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The Surrey Context: People and Place

The Surrey Context: People and Place

Links to dashboards and resources within this chapter

Contents

The Surrey Context: People and Place

Introduction

The JSNA is an assessment of the current and future health and social care needs of the local community that may be met by the local authorities, district and borough councils or NHS. In this chapter the contextual background is set for Surrey’s joint strategic needs assessment (JSNA), by exploring an overview of Surrey’s population, followed by an overview of Surrey as a place using geographical and economic indicators. Understanding the age profile, ethnicity, religions, language skills and sexual identity of residents as well as the wider determinants (such as housing, the economy and environment) in which the population lives is essential to enable appropriate services are provided.

The revised approach for the JSNA refresh in 2021 to 2022 has taken a lens through the COVID-19 pandemic. It also builds on some of the priorities that have come to light in our communities through the community impact assessment (CIA). The CIA explored how communities across Surrey were affected by COVID-19, communities’ priorities for recovery, and what support these communities needed. The findings of the research showed that COVID-19 had a disproportionate impact on some communities within Surrey who are likely to experience higher levels of health inequalities. There is an emphasis on making inequalities a key focus throughout the JSNA.

As part of the CIA a series of rapid needs assessments (RNAs) were carried out 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. By having a focus on key population groups, this engagement provided an opportunity to include resident voice in a powerful and effective way. The findings from the RNAs and CIA were incorporated into the Surrey Health and Well-being Strategy, and formed the basis of the priority population groups which will each have their own refreshed JSNA chapter and are briefly summarised in the Overview of people in Surrey section of this chapter.

The Surrey Health and Well-being Strategy was refreshed to reaffirm a focus on reducing health inequalities as well as improving community safety, so no-one is left behind.  This reasserts our joined-up efforts to create the best conditions for both physical and mental, health and well-being alongside addressing the wider determinants of health – such as housing, the economy and environment. This includes an emphasis on groups within the population with poorer health outcomes, alongside the refreshed priorities and outcomes that all partners across Surrey recognise and support.

Building on the community insights from the RNAs is key in identifying the needs of the population and understanding their experience of interacting with health and care services. Community and volunteer organisations across Surrey play a critical role in collection and collation of lived experience and advocacy for voice and understanding people’s lived experiences of health and social care services. Some of this community insight from patients, members of the public and service users can be found on the following partner websites:

To ensure the community voice is comprehensively incorporated throughout, various chapters of the JSNA that are currently under review will include more detailed insights from resident’s perspectives on specific topics by working closely with community and volunteer sector partner organisations.

This chapter is based on the latest available population data at time of publication. The population data included in the tableau dashboards is presented using small-area level data aggregated up to larger geographies such as place-based partnerships and county. Using the smallest available data enables users of the JSNA a better understanding of our local neighbourhoods, meeting the data needs for key wards and primary care networks (PCNs). The small level data currently available is based on the 2011 Census.

The dashboards included in this chapter will be updated following the 2021 Census data releases at small area level, which is anticipated towards the end of 2022.

This chapter was published in September 2022. 

Understanding health and other boundaries within Surrey

The area covered by Surrey County Council is covered by various administrative and health boundaries. These key geographical boundaries and places are described briefly in this section. The Surrey boundaries GIS map shown below provides an overview of the key health and council boundaries in Surrey and also provides an overview of GP practice locations, pharmacy and key hospital sites in Surrey.

Please select the checkboxes listed under “layers” to display various boundaries and detail available on the map.

County council

Surrey is a county council. In Surrey there is a two-tier system of local government, the county council (upper-tier local authority) and the 11 district and borough councils (lower-tier local authorities). Generally, the county council is responsible for the more strategic functions and services such as education and social care.

Districts and boroughs

Districts and boroughs are the local authorities within Surrey, they provide local services such as environmental health, housing, leisure centres, waste collection and planning applications. There are two districts and 11 boroughs in Surrey. Some functions are shared between county and districts and boroughs.  More detail on the responsibilities of each level of council can be found on the council website.

Integrated Care Systems (ICS)

Nationally, the 2022 Health and Care Act was passed in April 2022. The Act introduced legislative measures that aim to make it easier for health and care organisations to deliver joined-up care for people who rely on multiple different services (The King’s Fund, 2022).

Following changes brought about by the 2022 Health and Care Act, on 1 July 2022 Integrated Care Systems (ICSs) have been formalised as statutory bodies. ICSs are partnerships of NHS bodies and local authorities, working with other relevant local organisations, that come together to plan and deliver health and care services to improve the lives of people in their area. A further explanation of Integrated Care Systems and how they function and what they mean for different parts of the system is available from the Kingsfund.

The ICSs that cover parts of Surrey county can be viewed on the Surrey boundaries map above. In Surrey the ICSs cover the same geographical areas as the previous clinical commissioning groups (CCGs), which were groups of GPs that from April 2013 until June 2022 were responsible for designing local health services in England.

Integrate care board (ICB)

Each ICS has an integrated care board (ICB), which is a statutory NHS organisation responsible for developing a plan in collaboration with NHS trusts/foundation trusts and other system partners for meeting the health needs of the population, managing the NHS budget and arranging for the provision of health services in the defined area. Further detail is available from NHS England: Integrated care in your area.

Clinical commissioning groups (CCGs) were formally closed on 1 July 2022 when ICBs were established on a statutory basis. There are now two ICBs which cover Surrey’s population: NHS Surrey Heartlands Integrated Care Board and NHS Frimley Integrated Care Board.

Integrated care partnership (ICP)

Each ICS also has an integrated care partnership (ICP) which is a statutory committee jointly formed between the NHS integrated care board and all upper-tier local authorities that fall within the ICS area. Surrey Council works with both NHS Surrey Heartlands Integrated Care Board and NHS Frimley Integrated Care Board.

The ICP will bring together a broad alliance of partners concerned with improving the care, health and wellbeing of the population, with membership determined locally. The ICP is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population in the ICS area. Further detail is available from NHS England: What are integrated care systems.

Place-based partnerships

Place-based partnerships operate on a smaller footprint within an ICS. They include multi-agency partnerships involving the NHS, local authorities, the voluntary and community sector (VCSE) and local communities themselves. There are four place-based partnerships within Surrey Heartlands ICS and five within Frimley Health and Care ICS, these are listed in the table below.

All four of the place-based partnerships in Surrey Heartlands ICS (Surrey Heartlands place-based partnerships) sit within Surrey county boundaries. Three of the five place-based partnerships in Frimley health and care ICS (Frimley Health and Care communities map) overlap with Surrey county boundaries: Part of Windsor and Maidenhead (which covers Windsor PCN, on the edge of Runnymede and used to cover East Berkshire CCG), all of Surrey Heath (which covers Surrey Heath PCN, Surrey Heath borough council and a part of the West of Guildford borough council) and part of North East Hampshire and Farnham (Farnham PCN on the West of Waverley borough council). The place-based partnerships that cover parts of Surrey county can be viewed on the Surrey boundaries map above.

Integrated care system Place-based partnerships in Surrey
Surrey Heartlands North West Surrey
Guildford and Waverley
Surrey Downs
East Surrey
Frimley Windsor and Maidenhead (part)
Surrey Heath (all)
North East Hampshire and Farnham (part)
Further detail can be viewed on Surrey Heartlands place-based partnerships and Frimley Health and Care communities map.

Neighbourhoods

Neighbourhoods are formed of groups of GP practices working with NHS community services, social care and other providers to deliver more co-ordinated and proactive care, including through the formation of primary care networks (PCNs) and multi-agency neighbourhood teams. In Surrey, the term neighbourhoods usually refers to PCNs or wards, depending on the context; in health care we usually refer to neighbourhoods as PCNs, in Surrey’s health and well-being strategy we refer to a list of key neighbourhoods, which have been defined as wards based on key LSOA areas likely to have the poorest health outcomes based on the Index of Multiple Deprivation, 2019. In the tableau dashboards that accompany this chapter, the data is provided at ward and/or PCN level wherever data is available at a level of granularity that enables it to be shown.

The key neighbourhoods defined in Surrey’s health and well-being strategy can be viewed on the Surrey boundaries GIS map above by selecting the ‘Key neighbourhoods – ward layer. The LSOAs that are part of these wards can be shown by selecting ‘Key neighbourhoods – LSOA’ layer. Summaries about the key neighbourhoods are available on Surrey-i.

Primary care networks (PCNs)

PCNs bring together general practice and other primary care services, such as community pharmacy, to work at scale and provide a wider range of services at neighbourhood level. There are currently 25 PCNs in Surrey Heartlands, and four PCNs in Frimley which have patients in Surrey county.

The PCNs in Surrey have been allocated to geographical areas and are shown on the Surrey boundaries GIS map above. The methodology used to determine this mapping is detailed on the PCN aggregation methodology page of the Surrey population tableau dashboard.

Further detail on the work of PCNs is available on Surrey Heartlands primary care networks and Frimley Health and Care primary care networks.

Wards

Wards, or electoral wards, are one of the main administrative areas on which local government is based. Each local authority (district or borough) is divided into a number of wards and between 1 and 3 councillors are elected to represent each ward on the council.

Ward boundaries are regularly reviewed and in 2021 there were 186 wards in Surrey. There were previously 193 (2016) 206 (2011).

The wards in Surrey county can be viewed on the Surrey boundaries map above.

Middle-layer super output areas (MSOA)

MSOAs are units of geography used in the UK for statistical analysis. They are developed and released by UK Statistics. MSOAs have a minimum population 5000; mean 7200. Built from groups of LSOAs and constrained by the 2003 local authority boundaries used for 2001 Census outputs. There are 151 Middle Super Output Areas (MSOA) in Surrey.

Lower-layer super output areas (LSOA)

LSOAs are units of geography used in the UK for statistical analysis. They are developed and released by UK Statistics. LSOA have a minimum population of 1000; mean population of 1500. There are 709 Lower Super Output Areas (LSOA) in Surrey.

There is a helpful Geography FAQ page on Surrey-i that explains some of the boundaries further.

Overview of Surrey’s population

Understanding the population of Surrey, including the trends seen in demographics and the differences within the population, is key to ensuring the needs of communities are met.

Please follow this link to the Surrey population tableau dashboard containing the data visualisations relevant to this section of this chapter, these dashboards are also embedded below.

The table below summarises the key indicators available in each of the sections within the Surrey population tableau dashboard.

Table 1: Key data and levels of geography available in the Surrey population tableau dashboard

Section name Levels of geography available Key indicators
Current population estimates Country, region, county, districts and boroughs, ward, ICS, place-based partnership, PCN Population data for Surrey geographies available by age and sex
Religion, language and ethnicity Country, region, county, districts and boroughs, ward, ICS, place-based partnership, PCN Proportion of the population by ethnicity, main language spoken, proficiency in English and religion
Proportion in good/ very good health Country, region, county, districts and boroughs, MSOA Proportion of the population in good or very good health
Causes of mortality Country, region, county, districts and boroughs, MSOA Proportion of deaths attributed to each cause listed
Wellbeing and quality of life measures District and boroughs A large range of indicators from the ONS measuring various wider determinants and some indicators related to quality of life.
Life expectancy Country, county, districts and boroughs, ward Life expectancy data
Population projections Country, county, districts and boroughs Population projections over time, by age and sex
Births, deaths and migration County, districts and boroughs Births, deaths, plus various population inflow and outflow data

Population estimates

Please follow the link or explore the ‘Current population estimates’ page of the Surrey population tableau dashboard below. The dashboard also allows users to explore the data for health based geographies including PCNs, place-based partnerships, ICS.

As at the last census the population of Surrey is 1,203,100 (2021). 

The data dashboards for this section show the estimated resident population of Surrey in 2020 (1,199,870) as these are the latest population estimates available for all levels of geography which allow comparison between the data on population available at the smaller geographies: lower-layer super output area (LSOA), PCN and ward level in Surrey.

Some 2021 Census data on populations was made available (at local authority level) by the time of publication and the comparison between these estimates and those used in the dashboards is summarised below.

The early release Census 2021 local authority level population estimates show that across the local authorities in Surrey, the mid-year 2020 estimates are generally in line with the actual data. Woking is an exception, where the population was 3.9% more than estimated.

The dashboard shows that the largest local authorities by population are Guildford (150,352) and Reigate and Banstead (149,243) and the smallest is Epsom and Ewell (81,003).

Surrey Heartlands ICS has a population of 1,052,425, and Frimley ICS has a population of 746,739 (this includes people who are residents of other counties). Population estimates for ICS’s are based on residents of the relevant geographical area/s and will be different from the population of registered patients.

Please note that some data sources still use the term CCG, which in Surrey is coterminous with the new ICS boundaries (see further detail about boundaries in ‘Overview of Surrey as a place’).

Age

Within Surrey’s population, people aged 45 to 49 and 50 to 54 years old are the two largest five year cohorts.

Surrey’s population is broadly similar to England, with a slightly greater proportion of 5 to 19 year olds , a much smaller proportion of 20 to 34 year olds and a greater proportion of the population aged 40 to 59 years old than in England. This results in an older working-age population in Surrey, which has implications for the workforce and for population health and care needs. The lower proportion of 20 to 34 years olds is seen for both males and females and likely reflects a greater proportion of children and parents/ carers in Surrey than other areas in England.

Of Surrey’s population:

  • 5.7% (67,995) are 0 to 4 year olds, ranging from 4.6% in Mole Valley to 6.4% in Woking
  • 15.3% (183,093) are 5 to 16 year olds, ranging from 13% in Runnymede to 17.3% in Elmbridge
  • 9.9% (118,912) are 17 to 24 year olds, ranging from 7.5% in Elmbridge to 16.5% in Guildford
  • 50% (599,970) are 25 to 64 year olds, ranging from 47.6% in Waverley to 51.7% in Spelthorne
  • 19.2% (229,900) are 65 years and over, ranging from 16.7% in Guildford to 23.9% in Mole Valley

Life expectancy

Please follow the link or explore the ‘Life expectancy’ page of the Surrey population tableau dashboard below.

Surrey residents have longer life expectancies than people in the South East as a whole and this is longer than the life expectancies of people across most of England. Life expectancy at birth is a measure of the average number of years a person would expect to live based on contemporary mortality rates. For a particular area and time period, it is an estimate of the average number of years a new-born baby would survive if they experienced the age-specific mortality rates for that area and time period throughout their life.

Figures reflect mortality among those living in an area in each time period, rather than mortality among those born in the area. The figures are not therefore the number of years a baby born in the area could actually expect to live, both because the mortality rates of the area are likely to change in the future and because many of those born in the area will live elsewhere for at least some part of their lives.

There has been a widespread trend of rising life expectancy at birth for males and females across the country and this is also the case for Surrey. Surrey children born in 2018 to 2020 are expected to live longer than Surrey children born in 2001 to 2003.

The life expectancy at birth for those born in Surrey was 81.7 years for males and 85.0 years for females (2016-20), compared to 79.5 and 83.2 for England (2016-20) and 80.6 and 84.1 for the South East (2018-20).

Life expectancy (2016-20) for males is lowest in Spelthorne (80.7 years) and highest in Elmbridge (82.5 years). Life expectancy for females (2016-20) is also lowest in Spelthorne (84.2 years) and is highest in both Epsom & Ewell and Mole Valley (85.8 years). More detailed analysis of life expectancy is available on Surrey-i life expectancy

Inequalities in life expectancy

Inequalities in life expectancy exist between the most and least deprived areas nationally and in Surrey. The overarching measure of inequality in life expectancy in the Public Health Outcomes Framework (PHOF) PHOF data tool, is the slope index of inequality. The slope index of inequality is a measure of the social gradient in life expectancy (i.e., how much life expectancy varies with deprivation) which can be used to show this inequality. It measures variation in life expectancy across the whole range of deprivation, rather than just considering the extreme groups. The calculation takes into account life expectancy in each deprivation decile within an area and summarises the variation into a single number. This represents the range in years of life expectancy across the social gradient from most to least deprived, based on a statistical analysis of the relationship between life expectancy and deprivation across all deprivation deciles.

The range in years of life expectancy across the social gradient from most to least deprived in Surrey is 6.2 years for males and 5.4 years for females. This gap is lower than the difference across England, which is 9.7 years in males and 7.9 years in females, however there is a wider range in inequalities between people in each of the districts and boroughs in Surrey (OHID public health profiles).

The figure below shows that in males, the slope index of inequality is greatest in Tandridge – with 8.1 years between males born in the most and least derived areas. The gap is smallest in Elmbridge, with 3.7 years.

Figure 1: Inequality in LE in males in Surrey districts and boroughs (2018-2020)

Chart showing the inequality in life expectancy for males in Surrey local authorities. The chart shows that in males, the slope index of inequality is greatest in Tandridge – with 8.1 years between males born in the most and least derived areas. The gap is smallest in Elmbridge, with 3.7 years.

The figure below shows that in females the slope index of inequality is greatest in Waverley – with 8.0 years between females born in the most and least derived areas. The gap is smallest in Surrey Heath, with 2.3 years.

Figure 2: Inequality in LE in females in Surrey districts and boroughs (2018-2020)

Chart showing the inequality in life expectancy for females in Surrey local authorities. The chart shows that in females the slope index of inequality is greatest in Waverley – with 8.0 years between females born in the most and least derived areas. The gap is smallest in Surrey Heath, with 2.3 years.

Contributions to the life expectancy gap

The figure below is a chart from the OHID Segment Tool showing for each broad cause of death the contribution (number of years) that each cause contributes to the overall life expectancy gap between the most and least deprived quintiles of Surrey in 2020 to 2021. Data are only available for areas where the life expectancy in the most deprived quintile is lower than life expectancy in the least deprived quintile.

In Surrey circulatory diseases are the largest contributor to the gap in life expectancy in the most and least deprived quintiles in Surrey, followed by cancer and COVID-19.

Figure 3: Breakdown of the life expectancy gap by cause of death

Bar chart showing in Surrey circulatory diseases are the largest contributor to the gap in life expectancy in the most and least deprived quintiles in Surrey, followed by cancer and COVID-19.

The contribution of different causes of death to the gap in life expectancy between two areas (due to or cause specific death rates) has been calculated using a method of ‘life expectancy decomposition’. Further detail on this methodology is available in the OHID Segment Tool.

Please note that the difference in life expectancy between the most and least deprived quintiles differs from the slope index of inequality in life expectancy which is shown above. The Segment Tool breaks down the gap in life expectancy between the most deprived quintile and the least deprived quintile of each area. This gap looks at life expectancy at two extreme points within an area, without considering life expectancy between those points.

The overarching measure of inequality in life expectancy in the Public Health Outcomes Framework (PHOF), is the slope index of inequality. This measures variation in life expectancy across the whole range of deprivation, rather than just considering the extreme groups. The calculation takes into account life expectancy in each deprivation decile within an area and summarises the variation into a single number. These data are available from the PHOF data tool. This means that the difference between the most and least deprived quintile will be different to the slope index of inequality in life expectancy.

Life expectancy and healthy life expectancy are important indicators of population health and health inequalities.

Healthy life expectancy

Healthy life expectancy at birth is an estimate of the average number of years babies born this year would live in a state of good general health if mortality levels at each age, and the level of good health at each age, remain constant in the future. This is an important measure to consider alongside life expectancy and in terms of health inequalities. Between 2018 and 2020 healthy life expectancy in Surrey was 67.8 years and 69.7 years for males and females respectively. This was higher than both the South East and England.

Inequalities in healthy life expectancy

The level of inequality in healthy life expectancy (HLE) within English upper-tier local authorities was estimated for the first time for the period 2009 to 2013 to provide data to support the Public Health Outcomes Framework indicator on inequality in healthy life expectancy within local authorities. This is still the latest available measure of inequality in health life expectancy, and although old, is a useful indicator of inequalities experienced within Surrey.

The tables below summarise the inequality in life expectancy for males and females within each district and borough in Surrey. Please note that due to data availability, the ward names and areas are from 2011 Census boundaries, so will not align perfectly with the current ward names and due to rounding values may not tally.

The inequality in healthy life expectancy was derived by taking the difference between the 2011 census wards with the highest and lowest healthy life expectancy within its local area boundary. The measure indicates the gap and health inequalities experienced.

In males, the slope index of inequality in healthy life expectancy is greatest in Woking – with 15.4 years between males born in Maybury and Sheerwater (which is also the area in Surrey with the lowest HLE in males) and Limpsfield. The gap is smallest in Spelthorne (8.7 years), but the overall HLE scores in wards in Spelthorne are among the lowest in Surrey.

Table 2: Inequality in healthy life expectancy for males at birth (2009-2013)

Districts and boroughs Inequality in HLE 2011 Census ward with lowest HLE 2011 Census ward with highest HLE
Elmbridge 9.8 Walton North (64.1 years) Oatlands Park (74.0 years)
Epsom and Ewell 13.3 Court (60.5 years) Auriol (73.8years)
Guildford 12.8 Stoke (62.9 years) Pirbright (75.6 years)
Mole Valley 9.8 Leatherhead North (64.4 years) Fetcham East (74.2 years)
Reigate and Banstead 10.5 Preston (61.7 years) Horley East (72.2 years)
Runnymede 11.1 Addleston Bourneside (64.0 years) Englefield Green East (75.1 years)
Spelthorne 8.7 Stanwell North (62.0 years) Ashford Town (70.7 years)
Surrey Heath 13.0 Old Dean (62.0 years) St Pauls (75.0 years)
Tandridge 10.8 Westway (63.7 years) Limpsfield (74.5 years)
Waverley 9.7 Haslemere Critchmere and Shottermill (66.8 years) Godalming Holloway (76.5 years)
Woking 15.4 Maybury and Sheerwater (59.0 years) Horsell East and Woodham (74.4 years)

In females, the slope index of inequality in healthy life expectancy is also greatest in Woking – with 15.7 years between males born in Maybury and Sheerwater and Pyrford. Maybury and Sheerwater has the lowest HLE for both males and females across Surrey. The highest HLE in Surrey is in Waverley (in different wards) for males (Godalming Holloway) and for females (Blackheath and Wonersh).

Table 3: Inequality in healthy life expectancy for females at birth (2009-2013)

Districts and boroughs Inequality in HLE 2011 Census ward with lowest HLE 2011 Census ward with highest HLE
Elmbridge 9.9 Walton North (66.4 years) Weston Green (76.3 years)
Epsom and Ewell 12.2 Court (63.0 years) Nonsuch (75.1 years)
Guildford 11.4 Stoke (64.4years) Pirbright (75.8 years)
Mole Valley 10.6 Leatherhead North (65.0 years) Capel| Leigh and Newdigate (75.6 years)
Reigate and Banstead 9.9 Preston (64.3 years) Reigate Hill (74.2 years)
Runnymede 10.1 Chertsey St Ann’s (65.0 years) Englefield Green East (75.1 years)
Spelthorne 10.4 Sunbury Common (63.1 years) Riverside and Laleham (73.6 years)
Surrey Heath 16.4 Old Dean (61.5 years) Windlesham (77.9 years)
Tandridge 11.5 Westway (64.3 years) Limpsfield (75.8 years)
Waverley 17.0 Godalming Binscombe (66.0 years) Blackheath and Wonersh (83.0)
Woking 15.7 Maybury and Sheerwater (58.4 years) Pyrford (74.1 years)

The range in years of HLE across the social gradient from most to least deprived in Surrey overall was 8.3 years in males and 8.4 years for females (OHID public health profiles).

Wellbeing and indicators of quality of life

Please follow the link or explore the ‘quality of life and 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 (61.2%), however this is still significantly higher than the same age group nationally (51.7%).

The 65 and over age group is also where the biggest different between males and females in seen in Surrey, at 63.1% and 59.6% respectively

Population projections

Please follow the link or explore the ‘population projections’ page of the Surrey population tableau dashboard below.

2018 predictions estimate the population in Surrey will increase from 1,189,934 in 2018 to 1,227,467 in 2043. This prediction suggests the older population will increase, but also that the proportion of the population across age groups between 0 and 74 years old will become more similar. The increase in the population groups aged 45 and over in Surrey is likely to impact more on health and social care services due to increased risks of developing long term conditions and other needs.

Components of population change

Please follow the link or explore the ‘births, deaths and migration’ page of the Surrey population tableau dashboard below.

In recent years births in Surrey have declined from 13,542 births in 2015 to 11,880 in 2020. Deaths were also decreasing between 2015 and 2019 but increased from 9,855 in 2019 to 11,755 in 2020. This increase coincides with the COVID-19 pandemic. Migration into Surrey remains higher than migration out of Surrey, although since 2018 the gap has been reducing. In 2020 net migration was 3,758.

Leading causes of mortality

Please follow the link or explore the ‘mortality’ page of the Surrey population tableau dashboard below.

Common causes of mortality should be considered when exploring and implementing interventions to prevent or improve health outcomes. The leading causes of mortality in 2020 Surrey were:

  • Dementia and Alzheimer’s disease (13.79%)
  • COVID-19 (11.46%)
  • Ischaemic heart diseases (also called coronary heart/ artery disease (7.97%)
  • Cerebrovascular diseases (such as Stroke) (4.71%)
  • Some cancers (Malignant neoplasm of trachea, bronchus and lung) (3.86%)

Religion, languages spoken and ethnicity in Surrey

Please follow the link or explore the ‘Religion, language and ethnicity’ page of the Surrey population tableau dashboard below. The dashboard also allows users to explore the data for health based geographies including PCNs, place-based partnerships, ICS.

Religion

The majority (almost two thirds (62.8%)) of the population in Surrey reported their religion as Christianity, which is higher than the proportion in England (59.4%). Almost a quarter of the population (24.8%) reported no religion, which is similar to the national picture. Islam (2.15%) and Hinduism (1.33%) were the next most common religions in Surrey. Younger people are more likely to have no religion than older people in Surrey.

Religion and beliefs can influence attitudes towards medicine and health care there can also be concerns about discrimination that affect trust about how people of different religions and beliefs would be treated in different health care settings.  

Main language and proficiency in English

The majority (94.1%) of Surrey residents speak English as their first language, this ranges from 97.3% in Tandridge to 89.9% in Woking.

In the 2011 Census, nearly 65,000 Surrey residents reported that they speak a language other than English as their main language. The most common other languages spoken in Surrey were Polish (6,634 speakers) and Chinese languages (4,426 speakers). Most of those who spoke another main language, reported that they can speak English “well” or “very well”, but nearly 6,500 people cannot speak English well and a further 1,000 reported that they cannot speak English at all in Surrey.

Language is also very important in communicating health information, and may be a barrier to understanding, in populations where proficiency in English is not as high as others. 

Ethnicity

The most recent data on ethnicity uses 2011 Census data applied to the mid-year 2020 population to estimate ethnicity by area.

Surrey is less diverse than England as a whole with 83.5% of the population reporting their ethnic group as white British compared with 79.8% in England. In the South East, 85.2% were recorded as white British.

A further 78,000 (6.9%) of the population belonged to other white ethnic groups; ‘Irish’, ‘Gypsy or Irish Traveller’ and ‘other white’. A higher proportion of people in Surrey (6.9%) were recorded in other white ethnic groups than in England (5.7%) with fewer in all other ethnic groups (9.6% compared with 14.6%).

The next highest reported ethnicity group was Asian; 5.6% of the population reported their ethnicity as Asian, within which more detailed ethnicity was reported as ‘Indian’ (1.8%) followed by ‘Pakistani’ (1.0%). Two percent (2.1%) of the population reported mixed ethnicity and 1.1% reported their ethnicity as black. Surrey has the lowest proportion of black residents compared to the South East region and England. 

Using 2011 Census estimates adjusted for the 2020 population, 115,118 (9.6%) of people in Surrey are from a minority ethnicity group that is not white.

Woking is the most ethnically diverse area in Surrey with 16.4% of its population from minority ethnic groups. Waverley is the least diverse with 90.6% reporting their ethnicity as white British.

Spelthorne has the highest proportion of people from Indian ethnic groups (4.2%) and Woking has the highest proportion of people from Pakistani ethnic groups (5.7%).

Further detail on ethnicity of the population of Surrey is provided in the Overview of People section of this chapter.

Overview of Surrey as a place

Geographical and economic factors can significantly impact the health of population, as well as increasing health inequalities. This section will explore some of these factors and help to provide a picture of what it is like to live in Surrey.

Wider determinants of health and health inequalities

The following section provides a summary on wider determinants of health that are linked to the environment and place people live in.

The environment has a significant impact on health. A review of evidence by the World Health Organisation found that urban green spaces can improve air and water quality, reduce noise levels and contribute to temperature regulation. They also enable stress reduction and relaxation, physical activity, improved social interaction and community cohesion. Access to natural environments can improve overall mental health, physical fitness level, cognitive and immune function, and can lower mortality rates in general.

Please follow the link to explore the Surrey place tableau dashboard containing the data visualisations relevant to this section of the chapter, these dashboards are also embedded below. The dashboards allow users to explore the data for health based geographies including PCNs, place-based partnerships, ICS.

The table below summarises the key indicators available in each of the sections within the Surrey place tableau dashboard.

Table 4: Key data and levels of geography available in the Surrey place tableau dashboard

Section name Levels of geography available Key indicators
Access to greenspace Country, region, County, districts and boroughs, ward, ICS, place-based partnership, PCN Various indicators of average size, distance and number of parks, gardens, fields, built up areas
Population density Country, region, county, districts and boroughs, ward, ICS, place-based partnership, PCN Persons per square kilometre
Crime County, districts and boroughs, ward, PCN Police and crime indicators
 Deprivation County, districts and boroughs, LSOA, ward, ICS Indices of multiple deprivation, IDACI (Income Deprivation Affecting Children), IDAOPI (Income Deprivation Affecting Older People Index) and fuel poverty
Rural/ urban classification County, districts and boroughs, ward, ICS ONS rural and urban area classifications
Housing affordability County, districts and boroughs Median affordability ratio, earning, house price indicators
Pollution Country, county, districts and boroughs Air pollution and fraction of mortality attributable
Economy County, districts and boroughs, ward Various economic indicators

Access to Greenspace

Please follow the link or explore the ‘access to greenspace’ page of the Surrey place tableau dashboard below. The dashboard also allows users to explore the data for health based geographies including PCNs, place-based partnerships, ICS.

Private outdoor greenspace

Access to greenspace is important for both physical and mental health. The majority (90%) of private addresses in Surrey have private outdoor space, which is similar to the national average. This ranges from 87% in Reigate and Banstead to 92% in Surrey Heath and Woking. The average size of private outdoor space varies significantly from 239.5m2 in Spelthorne, to 762m2 in Tandridge.

Public outdoor greenspace

The average distance to the nearest park, public garden or playing field in Surrey is 370m, slightly below the national average of 379m. Guildford has the highest number of postcodes in a built-up area in Surrey[1].

Rural and urban areas

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

Surrey is a large geographical area with a mix of rural and urban areas. This complex geography is significant as access to services and transport are important concerns in the rural parts of Surrey.

  • Waverley is largely rural
  • Mole Valley and Tandridge are urban areas with significant rural areas
  • Surrey Heath, Reigate and Banstead and Guildford are urban areas with cities and towns
  • Elmbridge, Epsom and Ewell, Woking, Runnymede and Spelthorne are urban areas with major conurbations

Population density

Please follow the link or explore the ‘population density’ page of the Surrey place tableau dashboard below. The dashboard also allows users to explore the data for health based geographies including PCNs, place-based partnerships, ICS.

Surrey is the one of the most densely populated shire counties in England with 721.7 people per square kilometre, significantly higher than the national average of 434.1 and the South East regional value of 483.3. The most densely populated districts and boroughs are Epsom & Ewell and Spelthorne, and the least are Mole Valley, Tandridge and Waverley. Population density is an important consideration for service planning and understanding level of need in different areas.

Pollution and air quality

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

Air pollution is defined by the World Health Organisation (WHO) as being contamination of the indoor or outdoor environment by any chemical, physical or biological agent that modifies the natural characteristic of the atmosphere. Particulate Matter (PM)2.5, are small particles with a diameter of less than 2.5µm, produced mainly from combustion of hydrocarbon fuels and Industrial processes. PM2.5 particles can penetrate deeply into the lung leading to impaired lung function, exacerbation of asthma and a cough in the short term; stroke, lung cancer and cardiovascular disease in the long term. In 2021 the WHO published updated Air Quality Guidelines, outlining a mean annual concentration of 5µg/m3 as being the safe upper limit for PM2.5 concentrations. Population-weighted annual mean PM2.5 data is provided at local authority level by The Department for Environment, Food & Rural Affairs (DEFRA).

The population-weighted annual mean concentration of PM2.5 across Surrey in the year 2019 was 9.45 µg/m3, this is higher than the England average value of 9.04µg/m3. In 2011 Surrey’s PM2.5 level was 10.34 µg/m3, comparing this with the 2019 value shows a reduction in the PM2.5 concentration across this period.

Across districts and boroughs within Surrey in 2019, Spelthorne had the highest annual mean PM2.5 concentration with a value of 10.52 µg/m3 whereas Waverley had the lowest with a level of 9.03µg/m3. Looking at 2011 Runnymede (which had the second highest 2019 value, 10.1µg/m3) had the highest PM2.5 concentration with a value of 11.36 µg/ml and Waverley again had the lowest value of 9.25µg/m3.

Poor air quality is a significant public health issue. There is strong evidence that air pollution causes the development of coronary heart disease, stroke, respiratory disease, and lung cancer, exacerbates asthma and has a contributory role in mortality[2]  One metric that provides insight into how much pollution is affecting health in a local area is ‘Fraction of annual all-cause adult mortality attributable to particulate air pollution (PM2.5)’ which can be explored in more detail on the ‘pollution’ page of the Surrey place tableau dashboard.

Across Surrey in 2019 5.36% of all-cause mortality was attributable to particulate air pollution, across the same area in 2011 5.20% was attributable to particulate air pollution.

Across districts and boroughs within Surrey in 2019, Spelthorne had the highest proportional of all-cause mortality attributed to particulate matter air pollution with a value of 5.94%whereas Waverley had the lowest with a value of 4.62%. Looking at 2011 Runnymede and Spelthorne had the highest proportional of all-cause mortality attributed to particulate matter air pollution with a value of 6.40% and Waverley again had the lowest value of 5.20%.

Crime

Please follow the link or explore the ‘crime’ page of the Surrey place tableau dashboard below. The dashboard also allows users to explore the data for health based geographies including PCNs, place-based partnerships and ICS.

The most common types of crime in Surrey are violent and sexual offenses and anti-social behaviour, and this is also seen at district and borough level. The most common outcomes of crimes are ‘no suspect identified’ followed by ‘unable to prosecute suspect’. The Surrey index can be used to further explore these indicators in Surrey.

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

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 (34.5%).

The highest number of people on universal credit is in Spelthorne, and the lowest is in Mole Valley. In 2020, there were 2,150 (9.5%) of 16-17 year olds in Surrey not in education, employment or training.

Personal debt

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-heath[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.

Core 20 Plus 5 – an approach to reducing health inequalities

Core 20 Plus 5 is a national NHS England approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort as the ‘Core 20 Plus’ and identifies five additional focus clinical areas requiring accelerated improvement.

The approach is made up of three key parts. The first two parts together provide a population identification framework designed to be used at ICS level to offer direction & focus in improving health inequalities[4].

Figure 4: NHS Core 20 Plus 5 infographic

NHS infographic showing the Core 20 Plus 5 approach to reducing health inequalities. Details are summarised in the Core 20, Plus, and 5 sections below.
Core 20

The ‘core 20’ are the most deprived 20% of the national population as identified by the national Index of Multiple Deprivation (IMD). The IMD has seven domains with indicators accounting for a wide range of social determinants of health.

Plus

The ‘plus’ are ICS-determined population groups experiencing poorer than average health access, experience and/or outcomes, but not captured in the ‘core 20’ alone, based on ICS population health data.

Inclusion health groups may include: ethnic minority communities, coastal communities, people with multi-morbidities, protected characteristic groups, people experiencing homelessness, drug and alcohol dependence, vulnerable migrants, Gypsy, Roma and Traveller communities, sex workers, people in contact with the justice system, victims of modern slavery and other socially excluded groups.

5

The ‘5’ sets out five clinical areas of focus and targets:

  • Maternity: ensuring continuity of care for 75% of women from black, Asian and minority ethnic communities and from the most deprived groups.
  • Severe mental illness (SMI): ensuring annual health checks for 60% of those living with SMI (bringing SMI in line with the success seen in learning disabilities).
  • Chronic respiratory disease: a clear focus on chronic obstructive pulmonary disease (COPD) driving up uptake of COVID, flu and pneumonia vaccines to reduce infective exacerbations and emergency hospital admissions due to those exacerbations.
  • Early cancer diagnosis: 75% of cases diagnosed at stage 1 or 2 by 2028.
  • Hypertension case-finding and optimal management and lipid optimal management: to allow for interventions to optimise blood pressure and minimise the risk of myocardial infarction and stroke.

Governance for these five focus areas sits with national programmes; national and regional teams coordinate local systems to achieve national aims.

Methodology for identifying priority populations of geography (Core 20) in Surrey

The Surrey Health and Wellbeing Board have agreed a methodology for identifying geographical areas within Surrey that will be a focussed part of key strategies to support the reduction of health inequalities across Surrey, this is detailed in Surrey’s Health and Wellbeing Strategy.

The geographical areas are identified based on the IMD rank for each of the 709 LSOAs in Surrey but recognising how communities draw on assets and service provision in their vicinity, the slightly wider ward geography that each of the LSOAs sits within will be the areas of focus. Specifically:

  • Those wards that encompass the LSOAs that are in deciles 2-3 of the IMD (2019) in Surrey

and

  • Any additional wards that encompass LSOAs that are in decile 4 of the IMD (2019) AND in decile 1 for the IMD supplementary index of Income Deprivation Affecting Children (IDACI) or the IMD domain of Education, Skills and Training Deprivation in Surrey

This method results in a list of 21 key neighbourhoods (which are the wards) encompassing 22 LSOAs​, with the wards containing the most deprived five LSOAs being prioritised in strategies and action plans. This set of five LSOAs/wards (described as key neighbourhoods) aligns with the new NHS England national definition of the most deprived areas for priority action on health inequalities, as outlined in NHS England Core20PLUS5 – An approach to reducing health inequalities

The key neighbourhoods are listed in the table below and can also be viewed on the Surrey boundaries GIS map by selecting the ‘Key neighbourhoods – ward layer. The LSOAs that are part of these wards can be shown by selecting ‘Key neighbourhoods – LSOA’ layer. Summaries about the key neighbourhoods are available on Surrey-i.

Table 5: List of priority wards in Surrey’s health and wellbeing strategy

Key neighbourhood (electoral ward) Lower super output area
(ranked on IMD score)
IMD decile of LSOA
(lower is more deprived)
District / borough Place-based partnership
Hooley, Merstham and Netherne 1. Reigate / Banstead 008A 2 Reigate and Banstead East Surrey (SH)
Canalside 2. Woking 004F 2 Woking NW Surrey (SH)
Westborough 3. Guildford 012D 2 Guildford Guildford and Waverley (SH)
Stoke 4. Guildford 007C 2 Guildford Guildford and Waverley (SH)
Stanwell North 5. Spelthorne 001B
& Spelthorne 001C
3 Spelthorne NW Surrey (SH)
Holmwoods 6. Mole Valley 011D 3 Mole Valley Surrey Downs (SH)
Tattenham Corner & Preston 7. Reigate / Banstead 005A 3 Reigate & Banstead Surrey Downs (SH)
Court 8. Epsom and Ewell 007A 3 Epsom & Ewell Surrey Downs (SH)
Ashford North and Stanwell South 9. Spelthorne 002C 3 Spelthorne NW Surrey (SH)
Goldsworth Park 10. Woking 005B 3 Woking NW Surrey (SH)
Englefield Green West 11. Runnymede 002F 3 Runnymede Windsor and Maidenhead (East Berkshire)
Walton South 12. Elmbridge 004B 3 Elmbridge NW Surrey (SH)
Horley Central & South 13. Reigate and Banstead 018D 3 Reigate and Banstead East Surrey (SH)
Farnham Upper Hale 14. Waverley 002E 3 Waverley North East Hampshire and Farnham (Frimley)
Godalming Central and Ockford 15. Waverley 010A 3 Waverley Guildford & Waverley (SH)
Chertsey St. Ann’s 16. Runnymede 006D 3 Runnymede NW Surrey (SH)
Redhill West & Wray
Common
17. Reigate and Banstead 010E 3 Reigate and Banstead East Surrey (SH)
Ash Wharf 18. Guildford 010C 3 Guildford Surrey Heath (Frimley)
Walton North 19. Elmbridge 008A 4* Elmbridge NW Surrey (SH)
Cobham and Downside 20. Elmbridge 017D 4** Elmbridge Surrey Downs (SH)
Old Dean 21. Surrey Heath 004C 4** Surrey Heath Surrey Heath (Frimley)
Source: adapted from the table in https://www.healthysurrey.org.uk/about/strategy/surrey-health-and-well-being-strategy-update-2022 *Overall IMD decile 4 and in decile 1 (highest 10% nationally) for IMD supplementary index on Income Deprivation Affecting Children
** Overall IMD decile 4 and in decile 1 (highest 10% nationally) for IMD domain Education, Skills and Training.

The first four LSOAs/wards (key neighbourhoods) outlined in the health and wellbeing strategy align to the 0 to 20% most deprived nationally and are referred to in the guidance as Core20. The fifth LSOA/ward (key neighbourhood), the remaining 16 on the list and the priority populations of identity represent the plus groups in Surrey. The plus populations are described further in the Overview of people in Surrey section.

Deprivation

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

The Index of Multiple Deprivation

The Indices of Deprivation are a unique measure of relative deprivation at a small local area level (LSOA) across England and have been produced by the Ministry of Housing, Communities and Local Government (MHCLG) and its predecessors in similar way since 2000. The Indices of Deprivation 2019 (IoD2019) is the most recent release. The Indices provide a set of relative measures of deprivation for small areas across England, based on seven different domains, or facets, of deprivation.

The Index of multiple deprivation (IMD) is a useful composite measure of the above seven domains, which can be used for identifying localities where health outcomes are likely to remain poorest.

The domains are combined using the following weights (percentages shown in brackets):

  • Income Deprivation (22.5%)
  • Employment Deprivation (22.5%)
  • Education, Skills and Training Deprivation (13.5%)
  • Health Deprivation and Disability (13.5%)
  • Crime (9.3%)
  • Barriers to Housing and Services (9.3%)
  • Living Environment Deprivation (9.3%)

There are also two supplementary indictors:

The Income Deprivation Affecting Children Index (IDACI) measures the proportion of all children aged 0 to 15 living in income deprived families. It is a subset of the Income Deprivation Domain which measures the proportion of the population in an area experiencing deprivation relating to low income. The definition of low income used includes both those people that are out-of-work, and those that are in work but who have low earnings (and who satisfy the respective means tests).

The Income Deprivation Affecting Older People Index (IDAOPI) measures the proportion of all those aged 60 or over who experience income deprivation. It is a subset of the Income Deprivation Domain which measures the proportion of the population in an area experiencing deprivation relating to low income. The definition of low income used includes both those people that are out-of-work, and those that are in work but who have low earnings (and who satisfy the respective means tests).

Further summary of the IMD in Surrey is available on Surrey-i Indices of Deprivation 2019 for areas in Surrey

The Surrey place tableau dashboard shows that the majority (68.5%) of LSOAs in Surrey are in in the least deprived deciles 8, 9 and 10. There are no Surrey LSOAs in decile 1 of the overall Index of Multiple Deprivation, and just four (0.6% of areas) in decile 2. These are parts of Westborough and Stoke wards (in Guildford), Hooley, Merstham and Netherne ward (Reigate & Banstead) and Canalside ward (Woking).

The figure below shows the proportion of the population in Surrey estimated to live in each of the IMD deciles. The majority of residents in Surrey live in the most affluent areas in England.

Figure 5: Proportion and estimated number of people living within each deprivation decile in Surrey

The figure is a bar chart showing the proportion of the population in Surrey estimated to live in each of the IMD deciles. The majority of residents in Surrey live in the most affluent areas in England.

Whilst a small proportion of Surrey residents live in areas that are in the 20% most deprived nationally, it is important that these are recognised through, for example, the key neighbourhoods that are described earlier in the chapter. Without taking such a focus there is a risk that such inequalities become hidden and are not properly addressed.

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 2020 data and so do not represent the current levels of fuel poverty after the recent rising fuel costs and wider cost of living crisis. Therefore, these figures are likely to be underestimates of the current levels of fuel poverty.

Overall, Surrey had smaller proportions of households in fuel poverty (6.9%) than the English average (13.2%) in 2020. Guildford had the highest proportion of households in fuel poverty at 7.9 per cent alongside Waverley and Epsom & Ewell with 7.3 per cent in fuel poverty. Surrey Heath had the smallest percentage of households in fuel poverty at 5.8 per cent.

One Surrey ward had a higher percentage of households in fuel poverty than the national average; the Westborough ward in Guildford had 14.2 percent of households in fuel poverty compared to 13.2 per cent in England overall. The five wards with the highest proportions of households in fuel poverty in 2020 were:

  • Westborough in Guildford, 14.2%
  • Onslow in Guildford, 11.5%
  • Pirbright in Guildford, 11.3%
  • Stoke in Guildford, 11.1%
  • Canalside in Woking, 10.8%

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

Image taken from OHID fingertips, showing that 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).

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 or view the Priority population of identity in Surrey tableau dashboard below. 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 overall 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.

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 adults with learning disabilities is currently being developed and this section will be updated with high level insights once this is published. A further chapter on Autism is also planned.

Children and young people with additional needs or special educational 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 Rapid Needs Assessment was undertaken as part of the Surrey Covid-19 Community Impact Assessment.

A JSNA chapter on children with special educational need and disability is currently being developed and this section will be updated with high level insights once this is published.

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.

Children in care and care leavers

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. 2012/13 values have been compared with 2020/21 values for Surrey, the South East and England.

Table 6 – QOF Prevalence of long term health conditions

Indicator Surrey
2012/13
Surrey
2020/21
Surrey
Change
South East
2012/13
South East 2020/21 South East Change England
2012/13
England 2020/21 England
Change
Hypertension 12.90% 13.10% 0.20% 13.40% 14.10% 0.70% 13.70% 13.90% 0.20%
Stroke 1.60% 1.60% 0.00% 1.70% 1.80% 0.10% 1.70% 1.80% 0.10%
Diabetes 4.90% 5.70% 0.80% 5.40% 6.50% 1.10% 6.00% 7.10% 1.10%
Coronary Heart Disease 2.80% 2.60% -0.20% 3.00% 2.80% -0.20% 3.30% 3.00% -0.30%
Osteoporosis 0.20% 0.90% 0.70% 0.20% 1.00% 0.80% 0.20% 0.80% 0.60%
Rheumatoid Arthritis 0.70% 0.70% 0.00% 0.70% 0.80% 0.10% 0.70% 0.80% 0.10%

In the QOF period 2020/21 the prevalence of hypertension across registered patients in Surrey GP practices was 13.1% (166,745 people) compared to 14.1% across the South East region and 13.9% across England. In the QOF period 2012/13 the prevalence of hypertension across Surrey was 12.9%, this equates to a 0.2% increase in hypertension prevalence across Surrey. This is in line with the England prevalence change of 0.2% (13.7% 2012/13) and far less than the South East regional increase of 0.7% (13.4% 2012/13). Across Surrey, Mole Valley Local Authority had the highest prevalence of hypertension in 2020/21 with a value of 14.8%, Elmbridge had the lowest prevalence with a value of 11.6%.

The only long-term condition to decrease across the period was coronary heart disease, from 2012/13 to 2020/21 the prevalence across Surrey fell from 2.8% to 2.6%, a decrease of 0.2%. This is in line with the South East region and England, with both having reductions of 0.2% and 0.3% respectively.

The Royal National Institute of Blindness (RNIB) estimates that currently across Surrey 42,300 people are living with slight loss, this figure is made up of 36,630 people living with partial sight and 5,720 living with blindness[7]. This equates to 3.5% of the Surrey population living with sight loss compared to a national value of 3.2%. By 2030 it is predicted that 51,600 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 7: Estimated number of people living with sight threatening eye conditions

Cause 2021 2025 2030
Early-stage Age-related Macular Degeneration (AMD) 54,300 58,900 64,300
Late-stage dry AMD 4,270 4,730 5,370
Late-stage wet AMD 8,800 9,780 11,200
Total late state AMD 12,400 13,800 15,700
Cataract 13,700 15,100 17,200
Ocular hypertension 25,400 26,300 27,100
Glaucoma 13,200 14,300 15,800
Diabetes 79,000 82,400 86,200
Diabetic retinopathy 23,600 24,200 24,800
Severe retinopathy 2,170 2,230 2,280
Source: RNIB sight loss data tool

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 Community Impact Assessment.

Carers and young carers

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

According to the 2011 Census, 18,400 (9.6%) Surrey residents reported that they provide unpaid care. The proportion has changed little since 2001 when 9.4% were providing care. Most carers are providing less than 20 hours per week, but 11,000 are providing 20 to 49 hours per week and 18,474 (1.63%) are providing more than 50 hours per week.

The 2011 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, 1.63% of the population provide more than 50 hours unpaid care. Spelthorne has the highest proportion of the population providing this much care (2.08%), and Elmbridge has the lowest (1.43%).

There are 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 Mole Valley and Spelthorne and lowest in Elmbridge.

The Surrey Carers Strategy 2021 to 2024 sets out local aims and priorities and the young carers strategy draft has recently undergone consultation.

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 Community Impact Assessment.

People experiencing domestic abuse

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

In Surrey, 13,390 domestic abuse-related incidents and crimes were recorded in 2020/21. This is equivalent to 14 incidences and crimes per 1,000 people aged 16 years and over. This rate is lower than the South East and England, at 21 and 24 per 1,000 population respectively. 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 2018-2023 outlines local priorities and actions. A Domestic Abuse Rapid Needs Assessment was also undertaken as part of the Surrey Covid-19 Community Impact Assessment.

People with serious mental illness

In 2020/21, 9,343 (0.73%) people in Surrey had been diagnosed with Serious Mental Illness (SMI).

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

A JSNA chapter on mental health is currently being developed and this section will be updated with high level insights once this is published.

People with drug and alcohol problems

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.

Black and minority ethnic groups

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 community 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 Community Impact Assessment.

Gypsy Roma Traveller community

A small proportion (0.2%) of the population (2,400 people) described themselves as Gypsy or Irish Traveller, making it the smallest reported ethnic category (with a tick box) in the 2011 census. However, it is widely believed that the Gypsy, Roma and Traveller community is under reported in the 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 Community Impact Assessment.


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 residents.

People involved in 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

According to the 2011 Census there were around 2,500 members of the armed forces living in Surrey. Approximately 600 of these were living in communal establishments, mainly in Guildford (Pirbright Barracks) and Surrey Heath (Deepcut Barracks).

Please see the Health Needs Assessment of the Armed Forces Community (the Armed Forces, their families and veterans) for more information.

People in the LGBTQIA+ community

The 2019 ONS annual population survey found 1.6% of people in the South East identified as gay or lesbian, 1.3% bisexual, 1.4% responded other and 2.8% answered don’t know or declined to answer. This is a similar picture to what was seen nationally. This survey focuses on sexuality rather than gender identify, locally a survey is being developed to better understand the needs and experiences of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual and other identities) people in Surrey.

Evidence suggests LGBTQIA+ people have disproportionately worse health outcomes and experiences of healthcare[17].


Chapter acknowledgements and contributions

Project supervisor: Negin Sarafraz-Shekary

Authors: Katie Patrick, Cassandra Ranatunga, Conor Woolley

Data team: Conor Woolley, Minerva Lemonidou, Lorenzo Reitano, Beth Griffiths


Glossary

CCG Clinical Commissioning Group

DEFRA The Department for Environment, Food and Rural Affairs

HRA Homelessness Reduction Act

HWB Health and Wellbeing Board 

ICB Integrated Care Board 

ICS Integrated Care System 

IMD Index of Multiple Deprivation 

JSNA Joint Strategic Needs Assessment  

LA Local Authority  

LILEE Low-Income Low Energy Efficiency

LSOA Lower-layer super output area

MHCLG Ministry of Housing, Communities and Local Government

MSOA Middle-layer super output area

NHS National Health Service  

NHSE     NHS England 

OHID The Office for Health Improvement and Disparities, formerly PHE  

ONS Office for National Statistics 

PCN Primary care networks

PHE Public Health England 

RNIB Royal National Institute of Blindness

UKSHA UK Health Security Agency 

VCSE Voluntary and Community Sector


References

[1] WHO Europe Urban green spaces and health: A review of evidence

[2] Public Health England Improving outdoor air quality and health: review of interventions

[3] Jenkins R, Bhugra D, Bebbington P, Brugha T, Farrell M, Coid J, Fryers T, Weich S, Singleton N, Meltzer H. Debt, income and mental disorder in the general population. Psychol Med. 2008 Oct;38(10):1485-93. doi: 10.1017/S0033291707002516. Epub 2008 Jan 10. PMID: 18184442.

[4] Core 20 Plus 5 supporting document: Core 20 Plus 5: An Approach to Reducing Health Inequalities

[5] HE provider Good Practice briefing for students in receipt of free school meals [accessed 14/03/22]

[6] Sutton Trust: 6 findings from the latest EEF Report on the Attainment Gap [accessed 14/03/22]

[7] RNIB Sight Loss Data Tool

[8] CQC: The state of adult social services 2014 to 2017

[9] Ministry of Housing, Communities & Local Government Statutory Homelessness, October to December (Q4) 2018

[10] Homelessness Reduction Act 2017

[11] Howard, L.M., Trevillion, K., Khalifeh, H., Woodall, A., Agnew-Davies, R., & Feder, G. (2009). Domestic violence and severe psychiatric disorders: Prevalence and interventions. Psychological Medicine, 40(6), 881–893. DOI: 10.1017/S0033291709991589

[12] Trevillion, K., Oram, S., Feder, G., & Howard, L.M. (2012). Experiences of domestic violence and mental disorders: A systematic review and meta-analysis. PLOS One, 7, e51740.

[13] Gilbert, R., Kemp, A., Thoburn, J., Sidebotham, P., Radford, L., Glaser, D., & MacMillan, H. (2009). Recognising and responding to child maltreatment. The Lancet, 373(9658), 167–180.

[14] NDTMS Adult profiles: Adults in treatment

[15] Public Health England Health matters: preventing drug misuse deaths

[16] UK Parliament Achieving better health outcomes for Gypsy, Roma and Traveller communities

[17] NHS England LGBT Health

Archive

The PDF below is the archived version of the 2018 update for this chapter.