashboard below.

The Quality and Outcomes Framework (QOF) reports prevalence of several long-term health conditions at various geographies across England. Below is a table showing six long-term health conditions where the data is published at county level. QOF prevalence data have been compared for 2020/21 to 2023/24 values for Surrey, the South East and England.

Table 7: QOF Prevalence of long-term health conditions

Hypertension saw the largest change in prevalence. In the 2023/24 QOF period, the prevalence of hypertension across registered patients in Surrey GP practices was 14% (182,801 people) compared to 15% across the South East and 14.8% across England. In the 2020/21 QOF period prevalence of hypertension was 13.1% (166,745 people), this equates to a 0.9% increase in Surrey. This is in line with the change observed in the South East and England.

Across Surrey, Mole Valley Local Authority had the highest prevalence of hypertension in 2023/24 with a value of 16.2%, Guildford had the lowest prevalence with a value of 12.1%.

No conditions saw a decrease in their prevalence. Prevalence on rheumatoid arthritis remained static at 0.7% in surrey, and 0.8% in the South East and England. Only small increases were observed in coronary heart disease (0.1% in Surrey and static in South East and England) and stroke prevalence (increased by 0.1% in Surrey, South East and England).

The Royal National Institute of Blindness (RNIB) estimates that across Surrey in 2022, 43,100 people are living with sight loss, this figure is made up of 38,280 people living with partial sight and 5,850 living with blindness[7]. This equates to 3.6% of the Surrey population living with sight loss compared to a national value of 3.3%. By 2032 it is predicted that 51,000 people across Surrey will be living with sight loss. A summary of the main health conditions contributing to this increasing level of sight loss across Surrey can be found below.

Table 8: Estimated number of people living with sight threatening eye conditions

Older people (80+) and people in care homes

Please follow the link or explore the Older people and people in care homes tableau dashboard below.

In 2020 in Surrey, males over the age of 80 years account for 2.36% (28,399 people) of the population compared to 2.06% in England. Females over the age of 80 years make up 3.43% (41,094 people) of the population compared to 2.99% in England.

Surrey’s older population is expected to increase to 49,109 males over 80 years old and 64,119 females over 80 years old by 2043. This has important implications for social care provision as the likelihood of being disabled and/or experiencing multiple chronic and complex health conditions among those aged 65 years and over increases with age[8]. In 2020/21, there were 1,067 admissions to care homes, a rate of 464 per 100,000 of the population aged 65 years and older.

Ratings of personal well-being are lowest around mid-life but then start to rise around ages 60 to 64 years, peaking between the mid-60s and mid-70s before starting to decrease with age.

Needs assessments on Residential Care and Older People who were Shielding, had Chronic Illnesses and/or Physical Disabilities were undertaken as part of the Surrey Covid-19 Rapid Needs Assessments.

Carers and young carers

Please follow the link or explore the Carers tableau dashboard below.

According to the 2021 Census, 90,497 (7.5%) Surrey residents reported that they provide unpaid care. The proportion has changed since 2001 and 2011 when 9.4% and 9.6% respectively were providing care. This change may be a result of the covid-19 pandemic restrictions. Most carers are providing less than 20 hours per week, but 15,059 are providing 20 to 49 hours per week and 23,469 are providing more than 50 hours per week.

The 2021 Census asked people to rate their general health as either ‘very good’, ‘good’, ‘fair’, ‘bad’ or ‘very bad’. Generally, the self-rated health of unpaid carers deteriorated with the amount of unpaid care that they provided. Compared with people providing no unpaid care, those providing 50 hours or more of unpaid care a week were two to three times more likely to report their general health as not good (i.e. fair, bad or very bad). This trend is broadly seen in Surrey, however the difference in reported bad or very bad health in those who provide unpaid care and those who don’t reduces in the older age groups.

In Surrey, 2.1% of the population provide more than 50 hours unpaid care. Spelthorne has the highest proportion of the population providing this much care (2.4%), and Elmbridge has the lowest (1.8%).

There are proportionally fewer young carers (under 24 years old) in Surrey compared to the South East and England. The proportion of young carers aged 0 – 15 years old are highest in Woking and Waverley and lowest in Tandridge.

The Surrey Carers Strategy 2021 to 2024 sets out local aims and priorities and the young carers joint strategy (across the County Council and NHS) has been extended until 2026. More information about unpaid care can be found on Surrey-i.

People experiencing homelessness

Please follow the link or explore the Homelessness tableau dashboard below.

Statutory homelessness is used to describe a household when a local authority decides that that the occupiers of the home do not have a legal right to occupy accommodation that is accessible, physically available and which would be reasonable for the household to continue to live in[9]. Comparing the years 2008 with 2017 the rate of statutory homelessness per 1,000 households has stayed relatively consistent in England, values of 2.48 and 2.41. Looking at the same metric across Surrey there has been a sharp increase across the same period, in 2008 the rate was 0.35 per 1,000 households and in 2017 it was 1.34 per 1,000 households.

Looking at statutory homelessness on a district and borough level shows a great deal of variation across Surrey. In 2017 the highest rate of 2.87 per 1,000 households was seen in Spelthorne, during the same year the lowest rate was seen in Guildford with a value of 0.38 per 1,000 households. The rate is roughly seven times higher in Spelthorne than it is in Guildford.

The Homelessness Reduction Act (HRA) 2017 introduced new prevention and relief duties, that are owed to all eligible households who are homeless or threatened with becoming homeless, including those single adult households who do not have ‘priority need’ under the legislation. These meant significantly more households are being provided with a statutory service by local housing authorities[10]. One metric related to this is the number of households owed a duty (statutory service) under the HRA per 1,000 estimated households. In 2019 the England rate was 12.25 per 1,000 households, dropping to 11.34 in 2020. Across Surrey the value in 2019 was 7.78 per 1,000 households, dropping to 6.68 in 2020. Surrey’s rate in both 2019 and 2020 was lower than the South East values of 10.58 and 9.87 respectively.

Looking at the same metric as above at a district and borough level there is again a large difference between the areas with the highest and lowest values. In 2020 the district/borough in Surrey with the highest value was Spelthorne where the rate was 9.5 per 1,000 households. The area with the lowest value was Surrey Heath where the rate was 4.2 per 1,000 households.

A Homelessness Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Rapid Needs Assessments.

People experiencing domestic abuse

Please follow the link or explore the Domestic Abuse tableau dashboard below.

In Surrey, 10,125 domestic abuse related crimes were recorded by Surrey Police in the year to 31st December 2023.This rate is lower than the South East and England, at 21 and 24 per 1,000 population respectively. In 2022/23 there were 10,125 domestic abuse-related incidents and crimes were recorded. The rate of domestic abuse crimes and the proportion of all crimes that are domestic abuse related in Surrey are also low compared to other police areas across the country.

Women experiencing domestic abuse are more likely to experience a mental health problem, while women with mental health problems are more likely to be domestically abused, with 30-60% of women with a mental health problem having experienced domestic violence[11].

Domestic violence is associated with depression, anxiety, PTSD and substance abuse in the general population[12].

Exposure to domestic abuse has a significant impact on children’s mental health. Many studies have found strong links with poorer educational outcomes and higher levels of mental health problems[13].

The Surrey Against Domestic Abuse Strategy 2014-2029 outlines local priorities and actions. A Domestic Abuse Rapid Needs Assessment was also undertaken as part of the Surrey Covid-19 Rapid Needs Assessments.

People with serious mental illness

In 2020/21, 9,343 (0.73%) people in Surrey had been diagnosed with Serious Mental Illness (SMI). Where SMI are mental health problems so significant, they impact a person’s functional ability as well as their ability to work, attend education or in other ways achieve their potential.

A Mental Health Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

A JSNA chapter on mental health has been published here: Emotional and Mental Wellbeing in Surrey Adults

People with drug and alcohol problems

Please follow the link or explore the Substance Use Adults tableau dashboard below.

Following an overall downward trend from 2009/10 in the number of adults in substance misuse treatment in Surrey, an increase has been seen between 2017/18 and 2020/21. However, this is in the context of unmet need ranging from 54% of opiate users to 79% of alcohol users[14]. In 2020/21, 2,134 people in Surrey received in patient treatment for drug misuse and there were 3,954 admissions to hospital for an alcohol related condition.

Drug misuse and dependency can lead to a range of harms for the user including:

• poor physical and mental health and ultimately death

• unemployment

• homelessness

• family breakdown

• criminal activity[15]

The Surrey Substance Misuse Strategy sections on Drugs and Alcohol were refreshed in 2019. A Young People and Substance Misuse Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

Minoritised ethnic group

Please follow the link to explore the ‘Religion, language and ethnicity’ page of the Surrey population tableau dashboard as this covers the data on population groups from minority ethnicities in Surrey. The dashboard also allows users to explore the data for health-based geographies including PCNs, place-based partnerships and ICS.

Surrey is less diverse than England as a whole and the older population is less diverse than the younger cohorts in Surrey; the majority of people aged 65 and older are white British with under 3% from other ethnic groups. The highest proportion of Asian ethnicities (other than Indian and Pakistani) are in young adults aged 16-24 and the proportion of mixed/multiple ethnic groups is highest among children under 16.

Although the proportion of the population from minority ethnic groups is smaller in Surrey than in the country as a whole, it is essential to work across partner organisations to ensure that the needs of these small communities and individuals are appropriately met. Some minority ethnic groups may be seldom heard because of language or differences in culture which contribute to inequalities. The movement of Gypsy, Roma and Traveller people may also influence the ability of health services to reach and meet needs of this group. Levels of trust in different communities regarding healthcare and providers, different cultural patterns and behaviours may influence the experience of health and social care services for residents from different ethnicity groups in Surrey.

A Black, Asian and Minority Ethnic (BAME) Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Rapid Needs Assessments.

Gypsy, Roma and Traveller Communities

The term Gypsy, Roma and Traveller (GRT) has been used to describe a range of ethnic groups or people with nomadic ways of life who are not from a specific ethnicity. These groups are distinct, but are often reported together. In the UK, it is common in data collections to differentiate between:

• Gypsies (including English Gypsies, Scottish Gypsies or Travellers, Welsh Gypsies and other Romany people)

• Irish Travellers (who have specific Irish roots)

• Roma, understood to be more recent migrants from Central and Eastern Europe

Further details are available in the summary: Gypsy, Roma and Irish Traveller ethnicity summary – GOV.UK Ethnicity facts and figures (ethnicity-facts-figures.service.gov.uk).

It is widely believed that the Gypsy, Roma and Traveller community is under reported in the Census. The April 2019 House of Commons Women and Equalities Select Committee report on inequalities faced by Gypsy, Roma and Traveller communities noted that there was a lack of data on these groups. For the first time, the 2011 Census ethnic group question included a tick box for the ethnic group ‘Gypsy or Irish Traveller’ and the 2021 Census had a ‘Gypsy or Irish Traveller’ category, and a new ‘Roma’ category.

Data about Gypsy, Roma, and Traveller groups in Surrey is summarised from the 2021 census on surrey-i. In Surrey, a small proportion (0.2%) of the population (2,680 people) described themselves as White: Gypsy or Irish Traveller, and 1,675 (0.1%) described themselves as White: Roma in the 2021 Census. GRT communities have the poorest health outcomes of any ethnic groups, not only in the UK but internationally[16].

A Gypsy, Roma and Traveller Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Rapid Needs Assessments.

Other Priority Populations of identity:

Although the following groups are not currently listed as priority populations within the health and wellbeing strategy in Surrey, it is important for the JSNA to consider the needs of these groups when thinking about the population of Surrey and the needs of these groups when thinking about the population of Surrey and the needs of residents.

People in contact with the criminal justice system

In September 2018 there were 2,592 people in prison in Surrey. The five prisons in Surrey are:

• HMP & YOI Bronzefield: a privately run female prison in Ashford.

• HMP Coldingley: a prison for adult men in Woking.

• HMP & YOI Downview: a prison and young offender institution (YOI) in Sutton, for women aged 18 and over.

• HMP High Down: a men’s prison and young offender institution (YOI) near Sutton.

• HMP Send: a women’s prison in Woking.

Please see the Health Needs Assessments for the individual prisons for more information.

Students

There were 201,993 pupils registered in Surrey in 2021/22. Just under 1 in 5 Surrey pupils attend an independent school.

Just under half (46%) of Surrey pupils attend state-funded primary schools (Key Stages 1 to 2 which take place from ages 5 to 11). Just under 1 in 3 (32%) of pupils in Surrey are from state-funded secondary schools (Key Stages 3 to 4 which take place from ages 12 to 16).

The number of Surrey pupils in state-funded special schools increased by 8 per cent (223 pupils) in the last year. The number of pupils in state-funded special schools rose by 44 per cent in the last six years between 2015/16 to 2021/22 (from 2,024 to 2,911). Further detail on schools and students in Surrey is kept up to date and available on Surrey-i Number of schools and pupils by type of school.

There are four higher education establishments in Surrey; Surrey University in Guildford, Royal Holloway University in the borough of Runnymede, the University of Creative Arts which has campuses in Epsom and Farnham. (Royal Holloway, and the Farnham campus of the University of Creative Arts are outside the area covered by Surrey’s Health and Wellbeing Board) and the Academy of Contemporary Music in Guildford. Despite this Surrey is a net exporter of students, with the out of term time population almost 5,000 higher than during term time.

Armed forces & ex-service personnel/veterans

At the time of the 2021 Census, there were 32,596 residents of Surrey who had previously served in the armed forces which represented 3.4 percent of the Surrey population aged 16 and over. Around every 1 in 40 Surrey residents aged 16 or over were ex-service personnel/veterans of the regular UK armed forces (2.4%, representing 23,769 persons).

Just under three quarters of UK armed forces ex-service personnel/veterans residing in Surrey had previously served in the regular armed forces only (23,769, 72.9%), while 7,404 (22.7%) had served only in the reserve armed forces. The remaining 1,423 (4.4%) had served in both the regular and the reserve armed forces.

Of the UK armed forces ex-service/veteran population in Surrey, 96.5 per cent lived in households and 3.5 per cent lived in communal establishments (including Guildford (Pirbright Barracks) and Surrey Heath (Deepcut Barracks)). A higher percentage of Surrey ex-service personnel and veterans lived in communal establishments on Census Day than ex-service personnel/veterans in the whole of England (2.0%).

The ex-service/veteran population also had a much higher percentage who lived in communal establishments than the overall Surrey population (including non-veterans) at 2.3 per cent, whilst England had similar proportions for the ex-service/veteran and the overall population.

Please see the summary Census 2021: UK Armed Forces Veterans | Surrey-i (surreyi.gov.uk) and the Armed Forces Community JSNA chapter for more information.

People in the LGBTQIA+ community

The 2022 ONS data found 1.3% of people in the South East identified as gay or lesbian, 1.4% bisexual, 0.5% responded other and 2.2% answered don’t know or declined to answer. This is a similar picture to what was seen nationally. Evidence suggests LGBTQIA+ people have disproportionately worse health outcomes and experiences of healthcare[17].