The Surrey Context – People & Places

Executive Summary

This chapter was updated in January 2018 to include data from the 2016 population estimates.

The chapter provides background information about Surrey and the makeup of its population.

Information about the age profile, ethnicity, religion, language skills and sexual identity is essential to enable appropriate services to be provided.

There are 11 district and borough councils within Surrey, and Surrey‘s Health and Wellbeing board is responsible for 5 Clinical Commissioning Groups.

The Office for National Statistics (ONS) estimated that the resident population of Surrey at Mid 2016 was 1,176,500.

The estimate is broken down into 72,400 children aged under 5 (6.2% of the population), 172,100 children aged 5-16 (14.6%), 104,200 people aged 17-24 (8.9%), 608,100 people aged 25-64 (51.7%) and 219,800 older people aged 65+, (18.7%).

The population of Surrey is projected to increase by 19% over the next 25 years reaching 1,382,500 by 2039.

The proportion of the population in all age groups under 65 is projected to fall by 2039. However the overall number in all age groups is projected to increase, with 2,300 additional under 5s, 30,000 more aged 5-16, 12,800 additional people aged 17-24 and 47,600 more aged 25-64

The proportion of the population aged over 65 is projected to increase to 24.7% by 2039, with the proportion of over 85s projected to almost double from 2.8% to 5.4% over the same period. This will lead to an additional 128,500 over 65s in total with 43,600 more aged over 85.

The majority of the population, (83.5%) reported their ethnic group as “White British” in the 2011 Census. A further 6.9% belonged to other white ethnic groups; “Irish, “Gypsy or Irish Traveller” and “Other White”. The next largest ethnic group was “Indian” with 20,200 people (1.8% of the population) followed by Pakistani (1.0%).

The older population is less diverse than the younger cohorts. 92.5 % of people aged 65+ are White British with just 2.7% in non white ethnic groups.

Nearly 65,000 Surrey residents speak a language other than English as their main language. The most common other languages spoken in Surrey are Polish (6,634 speakers) and Chinese languages (4,426 speakers). Most of them consider that they can speak English “well” or “very well”, but nearly 6,500 people cannot speak English well and a further 1,000 cannot speak English at all.

In the 2011 Census, 62.8% of Surrey’s population, said that their religion was Christian. 24.8% said they had no religion. The greatest number of people belonging to another religion in Surrey were Muslim, who made up 2.2% of the population (24,400 people).

The 2011 Census did not collect information on sexual orientation so there is little reliable data on the number of people in these groups in Surrey. The UK Government estimates that 6% of the population are lesbian, gay or bisexual. This means that there may be 56,500 people aged 16+ and around 4,000 people aged 11 to 15 in Surrey who are lesbian, gay or bisexual.

There is no official estimate of the trans population, but applying percentages from a Home Office funded study would lead to an estimate of at least 7,000 trans people, defined as ‘a large reservoir of transgender people who experience some degree of gender variance’.

Although the proportion of the population from black and 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 hard to reach because of language or differences in culture which contribute to inequalities.

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Visualisation of data used in this chapter

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Boundaries

Most of Surrey is covered by 5 clinical commissioning groups (CCGs) – East Surrey, Guildford and Waverley, North West Surrey, Surrey Downs and Surrey Heath. Farnham is covered by North East Hampshire & Farnham CCG and Englefield Green is covered by Windsor, Ascot & Maidenhead CCG. As these latter two CCGs are outside of the remit of Surrey’s Health and Wellbeing Board, where this chapter discusses the population in relation to CCG boundaries it will exclude the Surrey residents from those areas.

There are 11 lower tier local authorities within Surrey – Elmbridge, Epsom & Ewell, Guildford, Mole Valley, Reigate & Banstead, Runnymnede,Spelthorne, Surrey Heath, Tandridge, Waverley and Woking

The largest towns in Surrey are Guildford (population 75,000) and Woking (69,000)

Parish and town councils exist in the rural parts of Surrey, but there are none in the boroughs of Epsom & Ewell, Runnymede, Spelthorne or Woking.
Map showing Local Authorities and Clinical Commissioning Groups in Surrey

Surrey County Council has coterminous boundaries with the area covered by the Surrey Local Resilience Forum (SLRF). The SLRF sits at the apex of local civil protection arrangements in Surrey, providing vision, leadership and cabinet responsibility to all responders.

Population estimates

The Office for National Statistics (ONS) estimated that the resident population of Surrey at Mid 2016 was 1,176,500. The largest local authorities in terms of population are Guildford (148,000) and Reigate and Banstead (145,600) and the smallest is Epsom and Ewell (79,600). The largest CCG is North West Surrey (344,600) and the smallest is Surrey Heath (96,700). Population estimates for Clinical Commissioning Groups are based on a geographical area and will be different from the population of registered patients.

Age and gender

The distribution of the estimated population for Surrey and England by 5 year age group split by gender is shown in the data dashboard.

The largest five year cohort for both Surrey and England is the 50-54 age group which corresponds to the ‘baby boom’ of the 1960s. The effect of the ‘post war bulge’ can be seen in the big difference between the 60-69 and the 70-74 age groups.

Compared with England, Surrey has a slightly larger proportion of people aged 35-54 and a smaller proportion aged 20-34, but is otherwise broadly similar.

Proportion in lifecourse age groups

There are estimated to be 72,400 children aged under 5 in Surrey (6.2% of the population). Elmbridge (7.2%) and Woking (7.1%) have the highest proportion of under 5s and Mole Valley the lowest (5.1%).

There are estimated to be 172,100 children aged 5-16 (14.6% of the population). Elmbridge has the highest proportion of children (16.6%) and Runnymede the lowest (12.4%).

There are estimated to be 104,200 people aged 17-24 making up almost a tenth of the population (8.9%). Runnymede (14.0%) and Guildford (13.9%) have the highest percentage due to the universities situated in these boroughs, and Elmbridge the lowest (6.5%).

There are estimated to be 608,100 people aged 25-64 making up just over half of the population (51.7%). Woking has the highest percentage (53.7%) and Waverley the lowest (48.9%).

There are estimated to be 219,800 older people aged 65+, making up just under one in five (18.7%) of the population. Mole Valley has the highest proportion of older people (23.0%) and Guildford the lowest (16.3%).

Population density

Surrey is the one of the most densely populated shire counties in England with 7.0 persons per hectare. The overall population density of England is 4.2 persons per hectare. In the most urban districts, Epsom & Ewell and Spelthorne, there are more than 20 persons per hectare, but in the highly rural districts, Mole Valley, Tandridge and Waverley, there are fewer than four persons per hectare. Eighty seven per cent of inhabitants live in urban areas and yet 73% of land in Surrey is green belt. Just over a quarter (26%) is designated as Areas of Outstanding Natural Beauty. This complex geography is significant as access to services and transport are important concerns in the rural parts of Surrey.
Surrey population density map

Population projections

Resident population projections are based on numbers of births, deaths, inward migration and outward migration. ONS population projections are trend-based, which means assumptions for future levels of births, deaths and migration are based on trends observed over the previous five years and show what the population will be if these recent trends continue. The latest population projections are based on the 2014 mid-year estimate and are calculated through to 2039. It should be noted that these population projections become less reliable the more into the future they reach and should be interpreted with caution.

The population of Surrey is projected to increase by 19% over the next 25 years reaching 1,382,500 by 2039. The borough with the biggest projected increase is Reigate & Banstead (28%) and the smallest is Surrey Heath (11%).

Age and gender

The projected change in population of Surrey until 2039 based on 5 year age groups split by gender is shown in the data dashboard.

This illustrates the aging population, with the proportion of the population in all age groups aged 55 and over projected to increase and the proportion of people in younger age groups (except 10-19) set to decrease.

Proportion in lifecourse age groups

The proportion of the population aged under 5 is projected to fall from 6.3% in 2014 to 5.5% in 2039. The proportion aged 5-16 is projected to fall slightly over the same period from 14.4% to 14.2%. However the overall number in both age groups is projected to increase, with 2,300 additional under 5s and 30,000 aged 5-16.

The proportion of the population aged 17-24 is projected to fall from 8.9% in 2014 to 8.4% in 2039. The proportion of the population aged 25-64 is projected to fall from 52.0% in 2014 to 47.1% in 2039. Again the overall number will increase, with 12,800 additional people aged 17-24 and 47,600 more aged 25-64.

The proportion of the population aged over 65 is projected to increase from 18.4% in 2014 to 24.7% in 2039, with the proportion of over 85s projected to almost double from 2.8% to 5.4% over the same period. This will lead to an additional 128,500 over 65s in total with 43,600 more aged over 85.

The age bands presented are of particular relevance to service planning as, for example, most health and social care is accessed by the younger (0-16) and the older (65+) sections of the population, but usually delivered by those in the middle age bands (17-64). The “dependency ratio”, calculated as the number of people in the younger and older age bands divided by the number of people aged 17-64 will increase from 64 “dependents” per 100 of working age to 80 by 2039.

The projected demographic change would cause an initial rise in demand for children’s services over the next 10 years, with demand remaining fairly steady after 2025, but the demand for services for older people will continue to rise over the next 25 years. However this does not take into account other factors influencing demand.

Components of population change

There are two main elements of population change; natural change and migration. Natural change is an expression of the number of births to mothers resident in an area minus the number of deaths of residents. Migration includes internal migration – people moving into and out of an area from within England and Wales, and international migration – moving to or from other countries.

Births and deaths

In 2016, the population of Surrey increased by 3,189 due to natural change. Births outnumbered deaths in all Surrey’s districts except Mole Valley where there were 111 more deaths than births. The highest natural change was in Elmbridge where there were 568 more births than deaths.

Migration

International migration is defined in ONS population estimates as people moving to a country other than that of their usual residence for a period of at least a year, so that the country of destination effectively becomes their new country of usual residence. There is no formal measure of international migration and it is estimated from the International Passenger Survey (a survey of passengers arriving and leaving British ports and airports).

The internal migration component estimates flows between local authorities in England & Wales. Since internal moves are not recorded formally, information obtained from the NHS Central Register (NHSCR) and GP Patient Registers are used as a proxy. These data are considered to be a good proxy for internal migration as, when moving, most patients will eventually register with a new GP.

In the year ending June 2016 Surrey’s population was estimated to have increased by 3,900 due to migration. This was an increase of 400 on the estimated net migration to Surrey in 2015. Net migration from overseas was 4,600 and there was net out migration to England and Wales of around 700. All local authorities except Elmbridge and Woking experienced overall net in-migration.

Guildford and Runnymede both experienced a high level of net international in-migration. This may be due to overseas students coming to these boroughs to study at Surrey and Royal Holloway Universities.

The population change due to migration can vary considerably from year to year. The average annual net migration into Surrey over the period from mid-2011 to mid-2016 was estimated at 4,200. Of this, 2,500 was international migration. In the last 5 years, the largest net migration, 5,500, occurred in the year ending mid 2014. The level of migration from overseas in the year ending mid 2016 was the highest in the last 5 years.

Birth rates

The number of births in an area is dependent on the number of women of childbearing age and the likelihood of them giving birth. There are two measures of the birth rate.

The Total Period Fertility Rate (TPFR) is the sum of all age-specific fertility rates across an average woman’s reproductive lifetime. It measures the average number of live-born children per woman which would occur if the current age specific fertility rates applied over the entire 30 years of the reproductive span. In 2016 Surrey had a slightly higher TPFR (1.90) than England (1.81) with the highest rate in Elmbridge (2.23) and lowest in Guildford (1.59).

The General Fertility Rate (GFR) is the number of births per 1,000 females aged 15-44 years. Surrey’s GFR was 62.8 in 2016, slightly higher than the rate for England (62.5).

Fertility rates are lower in Guildford and Runnymede than all other Surrey boroughs and districts. This may be due to the high number of students in these areas.

The number of births to mothers living in Surrey reached a peak of 14,237 in 2012. However the rate has fallen since then and there were 13,423 births in 2016.

Special populations

The population subgroups for prisoners and armed forces (UK forces and foreign) are included in the ONS mid-year population estimates, but they are estimated separately from the rest of the population as they are not covered by the migration data sources used.

Students are included in the mid-year estimates at their term time address, however data on out of term time population is available from the 2011 Census.

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.

Prisoners

In September 2017 there were 5 prisons in Surrey accommodating 2,691 prisoners. Downview prison reopened in May 2016 after a period of refurbishment. Please see Health Needs Assessments for the individual prisons which can be accessed from this pagefor more information.

Students

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

Ethnicity in Surrey

The majority of the population, 945,700 people (83.5% of the population) reported their ethnic group as “White British” in the 2011 Census. A further 78,000 (6.9% of the population belonged to other white ethnic groups; “Irish, “Gypsy or Irish Traveller” and “Other White”. The next largest ethnic group was “Indian” with 20,200 people (1.8% of the population) followed by Pakistani (1.0%).

There were two new tick boxes in the 2011 Census: Gypsy or Irish Traveller and Arab. 4,100 usual residents (0.4% of the population) reported their ethnic group as Arab and 2,300 usual residents (0.2% of the population) described themselves as Gypsy or Irish Traveller accounted, making it the smallest reported ethnic category (with a tick box) in 2011. However it is widely believed that the Gypsy, Roma and Traveller community is under reported in the Census.

Differences in ethnicity across local authorities and clinical commissioning groups

Woking is the most diverse local authority in Surrey with 16.4% of its population from non-white ethnic groups. Waverley is the least diverse with 90.6% White British.

Elmbridge has the highest proportion (10.4%) in all other white groups (“Irish, “Gypsy or Irish Traveller” and “Other White”) with Tandridge the lowest (4.6%)

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

North West Surrey is the most diverse clinical commissioning group (CCG) with 12.5% of its population from non-white ethnic groups. Guildford & Waverley is the least diverse with 85.9% of its population White British

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. However, in the South East as a whole 85.2% were recorded as White British.

More people in Surrey (6.9%) were recorded in other white ethnic groups than in England (5.7%) with fewer (9.6% compared with 14.6%) in all other ethnic groups.

Differences across age groups

The older population is less diverse than the younger cohorts. 92.5 % of people aged 65+ are White British with just 2.7% in non-white ethnic groups. Other white ethnicities (“Irish, “Gypsy or Irish Traveller” and “Other White”) are most dominant in the 25-64 age group (8.4%). The highest proportion of Asian ethnicities (other than Indian and Pakistani) is among young adults aged 16-24 (4.5%). The proportion of mixed/multiple ethnic groups is highest among children under 16 (5.2%).

Main language and proficiency in English

For the first time, the 2011 Census asked people about their main language and proficiency in English. In Surrey, 94% of people aged 3 and over stated that their main language was English. Nearly 65,000 Surrey residents gave another language as their main language. The most common other languages spoken in Surrey are Polish (6,634 speakers) and Chinese languages (4,426 speakers). The borough with the highest proportion of people with English as their main language was Tandridge (97.3%) and the lowest was Woking (89.9%). At CCG level, North West Surrey has the lowest proportion of people with English as their main language, with 7.5% of residents with a main language other than English.

Surrey has a higher proportion of people with English as their main language than England as a whole, where 92% of the population stated that their main language was English.

Proficiency in English

People who stated that their main language was not English were asked how well they could speak English. The options were: “Very well”, “well”, “not well” or “not at all”.

More than half (53.1%) of Surrey residents whose main language is not English consider that they can speak English very well, and a further 35.4% can speak it well. Nearly 6,500 people cannot speak English well and a further 1,000 cannot speak English at all. The borough with the highest number of people with poor English skills is Woking where nearly 1,500 cannot speak English or can’t speak it well.

Non English speakers in Surrey have better English skills than non English speakers in England as a whole where 79.3% of people whose main language is not English can speak English “well” or “very well”.

Religion in Surrey

In the 2011 Census, 62.8% of Surrey’s population, 711,100 people, said that their religion was Christian. This is a slightly greater proportion than in the South East (59.8%) and England as a whole (59.4%). The proportion of people in Surrey who said they had no religion was 24.8%, a slightly smaller proportion than in the South East (27.7%) but almost the same as in England as a whole (24.7%). The greatest number of people belonging to another religion in Surrey were Muslim, who made up 2.2% of the population (24,400 people) which is a similar proportion to the South East (2.3%) but only half that of England (5%).

The religion question on the 2011 Census form was not compulsory and 7.4% of the population of Surrey did not answer, a similar proportion to the South East (7.4%) and England (7.2%).

There has been a striking degree of change between the last two Censuses. The proportion of Christians in Surrey decreased by 11.8 percentage points from 74.6% to 62.8%. In the South East the proportion decreased by 13 percentage points and in England by 12.4 points. The proportion reporting no religion in Surrey rose in the same period by 9.6 percentage points from 15.2% in 2001 to 24.8% in 2011, whereas in the South East it rose by 11.2 points and in England by 10.1 points. There was an increase in the proportion of the Surrey population identifying with each of the other main religions.

Differences in religion across local authorities and clinical commissioning groups

In the 2011 Census, Waverley (65.2%) had the highest proportion of the population who said their religion was Christian. The lowest was Woking (58.8%). Guildford was the borough with the greatest proportion who said they had no religion (27.8%). Woking had the greatest proportion of Muslims in Surrey (7.4% of the borough’s population), followed by Epsom & Ewell (3%) whilst all other boroughs and districts had a Muslim population proportion that was lower than the overall Surrey proportion of 2.2%.

The proportion of the population who said their religion was Christian was similar in all of the CCGs. North West Surrey has the highest proportion of Muslims (3.4%).

Differences across age groups

Younger people were more likely to state they had no religion in the 2011 Census than people in older age groups. For example, more than one third (36%) of people aged 16 to 24 stated they had no religion compared with 10% of people aged 65 and over. Older people were more likely to say they were Christian, with 80% of people aged 65 and over stating this, compared with 51% of people aged 16 to 24.

Lesbian, Gay, Bisexual, Transgender and Questioning (LGBTQ)

The 2011 Census did not collect information on sexual orientation so there is little reliable data on the number of people in these groups in Surrey. The UK Government estimates that 6% of the population are lesbian, gay or bisexual. Applying this to mid-2015 population estimates for Surrey means that there may be 56,500 people aged 16+ and around 4,000 people aged 11 to 15 in Surrey who are lesbian, gay or bisexual.

The Integrated Household Survey asks a question on self-perceived sexual identity of adults in the UK. The 2014 survey showed 1.1% of the population nationally reporting as gay or lesbian (1.5% of men and 0.7% of women), 0.5% reporting as bisexual (0.3% of men and 0.7% of women) and 0.3% reporting an “other” option. However 5.3% of the sample refused to answer the question or answered “don’t know” or no response was received.

Data from the Census shows 0.7% of Surrey residents aged 16+ living in a same sex couple (in a registered civil partnership or cohabiting) compared with 0.9% nationally.

At present, there is no official estimate of the trans population. GIRES, in their Home Office funded study estimate the number of trans people in the UK to be between 300,000 – 500,000, defined as ‘a large reservoir of transgender people who experience some degree of gender variance’. (1)

Applying this percentage to the Surrey population would lead to an estimate of at least 7,000 such people in Surrey.

Who’s at risk and why

Although the proportion of the population from black and minority ethnic groups is smaller in Surrey than in the country as a whole, this varies between local authorities and clinical commissioning groups. This provides a challenge to ensure that the needs of these small communities and individuals are appropriately met. It is essential to work across partner organisations to ensure a good understanding of the varying needs this diversity brings. Furthermore, some minority ethnic groups may be hard to reach because of language or differences in culture which contribute to inequalities.

It is important that Surrey CCGs and Surrey County Council and partners consider the total population in developments and access to services as well as cultural/religious sensitivities when commissioning services. For example, it is important to be aware that ethnicity is linked to an increased risk of some diseases – cardiovascular disease, type 2 diabetes and some cancers. Relevant chapters cover these issues in more detail.

General issues that impact on service provision for minority groups:

  • Different understandings of mental health problems.
  • Lack of knowledge of services.
  • Stigma, fear of authority and lack of trust.
  • Lack of interpreting and translation services.

Individuals from different ethnic minorities have different religious backgrounds. Health and social care education providers must be aware of differing religious requirements regarding aspects of in and out-patient treatment and personal care, particularly around beliefs concerning birth, death and dying.

Cultural sensitiveness is important to help minimise stereotyping and biases due to insufficient awareness about religious and cultural particularities, to understand differences within religions and to help negate the risk of insufficient care arising from cultural and religious miscommunication. (2)

Cultural barriers for new migrants into the UK include inadequate information, for example when unfamiliar with UK health care systems; insufficient language interpretation; lack of access to transport because of poverty; poor services in deprived areas with high numbers of migrants; and confusion around entitlement to various services. Some of these barriers appear to affect longer established migrants as well. (3). Some women may be prevented from seeking medical help for maternal mental health issues due to cultural stigmatisation within some Commonwealth migrant communities. (4)

An example of the impact of cultural differences is on the health care of Eastern European groups, such as their frustration and confusion with the UK referral model where the GP acts as a gatekeeper to other services; not accessing mental health services until crisis point due to stigma within Eastern European communities; language difficulties; and a lack of knowledge and trust of UK health care. (5)

Traveller community

The lack of reliable demographic data, combined with the mobility of these groups, may lead to their invisibility throughout the planning of service provision and result in unmet needs. This is particularly important when considering that the health status of these communities has been shown to be significantly worse than other socio-economically disadvantaged or ethnic minority groups in the UK. Cultural barriers to health care include travellers’ resistance, lack of trust in settled institutions and individuals, fear of losing their cultural identity and heavy cultural reliance on close family and social ties for health support. (6)

LGBTQ

Issues facing the LGBTQ people include

  • LGBTQ people may be more likely to use drugs than heterosexual people
  • Younger LGBTQ people may experience homophobic bullying within school, often resulting in the development of symptoms of depression. (7)
  • LGBTQ people, especially transgender people, can experience more social isolation and discrimination. (7)
  • Transgender people are likely to experience mental health problems in response to the discomfort they feel. (8)
  • Societal ignorance, marginalisation and/or hostility can lead to health inequalities including increased psychological distress, often referred to as ‘minority stress.’ (9)
  • LGBTQ young people still experience significantly greater self-harm and suicidal distress than their non-minority counterparts with a low perception of family support often increasing the risk of suicide attempt. (10)
  • Psychosocial stressors associated with being transgender, including gender nonconformity, transphobia, lack of support, dropping out of school, family problems, suicide attempts by acquaintances, homelessness, cyberbullying, substance abuse, and psychiatric disorders increase transgender people’s risk of suicide. This may be elevated among minority communities that may strongly oppose LGBTQ people. (11)

Relevant chapters cover these issues in more detail

Key contacts

Kathy Trott, Surrey County Council, kathy.trott@surreycc.gov.uk

Chapter references

1. Reed et al 2009
2. Arousell, 2016
3. Jayaweera, 2014
4. Latif, 2014
5. Madden et al., 2014
6. Carr et al., 2015
7. Rethink, 2015
8. The National LGB&T Partnership, 2015
9. LGBT Mental Health Demonstration Project Impact Report, 2014
10. The RaRE Research Report, 2015
11. Public Health England, 2015

Signed off by

Surrey Joint Strategic Needs Assessment Project Group

If you have any comments/feedback please send it to jsnafeedback@surreycc.gov.uk