1. North West Surrey CCG: How healthy is our population? Prepared by Surrey Public Health

2. Outline Population demographics and future projections Where are the most deprived areas in North West Surrey CCG and which groups require a targeted approach Programme budgeting categories, disease prevalence and risk factors How healthy is the population relative to benchmarks What are the preventable conditions contributing to excess morbidity and mortality linked to programme budgeting categories

3. Demographics

4. CCGs and Surrey local authorities

5. Current population profile Relative to England (dark outlines), North west Surrey CCG has: – More children aged 0-9 – Fewer young adults aged 15- 30 – More adults aged 30-54 – Slightly fewer adults 60-74 – Slightly more adults 75+

6. Population projections The population of North West Surrey CCG is ageing almost in line with England 18.5% of the population of North West Surrey CCG is projected to be over the age of 65 by 2020

7. Population projections The over 85 population is growing at a faster rate than the national average 3.5% of the population of North West Surrey CCG is projected to be over the age of 85 by 2020

8. Cost Impact of ageing population Average cost of admission by age for North West Surrey CCG (Emergency admissions, 2011/12) Source: SUS

9. Deprivation

10. Deprivation and Health Following the publication of the Marmot Review in 2010, it is clear that there is a strong association between health inequalities and other measures of deprivation, including education, skills and employment, income, and housing. The Index of Multiple Deprivation (IMD) measures deprivation by a weighted average of seven domains: income, employment, health and disability, education, housing, crime, and environment. Accordingly, areas with higher IMD scores are likely to also have a poorer health status and health outcomes.

11. Deprivation in North West Surrey CCG

12. Life expectancy at birth by ward

15. Specific groups in North West Surrey CCG Specific groups requiring a targeted approach in North West Surrey include: – Carers: more than 32,000 people of all ages provide unpaid care; 2,300 are over 65 providing >20 hours a week – Older people: particularly with the high rate of falls, hip fractures, and increasing impact of excess winter deaths on local populations – Gypsy, Roma and Traveller community: Surrey has the 4 th largest GRT community in the country. North West Surrey has around 30 authorised GRT sites – Armed service personnel and veterans: large number of army personnel and family at Pirbright, and veterans and reservists in the local area, with particular health needs – Prisoners and ex-offenders: Coldingley and Send prisons located in Woking. Bronzefield is just outside CCG border

16. Programme budgeting categories, disease prevalence and risk factors

17. Programme budgeting expenditure in Surrey PCT 2011-12

18. Programme budgeting categories of highest spend in Surrey PCT 2011-12

19. North West Surrey CCG expenditure estimates: 10 programme budgeting categories of highest spend 2011-12

20. North West Surrey CCG Spend and outcome relative to other CCGs in England 2011-12

21. Most prevalent conditions by number - North West Surrey CCG: QOF 2012-13

22. Most prevalent conditions (%) - North West Surrey CCG: QOF 2012-13

23. Dementia diagnosis gap - North West Surrey CCG: 2011-12

24. Programme budgeting category: musculoskeletal. Emergency hospital admissions for fractured neck of femur 2010-11

25. Risk Factors The top 10 risk factors contributing to the overall burden of disease in the UK are: 1.Smoking (~12%)6. Diet (low fruits) (~5%) 2.Hypertension (~9%)7. High total cholesterol (~4%) 3.High Body Mass Index8. Diet (low nuts/seeds) (~3%) (~9%) 1.Physical inactivity (~5%)9. High fasting glucose (~3%) 2.Alcohol (~5%)10. Diet (high sodium) (~3%) Source: Global Burden of Disease Study 2010 (Lancet, March 2013)

26. Smoking and Alcohol Smoking rates are in places lower than the national average, BUT: – Smoking remains the single most important cause of ill-health and premature death in Surrey – There are particularly high rates of adult smoking in Stanwell North, Spelthorne (34%), Egham Hythe, Runnymede (32%), and Maybury and Sheerwater, Woking and Walton North, Elmbridge (33%) Increasing risk drinking rates are slightly higher than the national average, BUT: – The rates of alcohol related admissions in adults doubled between 2002/3 and 2008/9, and are projected to have doubled again by 2013/14 – this is increasing significantly faster than the national average

27. Smoking prevalence 2012

28. Drinking prevalence estimates

29. Admission episodes for alcohol- attributable conditions (all ages)

30. Emergency admissions for alcohol related liver disease 2012/2013

31. Diet, Obesity, and Exercise Diet and obesity rates are slightly better than the national average but: – Less than a third of adults eat healthily – Over a fifth of adults are obese – Almost 9/10 adults are not physically active enough – 19.0% of year 6 children are obese in Spelthorne. This is the same as the national percentage

32. Obesity and Exercise

33. Health behaviours: further data North West Surrey CCG, relative to the national average, has: – A higher rate of road injuries and deaths in Runnymede (52/100,000), Spelthorne (44.7/100,000) and Surrey Heath (55.7/100,000) than in England (44.3/100,000) – A lower level of drug misuse (6.8/1,000 15-64 year olds in ##Woking using opiates/crack cocaine vs 8.9 in England) – A higher percentage initiating breastfeeding (84.2% vs. 74.5% - though significant drop at 6-8wks) – Lower immunisation (especially MMR and pertussis) and Chlamydia screening rates – Fewer teenage mothers (34.6/1000 15-17 year olds in Spelthorne vs. 38.1/1,000 in England), though significantly higher in Sunbury Common in Spelthorne (61)

34. Drug misuse 2010-11

35. Chlamydia 2012

36. Teenage conception rate 2012

37. Causes of greatest morbidity and mortality in the UK

38. Global Burden of Disease Study 2010 The Global Burden of Disease Study 2010 (GBD 2010) UK analysis was published in March 2013 and looks at the major causes of premature mortality, disability, and attributable risk factors in the UK. It covers 259 diseases and injuries and 67 risk factors

39. Mortality The top 10 causes of mortality in all age groups in the UK are: 1.Ischaemic Heart Disease6.Colorectal cancer 2.Lung cancer7. Breast cancer 3.Stroke8. Self harm 4.Chronic Obstructive 9. Cirrhosis Pulmonary disease 5. Lower respiratory 10. Alzheimer’s disease tract infections

40. Mortality The top 10 causes of mortality in 20-54 year olds in the UK are: 1.Ischaemic Heart Disease 6. Drug use disorders 2.Self harm7. Lung cancer 3.Cirrhosis8. Stroke 4.Breast cancer9. Colorectal cancer 5.Road injury10. Lower respiratory tract infections

41. Morbidity The top 10 causes of morbidity in all age groups in the UK are: 1.Lower back pain6. Anxiety disorders 2.Falls7. Chronic obstructive pulmonary disease 3.(Major) depression8. Drug use disorders 4.Neck pain9. Asthma 5.Other musculoskeletal10. Migraine problems

42. Local indicators of mortality and hospital admissions Overlap exists with some of the programme budget categories. The SPOT tool gives specific mortality data for CCGs for the programme budgeting categories but has not been reproduced here except for suicide

43. CCG Indicators Relative to the rest of Surrey, North West Surrey CCG: – Has the second highest years of life lost to causes amenable to healthcare for women, and the third lowest for men. This has increased for men and women since 2009, significantly so for women – Has the highest under 75 mortality rate from all cancers, and liver disease

44. CCG Indicator 1.1: Age and sex standardised potential years of life lost to causes considered amenable to healthcare: 2012

45. CCG Indicator 1.9: Age and sex standardised under 75 mortality rates from cancer: 2012

46. CCG Indicator 1.2: Under 75 age and sex standardised mortality rates from cardiovascular disease: 2012

47. CCG Indicator 1.7: Age and sex standardised under 75 mortality rates from liver disease: 2012

48. CCG Indicator 1.6: Age and sex standardised under 75 mortality rates from respiratory disease: 2012

49. CCG Indicators

50. Relative to the rest of Surrey, North West Surrey CCG: – Has the third highest rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions – Has the third highest rate of unplanned hospitalisation for asthma, diabetes, and epilepsy in under 19s – Both these figures have decreased from 2010/11 to 2011/12

51. CCG Indicator 2.6: Directly standardised rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions all ages: 2012-13

53. CCG Indicator 2.7: Directly standardised rate of unplanned hospitalisation for asthma, diabetes, and epilepsy in under 19s: 2012-13

54. CCG Indicators Relative to the rest of Surrey, North West Surrey CCG: – Has the second highest rate of emergency admissions for acute conditions that should not usually require hospital admission (rate decreasing) – The highest percentage rate of emergency readmissions within 30 days of discharge from hospital – Has the second lowest rate for emergency admission for children with lower respiratory tract infections (rate decreasing)

55. CCG Indicator 3.1: Directly standardised rate of emergency admissions for acute conditions that should not usually require hospital admission: 2012/13

57. CCG indicator 3.2: Indirectly standardised rate of emergency readmissions within 30 days of discharge from hospital: 2011-12

58. CCG Indicator 3.4: Directly standardised rate of emergency admissions for children with lower respiratory tract infections: 2012-13

59. Hospital admissions (2010-11) Relative to the rest of Surrey, North West Surrey CCG: – Has the highest rate for hospital admissions for cancer per 100 persons on the disease register – The second highest rate for respiratory and long term neurological conditions

60. Hospital admissions (2010-11)

61. Key messages regarding preventable conditions Improve morbidity, mortality and unplanned admissions by: – Early identification and management of risk factors such as smoking, alcohol, diet, obesity, and exercise – Prompt diagnosis and effective management of long-term conditions with treatment based on evidence based guidelines – Improving the quality of care received by people, whether at home or in residential care, e.g. relating to recognising the symptoms of a stroke

62. Further information Further sources: – Surrey JSNA Health Profiles – NHS Health and Social Care Information Centre – NHS England CCG Commissioning Support Packs – PHE England SPOT tool – Quality and Outcomes Framework Data – APHO health profiles – NHS comparators – POPPI/PANSI databases – Murray CL et al. UK health performance: findings of the Global Burden of Disease Study 2010. Lancet 2013; 381: 997-1020 Contacts: – Jon Walker, Public Health Analyst Jon.Walker@surreycc.gov.uk