1. Guildford and Waverley 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 Guildford and Waverley 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), Guildford and Waverley CCG has: – Fewer children aged 0-4 – More young people aged 10-19 – Fewer young adults aged 25-34 – Slightly more older adults 45- 64 – More adults 75+

6. Population projections The population of Guildford and Waverley CCG is ageing almost in line with England 19.7% of the population of Guildford and Waverley CCG is projected to be over the age of 65 by 2020

7. Population projections The over 85 population is growing at a similar rate to the national rate 3.7% of the population of Guildford and Waverley 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 Guildford and Waverley 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 Guildford and Waverley CCG

12. Life expectancy at birth by ward

15. Specific groups in Guildford and Waverley CCG Specific groups requiring a targeted approach in Guildford and Waverley CCG include: – Carers: more than 18,700 people of all ages provide unpaid care; more than 1,300 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. Guildford and Waverley CCG has around 14 authorised GRT sites – Armed service personnel and veterans: large number of army personnel and family at Pirbright, Deepcut and Keogh barracks and veterans and reservists in the local area, with particular health needs – Offenders serving community sentences, those on probation and ex- offenders that remain in the community may remain hard to reach.

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. Guildford and Waverley CCG expenditure estimates: 10 programme budgeting categories of highest spend 2011-12

20. Guildford and Waverley CCG Spend and outcome relative to other CCGs in England 2011-12

21. Most prevalent conditions – Guildford and Waverley CCG: QOF 2012-13

22. Dementia diagnosis gap – Guildford and Waverley CCG: 2011-12

23. Most prevalent conditions – Guildford and Waverley CCG: QOF 2012-13

24. Programme budgeting category: musculoskeletal. Emergency hospital admissions for fractured neck of femur (65+) 2012-13

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 – Smoking prevalence in Guildford (10.7%) and Waverley (18.5%) compared to Surrey (14.7%). There are particularly high rates of adult smoking in Pirbright (37%), Stoke and Westborough (36%) in Guildford, and Godalming Binscombe (34%) in Waverley Increasing risk drinking rates are slightly higher than the national average: – The rate of alcohol related admissions in adults has more than doubled since 2002

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 2012-13

31. Diet, Obesity, and Exercise Diet and obesity rates are slightly better than the national average but: – Nearly a fifth of adults are obese – More than a third of adults are not physically active enough – 25.0% of year 6 children are overweight or obese in Guildford and Waverley CCG – Less than a third of adults eat healthily

32. Obesity and Exercise

33. Health behaviours: further data Guildford and Waverley CCG, relative to the national average, has: – A higher rate of road injuries and deaths in Guildford (66.1/100,000) and Waverley (43.3/100,000) than in England (40.5/100,000), Guildford significantly so – A lower level of drug misuse (5.5/1,000 15-64 year olds in Guildford and 3.2/1000 in Waverley using opiates/crack cocaine vs 8.6 in England) – A higher percentage initiating breastfeeding (81.8% vs. 73.9% in England - though significant drop at 6-8wks) – Lower immunisation than herd immunity requires (especially MMR and pertussis) and low Chlamydia screening rates – Lower teenage conception rates than England, though significantly higher in Stoke, Guildford

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 and has not been reproduced here

43. CCG Indicators Relative to the rest of Surrey, Guildford and Waverley CCG: – Has the lowest years of life lost to causes amenable to healthcare for women, and the second lowest for men. This has decreased for men and women since 2009, significantly so for women – Has the lowest under 75 mortality rate from cardiovascular 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 Relative to the rest of Surrey, Guildford and Waverley CCG: – Has the third lowest rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions. This has increased since 2010/11 – Has the third lowest rate of unplanned hospitalisation for asthma, diabetes, and epilepsy in under 19s. This has decreased from 2010/11

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

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

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

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

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

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

58. Hospital admissions (2010-11) Relative to the rest of Surrey, Guildford and Waverley CCG: – Has the lowest crude rate for hospital admissions for Chronic Obstructive Pulmonary Disease (COPD) per 100 persons on the disease register – The second lowest crude rate for cancer, coronary heart disease, diabetes, mental illness and long term neurological conditions

59. Hospital admissions (2010-11)

60. 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

61. 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 – DH programme budgeting benchmarking tool – Quality and Outcomes Framework Data – APHO health profiles and Local Health – NHS comparators – 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