Joint Strategic Needs Assessment
Joint Strategic Needs Assessment
ROTHERHAM
May 2011
-2-
Table of Contents
What is a Joint Strategic Needs Assessment (JSNA)? ...................................................
Why do we need a JSNA? ..............................................................................................
1.
Demographic Profile
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
2.
6
6
Population Numbers ..................................................................................
Age Profile ................................................................................................
Gender Profile ...........................................................................................
Birth Rate ..................................................................................................
Black and Minority Ethnic (BME) Population Profile ..................................
Disability Profile ........................................................................................
Population by Religious Group ..................................................................
Population by Migrant Status ....................................................................
Number of Households .............................................................................
Analysis of Areas of Deprivation ...............................................................
Social Marketing Categories and Urban/Rural Classification ....................
Sexuality ...................................................................................................
7
7
10
11
12
16
20
21
21
23
25
25
Social and Environmental Needs Assessment
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
2.14
2.15
2.16
2.17
2.18
2.19
2.20
2.21
2.22
2.23
2.24
RMBC Strategic Housing Role ..................................................................
Council Housing Stock ..............................................................................
Private Sector ...........................................................................................
Housing Tenure ........................................................................................
Ethnicity ....................................................................................................
Overcrowding ............................................................................................
Living Alone ..............................................................................................
Summary of Housing Demand in Rotherham ............................................
Condition of Stock .....................................................................................
Affordable Warmth and Fuel Poverty ........................................................
Energy .......................................................................................................
Empty Properties ......................................................................................
Affordability ...............................................................................................
Household Income ....................................................................................
Central Heating .........................................................................................
Access to Car or Van ................................................................................
Overall Employment Rate .........................................................................
Working Age People on Out-of-Work Benefits (NI 152) ............................
Number on Out-of-Work Benefits in Worst Performing Areas (NI153) ......
Contact with Mental Health Services whilst Employed (NI 150) ................
Unemployment Rate .................................................................................
Claimant Count .........................................................................................
Recent National Economic Down-Turn .....................................................
Average Incomes ......................................................................................
26
26
27
27
28
29
30
31
33
34
36
37
38
40
42
43
44
46
47
47
48
49
49
50
-32.25
2.26
3.
Smoking ....................................................................................................
Eating Habits .............................................................................................
Alcohol ......................................................................................................
Physical Activity ........................................................................................
Obesity ......................................................................................................
General profile of burden of ill health ........................................................
Diabetes ....................................................................................................
Circulatory Diseases .................................................................................
Cancer ......................................................................................................
Chronic Obstructive Pulmonary Disease (COPD) .....................................
Infectious Diseases ...................................................................................
Trauma ......................................................................................................
Musculoskeletal ........................................................................................
70
84
88
97
108
109
114
115
Mental Health Needs Assessment
5.1
Introduction ...............................................................................................
5.2
National Picture .........................................................................................
5.3
Local Picture .............................................................................................
5.4
Differences in the Extent of Mental Health Problems ................................
5.5
Local Services ...........................................................................................
5.6
Financial Costs - National Level ................................................................
5.7
Financial Costs - Local Level ....................................................................
5 .8
User Involvement ......................................................................................
5 .9
Emerging Patterns ....................................................................................
Appendix 1 – Indices of Multiple Deprivation .......................................................
6.
54
56
57
63
66
Burden of Ill Health
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
5.
51
53
Lifestyle and Risk Factors
3.1
3.2
3.3
3.4
3.5
4.
Access to Services ....................................................................................
Satisfaction of People Over 65 with Home and Neighbourhood (NI 138) ..
118
119
120
131
141
147
147
151
152
153
Learning Disability Needs Assessment
6 .1
6.2
6 .3
6.4
6.5
6.6
6.7
6 .8
6.9
6.10
6.11
Numbers of People with a Learning Disability ...........................................
Expenditure for Learning Disabilities in Rotherham for 2009/10 ...............
Local Analysis ...........................................................................................
BME Population – National Analysis .........................................................
BME Population – Rotherham in 2010 ......................................................
Life Expectancy of People with Learning Disabilities ................................
Health of People with Learning Disabilities in Rotherham .........................
Employment ..............................................................................................
Housing .....................................................................................................
Residential and Nursing Care in Rotherham .............................................
Community Based Services for People with Learning Disabilities ............
154
155
156
160
160
161
161
164
165
166
167
-46.12
7.
169
169
170
174
177
178
180
183
Early Access for Women to Maternity Services (NI 126) ...........................
Number of People Accessing NHS Dentistry ............................................
Uptake Rates for Seasonal Flu Jab ..........................................................
Screening for Breast Cancer .....................................................................
Access to GUM services ...........................................................................
Long Acting Reversible Contraception Methods .......................................
Access to NHS Funded Abortions before 10 weeks‟ Gestation ................
187
187
189
191
193
193
194
User Perspective on Social and Health Care
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
9.9
9.10
9.11
9.12
10.
National Profile of Need for Social Care ....................................................
Promoting Independence and Developing Community Support ................
Rotherham Profile of Need for Adult Social Care ......................................
Informal Care Needs Analysis ...................................................................
Home Care Services .................................................................................
Residential Care .......................................................................................
Intermediate Care .....................................................................................
Analysis of Community-Based Provision ...................................................
Access To Health Services
8.1
8.2
8.3
8.4
8.5
8.6
8.7
9.
168
Social Care Needs Assessment
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
8.
Carers .......................................................................................................
Support Older People Receive in order to Live Independently at Home ...
Respect and Dignity in their Treatment (NI128) ........................................
User Perspective on Social and Health Care –
Neighbourhoods and Adult Services (NAS) Research .............................
Patient Survey Programme Findings for Local Institutions
Patient Survey of Local Community Mental Health Services .....................
Patient Survey of Local Community Health Services .................................
Patient Survey of Local In-Patient Services – RFT ....................................
Patient Survey on Access to Primary Care ................................................
Patient Survey on Choice to Primary Care .................................................
Black Minority Ethnic (BME) Mental Health Consultation Event .................
Consultation with Focus Groups and Individual Interviews ........................
Consultation at Fair‟s Fayre ......................................................................
198
198
198
207
208
209
210
211
213
213
213
219
Children and Young People’s Needs Assessment
10.1
10.2
10.3
10.4
10.5
10.6
General Health ..........................................................................................
Proportion of Children in Poverty ..............................................................
Prevalence of Breast Feeding at 6 to 8 Weeks from Birth .........................
Teenage Pregnancy (Under 18 and Under 16 Conception rates) .............
Obesity among Primary School Age Children in Reception Year and
Year 6 ........................................................................................................
Infant Mortality ..........................................................................................
221
222
223
225
227
229
-510.7
10.8
10.9
10.10
Uptake of Chlamydia Screening in Under 25s ..........................................
Percentage DMFT in 5 Year Olds .............................................................
Children Killed or Seriously Injured on Roads (persons under 16 years) ..
Proportion of Children who Complete Immunisation by Recommended
Ages ..........................................................................................................
10.11 Parental Experience of Services for Disabled Children .............................
11.
229
229
230
233
234
Area Assembly Needs Profile
11.1
11.2
11.3
11.4
11.5
11.6
11.7
Rother Valley South ..................................................................................
Rother Valley West ...................................................................................
Rotherham North ......................................................................................
Rotherham South ......................................................................................
Wentworth North .......................................................................................
Wentworth South ......................................................................................
Wentworth Valley ......................................................................................
244
247
249
251
254
256
258
Glossary ........................................................................................................................
261
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What is a Joint Strategic Needs Assessment (JSNA)?
The Joint Strategic Needs Assessment (JSNA) establishes the current and future health and social care needs of a population, leading to improved outcomes and reductions in health inequalities. The JSNA informs the priorities and targets set by Local Area
Agreements, leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities throughout the Borough.
The JSNA marks the beginning of a process which will inform service reconfiguration, commissioning and decommissioning of services. The JSNA will evolve over the coming months and years as the demographic and health profile of the population changes. Information gathered in the Joint Strategic Needs Assessment will be used to create a needs profile for Rotherham. It will be used to target resources at those in most need.
Why do we need a JSNA?
Since 1 April, 2008, Local Authorities and Primary Care Trusts are under a statutory duty under the Local Government and Public Involvement in Health Act to produce a
Joint Strategic Needs Assessment (JSNA).
The Operating Framework for the NHS in England 2008/2009 refers to the importance of the JSNA in informing PCT Operational Plans. The JSNA underpins a number of the
World Class Commissioning competencies.
The JSNA forms the basis of the new duty to co-operate. This partnership duty involves a range of statutory and non-statutory partners, informing commissioning and the development of appropriate, sustainable and effective services.
Joint Strategic Needs Assessment Core Dataset
This document fully complies with the Department of Health’s JSNA Core Dataset, published on 1st August, 2008. It focuses on health and social care needs, breaking these down to Area Assembly level so a good understanding of these needs can be established for joint commissioning purposes.
-7-
1.
Demographic Profile
1.1
Population Numbers
Rotherham is one of four metropolitan boroughs in South Yorkshire, covering an area of 118 square miles with a population of 253,900 (2009). The population of Rotherham has been rising by 1.0% (2,600) since 2004 and 1.8%
(4,500) since 2002.
Population projections suggest that the population of Rotherham will increase by 5.1% to 266,900 by 2020 and by 9.8% to 278,900 by 2030. The projected increase is the result of rising life expectancy, natural increase (more births than deaths) and migration into the Borough.
The Borough is divided into 21 wards, grouped into 7 Area Assemblies as follows: Rother Valley South – Dinnington, Anston & Woodsetts and Wales
Rother Valley West – Brinsworth & Catcliffe, Holderness and Rother Vale
Rotherham North – Rotherham West, Keppel and Wingfield
Rotherham South – Boston Castle, Rotherham East and Sitwell
Wentworth North – W ath, Swinton and Hoober
Wentworth South – Rawmarsh, Silverwood and Valley
Wentworth Valley. – Wickersley, Hellaby and Maltby
About half of the population lives in and around the main urban area of
Rotherham town. The remainder lives in satellite towns such as Wath,
Dinnington and Maltby and in rural areas1.
Rotherham comprises a diverse and vibrant blend of people, cultures and communities. It is made up of a mix of urban areas and rura l villages, interspersed with large areas of open countryside. About 70% of the Borough area is rural, but it is well connected to all areas of the country by its proximity to the motorway network and intercity rail networks. Rotherham‟s traditional steel and coal industries have largely given way to new industries in an economy which grew rapidly in the 1995 – 2005 period.
1.2
Age Profile
There are approximately 197,500 adults currently living in Rotherham (2009).
57,800 people are aged 60 and over (22.8%), 102,800 are aged 30 to 59 years
(40.5%) and 37,000 are aged 18 to 29 years (14.6%). In addition, there are
56,400 (22.1%) children aged 0 to 17 years.
The age profile of the Borough population is shown in Figure 1.1.
Rotherham has more people aged over 50 (1 in 3 people) than people under 16
(1 in 5 people). Rotherham has 90,200 people aged 50 or over which equates to 35.5% of the total population and this proportion is rising.
1
RMBC 2007 Area Assembly Profiles (www.rotherham.gov.uk)
-8Distribution of Older People
Figure 1.1: Age Profile of Rotherham
Rotherham
60 and over
22.8%
30 to 59
40.5%
18 to 29
14.6%
5 to 17
0 to 4
0.0%
16.1%
6.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Rotherham
Source: Mid Year Estimates 2009
The most significant demographic change occurring in Rotherham is the growth in the number of older people which is shown in Figure1.2. The number of people over 65 will increase by more than a half by 2028, from 4 1,500 to
61,400. The number of people over 85 will almost double (+96%) from 5,000 to
9,800 by 2028. Although people will tend to remain healthy for longer than they do now, the rising numbers of older people will have major implications for health and adult social care services, informal care and all services used by older people.
Figure 1.2: Projected Growth in the over 65 population from 2008 to 2028
18,000
16,000
2008
2028
Population
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
65 to 69
Source: 2008 Population Projections
70 to 74
75 to 79
80 to 84
85 and over
-9Figure 1.3: Projected Growth in over 65 population from 2008 to 2028
Population aged 65+
65
60
Thousands
55
50
45
40
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
35
Source: 2008 Population Projections
The number of people aged 65+ is projected to increase at a steady rate over the next twenty years. The number is projected to increase by 48% from
41,500 to 61,400.
Figure 1.4: Projected Growth in over 85 population from 2008 to 2028
Population aged 85+
10.0
9.0
Thousands
8.0
7.0
6.0
5.0
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
4.0
Source: 2008 Population Projections
The steady increase in the 65+ population hides a much faster rise in the population aged 85+ which is projected to increase by 96% between 2008 and
2028. The rate of increase is projected to rise after 2014, peaking between
2020 and 2025 when there will be 29% growth over 5 years.
- 10 1.3
Gender Profile
In Rotherham, there are 129,400 (51%) females and 124,400 (49%) males, which is very similar to the national average. The age and gender distribution of Rotherham‟s population is similar to the national profile, although Rotherham has a slightly lower proportion of young adults (20-34). Figure 1.3 shows the age and gender structure of Rotherham compared to England and Wales in
2009.
Office of National Statistics data illustrates that up to the age of 72 years the number of males and females are fairly equal. From the age of 73 years the proportion of females to males increases significantly2. 2.9% of the female population are over 85 years compared to 1.4% for men. There are 3.7 women for every man aged over 90 years. The rising population imbalance between males and females as old age progresses results from women‟s higher life expectancy. 62% of the entire population are of working age, of these 51.1% are under 40 years of age.
Figure 1.5 also shows a relatively low proportion of people aged 30-34 years which reflects the low birth rates from the mid to late 1970s. Likewise, the high proportion aged 40-45 reflects high birth rates in the early 1960s.
Figure 1.5: Age and gender profile
Broken down by percentage of male/female population
Rotherham
9.0%
8.0%
7.0%
6.0%
5.0%
Males
4.0%
Females
3.0%
2.0%
1.0%
0.0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 to to to to to to to to to to to to to to to to to to +
4 9 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89
Age Group
Source: Mid Year Estimates 2009
2
Office of National Statistics 2009 Live Births
- 11 England and Wales
9.0%
8.0%
7.0%
6.0%
5.0%
Males
4.0%
Females
3.0%
2.0%
1.0%
0.0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 to to to to to to to to to to to to to to to to to to +
4 9 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89
Age Group
Source: Mid Year Estimates 2009
1.4
Birth Rate
The birth rate in Rotherham has been steadily increasing since 2002
(Figure 1.6). Live births decreased from over 3,700 in 1991 to 2,730 in 2001.
Since then the numbers of births has increased each year to 3,300 in 2008 before dropping slightly in 2009 to 3,200. There has been an average increase of about 60 live births each year over the last eight years. This increase in birth rate reflects similar increases nationally.
Figure 1.6: Number of Births in Rotherham between 1959 to 2009
Source: Office of National Statistics 2998, Live Births
The Total Fertility Rate (TFR) for 2009 shows an average of 1.96 children per woman in England and Wales. This represents a small decrease in fertility from 1.97 children in 2008. This is the first annual decrease since 2001 when the TFR fell to 1.63 from 1.65 in 2000. The TFR for 2009 is still comparably high. In 2008 the TFR was at its highest point in 35 years. The provisional
- 12 General Fertility Rate (GFR) for 2009 was 63.7 live births per 1,000 women aged 15-44, a decrease compared with 63.8 in 2008.
In 2009, there were decreases in fertility rates for women aged under 30 and increases for women aged 35 and over, compared with 2008; fertility rates for women aged 30–34 remained unchanged. The largest percentage decrease
(2.7 per cent) occurred among women aged under 20. For this age group the fertility rate fell from 26 live births per thousand women aged under 20 in 2008 to 25.3 in 2009. The standardised average (mean) age of women giving birth increased slightly to 29.4 in 2009 from 29.3 in 2008. The figure for 2009 is the highest on record. The sex ratio at birth for 2007 was 1,052 live males per
1,000 live females born.
There was a continued rise in the proportion of births to mothers born outside the UK: 24.7 per cent in 2009 compared with 24.1 per cent in 2008. In 1999,
14.3 per cent of births were to non-UK born mothers.
1.5
Black and Minority Ethnic (BME) Population Profile
Rotherham‟s Black and Minority Ethnic (BME) population is relatively small but has been growing and becoming increasingly diverse. Rotherham MBC estimates that there are 19,000 people from BME communities in 2009 which equates to 7.5% of the local population (5.6% are non-white), with 92.5% from the White British population3. By comparison in 2001, 4.1% of the population were from BME communities, suggesting that the number of BME residents has almost doubled over the last eight years.
BME residents are fairly evenly divided between those born in the UK and those born abroad, the latter being more likely to have limited English language skills. Figure 1.7: Projected BME Population Growth in Rotherham between
2005 and 2030
Source: BME Health Needs Assessment 2008, Black a nd Minority Ethnic Populations in Rotherham
(page 12)
In 2006, Yorkshire Futures produced population projections by ethnic group.
Figure 1.7 illustrates the projection for Rotherham which suggests a 61% increase in the non-White population between 2005 and 2030. Of the total of
3
Rotherham MBC Population Estimates by Ethic Group 2009
- 13 17,600 non-white residents projected for 2030, about 11,400 would be Asians.
However, the fact that Rotherham‟s BME population more than doubled in the
13 year period 1991-2004, and that non-white residents already number about
14,000 suggests that this projection may underestimate the likely rate of growth. Immigration and natural increase means that Rotherham‟s black and minority ethnic population has continued to grow in recent years, reaching 19,000 people. The white minority population (mainly European) was estimated to have a population of about 3,000 in 2004, rising to 4,000 in 2006 and an estimated at 5,000 in 2009. Most minority ethnic groups have young populations, notably the Kashmiri and Pakistani. There is a growing mixed or dual heritage population, the majority of who are children and young people.
The Irish community is an exception, being much older than average.
Figure 1.8: BME Population Breakdown in Rotherham – Mid-Year
Estimates 2009
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
The largest BME community is that from Pakistan and Kashmir which constitutes 3.0% of the overall population, higher than the average of 1.5% in
England and Wales. The Kashmiri and Pakistani community is well established in Rotherham following initial migration in the 1960s and 1970s. There are also much smaller established communities such as Chinese, Indian and Irish. The fastest growing population is the Black African community and other new communities, including migrant workers from Eastern Europe, have also settled in Rotherham which now has a Roma community of around 2,000 people.
- 14 Figure 1.9: Number of People in each Ethnic Group in Rotherham in 2009
Ethnic Group
White British
White Irish
White Other
White and Black Caribbean
White and Black African
White and Asian
Other Mixed
Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Black Other
Chinese
Other Ethnic
No. of People
234,900
1,100
3,900
400
100
700
400
700
7,600
100
700
200
1,500
200
600
800
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
Figure 1.9 shows the breakdown of the numbers of people from each BME community who are living in Rotherham. The largest number of people who are from minority ethnic groups are those from the Pakistani (and Kashmiri) community (7,600) which equates to 40% of the BME population in Rotherham.
3,900 people (20.5%) are from the White Other ethnic group which includes EU migrant workers from other European countries such as Poland and Slovakia.
Further migration from European countries may result in continued growth in the years ahead.
Figure 1.10: Gender by Ethnic Origin of all Ethnic Groups in Rotherham in
2008
Source: BME Health Needs Assessment 2008, Black and Minority Ethnic Populations in Rotherham, p13
Figure 1.10 provides a gender breakdown across all BME communities. It shows that white minority ethnic communities, Indian and Black groups have a larger number of men in contrast to women.
People from Pakistani/Kashmiri origin have a similar gender balance to the
White British population, whilst the Chinese community has a higher proportion of women. The higher proportion of men amongst certain BME groups in
- 15 Rotherham is likely to reflect economic migration with men moving to
Rotherham to find employment. This trend is more significant amongst more recent migrant groups where two thirds are often male.
Figure 1.11: Population Structure of Different Ethnic Groups in
Rotherham 2009
Ethnic Group
Total
Number
1,600
7,600
800
600
800
234,900
700
1,900
3,900
1,100
253,900
Mixed
Pakistani
Other Asian
Chinese
Other
W hite British
Indian
Black
W hite Other
W hite Irish
All People
%
Population
aged 0-15
0.39%
1.18%
0.08%
0.04%
0.12%
16.86%
0.04%
0.16%
0.47%
0.04%
19.38%
%
Population
aged 16+
0.28%
1.81%
0.24%
0.20%
0.20%
75.62%
0.24%
0.59%
1.06%
0.39%
80.62%
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
Figure 1.11 provides an insight into the children to adults for each of
Rotherham‟s BME population. Some BME communities have a significantly younger age profile than the general population of the Borough. The percentage of the Pakistani community under 15 years (1.18%) is around 60% of the adult population total and the Mixed community have more children than adults. This reflects a significantly higher birth rate for the Pakistani and Mixed ethnic groups. There is a big difference in the White British community where the adults outnumber the 0-15 population by approximately 5 to 1.
In contrast, the Mixed and Pakistani ethnic groups have a much smaller proportion of their population aged 65 and over (less than one seventh of the general population). The largest non-White British community is Pakistani with an estimated 550 elders (55 years of age+)4. BME communities have a younger age profile compared to the general population. The child population of Rotherham is far more ethnically diverse than that of the older population.
Figure 1.12: Percentage of BME pupils in each Area Assembly in Rotherham
60.0%
BME Pupils
50.0%
40.0%
30.0%
20.0%
10.0%
W es ot t he rh am
N
or
R
th ot he rh am
So
ut
W
h en tw or th
N
or
W
th en tw or th
So
W ut h en tw or th
Va
ll e y R
ot he rV
R
R
ot he rh
Va
lle y al le y
So
ut h 0.0%
Source: PLASC Data 2010
4
Rotherham State of the Borough 2008 A Statistical Portrait, p14
- 16 Figure 1.12 provides a breakdown of the BME pupils by Area Assembly in
2010. This shows that 52% of BME pupils live in Rotherham South. The distribution of pupils shows a similar pattern to the distribution of BME residents in the 2001 Census, 4,809 of who lived in the Rotherham South, 48% of the
Borough‟s BME population. Only three wards – Rotherham East, Rotherham
West and Boston Castle – had significant minority ethnic populations in 2001, with 61% of Rotherham‟s non-white population and 77% of the Pakistani and
Kashmiri population. Data on pupil ethnicity shows that increasing numbers of
BME families live in Sitwell ward. Rotherham North had the second largest
BME population with 1,746 people (17%) in 2001. In comparison, there were
562 people (6%) living in Wentworth North which had the smallest BME population5. Within Rotherham South, BME communities are particularly concentrated in
Eastwood, Ferham, Masbrough, Wellgate and Broom Valle y which are mainly deprived areas close to the town centre. These are the original settlement areas for the Kashmiri and Pakistani community. Since 2001, there has been some movement of Pakistani and Kashmiri families to suburban areas in
Broom.
1.6
Disability Profile
Sensory Impairment – Blind/Partially Sighted
In 2008 there were 152,980 people in England and Wales registered blind.
This is a slight increase of 525 people (0.3%) from March 2006. There were
10,300 new registrations in 2008, a fall of 5% compared to 20066. There were approximately 156,285 people in England registered as partially sighted, an increase of 1,085 people since 2006. There were approximately 13,200 new registrations in 2008, a fall of 8% compared to 20067.
The leading cause of certifications for blindness is degeneration of the macula and posterior pole (57.2%) which largely comprises Age-related Muscular
Degeneration (AMD). This is the leading cause of blindness amongst older people, in particular for the age group 75 years and over. Other common causes of certification are glaucoma (10.9%), diabetic retinopathy (5.9%), optic atrophy (3.1%), hereditary retinal disorders (2.8%) and cerebrovascular disease/accidents (2.5%)8. Common causes of certification among partially sighted people are: degeneration of the macula and posterior pole (56%), glaucoma (10.2%), diabetic retinopathy (7.4%), cerebrovascular disease
(4.9%), hereditary retinal disorders (2%), optic atrophy (1.9%), myopia (1.9%) and retinal vascular occlusions (2%)8.
Figure 1.13 provides a national breakdown by age of the number of people on the blind and partially blind registers.
5
Census 2001 BME Population
National Statistics 2006 Registered Blind and Partially Sighted, p(i)
7
National Statistics 2008 Council Tables – Blind and Partially Sighted, pPS1
8
Public Medical Health 2009 Research and Development, Leading Causes of Blindness
6
- 17 Figure 1.13: % of People on Blind or Partially Sighted (P/S) Register by
Age Group in England 1994-2008
Category
1994
1997
2000
2003
2006
2008
0-4
Blind P/S
0
1
1
1
0
0
0
0
0
0
1
0
5-17
Blind P/S
2
2
2
2
2
2
2
3
2
3
3
3
18-49
Blind P/S
10
10
10
10
10
9
11
10
12
10
13
11
50-64
Blind P/S
8
8
8
8
8
8
9
8
10
9
10
9
65-74
Blind P/S
11
12
10
12
10
11
10
11
10
10
10
10
75 and
Over
Blind P/S
68
68
69
68
69
69
67
68
66
68
64
68
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, p6
Nationally the proportion of young people registered blind is increasing, in particular in the 18-49 age range. The number of blind people aged 75 and over is falling, with a 5% reduction in the last ten years from 69% to 64%.
However, the local picture is different to the national one. In Rotherham there were 860 people on the blind register in 2008, a reduction of 325 people since
2006. This reduction may be due to recent data cleansing of the local register.
There are a total of 1,365 people who are on the partially sighted register, a decrease of 95 people since 20069. Information for this register is obtained by the completion of SSDA902 returns by all Councils with Adult Social Services
Responsibilities (CASSRs) on an annual basis to capture the number of people who are blind or partially sighted under Section 29 of the National Assistance
Act, 1948.
Figure 1.14: Number of people registered blind/partially sighted by age group in Rotherham in 2008
Blind
Partially Sighted
3%
4%
13%
11%
0-18 years
10%
11%
18-49 years
50-64 years
65-74 years
63%
10%
64%
11%
75 and over
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, pB1
Figure 1.14 provides an age profile of those who are registered blind or partially sighted in Rotherham. Approximately 63% of blind/partially sighted people in
Rotherham are over 75 years of age. There has been an increase in the number of people registered blind in the 65 to 74 age group.
There has also been a reduction in the number of people registered blind between 18 and 49 years and 75 and over. In 2008 there were 95 new registrations for blind people compared to 85 new registrations in 2006. Of these 16% were between 50 and 64 years, 11% between 65 and 74 years and
63% who are 75 years and over. There has been a larger increase in the number of new registrations by people between 50 and 64 years10.
9
National Statistics (2007), Deaf and Hard of Hearing, pPS1
National Statistics 2007, Deaf and Hard of Hearing, pB2
10
- 18 Figure 1.15 shows the predicted future prevalence rates of people with a serious visual impairment who will require help with daily activities. These prevalence rates have been derived from ONS population projections.
Figure 1.15: No. of people projected to have a serious visual impairment and requiring help with daily living in Rotherham. 2010-2030
25
20
18 - 2 4 ye a rs
15
2 5 - 3 4 ye a rs
10
3 5 - 4 4 ye a rs
4 5 - 5 4 ye a rs
5
0
2010
2015
2020
2025
2030
Source: PANSI 2008, People predicted to have a serious visual impairment projected to 2025
Projecting Adult Needs and Service Information System (PANSI) predicts that there are 102 people with a serious visual impairment in Rotherham who require help with daily activities. It is predicted that this will slowly increase over the next 17 years, in particular in the age groups 55 -64 age group.
Deaf or Hard of Hearing
There are approximately 9 million people who are deaf or hard of hearing in
England. Around 688,000 people are severely or profoundly deaf 11. More than
50% of people over the age of 60 years have some degree of hearing loss, but only one in three older people has an hearing aid12. The commonest cause of hearing loss is ageing and three quarters of people who are deaf are aged over
60. More men become hard of hearing than women. Among people over the age of 80 years there are more women than men who are deaf or hard of hearing. This is mainly attributable to the larger population of women in this age range.
Common causes of deafness in adults and older people include; presbyacusis
(age-related hearing loss known as senile deafness), side-effects of medication, acoustic neuroma and Meniere's disease. Com mon causes of deafness in children include inherited conditions, infection during pregnancy, meningitis, head injury and glue ear.
In 2007 there were 54,500 people in England on the register of deaf people.
Between March 2004 and March 2007 the number of people on the register has remained constant13. However, during this same period the number of deaf people on the age profile of those on the register has changed significantly14. There are approximately 164,600 people in England on the register of hard of hearing. This is an increase of around 5,600 (4%) since
March 2004 and an increase of 73% since March 1992. The large increase from 1992 could be partially attributed to improved systems of information capture or a failure to remove old registrations15.
11
RNID 2008, www.rnid.org.uk
Public Medical Health 2008, Research and Development, Leading Causes of Blindness
National Statistics 2007, Deaf and Hard of Hearing, p(iii)
14
Office of National Statistics 2004, Religion in Rotherham, p(iii)
15
National Statistics 2007, Deaf and Hard of Hearing, p3
12
13
- 19 Figure 1.16 provides a breakdown of the number registered as deaf and hard of hearing by age group.
Figure 1.16: Age profile of people registered as deaf or hard of hearing
(HofH) in England from 1992 to 2007
Category
Number of
People
1992
1995
1998
2001
2004
2007
% of People
1992
1995
1998
2001
2004
2007
All Ages
Deaf
H of H
Under 18
Deaf
H of H
18-64
Deaf
H of H
65-74
Deaf
H of H
75 or over
Deaf
H of H
41,800
45,500
50,100
50,300
55,000
54,500
95,300
125,900
139,500
144,600
158,900
164,600
3,800
4,400
4,200
4,000
4,100
3,400
2,100
3,500
2,800
2,900
3,000
4,100
24,200
26,000
27,100
27,200
29,200
28,700
16,000
21,900
25,100
25,400
29,800
30,500
4,900
5,000
5,800
6,400
8,300
6,400
18,400
23,800
22,300
24,700
24,400
23,100
8,900
10,100
13,000
12,600
13,400
16,000
58,800
76,700
89,300
91,300
101,700
106,900
100
100
100
100
100
100
100
100
100
100
100
100
9
10
8
8
7
6
2
3
2
2
2
2
58
57
54
54
53
53
17
17
18
18
19
19
12
11
12
13
15
12
19
19
16
17
15
14
21
22
26
25
24
29
62
61
64
63
64
65
Source: National Statistics 2007, Deaf and Hard of Hearing, p3
In 2007 more than half (52.6%) of those on the deaf register were working age adults (18-64 years). The highest incidence of hearing loss occurred in the older age groups, particularly those over 75 years16.
In Rotherham there are currently 280 people on the deaf register. 66% are in the age range 18 to 64 years, 13.4% above the national average. There are currently 15 children (5%) on the register17. The high number of younger people on the register suggests under-reporting in the older age groups.
There are a total of 980 people on the hard of hearing register. Almost two thirds (62%) are in the age groups 75 years and over18. This is just under the national average of 64.9%. Figure 1.16 provides a local age profile of those who are registered deaf or hard of hearing. Information for this register is obtained by the completion of SSDA910 returns by all Councils with Adult
Social Services Responsibilities (CASSRs) on an annual basis to capture the number of people who are deaf or hard of hearing under Section 29 of the
National Assistance Act, 1948.
Figure 1.17: Number of people registered deaf/hard of hearing by age group in Rotherham in 2008
Deaf
18%
Partially Sighted
2%
5%
19%
0-18 years
18-64 years
11%
65-74 years
62%
66%
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, pB1
16
National Statistics (2007), Deaf and Hard of Hearing, p5
Office of National Statistics 2004, Religion in Rotherham, p15
18
Office of National Statistics 2004, Religion in Rotherham, p20
17
17%
75 and over
- 20 In 2006 there were 79,900 people registered blind or partially sighted with an additional disability in England. 24% of those registered as blind and had a n additional disability were recorded as deaf or hard of hearing. 22% of those registered as partially sighted with an additional disability were recorded as deaf or hard of hearing19.
Figure 1.18 shows the number of people registered as blind or partially sighted with a hearing impairment in England.
Figure 1.18: People registered as blind or partially sighted with a hearing impairment in 2006
Category
Blind
Partially Sighted
Deaf with
Speech
1,800
1,100
Deaf without
Speech
400
300
Hard of Hearing
7,600
7,400
Source: National Statistics 2007, Deaf and Hard of Hearing, p 6
Carers
1.7
Population by Religious Group
The 2001 Census showed that 197,102 people (79.4%) of Rotherham‟s population described themselves as Christians. This is above the regional average of 73.1% and the national average of 71.7%, mainly because of the low proportion belonging to minority religions20.
In 2001, 2.6% of Rotherham‟s population belonged to minority religions compared to 6% nationally. 10.2% of the local population have no religion compared to 14.6% nationally. The largest minority religious group in
Rotherham in 2001 were Muslims with 2.2% of the population 20.
A local estimate of the religious profile of Rotherham carried out in 200921 suggested that 4.2% of the local population now hold minority religious beliefs.
There are estimated to be 9,300 (3.7%) Muslims, 400 Hindus (0.2%), 300 Sikh s
(0.1%), 200 Buddhists (0.1%), 40 Jews and 400 people (0.2%) who have other religious beliefs. There are estimated to be 25,700 people (10.2%) who have no religious beliefs20.
The influx of EU migrants, mainly from Poland and Slovakia, over recent years in Rotherham is likely to have impacted on the number of people from certain religious groups. For example, it is estimated that approximately 90% of Polish people are nominally Roman Catholic with over 50% attending church regularly. The rest of the Polish population (10%) are mainly Eastern
Orthodox, Protestants, Jehovah‟s Witness or have no religion21.
19
Office of National Statistics 2004, Religion in Rotherham, p6
Office of National Statistics 2004, Religion in Rotherham
21
Studies from Stays in Poland (2008)
20
- 21 1.8
Population by Migrant Status
The total number of NINo registrations to adult overseas nationals in 2008/09 was 686,000, a decrease of 47,000 (6.4%) on the previous year. This is the first annual percentage decrease in the period for which figures are available.
This overall fall in NINo registrations masks some significant variations by world area. Poland forms the largest nationality: 134,000 NINo registrations were made to Polish citizens in 2008/09 (a 36.2% decrease from the previous year).
163,000 NINos were registered to Asian and Middle Eastern nationals during
2008/09 - an increase of 8.8% on the previous year. Similarly registrations to
African nationals and those from the Americas rose by 6.2% and 11.7% respectively. Registrations from Australasia and Oceania fell by 11.5%. The average age is between 25 and 34 years22. The number of migrants entering
Rotherham in 2008-09 was 1,330 which is 0.5% of the overall population.
Since 2008, economic recession has meant that there are fewer migrants arriving in the UK. This trend has been particularly evident amongst EU migrants from the “A8” countries where a net inflow of 43,000 in 2007/08 turned into a net outflow 12,000 in 2008/0923.
According to the “Flag 4” Patient Registration Data System there were 567,500 people on the Patient Register Data System in England and Wales in 200624.
The “Flag 4” system identifies those migrants who have registered with a GP.
These figures suggest that there are 165,590 migrants (23%) who have not registered with their local GP. In Rotherham there were 1,220 people registered with a NINo registration which suggests that 18% of migrants in
Rotherham are not registered with a GP24.
1.9
Number of Households
For the purpose of the JSNA a household is defined as comprising one person living alone or a group of people living at the same address sharing a living room or at least one meal a day. In 2001 there were 102,288 households in
Rotherham11. By 2009 there were nearly 107,695 households, an increase of nearly 6,000 over the last eight years. The number of households had increased faster over the last few years, whereas the number of properties has decreased slightly from 2008 with old properties being demolished. 3.3% of properties in Rotherham are vacant and 19.4% of the properties are council owned25. Over two thirds of households in Rotherham have no children (68%), slightly below the national average. Lone parents with dependent children make up
6.8% of all households which is slightly above the national average of 6.5%.
Almost one in seven households consists of a pensioner living alone (14.4%) , equivalent to the national average26.
22
DWP NINo Registrations 2008-09
Migration New Communities Briefing, Spring 2010
„Flag 4‟ Mid Year Estimates 2006, Patient Register Data System
25
Rotherham Properties List 2009
26
Rotherham State of the Borough (2008), A Statistical Portrait
23
24
- 22 Figure 1.19 estimates the growth in the number of households in Rotherham by
2021.
Figure 1.19: Predicted Number of Households in Rotherham from 2008 to
2021
Source: Office of National Statistics 2006 Household Projections to 2029
It is predicted that the number of households is set to increase to 112,000 by
2011, 118,000 by 2016 and 122,000 by 2021. This is a total increase of 12,000 additional households over the next 13 years, an increas e of 11%.
One family households account for over 68% of all households in Rotherham compared to the average of 63% for England and Wales. The number of one family pensioner households (9%), one family couple (49%) and one family lone parent (10%) is also above average compared to England and Wales but the number of one person households is below average at 27%27.
The average household size in Rotherham was 2.57 people in 1991, 2.41 in 2001 and 2.31 people in 2006. This trend is likely to continue in future years to 2.25 by
2011, 2.19 by 2016 and 2.14 by 2021. The decrease in the number of people per household is partly attributable to an increase in one person households. This trend is reflected in national figures.
The composition of households is expected to change over the next 13 years.
There were 97,200 married couples in Rotherham in 2006. This is predicted to decrease to 95,200 by 2011, 94,400 by 2016 and 94,100 by 2021. This constitutes a 3.2% decrease in the number of married couples. There were
23,000 cohabiting couples in Rotherham in 2006. It is predicted that this will increase to 27,500 by 2011, 31,000 by 2016 and 33,600 by 2021. This constitutes a 35% increase in the next 13 years.
In 2006 there were 5,040,000 private households in the Yorkshire and Humber region. This is expected to rise to 5,172,000 by 2011, 5,308,000 by 2016 and by 5,442,000 by 2021. This is an additional 402,000 private households in the next 13 years, an increase of 8%.
27
Census 2004, Number of Households in Rotherham
- 23 1.10
Analysis of Areas of Deprivation
According to the Index of Multiple Deprivation (IMD 2007), Rotherham is currently 68th most deprived Borough out of 354 English districts. Rotherham‟s
IMD classification has improved from 63rd in 2004 to 68th in 2007. In 2000 the
IMD classification for Rotherham was 48th most deprived.
The two IMD domains that are most challenging in Rotherham are “Health and
Disability” and “Education, Training and Skills”. Although the overall trend is improving there has been no improvement in the 10% of areas suffering greatest levels of deprivation. 33% of Rotherham‟s population live in areas of deprivation. The key drivers of deprivation in Rotherham are: Employment (51st most deprived), Health and Disability (42nd most deprived) and Education and Skills
(30th most deprived). Rotherham has average or low levels of deprivation in other domains such as Living Environment (147th most deprived), barriers to
Housing and Services (285th most deprived) and Crime (136th most deprived).
Figure 1.20 shows how the IMD scores of the 166 super output areas (SOA) in
Rotherham compared nationally. In 2007 12% of Rotherham‟s population were living in the most deprived tenth of IMD in England. 32% were in the most deprived fifth. In contrast 11% of Rotherham‟s SOA areas are in the least deprived fifth28. Figure 1.18 also shows the overall improvement between 2004 and 2007. Fewer Rotherham SOAs were in the 10-60% decile in 2007 but the proportion in the most deprived tenth remained unchanged 28.
Figure 1.20: Percentage of Rotherham Residents Living in National Index of Multiple Deprivation Deciles (comparison between 2004 and 2007)
Source: Census 2004, Number of Households in Rotherham
28
Indices of Deprivation 2007
- 24 Figure 1.21 breaks down the Index of Multiple Deprivation into seven domains.
It shows the proportion of the Rotherham population that are in the most deprived areas of England. For example 28% of Rotherham‟s population live in the 10% most deprived areas in terms of employment and education. In order to achieve equity 10% of Rotherham‟s population should live in these areas.
Conversely 0% of the Rotherham population live in those areas where it is most difficult to access housing. The red shaded areas show where Rotherham is performing below average.
The two domains that are most challenging for Rotherham are “Health and
Disability” and “Education, Training and Skills”. Analysis of the distribution of the health component of IMD shows that 25% of the Rotherham population lives in the bottom 10% of English SOAs. 93% of the population live in the most deprived 50%28.
Figure 1.21: Distribution of Rotherham’s population by national IMD domains Education, Skills and Training
Health and Disability
Employment
Income
Crime
Living Environment
Barriers to Housing and Services
Most deprived 10%
28%
25%
17%
13%
3%
3%
0%
Most deprived 20%
43%
46%
38%
27%
14%
6%
1%
Most deprived 50%
78%
93%
74%
60%
52%
32%
9%
Source: Indices of Deprivation 2007
Although the IMDs for employment and income are still above average the IMD for employment has improved over the last two decades with only 17% of people living in the most deprived tenth of English SOAs. Improvements have been made in income levels as they are only 13% of people in the most deprived areas of Rotherham. Figure 1.21 shows the geographical distribution of aggregated IMDs across the Borough. A substantial proportion of areas with the highest IMD scores are in the town centre but there are also significant pockets of deprivation in surrounding towns such as Rawmarsh, Wath, Maltby and Dinnington. Two of the most deprived SOAs across Rotherham are in the
Herringthorpe and Boston wards where 50% of the population live in areas of income deprivation. The areas with the lowest deprivation levels are Anston,
Woodsetts, Wales, Sitwell and Keppel.
- 25 Figure 1.22: Indices of Multiple Deprivation 2007 in Rotherham
Source: Indices of Deprivation 2007
1.11
Social Marketing Categories and Urban/Rural Classification
The 2001 ONS Classification and social marketing categories are used to group together geographic areas according to key characteristics common to the population in that grouping. Both the Social Marketing and Urban/Rural sections of the DH Core Dataset will be covered in more detail in Chapters 2 and 11 respectively. Around 70% of the Borough is classed as rural in nature.
The majority of Rotherham‟s residents live in urban areas, around 50% in the
Rotherham Town Centre area and 38% in smaller towns such as Wath, Maltby and Dinnington. Rural areas in the South of the Borough contain 12% of the population. Half of the land use in the Borough is for agriculture.
1.12
Sexuality
There are no local statistics on the number of people in Rotherham wh o are
Lesbian, Gay, Bisexual or Transgender (LBGT). Government estimates based on reliable survey evidence suggest that 6% of the UK population are LGBT which would equate to 15,200 people in Rotherham or 11,800 adults. The
Transgender population is estimated at 0.8% nationally which would translate into 2,000 people or 1,600 adults in Rotherham.
- 26 -
2.
Social and Environmental Needs Assessment
2.1
RMBC Strategic Housing Role
The Council‟s strategic housing role is central to delivering “sustainable communities and successful neighbourhoods where the quality and choice of housing underpins a buoyant economy and an improved quality of life". The role of the local authority in delivering strategic housing services was strengthened through the national regulatory and policy framework and looks set to continue via the emphasis on localism albeit with severely restrained resourcing and an increasing emphasis on making the most of existing opportunities and assets.
Rotherham Metropolitan Borough Council (RMBC) transferred responsibility for the delivery of housing management services to an arms length management organisation (ALMO) in 2005, which has allowed the Council to focus on its retained housing functions and its strategic place-shaping agenda. This transfer is currently under review.
As strategic landlord the Council has a key role in ensuring housing is provided to households with specific needs. In particular:
BME population
Gypsies and travellers
Vulnerable adults with a physical and/or sensory impairment, mental health problems or learning disabilities
Extra care accommodation
Floating support and move-on accommodation for teenage parents
2.2
Council Housing Stock
The ALMO currently delivers the following services:
Decent Homes works including environmental improvements.
Repairs and maintenance services (delivered by the in-house service provider). Income collection, low-level antisocial behaviour, tenancy management, estate services and tenant involvement (provided by the neighbourhood management teams).
All homes will meet the Decent Homes Standard by December 2010 and environmental improvement works will be completed during 2011. The repairs and maintenance service is to be externalised in order to improve value for money. The Council will make a decision in late 2010 regarding the future of the remaining housing management functions (beyond the term of the cur rent
ALMO management agreement) and what model of service delivery will best serve the aspirations of the tenants and leaseholders of Rotherham. An improvement plan has been established that clearly sets out the Council‟s expectations of the ALMO and of any future housing management service provider, which are to:
Address tenants‟ and leaseholders‟ priorities for improvement
Achieve the standards expected of top-performing organisations
- 27 Make a unique contribution to Rotherham‟s priorities
Ensure all services are well-governed and well-managed
Ensure strong financial management processes are in place
Deliver value for money, making excellent use of resources
The ALMO has implemented the new Tenant Services Authority National
Standards and will have developed the local offer, in consultation with tenants, by October 2010.
2.3
Private Sector
Rotherham‟s Private Sector housing interventions are aligned to support the priorities of the Community Strategy and Housing Strategy and will increase choice in the housing market and address decency standards in the private sector. The energy efficiency profile of private rented dwellings is poor when compared with other private sector dwellings in Rotherham (although good when compared with the national position).
Around 67% of private rented stock would fail the Government‟s Decent
Homes standard due to excessive cold.
Almost half of the private rented stock would fail the Government‟s
Decent Homes standard due to levels of disrepair.
It is anticipated that with the Government priority to rebalancing the economy increasing emphasis will be placed upon private householders to utilise the equity in their property to manage adaptation and modernisation. There will also be an increasing role for the private sector in addressing demands previously considered the domain of Registered Providers, particularly low cost housing provision and addressing the needs of vulnerable groups on a commercial basis.
2.4
Housing Tenure
Rotherham has a population of around 253,900 people living in 111,822 households in 2010. Figure 2.1 illustrates that more than two thirds of people own their own homes in Rotherham and nearly a quarter of people socially rent from Local Authority and Housing Associations. Figure 2.1 shows a breakdown of household tenure in Rotherham.
Figure 2.1: Breakdown of Household Tenure in Rotherham
Owner-occupied (no mortgage)
3.30%
8.40%
31.30%
Owner-occupied (with mortgage)
18.60%
Council owned
Registered Provider
38.40%
Source: Census 2004, Mid Year Estimates – Household Tenure
Private rented
- 28 69.7% of the local population are owner occupiers in Rotherham which is slightly above the national average of 67.9%. The proportion of the local population renting from the Local Authority or a Housing Association in
Rotherham, which contributes toward the provision of affordable social housing, is 21.9%. This figure is higher than the national average of 17.8%.
2.5
Ethnicity
The 2001 Census indicates that the proportion of the population in a Black or
Minority Ethnic (BME) (non-White) group in Rotherham is quite low by national and regional standards at just 3.6%, compared to 7.7% in the region and 11.7% nationally. ONS have produced some estimates of the changes in population by ethnicity to 2007, although these are classed as experimental statistics and should be treated with caution. They suggest that the BME population of Rotherham increased substantially from 3.6% to 5.2% of the total population since the
Census. This amounts to an increase from 7,712 to 13,200 people (+71.2%) in
BME groups between 2001 and 2007. Although this increase is more than the regional and national level (51.2% and 34.7% respectively), the proportion of the population in BME groups remains below the regional and national average
(9.4% and 11.7% respectively).
Figure 2.2 presents the ethnicity of the population in the Metropolitan Borough according to the latest (2007) figures. The “Asian or Asian British” ethnic group represents the largest BME group in Rotherham (3.0% of total populatio n).
Figure 2.2: Ethnicity of the Rotherham Population, 2007
1%
White
Mixed
94%
6%
3%
Asian or Asian British
1%
Black or Black British
1%
Chinese or other Ethnic Group
Table 2.1, below, sets out the home ownership across the Ethnicity bands, which indicates that a large proportion of White British people (68.2%) are owner occupiers, the same as the local average for all ethnic groups. The number of White British people who socially rent is equivalent to the national average at 24%. The proportion of the local population renting from private landlords is 6.1%, marginally lower than the national average of 1 8%. A small minority of the population live in communal accommodation (0.9%) such as hostels, bed and breakfast or staffing accommodation.
- 29 Table 2.1: Household Tenure and Communal Establishments3p15
Source: Health Needs Assessment 2008, BME Populations in Rotherham, p15
Home ownership within the BME population varies according to ethnic origin.
Ownership ranges from 42.4% to 86.5%. BME groups are under-represented in the social rented sector but significantly over-represented in the private rented sector. People with mixed ethnicity are most likely to live in Council or
Housing Association rented housing.
Members of the Black community are the least likely to be owner occupiers and have the highest proportion living in communal establishments. The increased prevalence in communal establishments is mainly due to Black Africans living in staff hospital accommodation.
2.6
Overcrowding
The government published a report, “Impact of Overcrowding on Health and
Education”, which demonstrates that overcrowding is either associated with or a casual factor in:
Infant mortality.
Respiratory conditions in children (although housing conditions themselves have a larger effect) and through into adulthood.
Rates of serious infectious diseases such as meningitis and tuberculosis. Infections with Helibacter Pylori which have implications for growth and diseases of the digestive system.
Self-reported health status.
Female mortality rates.
Mental ill-health ranging from issues with self-esteem to psychiatric symptoms. It is important to note that many of these effects are long-lasting. Exposure to overcrowding in childhood can lead to poor health in adulthood, even when they no longer live in overcrowded accommodation.
- 30 Table 2.2 shows the number of overcrowded households in Rotherham. An overcrowded household is one where there are fewer habitable rooms than people. This can have some implications for health and well-being of the local population. Table 2.2: Households and Overcrowding in Rotherham
Ethnicity
All People
White British
White Irish
White Other
Mixed
Indian
Pakistani
Other Asian
Black
Chinese
Other
Households
102,273
99,086
608
612
229
191
1,057
118
182
89
101
Overcrowded – over one person per room
3,994
3,549
29
51
19
35
223
26
24
15
23
% Overcrowded
3.9%
3.6%
4.8%
8.3%
8.3%
18.3%
21.1%
22.0%
13.2%
16.9%
22.8%
Source: Health Needs Assessment 2008, BME Populations in Rotherham , p16
Generally, overcrowding is not a major issue for the local population, with 3.9% of households suffering overcrowding (3,997). Rotherham has lower overcrowding than both the regional average of 5.5% and national average of
7.1%.
Only 3.6% of the White British population live in overcrowded accommodation.
However, BME groups are more affected, with overcrowding ranging from
13.2% to 22.8% of the community‟s population. The proportion of BME households suffering overcrowding in the BME community is up to six times greater than the local average. There are 1 in 5 Pakistani/Kashmiri households who are overcrowded, compared to 1 in 25 for White British. More recent inward migrations of Eastern European Economic Migrants also experience high levels of overcrowding.
Whilst the Indian and Chinese communities tend to live in areas of low deprivation, many have high levels of overcrowding, of 18.3% and 16.9% respectively. 2 .7
Living Alone
Approximately one in seven local households consists of a pensioner living alone (14.4%). This equates to the regional and national average. Projecting
Older People Population Information System (POPPI) estimates that there were 14,670 people29 over 64 years who were living alone in Rotherham in
2008. This is 5.8% of the local population. The gender breakdown of older people living on their own is 39.6% males and 60.4% females.
29
POPPI 2008, Number of People over 65 years living alone
- 31 The Office of National Statistics estimates that there are 14,701 people living alone in Rotherham, 5.9% of the local population. This equates with POPPI estimates30. Figure 2.3: Number of people over 64 years living alone in Rotherham in
2008
12,000
10,000
8,000
Males Aged 65-74
6,000
Males Aged 75+
4,000
Females Aged 65-74
Females Aged 75+
2,000
0
2008
2010
2015
2020
2025
Source: POPPI 2008, Number of People over 65 years living alone
POPPI predicts that the number of people over 64 years living alone in
Rotherham is set to increase to 17,202 by 2015 and 21,234 by 2025. This is an anticipated increase of 17% in the next 7 years and 45% in the next 17 years. The most significant increase in population is males over 74 years. It is predicted that there will be an increase of 82% living alone by 2025 from 2,072 in 2008 to 3,808 in 2025. For females over 74 years it is predicted that there will be an increase of 48% by 2025 from 6,785 in 2008 to 10,030 in 2025. This significant increase in the population of older people living alone is due to a number of factors:
Reduced impact of mining and heavy industry
Increases in life expectancy particularly for men
The ageing baby boomer population from the 1950s and early 1960s
Intergenerational changes in family structure
People who are living alone tend to require more formal support from adult social care services, especially if their family or carers do not live in the local area and are unable to provide informal support. Therefore, the increasing number of people living alone is likely to have a significant impact on adult social care in the future.
2 .8
Summary of Housing Demand in Rotherham
Properties take an average 8.4 weeks to sell compared to the regional average of 11.2 weeks achieving. On average, 88.9% of their asking price co mpared to the regional average of 90.8%.
In 2008, there were 20,826 people on the Housing Register in Rotherham compared to 21,636 in 2002.
30
Office of National Statistics 2008, Household Composition (UV46)
- 32 The most common house type is semi-detached (see table 4), of which there are 51,946, representing 49% of all housing in the area.
The most common housing tenure is “owns mortgage with a loan” (see table 3) of which there are 39,588 representing 39% of all housing in the area.
Housing density is 4 dwellings per hectare31.
Rotherham Metropolitan Borough Council has a stock of 20,971 homes (as at
April 2009). They are managed and repaired by the arms length management organisation (ALMO), 2010 Rotherham Ltd.
There are currently 111,822 households in Rotherham, however statistical information related to tenure distribution is based on figures reported for April
2008 when there were 109,959 homes in Rotherham. The tenure distribution is set out in table 2.3.
Table 2.3: Tenure of Rotherham’s housing stock, April 2008
Dwelling stock by tenure, April 2008
Tenure
LA dwelling stock
RSL dwelling stock
Other public sector dwelling stock
Owner occupied and private rented dwelling stock
Total
Rotherham
Count
%
21,289 19.4
3,559
3.2
Yorkshire &
Humber
Count
%
242,854
10.7
178,000
7.8
England
Count
%
1,870,365 8.3
2,142,297 9.5
244
3,869
74,134
0.2
84,867 77.2
109,959 100
0.2
0.3
1,854,154 81.4 18,407,061 81.8
2,278,877 100.1 22,493,857 99.9
Source: Hometrack
Table 2.4: Size of homes in Rotherham
No of rooms
1 room
2 rooms
3 rooms
4 rooms
5 rooms
6 rooms
7 rooms
8 or more rooms Rotherham
Count %
336
0.3
974
1.0
7,183
7
19,954 19.5
34,972 34.2
25,261 24.7
7,936
7.8
Doncaster
Count %
378
0.3
1,221
1.0
6,974
5.9
20,311 17.1
41,880 35.3
30,107 25.4
9,679
8.2
Barnsley
Count %
291
0.3
889
1.0
5,607
6.1
22,260 24.2
33,234 36.1
19,218 20.9
5,974
6.5
Sheffield
Count
%
1,501
0.7
4,508
2.1
19,998 9.2
46,973 21.6
70,050 32.2
43,954 20.2
16,461 7.6
5,608
8,164
4,675
14,214
Source: Census 2001
31
Hometrack – February 2010
5.5
6.9
5.1
6.5
- 33 Table 2.5: Property types in Rotherham
Housing stock by property type Detached
Semi-detached
Terraced
Flats - purpose built block
Flats – conversion
Flats - commercial building
Mobile or temporary structure
In a shared dwelling
Rotherham
21,479
51,946
21,416
9,315
682
694
59
315
Doncaster
28,326
55,374
30,782
5,966
1,050
894
784
256
Barnsley
20,075
45,023
24,391
4,692
743
727
74
137
Sheffield
31,676
84,075
67,381
34,561
4,367
2,258
147
756
Source: Hometrack, February 2010
2 .9
Condition of Stock
The Private Sector Stock Condition Survey carried out in 2007 revealed that the average cost of repairs required were significantly higher in the private rented sector than the owner-occupier sector.
Table 2.6: Overall repair costs in Rotherham private sector
Repair category Urgent repair
Basic repair
Comprehensive
Repair
Standardised
repair cost (/m2)
Owner Occupied
Average
Total cost per cost dwelling
£77.2m
£1,011
£124.5m £1,631m
£331.7m £4,341
Private Rented
Average
Total cost per cost dwelling
£16.0m £2,031
£25.0m £3,177
£48.2m £6,125
£19.5
All private sector dwellings Average
Total
cost per cost dwelling
£93.2m
£1,106
£149.6m £1,775
£380.0m £4,510
£42.2
£21.6
Source: RMBC Private Sector Stock Condition Survey 2007
The Private Sector Stock Condition Survey revealed that the main reason for not attaining the Decent Home standard was thermal comfort. Groups with high levels of non-decency included; private rented, pre-1919 dwellings, converted flats and terraced houses. The households which showed high levels of non-decency included single pensioner, special needs and vulnerable households. Table 2.7: Non-decent homes and dwelling characteristics (2007data)
Dwelling
characteristic
Non decent Category
1 Hazard
Fail disrepair Owner occupied
(no mortgage)
Owner occupied
(with mortgage)
Private rented
2010 stock
21.7%
10.5%
4.1%
Fail
Fail
modernisation thermal comfort 5.9%
10.2%
15.6%
7.6%
3.2%
1.7%
7.0%
44.9%
64.9%
21.4%
4.6%*
14.2%
79.7%
12.3%
66.9%
28.2%
13.4%
*Statutory minimum standard
- 34 2010 Rotherham Ltd. manages 21,500 social homes on behalf of the Council and is now in the final year of Decent Homes investment delivery. By the end of March 2010 6.29% of the stock was non-decent and the programme will be completed by December 2010. 2010 Rotherham Ltd . are also working in partnership with RMBC to deliver a programme of environmental improvement works and the investment programme has secured the long term sustainability of Council housing by aligning with other major neighbourhood investments such as building schools for the future, Housing Market Renewal and Economic regeneration. During the financial year 2009/2010 Rotherham Metropolitan Borough Council‟s
Home Energy Advice Team has been able to improve the energy efficiency of council and privately owned housing stock through gaining access to over £3.5 million of funding from partners such as Warm Front and South Yorkshire
Housing and Regeneration Partnership. Initiatives include installation of central heating systems to over 700 homes, replacing boilers in 68 homes, loft insulation and cavity wall insulation to 3,198 homes.
2.10
Affordable Warmth and Fuel Poverty
Fuel poverty has a negative impact on a person‟s quality of life and health.
Cold and damp homes are linked with health problems such as asthma , bronchitis, influenza, heart disease, strokes and exacerbation of arthritis.
Periods of prolonged immobility can result, making it even more difficult for older people to keep warm. Research has shown that domestic accidents, including fatal accidents, are more common in cold homes in winter, resulting in costly hospital admissions and social care such as home care or residential care. Rotherham Metropolitan Borough Council is currently working with Sheffield
Hallam University, Chartered Institute of Marketing and Positive Sum Ltd. for a research project investigating the role of domestic renewable energy technologies in alleviating fuel poverty. The main aims of the project are to:
Determine the extent to which the retrofitting of renewable energy technologies into existing homes can help to alleviate fuel poverty.
Establish which renewable energy technologies offer the most cost effective means of alleviating fuel poverty.
Identify factors that influence the effectiveness of such projects to enabl e optimum design of future fuel poverty alleviating schemes.
2.10.1 Keeping warm at home in later life (KWILLT)
This is a study to develop social marketing interventions that promote engagement of older people in keeping warm behaviour and access to anti-fuel poverty services.
Contracting NHS Organisation: NHS Rotherham
Project Duration: 26 months
Funding body: National Institute for Health research - Research for
Patient Benefit
- 35 Summary Background
It is a public health priority to reduce the health b urden of individuals on the health service due to cold housing. Cold, damp housing and fuel poverty link to chronic health problems, excess winter deaths and impaired quality of life. 7.7% of Yorkshire and Humber households are fuel poor. This is due to an ageing population, barriers to accessing energy efficiency and increases in fuel costs. This translational study uses social marketing and lay epidemiology to explore the issue and develop interventions. Social marketing is an approach to promote healthy behaviour change (e.g. keeping warm) and overcome barriers to healthy behaviour e.g. tools to identify those at risk and increase access to services. Lay epidemiology (knowledge, beliefs and values) provides a theoretical framework.
Summary Aims
This qualitative study aims to
(i)
examine older person‟s lay epidemiology, this is the network of empirical beliefs, values and non-rational factors that influence their health-affecting choices regarding keeping warm at home
(ii)
develop a package of social marketing products PCTs can adopt to promote keeping warm at home in later life that is informed by the lay epidemiology identified. These are:
Brief intervention training materials for health and social care staff.
A risk assessment and referral tool.
The insight required for PCTs to commission a social marketing public campaign.
The study results and user informed outputs can be readily adopted by PCTs. Their impact on patients and NHS efficiency can be measured using routine audit and evaluation. This is currently work in progress and more details will be available in the next JSNA.
Scientific Summary Plan of Investigation
A qualitative study using in-depth semi-structured individual, group interviews, social marketing and framework analysis techniques. The study has three stages. Triangulation of methods adds to the rigor of the findings: (i)
Individual interviews and room temperature measurement with 50 older people and interviews with 25 health and social care professionals to explore the lay epidemiology of older people regarding keeping warm at home.
- 36 (ii)
(iii)
2.11
6 focus groups with older people and professionals to verify, challenge and expand upon findings from the individual interviews. A structured social marketing consultation of up to 50 key stakeholders to examine the findings and shape the study outputs including education materials, an assessment/referral tool and social marketing insight.
Energy
Rotherham Metropolitan Borough Council‟s Private Sector Stock Condition
Survey 2007 revealed the following information regarding energy efficiency and heating in private housing in Rotherham:
It is estimated that 83.2% of private sector dwellings in Rotherham have cavity walls, of which 38% have no cavity insulation (around 27,000 dwellings). This provides considerable scope for improving energy efficiency through the insulation of unfilled cavities.
It was found that dwellings in the private rented sector are noticeably less likely to have full double glazing rather than those in the owneroccupied sector.
79.5% of dwellings with insulation have 100mm or more of insulation whilst 12.6% were estimated to have over 200mm (2.1% do not have a loft). The main types of fuel used are gas (95.1%), solid fuel (2.3%), electric
(2.1%) and oil (0.5%).
The average SAP (Standard Assessment Procedure) rating for the private sector is 60. Older dwellings typically display lower SAP ratings.
Households living in dwellings with particularly low SAP ratings also appear to show quite distinct characteristics with single pensioner households showing the lowest average SAP rating.
8.4% (6,873) of private sector households in Rotherham were found to be in fuel poverty.
The long term impacts of climate change are unknown but several loca lised flooding incidents in recent years underline the seriousness of the issue and the potential for adverse impact on the Rotherham community in years to come. The Climate Change Act (November 2008) puts the UK in an international leadership role, setting the world‟s most ambitious national targets for emissions cuts: an 80% reduction in carbon dioxide and other greenhouse gas emissions by 2050 as compared with 1990.
The impact of climate change is likely to be greatest on the most disadvantaged measured in terms of the cost of heating and cooling poorly adapted homes.
The Government has set out its ambitious timetable for the progressive tightening of building regulations (Part L) in 2010 and 2013, with the aim of
- 37 achieving zero carbon emissions in all new homes by 2016. This will be supported by the Code for Sustainable Homes, the Planning Policy Statement on Climate Change and stamp duty relief for zero carbon homes.
Although new private sector development is to have Zero Carbon emissions by
2016, Central Government wants social housing to reach this by 2013 by way of demonstrating the technologies and contributing to developing economies of scale, thereby bringing down the current additional development cost of a Code
6 Zero Carbon home of ca. £34,000.
Emissions related to the existing housing stock present the greatest challenge.
Constructed in eras of cheap fuel, hence poor in energy efficiency, they are unsuited to a projected period of fuel scarcity. W e are reaching 3,000 private households per year, mainly promoting cavity and loft insulation. Our strategy directs priority to this issue.
Empty Properties
The number of empty properties across the district is recorded on an annual basis by the Housing Strategy Statistical Appendix (HSSA). A recent review of current statistics indicates that the empty homes picture for Rotherham is changing and that the mid year outturn for 2009/10 demonstrates that the number of empty properties in the Borough has reduced to 3,881 (3.53%) from
4,273 (3.88%). The figures include an amount of short term properties (less than 6 months) which are deemed vital to allow the housing market to function effectively and to facilitate both residential mobility and the improvement or redevelopment of the housing stock.
The table below identifies the wards where there has been high demand for housing based on Key Choices monitoring of Choice Based Letting requests and the wards where there are the highest numbers of empty properties and low demand.
Figure 2.4: Empty properties in Rotherham
Number of long-term (>6 months) empties compared with Borough average by Ward
500
450
400
350
300
250
200
150
100
50
Ward
Hsg Requests
>6 months
Borough average
W at h
Ra
wm ar sh
M
al tb y
Di
nn
Ro
ing th to er n ha m
W
Bo es sto t n
Ca
stl e y
Si
tw el l
Sw
in to n
W
in gf Br iel ins d wo
Va
rth lle An
An
y sto d
Ca
n
An
tc liff d e W oo ds et ts
He
lla by Ho ld er ne ss
W
al es Ro th er
Va
le
Ho
Ro ob th er er ha m
Ea
st
Si
lve rw oo d pp e Ke
er sle l
0
W ick No. of housing requests and long-term empty properties 2.12
- 38 Source: Empty Property Update Report, March 2010
As a result of direct council involvement 124 properties have been successfully returned back into use during 2008/09 - an increase of 45 properties compared to the number returned to use by the Council during 2007/08.
2.13
Affordability
Rotherham‟s Strategic Housing Market Assessment 2007 suggested a target for 411 affordable homes, mainly to be delivered by the private sector but with some delivered via social housing grant. In August 2008, the Council adopted a new Interim Planning Policy as a basis for negotiation but the collapse of the private house building market has rendered this practically obsolete.
As a result of the economic downturn the Borough has experienced increased unemployment, leading to reduced demand for open market housing and increasing the number of repossessions.
In turn, house builders have slowed supply and mothballed development. In response to the decline in supply of private housing the affordable housing target increased to 546 new homes in Rotherham by 201132.
Figure 2.5: Rotherham average property prices Feb 2008 – Nov 2009
Rotherham average property prices based on sales Feb 2008 to Nov 2009
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
ay
-0
8 n08 Ju l-0 8
Au
g08
Se
p08
O
ct
-0
8
N
ov
-0
8
D
ec
-0
8
Ja
n09
Fe
b09
M
ar
-0
9
Ap
r-0
9
M ay -0
9
Ju n09 Ju l-0 9
Au
g09
Se
p09
O
ct
-0
9
N
ov
-0
9
Ju
M
-0
8
r-0
8
ar
Ap
M
Fe b -0
8
0
Upper Quartile
Source: Land Registry, Hometrack
32
Rotherham Housing Strategy 2010 (draft)
Average
Lower Quartile
- 39 Figure 2.6: Average house prices by number of bedrooms
Average House Prices in South Yorkshire by Number of Bedrooms
£300,000.00
£250,000.00
£200,000.00
£150,000.00
£100,000.00
£50,000.00
£-
1 bed Prices
(Flat)
2 bed Prices
(Flat)
2 bed Prices
(House)
3 bed Prices
(House)
4 bed Prices
(House)
Rotherham (MD)
£64,778.00
£98,614.00
£98,702.00
£122,486.00
£213,191.00
Doncaster (MD)
£68,500.00
£86,313.00
£89,531.00
£113,039.00
£191,072.00
Barnsley (MD)
£71,500.00
£83,369.00
£92,563.00
£119,705.00
£208,608.00
Sheffield (MD)
£85,226.00
£117,235.00
£103,114.00
£136,598.00
£257,827.00
Source: Land Registry, Hometrack, February 2010
Table 2.8: Lowest 10 Average House Prices by SOA in 2008
LOCAL NAME
Herringthorpe North
Brinsworth North
Brecks East
Whiston South & Morthen
Anston Greenlands
Maltby West - Amory's Holt
Swinton South East
Aston South
Bramley West
Rawmarsh Victoria Park
Average
House
Price
(current)
£40,000
£46,700
£58,360
£58,500
£60,000
£62,600
£63,500
£64,800
£65,500
£65,600
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
1
14
50-150
2
22
40-150
3
13
20-400
4
15
50-150
5
55
40-150
6
26
40-150
7
29
30-200
8
15
60-300
9
11
60-300
10
6
30-120
Source: Land Registry, Hometrack
Table 2.9: Highest 10 Average House Prices by SOA in 2008
LOCAL NAME
Moorgate West
Wath Central & Newhill
Eastwood Village
Canklow North
Masbrough West
Average
House
Price
(current)
£370,000
£365,000
£311,300
£275,000
£266,900
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
166
10
150-200
165
7
80-300
164
17
150-300
163
14
100-300
162
29
120-600
- 40 -
LOCAL NAME
Parkgate
Eastwood Central
Masbrough East
Meadowbank
Broom East
Town Centre
Average
House
Price
(current)
£249,000
£237,500
£225,100
£214,100
£205,000
£203,500
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
161
15
90-300
160
19
70-200
159
16
80-600
158
7
80-200
157
14
120-200
156
13
70-300
Source: Land Registry, Hometrack
The average house price in Rotherham as at November 2009 was £130,048, compared to £122,339 for the region and £152,898 for the whole of England and Wales. Following falls at the end of the 1990s, house prices in Rotherham have increased substantially since 2001 with annual rates of increase above
20% from 2003 to mid 2005. In the last year Rotherham has seen a fall in house prices of 11.3%, but this was less than the national fall of 16.2%.
Table 2.10 illustrates the average weekly cost of renting a home in Rotherham in August 2009.
Table 2.10: Average rents by property size
Cross Tenure Affordability (wkly cost)
Renting (Public)*
Renting (HA)
Renting (intermediate)
Renting (Private)
Buying a lower quartile re-sale
Buying an average re-sale
Buying a 40% new-build HomeBuy
Buying a lower quartile new-build
Buying an average new-build
1 bed prop
£53.99
£55.30
£73.00
£91.00
£73.00
£88.00
£51.00
n/a n/a 2 bed prop
£61.52
£59.70
£89.00
£111.00
£86.00
£109.00
£78.00
n/a n/a 3 bed prop
£75.85
£65.70
£101.00
£126.00
£104.00
£133.00
£91.00
£142.00
£155.00
*Figures provided by 2010 Rotherham Ltd - August 2009
Source: Hometrack, RSR
2.14
Household Income
The average hourly earnings (median for full time workers including overtime) in Rotherham in 2008 was £10.04, compared to £10.96 regionally, and £11.97 in the UK. This represents a fall of 1.2% from the 2007 figure in Rotherham, compared to a 4.6% rise seen regionally and a 4.4% rise in the UK.33
33
data is workplace based, taken from the Annual Survey of Hours and Earnings (ASHE), which has been developed to replace the N ew
Earnings Survey (NES).
- 41 Table 2.11: Income Ranking Report by Ward (2009)
Income Ranking Report 2009
Ranking
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Name
Anston and Woodsetts
Wales
Dinnington
Holderness
Wickersley
Hellaby
Sitwell
Rother Vale
Brinsworth and Catcliffe
Keppel
Silverwood
Hoober
Wath
Rotherham West
Boston Castle
Swinton
Wingfield
Rawmarsh
Maltby
Valley
Rotherham East
Whole of Rotherham
Average Annual
Household
Income
£31,865
£30,280
£30,169
£30,023
£30,988
£33,528
£34,302
£28,616
£29,035
£29,233
£27,246
£25,954
£23,098
£25,084
£28,712
£22,461
£21,955
£23,010
£21,050
£23,484
£20,840
£27,017
Total
Households
4,742
4,628
5,175
5,096
5,572
4,883
4,921
4,909
5,078
5,215
4,671
5,135
5,197
5,571
5,881
5,386
5,771
5,714
5,366
5,499
5,747
110,157
Median Annual
Household
Income
£31,039
£29,589
£29,247
£28,362
£28,122
£27,860
£27,813
£26,142
£24,944
£24,638
£24,478
£24,065
£22,226
£21,460
£20,858
£18,733
£17,762
£17,759
£16,795
£16,563
£14,555
£23,005
Source: Acxiom Lifestyle Survey Data
Housing remains far more affordable for first time buyers in Rotherham than nationally, or those looking to move up the property ladder in Rotherham 34.
Table 2.12: Affordability by Income Bands
Affordability by income bands
FTB households – Flats
FTB households - Terraced houses
FTB households - Semi-detached houses FTB households - Detached houses
Owner occupier – Flats
Owner occupier – Terraced houses
Owner occupier - Semi-detached houses Owner occupier - Detached houses
Source: Hometrack; CACI Paycheck, February 2010
34
Rotherham In Focus – An Economic Assessment of Borough – April 2009
3.5 x
4x
3 x income income income
Rotherham (MD)
Percent of households priced out of market 36.22%
36.22%
22.59%
36.22%
36.22%
22.59%
60.19%
76.32%
36.22%
36.22%
49.11%
69.20%
22.59%
22.59%
36.22%
60.19%
22.59%
22.59%
49.11%
69.20%
36.22%
60.19%
36.22%
60.19%
- 42 Table 2.11 shows the percentage of households priced out of the market in the area. The analysis differentiates between house types and whether or not the purchasers are first time buyers. This is a modelled figure which is derived from the house price and income assumptions. The figures displayed are simply derived from incomes and house prices and do not account for the existing tenures of local residents.
The Council has a key role in ensuring housing is provided to households with specific needs and we will;
Seek to improve standards in private rental housing by agreeing codes of practice and by enforcement using all available powers where necessary Work with private landlords to encourage voluntary improvements in decency standards of their property
Demolish unsustainable stock subject to rigorous environmental assessment Tackle non-decent homes via our Home Improvement Agency
Encourage households to invest their own resources to fund repairs
Target void and empty properties to be brought back into use
Work with clients with particular needs to personalise housing choice
Develop a Common Housing Register with Registered Providers to update and inform housing needs
Work with housing developers to establish a viable supply of affordable low carbon housing from new planning permissions
Build new council houses that have zero carbon emissions by 2013
Continue to monitor need for Gypsy and Traveller accommodation
2.15
Central Heating
The 2001 Census shows that Rotherham has a lower number of households
(4,260) lacking central heating (4.2%) than both the regional average of 12.9% and national average of 8.4%. 6% of households living in the 10% most deprived areas of Rotherham have no central heating with 2.22% in the least
10% deprived areas35. People who live in the private rented sector are the most likely to be without central heating in their home.
POPPI estimates that there are 2,374 people over 64 years who have no central heating, 6.14% of the older population of Rotherham36. It is predicted that these numbers will reduce as a result of the Decent Homes programme currently being delivered by Local Authorities.
There is evidence that households without central heating are more likely to adversely affect the health of people with conditions such as cardio-vascular disease or chronic obstructive pulmonary disorders. Approximately 13,300 people (5.2% of local population) live in fuel poverty.
35
36
Census 2004, Households with No Central Heating
POPPI 2008, People over 65 with No Central Heating
- 43 2.16
Access to Car or Van
For the purpose of this section the term “car” is equivalent to “car or va n”.
There were a total of 104,845 cars available to households in the Borough at the time of the Census in 200137. There is approximately 1 car for every household in Rotherham with 30% of households (30,374) having no car. This is above the national average of 26.84% but below the regional average of
30.31%.
Figure 2.7: Breakdown of Households who have Access to Car or Van
Source: Office of National Statistics 2007, Cars or Vans (KS17)
44% of households (45,009) have access to a car. This is similar to the regional (44.1%) and national (43.7%) averages. 21.7% of households
(22,204) have two cars, 3.6% (3,704) with three cars and 1.0% (988) with four or more cars30.
According to the Office of National Statistics there are around 106,489 people of working age in Rotherham who regularly travel to work. Figure 2.6 shows a breakdown of the method of travel people use in order to attend work in
Rotherham.
Figure 2.8: Breakdown of Methods of Travel to Work in Rotherham
Source: Office of National Statistics 2007, Method of Travel to Work – Resident Population (UV39)
Over two thirds of people (69.3%) travel to work by car either as a driver or passenger. 12% of people travel by bus, minibus or coach and 8.2% travel by foot. A small minority of people travel to work by other means of transport
e.g. by bicycle or taxi. 6.9% of people work from home.
Figure 2.9 breaks down the distances that people travel into work. 22.5% of people travel 5km and 10km when going to work. 18.9% of people travel
37
Office of National Statistics 2007, Cars or Vans (KS17)
- 44 between 10km and 20km. 23.4% work from home, work abroad or have no fixed place of work. A small proportion of people (2.5%) commute to work and cover a distance of over 60 km.
Figure 2.9: Breakdown of Distances Travelled to Work
Source: Office of National Statistics 2004, Distance Travelled to Work (UV35)
2.17
Overall Employment Rate
Rotherham‟s traditional industrial and mining industries have diminished during the last fifteen years. There was a long period of decline in employment during the 1980s and 1990s. However, new industries have developed and economic growth has boosted the employment rate. There has been a dramatic improvement in Rotherham‟s employment rate over the last ten years, an increase which has been faster than across England as a whole.
Overall, it would appear that Rotherham has significantly closed the gap in terms of employment38. This has been driven by a growing economy and associated job creation. Rotherham‟s employment rate began to increase strongly during 2001.
Between 1998 and 2006, the number of jobs located in Rotherham increased from 80,900 to 104,000, a 28.6% increase. This was the highest increase in the region and amongst the 20 highest increases nationally. Much of the rise is attributable to the development of large new employment sites such as
Manvers39.
Between 2000 and 2006 there was a significant increase in job creation in
Rotherham with 14,600 jobs being created which was well above the regional and national averages40. The employment rate continued to increase up to the end of 2006 when it reached the national average, but since then it has fallen back below the regional and national averages, falling particularly sharply since the start of the recession in mid-2008.
According to NOMIS Official Labour Market Statistics there are 123,100 people who are economically active, either in employment or unemployed and actively seeking a job. Of these, there are 107,900 people who are employed. This equates to 68.0% of the working age population, below the regional average of
71.2% and the national average of 72.9%41.
38
Rotherham State of the Borough 2008, A Statistical Portrait, p3
Rotherham State of the Borough 2008, A Statistical Portrait, p12
40
Rotherham State of the Borough 2008, A Statistical Portrait, p10
41
NOMIS Official Labour Market Statistics 2009, Labour Supply – Economically Active
39
- 45 Breaking down the employment figures: 55,800 (52%) are males with 52,100
(48%) females. The difference is mainly attributable to the working age of females being 16-59 years and males being 16-64 years. 11,900 (7.6%) of people are self-employed which is below the regional average of 8.3% and national average of 9.1%. Males are more likely to be self-employed (11.5%) in comparison to females (3.2%)41.
The National Indicator (NI151) captures the number of people who are in employment according to the International Labour Organisation (ILO). The working age population is classed as 16-59 years for women and 16 -64 years for men. Figure 2.10 illustrates the employment rate in Rotherham from 2004 to 2009.
Figure 2.10: Employment Rate in Rotherham from 2004-2009
Employment Rate Comparisons 2004 onwards
76.0
75.0
74.0
73.0
75.0
74.0
74.2 74.3 74.2
72.0
71.0
70.0
72.0
71.5 71.7
71.6 71.5
70.9
69.0
GB
72.0 72.0 71.8
71.2
Y&H
70.4
69.6
Rotherham
69.9
68.0
67.0
68.0
De c0 M4 ar -0
Ju 5 nSe 0 5 pDe 05 c0 M5 ar -0
Ju 6 nSe 0 6 pDe 06 c0 M6 ar -0
Ju 7 nSe 0 7 pDe 07 c0 M7 ar -0
Ju 8 nSe 0 8 pDe 08 c0 M8 ar -0
Ju 9 nSe 0 9 p09 66.0
Source: NI151 (2009) – Employment Rate in Rotherham
In September 2009 68.0% of people who are of working age were in paid employment compared to the regional average of 71.2% and the national average of 72.9%.
Data for 2008 shows that public sector, financial/b usiness services, manufacturing and distribution are the four largest employment sectors in
Rotherham. In comparison with the UK, the biggest differences in employment were in financial/business sector and in manufacturing. Despite a decline in recent years 15.3% of Rotherham‟s working population work in manufacturing compared to only 10.2% in the UK as a whole. The financial/business sector employs 17.6% of Rotherham‟s population (despite recent strong increases) compared to 22.0% in the UK42.
Figure 2.11 shows levels of economic activity across all ethnic groups in
Rotherham. Highest economic activity is amongst the Indian (75.3%) and
Black ethnic groups (68.1%). A high percentage of people from these ethnic
42
ONS Annual Business Inquiry 2008
- 46 groups are self-employed. Both have higher economic activity rates than White
British people (64.4%).
Levels of economic activity are generally higher for the White British population but lower for BME groups. Lowest levels of economic activity occur in the
Kashmiri/Pakistani community (44.2%) and people identified as “Other” ethnic origin (41.6%). This is mainly due to particularly low levels of female economic activity and the role of women as carers.
Figure 2.11: Number of People who are Economically Active in Rotherham by
Ethnicity
Population
Aged 16-74
178356
171723
867
996
559
401
2815
231
329
226
209
Group
All People
White British
White Irish
White Other
Mixed
Indian
Pakistani
Other Asian
Black
Chinese
Other
Economically
Active
114116
110634
447
568
347
302
1244
124
224
139
87
%
64.0
64.4
51.6
57.0
62.1
75.3
44.2
53.7
68.1
61.5
41.6
Unemployed
7,041
6,611
29
46
32
13
251
18
23
6
18
%
6.2
6.0
6.5
8.1
9.6
4.4
20.2
4.6
7.4
4.3
20.0
Source: Health Needs Assessment 2008, BME Populations in Rotherham, p17
Working Age People on Out-of-Work Benefits (NI 152)
The National Indicator (NI152) measures the percentage of the working age population who are claiming out of work benefits. Out of work benefits include
Job Seekers Allowance, Lone Parents on Income Support, Incapa city Benefit and other income related benefits. These benefits do not include carers, people who are disabled or people who have been recently bereaved.
Figure 2.12: Rotherham people claiming out-of-work benefits from 2005-2009
15.4%
14.7%
14.4%
14.3%
14.3%
14.5%
14.4%
14.7%
15,000
14.6%
15.0%
14.9%
15.0%
14.9%
20,000
15.0%
25,000
16.2%
17.3%
30,000
16.8%
Out of Work Benefits: Claimants 2005 - 2009
18.0%
17.0%
16.0%
15.0%
26,710
26,920
26,680
26,520
24,130
22,800
22,120
22,210
21,810
22,240
22,230
22,760
22,700
22,900
23,020
0
23,500
13.0%
23,290
5,000
23,110
14.0%
22,770
10,000
23,070
2.18
0 5 05 05 05 0 6 06 06 06 0 7 07 07 07 0 8 08 08 08 0 9 09 09 09 b- y- g- v - b- y- g- v - b- y- g- v - b- y- g- v - b- y- g- v Fe Ma Au No Fe Ma Au No Fe Ma Au No Fe Ma Au No Fe Ma Au No
Source: NI152 (2009), Working Age People on Out-of-Work Benefits
12.0%
Out of work benefit claimants 4Q average % working age pop.
- 47 There are 154,400 people who are of working age population in Rotherham.
Figure 2.12 shows that the total number of people on out of work benefits had been steadily declining from 23,290 people (14.9%) in No vember 2005 to
21,810 (14.4%) in November 2007. Since then the number of people on benefits has shown an increase, particularly since the economic downturn began in mid-2008. This is due to increasing numbers of Job Seeker
Allowance claimants and at November 2009 there were 26,710 people (17.3%) on out of work benefits.
2.19
Number on Out-of-Work Benefits in Worst Performing Areas (NI153)
The National Indicator (NI153) captures the number of working age people who are claiming out-of-work benefits in the worst performing neighbourhoods in
Rotherham. These neighbourhoods are defined as Lower Super Output Areas
(LSOA) and made a benefit claim rate of 25% or more at the 2007 baseline.
An average LSOA contains around 1,500 people.
Figure 2.13: Working Age people claiming out-of-work benefits from
2005-2009 in the worst performing neighbourhoods
Out of Work Benefits: Claimants in Rotherham's worst performing SOA's
(rate >=25% ): all rates based on 4-Quarter rolling averages.
7,000
32.0%
31.2%
6,800
30.6%
6,600
31.0%
29.7%
6,400
30.0%
28.7%
29.0%
28.3%
28.1% 28.2%
28.0%
28.0%
27.9%
27.8%
27.8%
27.7% 27.6%
27.7%
27.4%
27.4%
6,200
6,000
28.0%
6,885
6,885
6,845
6,810
6,340
6,060
5,960
6,030
6,005
6,015
6,020
6,110
6,030
6,115
6,155
6,215
6,190
6,120
5,960
6,030
26.0%
25.0%
Fe bM 05 ay A 05 ug N 05 ov Fe 05 bM 06 ay A 06 ug N 06 ov Fe 06 bM 07 ay A 07 ug N 07 ov Fe 07 bM 08 ay A 08 ug N 08 ov Fe 08 bM 09 ay A 09 ug N 09 ov -0
9
5,400
% working age pop.
27.0%
5,800
5,600
Workless
Benefits:
Claimants
Source: NI153 (2009), Working Age People on Out-of-Work Benefits in Worst Performing Neighbourhoods
23 (13.9%) of Rotherham‟s 166 Super Output Areas (SOAs) had a claim rate of
25% at the 2007 baseline with an average claim rate across all 166 SOAs of
14.9%. The average claim rate for SOAs, not including the LSOA rates (143
SOAs) was 12.7%.
The number of people who are claiming out-of-work benefits in the worst performing SOAs has increased from 5,960 in May 2008 to 6,885 people in
November 2009, an increase of over 15%. The percentage of the working age population claiming out-of-work benefits had been falling slowly up to May 2008 but the recent recession has seen the rate increase to 31.2% in November
2009.
2.20
Contact with Mental Health Services whilst Employed (NI 150)
The National Indicator (NI 150) measures the percentage of adults receiving secondary mental health services in paid employment at t he time of their most
- 48 recent assessment, formal review or other multi-disciplinary care planning meeting, in August 2010 this measured at 3.1%.
2.21
Unemployment Rate
Rotherham‟s unemployment rate at September 2009 was 10.2% which is above the national average of 7.4% and the regional rate of 8.2%. Rotherham had 12,300 people unemployed in 2009, including 430 from minority ethnic groups. 7.4% of the unemployed are therefore from the BME community.
Unemployment had fallen dramatically from twice the national average to just below the national average by 2005 - the number unemployed in Rotherham peaked at 20,574 in September 1986 but, after falling to around 5,000, has increased again following the recession to reach 12,300 in September 2009.
Employment deprivation is one of the main drivers of deprivation affecting
Rotherham as measured by the Indices of Deprivation 2007. Although there have been some significant improvements since the mid-1980s Rotherham is still ranked as the 58th most deprived of 354 English Districts on the
Employment Domain. This is an improvement from 51st in 2004.
Employment deprivation has a distribution similar to overall deprivation levels, with the most deprived areas being Thrybergh, East Herringthorpe, Eastwood,
Canklow, East Dene and East Maltby. The areas with the highest levels of employment deprivation have 28% of all working age people on long term sick or unemployed. However, even in the most affluent areas in Rotherham, around 5.1% of people are employment deprived43.
The main reason for high worklessness rates are the high levels of long-term sickness. These high numbers are a legacy from the old heavy and mining industries. Local regeneration has made a great impact in Rotherham in recent years and the local economy has recovered strongly, creating jobs and prosperity, particular in the Manvers area. However, due to the impact of the recession overall unemployment has risen and there are still some neighbourhoods in Rotherham where unemployment remains very high.
There is substantial evidence that work leads to better physical, mental health and well-being. Conversely, worklessness can lead to poorer health, shorter life expectancy and loss of other health-related aspects of life such as daily routine, social contact and self-esteem. However, the nature of the work must be taken into consideration. Work can cause negative health impacts if, for example, it is stressful or performed in an unhealthy environment. Lack of secure and stable job opportunities cause anxiety through poor living standards and feeling deprived and isolated.
In Rotherham the rates of worklessness decreased over the period February
2001 to February 2008, with a 7% reduction and a fall of just over 2,000. This is made up of a reduction in the numbers on long-term sickness benefits
(15,270 in 2001 reducing to 14,120 in 2008), and a larger fall in people on Job
Seekers Allowance from 5,450 in 2001 to 3,910 in 2008. There has been progress in areas such as the Town Centre and Eastwoo d in reducing
43
Rotherham State of the Borough 2008, A Statistical Portrait, p8
- 49 unemployment levels, but long-term sickness levels remain high in the most deprived areas of Rotherham44.
Since 2008 the position has worsened with worklessness increasing again.
Whilst long-term sickness benefits have remained broadly similar the numbers on Job Seekers Allowance had risen to over 8,000 by the end of 2009.
People who are not working but seeking work are unemployed and unemployment rates are calculated as a percentage of the economically active population (those working or seeking work). The unemployment rate in 2001 averaged 6.2% for Rotherham as a whole but for BME groups overall, unemployment is twice as high. For non-White groups 14.4% were unemployed in 2001, rising to over 20% for people who originated from Kashmir/Pakistan.
This contrasts with the below average levels of unemployment for Chinese and
Indian people45.
Unemployment in 2001 was higher for men than women although this was not the case in every ethnic group. Although unemployment for Kashmiri and
Pakistani men was high at 18.9%, women had an even higher rate of 23.2%.
Men of “Other” ethnic groups and women of “Other Asian” groups also had unemployment rates over 20%. Chinese and Indian men had very low unemployment rates, as did Black women45.
2.22
Claimant Count
The number unemployed at September 2009 was 8,838 according to the claimant count but, according to the Annual Population Survey (APS), was
12,300. The APS unemployment rate takes account of people not entitled to benefits. The APS unemployment rate for Rotherham in September was
10.2%, above the regional rate of 8.2% and national rate of 7.4%.
According to NOMIS Official Labour Market Statistics there were 7,498 people claiming Job Seekers Allowance in June 2010. 75.0% are males and 25.0% are females. 55.0% of claimants are between the ages of 25 -49, 31.5% between 18-24 and 13.3% aged 50 and over. 73.0% have been claiming this allowance up to 6 months with only 12.7% claiming over a 12 month period 46.
Across Rotherham 28,450 people were receiving means-tested benefits Income Support, Jobseekers Allowance or Pension Credit in 2008, which equates to 14% of all people aged over 16. This is made up mainly of Income
Support claimants (10,270) and Pension Cred it claimants (14,270). The numbers of people living in income deprivation has been fairly static since
2001, with a fall in younger age groups being matched by a small rise in the older age groups44.
2.23
Recent National Economic Down-Turn
The UK economy is only just beginning to recover from the severe recession experienced since the middle of 2008. Rotherham has been severely impacted upon with significant job losses and increasing levels of unemployment. Most
44
Rotherham State of the Borough 2008, A Statistical Portrait, p11
Health Needs Assessment 2008, BME Populations in Rotherham, p17
46
NOMIS Official Labour Market Statistics (2009), Working Age Client Group – Benefit Claimants
45
- 50 analysts expect the recovery to be slow with little significant improvement in employment numbers until 2011 at the earliest and employment numbers not getting back to pre-recession levels for a number of years.
The chart below shows how the claimant rate increased more quickly in
Rotherham compared to regionally and nationally, although there have been some recent encouraging signs with falls in the claimant count locally in five of the first six months of 2010 and the overall rate falling faster than other are as.
Claimant Count Rates : June 08 - June 10
6.5%
5.9%
5.9%
5.7%5.7%
5.7%5.6%
5.7%5.6%
5.6%5.5%
5.6%
5.5%
5.5%
5.4%
5.2%
5.2%
6.0%
5.5%
5.0%
4.5%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
4.0%
4.8%
5.1%
5.0%
4.9%4.8%
4.8%4.8%
4.8%4.8%
4.8%
4.7%4.7%
4.7%
4.6%4.7%
4.6%
4.4%
4.4%
3.6%
4.3%
4.3%
3.9%
4.2%4.2%
4.2%4.1%
4.1%4.1%
4.1%
4.1%4.1%
4.1%
4.0%4.1%
3.2%
3.9%3.8%
3.5%3.8%
3.0%3.0%
3.2%
3.4%
2.6%2.7%
2.9%
2.8%2.9%
3.0%
2.5%2.6%
2.8%
2.5%
2.4%2.5%
2.2%2.3%
Ju n -0
Ju 8 l Au -08 gSe 08 pO 08 ct No -08 v De -08 c Ja -08 nFe 09 b M -0 9 ar Ap 0 9 rM 09 ay Ju 09 nJu 0 9 l Au -09 gSe 09 pO 09 ct No -09 v De -09 cJa 09 n Fe - 10 b M -1 0 ar Ap 1 0 r M - 10 ay Ju 10 n10 1.5%
Great Britain
Yorkshire & Humber
Rotherham
In the long-term the latest forecasts from Yorkshire forward suggest that employment levels in Rotherham may not recover to pre -recession levels until around 2020, particularly taking into account the expected job losses in the public sector over the next few years, but this will depend to a large extent on the speed/strength of recovery in the national economy.
2.24
Average Incomes
Levels of income deprivation across Rotherham are relatively high, with the
Borough ranked 70th most deprived of the 354 English Districts. There is a close relationship between multiple deprivation and income deprivation. This is evident in parts of East Herringthorpe and Canklow where half the population are affected by income deprivation, whilst in the least depri ved areas only 4% of people are similarly affected44.
The Indices of Deprivation 2007 showed that 18% of people over 60 in
Rotherham live in very low income households but in the most deprived areas such as East Herringthorpe and Canklow this can rise to over 50% of people living in income deprivation44.
Median average hourly earnings for full time workers (including overtime) in
Rotherham were £11.24 in 2009, compared to £11.37 regionally and £12.43 in the UK. This represents a rise of 11.8% from the 2008 figure in Rotherham, compared to a 3.6% rise in the region and a 3.8% rise in the UK. However,
- 51 when comparing earning rates it should be noted that there is a lower cost of living in Rotherham.
In 2009, men earned an average of £11.40 per hour compared to £10.62 for women. W omen‟s hourly pay was 93.2% of men‟s pay in Rotherham, slightly higher than the regional figure of 89.1% and the national figure of 87.1%.
Weekly average full time earnings were £450.90 in Rotherham, compared to
£490.20 nationally. Male earnings were 20.4% higher than female earnings, below the national figure of 25.1%47.
Historically the earnings of Rotherham‟s employed population have been above the level of the earnings of employees working within Rotherham. People from
Rotherham have taken advantage of higher earnings outside the borough, particularly Sheffield. This gap has shrunk over the last few years and work place/residence based earnings are now broadly at similar levels. This is an indication that higher paid jobs have been created in Rotherham48.
Average household income in Rotherham is estimated at £30,100 (2007), 88% of the national average of £34,166. Average household income varies greatly from £14,360 in the poorest 1% of the Borough, to £58,975 in the most affluent
1%, over four times higher48.
2.25
Access to Services
According to the Index of Multiple Deprivation (IMD 2007), Rotherham is currently ranked as 285th most deprived out of 354 English districts for Barriers to Housing and Access to Services. This means that Rotherham has relatively good access to housing and services and is in the top 20% nationally. 0% of the Rotherham population live in areas where it is most difficult to access services. Rotherham has excellent transport links to the rest of the country, being served by the M1 motorway which provides access to Leeds and Nottingham and the
M18 which gives access to the Humber ports. There is an extensive network of rail and bus services, providing good links with Sheffield and other neighbouring towns.
The Department of Transport has produced a range of Core Accessibility
Indicators which measures accessibility either by public transport, walking or cycling to primary schools, secondary schools, further education, GP surgeries, hospitals, supermarkets and employment. The findings from the indicators for
Rotherham are as follows:
Access to GP Surgeries - 88.32% of households who do not have access to a car are able to access a GP surgery within 15 minutes. This is below the regional average of 92.29%. 100% of households with no car have access within 30 minutes in Rotherham49.
Access to Hospital - 88.56% of households who do not have access to a car are able to access a hospital within 30 minutes for routine appointments. This
47
ONS Annual Survey of Hours & Earnings (2009)
Rotherham State of the Borough 2008, A Statistical Portrait, p13
49
Department of Transport 2005, GP Indicators
48
- 52 is above the regional average of 85.91%. 100% of households with no car have access within 60 minutes in Rotherham50.
Access to Employment - 95.2% of the local population can get to work by public transport within 20 minutes. This is above the regional average of
94.84%. 100% of the population have access within 40 minutes. 96.5% of Job
Seekers can travel to work within 20 minutes, 100% within 40 minutes 51.
Access to Primary Schools - 96.46% of target population have access to a local primary school within 15 minutes. This is above the regional average of
95.78%. 100% have access within 30 minutes52.
Access to Secondary Schools - 94.38% of target population have access to a secondary school within 20 minutes. This is above the regional average of
92.05%. 100% have access within 40 minutes53.
Access to Further Education - 99% of target population have access to
Further Education facilities within 30 minutes. This is above the regional average of 96.51%. 100% have access within 60 minutes54.
Access to Supermarkets - 92.63% of households who have a car can access a local supermarket within 15 minutes. 92.66% of households who do not have a car can access a local supermarket. This is below the regional average of
95.06%. 100% of households have access within 30 minutes55.
In summary, in comparison to other regional areas, Rotherham scored above average in 5 out of 7 areas for accessibility, in particular to primary and secondary schools, further education, hospitals and employment. This is as expected as Rotherham has low levels of deprivation in barriers to Housing and
Access to Services.
The two areas that were slightly under average were access to a GP surgery
(3.97% below the regional average). However, two new GP surgeries are currently being commissioned and will be fully operational by the summer of
2009. The first one, located in the Wentworth North Area Assembly, will register patients from Wath, Swinton, Mexborough and Bolton-on-Dearne. The second, located in the Town Centre of Rotherham at the Community Health
Centre, will take patients from across the borough. Both GP practices will be registering around 6,000 new patients and will be offering extended evening and weekend opening hours. This will improve accessibility rates for the local population, especially for the working age population.
The other area where accessibility rates were lower than the regional average was access to a local supermarket (2.43% below the regional average). Better transport links need to be established for some areas where access is difficult in remote areas such as Braithwell, Wentworth and Hooton Roberts. There may be more isolated communities who may not have access to a car.
50
Department of Transport 2005, Hospital Indicators
Department of Transport 2005, Employment Indicators
52
Department of Transport 2005, Primary School Indicators
53
Department of Transport 2005, Secondary School Indicators
54
Department of Transport 2005, Further Education Indicators
55
Department of Transport 2005, Supermarket Indicators
51
- 53 2.26
Satisfaction of People Over 65 with Home and Neighbourhood (NI 138)
The National Indicator (NI138) measures the satisfaction of how people who are over 65 years within their home and their local neighbourhood. The biannual Place survey was sent out to a random sample of around 5,200 households (about 1 in 20) in Rotherham in the autumn of 2008 in order to capture their views. The results of the survey identified that 80% of Older
People were satisfied with their home and local neighbourhood.
- 54 3.
Lifestyle and Risk Factors
3.1
Smoking
Smoking is a major contributor to ill health, particularly in relation to coronary heart disease and cancer.
A Smokefree Future, A Comprehensive Tobacco Control Strategy for England gives aspirations to reduce smoking rates among adults to 10% or less and to halve smoking rates among routine and manual workers, pregnant women and in the most disadvantaged areas by 2020.
The 2008 General Lifestyle Survey (formally the General Household Survey
(GHS)) shows that overall smoking prevalence in England has decreased from
39% of adults in 1980 to 21% in 2008. Reported prevalence was highest in the age groups 20-24 and 25-34 (32% and 27% respectively) and lowest (12%) for those aged 60+ (see Figure 3.1 below)56. 66% of current or former regular smokers state that they started before the age of 18 and 39% before the age of
1657.
Figure 3.1
Prevalence of smoking by age group for adults 2000 and
2008
40%
2000
2008
35%
30%
25%
20%
15%
10%
5%
0%
16-19
20-24
25-34
35-49
50-59
60+
Source: General Lifestyle Survey 2008, GLS 2008 data
Prevalence of smoking in England is slightly higher amongst men (21%) than women (20%), but the gap has decreased since 1980 when 42% of men reported smoking compared with 36% of women. The main reason for the decrease appears to be an increase in adults who have never or only occasionally smoked. This has risen from 42% in 1982 to 53% in 2008. The increase in those never smoking has been much larger amongst men t han women, increasing from 32% in 1982 to 48% in 2008 for men, whereas the increase for women was from 51% to 58%56.
Prevalence rates vary significantly with marital status. Those who are divorced or separated are most likely to smoke (33%) whilst those who are widowed are least likely to smoke (12%). In every age group, apart from the youngest and oldest, married people were less likely to smoke56.
56
NHS Information Centre 2010, Statistics on Smoking 2010
(http://www.ic.nhs.uk/webfiles/publications/smoking%2010/Statistics_on_Smoking_England_2010.Report.pdf )
57
General Lifestyle Survey 2008, GLS 2008 data
(http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=5756&Pos=&ColRank=1&Rank=272 )
- 55 29% of those in manual employment groups are cigarette smokers, compared with 33% in 1998, confirming progress towards the targets. Routine and manual employment groups report the highest level of smoking. Those in managerial or professional households are the most likely to have never or only occasionally smoked56.
People who live in an area of deprivation are more likely to smoke. Rates of smoking also increase for men and women in households with low household income56. The Health Survey England (HSE) 2004 reported on the proportion of people from the Black and Minority Ethnic (BME) Community that smoked. This
Survey reported on smoking prevalence among BME men. 20% of Indian men smoke, 21% of black African, 21% Chinese and 40% of Bangladeshi men.
Men in Bangladeshi and Irish groups were more likely to report smoking than men in the general population. With the exception of Bangladeshi and Irish men, men from BME groups were more likely than those in the general population to report that they had never smoked. Chewing tobacco is quite widely used amongst specific BME groups58.
The reported pattern of smoking amongst ethnic minority groups was very different to that from women. The reported prevalence amongst women ranges from 2% of Bangladeshi women to 24% of Black Caribbean women and 26% of
Irish women. This compares with 23% of the general female population58.
The latest modelled estimate, based on the Health Survey England 2006 -08, of adults that smoke in Rotherham (26.4%) is above the England average
(22.21%)59. The responses to the latest Lifestyle Survey conducted in 2008 show a decrease in reported smoking from 24% to 21%. Information from GP registers tends to be more reliable, data for Q1 2010-11 shows the prevalence rate in persons 16+ 18.1%60. Information is available from 22 Rotherham GP practices on the numbers of BME patients who smoke and this suppo rts the national data that suggests a higher smoking prevalence particularly amongst
Pakistani males and the Irish community.
During 2006-08 there were on average 481 deaths each year from smoking in
Rotherham. This equates to a directly age-standardised rate of 254.8 per
100,000 of the population aged 35+. This is above the national average of
206.859.
The prevalence of smoking at the time of delivery in Rotherham in Q1 2010 -11 is 22.6%. This is well above the England average of 13.6%, the Y&H average of 17.4% and the national target for 2010 of below 15%60&61. Rotherham has met the target of reducing the number of mothers whose smoking status is not known at delivery to less than 5%. However this is near the lower end of performance with 4.9% in Q1 2010-11 on this indicator when compared with other PCTs60.
58
NHS Information Centre 2008, Statistics on Smoking: England 2008, p7
Rotherham Health Profile 2010, Health Summary for Rotherham (http://www.apho.org.uk/resource/view.aspx?RID=92295)
Department of Health (2010) Statistical Release: Smoking at delivery, GP recorded smoking and GP recorded obesity, Q1 2010/11
61
Department of Health (2010) Statistical Release: Smoking at delivery, GP recorded smoking and GP recorded obesity, Q4 2010/11
(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_116059)
59
60
- 56 There is evidence that younger mothers are more likely to smoke throughout pregnancy. 45% of mothers aged 20 or under reported smoking throughout pregnancy, compared with 9% of mothers aged 35 and over. Between 2000 and 2005 the proportion of mothers who smoked throughout pregnancy fell for all but the under 20 age group62.
The HealthCare Commission carried out an improvement review of tobacco control by Rotherham PCT in 2006 and gave the PCT an excellent rating on the work it was doing to reduce smoking prevalence. This was despite the fact that
NHS Rotherham was one of 40% of PCTs which failed to meet national targets on reducing smoking in 2006-7.
Rotherham‟s Tobacco Control Alliance is working to deliver a revised action plan based upon the new national strategy, A Smokefree Future. Work is based around four key themes:
Prevention
Cessation
Protection
Communication
2,763 people achieved 4-week quit success in Rotherham in 2009/10. This exceeds the SHA target of 1,458 and the PCT stretch target of 2,550 63.
There are wide variations in smoking rates across Rotherham64. Recorded smoking rates per GP practice vary from 15% to 56%. The rates at which people quit smoking varies dramatically according to the GP practice patients are registered with. Some practices in high prevalence areas have high quit rates, other practices do not. Some of the variation is related to whether or not practices offer patients a locally enhanced service (LES) for smoking cessation.
Another factor includes how accessible the NHS Rotherham Stop Smoking
Service is to the local population65.
3.2
Eating Habits
Poor diet and nutrition are major contributory factors to ill health and premature death. A significant proportion of the population are not eating the recommended daily intake of five or more fruit and vegetables a day although this is steadily increasing.
Research indicates that eating habits vary with gender and age. Men tend to eat larger quantities of most food groups and are more likely to consume fats, meat dishes, sugars, preserves, non-diet soft drinks and alcohol. Women are more likely to consume yogurts, fruit and diet soft drinks66.
Similar patterns have also been found among the low income population, with men from low income households being more likely to consume foods such as
62
NHS Information Centre 2008, Statistics on Smoking: England 2008, p25
NHS Information Centre 2010, Statistics on NHS Stop Smoking Services, April 2009 to March 2010
NHS Rotherham Stop Smoking Services 2008, Latest updates on targets
65
NHS Rotherham 2008, Strategic Plan v 5 Annex A
66
NHS Information Centre 2008, Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08
63
64
- 57 sausages, beer/lager and table sugar. Women are more likely to consume salad vegetables, dairy desserts and fruit66.
Model-based estimates using HSE data for 2006-08 predicted that 28.7% of adults in England eat healthily. Rotherham had the third worst prediction for the region at 19.8% compared with a regional average of 24.5% 59.
Figure 3.2 Model-based estimates of fruit and vegetable consumption
Source: NHS Information Centre 2008, Model Based Estimates of Fruit and Vegetable
Consumption for PCOs in England 2003-5
The HSE Survey (2008) reports that the proportion of men consuming 5 or more portions of fruit and vegetables a day has increased from 22% in 2001 to
25% in 2008 and for women from 25% to 29%. For both males and females, the number of portions of fruit and vegetables consumed per day was lowest in the 16-24 age group with an average of 2.9% (men) and 3.1% (women). This increases with age, peaking at an average of 4.0 portions per day for men aged
55-74 and 4.3 portions a day for women aged 55-6467.
There is a correlation between consumption of the recommended amounts of fruit and vegetables and household income. In 2006 both men and women i n the highest income quintile were more likely to consume 5 or more portions per day than those in the lowest income quintile68.
3.3
Alcohol
The Alcohol Harm Reduction Strategy sets out the government‟s strategy for tackling the harms and costs of alcohol misuse in England. In 2008, the government produced a report that estimated alcohol misuse costs to NHS
67
NHS Information Centre (2009), Health Survey for England 2008 – Trend Tables ( http://www.ic.nhs.uk/statistics-and-datacollections/health-and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england--2008-trend-tables)
68
NHS Information Centre (2008), Health Survey for England 2008 Volume 1, Physical Activity and Fitness
(http://www.ic.nhs.uk/webfiles/publications/HSE/HSE08/Volume _1_Physical_activity_and_fitness_revised.pdf)
- 58 England at 2.7 billion in 2006/07 prices69, while the cost associated with alcohol-related crime and anti-social behaviour was estimated to be up to £7.3 billion each year. The strategy also estimated that workplace costs of alcohol misuse are as high as £6.4 billion per year through loss in productivity70.
Alcohol misuse can be directly related to deaths from certain types of conditions such as cirrhosis of the liver and stroke. The Alcohol Harm
Reduction Strategy for England estimates that up to 22,000 premature deaths per year are associated in some way with alcohol misuse. The total number of deaths linked to alcohol consumption has increased each year since 2001.
This is mainly due to the increase in the number of deaths from alcoholic liver disease in each year70.
In England, the directly standardised death rates from alcohol-specific conditions (all ages) per 100,000 of the population for 2005-07 were 12.7 for males and 5.9 for females and the regional averages were similar at 13.9 for males and 5.9 for females. The death rates in Rotherham were higher at 15.5 for males and 6.2 for females. Rotherham MBC is ranked 251 and 209 respectively on this indicator out of 326 Local Authorities. Figure 3.3 sets out a full profile of alcohol related indicators for Rotherham 71. The most common cause of death directly related to alcohol is alcoholic liver disease; other main causes are fibrosis and cirrhosis of the liver and mental and behavioural disorders. In Rotherham the death rates in 2007 for alcohol-attributable conditions are higher than the national average for both males at 51.1 compared with 36.1 and females at 19.0 compared with 15.2. The rate for both males and females was higher than the regional averages of 37.3 and 15.7 respectively.
Rotherham MBC is ranked 310 on this indicator for males and 268 for females out of 326 local authorities71. Mortality from chronic liver disease (including cirrhosis) in Rotherham in 2006-08 was 18.3 for males and 5.8 for females.
The rate for males is higher than for England (14.10) and Yorkshire and
Humber (14.1). The rate for females is lower than national (7.3) and regional rates (7.3). Rotherham MBC is ranked 203 and 231 respectively on this indicator71. There is evidence that men are more likely to exceed daily and weekly guidelines on alcohol consumption than women. Men and women who drink above the daily recommended guidelines also have a higher weekly consumption of alcohol. The youngest and oldest age groups are less likely to report drinking alcohol in the previous week, although older people reported drinking more frequently than younger people. There are some indications that consumption may be declining, particularly among men72.
According to the Rotherham Lifestyle Survey 2008, 34% of males and 22% of females reported that they had exceeded the recommended number of units in the previous week. This is the same proportion as the previous survey in 2005 for males, but an increase of 5% for females. For females there have been
69
Department of Health (2008), The cost of alcohol harm to the NHS in England
(http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_0864 21.pdf)
70
NHS Information Centre 2008, Lifestyles Statistics: Statistics on Alcohol England 2008
71
North West Public Health Observatory: Local Alcohol Profiles England (http://www.nwph.net/) and Rotherham Alcohol Profile
72
NHS Information Centre (2010) Lifestyle Statistics, Statistics on Alcohol, England 2010-Tables (http://www.ic.nhs.uk/statistics-and-datacollections/health-and-lifestyles/alcohol/statistics-on-alcohol-england-2010)
- 59 increases of 8% in the percentage of females aged 16-34 and 55-70 reporting that they exceeded the guidelines. For males, the most significant change was a decrease of 16% for the 16-34 age group.
Binge drinking is defined as drinking more than twice the daily recommendations, i.e. more than 8 units for men and 6 units for women. GHS reported that in 2008, 22% of men and 15% of women reported binge drinking on at least 1 day in the week72. The proportion was greatest amongst younger age groups with 32% of men aged 16-44 reporting binge drinking compared with 7% of those aged 65+. For women, 25% of those aged between 16 and
24 reported drinking over 6 units compared with 2% of people aged 65+72. In
Rotherham the estimated prevalence of binge drinking is 27.8% of the adult population, which is significantly above both the regional average of 24.5% and the England average of 20.1%73. 18% of male and 11% of female respondents to the 2008 Rotherham Lifestyle Survey reported that they had drunk more than
6 units of alcohol more than 4 times in the previous month. This is a significant reduction for males since the last survey in 2005, when the results were 36% for males and 14% for females. Skilled manual workers and the unemployed were most likely to be in this category of respondents.
73
Association of Public Health Observatories (2010), Rotherham Health Profile 2010
(http://www.apho.org.uk/resource/view.aspx?RID=50215&SEARCH=R*)
- 60 Figure 3.3 Alcohol Profile Rotherham
Source:
North West Public Health Observatory, Local Profiles England and Rotherham Alcohol Profile
In 1992 the Government defined sensible drinking as no more than 21 units of alcohol per week for men and 14 units for women70. Hazardous drinking is defined as drinking between 22 and 50 units of alcohol pe r week for men and between 15 and 35 units of alcohol per week for women. In 2005, the estimated proportion of the adult population in Rotherham who were a regional average of 6.0% and a national average of 5.0%. Rotherham ranks 242 on this indicator compared with other local authorities71.
- 61 Figure 3.4
Proportion of men and women in England consuming more than the recommended weekly guidelines by age
Source: NHS Information Centre (2008), Lifestyles Statistics: Statistics on Alcohol England 2008
Alcohol dependence is defined as people drinking above sensible levels and experiencing harm and symptoms of dependence. In 2004 the overall prevalence of alcohol dependence in England was 3.6%, with 6% of men and
2% of women meeting the criteria equating to 1.1 million people. 2% of male and female respondents to the 2008 Rotherham Lifestyle Survey said they relied on alcohol compared with 2% and 1% respectively in the previous survey in 2005. Out of the English regions, Yorkshire and Humberside has the second largest gap between the number of alcohol dependent people and the number accessing treatment, with only 2.2% of the „in need‟ population accessing treatment compared with a national level of 5.6%74.
Figure 3.5
Percentage of people in England with an alcohol use disorder broken down by category of problem drinking and gender Source: Department of Health (2005), 2004 Alcohol Needs Assessment Research Project
People from ethnic minority groups were found to have considerably lower prevalence of hazardous/harmful drinking use but a similar prevalence of alcohol dependence compared with the white population 70.
NI39 is a national indicator which measures alcohol-harm related hospital admission rates per 100,000 of the population. It measures all admissions that are attributable to alcohol. In 2007-08 in Rotherham 1,552 admissions were
74
Department of Health (2005), 2004 Alcohol Needs Assessment Research Project
- 62 reported, which is higher than the regional average of 1,413 and significantly worse than the national average of 1,47371.
There is evidence that drinking behaviour is affected by socio-demographic factors. People in employment are more likely to have drunk alcohol on f ive or more days in the previous week. They are also more likely to binge drink than unemployed people. Those in managerial and professional households are more likely to drink more frequently and drink above the daily recommendations than those in routine and manual households72.
Married adults (including those cohabiting) are more likely to have drunk alcohol in the week previous. They are also most likely to report drinking on five or more days in the previous week and single adults least likely. Single people are more likely to drink more than the recommended daily amount of units and to binge drink72.
Figure 3.6
Adults who drank alcohol in the last week by marital status
2006
Analysis shows that variation in drinking in the last week ranged from 4% to 5% of those of Bangladeshi or Pakistani origin to 67% to 68% of those recording their ethnicity as White British or White Other. Adults of mixed eth nicity were more likely to drink over the recommended daily limits on at least one day in the previous week as were the White British and the White Other ethnic groups.
The same pattern is seen for binge drinking. It should be noted that this analysis was carried out using the original method of unit conversion and it is unclear whether or not the same patterns would emerge using the improved method70. Over half of pregnant women in the UK reported drinking during pregnancy in
2005, although this proportion has decreased from 66% in 1995 to 55% in
2005. There has also been an increase in the percentage of mothers who gave up drinking when pregnant from 24% in 1995 to 34% in 2005. Older women are more likely to report drinking during pregnancy than younger women. The proportion who gave up drinking during pregnancy decreased with age while the proportion reporting they drank less increased with age 70.
Overall a higher percentage of adults across all age groups in England reported
Saturday as their heaviest drinking day (28%), followed by Sunday (23%) and
- 63 Friday (14%). For 16 to 24 year olds however, 38% reported Saturday as their heaviest drinking day followed by Friday (23%) and Sunday (13%).
Respondents over 65 were more likely to drink most on a Sunday (32%)72.
In 2009, there were 139,584 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings and dispensed in the community in England. This is a big increase since 2003 when there were
93,241 prescription items. The Net Ingredient Cost (NIC) was £1.6 million in
2003 but has now increased to £2.4 million in 2009. The NIC per item has decreased from £17 in 2003 to £16 in 200972.
These drugs are also prescribed in hospitals for dispensing in the community, though in smaller numbers than those prescribed in primary care settings. In
2009, 10,861 prescription items were prescribed in hospitals. This has increased by over 10% since 2003 when there were 9,500 prescription items for the treatment of alcohol dependency72.
3.4
Physical Activity
Physical activity contributes to a wide range of health benefits and can reduce the incidence of many chronic conditions. Regular physical activity can improve health outcomes irrespective of whether individuals lose weight.
Current recommendations are:
Adults: To encourage participation in at least 30 minutes of moderate intensity* activity five times (or more) a week.
Children: To encourage participation in at least 60 minutes of moderate intensity activity per day, and at least twice a week exercise befitting bone health, muscle strength and flexibility.
Active Living: To encourage the majority of the population, who do not exercise on a regular basis, to build physical activity of moderate intensity into their daily routines**.
*
Moderate intensity activity will raise the heart rate and leave the individuals a little out of breath.
** The 30 minutes target can be accumulated during the course of the day by undertaking a variety of activities in bouts of 10 minutes or more, these can include brisk walking and gardening75
The Health Survey England (HSE) indicates that for both men and women, the proportion achieving the physical activity recommendations has increased overall, from 32% in 1997 to 42% in 2008 for men and from 21% to 31% for women68. In 2006, for both men and women, the proportion meeting the guidelines decreased with age. For men, over 50% of 16 to 34 year olds met the guidelines compared to 9% for those aged 75 and over. The proportion of women meeting the guidelines remained stable for those between the ages of
16 and 54 (between 33% and 36%) and decreased thereafter to 4% among those aged 75 and over76.
75
76
NHS Information Centre (2008). Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08 p 53
- 64 52% of respondents to the 2008 Rotherham Lifestyle Su rvey reported doing no moderate or strenuous exercise compared with 50% in 2005, and only 9% reported an optimal activity level (as defined by the Allied Dunbar Survey) compared with 15% in 2005. 56% of respondents to the 2008 survey reported a total of 30 minutes or more energetic exercise per day compared with 58% in
2005. 65% of respondents said they would like to increase their activity and fitness levels compared with 70% in 2005. Of these 52% said they needed more time, 48% said they needed more willpower and 34% thought they needed better health.
In England between 41% and 42% of men in the 3 highest household income quintiles met the recommendations for physical activity in 2006, falling to 31% in the lowest income quintile. For women, 34% of those in the highest income quintile met the recommendations compared to 26% of those from the lowest income group. There is a clear trend in the prevalence of low activity levels for both men and women, with those in the lowest income quintile more likely to be low participators than those in the highest income quintile77. Results from the
“Taking Part” household survey (TPS) show that those with the highest incomes were more likely to take part in active sport. 89% of those earning over £50,000 had done so at least once in the previous twelve months compared with 61% of those with an income of less than £10,00078.
16.6% of the adult population in England (7 million people) takes part regularly in sport and active recreation (figures from the 12 month period up to April
2010)79. Regular participation in sport and recreation is defined as taking part on at least 3 days a week in moderate intensity sport and active recreation (at least 12 days in the last 4 weeks) for at least 30 minutes continuously in any one session80.
Results from the 2009-10 Active People survey show Rotherham to be in the bottom 25% of Local Authorities with 13.6% of adults taking part regularly in sport and active recreation81. For the active people 3 survey the rate was
19.2%. Participation is slightly higher for males with 21.9% participating compared with 16.6% of females. Participation is highest amongst individuals aged 35-54 at 26.8% and lowest amongst those over 55 at 9.2%82.
The HSE 2004 reported that within minority ethnic grou ps Irish (39%) and Black
Caribbean (37%) men had the highest rates for meeting physical activity recommendations, similar to the proportion of men in the general population
(37%). Black Caribbean, Black African and Irish women reported the highest rates of meeting current physical activity guidelines (31%, 29% and 29% respectively), compared with 25% of women in the general population. Only
11% of Bangladeshi and 14% of Pakistani women did the recommended amounts of physical activity in the four weeks prior to interview78. In
Rotherham, the Active People survey 3 indicated a higher percentage of
77
NHS Information Centre (2008), Health Survey for England 2008 Volume 1, Physical activity and fitness, p46
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08 p 55
79
Sport England, Active People Survey 4 – 2009-10. Sports Participation Factsheet: Summary of results for England, Quarter 2, 2009/10
80
Sport England, Active People Survey 2005-6 Headline Results
81
Sport England, Active People Survey 4 – 2009-10. Sports Participation: England, regions, counties and districts. Quarter 2, 2009/10
(http://www.sportengland.org/research/active_people_survey/active_people_survey_4/aps4_quarter_2.aspx)
82
Active People Survey 3 Results
78
- 65 non-white adults (47.1%) take part regularly in sport than the general population (19.2%)82.
The TPS indicated that adults living in single adult households with no children had significantly lower rates of participation (50%) in active sport than any other group in 2005-6. Adults living in households with adults and children had the highest rates with 82% reporting participation in at least one active sport in the last twelve months. The TPS also showed significant variations in participation in active sport between those with no formal qualifications (41%) and those with
A-levels or above (83%)83.
The TPS is used to monitor the Public Service Agreement 3 (PSA3). Part of this PSA is, by 2008, to increase the number who participate in active sport at least twelve times a year by 3%, among those in priority groups (black and minority ethnic group, limiting disability, lower socio-economic groups and women). Results from the TPS 2009-10 showed that 53.4% of all adults participated at least once in active sport during the past 4 weeks. The report also states than men are more likely than women to have done active sport in the last 4 weeks (59.4% and 47.7% respectively). 60.7% of people without a long-term limiting illness or disability compared to 33.6% of people with a long-term limiting illness or disability reported to have done active sport in the last 4 weeks84. The proportion of those participating from all of the priority groups fell slightly between Year 1 and Year 2, with the largest decrease being in participation by females which fell by 1.5%85.
The second part of the PSA indicator relates to participation in moderate intensity level sport for at least 30 minutes on at least three separate days during the past week. The TPS reported that overall the percentage of adults meeting this indicator increased from 20.9% in Year 1 to 21.5% in Year 2. The
TPS 2009/10 reports that “between 2005/06 and 2009/10, the proportion of adults doing active sport in England for more than 30 minutes at a time increased from 49.9% to 52.9%”84. Participation from black and minority ethnic groups rose from 19.2% to 19.6% and from lower socio -economic groups from 15.2% to 15.3%. Participation by women fell from 18.5% to 18.3% and by those with a limiting disability from 9.5% to 9.4%85. In Rotherham only
11.8% of people with a limiting disability take part in sport compared with
21.1% of people with no limiting disability82.
83
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p56
Taking Part: The National Survey of Culture, Leisure and Sport, Adult and Child Report 2009/10 (2010)
(http://www.culture.gov.uk/publications/7386.aspx)
85
Department for Culture, Media and Sport (2007), Taking Part Progress Report on PSA3: Final Estimates from Year 2
84
- 66 3.5
Obesity
The national obesity strategy “Healthy Weight, Healthy Lives” sets out measures to meet the challenge of excess weight in the population. In England almost two thirds of adults and a third of children are either overweight or obese and without effective action this could rise to almost nine in ten adults and two thirds of children by 2050. Overweight and obesity increase the risk of a wide range of diseases and illnesses, including coronary heart disease and stroke, type 2 diabetes, high blood pressure, metabolic syndrome, osteoarthritis and cancer. In 2007 it was estimated that the total annual cost to the NHS was
4.2 billion and to the wider economy 15.8 billion. By 2050 it has been estimated that overweight and obesity could cost the NHS 9.7 billion and the wider economy 49.9 billion (at 2007 prices)86.
NICE guidance currently states that assessment of health risks associated with overweight and obesity should be based on both Body Mass Index (BMI) and waist circumference68. Using both BMI and waist circumference to assess risk of health problems, in 2008 20% of men were estimated to be at increased risk,
14% at high risk and 21% at very high risk. Equivalent figures for women were
15% at increased risk, 17% at high risk and 24% at very high risk68. The proportion of both men and women at very high risk of the health effects of obesity increased with age peaking in the 65 to 74 age group, where 30% of men and 34% of women were in this category87.
In 2008, 24% of men and 25% of women (over 16) in England were classified as obese (BMI>30)88. Women are more likely than men to be morbidly obese
(3% compared with 1%). 37% of adults were overweight (BMI >25), with men more likely to be overweight than women (42% compared with 32%). Overall
66% of men and 57% of women were either overweight or obese in 2008 68.
The estimated prevalence of obesity for adults in Rotherham, based on Health
Survey England (HSE) - 2006-08, is 28.3%. This is slightly above the national estimate of 24.2% and the regional estimate of 26.3%89. QUEST and QOF data indicate that 32% of people in Rotherham with a recorded BMI are overweight, compared with 37% of people in the HSE 2005 and 23% are obese
(HSE 24%). In Rotherham the number of people in the extreme BMI categories is of particular concern: 4,286 people are identified on GP practice registers with a BMI of over 40 (2.7% of the whole population compared with 1.8% in
HSE 2005) and 614 of these have a BMI over 50 which equates to 0.3% of the population. There are also likely to be more cases of extreme BMI in the 22% of the population that have not had their BMI recorded. It is predicted that by
2050 there will be 142,000 people who are obese which equates to 50% of the population90. 86
National Heart Forum (2008), Healthy Weight Healthy Lives
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p5
NHS Information Centre (2010), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet, England February 2010
(Chapter%201%20(withhttp:/www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/statistics-on-obesity-physicalactivity-and-diet-england-2010%20footnotes).doc)
89
NHS Information Centre (2010): Estimates of Obesity for PCOs in England 2006-8
(http://www.apho.org.uk/resource/view.aspx?RID=71961))
90
NHS Information (2008): Transformational Initiatives for Strategic Plan Obesity
87
88
- 67 QOF estimated raw obesity prevalence for Rotherham for 2009/10 is 13.7%, calculated from an obesity register total of 28,463 for persons over 16 91. The obesity prevalence in England in 2009/10 based on GP obesity registers was
9.9%. However, the HSE 2008 reported obesity in adults to be 24.5%88.
34% of respondents to the 2008 Rotherham Lifestyle Survey reported they were of normal weight, 38% overweight and 19% obese. This compares with
38%, 35% and 18% respectively to the 2005 survey. 57% of respondents in
2008 said they had tried to lose weight, but only 25% had been successful.
The HSE 2006 found overweight and obesity are more common in lower socioeconomic and socially disadvantaged groups, particularly among women.
Women‟s obesity prevalence is far lower in managerial and professional households (18.7%) than in households with routine or semi-routine occupations (29.1%). The prevalence of morbid obesity (BMI over 40kg/m2) among women is also lower in managerial and professional households (1.6%) than in households with routine or semi-routine occupations (4.1%). However the proportion overweight was generally directly proportional to income in men92. Among ethnic minority groups, obesity prevalence was highest among the
Black Caribbean and Irish groups for men with 25% classified as obese in each ethnic group.
Bangladeshi and Chinese men had the lowest obesity prevalence at 6% each.
Obesity prevalence was highest in Black African (38%), Black Caribbean (32%) and Pakistani
(28%) groups for women and lowest in Chinese women (8%)93.
Figure 3.7 Obesity Prevalence by Ethnic Group
There are also regional variations in obesity and it is estimated that incidence will generally be greater in the north of England than the south -west. In
91
NHS Information Centre (2010), Quality and Outcomes framework (QOF) for April 2009-March 2010. Numbers on age-specific QOF disease registers and estimated raw prevalence rates by PCT
92
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p16
93
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p6
- 68 Yorkshire and Humberside, obesity levels amongst women are predicted to reach 65% by 2050, compared with 7% in the southwest which is a reduction from the current 17%. Among men in Yorkshire and Humber, the West
Midlands and north-east England obesity levels are predicted to reach 70% by
2050 compared with London where the predicted level is 38%94.
The HSE report 2003 showed that men who were co-habiting were most likely to be overweight or obese. Among women, those who were widowed were most likely to be overweight or obese. For both men and women, those who were single were least likely to be either obese or overweight95.
The proportion of men who were obese was higher among ex-regular smokers
(31%) and non-smokers (21.2%) than current smokers (15.1%). Among women, those who were ex-regular smokers showed the highest prevalence of obesity (29.1%), whereas the proportion of those who were obese was similar for current smokers (19.9%) and non-smokers (22.2%). The HSE report 2006 found that overall, amongst both men and women, the odds of a raised waist circumference were higher for ex-smokers than for non-smokers (odds ratio 1:6 in men and 1:2 in women)95.
The HSE report 2003 found that women who did not drink (61.3%) or drank within recommended limits (55.9%) during the week prior to interview had a higher prevalence of being overweight or obese than women who drank more than twice the recommended limits (48.8%)96.
Both men and women had a higher prevalence of obesity among those with low levels of activity than those with high activity levels. Adults with low physical activity levels were twice as likely to have a raised waist circumference as those with high physical activity levels96.
Results from the HSE 2008 show that in England prevalence of both obesity and raised waist circumference has shown an overall increase since 1993, however overweight prevalence has remained relatively similar68.
Weight loss in overweight and obese people can improve physical, psychological and social health. Evidence suggests that a moderate weight loss of 5-10% of body weight is associated with important health benefits, particularly in a reduction in blood pressure and a reduced risk of developing type-2 diabetes and coronary heart disease. However, it is important to recognise that for very obese people, such changes will not nec essarily bring them out of the “at-risk” category, but there are nevertheless worthwhile health gains. A continuous programme of weight reduction should be ma intained to help continue to reduce the risks97.
Rotherham PCT recognises being a healthy weight, healthy eating and physical activity are important to prevent overweight and obesity in the short and longer term. The PCT have invested in a range of obesity services including community weight management programmes, a Multi Disciplinary Team of
94
National Heart Forum (2008), Healthy Weight Healthy Lives, p13
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p7
96
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p8
97
National Heart Forum (2008), Healthy Weight Healthy Lives, p28
95
- 69 health professionals and Bariatric surgery to support 2,000 adults over the next
3 years to have a healthier lifestyle and healthier future90.
The evidence from published papers on community weight management programmes (Tier 1) is consistent, reporting reduced incidence of Type 2 diabetes in the population of 58% compared to a control group. The local
Yorkshire and Humber programmes, which follow the same proposed model, report an average of 5% body weight loss in those completing the programme and one could assume the well-documented health benefits this weight loss infers. In addition to the physical health benefits, there are other less well-documented benefits, such as: increasing self -esteem and self-confidence; and beneficial knock on effects upon family members. These programmes also address other lifestyle issues such as: alcohol; smoking and issues of social support and social capital90.
Estimate annual costs to the NHS in Rotherham of diseases related to overweight and obesity are £72.2 million in 2007, rising to £74.9 million by 2010 and £80.1 million by 201598. If the planned interventions prove successful the investment will pay for itself by preventing the ill health associated with overweight and obesity in the future.
98
National Heart Forum (2008), Healthy Weight Healthy Lives, p97
- 70 -
4.
Burden of Ill Health
4.1
General profile of burden of ill health
The Government has set Public Service Agreement (PSA) targets for life expectancy and infant mortality. The target to be achieved for average life expectancy in England by 2010 is 78.6 years for men and 82.5 years for women. The target for reduction in health inequalities is 10% by 2010, as measured by infant mortality and life expectancy. By 2010, PCTs are expected to reduce by at least 10% the gap in life expectancy between the 20% most deprived areas (the Spearhead Group) and the population as a whole. For children under one year, it is expected that there is a reduction of at least 10% in the gap in mortality between the “routine and manual” socioeconomic group and the population as a whole99.
4.1.1 Mortality
All-age all-cause mortality rate is a national indicator which supports government targets on increasing life expectancy and decreasing health inequalities. Over the last ten years, all-age all-cause mortality rates have decreased in Rotherham, but remain higher than the England average. The following charts compare the mortality rates in Rotherham against the national average for the general population. They also compare mortality rates between males and females, using age-standardised rates based on the number of deaths from all causes per 100,000 of the population. Figure 4.1 All-Age All-Cause Mortality Rates Rotherham and
England for all persons 1993-2008
1000
England
900
Rotherham
800
700
600
500
400
300
200
100
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The mortality rate in Rotherham has generally been decreasing since
1993. However, since 2006 the mortality rate has increased. The gap in mortality rate between Rotherham and England is larger in 2008 than it was in 1993.
99
HM Government 2007, PSA Delivery Agreement 18: Promote Better Health and Wellbeing for All, p19
- 71 -
Figure 4.2
All-Age All-Cause Mortality Rates for Males,
Rotherham and England 1993-2008
1200
England
Rotherham
1000
800
600
400
200
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The Rotherham mortality rate for males has been on a general decreasing trend since 1993. However, since 2006 it appears to be levelling off. The gap between the local and national average remains much higher for males than females.
Figure 4.3
All-Age All-Cause Mortality Rates for Females,
Rotherham and England1993-2008
800
England
Rotherham
700
600
500
400
300
200
100
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The mortality rate for Rotherham females fell in 2006 but has risen to higher rates again in 2007 and 2008. The gap between local and national rates is still prominent.
4.1.2 Infant Mortality
Infant mortality rate is calculated from the number of deaths per 1,000 live births. Figures from the National Centre for Health Outcomes show
- 72 that infant mortality rates in Rotherham for 2008 are above the national and regional averages100.
Figure 4.4
Infant mortality rates 2008 for England, Yorkshire and
Humber and Rotherham
9
England
Yorkshire & Humber
Rotherham
Mortality rate per 1000 live births
8
7
6
5
4
3
2
1
0
Under 1 yr
Under 28 days
Under 7 days
Source: NHS Information Centre (2009), Clinical and Health Indicators, Infant Mortality
The infant mortality rate in England and Wales for the period 2006-08 was 4.8 per 100,000 based on 9,866 deaths overall 101. Although infant mortality rates are at an all time low, the government remains concerned that a gap remains between different social groups. For example, for the same period the IMR for routine and manual groups was 5.2 per
100,000. This confirms that whilst IMRs continue to be higher in routine and manual (R&M) households, the gap has narrowed between this group and the population from 19% in 2002-04 to 16% in 2006-08101.
Data from 2002-4 shows that infant mortality rates (IMR) were likely to be higher in “Spearhead Groups” indicating a correlation between infant mortality and deprivation. Rotherham was one of 43 Local Authorities identified with more than 20 infant deaths in the R&M group between
2002-04102.
.
The Government target does not reflect other inequalities relating to infant mortality. During the period 2002-04 infant mortality for mothers born in Pakistan (10.2/1,000) was double the overall IMR. For mothers born in the Caribbean (8.3/1,000), the IMR was 63% above the national average. For mothers aged under 20 years (7.9/1,000), the IMR was
60% higher than for mothers aged 20–39103. In 2008 the IMR for sole registrations was 6.9 per 100,000 which is up on the previous two years‟ figures. Tackling health inequalities relating to infant mortality at local level is complicated by the relatively small numbers of infant deaths. A research
100
NHS Information Centre (2009), Clinical and Health Indicators, Infant Mortality
Department of Health (2009), Mortality Target Monitoring (Infant Mortality, Inequalities) update to include data for 2008 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_109444.pdf 102
Department of Health (2007), Review of the Health Inequalities Infant Mortality PSA Target, p14
103
Department of Health (2007), Review of the Health Inequalities Infant Mortality PSA Target, p5
101
- 73 project has been undertaken in Rotherham to try and identify if infant mortality is higher in BME groups. It compared the percentage of live births with the percentage of infant deaths (under 1 year) for the years
2004 and 2005 combined. The analysis indicated that BME groups have a higher proportion of infant deaths than the general population. Even when it was assumed that non-declaration of ethnicity meant ethnic origin was White British this pattern still applied104.
Evidence about the effectiveness of interventions to reduce infant mortality is inconclusive, particularly interventions that will narrow the gap between the R&M group and the overall population. There are four potential strategies which could have an impact on infant mortality rates and for which predictive modelling exists;
Reducing prevalence of obesity in the R&M population Reducing smoking in pregnancy from 23% to
15% for R&M
Reducing no. of women in the R&M group who share a bed with their baby or put it to sleep on its front
Achievement of teenage pregnancy target105
2.8% reduction
2.0% reduction
1.4% reduction
1.0% reduction
An Infant Mortality Summit was held in February 2007 and NHS
Rotherham and Rotherham Foundation Trust have worked together to implement and refresh the action plan that was developed as a result.
Recent data shows the 2008 rate as 7.7 deaths per 1,000, up on the previous figure of 5.9 although large fluctuations in rates are possible with low numbers. A Child Death Review Panel chaired by the Director for Public Health and a Designated Doctor for Death in Childhood are now in place to build upon existing strong SUDI arrangements.
4.1.3 Life Expectancy
Life expectancy at birth in England has reached its highest level to date for both males and females. The latest ONS statistics for 2006-2008 are
77.9 for males and 82.0 for females. In Rotherham life expectancy is significantly lower for males and females at 76.5 and 80.7 respectively
(see figure 4.5)106.
Females continue to live longer than males, but the gap has been closing. Although both sexes have shown annual improvements in life expectancy at birth, over the past 25 years the gap has narrowed from
6.0 years to 4.1 years nationally. The current gap regionally and in
Rotherham is similar at 4.2 years106.
Figure 4.5
104
Rotherham Life Expectancy at Birth Compared with
Regional and National Averages 2006-08
UK Statistics Agency (2008), UK Snapshot, Life Expectancy at www.ukstatistics.gov.uk
Department of Health 2007, Review of the Health Inequalities Infant Mortality PSA Target, p30
106
APHO 2010, Health Profile Rotherham 2010
105
- 74 83
Male
82
Female
81
80
79
78
77
76
75
74
73
England
Yorkshire & Humber
Rotherham
Source: APHO 2010, Health Profile Rotherham 2010
Life expectancy at 65 years is higher for women than for men. From
2006-08 a man aged 65 could expect to live another 17.7 years and a woman another 20.4 years107.
The relative gap in life expectancy from 2004-06 between the overall population and the 20% most deprived areas of England was wider than in the period 1995–97 for both males and females108. There is evidence that health improvements among higher socio-economic groups may have occurred at a faster rate than in other groups in the population. The result has been that the gap has not narrowed for life expectancy in disadvantaged areas; indeed, the gap has widened, particularly for women. This is a challenge for health inequality strategies when seeking to improve the relative health of disadvantaged groups. In Rotherham men in the least deprived areas have nearly 8 years longer life expectancy than those in the most deprived areas106.
The latest data on life expectancy and ethnicity shows life expectancy for
South Asians in Rotherham between 2001 and 2005 was lower than that of the general population. Less than a quarter of South Asians lived beyond the age of 75 compared with two thirds of the general population.
Average life expectancy for this period was 74.6 years compared with a
Rotherham average of 77.4104.
The target for inequalities in life expectancy is to reduce the relative gap in life expectancy at birth between Spearhead Group and the England average by at least 10% by 2010. Life expectancy at birth in the
Spearhead Group for 2006-2008 is 75.8 for males and 80.4 for females.
Rotherham is part of the Spearhead Group but has above average life expectancies at birth than the average for this group109. Although life expectancy at birth has improved for both the Spearhead Group and for
England as a whole, it has improved more slowly in the Spearhead
Group. As a result of this the gap in life expectancy has actually widened
107
Department of Health (2008) Tackling Health Inequalities: 2007 Status Report on the Programme for Action
Information Centre for Health and Social Care (2010), Compendium of Clinical and Health Indicators, p5
109
Department of Health (2009) Mortality target monitoring (life expectancy and all -age all-cause mortality, overall and inequalities. Update to include data for 2008.
108
- 75 to 7% for males and 14% for females 14% in 2006-08 compared to at baseline in 1995-97109. There is a significant variation within the
Spearhead Group of PCTs. In some areas life expectancy is increasing faster than average. If their trends were replicated in all Spearhead
Areas the Government‟s life expectancy targets for 2010 would be met110.
However, in general if current trends were to continue then 2010 targets will not be met109.
To meet the life expectancy target it is important to focus on preventing deaths from early middle age in Spearhead areas, including those at older ages. Deaths from CVD, cancer and respiratory disease account for approximately two-thirds of the gap between Spearhead Areas and the national average. There is substantial evidence that smoking reduction strategies will have an impact on the number of premature deaths from these conditions. Figures 4.6 and 4.7 predict the effect of interventions to narrow the life expectancy gap111.
4.1.4 Main Causes of Death
Ranking leading causes of mortality can provide a useful picture of mortality patterns in England and Wales. The main causes of death should be viewed in the context of other indicators such as age, sex and cause-specific mortality rates. There are more deaths from cancer than from ischaemic heart disease (see Figure 4.8). However, no single cancer is a more common cause of death than ischaemic heart disease.
In children, there are now more deaths from cancer than from accidents.
Ranking leading causes of death is limited by the nature and quality of the information available through death registration112.
The figures below illustrate the effects of the selected interventions to narrow the life expectancy gap.
110
APHO (2010), Health Profile Rotherham 2010, p9
APHO (2010), Health Profile Rotherham 2010, p14
112
Office for National Statistics (2005), Health Statistics Quarterly, Leading causes of death in England and Wales – how should we group causes? 111
- 76 Figure 4.6
Interventions Model for Males
- 77 Figure 4.7
Interventions Model for Females
Figure 4.8
10 leading causes of death in England and Wales, by
Figure 4.8ender, all ages of death in England and Wales 2008 by gender, all ages g : 10 leading causes
24.7%
Malignant neoplasms
29.7%
12.6%
Ischaemic heart diseases
17.9%
10.8%
Cerebrovascular diseases
7.3%
6.6%
4.8%
Influenza and pneumonia
Chronic lower respiratory diseases
4.7%
5.5%
Heart f ailure, complications and ill-def ined heart disease
5.5%
4.2%
Dementia and Alzheimer's Disease
6.1%
2.8%
Accidents
2.1%
2.7%
Diseases of the urinary system
2.7%
2. 0%
Cirrhosis and other liver diseases
0.0%
Females
Males
1. 0%
1.9%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Figure 4.9 compares the causes of premature mortality in Rotherham with England and Wales for 2006-08 (3 years). It shows the number of years lost broken down by individual conditions and assumes that the timely age for death is 75 years. For example if one person dies of
35.0%
- 78 cancer at 65 this accounts for 10 years of life lost. The chart shows that overall there are more premature deaths in Rotherham than nationally.
The three most significant causes of years of life lost are cancer, circulatory disease and diseases of the digestive system113.
Figure 4.9
Years of life lost by conditions 2006-08 (3 years)
Figure 4.9: Years of life lost by conditions 2006-08 (3 years)
600
Total 486.9
500
Total 445.4
Years of Life Lost per 10,000
48.6
Other
400
24.8
30.7
55.3
49.6
300
Suicide/Injury Undetermined
Diseases of Digestive System
36.1
Diseases of Respiratory System
28.5
Accidents
38.2
35.7
36.3
200
Diseases of Nervous System
18.8
25.4
Diseases of Circulatory System
Malignant Cancers
96.7
92.9
100
164.5
150.1
0
Rotherham
113
England and Wales
Area
Source: Office for National Statistics.
Figure 4.10 looks at the difference in life expectancy between the most deprived 20% of Rotherham compared with the Rotherham average by cause of death. From 2003-05 cancer, accidents and circulatory disease have been the three conditions which have had the greatest impact on life expectancy gap. Since 2005 Rotherham‟s position with regard to circulatory disease has improved. The gap on circulatory disease mortality has virtually been eliminated. However this does not mean that circulatory disease should become less of a priority.
Circulatory conditions are still a major contributor to premature mortality and there are cost effective interventions which, if made available to everyone at high risk, could have a substantial impact on life expectancy113. Figure 4.10a: Breakdown of life expectancy gap between most deprived quintile in Rotherham and Rotherham average by cause of death
Source: London Health Observatories (2008), Health Inequalities Intervention T ool
(www.lho.org.uk)
113
London Health Observatories (2008), Health Inequalities Intervention Tool (available at www.lho.org.uk)
- 79 Figure 4.10b: Breakdown of life expectancy gap between
Rotherham and England, by cause, 2006-08
Source: London Health Observatories (2008), Health Inequalities Intervention Tool
(www.lho.org.uk)
4.1.5 Hospital Admissions
NHS Rotherham had the second highest rate of hospital admissions in the region in 2008-09. The rate was 278.9 admissions per 1,000 population, significantly higher than regional (237.3) and (218.6) national averages. This suggests either a higher level of morbidity in the population, a lack of community care provision or reduced effectiveness in primary care114.
The needs weighted total cost of acute admissions is higher than the regional and national rates. It is possible that the needs weighted adjustment under-compensates for actual need. Assuming that it does not, the possible causes of the relatively high needs weighted total cost could be due to; low provider admission threshold, lack of community care provision, high levels of inappropriate referrals, lack of post discharge community support and ineffective discharge planning115.
In 2008/09 Rotherham had a significantly higher rate of emergency hospital admission per 1,000 than the regional and national averages.
The rate in Rotherham was the highest of all PCTs in the region.
Rotherham also has a significantly higher rate of A&E emergency admissions per 1,000 than the regional and national averages.
Rotherham had the second highest rate in the region115.
Rotherham has the 2nd highest rate of emergency admissions for ambulatory care conditions in the region. These 19 conditions have been identified as those which could be prevente d by effective
114
115
NHS Comparators (2010), Total Admissions per 1,000 population
NHS Comparators (2010) available at https://www.nhscomparators.nhs.uk
- 80 community care. The rate of admission for these conditions in
Rotherham is significantly higher than regional and national rates. This could be due to factors such as higher levels of morbidity and a more complex case mix. However other factors could include; lack of appropriate community care provision, post discharge support and effective discharge planning115.
Rotherham had the second highest regional percentage of emergency admissions discharged home with no overnight stay in 2009-10. This suggests low provider threshold for admissions, high level of inappropriate referrals and/or classification of A&E observation beds as inpatients115. In 2009/10 the standardised cost rate for emergency admissions per
1,000 Rotherham was the 4th highest in the region and higher than the national and regional averages115.
4.1.6 Self-Reported Measure of Health and Well-being
According to the Lifestyle Survey 2008 77% of respondents across
Rotherham regard themselves as being in “good health”. Only 7% consider themselves to be in “poor health”. This compares with 65% and 11% of respondents in the most deprived areas116.
4.1.7 Healthy Life Expectancy at 65
The UK population has been living longer over the last 20 years, but the additional years have not necessarily been in good health or free from disability or limiting illness. Healthy life expectancy (expected years of life in good or fairly good health) and disability free life expectancy
(expected years of life free from disability or limiting illness) have all increased between 2000-02 and 2005-07117.
The gap in healthy life expectancy between men and women is smaller than for total life expectancy. In 2005-07, healthy life expectancy at birth was 68.4 years for men and 70.4 years for women, a gap of 2 years.
The gap in disability-free life expectancy between men and women is also smaller than for total life expectancy and healthy life expectancy. In
2005-07, disability-free life expectancy at birth was 62.5 years for men and 63.7 years for women, a gap of 1.2 years117.
The latest local comparative figures on health and disability free life expectancy for men and women 65+ are from 2001 but the latest figures on life expectancy at 65 are from 2006-08. Figure 4.11 below shows the difference between rates for Rotherham, Yorkshire and Humberside and
England. The graph shows Rotherham rates to be lower than the regional or national averages118.
116
Rotherham Lifestyle Survey (2009)
Office for National Statistics (2010), Healthy life expectancy at birth 2000-02 to 2005-07 for England and Wales (experimental statistics)
118
HM Government (2008), National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions Ann ex 3
117
- 81 Figure 4.11 Life expectancy for people over 65 years
25
20.4
19.4
20
19
17.7
1 6.5
15.7
15
10.65
11.7
10
7.2
14.51
13.6
12.53
12.33
9.06
8.3
8.08
6.71
5.95
5
0
Rotherham
Y&H
England
Rotherham
Males
Life expectancy
Healthy life expectancy
Y&H
England
Females
Disability free life expectancy
Source: HM Government (2008), National Indicators for Local Authorities and Local Authority
Partnerships: Handbook of Definitions Annex 3
4.1.8 Mortality Rate from Causes Considered Amenable to Health Care
Many determinants of health lie outside healthcare and therefore it can be difficult to measure the effectiveness of health care systems.
Mortality data that is based on the concept that deaths from certain causes should not occur in the presence of timely and effective health care is one way of trying to measure health system effectiveness.
Amenable mortality, according to the Nolte and McKee definition118, is defined as deaths occurring before age 75 from causes that are considered amenable to medical intervention. Examples include: breast cancer, cancer of colon, leukaemia, gastric and duodenal ulcer and hypertensive diseases. Deaths from these causes may be avoidable through treatment of the condition after onset. Using this definition 43% of male and 47% of female deaths before age 75 were considered avoidable in 2005119.
The leading cause of amenable mortality for males in 2005 was ischaemic heart disease (IHD). The picture was slightly more complex for females, where IHD was the largest contributor to amenable mortality based on age-standardised rates, but breast cancer was the largest contributor when standardised years of life lost were used. This indicates that, although mortality from both IHD and breast cancer increases with age, significant numbers of deaths from breast cancer begin to appear in women at younger ages than IHD119.
There have been considerable reductions in levels of avoidable mortality between 1993 and 2005. The age-standardised mortality rate for causes considered amenable to medical intervention fell by 43% for males and 38% for females in this period. Mortality from causes not considered avoidable decreased by 14 per cent and 8 per cent for males and females respectively over the same period. Results indicate that medical interventions are likely to have contributed positively to reductions in amenable mortality, since the decreases are unlikely to be
119
Office for National Statistics (2007), Health Statistics Quarterly issue 34
- 82 the result of a general decrease in mortality rates. The biggest reduction in amenable mortality has been deaths from IHD119.
Directly standardised mortality data from 2006-08 show that mortality rates for causes considered amenable to health care are higher in
Rotherham than nationally and regionally. Mortality rates are higher for both males and females, but the difference is much narrower for females than males120. The ratio of deaths in Rotherham that are considered amenable to health care compared with those considered non -amenable to health care decreased faster than the national and regional averages between 1993 and 2006 and in 2006 was virtually the same (36% in
Rotherham and regionally and 35% nationally). This suggests that differences in death rates are not related to variations in the quality of health care119.
Figure 4.12 Mortality rates for causes amenable to health care
2006-2008
DSR mortality rate per 100,000
160
Rotherham
140
Yorkshire & Humber
England
120
100
80
60
40
20
0
Males
Females
Persons
4.1.9 Deaths attributable to smoking
Please see under section 1 of Lifestyle and Risk Factors
4.1.10 Long Term Conditions/Physical Disability
It is estimated that in 2015 there will be 28,199 people over 65 in
Rotherham with a limiting long-term condition. By 2025, it is estimated that the number will have risen to 33,831121.
Statistics from the Department of Work and Pensions show 10,540 people in Rotherham claimed Incapacity Benefit in February 2010 which equates to 6.5% of the working age population, compared with 5% nationally. Incapacity Benefit is generally claimed by adults of working age122. The 2001 census shows that 22.4% of the population considered themselves to have a limiting long-term illness or disability compared
120
Information Centre for Health and Social Care (2010), Compendium of Clinical Health Indicators
POPPI (2008) People aged 65 and over with a limiting long-term illness by age (65-74, 75-84, 85 and over) projected to 2025
122
Department of Work and Pensions tabulation tool (http://www.dwp.gov.uk/asd/tabtool.asp)
121
- 83 with 17.9% nationally123. It is clear therefore that Rotherham has a higher prevalence of long-term conditions than the national average and this seems likely to increase as the population continues to age. Figure
4.13 shows the range of long term conditions experienced by working age adults in Rotherham, Yorkshire and Humber and England, based on information relating to incapacity benefit claimants from 2007 122.
Figure 4.13: Types of long term conditions using data on Incapacity
Benefit Claimants-May 2007
Source: Department of Work and Pensions tabulation tool
Mental health disorders, although slightly lower than the England and regional averages, are still by far the highest cause of disability, followed by musculoskeletal problems. Using data from the 2008 Lifestyle
Survey for Rotherham it is estimated that 35% of the population consider themselves to have a long term condition, an increase of 5% since the previous survey in 2005124. This increases to 39% of respondents in areas of deprivation, but this is a decrease of 3% since the last survey in
2005, which suggests that health is improving in NRS areas and the gap between NRS areas and the general population is decreasing125.
PANSI estimates that 16,115 people in Rotherham aged 18 -64 had a moderate or serious physical disability in 2010. This equates to 6.4% of the total population or 9.9% of the working age population. PANSI predicts that by 2025 this number will have increased to 16,476125.
PANSI estimates that in 2010, 4,202 males and 2,585 females in
Rotherham were permanently unable to work due to physical disability.
This equates to 5.2% of working-age males and 3.2% of females. By
2025 the numbers in Rotherham are predicted to rise to 4,361 males and 2,610 females126.
Figure 4.14 shows predicted change in numbers of working-age adults in
Rotherham who are permanently unable to work due to physical
123
Census 2001 Table UV22 (http://www.statistics.gov.uk/)
NHS Rotherham (2005), Rotherham Lifestyle Survey
125
PANSI (2008)
126
Health Care Commission (2008), Patient Survey Report 2008 Rotherham PCT
124
- 84 disability, broken down by age and gender. There is a significant decrease predicted in the number of people aged 45 -54 years but increases in the number of people permanently out of work up to 2025 who are aged between 55 and 64 years126.
Figure 4.14 Predicted numbers of working age adults permanently unable to work due to physical disability in Rotherham,
2010-2030
3000
2010
2015
2020
2500
2025
Number of working age adults
2030
2000
1500
1000
500
0
Males
Females
18-34
Males
Females
35-44
Males
Females
45-54
Males
Females
55-64
Source: PANSI (2008)
National Indicator NI124 measures the percentage of people with a long term condition who report that they have had enough support from local services or organisations to help manage their long-term health condition(s). This data is sourced from the Health Care Commission PCT patient survey which is a random sample of adults registered with GP practices in England. In 2008, 63% of the 115 Rotherham respondents to this question in the National Patient Survey reported they got enough support from local services and organisations to manage their long-term condition (includes health and social care services)127. This suggests services are working quite well together to support people with long term conditions but there is further improvement to be made.
4.2
Diabetes
According to the APHO Diabetes Prevalence Model there were an estim ated
3.1 million people in England with diabetes in 2010, 7.4% of the population. 1 in 4 of these is estimated to be undiagnosed. The prevalence rate is predicted to rise to 4.6 million by 2030, 9.5% of the population128.
Life expectancy is reduced by at least fifteen years for someone with Type 1 diabetes. In Type 2 diabetes, which is preventable in two thirds of cases, life
127
128
Quality and Outcomes framework (2010), PCT indicator group level summary of achievement submission detail, DM19
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 (www.yhpho.org.uk/resource/view.aspx?RID=81090)
- 85 expectancy is reduced by up to 10 years129. It is estimated that around 90% of people with diabetes have type 2 diagnosis. Diabetes is the leading cause of blindness in people of working age in the UK129.
Diabetes prevalence increases sharply with age. The diabetes prevalence rate in persons aged 55-74 years and 75+ years was 14.3% and 16.5% respectively. By 2030, approximately half of the increase in diabetes prevalence will be due to the changing and ethnic group structure of the population and about half will be due to the projected increase in obesity 130.
Assuming a continuing trend of rising obesity, the PBS prevalence model predicts that the number of people in Rotherham with diabetes will have risen to 18,164 by 2025 equating to 6.7% of the population131.
The main contributing factors to rising rates of diabetes are;
Increases in population of older people
Increases in rates of obesity
Figure 4.15 illustrates how much of the forecasted increase in diabetes is likely to be due to population change and how much is likely to be due to rising obesity levels. The graph summarises the diabetes prevalence rate and number that would occur under two different scenarios of obesity (both use the same ONS population projections). The first and most likely scenario is that the 1991-2006 obesity rise continues at the same rate. The second sce nario is based on obesity being maintained at 2005 levels.
Figure 4.15: Diabetes prevalence forecast based on 2 scenarios of obesity levels
Source: APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 -3
In Rotherham there were 11,084 patients registered with diabetes in Q4
2009/10127. This is equivalent to 4.6% of all Rotherham registered patients. Of these 1,004 are Type 1 and 10,080 are Type 2 which is 0.4% and 4.2% of
Rotherham registered patients respectively. 15% of those diagnosed with Type
2 diabetes are prescribed insulin. 16% of diabetes patients are recorded as current smokers (of those with a smoking status ever recorded)132.
129
Diabetes UK (2007), Diabetes: State of the Nations 2006, p5
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p2 (www.yhpho.org.uk/resource/view.aspx?RID=81090)
131
NHS Rotherham (2008), Practice Based HNA: table of supporting data
132
NHS Rotherham (2010), QUEST diabetes data 2009/10 Q4
130
- 86 As mentioned above prevalence of diabetes is higher in older age groups. This is reflected in the Rotherham data. 9% of registered patients over 40 have a diabetes diagnosis. Of these 85% are prescribed a statin for 6 months and
52% are prescribed an aspirin for 6 months132.
Prevalence and mortality rates for diabetes are greater in areas of deprivation and for people in lower socio-economic groups. One likely reason is that obesity prevalence is higher in areas of deprivation. In addition, people from
BME communities are concentrated in areas of deprivation and African
Caribbean and South Asian communities have a higher prevalence of Type 2 diabetes (4 times higher in African Caribbean and 6 times higher in South
Asian). This is a result of genetic predisposition and lifestyle factors such as overweight or obesity and limited physical activity. Type 2 diabetes occurs at an earlier age in these communities and complications resulting from this condition are more likely in this population. Several studies report inadequate quality of health care for Asian, Black African and Black Caribbean diabetics and poor treatment compliance, which may lead to higher than average hospital admissions104.
The all age all persons mortality rate from diabetes in Rotherham for 2006 -08 was 5.9. This is slightly lower than regional and national rates which were 6.2 and 6.1 respectively. Locally, regionally and nationally the mortality rate from diabetes is higher in men than women. In Rotherham the rates for men and women are 8.0 and 4.1133.
Hospital admissions data shows levels of diabetes are higher in the Rotherham
BME community. The data shows that 88.4 per cent of the 1,400 people admitted to hospital in Rotherham with diabetes were White British. Just under
2% (1.86 per cent) reported being of Black or Minority Ethnic origin104. This latter figure seems low compared to the proportion of the population from BME groups (over 5 per cent). However, when the younger age structure of the
BME population and the large number of people not stating their ethnicity are considered, diabetes may be more significant, particularly considering the high rates of obesity in some BME groups104.
Admissions due to diabetes amongst the Pakistani community increased from
87 in 2002/03 to 154 in 2006/07, an increase of approximately 77 per cent.
The overall increase in admissions for all minority ethnic groups was 12% for the same period which suggests that other ethnic groups experience significantly lower rates of diabetes, moderating the overall increase for BME communities104. Figure 4.16134 shows the national variation in prevalence by ethnic group. A comparison of the local authorities with the highest and lowest prevalence rates of diabetes shows that those with the highest rates had correspondingly higher rates either of people over 65 or ethnic minorities in their populations134.
133
NHS Information Centre for Health and Social Care (2009), Compendium of Clinical and Health Indicators, Mortality from Diabet es, All ages 134
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1-2
(www.yhpho.org.uk/resource/view.aspx?RID=81090)
- 87 Figure 4.16 Diabetes Prevalence by Ethnic Group
Source: APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 -2
People with diabetes have a higher risk of dying at all ages under 80. The relative increase in risk of death is higher for women than men. For example, women aged between 40 and 59 years with diabetes are 2.54 times more likely to die than women of the same age without diabetes, compared with 2.17 times for men135.
In England 26,300 deaths between the ages of 20 and 79 years in 2005 can be attributed to diabetes. This equates to 11.6% of all deaths in this age group. If current trends in diabetes prevalence and mortality rates continue, 12.2% of deaths between 20 and 79 years will be attributable to diabetes in 2010. The percentage of diabetes attributable deaths in 2005 varies from 17.08% to 9.25% between Local Authorities135. In Rotherham the proportion of diabetes attributable deaths was 11.57%, which is close to the national average 136.
4.2.1
Impact on services
Nationally around 5% of total NHS spend is used for the care of people with diabetes137. Up to 9% of hospital expenditure is used for the care of people with diabetes. In Rotherham, during 2007/08, 0.5% of all A&E attendances were for diabetic related conditions138. 61% of these were by people aged 18-64 years139. There were 203 unplanned admissions where diabetes was the primary diagnosis and 2,680 unplanned admissions where diabetes was listed as a secondary diagnosis140.
Prescribing costs for diabetic drugs was £2.8 million, 7% of the total prescribing budget141. Rotherham has the highest prescribing costs for insulin in NE England and is well above the regional and national average141. Rotherham also has the third lowest costs for prescribing anti-diabetic drugs141.
135
Yorkshire and Humber Public Health Observatory (2008), Diabetes Attributable Deaths
Yorkshire and Humber Public Health Observatory (2008), Diabetes Attributable Deaths for Primary Care Trusts
137
Diabetes UK (2007), Diabetes: State of the Nations 2006, p5
138
NHS Rotherham (2008), Diabetes A&E Attendances at All Providers (spreadsheet)
139
NHS Rotherham (2008), A&E Attendances Patients aged 18+ 05-08 (spreadsheet)
140
NHS Rotherham (2008), Diabetes Spells at all Providers (spreadsheet)
141
NHS Rotherham (2008), 07-08 Diabetes Expenditure NHS Rotherham
136
- 88 4 .3
Circulatory Diseases
4.3.1 General
Circulatory disease is one of the main causes of premature death in
England. It is therefore a significant condition when considering strategies for increasing life expectancy. The Department of Health has set the following PSA target:
To substantially reduce mortality rates by 2010 from heart disease and stroke and related diseases by at least 40% in people under 75, with at least a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole142. The Coronary Heart Disease (CHD) National Service Framework (NSF)
Progress Report for 2008 stated that the Government target to reduce deaths from circulatory diseases by 40% for people unde r 75 had been met 5 years early. Inequalities in the death rate for circulatory diseases among the under 75s have been narrowing and the absolute gap between the England average and the 20% most deprived areas of
England has reduced by 32% since 1995-7143.
Deaths from cardiovascular diseases (CVD) in Rotherham have more than halved since 1991 and rates have been falling more than the national rates. It is expected that by 2010 mortality rates in Rotherham will have fallen to below the national average. Although mortality rates continue to be higher in NRS target areas, improvements have occurred at the same rate as for the rest of the population (see Figure 4.17 below)144. National Indicator NI121 measures the mortality rate from all circulatory diseases per 100,000 of the population for people aged under 75 142.
Between 2006-08 the local mortality rate was 81.6, just below the regional rate of 82.8 but above the national rate of 74.8145.
142
NHS Rotherham (2005), Lifestyle Survey – most deprived 20% of residents, p10
Department of Health (2008), The CHD National Service Framework Progress Report for 2007
NHS Rotherham (2007), Director of Public Health Annual Report 2006-7, p41
145
NHS Information Centre (2009), Compendium of Clinical and Health Indicators, Mortality from circulatory diseases (under 72, 20062008)
143
144
- 89 Figure 4.17: Circulatory Diseases Mortality Rates 1993/5-2006/8:
Persons Aged Under 75 Neighbourhood Renewal
Strategy Areas Compared /with Rotherham and
Circulatory Diseases Mortality Rates 1993/95-2006 08: Persons Aged Under 75
Neighbourhood Renewal(+ 95% CIs)
England Strategy areas compared with Rotherham and England (+ 95% CIs)
300
2009-11 Forecast
Age-standardised rate per 100,000
250
200
150
100
50
0
93/95 94/96 95/97 96/98 97/99 98/00 99/01 00/02 01/03 02/04 03/05 04/06 05/07 06/08 2008 2009 2010 2011
3 Year Average
NRS Areas
All Rotherham
CI = Confidence Intervals
England
NRS 95% CI
* 40% reduction by 2010
Roth 95% CI
Roth Target*
Source: London Health Observatories (2008), Health Inequalities Intervention Tool
Within the broad category of cardiovascular disease are a number of more specific health problems of which the two most important, in terms of causes of death, are Coronary Heart Disease (CHD, also known as
Ischaemic Heart Disease - IHD) and Cerebrovascular Disease (stroke).
Other significant conditions include angina and hypertension (high blood pressure). Cardiovascular disease is linked with other conditions, notably respiratory problems and diabetes. CVD is more common in men than women. 4.3.2 CHD and Heart Failure
Mortality from CHD in the UK is declining but it remains the most common cause of death146. The mortality rate for CHD has decreased both in Rotherham and nationally between 1993 and 2007. Up to 2007, the mortality rate for CHD in Rotherham has been falling faster than the national and regional averages (Figure 4.18 below147). In 2008 the mortality rate for Rotherham increased slightly pushing Rotherham back above regional and national rates.
146
147
SEPHO (2009) Coronary Heart Disease
NHS Information Centre (2007), Compendium of Clinical and Health Indicators, Mortality from coronary heart disease
- 90 Figure 4.18: CHD mortality rates between 1993 and 2008 for
Rotherham, Yorkshire & Humberside and England.
Persons Under 75
160
Rotherham
Y&H
Enlgand
140
120
DSR per 100,000
100
80
60
40
20
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2007), Compendium of Clinical and Health Indicators,
Mortality for coronary heart disease
The national rate of decrease in premature deaths from corona ry heart disease in people under 45, particularly women, has started to slow and may be starting to rise. This is due to lifestyle factors such as young people smoking, low levels of exercise and an increase in obesity prevalence. The latest report from the British Heart Foundation suggests that unless these risk factors are tackled aggressively in the younger age groups there is likely to be a reversal of the benefits achieved so far148.
More deaths from CHD occur in winter months than the rest of the yea r.
Excess winter mortality is the increase in mortality over and above the rate of mortality in the rest of the year. For example in 2004-5 19% more deaths occurred in winter than would be expected based on the average mortality for the whole year. Excess winter mortality is more than double the rate for over 85s compared to those under 65s148.
The CHD prevalence model estimates that in 2010 there are 6.4% of people all ages in Rotherham with CHD compared to 5.7% in
England149. In July 2010 there were 11,301 patients on Rotherham GP registers with CHD. This is 4.4% of the registered population giving a difference of 2% between numbers on GP registers and estimated prevalence150. There were 2,086 patients on GP registers of all ages with heart failure which is 0.8% of registered patients150. It is estimated that the percentage of the Rotherham population with CHD will rise to
7.2 % by 2020 compared with 6.2% nationally151.
CHD is more prevalent among males than females. The CHD prevalence model estimates that in 2008 in England 6.8% of males and
4.5% of females have CHD. This compares with 7.6% and 5.0% respectively in Rotherham151. CHD is more prevalent amongst the white population in Rotherham at 6.4% in 2008, followed by the Asian population at 3.6% and the Black population at 1.4%. This compares with 5.9%, 3.9% and 2.1% respectively nationally. This suggests that
148
British Heart Foundation (2008), Heart Statistics 2008 - General
Association of Public Health Observatories (2009), CHD Model and Benchmarking Tool (www.apho.org.uk)
150
Quality and Outcomes framework (2010), PCT indicator group level summary of achievement and submissio n detail, CHD1
151
Yorkshire and Humber Public Health observatory (2009), CVD prevalence – observed and expected - spreadsheet
149
- 91 CHD is less prevalent amongst ethnic minority groups in Rotherham than it is nationally, but this is likely to be due to the young age profile of
BME groups in Rotherham and the prevalence is likely to increase as their average age increases152.
Figure 4.19 compares the predicted trend in prevalence of CHD for different ethnic groups in Rotherham between 2008 and 2020. This suggests that CHD prevalence is likely to remain fairly stable among black, mixed and other ethnic groups and increase amongst whi te and
Asian groups151.
Figure 4.19: Predicted CHD prevalence in Rotherham by Ethnic
Group between 2008–2020
Source: Yorkshire and Humber Public Health Observatory (2008), CVD prevalence – observed and expected - spreadsheet
Prevalence rates for CHD increase as people get older. In Rotherham in
2008 CHD rates were; 23.2% (75+ years), 17.0% (45-64) and 6.3% (all adults). The rates are higher than the estimated national prevalence for each group at 21.3%, 15.6% and 5.6% respectively. Figure 4.20 compares the predicted trend for CHD prevalence for different age groups in Rotherham and England between 2008 and 2020 151.
Figure 4.20a: Predicted prevalence of CHD in different age groups between 2008 and 2020 for Rotherham and England
Source: Association of Public Health Observatories (2008), CHD Model and Benchmarking Tool
152
NHS Rotherham (2007), CHD in South Asians Equity Audit
- 92 CHD is more prevalent in areas of high deprivation for both men and women. Towards the end of the 1990s the premature death rate for female manual workers was 73% higher than for female non -manual workers. For males premature death rates were 50% higher. Since the introduction of inequalities targets there has been clear progress in reducing the gap between the most deprived areas and the nation as a whole. NHS Rotherham has carried out a series of CVD equity audits focusing on ensuring that practices in deprived areas have maximised case finding. In the 1990s there was evidence that patients from deprived areas were less likely to receive specialist procedures such as coronary artery bypass grafts even though they had much higher CVD mortality113. By 2005 this trend had been reversed and the use of specialised cardiac services by patients in deprived parts of Rotherham is now higher than the overall average. However it is likely that uptake is still not completely proportionate to the prevalence of disease153. Figure
4.2.2 below shows that the CHD mortality rates in the 20% most deprived areas are higher than the rest of Rotherham. However, the gap has narrowed since 1991.
Figure 4.20b: CHD mortality rates for Rotherham residents 19912008: Persons under 75, 20% most deprived areas compared Rates the rest of Rotherham (with under
A2(i): CHD Mortalitywithfor Rotherham Residents 1991-2008: Persons aged95%75
20% most deprived areas compared with the rest of Rotherham (with 95% confidence intervals) confidence intervals)
350
< 2009-2012 >
Forecast
Age-standardised rate per 100,000
300
250
200
150
100
50
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
20% most deprived areas
Rest of Rotherham
95% CI
95% CI
National evidence has shown that South Asians living in the UK have a higher premature death rate from CHD than the population average.
The rate is 46% higher for men and 51% higher for women (British Heart
Foundation). There is also evidence that people from ethnic minorities have less access to these services as a result of language barriers and cultural differences etc152.
In Rotherham people of South Asian origin are more likely to be admitted to hospital with cardiac complaints and receive cardiac interventions (heart bypass and angioplasty) than the population
153
London Health Observatories (2008), Health Inequalities Intervention Tool, p23
- 93 average, once age differences in the populations are adjusted for. It indicates that the South Asian community has access to hospital services but it highlights the need for targeted health promotion and risk management for this population153.
The South Asian population age profile is much younger than that of the general population. Over 50% of the South Asian population are under
25 years of age. As this population ages there is likely to be a sharp increase in the number of South Asians at risk of CHD154.
In Rotherham, South Asians appear to be admitted for treatment for
CHD around 6-7 years earlier than the general population. A substantial proportion of South Asian secondary care admissions occur in the 45 -54 age group. There is then a dip in the proportion of South Asian admissions between ages 55-64. This pattern is not seen in the general population where a gradual rise in admissions with age is observed155.
The BME community in Rotherham had twice the rate of hospital admissions for congestive heart failure (CHF) between 2000 and 2005 than for the general population. The Pakistani community had two and a half times the rate of hospital admissions for this condition compared to the general population. Consultation with BME groups suggests that raising awareness of the importance of taking medication to control the condition would be of benefit104.
Rotherham has one of the highest hospital admission rates for coronary heart disease. Rates are high for all types of admissions but especially for emergency admissions. In Rotherham 2007/08 there are 331 admissions per 100,000 population compared with 242 regionally and
222 nationally156. Although the prevalence rate in Rotherham is in the top 25%156, the level of hospital admissions is still much higher than other areas where there are high prevalence rates156. The number of emergency admissions for myocardial infarction (MI) in Rotherham in
2005-6 was 124.7 per 100,000 of population. This is higher than the regional rate of 106.7 and the national rate of 101 but the gap is less than for other types of heart conditions156. Further investigation may be required to look at the impact of avoidable admissions, hospital admission thresholds and availability of appropriate community based services. In Rotherham, the revascularisation rate in 2007/8 was 105.1 per
100,000 of the population. This is a big drop from the previous years which had a rate of around 140 per 100,000. Therefore for 2007/08 the
Rotherham revascularisation rate is below regional and national rates of
129 and 136 per 100,000 population. 160 revascularisations were carried out in 2008/09 in persons 65 and over, which equates to a rate of
413.9 per 100,000 of population in this age group157.
154
NHS Rotherham (2007), CHD in South Asians Equity Audit, p6
NHS Rotherham (2007), CHD in South Asians Equity Audit, p7
156
Yorkshire and Humber Public Health Observatory (2008), Local Authority Maps
(www.yhpho.org.uk/atlas/0Local_Authorities_Eng/singlemap%20england2/atlas.html )
157
London Health Observatory (2010) Age standardised hospital episode rate for revascularisation procedures, people aged 65 yea rs and over 155
- 94 The CHD National Service Framework recognises the importance of cardiac rehabilitation services in reducing mortality and morbidity and set a goal that in every hospital over 85% of people diagnosed with a primary diagnosis of heart attack or after cardiac revascularisation should be offered cardiac rehabilitation. The 2008 National Audit of
Cardiac Rehabilitation reports that only 43% of people who suffer a heart attack in England are accessing treatment, with major regional variations. The report also reveals no cardiac rehabilitation programme meets minimum staffing levels set out for the NHS. Also, rehabilitation is also only routinely offered to 3 of the many diagnostic groups that could benefit and therefore only reaches a small proportion of the people who need to attend158.
4.3.3 Hypertension
The APHO hypertension prevalence model estimates that 25.5% of the
Rotherham population has hypertension compared with 24.2 % in
England. It is estimated that 10.2% of the Rotherham population is currently receiving treatment for hypertension compared with 9.8% nationally, which equates to 42% and 41.2% of hypertensives respectively. The model estimates that 18.9% of the hypertensives receiving treatment in Rotherham have the condition controlled compared to 18.6% nationally159.
38,666 patients on Rotherham GP registers were diagnosed with hypertension in March 2010, 32 compared with the expected p revalence of 65,027159. This equates to 15.2% of the population or 59.5% of expected prevalence. This indicates that NHS Rotherham is better at case finding than the prevalence model predicts.
4.3.4 Stroke
Every year approximately 110,000 people in England have a stroke. It is the third largest cause of death in England. 25% of strokes occur in people who are under the age of 65. There are over 900,000 people living in England who have had a stroke and it is the single largest cause of adult disability. 300,000 people in England live with moderate to severe disability as a result of stroke160.
In March 2010 there were 5,474 patients on Rotherham GP registers with stroke and TIA. This is very close to the estimated prevalence of
5,420161. The average recorded incidence of stroke is approximately
530/year and of TIA approximately 150/year. This compares with estimated rates of 550 and 260 respectively, suggesting that TIAs may be under-diagnosed161. The National Stroke Strategy reports that too few people understand what a stroke is or that it needs to be treated as medical emergency when the symptoms occur. The strategy suggests
158
British Heart Foundation (2008), National Audit of Cardiac Rehabilitation
Association of Public Health Observatories (2008), Hypertension Model (www.apho.org.uk)
160
Department of Health (2007), National Stroke Strategy, p31
161
Department of Health (2007), ASSET2 for Commissioners
159
- 95 that this is a likely reason for the discrepancy between actual and predicted incidence162.
It is estimated that 1,550 people in Rotherham have moderate or severe disability following a stroke and 201 deaths per year are due to stroke 161.
POPPI predicts that 986 people aged over 65 in Rotherham in 2010 had a long-standing health condition caused by stroke, and that this will have risen to 1,504 by 2030163. This represents a 53% increase.
PANSI estimates that in Rotherham 60 males and 99 fema les of working age require help with daily activities due to stroke. PANSI predicts these numbers will increase to 67 males and 108 females by 2025, an increase of 12% and 9% respectively125. Local data sources do not record actual numbers of people receiving assistance with daily living due to particular conditions, so it is currently hard to test how accurate these estimates are. Although the number of females disabled by stroke remains significantly higher than the number of males, the predicted increases in Rotherham follow the predicted national pattern of higher increases in the number of males. Overall the predicted rate of increase is lower in Rotherham than the national average of 16% for males and
12% for females125.
More women who have strokes die from them compared with men.
However, stroke is more common in men compared with women by the age of 75. People who are economically disadvantaged have a higher rate of stroke. People of African or Caribbean ethnicity are at higher risk of having a stroke, whilst people of South Asian origin are less likely to have hypertension managed. Incidence rates, adjusted for age and sex, are twice as high in black people as for white people. People who are overweight or obese, and who also suffer from hypertension, have a higher risk of stroke. Targeting prevention work at these groups is likely to yield significant results162.
In Rotherham between 2005-06 and 2009-10 2.6% of hospital admissions for stroke were from the BME community (i.e. non-White
British) although for about 7% ethnicity was not stated. People of
Pakistani origin accounted for 0.8% of hospital admissions and data suggests that stroke is a significantly greater issue for BME groups than the general population104. Stroke is primarily a condition that affects older people and the low proportion of BME strokes in Rotherham reflects the younger age structure of the BME community. Stroke is likely to become a significant issue as these populations get older104.
Rotherham has a higher rate of emergency episodes for stroke for both males and females than the regional and national rates. In 2006-7 there were 115.4 episodes in Rotherham per 100,000 of the population compared with 97.4 regionally and 99.4 nationally156.
The Asset 2 model indicates that in 2007-08 67% of 382 acute hospital admissions due to stroke returned to their usual place of residence. This
162
163
Department of Health (2007), National Stroke Strategy
POPPI (2008)
- 96 is significantly higher than the national average of 52% and rates in the
90th to 95th centile nationally. 12% of stroke survivors were discharged to care homes or another hospital, significantly lower than the national average of 21%. Average length of stay was higher than the national average at 20.5 days compared with 18.1 days for people discharged to their usual place of residence, but lower at 28.2 days compared with
32.0 days for those discharged to residential care or another hospital.
The high lengths of stay suggest a lack of early supported discharge services/community based rehabilitation, although they may contribute to the success in returning people to their usual place of residence . The model also highlights the lack of community based services in
Rotherham for stroke survivors such as dysphasia or family and carer support services161.
4.3.5 Impact on services
Rotherham resident hospital admissions 2009/10
3,169 (8%) non-elective admissions are due to cardiovascular illness164 5143 (9%) attendances at A&E (20% of attendances by people
65+)139
2,107 (5% ) elective admissions are due to cardiovascular illness165 Prescribing costs were £8,814,822166
CVD prescribing costs constitute 23% of the total prescribing costs for the PCT167.
Programme budget costs for CVD in 2007-8 were £29,409,000168
The ASSET2161 model suggests the following preventive measures which would reduce the incidence of CVD and the likely number of strokes prevented per year by the following amounts in Rotherham:
Managing all individuals with hypertension to below 140mmHg systolic BP - 47
Warfarin for all patients with atrial fibrillation - 50
Statins for all people with >20% risk CVD in 10 years - 22
Smoking cessation for all patients who have suffered a stroke or
TIA - 10
4.4
Cancer
4.4.1 Mortality
Cancer is one of the biggest killers in England – 1 in 3 people will be diagnosed with cancer in their lifetime and it is the cause of 1 in 4
164
NHS Rotherham (2008), Unplanned Hospital Admission 2007-08 (spreadsheet)
NHS Rotherham (2008), All Elective Admissions 2007-08 (spreadsheet)
NHS Rotherham (2008), Prescribing Costs CVD
167
NHS Rotherham (2008), Total Prescribing Costs 2007-08
168
NHS Rotherham (2008), Programme budget costs 2007-08
165
166
- 97 deaths169. In 2008 there were approximately 128,800 cancer deaths equating to 172.2 deaths per 100,000 of the population170.
During the 1980s and 1990s the UK had one of the poorest cancer survival rates in Western Europe and patients often waited long periods for diagnosis and treatment. This led to the introduction of government targets to reduce mortality rates from cancer overall and within areas of deprivation171. Between 1996 and 2008 cancer mortality in people under 75 fell by over
13%170. Since the implementation of the NHS Cancer Plan in 2000, there has been a significant fall in smoking rates, improved screening and faster diagnosis/treatment, all contributing to significant progress on mortality rates172.
The Government target is to reduce cancer mortality in people under 75 by 20% by 2010 from the 1995/1997 rate (see figure 4.21)173.
Considerable progress has been made towards this target and the latest data for 2006-08 shows a 19.3% fall in rates since 1995/97174. Survival rates for some cancers, such as colorectal and breast cancer, are improving year on year in line with other European countries175. In 2006 the UK ranked 9th out of 28 European countries for male cancer mortality (where first has lowest rate) and 22nd out of 28 for female mortality. The higher comparative mortality rate for females reflects higher smoking prevalence in the 1980s and 1990s compared with other
European countries175.
In 2006, cancer accounted for 29% of all deaths in m ales and 25% in females170. Mortality rates are higher for men than women although differences in mortality rates are not fully understood170. In some cases such as lung and oesophageal cancer, it may be due to high levels of smoking prevalence, later presentation, unidentified risk factors or biological predispositions176.
169
UK Statistics Agency (2008) www.statistics.gov.uk/cci/nugget.asp?id=915
NHS Information Centre (2009), Compendium of Clinical and Health Indicators, Mortality from all cancers
Department of Health (2007), Cancer Reform Strategy, p17
172
Department of Health (2007), Cancer Reform Strategy, p17-18
173
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p6
174
Department of Health (2009), Cancer Reform Strategy. Achieving Local Implementation Second Annual Report http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109338 175
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p18
176
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p90
170
171
- 98 Figure 4.21: Cancer mortality (persons under 75) from all cancers in England, 1993-2007
Source: Department of Health, Cancer Reform Strategy – Achieving local implementation,
Second Annual Report
In 2008 Rotherham had an all age cancer mortality rate of 202.1 per
100,000. This is higher than the regional rate of 181.3 and England rate of 172.2170. The under 75 cancer mortality rate for Rotherham residents in 2006-08 was 131.5. This is above the national rate of 114.0. The rate of reduction in cancer mortality for people under 75 decreased faster than the national and regional averages between 2002 and 2006. This is mainly due to larger than average decreases in the female mortality rate (Figure 4.22)177.
Figure 4.22a: National, Regional and Rotherham age-standardised mortality rates for all cancers, all persons aged under
75, 2004-2008
160
Rotherham
Y&H
Age-standardised mortality rate per 100,000
140
England
120
100
80
60
40
20
0
2004
177
2005
Health Care Commission (2008), Data Set for the 2007-08 New National Targets
2006
2007
2008
- 99 Figure 4.22b: Rotherham age-standardised mortality rates for under 75’s, all cancers by sex, 2004-2008
180
Males
Females
160
Age-standardised mortality rate per 100,000
140
120
100
80
60
40
20
0
2004
2005
2006
2007
2008
Vital Sign VSB03 measures the age standardised mortality rate for all cancers for people under the age of 75 against the planned target for reducing mortality178. The most up-to-date performance report (2007-8) shows that NHS Rotherham has achieved its planned reductions in cancer mortality for the last 3 years. However, the data also shows that cancer death rates increased in 2006 and 2007 and NHS Rotherham may be struggling to reach their current target177.
Comparative data for 2003-5 suggests that Rotherham has particularly high mortality rates for stomach cancer and cervical cancer when compared nationally, although they are comparable regionally156. Data from the Trent Cancer Registry does not indicate any significant statistical differences in age standardised cancer mortality rates for
Rotherham, in comparison with other PCTs in the cancer network, between 2002-6 for any of the top 10 cancer sites179.
In 2006-08 there were 381 early deaths from cancer in Rotherham. This is a rate of 132 per 100,000, significantly worse than the England average and in the worst quartile of regional local authorities.
4.4.2 Incidence
In 2007 there were 297,991 new cases of cancer in the UK, equating to an age standardised rate of 377 per 100,000 of the population180. The increase in the incidence between 2005 and 2006 for both males and females was less than 1%.
The incidence of new cases was higher in men at 409 per 100,000 compared to 357 per 100,000 in women. In the UK in 2007 the 3 most common sites for new cancer types in males were prostate, lung and
178
Health Care Commission (2008), New National Target Indicators for Primary Care Trusts 2007-08
Trent Cancer Registry(2008), Cancer Fact Sheet for Rotherham PCT
180
NHS Information Centre for health and social care (2009), Incidence for all cancers 2006
179
- 100 colorectal and for females, breast, colorectal and lung181. Figure 4.23 shows the UK prevalence rates of the most common cancer types in
2007181.
Cancer incidence in Rotherham follows the national pattern for the most common cancer sites, but there are some significant variations when compared regionally. Figure 4.24 shows the age standardised incidence rates for the most prevalent cancer sites in Rotherham for 2003 -7 compared with the North Trent Cancer Network. The most significant exceptions to the regional averages are the lower rate of prostate cancer in Rotherham and the higher rate of bladder cancer in men 179.
Figure 4.23: The 20 most commonly diagnosed cancers (excluding
Figure 1.1: The -melanoma skin cancer), UK 2007 non20 most commonly diagnosed cancers
(excluding non-melanoma skin cancer), UK, 2007
Breast
Lung
Colorectal
Prostate
N-H-L
Malignant melanoma
Bladder
Kidney
Oesophagus
Stomach
Pancreas
Uterus
Leukaemias
Ovary
Oral
Brain with CNS
Multiple myeloma
Liver
Cervix
Mesothelioma
Other
Male
0
10,000
20,000
Female
30,000
40,000
50,000
Number of new cases
Source: Cancer Research UK – Cancer Stats Key Facts (http://info.cancerresearchuk.org)
181
UK Statistics Agency (200( (www.statistics.gov.uk/downloads/theme_health/2006cancerfirstrelease.xls )
- 101 Figure 4.24: Comparison of cancer incidence by site between
Rotherham and North Trent Cancer Network for males and females, 2003-07
Lung
Colorectal
Prostate
Bladder
Head & Neck
Stomach
Oesophagus
Melanoma
Leukaemia
Trent
Rotherham
0
20
40
60
80
100
Breast
Lung
Colorectal
Ovary
Melanoma
Cervix
Head & Neck
Stomach
Bladder
Trent
Rotherham
0 20 40 60 80 100 120 140
Source: Trent Cancer Registry (2010) Cancer Data. Local incidence. mortality and survival data by cancer site (http://www.empho.org.uk/tcr/data.aspx)
Approximately 1 in 10 cases of cancer occur in people aged 25 –49 years. Breast cancer is the most common cancer in this age group accounting for over 30% of all cancers. Malignant melanoma, bowel, testicular and cervical cancers are the next most likely. There are almost twice as many females diagnosed with cancer than males in the
25–49 year group, while in the over 65s the number of diagnoses is higher in males even though the female population is much larger182.
Cancer occurs predominantly in older people. Around two thirds of cancer deaths occur in people aged 65+ and more than one third (36%) in people 75+. Less than 1% of all newly diagnosed cases (0.5%) occur in children under 15, 1,400 new cases in 2004. The risk of a child in the
UK being diagnosed with cancer under age 15 is approximately 1 in 500.
Leukaemia is the most common form of childhood cancer, responsible for nearly one third of all cases, and tumours of the brain or central nervous system account for approximately one quarter.
4.4.3 Inequalities
Cancer incidence varies according to socioeconomic group. This is probably the result of environmental and lifestyle factors, differences in access to health care and health seeking behaviour. Evidence indicates that incidence of lung and cervical cancer is highest in patients from deprived backgrounds, whereas the opposite is true for malignant melanoma and breast cancer. The difference in incidence rates between the most and least deprived groups was higher for lung cancer patients aged under 65183.
The higher incidence of breast cancer in women from higher socioeconomic groups could be connected to increased likelihood of having a first child at a later age, having fewer children and increased take-up of hormone replacement therapy. Breast cancer in post
182
Cancer Research UK – Cancer Stats Key Facts (http://info.cancerresearchuk.org)
BMC Cancer (2008), variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England
183
- 102 menopausal women is linked with obesity with the association particularly strong for women in more deprived areas183.
People in deprived areas, older people (particularly for breast cancer) and those from ethnic minority groups are more likely to delay seeking help. There is evidence that awareness of risk factors associated with cancer is particularly low in deprived groups183.
Incidence of cancer varies between different ethnic groups. Compared to the general population, prostate cancer incidence is higher in African
Caribbean men. Mouth cancer has a higher incidence in the South
Asian community and liver cancer is higher in the Bangladesh and
Chinese communities. Some differences are due to lifestyle factors and exposure to infections. Others may be due to genetic factors183.
People with learning disabilities have the same overall risk of cancer as the general population, but a higher risk of some cancers such as gall bladder, thyroid and leukaemia. There is a lower risk of prostate, lung and urinary tract cancers183.
If the incidence of lung and cervical cancer were decreased to that of the least deprived group it would prevent 36% of lung cancer cases in men,
38% of lung cancer cases in women and 28% of cervical cancer cases.
Incidence of breast cancer and melanoma was highest in the least deprived group. If all socioeconomic groups had incidence rates similar to the least deprived group it is estimated that the number of cases would increase by 7% for breast cancer, 27% for melanoma in men and
29% for melanoma in women183.
Figure 4.25 shows that in Rotherham people in more affluent areas are almost as likely as those in more deprived areas to contract cancer.
However they are less likely to die from cancer179. This is partly due to the fact that there are higher incidences of lung cancer in areas of deprivation, for which mortality rates are higher. Breast cancer, which is more common in affluent areas, has a lower mortality rate. Cancer mortality rates in Rotherham NRS areas are decreasing faster than the national average which indicates that targeted interventions are proving successful (see Figure 4.26)113.
Figure 4.25: Incidence of All Cancer in NHS Rotherham: by ward
2002-06
- 103 Figure 4.26: Malignant Cancer Mortality Rates 1993/1995-2006/08:
Neighbourhood Renewal Strategy Areas Compared with Rotherham and England (+ 95% CIs)
250
Age-standardised rate per 100,000
2009-11 Forecast
200
150
100
50
0
93/95 94/96 95/97 96/98 97/99 98/00 99/01 00/02 01/03 02/04 03/05 04/06 05/07 06/08 2008 2009 2010 2011
3 Year Average
NRS Areas
Rotherham
CI = Confidence Intervals
England
NRS 95% CI
* 20 % reduction by 2010
Roth 95% CI
Roth Target*
Source: NHS Rotherham (2007), Director of Public Health Annual Report 2006 -07
4.4.4 Prevention184
Over half of all cancers could be prevented by changes to lifestyle.
Improving awareness and encouraging people to adopt healthy lifestyles is therefore a key factor in improving cancer outcomes.
Smoking is the single largest preventable risk factor, being a factor in a third of all cancer deaths and up to 90% of lung cancer cases.
Differences in smoking rates between the most and least affluent groups account for around half of the inequalities gap in cancer mortality. Much of the improvement in cancer death rates can be attributed to reductions in smoking amongst adults. There is evidence that, since smoke free legislation was introduced in Scotland in March 2006, there has been a dramatic improvement in air quality in pub, no increase in smoking in the home and reduced tobacco consumption, particularly in disadvantaged communities. Smoking rates remain comparatively high in routine and manual workers, the North of England and in some very deprived groups. Obesity increases the risk of many cancers including those of the uterus, kidney, gallbladder, colon and oesophagus. There is evidence that obesity is associated with breast cancer in post menopausal women.
Obesity is now the most significant cancer risk factor besides smoking.
There is evidence that for middle aged and older women in the UK, around 5% of cancers (6,000 per annum) are caused by being overweight or obese and 66% of these were cancers of the breast or womb. 184
Department of Health (2007), Cancer Reform Strategy, p33-39
- 104 Excess alcohol consumption is linked to the development of several cancers, particularly the mouth, larynx, oesophagus, liver and breast.
This risk is further increased when combined with smoking.
Melanoma is one of the fastest growing types of cancer, and although it is more common in women, the death rate is higher amongst men at 3.1 per 100,000 compared with 2.0 amongst women (2006-08 data). A particular concern is the use of cosmetic tanning salons with risks of excessive exposure amongst young people and lack of adequate health information provided to customers about health risks.
4.4.5 Treatment and survival
Evidence suggests that late diagnosis of cancer has been a major fact or in the poorer survival rates in the UK compared with other countries in
Europe. The Cancer Reform Strategy states that improving access to diagnostics was the single most important priority in primary care to improve outcomes in cancer treatment185. There has been a significant improvement in diagnostics in recent years. In 2005, the DH set out milestones for the NHS to reduce waits for diagnostic tests to a maximum of 13 weeks by March 2007 and to six weeks by March
2008185.
NHS Rotherham met the national target of having less than 2% of cases waiting more than 6 weeks for diagnostic tests by March 2008 with only
1.1% having to wait longer177. NHS Rotherham also significantly exceeded the national targets for breast screening in 2007 -8, with 83.4%
(nat. target 70%) of women aged 53-64 being screened and 78.5% (nat. target 55%) aged 65-70. NHS Rotherham also met all the national targets in 2007/08 on waiting times between referral and diagnosis/treatment and on improving cancer services 186.
The Radiotherapy Advisory Group suggests that demand is likely to grow over the next 10 years for radiotherapy services. On average
30,000 fractions are currently delivered per million population and it is anticipated that this will grow to 54,000 by 2016, requiring more staff and equipment, particularly if new Government targets are to be achieved185.
Nationally, there is a wide variation in radiotherapy activity, which cannot be explained by need alone. The number of fractions delivered varies from between 17,000 and 48,000 per million population187. There is some evidence to show that older people are likely to receive le ss intensive treatment than younger people e.g. older women may not be offered radiotherapy for breast cancer. Also older people are less likely to be offered radical treatment for lung cancer and there is low screening uptake for people with learning disabilities188.
1 and 5 year survival rates for breast, colon, rectum and prostate cancer have shown big improvements since the publication of the Cancer Plan.
185
Department of Health (2007), Cancer Reform Strategy
Health Care Commission (2008), Data Set for 2007-08 Existing National Targets
187
Department of Health (2007), Cancer Reform Strategy, p60
188
Department of Health (2007), Cancer Reform Strategy, p89-91
186
- 105 The 5 year survival for breast cancer has risen from 80.6% in 2000 to
86.0% in 2007. For colon cancer the figures for men are 47.6% to
53.4% and for women 47.6% to 52.7%174.
1 and 5 year survival rates for breast, colon, rectum and prostate cancer in England have shown big improvements since the publication of the
Cancer Plan. The 5 year survival for breast cancer has risen from
80.6% in 2000 to 86.0% in 2007. For colon cancer the figures for men are 47.6% to 53.4% and for women are 47.6% to 52.7%174.
4.4.6 Trends
Nationally it is projected that there will be about 262,000 new cancer cases in 2011 and 283,000 in 2016. This represents increases of around 8% and 16% since 2006. For many types of cancer the projected increase to 2016 exceed 20%. However, the number of lung cancer and stomach cancer cases will remain broadly stable and the number of cases of cervical cancer is predicted to fall189.
Table 4.1 shows the predicted national increases in different types of cancer189. Figures 4.27 and 4.28 show how these trends will affect cancer incidence in Rotherham179.
Table 4.1: Predicted increase/decrease in incidence of the 10 key cancer sites for males and females nationally, 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13
189
National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class Service for England, p13
- 106 Figure 4.27: Predicted increase in case numbers for top 10 cancer sites for Rotherham males 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13 and Trent Cancer Registry (2008) Cancer Fact Sheet for
Rotherham PCT
Figure 4.28: Predicted increase in case numbers for top 10 cancer sites for Rotherham females 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13 and Trent Cancer Registry (2008) Cancer Fact Sheet for
Rotherham PCT
4.4.7 Costs
Expenditure on cancer care in England has risen by 27% over recent years and cancer is the third largest disease programme in the NHS behind mental health and circulatory diseases, costing the NHS £4.35 billion per year. Approximately 80% of this is spent on acute services
(outpatients, diagnostics, treatment, and emergency care) and the other
20% is spent on community care (screening, GP consultations and palliative care). This estimate does not include preventative services, pre-diagnosis assessment and diagnostics and palliative care provided by the voluntary sector190. Expenditure per head of population is £80 compared with £121 in France and £143 in Germany. Figure 4.29 provides a breakdown of spend on cancer nationally.
190
Department of Health (2007), Cancer Reform Strategy, p118-120
- 107 Inpatient care for patients diagnosed with cancer accounts for around twelve percent of all inpatient bed days in England. Cancer patients account for approximately 5.3 million bed days/year. This equates to approximately 14,550 cancer patients being in a hospital bed on any one day191. Figure 4.29: Estimated Total NHS Spend on Cancer Care 2005-6
Source: Department of Health (2007), Cancer Reform Strategy, p119
From 2000-2008 inpatient admissions for cancer nationally have risen by
25% from 625,000 to 785,000 per annum. Bed days are rising by 1% each year. Much of the increase relates to emergency inpatient episodes, which have increased by 47% as opposed to elective inpatient episodes which have only increased by 8.6%. Over the same time period elective day case episodes have risen by 50% (from around 520,000 per annum to around 780,000 per annum)192.
Cancer incidence in England is projected to increase by 25% over the next 15 years, mostly due to the anticipated effects of population growth and ageing. Given the projected increase in the incidence of cancer within the population, bed utilisation for cancer is likely to increase rapidly unless action is taken. Department of Health analysis suggests that, unless actions are taken to reduce lengths of stays and avoidable admissions, inpatient costs for cancer are expected to increase by 24% in the same period. The increase will differentially affect certain groups.
For example, inpatient costs for the over 70s are expected to increase by
37% compared to 13% for the under 70s192.
To maintain inpatient costs at current levels, it is estimated that average length of stay would need to reduce by a third. Alternatively emergency admissions would need to reduce to 50% of current levels192.
The programme budget cost for NHS Rotherham for all cancers and tumours in 2007-8 was £23,722,000.
191
192
Department of Health (2007), Cancer Reform Strategy, p96
Department of Health (2007), Cancer Reform Strategy, p97
- 108 4.5
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic condition, which is usually symptomatic from middle age.
18% of male smokers and 14% of female smokers in the UK have COPD. It is a significant reason for hospital admissions and lost working days 193. It is currently the 5th leading cause of death in the UK, with over 30,000 people dying each year from end stages of the disease. The direct cost to the NHS of
COPD is almost £500 million per year and the estimated annual cost of treating a patient with severe COPD is £1,307194.
A recent American Lung Association survey revealed that 51% of all COPD patients say that their condition limits their ability to work. 70% are limited in normal physical exertion, 56% in household chores, 53% in social activities,
50% in sleeping and 46% in family activities193. Although the level of COPD in males appears to have peaked in the UK, it continues to rise in females. The cumulative effect of an ageing population and the higher smoking levels amongst women is likely to increase the present burden of COPD in the UK 194.
In Rotherham 121 people died from COPD in 2008, which equates to an age standardised mortality rate of 28.7 deaths per 100,000 of the population. This was higher than the national rate of 27.2 but less than the regional rate of 31.1.
Mortality rates are higher in men than women195.
There were 5,821 patients on Rotherham GP registers with COPD in July
2010196. This is below the predicted prevalence of 7,355197. This indicates significant levels of under-reporting. The British Lung Foundation reports that there may be as many as 3.7 million people with the disease in the UK compared with the 900,000 on GP registers194. According to QOF data the recorded prevalence is 1.5% in England in 2008/09198, compared with an expected prevalence of 3.6% in adults over 16 years)197.
In 2009/10 there were 1,509 hospital admissions from Rotherham registered patients. Of these 1,127 were emergency admissions. These figures equate to
4.2 and 3.1 per 1,000 patients199. Examination of data on hospital admissions for Rotherham from 2002-06 shows an increase in COPD admissions for BME groups. Hospital admissions from BME groups for COPD rose by 42% from
2002-06. The standardised admission ratio for BME groups in Rotherham was
113.2 (Rotherham = 100). For the Pakistani community this rises to 182.2 demonstrating that COPD is a significant risk for this group104.
The Disease Management Information Toolkit (DMIT)200 indicates that the number of emergency bed days used in Rotherham was 118 per 100 people on the QOF COPD (2006-07). NHS Rotherham was ranked 96 out of 152 PCTs, which suggests Rotherham performs fairly poorly against other PCTs. The hospital admission rate in Rotherham was 15.8 per 100 people on the disease
193
DWP (2008), Prevalence of COPD (www.dwp.gov.uk/medical/med_conditions/major/copd/prevalence_copd.asp)
British Lung Foundation (2007), Invisible Lives – COPD Finding the Missing Millions
195
NHS Information Centre (2009), Mortality from bronchitis, emphysema and other chronic obstructive pulmonary disease
(www.nchod.nhs.uk)
196
Quality and Outcomes Framework (2010) COPD register size (www.qmas.nhs.uk)
197
Eastern Region Public Health Observatory (2008) Modelled estimated and projections of COPD for local authorities in England
(http://www.erpho.org.uk/ViewResource.aspx?id=18024)
198
NHS Information Centre, QOF Disease Prevalence 2008-09 (www.ic.nhs.uk)
199
Hospital Episode Statistics, Inpatient Minimum Data Sets via Secondary Uses Services (SUS) (2010)
200
Department of Health (2008), Disease Management Information Toolkit
194
- 109 register, which is above the national average of 13.6. The average length of hospital stay in Rotherham was 7.7 days, slightly below the national average of
7.9 days. Rates of admission increased by 3.8% over the previous year compared with a national average decrease of -0.4%. DMIT estimates that a reduction in Rotherham‟s admission rate to the national average would save
£213,367/year. The number of emergency bed days and length of stay are decreasing but at a rate that is 3-4% less than the national average.
4.6
Infectious Diseases
4.6.1 Tuberculosis
Tuberculosis is the world‟s leading cause of death by a curable infectious disease. About 9 million new cases and 2 million deaths are estimated to occur around the world every year. Around 9,000 cases of
TB are currently reported each year in the United Kingdom. Most cases occur in major cities, particularly in London201.
In 2009 in the UK, 9,153 TB cases were provisionally reported to enhanced national surveillance, a rate of 14.9 per 100,000 population.
This represents a 5.5% increase compared with the number of cases provisionally reported in 2008.
In England, London continues to account for the largest proportion of cases reported (41%), followed by the West Midlands (12.3%). A rise in cases was seen in eight out of nine regions, with only the North East showing a decrease (-2%). 73% of cases were in persons who were born outside the UK, of whom the majority were from South Asia (55%) and sub-Saharan Africa (30%). Only 21% of non-UK born cases were diagnosed within two years of entering the UK. Individuals aged 15-44 years accounted for 60% of reported cases; 21% were 45-64 years old,
15% were 65 years and over and 5% of cases were aged under 15 years. Overall, 55% of cases were male, though females made up 54% of cases aged less than 15 years. 53% of cases were reported to have pulmonary disease. Of these, 57% had a reported smear result, of which 57% were sputum-smear positive202.
One of the biggest issues relating to tuberculosis treatment is the increase in drug resistant strains of the disease. Levels of drug resistance remain stable and resistance is more common amongst younger people and those born outside the UK.
In Rotherham there were 16 new cases of tuberculosis diagnosed in
2006-08 which equates to 6.0 cases per 100,000 of the population203.
201
Tuberculosis, Health Protection Agency (2010) (www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis )
Tuberculosis Update, Health Protection Agency (2010)
203
Table 2a, Three year average tuberculosis case reports and rates by Primary Care Trust, England 2006-2008. TB Tables and Figures
[Online] Health Protection Agency, September 2009
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis/EpidemiologicalData/TBUKSurveillance/TBTablesAndFig ures/t btable2a/) 202
- 110 4.6.2 Sexually Transmitted Infections and HIV
4.6.2.1 Overview
New figures released today by the Health Protection Agency show that 15 to 24 year olds, particularly young women, continue to be the group most affected by sexually transmitted infections (STIs) in the UK.
In 2009 a total of 482,696 new STI diagnoses were reported to the agency from sexual health clinics across the UK and community based Chlamydia testing. This is almost 12,000 more cases than were reported in 2008 when there were
470,701 new diagnoses, continuing the steady upward trend we have seen over the past decade as illustrated in figure 1.
Figure 30: Number of new STI episodes seen at genitourinary medicine clinics by gender: 2000-2009
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
Last year around two thirds of new STI diagnoses in women were in those under 25. In women, 73% (3,955 out of 5,434) of all new gonorrhoea diagnoses and 66% (27,626 out of 42,095) of all new genital warts were in the under 25s. Of all women diagnosed with Chlamydia 88% (112,334 out of 127,741) were under 25 – this is in part due to more sensitive tests and community based testing targeting the under 25s in England.
In men, over half of new STI diagnoses were in those aged under 25. They accounted for 41% (4,683 out of 11,541) of male gonorrhoea diagnoses, 47% (22,972 out of 49,105) of male genital warts and 69% (58,170 out of 84,863) of male
Chlamydia diagnoses. High rates of STI diagnoses have also been found among men who have sex with men.
The peak age for an STI in women is between 19 and 20 years and in men between 20 and 23 years. Of all the 15-24 year
- 111 olds diagnosed with an STI last year around one in ten of these will become re-infected within a year204.
Sexually Transmitted Infections (STIs) are diseases that can be transmitted through unprotected sex. Sexual health problems are more prevalent in low-income groups and those that are hard to reach. The most vulnerable groups include; asylum seekers and refugees, sex workers and their clients, homeless people and young people in or who are leaving care. Other high risk groups include gay men, some black and minority ethnic groups and young people.
The latest overall UK-wide figures show:
Chlamydia diagnoses increased by 7% (from 203,773 in
2008 to 217,570 in 2009)
Gonorrhoea diagnoses increased by 6% (from 16,451 in
2008 to 17,385 in 2009)
Genital herpes diagnoses increased by 5% (from 28,807 in
2008 to 30,126 in 2009)
Genital warts diagnoses stabilised decreasing by just 0.3%
(from 91,503 in 2008 to 91,257 in 2009)
Syphilis diagnoses also stabilised decreasing by just 1%
(from 3,309 in 2008 to 3,273 in 2009)204
In 2009 Rotherham saw a higher rate of diagnoses for all of the major STIs, with the exception of gonorrhoea, than England.
The rate of Chlamydia diagnoses in the 15-24 age group was particularly high for Rotherham compared to the national average (Figure 2).
Figure 31: Rates of selected STI & acute STI diagnoses per
100,000 population for Rotherham and England
(2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
204
Sexually transmitted infections reach almost half a million. Health Protection Agency. [Online] August 2010.
(http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1281953109509 )
- 112 4.6.2.2 Chlamydia
Genital Chlamydial infections were the most common form of
STI diagnosed in GUM clinics in the UK in 2009. In Rotherham, the male group aged 20-24 has the highest number of diagnoses and lower numbers in the 16-19 and 35+ groups.
There are higher numbers amongst younger women (16-19 and
20-24 year olds), with a sharp increase in these groups between
2006-07.
Figure 32a: Numbers of diagnosis of uncomplicated genital chlamydial infection by sex (males) and age group in Rotherham (1995-2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
- 113 Figure 32b: Numbers of diagnosis of uncomplicated genital chlamydial infection by sex (females) and age group in Rotherham (1995-2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
Approximately 50% men and 70% women with Chlamydia do not have any symptoms. If left untreated, genital Chlamydial infection can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Due to the high proportion of asymptomatic infection, the National Chlamydia Screening
Programme (NCSP) offers opportunistic screening for
Chlamydia, with the aim of detecting asymptomatic infection in sexually active men and women under the age of 25 who would not otherwise access, or be offered a Chlamydia test. The Vital
Signs Indicator, VSB13: Chlamydia Prevalence (Screening), measures the proportion of the 15-24 year old population tested for Chlamydia and for the first time will include screening that takes place outside GUM clinics. The Government has set a target for the 2008/09 period of screening 17% of the target population. In 2008/09 Rotherham achieved this target by screening 19.7% of the target population. In 2009/10 the percentage screened increased to 25.7%205.
4.6.2.3 HIV
The number of people living with HIV in the UK continues to rise, with an estimated 83,000 infected at the end of 2008, of whom over a quarter (27%) were unaware of their infection.
During 2008, there were 7,298 new diagnoses of HIV in the UK.
This represents a slight decline on previous years, predominantly due to fewer diagnoses among black African women who acquired their infection abroad. New diagnoses
205
Department of Health. Vital Signs 2010/11 refresh documents. Tiers 1 and 2 Technical Guidance : Unify, 2010
- 114 among men who have sex with men remained high in 2008 and an estimated four out of every five acquired their infection in the
UK.
New HIV diagnoses among those who acquired their infection heterosexually within the UK have risen, from an estimated 740 in 2004 to 1,130 in 2008.
The number of deaths among HIV-infected people has remained stable over the past decade and the number of AIDS diagnoses has continued to decline. A total of 525 people (387 men and 138 women) infected with HIV were reported to have died in 2008. Of these, 57% and 73% had been diagnosed with a CD4 cell count
ROTHERHAM
May 2011
-2-
Table of Contents
What is a Joint Strategic Needs Assessment (JSNA)? ...................................................
Why do we need a JSNA? ..............................................................................................
1.
Demographic Profile
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
1.10
1.11
1.12
2.
6
6
Population Numbers ..................................................................................
Age Profile ................................................................................................
Gender Profile ...........................................................................................
Birth Rate ..................................................................................................
Black and Minority Ethnic (BME) Population Profile ..................................
Disability Profile ........................................................................................
Population by Religious Group ..................................................................
Population by Migrant Status ....................................................................
Number of Households .............................................................................
Analysis of Areas of Deprivation ...............................................................
Social Marketing Categories and Urban/Rural Classification ....................
Sexuality ...................................................................................................
7
7
10
11
12
16
20
21
21
23
25
25
Social and Environmental Needs Assessment
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8
2.9
2.10
2.11
2.12
2.13
2.14
2.15
2.16
2.17
2.18
2.19
2.20
2.21
2.22
2.23
2.24
RMBC Strategic Housing Role ..................................................................
Council Housing Stock ..............................................................................
Private Sector ...........................................................................................
Housing Tenure ........................................................................................
Ethnicity ....................................................................................................
Overcrowding ............................................................................................
Living Alone ..............................................................................................
Summary of Housing Demand in Rotherham ............................................
Condition of Stock .....................................................................................
Affordable Warmth and Fuel Poverty ........................................................
Energy .......................................................................................................
Empty Properties ......................................................................................
Affordability ...............................................................................................
Household Income ....................................................................................
Central Heating .........................................................................................
Access to Car or Van ................................................................................
Overall Employment Rate .........................................................................
Working Age People on Out-of-Work Benefits (NI 152) ............................
Number on Out-of-Work Benefits in Worst Performing Areas (NI153) ......
Contact with Mental Health Services whilst Employed (NI 150) ................
Unemployment Rate .................................................................................
Claimant Count .........................................................................................
Recent National Economic Down-Turn .....................................................
Average Incomes ......................................................................................
26
26
27
27
28
29
30
31
33
34
36
37
38
40
42
43
44
46
47
47
48
49
49
50
-32.25
2.26
3.
Smoking ....................................................................................................
Eating Habits .............................................................................................
Alcohol ......................................................................................................
Physical Activity ........................................................................................
Obesity ......................................................................................................
General profile of burden of ill health ........................................................
Diabetes ....................................................................................................
Circulatory Diseases .................................................................................
Cancer ......................................................................................................
Chronic Obstructive Pulmonary Disease (COPD) .....................................
Infectious Diseases ...................................................................................
Trauma ......................................................................................................
Musculoskeletal ........................................................................................
70
84
88
97
108
109
114
115
Mental Health Needs Assessment
5.1
Introduction ...............................................................................................
5.2
National Picture .........................................................................................
5.3
Local Picture .............................................................................................
5.4
Differences in the Extent of Mental Health Problems ................................
5.5
Local Services ...........................................................................................
5.6
Financial Costs - National Level ................................................................
5.7
Financial Costs - Local Level ....................................................................
5 .8
User Involvement ......................................................................................
5 .9
Emerging Patterns ....................................................................................
Appendix 1 – Indices of Multiple Deprivation .......................................................
6.
54
56
57
63
66
Burden of Ill Health
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
5.
51
53
Lifestyle and Risk Factors
3.1
3.2
3.3
3.4
3.5
4.
Access to Services ....................................................................................
Satisfaction of People Over 65 with Home and Neighbourhood (NI 138) ..
118
119
120
131
141
147
147
151
152
153
Learning Disability Needs Assessment
6 .1
6.2
6 .3
6.4
6.5
6.6
6.7
6 .8
6.9
6.10
6.11
Numbers of People with a Learning Disability ...........................................
Expenditure for Learning Disabilities in Rotherham for 2009/10 ...............
Local Analysis ...........................................................................................
BME Population – National Analysis .........................................................
BME Population – Rotherham in 2010 ......................................................
Life Expectancy of People with Learning Disabilities ................................
Health of People with Learning Disabilities in Rotherham .........................
Employment ..............................................................................................
Housing .....................................................................................................
Residential and Nursing Care in Rotherham .............................................
Community Based Services for People with Learning Disabilities ............
154
155
156
160
160
161
161
164
165
166
167
-46.12
7.
169
169
170
174
177
178
180
183
Early Access for Women to Maternity Services (NI 126) ...........................
Number of People Accessing NHS Dentistry ............................................
Uptake Rates for Seasonal Flu Jab ..........................................................
Screening for Breast Cancer .....................................................................
Access to GUM services ...........................................................................
Long Acting Reversible Contraception Methods .......................................
Access to NHS Funded Abortions before 10 weeks‟ Gestation ................
187
187
189
191
193
193
194
User Perspective on Social and Health Care
9.1
9.2
9.3
9.4
9.5
9.6
9.7
9.8
9.9
9.10
9.11
9.12
10.
National Profile of Need for Social Care ....................................................
Promoting Independence and Developing Community Support ................
Rotherham Profile of Need for Adult Social Care ......................................
Informal Care Needs Analysis ...................................................................
Home Care Services .................................................................................
Residential Care .......................................................................................
Intermediate Care .....................................................................................
Analysis of Community-Based Provision ...................................................
Access To Health Services
8.1
8.2
8.3
8.4
8.5
8.6
8.7
9.
168
Social Care Needs Assessment
7.1
7.2
7.3
7.4
7.5
7.6
7.7
7.8
8.
Carers .......................................................................................................
Support Older People Receive in order to Live Independently at Home ...
Respect and Dignity in their Treatment (NI128) ........................................
User Perspective on Social and Health Care –
Neighbourhoods and Adult Services (NAS) Research .............................
Patient Survey Programme Findings for Local Institutions
Patient Survey of Local Community Mental Health Services .....................
Patient Survey of Local Community Health Services .................................
Patient Survey of Local In-Patient Services – RFT ....................................
Patient Survey on Access to Primary Care ................................................
Patient Survey on Choice to Primary Care .................................................
Black Minority Ethnic (BME) Mental Health Consultation Event .................
Consultation with Focus Groups and Individual Interviews ........................
Consultation at Fair‟s Fayre ......................................................................
198
198
198
207
208
209
210
211
213
213
213
219
Children and Young People’s Needs Assessment
10.1
10.2
10.3
10.4
10.5
10.6
General Health ..........................................................................................
Proportion of Children in Poverty ..............................................................
Prevalence of Breast Feeding at 6 to 8 Weeks from Birth .........................
Teenage Pregnancy (Under 18 and Under 16 Conception rates) .............
Obesity among Primary School Age Children in Reception Year and
Year 6 ........................................................................................................
Infant Mortality ..........................................................................................
221
222
223
225
227
229
-510.7
10.8
10.9
10.10
Uptake of Chlamydia Screening in Under 25s ..........................................
Percentage DMFT in 5 Year Olds .............................................................
Children Killed or Seriously Injured on Roads (persons under 16 years) ..
Proportion of Children who Complete Immunisation by Recommended
Ages ..........................................................................................................
10.11 Parental Experience of Services for Disabled Children .............................
11.
229
229
230
233
234
Area Assembly Needs Profile
11.1
11.2
11.3
11.4
11.5
11.6
11.7
Rother Valley South ..................................................................................
Rother Valley West ...................................................................................
Rotherham North ......................................................................................
Rotherham South ......................................................................................
Wentworth North .......................................................................................
Wentworth South ......................................................................................
Wentworth Valley ......................................................................................
244
247
249
251
254
256
258
Glossary ........................................................................................................................
261
-6-
What is a Joint Strategic Needs Assessment (JSNA)?
The Joint Strategic Needs Assessment (JSNA) establishes the current and future health and social care needs of a population, leading to improved outcomes and reductions in health inequalities. The JSNA informs the priorities and targets set by Local Area
Agreements, leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities throughout the Borough.
The JSNA marks the beginning of a process which will inform service reconfiguration, commissioning and decommissioning of services. The JSNA will evolve over the coming months and years as the demographic and health profile of the population changes. Information gathered in the Joint Strategic Needs Assessment will be used to create a needs profile for Rotherham. It will be used to target resources at those in most need.
Why do we need a JSNA?
Since 1 April, 2008, Local Authorities and Primary Care Trusts are under a statutory duty under the Local Government and Public Involvement in Health Act to produce a
Joint Strategic Needs Assessment (JSNA).
The Operating Framework for the NHS in England 2008/2009 refers to the importance of the JSNA in informing PCT Operational Plans. The JSNA underpins a number of the
World Class Commissioning competencies.
The JSNA forms the basis of the new duty to co-operate. This partnership duty involves a range of statutory and non-statutory partners, informing commissioning and the development of appropriate, sustainable and effective services.
Joint Strategic Needs Assessment Core Dataset
This document fully complies with the Department of Health’s JSNA Core Dataset, published on 1st August, 2008. It focuses on health and social care needs, breaking these down to Area Assembly level so a good understanding of these needs can be established for joint commissioning purposes.
-7-
1.
Demographic Profile
1.1
Population Numbers
Rotherham is one of four metropolitan boroughs in South Yorkshire, covering an area of 118 square miles with a population of 253,900 (2009). The population of Rotherham has been rising by 1.0% (2,600) since 2004 and 1.8%
(4,500) since 2002.
Population projections suggest that the population of Rotherham will increase by 5.1% to 266,900 by 2020 and by 9.8% to 278,900 by 2030. The projected increase is the result of rising life expectancy, natural increase (more births than deaths) and migration into the Borough.
The Borough is divided into 21 wards, grouped into 7 Area Assemblies as follows: Rother Valley South – Dinnington, Anston & Woodsetts and Wales
Rother Valley West – Brinsworth & Catcliffe, Holderness and Rother Vale
Rotherham North – Rotherham West, Keppel and Wingfield
Rotherham South – Boston Castle, Rotherham East and Sitwell
Wentworth North – W ath, Swinton and Hoober
Wentworth South – Rawmarsh, Silverwood and Valley
Wentworth Valley. – Wickersley, Hellaby and Maltby
About half of the population lives in and around the main urban area of
Rotherham town. The remainder lives in satellite towns such as Wath,
Dinnington and Maltby and in rural areas1.
Rotherham comprises a diverse and vibrant blend of people, cultures and communities. It is made up of a mix of urban areas and rura l villages, interspersed with large areas of open countryside. About 70% of the Borough area is rural, but it is well connected to all areas of the country by its proximity to the motorway network and intercity rail networks. Rotherham‟s traditional steel and coal industries have largely given way to new industries in an economy which grew rapidly in the 1995 – 2005 period.
1.2
Age Profile
There are approximately 197,500 adults currently living in Rotherham (2009).
57,800 people are aged 60 and over (22.8%), 102,800 are aged 30 to 59 years
(40.5%) and 37,000 are aged 18 to 29 years (14.6%). In addition, there are
56,400 (22.1%) children aged 0 to 17 years.
The age profile of the Borough population is shown in Figure 1.1.
Rotherham has more people aged over 50 (1 in 3 people) than people under 16
(1 in 5 people). Rotherham has 90,200 people aged 50 or over which equates to 35.5% of the total population and this proportion is rising.
1
RMBC 2007 Area Assembly Profiles (www.rotherham.gov.uk)
-8Distribution of Older People
Figure 1.1: Age Profile of Rotherham
Rotherham
60 and over
22.8%
30 to 59
40.5%
18 to 29
14.6%
5 to 17
0 to 4
0.0%
16.1%
6.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
Rotherham
Source: Mid Year Estimates 2009
The most significant demographic change occurring in Rotherham is the growth in the number of older people which is shown in Figure1.2. The number of people over 65 will increase by more than a half by 2028, from 4 1,500 to
61,400. The number of people over 85 will almost double (+96%) from 5,000 to
9,800 by 2028. Although people will tend to remain healthy for longer than they do now, the rising numbers of older people will have major implications for health and adult social care services, informal care and all services used by older people.
Figure 1.2: Projected Growth in the over 65 population from 2008 to 2028
18,000
16,000
2008
2028
Population
14,000
12,000
10,000
8,000
6,000
4,000
2,000
0
65 to 69
Source: 2008 Population Projections
70 to 74
75 to 79
80 to 84
85 and over
-9Figure 1.3: Projected Growth in over 65 population from 2008 to 2028
Population aged 65+
65
60
Thousands
55
50
45
40
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
35
Source: 2008 Population Projections
The number of people aged 65+ is projected to increase at a steady rate over the next twenty years. The number is projected to increase by 48% from
41,500 to 61,400.
Figure 1.4: Projected Growth in over 85 population from 2008 to 2028
Population aged 85+
10.0
9.0
Thousands
8.0
7.0
6.0
5.0
20
08
20
09
20
10
20
11
20
12
20
13
20
14
20
15
20
16
20
17
20
18
20
19
20
20
20
21
20
22
20
23
20
24
20
25
20
26
20
27
20
28
4.0
Source: 2008 Population Projections
The steady increase in the 65+ population hides a much faster rise in the population aged 85+ which is projected to increase by 96% between 2008 and
2028. The rate of increase is projected to rise after 2014, peaking between
2020 and 2025 when there will be 29% growth over 5 years.
- 10 1.3
Gender Profile
In Rotherham, there are 129,400 (51%) females and 124,400 (49%) males, which is very similar to the national average. The age and gender distribution of Rotherham‟s population is similar to the national profile, although Rotherham has a slightly lower proportion of young adults (20-34). Figure 1.3 shows the age and gender structure of Rotherham compared to England and Wales in
2009.
Office of National Statistics data illustrates that up to the age of 72 years the number of males and females are fairly equal. From the age of 73 years the proportion of females to males increases significantly2. 2.9% of the female population are over 85 years compared to 1.4% for men. There are 3.7 women for every man aged over 90 years. The rising population imbalance between males and females as old age progresses results from women‟s higher life expectancy. 62% of the entire population are of working age, of these 51.1% are under 40 years of age.
Figure 1.5 also shows a relatively low proportion of people aged 30-34 years which reflects the low birth rates from the mid to late 1970s. Likewise, the high proportion aged 40-45 reflects high birth rates in the early 1960s.
Figure 1.5: Age and gender profile
Broken down by percentage of male/female population
Rotherham
9.0%
8.0%
7.0%
6.0%
5.0%
Males
4.0%
Females
3.0%
2.0%
1.0%
0.0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 to to to to to to to to to to to to to to to to to to +
4 9 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89
Age Group
Source: Mid Year Estimates 2009
2
Office of National Statistics 2009 Live Births
- 11 England and Wales
9.0%
8.0%
7.0%
6.0%
5.0%
Males
4.0%
Females
3.0%
2.0%
1.0%
0.0%
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 to to to to to to to to to to to to to to to to to to +
4 9 14 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89
Age Group
Source: Mid Year Estimates 2009
1.4
Birth Rate
The birth rate in Rotherham has been steadily increasing since 2002
(Figure 1.6). Live births decreased from over 3,700 in 1991 to 2,730 in 2001.
Since then the numbers of births has increased each year to 3,300 in 2008 before dropping slightly in 2009 to 3,200. There has been an average increase of about 60 live births each year over the last eight years. This increase in birth rate reflects similar increases nationally.
Figure 1.6: Number of Births in Rotherham between 1959 to 2009
Source: Office of National Statistics 2998, Live Births
The Total Fertility Rate (TFR) for 2009 shows an average of 1.96 children per woman in England and Wales. This represents a small decrease in fertility from 1.97 children in 2008. This is the first annual decrease since 2001 when the TFR fell to 1.63 from 1.65 in 2000. The TFR for 2009 is still comparably high. In 2008 the TFR was at its highest point in 35 years. The provisional
- 12 General Fertility Rate (GFR) for 2009 was 63.7 live births per 1,000 women aged 15-44, a decrease compared with 63.8 in 2008.
In 2009, there were decreases in fertility rates for women aged under 30 and increases for women aged 35 and over, compared with 2008; fertility rates for women aged 30–34 remained unchanged. The largest percentage decrease
(2.7 per cent) occurred among women aged under 20. For this age group the fertility rate fell from 26 live births per thousand women aged under 20 in 2008 to 25.3 in 2009. The standardised average (mean) age of women giving birth increased slightly to 29.4 in 2009 from 29.3 in 2008. The figure for 2009 is the highest on record. The sex ratio at birth for 2007 was 1,052 live males per
1,000 live females born.
There was a continued rise in the proportion of births to mothers born outside the UK: 24.7 per cent in 2009 compared with 24.1 per cent in 2008. In 1999,
14.3 per cent of births were to non-UK born mothers.
1.5
Black and Minority Ethnic (BME) Population Profile
Rotherham‟s Black and Minority Ethnic (BME) population is relatively small but has been growing and becoming increasingly diverse. Rotherham MBC estimates that there are 19,000 people from BME communities in 2009 which equates to 7.5% of the local population (5.6% are non-white), with 92.5% from the White British population3. By comparison in 2001, 4.1% of the population were from BME communities, suggesting that the number of BME residents has almost doubled over the last eight years.
BME residents are fairly evenly divided between those born in the UK and those born abroad, the latter being more likely to have limited English language skills. Figure 1.7: Projected BME Population Growth in Rotherham between
2005 and 2030
Source: BME Health Needs Assessment 2008, Black a nd Minority Ethnic Populations in Rotherham
(page 12)
In 2006, Yorkshire Futures produced population projections by ethnic group.
Figure 1.7 illustrates the projection for Rotherham which suggests a 61% increase in the non-White population between 2005 and 2030. Of the total of
3
Rotherham MBC Population Estimates by Ethic Group 2009
- 13 17,600 non-white residents projected for 2030, about 11,400 would be Asians.
However, the fact that Rotherham‟s BME population more than doubled in the
13 year period 1991-2004, and that non-white residents already number about
14,000 suggests that this projection may underestimate the likely rate of growth. Immigration and natural increase means that Rotherham‟s black and minority ethnic population has continued to grow in recent years, reaching 19,000 people. The white minority population (mainly European) was estimated to have a population of about 3,000 in 2004, rising to 4,000 in 2006 and an estimated at 5,000 in 2009. Most minority ethnic groups have young populations, notably the Kashmiri and Pakistani. There is a growing mixed or dual heritage population, the majority of who are children and young people.
The Irish community is an exception, being much older than average.
Figure 1.8: BME Population Breakdown in Rotherham – Mid-Year
Estimates 2009
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
The largest BME community is that from Pakistan and Kashmir which constitutes 3.0% of the overall population, higher than the average of 1.5% in
England and Wales. The Kashmiri and Pakistani community is well established in Rotherham following initial migration in the 1960s and 1970s. There are also much smaller established communities such as Chinese, Indian and Irish. The fastest growing population is the Black African community and other new communities, including migrant workers from Eastern Europe, have also settled in Rotherham which now has a Roma community of around 2,000 people.
- 14 Figure 1.9: Number of People in each Ethnic Group in Rotherham in 2009
Ethnic Group
White British
White Irish
White Other
White and Black Caribbean
White and Black African
White and Asian
Other Mixed
Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Black Other
Chinese
Other Ethnic
No. of People
234,900
1,100
3,900
400
100
700
400
700
7,600
100
700
200
1,500
200
600
800
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
Figure 1.9 shows the breakdown of the numbers of people from each BME community who are living in Rotherham. The largest number of people who are from minority ethnic groups are those from the Pakistani (and Kashmiri) community (7,600) which equates to 40% of the BME population in Rotherham.
3,900 people (20.5%) are from the White Other ethnic group which includes EU migrant workers from other European countries such as Poland and Slovakia.
Further migration from European countries may result in continued growth in the years ahead.
Figure 1.10: Gender by Ethnic Origin of all Ethnic Groups in Rotherham in
2008
Source: BME Health Needs Assessment 2008, Black and Minority Ethnic Populations in Rotherham, p13
Figure 1.10 provides a gender breakdown across all BME communities. It shows that white minority ethnic communities, Indian and Black groups have a larger number of men in contrast to women.
People from Pakistani/Kashmiri origin have a similar gender balance to the
White British population, whilst the Chinese community has a higher proportion of women. The higher proportion of men amongst certain BME groups in
- 15 Rotherham is likely to reflect economic migration with men moving to
Rotherham to find employment. This trend is more significant amongst more recent migrant groups where two thirds are often male.
Figure 1.11: Population Structure of Different Ethnic Groups in
Rotherham 2009
Ethnic Group
Total
Number
1,600
7,600
800
600
800
234,900
700
1,900
3,900
1,100
253,900
Mixed
Pakistani
Other Asian
Chinese
Other
W hite British
Indian
Black
W hite Other
W hite Irish
All People
%
Population
aged 0-15
0.39%
1.18%
0.08%
0.04%
0.12%
16.86%
0.04%
0.16%
0.47%
0.04%
19.38%
%
Population
aged 16+
0.28%
1.81%
0.24%
0.20%
0.20%
75.62%
0.24%
0.59%
1.06%
0.39%
80.62%
Source: Rotherham MBC Population Estimates by Ethnic Group 2009
Figure 1.11 provides an insight into the children to adults for each of
Rotherham‟s BME population. Some BME communities have a significantly younger age profile than the general population of the Borough. The percentage of the Pakistani community under 15 years (1.18%) is around 60% of the adult population total and the Mixed community have more children than adults. This reflects a significantly higher birth rate for the Pakistani and Mixed ethnic groups. There is a big difference in the White British community where the adults outnumber the 0-15 population by approximately 5 to 1.
In contrast, the Mixed and Pakistani ethnic groups have a much smaller proportion of their population aged 65 and over (less than one seventh of the general population). The largest non-White British community is Pakistani with an estimated 550 elders (55 years of age+)4. BME communities have a younger age profile compared to the general population. The child population of Rotherham is far more ethnically diverse than that of the older population.
Figure 1.12: Percentage of BME pupils in each Area Assembly in Rotherham
60.0%
BME Pupils
50.0%
40.0%
30.0%
20.0%
10.0%
W es ot t he rh am
N
or
R
th ot he rh am
So
ut
W
h en tw or th
N
or
W
th en tw or th
So
W ut h en tw or th
Va
ll e y R
ot he rV
R
R
ot he rh
Va
lle y al le y
So
ut h 0.0%
Source: PLASC Data 2010
4
Rotherham State of the Borough 2008 A Statistical Portrait, p14
- 16 Figure 1.12 provides a breakdown of the BME pupils by Area Assembly in
2010. This shows that 52% of BME pupils live in Rotherham South. The distribution of pupils shows a similar pattern to the distribution of BME residents in the 2001 Census, 4,809 of who lived in the Rotherham South, 48% of the
Borough‟s BME population. Only three wards – Rotherham East, Rotherham
West and Boston Castle – had significant minority ethnic populations in 2001, with 61% of Rotherham‟s non-white population and 77% of the Pakistani and
Kashmiri population. Data on pupil ethnicity shows that increasing numbers of
BME families live in Sitwell ward. Rotherham North had the second largest
BME population with 1,746 people (17%) in 2001. In comparison, there were
562 people (6%) living in Wentworth North which had the smallest BME population5. Within Rotherham South, BME communities are particularly concentrated in
Eastwood, Ferham, Masbrough, Wellgate and Broom Valle y which are mainly deprived areas close to the town centre. These are the original settlement areas for the Kashmiri and Pakistani community. Since 2001, there has been some movement of Pakistani and Kashmiri families to suburban areas in
Broom.
1.6
Disability Profile
Sensory Impairment – Blind/Partially Sighted
In 2008 there were 152,980 people in England and Wales registered blind.
This is a slight increase of 525 people (0.3%) from March 2006. There were
10,300 new registrations in 2008, a fall of 5% compared to 20066. There were approximately 156,285 people in England registered as partially sighted, an increase of 1,085 people since 2006. There were approximately 13,200 new registrations in 2008, a fall of 8% compared to 20067.
The leading cause of certifications for blindness is degeneration of the macula and posterior pole (57.2%) which largely comprises Age-related Muscular
Degeneration (AMD). This is the leading cause of blindness amongst older people, in particular for the age group 75 years and over. Other common causes of certification are glaucoma (10.9%), diabetic retinopathy (5.9%), optic atrophy (3.1%), hereditary retinal disorders (2.8%) and cerebrovascular disease/accidents (2.5%)8. Common causes of certification among partially sighted people are: degeneration of the macula and posterior pole (56%), glaucoma (10.2%), diabetic retinopathy (7.4%), cerebrovascular disease
(4.9%), hereditary retinal disorders (2%), optic atrophy (1.9%), myopia (1.9%) and retinal vascular occlusions (2%)8.
Figure 1.13 provides a national breakdown by age of the number of people on the blind and partially blind registers.
5
Census 2001 BME Population
National Statistics 2006 Registered Blind and Partially Sighted, p(i)
7
National Statistics 2008 Council Tables – Blind and Partially Sighted, pPS1
8
Public Medical Health 2009 Research and Development, Leading Causes of Blindness
6
- 17 Figure 1.13: % of People on Blind or Partially Sighted (P/S) Register by
Age Group in England 1994-2008
Category
1994
1997
2000
2003
2006
2008
0-4
Blind P/S
0
1
1
1
0
0
0
0
0
0
1
0
5-17
Blind P/S
2
2
2
2
2
2
2
3
2
3
3
3
18-49
Blind P/S
10
10
10
10
10
9
11
10
12
10
13
11
50-64
Blind P/S
8
8
8
8
8
8
9
8
10
9
10
9
65-74
Blind P/S
11
12
10
12
10
11
10
11
10
10
10
10
75 and
Over
Blind P/S
68
68
69
68
69
69
67
68
66
68
64
68
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, p6
Nationally the proportion of young people registered blind is increasing, in particular in the 18-49 age range. The number of blind people aged 75 and over is falling, with a 5% reduction in the last ten years from 69% to 64%.
However, the local picture is different to the national one. In Rotherham there were 860 people on the blind register in 2008, a reduction of 325 people since
2006. This reduction may be due to recent data cleansing of the local register.
There are a total of 1,365 people who are on the partially sighted register, a decrease of 95 people since 20069. Information for this register is obtained by the completion of SSDA902 returns by all Councils with Adult Social Services
Responsibilities (CASSRs) on an annual basis to capture the number of people who are blind or partially sighted under Section 29 of the National Assistance
Act, 1948.
Figure 1.14: Number of people registered blind/partially sighted by age group in Rotherham in 2008
Blind
Partially Sighted
3%
4%
13%
11%
0-18 years
10%
11%
18-49 years
50-64 years
65-74 years
63%
10%
64%
11%
75 and over
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, pB1
Figure 1.14 provides an age profile of those who are registered blind or partially sighted in Rotherham. Approximately 63% of blind/partially sighted people in
Rotherham are over 75 years of age. There has been an increase in the number of people registered blind in the 65 to 74 age group.
There has also been a reduction in the number of people registered blind between 18 and 49 years and 75 and over. In 2008 there were 95 new registrations for blind people compared to 85 new registrations in 2006. Of these 16% were between 50 and 64 years, 11% between 65 and 74 years and
63% who are 75 years and over. There has been a larger increase in the number of new registrations by people between 50 and 64 years10.
9
National Statistics (2007), Deaf and Hard of Hearing, pPS1
National Statistics 2007, Deaf and Hard of Hearing, pB2
10
- 18 Figure 1.15 shows the predicted future prevalence rates of people with a serious visual impairment who will require help with daily activities. These prevalence rates have been derived from ONS population projections.
Figure 1.15: No. of people projected to have a serious visual impairment and requiring help with daily living in Rotherham. 2010-2030
25
20
18 - 2 4 ye a rs
15
2 5 - 3 4 ye a rs
10
3 5 - 4 4 ye a rs
4 5 - 5 4 ye a rs
5
0
2010
2015
2020
2025
2030
Source: PANSI 2008, People predicted to have a serious visual impairment projected to 2025
Projecting Adult Needs and Service Information System (PANSI) predicts that there are 102 people with a serious visual impairment in Rotherham who require help with daily activities. It is predicted that this will slowly increase over the next 17 years, in particular in the age groups 55 -64 age group.
Deaf or Hard of Hearing
There are approximately 9 million people who are deaf or hard of hearing in
England. Around 688,000 people are severely or profoundly deaf 11. More than
50% of people over the age of 60 years have some degree of hearing loss, but only one in three older people has an hearing aid12. The commonest cause of hearing loss is ageing and three quarters of people who are deaf are aged over
60. More men become hard of hearing than women. Among people over the age of 80 years there are more women than men who are deaf or hard of hearing. This is mainly attributable to the larger population of women in this age range.
Common causes of deafness in adults and older people include; presbyacusis
(age-related hearing loss known as senile deafness), side-effects of medication, acoustic neuroma and Meniere's disease. Com mon causes of deafness in children include inherited conditions, infection during pregnancy, meningitis, head injury and glue ear.
In 2007 there were 54,500 people in England on the register of deaf people.
Between March 2004 and March 2007 the number of people on the register has remained constant13. However, during this same period the number of deaf people on the age profile of those on the register has changed significantly14. There are approximately 164,600 people in England on the register of hard of hearing. This is an increase of around 5,600 (4%) since
March 2004 and an increase of 73% since March 1992. The large increase from 1992 could be partially attributed to improved systems of information capture or a failure to remove old registrations15.
11
RNID 2008, www.rnid.org.uk
Public Medical Health 2008, Research and Development, Leading Causes of Blindness
National Statistics 2007, Deaf and Hard of Hearing, p(iii)
14
Office of National Statistics 2004, Religion in Rotherham, p(iii)
15
National Statistics 2007, Deaf and Hard of Hearing, p3
12
13
- 19 Figure 1.16 provides a breakdown of the number registered as deaf and hard of hearing by age group.
Figure 1.16: Age profile of people registered as deaf or hard of hearing
(HofH) in England from 1992 to 2007
Category
Number of
People
1992
1995
1998
2001
2004
2007
% of People
1992
1995
1998
2001
2004
2007
All Ages
Deaf
H of H
Under 18
Deaf
H of H
18-64
Deaf
H of H
65-74
Deaf
H of H
75 or over
Deaf
H of H
41,800
45,500
50,100
50,300
55,000
54,500
95,300
125,900
139,500
144,600
158,900
164,600
3,800
4,400
4,200
4,000
4,100
3,400
2,100
3,500
2,800
2,900
3,000
4,100
24,200
26,000
27,100
27,200
29,200
28,700
16,000
21,900
25,100
25,400
29,800
30,500
4,900
5,000
5,800
6,400
8,300
6,400
18,400
23,800
22,300
24,700
24,400
23,100
8,900
10,100
13,000
12,600
13,400
16,000
58,800
76,700
89,300
91,300
101,700
106,900
100
100
100
100
100
100
100
100
100
100
100
100
9
10
8
8
7
6
2
3
2
2
2
2
58
57
54
54
53
53
17
17
18
18
19
19
12
11
12
13
15
12
19
19
16
17
15
14
21
22
26
25
24
29
62
61
64
63
64
65
Source: National Statistics 2007, Deaf and Hard of Hearing, p3
In 2007 more than half (52.6%) of those on the deaf register were working age adults (18-64 years). The highest incidence of hearing loss occurred in the older age groups, particularly those over 75 years16.
In Rotherham there are currently 280 people on the deaf register. 66% are in the age range 18 to 64 years, 13.4% above the national average. There are currently 15 children (5%) on the register17. The high number of younger people on the register suggests under-reporting in the older age groups.
There are a total of 980 people on the hard of hearing register. Almost two thirds (62%) are in the age groups 75 years and over18. This is just under the national average of 64.9%. Figure 1.16 provides a local age profile of those who are registered deaf or hard of hearing. Information for this register is obtained by the completion of SSDA910 returns by all Councils with Adult
Social Services Responsibilities (CASSRs) on an annual basis to capture the number of people who are deaf or hard of hearing under Section 29 of the
National Assistance Act, 1948.
Figure 1.17: Number of people registered deaf/hard of hearing by age group in Rotherham in 2008
Deaf
18%
Partially Sighted
2%
5%
19%
0-18 years
18-64 years
11%
65-74 years
62%
66%
Source: National Statistics 2008, Council Tables - Blind and Partially Sighted, pB1
16
National Statistics (2007), Deaf and Hard of Hearing, p5
Office of National Statistics 2004, Religion in Rotherham, p15
18
Office of National Statistics 2004, Religion in Rotherham, p20
17
17%
75 and over
- 20 In 2006 there were 79,900 people registered blind or partially sighted with an additional disability in England. 24% of those registered as blind and had a n additional disability were recorded as deaf or hard of hearing. 22% of those registered as partially sighted with an additional disability were recorded as deaf or hard of hearing19.
Figure 1.18 shows the number of people registered as blind or partially sighted with a hearing impairment in England.
Figure 1.18: People registered as blind or partially sighted with a hearing impairment in 2006
Category
Blind
Partially Sighted
Deaf with
Speech
1,800
1,100
Deaf without
Speech
400
300
Hard of Hearing
7,600
7,400
Source: National Statistics 2007, Deaf and Hard of Hearing, p 6
Carers
1.7
Population by Religious Group
The 2001 Census showed that 197,102 people (79.4%) of Rotherham‟s population described themselves as Christians. This is above the regional average of 73.1% and the national average of 71.7%, mainly because of the low proportion belonging to minority religions20.
In 2001, 2.6% of Rotherham‟s population belonged to minority religions compared to 6% nationally. 10.2% of the local population have no religion compared to 14.6% nationally. The largest minority religious group in
Rotherham in 2001 were Muslims with 2.2% of the population 20.
A local estimate of the religious profile of Rotherham carried out in 200921 suggested that 4.2% of the local population now hold minority religious beliefs.
There are estimated to be 9,300 (3.7%) Muslims, 400 Hindus (0.2%), 300 Sikh s
(0.1%), 200 Buddhists (0.1%), 40 Jews and 400 people (0.2%) who have other religious beliefs. There are estimated to be 25,700 people (10.2%) who have no religious beliefs20.
The influx of EU migrants, mainly from Poland and Slovakia, over recent years in Rotherham is likely to have impacted on the number of people from certain religious groups. For example, it is estimated that approximately 90% of Polish people are nominally Roman Catholic with over 50% attending church regularly. The rest of the Polish population (10%) are mainly Eastern
Orthodox, Protestants, Jehovah‟s Witness or have no religion21.
19
Office of National Statistics 2004, Religion in Rotherham, p6
Office of National Statistics 2004, Religion in Rotherham
21
Studies from Stays in Poland (2008)
20
- 21 1.8
Population by Migrant Status
The total number of NINo registrations to adult overseas nationals in 2008/09 was 686,000, a decrease of 47,000 (6.4%) on the previous year. This is the first annual percentage decrease in the period for which figures are available.
This overall fall in NINo registrations masks some significant variations by world area. Poland forms the largest nationality: 134,000 NINo registrations were made to Polish citizens in 2008/09 (a 36.2% decrease from the previous year).
163,000 NINos were registered to Asian and Middle Eastern nationals during
2008/09 - an increase of 8.8% on the previous year. Similarly registrations to
African nationals and those from the Americas rose by 6.2% and 11.7% respectively. Registrations from Australasia and Oceania fell by 11.5%. The average age is between 25 and 34 years22. The number of migrants entering
Rotherham in 2008-09 was 1,330 which is 0.5% of the overall population.
Since 2008, economic recession has meant that there are fewer migrants arriving in the UK. This trend has been particularly evident amongst EU migrants from the “A8” countries where a net inflow of 43,000 in 2007/08 turned into a net outflow 12,000 in 2008/0923.
According to the “Flag 4” Patient Registration Data System there were 567,500 people on the Patient Register Data System in England and Wales in 200624.
The “Flag 4” system identifies those migrants who have registered with a GP.
These figures suggest that there are 165,590 migrants (23%) who have not registered with their local GP. In Rotherham there were 1,220 people registered with a NINo registration which suggests that 18% of migrants in
Rotherham are not registered with a GP24.
1.9
Number of Households
For the purpose of the JSNA a household is defined as comprising one person living alone or a group of people living at the same address sharing a living room or at least one meal a day. In 2001 there were 102,288 households in
Rotherham11. By 2009 there were nearly 107,695 households, an increase of nearly 6,000 over the last eight years. The number of households had increased faster over the last few years, whereas the number of properties has decreased slightly from 2008 with old properties being demolished. 3.3% of properties in Rotherham are vacant and 19.4% of the properties are council owned25. Over two thirds of households in Rotherham have no children (68%), slightly below the national average. Lone parents with dependent children make up
6.8% of all households which is slightly above the national average of 6.5%.
Almost one in seven households consists of a pensioner living alone (14.4%) , equivalent to the national average26.
22
DWP NINo Registrations 2008-09
Migration New Communities Briefing, Spring 2010
„Flag 4‟ Mid Year Estimates 2006, Patient Register Data System
25
Rotherham Properties List 2009
26
Rotherham State of the Borough (2008), A Statistical Portrait
23
24
- 22 Figure 1.19 estimates the growth in the number of households in Rotherham by
2021.
Figure 1.19: Predicted Number of Households in Rotherham from 2008 to
2021
Source: Office of National Statistics 2006 Household Projections to 2029
It is predicted that the number of households is set to increase to 112,000 by
2011, 118,000 by 2016 and 122,000 by 2021. This is a total increase of 12,000 additional households over the next 13 years, an increas e of 11%.
One family households account for over 68% of all households in Rotherham compared to the average of 63% for England and Wales. The number of one family pensioner households (9%), one family couple (49%) and one family lone parent (10%) is also above average compared to England and Wales but the number of one person households is below average at 27%27.
The average household size in Rotherham was 2.57 people in 1991, 2.41 in 2001 and 2.31 people in 2006. This trend is likely to continue in future years to 2.25 by
2011, 2.19 by 2016 and 2.14 by 2021. The decrease in the number of people per household is partly attributable to an increase in one person households. This trend is reflected in national figures.
The composition of households is expected to change over the next 13 years.
There were 97,200 married couples in Rotherham in 2006. This is predicted to decrease to 95,200 by 2011, 94,400 by 2016 and 94,100 by 2021. This constitutes a 3.2% decrease in the number of married couples. There were
23,000 cohabiting couples in Rotherham in 2006. It is predicted that this will increase to 27,500 by 2011, 31,000 by 2016 and 33,600 by 2021. This constitutes a 35% increase in the next 13 years.
In 2006 there were 5,040,000 private households in the Yorkshire and Humber region. This is expected to rise to 5,172,000 by 2011, 5,308,000 by 2016 and by 5,442,000 by 2021. This is an additional 402,000 private households in the next 13 years, an increase of 8%.
27
Census 2004, Number of Households in Rotherham
- 23 1.10
Analysis of Areas of Deprivation
According to the Index of Multiple Deprivation (IMD 2007), Rotherham is currently 68th most deprived Borough out of 354 English districts. Rotherham‟s
IMD classification has improved from 63rd in 2004 to 68th in 2007. In 2000 the
IMD classification for Rotherham was 48th most deprived.
The two IMD domains that are most challenging in Rotherham are “Health and
Disability” and “Education, Training and Skills”. Although the overall trend is improving there has been no improvement in the 10% of areas suffering greatest levels of deprivation. 33% of Rotherham‟s population live in areas of deprivation. The key drivers of deprivation in Rotherham are: Employment (51st most deprived), Health and Disability (42nd most deprived) and Education and Skills
(30th most deprived). Rotherham has average or low levels of deprivation in other domains such as Living Environment (147th most deprived), barriers to
Housing and Services (285th most deprived) and Crime (136th most deprived).
Figure 1.20 shows how the IMD scores of the 166 super output areas (SOA) in
Rotherham compared nationally. In 2007 12% of Rotherham‟s population were living in the most deprived tenth of IMD in England. 32% were in the most deprived fifth. In contrast 11% of Rotherham‟s SOA areas are in the least deprived fifth28. Figure 1.18 also shows the overall improvement between 2004 and 2007. Fewer Rotherham SOAs were in the 10-60% decile in 2007 but the proportion in the most deprived tenth remained unchanged 28.
Figure 1.20: Percentage of Rotherham Residents Living in National Index of Multiple Deprivation Deciles (comparison between 2004 and 2007)
Source: Census 2004, Number of Households in Rotherham
28
Indices of Deprivation 2007
- 24 Figure 1.21 breaks down the Index of Multiple Deprivation into seven domains.
It shows the proportion of the Rotherham population that are in the most deprived areas of England. For example 28% of Rotherham‟s population live in the 10% most deprived areas in terms of employment and education. In order to achieve equity 10% of Rotherham‟s population should live in these areas.
Conversely 0% of the Rotherham population live in those areas where it is most difficult to access housing. The red shaded areas show where Rotherham is performing below average.
The two domains that are most challenging for Rotherham are “Health and
Disability” and “Education, Training and Skills”. Analysis of the distribution of the health component of IMD shows that 25% of the Rotherham population lives in the bottom 10% of English SOAs. 93% of the population live in the most deprived 50%28.
Figure 1.21: Distribution of Rotherham’s population by national IMD domains Education, Skills and Training
Health and Disability
Employment
Income
Crime
Living Environment
Barriers to Housing and Services
Most deprived 10%
28%
25%
17%
13%
3%
3%
0%
Most deprived 20%
43%
46%
38%
27%
14%
6%
1%
Most deprived 50%
78%
93%
74%
60%
52%
32%
9%
Source: Indices of Deprivation 2007
Although the IMDs for employment and income are still above average the IMD for employment has improved over the last two decades with only 17% of people living in the most deprived tenth of English SOAs. Improvements have been made in income levels as they are only 13% of people in the most deprived areas of Rotherham. Figure 1.21 shows the geographical distribution of aggregated IMDs across the Borough. A substantial proportion of areas with the highest IMD scores are in the town centre but there are also significant pockets of deprivation in surrounding towns such as Rawmarsh, Wath, Maltby and Dinnington. Two of the most deprived SOAs across Rotherham are in the
Herringthorpe and Boston wards where 50% of the population live in areas of income deprivation. The areas with the lowest deprivation levels are Anston,
Woodsetts, Wales, Sitwell and Keppel.
- 25 Figure 1.22: Indices of Multiple Deprivation 2007 in Rotherham
Source: Indices of Deprivation 2007
1.11
Social Marketing Categories and Urban/Rural Classification
The 2001 ONS Classification and social marketing categories are used to group together geographic areas according to key characteristics common to the population in that grouping. Both the Social Marketing and Urban/Rural sections of the DH Core Dataset will be covered in more detail in Chapters 2 and 11 respectively. Around 70% of the Borough is classed as rural in nature.
The majority of Rotherham‟s residents live in urban areas, around 50% in the
Rotherham Town Centre area and 38% in smaller towns such as Wath, Maltby and Dinnington. Rural areas in the South of the Borough contain 12% of the population. Half of the land use in the Borough is for agriculture.
1.12
Sexuality
There are no local statistics on the number of people in Rotherham wh o are
Lesbian, Gay, Bisexual or Transgender (LBGT). Government estimates based on reliable survey evidence suggest that 6% of the UK population are LGBT which would equate to 15,200 people in Rotherham or 11,800 adults. The
Transgender population is estimated at 0.8% nationally which would translate into 2,000 people or 1,600 adults in Rotherham.
- 26 -
2.
Social and Environmental Needs Assessment
2.1
RMBC Strategic Housing Role
The Council‟s strategic housing role is central to delivering “sustainable communities and successful neighbourhoods where the quality and choice of housing underpins a buoyant economy and an improved quality of life". The role of the local authority in delivering strategic housing services was strengthened through the national regulatory and policy framework and looks set to continue via the emphasis on localism albeit with severely restrained resourcing and an increasing emphasis on making the most of existing opportunities and assets.
Rotherham Metropolitan Borough Council (RMBC) transferred responsibility for the delivery of housing management services to an arms length management organisation (ALMO) in 2005, which has allowed the Council to focus on its retained housing functions and its strategic place-shaping agenda. This transfer is currently under review.
As strategic landlord the Council has a key role in ensuring housing is provided to households with specific needs. In particular:
BME population
Gypsies and travellers
Vulnerable adults with a physical and/or sensory impairment, mental health problems or learning disabilities
Extra care accommodation
Floating support and move-on accommodation for teenage parents
2.2
Council Housing Stock
The ALMO currently delivers the following services:
Decent Homes works including environmental improvements.
Repairs and maintenance services (delivered by the in-house service provider). Income collection, low-level antisocial behaviour, tenancy management, estate services and tenant involvement (provided by the neighbourhood management teams).
All homes will meet the Decent Homes Standard by December 2010 and environmental improvement works will be completed during 2011. The repairs and maintenance service is to be externalised in order to improve value for money. The Council will make a decision in late 2010 regarding the future of the remaining housing management functions (beyond the term of the cur rent
ALMO management agreement) and what model of service delivery will best serve the aspirations of the tenants and leaseholders of Rotherham. An improvement plan has been established that clearly sets out the Council‟s expectations of the ALMO and of any future housing management service provider, which are to:
Address tenants‟ and leaseholders‟ priorities for improvement
Achieve the standards expected of top-performing organisations
- 27 Make a unique contribution to Rotherham‟s priorities
Ensure all services are well-governed and well-managed
Ensure strong financial management processes are in place
Deliver value for money, making excellent use of resources
The ALMO has implemented the new Tenant Services Authority National
Standards and will have developed the local offer, in consultation with tenants, by October 2010.
2.3
Private Sector
Rotherham‟s Private Sector housing interventions are aligned to support the priorities of the Community Strategy and Housing Strategy and will increase choice in the housing market and address decency standards in the private sector. The energy efficiency profile of private rented dwellings is poor when compared with other private sector dwellings in Rotherham (although good when compared with the national position).
Around 67% of private rented stock would fail the Government‟s Decent
Homes standard due to excessive cold.
Almost half of the private rented stock would fail the Government‟s
Decent Homes standard due to levels of disrepair.
It is anticipated that with the Government priority to rebalancing the economy increasing emphasis will be placed upon private householders to utilise the equity in their property to manage adaptation and modernisation. There will also be an increasing role for the private sector in addressing demands previously considered the domain of Registered Providers, particularly low cost housing provision and addressing the needs of vulnerable groups on a commercial basis.
2.4
Housing Tenure
Rotherham has a population of around 253,900 people living in 111,822 households in 2010. Figure 2.1 illustrates that more than two thirds of people own their own homes in Rotherham and nearly a quarter of people socially rent from Local Authority and Housing Associations. Figure 2.1 shows a breakdown of household tenure in Rotherham.
Figure 2.1: Breakdown of Household Tenure in Rotherham
Owner-occupied (no mortgage)
3.30%
8.40%
31.30%
Owner-occupied (with mortgage)
18.60%
Council owned
Registered Provider
38.40%
Source: Census 2004, Mid Year Estimates – Household Tenure
Private rented
- 28 69.7% of the local population are owner occupiers in Rotherham which is slightly above the national average of 67.9%. The proportion of the local population renting from the Local Authority or a Housing Association in
Rotherham, which contributes toward the provision of affordable social housing, is 21.9%. This figure is higher than the national average of 17.8%.
2.5
Ethnicity
The 2001 Census indicates that the proportion of the population in a Black or
Minority Ethnic (BME) (non-White) group in Rotherham is quite low by national and regional standards at just 3.6%, compared to 7.7% in the region and 11.7% nationally. ONS have produced some estimates of the changes in population by ethnicity to 2007, although these are classed as experimental statistics and should be treated with caution. They suggest that the BME population of Rotherham increased substantially from 3.6% to 5.2% of the total population since the
Census. This amounts to an increase from 7,712 to 13,200 people (+71.2%) in
BME groups between 2001 and 2007. Although this increase is more than the regional and national level (51.2% and 34.7% respectively), the proportion of the population in BME groups remains below the regional and national average
(9.4% and 11.7% respectively).
Figure 2.2 presents the ethnicity of the population in the Metropolitan Borough according to the latest (2007) figures. The “Asian or Asian British” ethnic group represents the largest BME group in Rotherham (3.0% of total populatio n).
Figure 2.2: Ethnicity of the Rotherham Population, 2007
1%
White
Mixed
94%
6%
3%
Asian or Asian British
1%
Black or Black British
1%
Chinese or other Ethnic Group
Table 2.1, below, sets out the home ownership across the Ethnicity bands, which indicates that a large proportion of White British people (68.2%) are owner occupiers, the same as the local average for all ethnic groups. The number of White British people who socially rent is equivalent to the national average at 24%. The proportion of the local population renting from private landlords is 6.1%, marginally lower than the national average of 1 8%. A small minority of the population live in communal accommodation (0.9%) such as hostels, bed and breakfast or staffing accommodation.
- 29 Table 2.1: Household Tenure and Communal Establishments3p15
Source: Health Needs Assessment 2008, BME Populations in Rotherham, p15
Home ownership within the BME population varies according to ethnic origin.
Ownership ranges from 42.4% to 86.5%. BME groups are under-represented in the social rented sector but significantly over-represented in the private rented sector. People with mixed ethnicity are most likely to live in Council or
Housing Association rented housing.
Members of the Black community are the least likely to be owner occupiers and have the highest proportion living in communal establishments. The increased prevalence in communal establishments is mainly due to Black Africans living in staff hospital accommodation.
2.6
Overcrowding
The government published a report, “Impact of Overcrowding on Health and
Education”, which demonstrates that overcrowding is either associated with or a casual factor in:
Infant mortality.
Respiratory conditions in children (although housing conditions themselves have a larger effect) and through into adulthood.
Rates of serious infectious diseases such as meningitis and tuberculosis. Infections with Helibacter Pylori which have implications for growth and diseases of the digestive system.
Self-reported health status.
Female mortality rates.
Mental ill-health ranging from issues with self-esteem to psychiatric symptoms. It is important to note that many of these effects are long-lasting. Exposure to overcrowding in childhood can lead to poor health in adulthood, even when they no longer live in overcrowded accommodation.
- 30 Table 2.2 shows the number of overcrowded households in Rotherham. An overcrowded household is one where there are fewer habitable rooms than people. This can have some implications for health and well-being of the local population. Table 2.2: Households and Overcrowding in Rotherham
Ethnicity
All People
White British
White Irish
White Other
Mixed
Indian
Pakistani
Other Asian
Black
Chinese
Other
Households
102,273
99,086
608
612
229
191
1,057
118
182
89
101
Overcrowded – over one person per room
3,994
3,549
29
51
19
35
223
26
24
15
23
% Overcrowded
3.9%
3.6%
4.8%
8.3%
8.3%
18.3%
21.1%
22.0%
13.2%
16.9%
22.8%
Source: Health Needs Assessment 2008, BME Populations in Rotherham , p16
Generally, overcrowding is not a major issue for the local population, with 3.9% of households suffering overcrowding (3,997). Rotherham has lower overcrowding than both the regional average of 5.5% and national average of
7.1%.
Only 3.6% of the White British population live in overcrowded accommodation.
However, BME groups are more affected, with overcrowding ranging from
13.2% to 22.8% of the community‟s population. The proportion of BME households suffering overcrowding in the BME community is up to six times greater than the local average. There are 1 in 5 Pakistani/Kashmiri households who are overcrowded, compared to 1 in 25 for White British. More recent inward migrations of Eastern European Economic Migrants also experience high levels of overcrowding.
Whilst the Indian and Chinese communities tend to live in areas of low deprivation, many have high levels of overcrowding, of 18.3% and 16.9% respectively. 2 .7
Living Alone
Approximately one in seven local households consists of a pensioner living alone (14.4%). This equates to the regional and national average. Projecting
Older People Population Information System (POPPI) estimates that there were 14,670 people29 over 64 years who were living alone in Rotherham in
2008. This is 5.8% of the local population. The gender breakdown of older people living on their own is 39.6% males and 60.4% females.
29
POPPI 2008, Number of People over 65 years living alone
- 31 The Office of National Statistics estimates that there are 14,701 people living alone in Rotherham, 5.9% of the local population. This equates with POPPI estimates30. Figure 2.3: Number of people over 64 years living alone in Rotherham in
2008
12,000
10,000
8,000
Males Aged 65-74
6,000
Males Aged 75+
4,000
Females Aged 65-74
Females Aged 75+
2,000
0
2008
2010
2015
2020
2025
Source: POPPI 2008, Number of People over 65 years living alone
POPPI predicts that the number of people over 64 years living alone in
Rotherham is set to increase to 17,202 by 2015 and 21,234 by 2025. This is an anticipated increase of 17% in the next 7 years and 45% in the next 17 years. The most significant increase in population is males over 74 years. It is predicted that there will be an increase of 82% living alone by 2025 from 2,072 in 2008 to 3,808 in 2025. For females over 74 years it is predicted that there will be an increase of 48% by 2025 from 6,785 in 2008 to 10,030 in 2025. This significant increase in the population of older people living alone is due to a number of factors:
Reduced impact of mining and heavy industry
Increases in life expectancy particularly for men
The ageing baby boomer population from the 1950s and early 1960s
Intergenerational changes in family structure
People who are living alone tend to require more formal support from adult social care services, especially if their family or carers do not live in the local area and are unable to provide informal support. Therefore, the increasing number of people living alone is likely to have a significant impact on adult social care in the future.
2 .8
Summary of Housing Demand in Rotherham
Properties take an average 8.4 weeks to sell compared to the regional average of 11.2 weeks achieving. On average, 88.9% of their asking price co mpared to the regional average of 90.8%.
In 2008, there were 20,826 people on the Housing Register in Rotherham compared to 21,636 in 2002.
30
Office of National Statistics 2008, Household Composition (UV46)
- 32 The most common house type is semi-detached (see table 4), of which there are 51,946, representing 49% of all housing in the area.
The most common housing tenure is “owns mortgage with a loan” (see table 3) of which there are 39,588 representing 39% of all housing in the area.
Housing density is 4 dwellings per hectare31.
Rotherham Metropolitan Borough Council has a stock of 20,971 homes (as at
April 2009). They are managed and repaired by the arms length management organisation (ALMO), 2010 Rotherham Ltd.
There are currently 111,822 households in Rotherham, however statistical information related to tenure distribution is based on figures reported for April
2008 when there were 109,959 homes in Rotherham. The tenure distribution is set out in table 2.3.
Table 2.3: Tenure of Rotherham’s housing stock, April 2008
Dwelling stock by tenure, April 2008
Tenure
LA dwelling stock
RSL dwelling stock
Other public sector dwelling stock
Owner occupied and private rented dwelling stock
Total
Rotherham
Count
%
21,289 19.4
3,559
3.2
Yorkshire &
Humber
Count
%
242,854
10.7
178,000
7.8
England
Count
%
1,870,365 8.3
2,142,297 9.5
244
3,869
74,134
0.2
84,867 77.2
109,959 100
0.2
0.3
1,854,154 81.4 18,407,061 81.8
2,278,877 100.1 22,493,857 99.9
Source: Hometrack
Table 2.4: Size of homes in Rotherham
No of rooms
1 room
2 rooms
3 rooms
4 rooms
5 rooms
6 rooms
7 rooms
8 or more rooms Rotherham
Count %
336
0.3
974
1.0
7,183
7
19,954 19.5
34,972 34.2
25,261 24.7
7,936
7.8
Doncaster
Count %
378
0.3
1,221
1.0
6,974
5.9
20,311 17.1
41,880 35.3
30,107 25.4
9,679
8.2
Barnsley
Count %
291
0.3
889
1.0
5,607
6.1
22,260 24.2
33,234 36.1
19,218 20.9
5,974
6.5
Sheffield
Count
%
1,501
0.7
4,508
2.1
19,998 9.2
46,973 21.6
70,050 32.2
43,954 20.2
16,461 7.6
5,608
8,164
4,675
14,214
Source: Census 2001
31
Hometrack – February 2010
5.5
6.9
5.1
6.5
- 33 Table 2.5: Property types in Rotherham
Housing stock by property type Detached
Semi-detached
Terraced
Flats - purpose built block
Flats – conversion
Flats - commercial building
Mobile or temporary structure
In a shared dwelling
Rotherham
21,479
51,946
21,416
9,315
682
694
59
315
Doncaster
28,326
55,374
30,782
5,966
1,050
894
784
256
Barnsley
20,075
45,023
24,391
4,692
743
727
74
137
Sheffield
31,676
84,075
67,381
34,561
4,367
2,258
147
756
Source: Hometrack, February 2010
2 .9
Condition of Stock
The Private Sector Stock Condition Survey carried out in 2007 revealed that the average cost of repairs required were significantly higher in the private rented sector than the owner-occupier sector.
Table 2.6: Overall repair costs in Rotherham private sector
Repair category Urgent repair
Basic repair
Comprehensive
Repair
Standardised
repair cost (/m2)
Owner Occupied
Average
Total cost per cost dwelling
£77.2m
£1,011
£124.5m £1,631m
£331.7m £4,341
Private Rented
Average
Total cost per cost dwelling
£16.0m £2,031
£25.0m £3,177
£48.2m £6,125
£19.5
All private sector dwellings Average
Total
cost per cost dwelling
£93.2m
£1,106
£149.6m £1,775
£380.0m £4,510
£42.2
£21.6
Source: RMBC Private Sector Stock Condition Survey 2007
The Private Sector Stock Condition Survey revealed that the main reason for not attaining the Decent Home standard was thermal comfort. Groups with high levels of non-decency included; private rented, pre-1919 dwellings, converted flats and terraced houses. The households which showed high levels of non-decency included single pensioner, special needs and vulnerable households. Table 2.7: Non-decent homes and dwelling characteristics (2007data)
Dwelling
characteristic
Non decent Category
1 Hazard
Fail disrepair Owner occupied
(no mortgage)
Owner occupied
(with mortgage)
Private rented
2010 stock
21.7%
10.5%
4.1%
Fail
Fail
modernisation thermal comfort 5.9%
10.2%
15.6%
7.6%
3.2%
1.7%
7.0%
44.9%
64.9%
21.4%
4.6%*
14.2%
79.7%
12.3%
66.9%
28.2%
13.4%
*Statutory minimum standard
- 34 2010 Rotherham Ltd. manages 21,500 social homes on behalf of the Council and is now in the final year of Decent Homes investment delivery. By the end of March 2010 6.29% of the stock was non-decent and the programme will be completed by December 2010. 2010 Rotherham Ltd . are also working in partnership with RMBC to deliver a programme of environmental improvement works and the investment programme has secured the long term sustainability of Council housing by aligning with other major neighbourhood investments such as building schools for the future, Housing Market Renewal and Economic regeneration. During the financial year 2009/2010 Rotherham Metropolitan Borough Council‟s
Home Energy Advice Team has been able to improve the energy efficiency of council and privately owned housing stock through gaining access to over £3.5 million of funding from partners such as Warm Front and South Yorkshire
Housing and Regeneration Partnership. Initiatives include installation of central heating systems to over 700 homes, replacing boilers in 68 homes, loft insulation and cavity wall insulation to 3,198 homes.
2.10
Affordable Warmth and Fuel Poverty
Fuel poverty has a negative impact on a person‟s quality of life and health.
Cold and damp homes are linked with health problems such as asthma , bronchitis, influenza, heart disease, strokes and exacerbation of arthritis.
Periods of prolonged immobility can result, making it even more difficult for older people to keep warm. Research has shown that domestic accidents, including fatal accidents, are more common in cold homes in winter, resulting in costly hospital admissions and social care such as home care or residential care. Rotherham Metropolitan Borough Council is currently working with Sheffield
Hallam University, Chartered Institute of Marketing and Positive Sum Ltd. for a research project investigating the role of domestic renewable energy technologies in alleviating fuel poverty. The main aims of the project are to:
Determine the extent to which the retrofitting of renewable energy technologies into existing homes can help to alleviate fuel poverty.
Establish which renewable energy technologies offer the most cost effective means of alleviating fuel poverty.
Identify factors that influence the effectiveness of such projects to enabl e optimum design of future fuel poverty alleviating schemes.
2.10.1 Keeping warm at home in later life (KWILLT)
This is a study to develop social marketing interventions that promote engagement of older people in keeping warm behaviour and access to anti-fuel poverty services.
Contracting NHS Organisation: NHS Rotherham
Project Duration: 26 months
Funding body: National Institute for Health research - Research for
Patient Benefit
- 35 Summary Background
It is a public health priority to reduce the health b urden of individuals on the health service due to cold housing. Cold, damp housing and fuel poverty link to chronic health problems, excess winter deaths and impaired quality of life. 7.7% of Yorkshire and Humber households are fuel poor. This is due to an ageing population, barriers to accessing energy efficiency and increases in fuel costs. This translational study uses social marketing and lay epidemiology to explore the issue and develop interventions. Social marketing is an approach to promote healthy behaviour change (e.g. keeping warm) and overcome barriers to healthy behaviour e.g. tools to identify those at risk and increase access to services. Lay epidemiology (knowledge, beliefs and values) provides a theoretical framework.
Summary Aims
This qualitative study aims to
(i)
examine older person‟s lay epidemiology, this is the network of empirical beliefs, values and non-rational factors that influence their health-affecting choices regarding keeping warm at home
(ii)
develop a package of social marketing products PCTs can adopt to promote keeping warm at home in later life that is informed by the lay epidemiology identified. These are:
Brief intervention training materials for health and social care staff.
A risk assessment and referral tool.
The insight required for PCTs to commission a social marketing public campaign.
The study results and user informed outputs can be readily adopted by PCTs. Their impact on patients and NHS efficiency can be measured using routine audit and evaluation. This is currently work in progress and more details will be available in the next JSNA.
Scientific Summary Plan of Investigation
A qualitative study using in-depth semi-structured individual, group interviews, social marketing and framework analysis techniques. The study has three stages. Triangulation of methods adds to the rigor of the findings: (i)
Individual interviews and room temperature measurement with 50 older people and interviews with 25 health and social care professionals to explore the lay epidemiology of older people regarding keeping warm at home.
- 36 (ii)
(iii)
2.11
6 focus groups with older people and professionals to verify, challenge and expand upon findings from the individual interviews. A structured social marketing consultation of up to 50 key stakeholders to examine the findings and shape the study outputs including education materials, an assessment/referral tool and social marketing insight.
Energy
Rotherham Metropolitan Borough Council‟s Private Sector Stock Condition
Survey 2007 revealed the following information regarding energy efficiency and heating in private housing in Rotherham:
It is estimated that 83.2% of private sector dwellings in Rotherham have cavity walls, of which 38% have no cavity insulation (around 27,000 dwellings). This provides considerable scope for improving energy efficiency through the insulation of unfilled cavities.
It was found that dwellings in the private rented sector are noticeably less likely to have full double glazing rather than those in the owneroccupied sector.
79.5% of dwellings with insulation have 100mm or more of insulation whilst 12.6% were estimated to have over 200mm (2.1% do not have a loft). The main types of fuel used are gas (95.1%), solid fuel (2.3%), electric
(2.1%) and oil (0.5%).
The average SAP (Standard Assessment Procedure) rating for the private sector is 60. Older dwellings typically display lower SAP ratings.
Households living in dwellings with particularly low SAP ratings also appear to show quite distinct characteristics with single pensioner households showing the lowest average SAP rating.
8.4% (6,873) of private sector households in Rotherham were found to be in fuel poverty.
The long term impacts of climate change are unknown but several loca lised flooding incidents in recent years underline the seriousness of the issue and the potential for adverse impact on the Rotherham community in years to come. The Climate Change Act (November 2008) puts the UK in an international leadership role, setting the world‟s most ambitious national targets for emissions cuts: an 80% reduction in carbon dioxide and other greenhouse gas emissions by 2050 as compared with 1990.
The impact of climate change is likely to be greatest on the most disadvantaged measured in terms of the cost of heating and cooling poorly adapted homes.
The Government has set out its ambitious timetable for the progressive tightening of building regulations (Part L) in 2010 and 2013, with the aim of
- 37 achieving zero carbon emissions in all new homes by 2016. This will be supported by the Code for Sustainable Homes, the Planning Policy Statement on Climate Change and stamp duty relief for zero carbon homes.
Although new private sector development is to have Zero Carbon emissions by
2016, Central Government wants social housing to reach this by 2013 by way of demonstrating the technologies and contributing to developing economies of scale, thereby bringing down the current additional development cost of a Code
6 Zero Carbon home of ca. £34,000.
Emissions related to the existing housing stock present the greatest challenge.
Constructed in eras of cheap fuel, hence poor in energy efficiency, they are unsuited to a projected period of fuel scarcity. W e are reaching 3,000 private households per year, mainly promoting cavity and loft insulation. Our strategy directs priority to this issue.
Empty Properties
The number of empty properties across the district is recorded on an annual basis by the Housing Strategy Statistical Appendix (HSSA). A recent review of current statistics indicates that the empty homes picture for Rotherham is changing and that the mid year outturn for 2009/10 demonstrates that the number of empty properties in the Borough has reduced to 3,881 (3.53%) from
4,273 (3.88%). The figures include an amount of short term properties (less than 6 months) which are deemed vital to allow the housing market to function effectively and to facilitate both residential mobility and the improvement or redevelopment of the housing stock.
The table below identifies the wards where there has been high demand for housing based on Key Choices monitoring of Choice Based Letting requests and the wards where there are the highest numbers of empty properties and low demand.
Figure 2.4: Empty properties in Rotherham
Number of long-term (>6 months) empties compared with Borough average by Ward
500
450
400
350
300
250
200
150
100
50
Ward
Hsg Requests
>6 months
Borough average
W at h
Ra
wm ar sh
M
al tb y
Di
nn
Ro
ing th to er n ha m
W
Bo es sto t n
Ca
stl e y
Si
tw el l
Sw
in to n
W
in gf Br iel ins d wo
Va
rth lle An
An
y sto d
Ca
n
An
tc liff d e W oo ds et ts
He
lla by Ho ld er ne ss
W
al es Ro th er
Va
le
Ho
Ro ob th er er ha m
Ea
st
Si
lve rw oo d pp e Ke
er sle l
0
W ick No. of housing requests and long-term empty properties 2.12
- 38 Source: Empty Property Update Report, March 2010
As a result of direct council involvement 124 properties have been successfully returned back into use during 2008/09 - an increase of 45 properties compared to the number returned to use by the Council during 2007/08.
2.13
Affordability
Rotherham‟s Strategic Housing Market Assessment 2007 suggested a target for 411 affordable homes, mainly to be delivered by the private sector but with some delivered via social housing grant. In August 2008, the Council adopted a new Interim Planning Policy as a basis for negotiation but the collapse of the private house building market has rendered this practically obsolete.
As a result of the economic downturn the Borough has experienced increased unemployment, leading to reduced demand for open market housing and increasing the number of repossessions.
In turn, house builders have slowed supply and mothballed development. In response to the decline in supply of private housing the affordable housing target increased to 546 new homes in Rotherham by 201132.
Figure 2.5: Rotherham average property prices Feb 2008 – Nov 2009
Rotherham average property prices based on sales Feb 2008 to Nov 2009
180,000
160,000
140,000
120,000
100,000
80,000
60,000
40,000
20,000
ay
-0
8 n08 Ju l-0 8
Au
g08
Se
p08
O
ct
-0
8
N
ov
-0
8
D
ec
-0
8
Ja
n09
Fe
b09
M
ar
-0
9
Ap
r-0
9
M ay -0
9
Ju n09 Ju l-0 9
Au
g09
Se
p09
O
ct
-0
9
N
ov
-0
9
Ju
M
-0
8
r-0
8
ar
Ap
M
Fe b -0
8
0
Upper Quartile
Source: Land Registry, Hometrack
32
Rotherham Housing Strategy 2010 (draft)
Average
Lower Quartile
- 39 Figure 2.6: Average house prices by number of bedrooms
Average House Prices in South Yorkshire by Number of Bedrooms
£300,000.00
£250,000.00
£200,000.00
£150,000.00
£100,000.00
£50,000.00
£-
1 bed Prices
(Flat)
2 bed Prices
(Flat)
2 bed Prices
(House)
3 bed Prices
(House)
4 bed Prices
(House)
Rotherham (MD)
£64,778.00
£98,614.00
£98,702.00
£122,486.00
£213,191.00
Doncaster (MD)
£68,500.00
£86,313.00
£89,531.00
£113,039.00
£191,072.00
Barnsley (MD)
£71,500.00
£83,369.00
£92,563.00
£119,705.00
£208,608.00
Sheffield (MD)
£85,226.00
£117,235.00
£103,114.00
£136,598.00
£257,827.00
Source: Land Registry, Hometrack, February 2010
Table 2.8: Lowest 10 Average House Prices by SOA in 2008
LOCAL NAME
Herringthorpe North
Brinsworth North
Brecks East
Whiston South & Morthen
Anston Greenlands
Maltby West - Amory's Holt
Swinton South East
Aston South
Bramley West
Rawmarsh Victoria Park
Average
House
Price
(current)
£40,000
£46,700
£58,360
£58,500
£60,000
£62,600
£63,500
£64,800
£65,500
£65,600
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
1
14
50-150
2
22
40-150
3
13
20-400
4
15
50-150
5
55
40-150
6
26
40-150
7
29
30-200
8
15
60-300
9
11
60-300
10
6
30-120
Source: Land Registry, Hometrack
Table 2.9: Highest 10 Average House Prices by SOA in 2008
LOCAL NAME
Moorgate West
Wath Central & Newhill
Eastwood Village
Canklow North
Masbrough West
Average
House
Price
(current)
£370,000
£365,000
£311,300
£275,000
£266,900
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
166
10
150-200
165
7
80-300
164
17
150-300
163
14
100-300
162
29
120-600
- 40 -
LOCAL NAME
Parkgate
Eastwood Central
Masbrough East
Meadowbank
Broom East
Town Centre
Average
House
Price
(current)
£249,000
£237,500
£225,100
£214,100
£205,000
£203,500
2008
Average
No of
House
Sales - Range £ k
Price
2008
Rank
161
15
90-300
160
19
70-200
159
16
80-600
158
7
80-200
157
14
120-200
156
13
70-300
Source: Land Registry, Hometrack
The average house price in Rotherham as at November 2009 was £130,048, compared to £122,339 for the region and £152,898 for the whole of England and Wales. Following falls at the end of the 1990s, house prices in Rotherham have increased substantially since 2001 with annual rates of increase above
20% from 2003 to mid 2005. In the last year Rotherham has seen a fall in house prices of 11.3%, but this was less than the national fall of 16.2%.
Table 2.10 illustrates the average weekly cost of renting a home in Rotherham in August 2009.
Table 2.10: Average rents by property size
Cross Tenure Affordability (wkly cost)
Renting (Public)*
Renting (HA)
Renting (intermediate)
Renting (Private)
Buying a lower quartile re-sale
Buying an average re-sale
Buying a 40% new-build HomeBuy
Buying a lower quartile new-build
Buying an average new-build
1 bed prop
£53.99
£55.30
£73.00
£91.00
£73.00
£88.00
£51.00
n/a n/a 2 bed prop
£61.52
£59.70
£89.00
£111.00
£86.00
£109.00
£78.00
n/a n/a 3 bed prop
£75.85
£65.70
£101.00
£126.00
£104.00
£133.00
£91.00
£142.00
£155.00
*Figures provided by 2010 Rotherham Ltd - August 2009
Source: Hometrack, RSR
2.14
Household Income
The average hourly earnings (median for full time workers including overtime) in Rotherham in 2008 was £10.04, compared to £10.96 regionally, and £11.97 in the UK. This represents a fall of 1.2% from the 2007 figure in Rotherham, compared to a 4.6% rise seen regionally and a 4.4% rise in the UK.33
33
data is workplace based, taken from the Annual Survey of Hours and Earnings (ASHE), which has been developed to replace the N ew
Earnings Survey (NES).
- 41 Table 2.11: Income Ranking Report by Ward (2009)
Income Ranking Report 2009
Ranking
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Name
Anston and Woodsetts
Wales
Dinnington
Holderness
Wickersley
Hellaby
Sitwell
Rother Vale
Brinsworth and Catcliffe
Keppel
Silverwood
Hoober
Wath
Rotherham West
Boston Castle
Swinton
Wingfield
Rawmarsh
Maltby
Valley
Rotherham East
Whole of Rotherham
Average Annual
Household
Income
£31,865
£30,280
£30,169
£30,023
£30,988
£33,528
£34,302
£28,616
£29,035
£29,233
£27,246
£25,954
£23,098
£25,084
£28,712
£22,461
£21,955
£23,010
£21,050
£23,484
£20,840
£27,017
Total
Households
4,742
4,628
5,175
5,096
5,572
4,883
4,921
4,909
5,078
5,215
4,671
5,135
5,197
5,571
5,881
5,386
5,771
5,714
5,366
5,499
5,747
110,157
Median Annual
Household
Income
£31,039
£29,589
£29,247
£28,362
£28,122
£27,860
£27,813
£26,142
£24,944
£24,638
£24,478
£24,065
£22,226
£21,460
£20,858
£18,733
£17,762
£17,759
£16,795
£16,563
£14,555
£23,005
Source: Acxiom Lifestyle Survey Data
Housing remains far more affordable for first time buyers in Rotherham than nationally, or those looking to move up the property ladder in Rotherham 34.
Table 2.12: Affordability by Income Bands
Affordability by income bands
FTB households – Flats
FTB households - Terraced houses
FTB households - Semi-detached houses FTB households - Detached houses
Owner occupier – Flats
Owner occupier – Terraced houses
Owner occupier - Semi-detached houses Owner occupier - Detached houses
Source: Hometrack; CACI Paycheck, February 2010
34
Rotherham In Focus – An Economic Assessment of Borough – April 2009
3.5 x
4x
3 x income income income
Rotherham (MD)
Percent of households priced out of market 36.22%
36.22%
22.59%
36.22%
36.22%
22.59%
60.19%
76.32%
36.22%
36.22%
49.11%
69.20%
22.59%
22.59%
36.22%
60.19%
22.59%
22.59%
49.11%
69.20%
36.22%
60.19%
36.22%
60.19%
- 42 Table 2.11 shows the percentage of households priced out of the market in the area. The analysis differentiates between house types and whether or not the purchasers are first time buyers. This is a modelled figure which is derived from the house price and income assumptions. The figures displayed are simply derived from incomes and house prices and do not account for the existing tenures of local residents.
The Council has a key role in ensuring housing is provided to households with specific needs and we will;
Seek to improve standards in private rental housing by agreeing codes of practice and by enforcement using all available powers where necessary Work with private landlords to encourage voluntary improvements in decency standards of their property
Demolish unsustainable stock subject to rigorous environmental assessment Tackle non-decent homes via our Home Improvement Agency
Encourage households to invest their own resources to fund repairs
Target void and empty properties to be brought back into use
Work with clients with particular needs to personalise housing choice
Develop a Common Housing Register with Registered Providers to update and inform housing needs
Work with housing developers to establish a viable supply of affordable low carbon housing from new planning permissions
Build new council houses that have zero carbon emissions by 2013
Continue to monitor need for Gypsy and Traveller accommodation
2.15
Central Heating
The 2001 Census shows that Rotherham has a lower number of households
(4,260) lacking central heating (4.2%) than both the regional average of 12.9% and national average of 8.4%. 6% of households living in the 10% most deprived areas of Rotherham have no central heating with 2.22% in the least
10% deprived areas35. People who live in the private rented sector are the most likely to be without central heating in their home.
POPPI estimates that there are 2,374 people over 64 years who have no central heating, 6.14% of the older population of Rotherham36. It is predicted that these numbers will reduce as a result of the Decent Homes programme currently being delivered by Local Authorities.
There is evidence that households without central heating are more likely to adversely affect the health of people with conditions such as cardio-vascular disease or chronic obstructive pulmonary disorders. Approximately 13,300 people (5.2% of local population) live in fuel poverty.
35
36
Census 2004, Households with No Central Heating
POPPI 2008, People over 65 with No Central Heating
- 43 2.16
Access to Car or Van
For the purpose of this section the term “car” is equivalent to “car or va n”.
There were a total of 104,845 cars available to households in the Borough at the time of the Census in 200137. There is approximately 1 car for every household in Rotherham with 30% of households (30,374) having no car. This is above the national average of 26.84% but below the regional average of
30.31%.
Figure 2.7: Breakdown of Households who have Access to Car or Van
Source: Office of National Statistics 2007, Cars or Vans (KS17)
44% of households (45,009) have access to a car. This is similar to the regional (44.1%) and national (43.7%) averages. 21.7% of households
(22,204) have two cars, 3.6% (3,704) with three cars and 1.0% (988) with four or more cars30.
According to the Office of National Statistics there are around 106,489 people of working age in Rotherham who regularly travel to work. Figure 2.6 shows a breakdown of the method of travel people use in order to attend work in
Rotherham.
Figure 2.8: Breakdown of Methods of Travel to Work in Rotherham
Source: Office of National Statistics 2007, Method of Travel to Work – Resident Population (UV39)
Over two thirds of people (69.3%) travel to work by car either as a driver or passenger. 12% of people travel by bus, minibus or coach and 8.2% travel by foot. A small minority of people travel to work by other means of transport
e.g. by bicycle or taxi. 6.9% of people work from home.
Figure 2.9 breaks down the distances that people travel into work. 22.5% of people travel 5km and 10km when going to work. 18.9% of people travel
37
Office of National Statistics 2007, Cars or Vans (KS17)
- 44 between 10km and 20km. 23.4% work from home, work abroad or have no fixed place of work. A small proportion of people (2.5%) commute to work and cover a distance of over 60 km.
Figure 2.9: Breakdown of Distances Travelled to Work
Source: Office of National Statistics 2004, Distance Travelled to Work (UV35)
2.17
Overall Employment Rate
Rotherham‟s traditional industrial and mining industries have diminished during the last fifteen years. There was a long period of decline in employment during the 1980s and 1990s. However, new industries have developed and economic growth has boosted the employment rate. There has been a dramatic improvement in Rotherham‟s employment rate over the last ten years, an increase which has been faster than across England as a whole.
Overall, it would appear that Rotherham has significantly closed the gap in terms of employment38. This has been driven by a growing economy and associated job creation. Rotherham‟s employment rate began to increase strongly during 2001.
Between 1998 and 2006, the number of jobs located in Rotherham increased from 80,900 to 104,000, a 28.6% increase. This was the highest increase in the region and amongst the 20 highest increases nationally. Much of the rise is attributable to the development of large new employment sites such as
Manvers39.
Between 2000 and 2006 there was a significant increase in job creation in
Rotherham with 14,600 jobs being created which was well above the regional and national averages40. The employment rate continued to increase up to the end of 2006 when it reached the national average, but since then it has fallen back below the regional and national averages, falling particularly sharply since the start of the recession in mid-2008.
According to NOMIS Official Labour Market Statistics there are 123,100 people who are economically active, either in employment or unemployed and actively seeking a job. Of these, there are 107,900 people who are employed. This equates to 68.0% of the working age population, below the regional average of
71.2% and the national average of 72.9%41.
38
Rotherham State of the Borough 2008, A Statistical Portrait, p3
Rotherham State of the Borough 2008, A Statistical Portrait, p12
40
Rotherham State of the Borough 2008, A Statistical Portrait, p10
41
NOMIS Official Labour Market Statistics 2009, Labour Supply – Economically Active
39
- 45 Breaking down the employment figures: 55,800 (52%) are males with 52,100
(48%) females. The difference is mainly attributable to the working age of females being 16-59 years and males being 16-64 years. 11,900 (7.6%) of people are self-employed which is below the regional average of 8.3% and national average of 9.1%. Males are more likely to be self-employed (11.5%) in comparison to females (3.2%)41.
The National Indicator (NI151) captures the number of people who are in employment according to the International Labour Organisation (ILO). The working age population is classed as 16-59 years for women and 16 -64 years for men. Figure 2.10 illustrates the employment rate in Rotherham from 2004 to 2009.
Figure 2.10: Employment Rate in Rotherham from 2004-2009
Employment Rate Comparisons 2004 onwards
76.0
75.0
74.0
73.0
75.0
74.0
74.2 74.3 74.2
72.0
71.0
70.0
72.0
71.5 71.7
71.6 71.5
70.9
69.0
GB
72.0 72.0 71.8
71.2
Y&H
70.4
69.6
Rotherham
69.9
68.0
67.0
68.0
De c0 M4 ar -0
Ju 5 nSe 0 5 pDe 05 c0 M5 ar -0
Ju 6 nSe 0 6 pDe 06 c0 M6 ar -0
Ju 7 nSe 0 7 pDe 07 c0 M7 ar -0
Ju 8 nSe 0 8 pDe 08 c0 M8 ar -0
Ju 9 nSe 0 9 p09 66.0
Source: NI151 (2009) – Employment Rate in Rotherham
In September 2009 68.0% of people who are of working age were in paid employment compared to the regional average of 71.2% and the national average of 72.9%.
Data for 2008 shows that public sector, financial/b usiness services, manufacturing and distribution are the four largest employment sectors in
Rotherham. In comparison with the UK, the biggest differences in employment were in financial/business sector and in manufacturing. Despite a decline in recent years 15.3% of Rotherham‟s working population work in manufacturing compared to only 10.2% in the UK as a whole. The financial/business sector employs 17.6% of Rotherham‟s population (despite recent strong increases) compared to 22.0% in the UK42.
Figure 2.11 shows levels of economic activity across all ethnic groups in
Rotherham. Highest economic activity is amongst the Indian (75.3%) and
Black ethnic groups (68.1%). A high percentage of people from these ethnic
42
ONS Annual Business Inquiry 2008
- 46 groups are self-employed. Both have higher economic activity rates than White
British people (64.4%).
Levels of economic activity are generally higher for the White British population but lower for BME groups. Lowest levels of economic activity occur in the
Kashmiri/Pakistani community (44.2%) and people identified as “Other” ethnic origin (41.6%). This is mainly due to particularly low levels of female economic activity and the role of women as carers.
Figure 2.11: Number of People who are Economically Active in Rotherham by
Ethnicity
Population
Aged 16-74
178356
171723
867
996
559
401
2815
231
329
226
209
Group
All People
White British
White Irish
White Other
Mixed
Indian
Pakistani
Other Asian
Black
Chinese
Other
Economically
Active
114116
110634
447
568
347
302
1244
124
224
139
87
%
64.0
64.4
51.6
57.0
62.1
75.3
44.2
53.7
68.1
61.5
41.6
Unemployed
7,041
6,611
29
46
32
13
251
18
23
6
18
%
6.2
6.0
6.5
8.1
9.6
4.4
20.2
4.6
7.4
4.3
20.0
Source: Health Needs Assessment 2008, BME Populations in Rotherham, p17
Working Age People on Out-of-Work Benefits (NI 152)
The National Indicator (NI152) measures the percentage of the working age population who are claiming out of work benefits. Out of work benefits include
Job Seekers Allowance, Lone Parents on Income Support, Incapa city Benefit and other income related benefits. These benefits do not include carers, people who are disabled or people who have been recently bereaved.
Figure 2.12: Rotherham people claiming out-of-work benefits from 2005-2009
15.4%
14.7%
14.4%
14.3%
14.3%
14.5%
14.4%
14.7%
15,000
14.6%
15.0%
14.9%
15.0%
14.9%
20,000
15.0%
25,000
16.2%
17.3%
30,000
16.8%
Out of Work Benefits: Claimants 2005 - 2009
18.0%
17.0%
16.0%
15.0%
26,710
26,920
26,680
26,520
24,130
22,800
22,120
22,210
21,810
22,240
22,230
22,760
22,700
22,900
23,020
0
23,500
13.0%
23,290
5,000
23,110
14.0%
22,770
10,000
23,070
2.18
0 5 05 05 05 0 6 06 06 06 0 7 07 07 07 0 8 08 08 08 0 9 09 09 09 b- y- g- v - b- y- g- v - b- y- g- v - b- y- g- v - b- y- g- v Fe Ma Au No Fe Ma Au No Fe Ma Au No Fe Ma Au No Fe Ma Au No
Source: NI152 (2009), Working Age People on Out-of-Work Benefits
12.0%
Out of work benefit claimants 4Q average % working age pop.
- 47 There are 154,400 people who are of working age population in Rotherham.
Figure 2.12 shows that the total number of people on out of work benefits had been steadily declining from 23,290 people (14.9%) in No vember 2005 to
21,810 (14.4%) in November 2007. Since then the number of people on benefits has shown an increase, particularly since the economic downturn began in mid-2008. This is due to increasing numbers of Job Seeker
Allowance claimants and at November 2009 there were 26,710 people (17.3%) on out of work benefits.
2.19
Number on Out-of-Work Benefits in Worst Performing Areas (NI153)
The National Indicator (NI153) captures the number of working age people who are claiming out-of-work benefits in the worst performing neighbourhoods in
Rotherham. These neighbourhoods are defined as Lower Super Output Areas
(LSOA) and made a benefit claim rate of 25% or more at the 2007 baseline.
An average LSOA contains around 1,500 people.
Figure 2.13: Working Age people claiming out-of-work benefits from
2005-2009 in the worst performing neighbourhoods
Out of Work Benefits: Claimants in Rotherham's worst performing SOA's
(rate >=25% ): all rates based on 4-Quarter rolling averages.
7,000
32.0%
31.2%
6,800
30.6%
6,600
31.0%
29.7%
6,400
30.0%
28.7%
29.0%
28.3%
28.1% 28.2%
28.0%
28.0%
27.9%
27.8%
27.8%
27.7% 27.6%
27.7%
27.4%
27.4%
6,200
6,000
28.0%
6,885
6,885
6,845
6,810
6,340
6,060
5,960
6,030
6,005
6,015
6,020
6,110
6,030
6,115
6,155
6,215
6,190
6,120
5,960
6,030
26.0%
25.0%
Fe bM 05 ay A 05 ug N 05 ov Fe 05 bM 06 ay A 06 ug N 06 ov Fe 06 bM 07 ay A 07 ug N 07 ov Fe 07 bM 08 ay A 08 ug N 08 ov Fe 08 bM 09 ay A 09 ug N 09 ov -0
9
5,400
% working age pop.
27.0%
5,800
5,600
Workless
Benefits:
Claimants
Source: NI153 (2009), Working Age People on Out-of-Work Benefits in Worst Performing Neighbourhoods
23 (13.9%) of Rotherham‟s 166 Super Output Areas (SOAs) had a claim rate of
25% at the 2007 baseline with an average claim rate across all 166 SOAs of
14.9%. The average claim rate for SOAs, not including the LSOA rates (143
SOAs) was 12.7%.
The number of people who are claiming out-of-work benefits in the worst performing SOAs has increased from 5,960 in May 2008 to 6,885 people in
November 2009, an increase of over 15%. The percentage of the working age population claiming out-of-work benefits had been falling slowly up to May 2008 but the recent recession has seen the rate increase to 31.2% in November
2009.
2.20
Contact with Mental Health Services whilst Employed (NI 150)
The National Indicator (NI 150) measures the percentage of adults receiving secondary mental health services in paid employment at t he time of their most
- 48 recent assessment, formal review or other multi-disciplinary care planning meeting, in August 2010 this measured at 3.1%.
2.21
Unemployment Rate
Rotherham‟s unemployment rate at September 2009 was 10.2% which is above the national average of 7.4% and the regional rate of 8.2%. Rotherham had 12,300 people unemployed in 2009, including 430 from minority ethnic groups. 7.4% of the unemployed are therefore from the BME community.
Unemployment had fallen dramatically from twice the national average to just below the national average by 2005 - the number unemployed in Rotherham peaked at 20,574 in September 1986 but, after falling to around 5,000, has increased again following the recession to reach 12,300 in September 2009.
Employment deprivation is one of the main drivers of deprivation affecting
Rotherham as measured by the Indices of Deprivation 2007. Although there have been some significant improvements since the mid-1980s Rotherham is still ranked as the 58th most deprived of 354 English Districts on the
Employment Domain. This is an improvement from 51st in 2004.
Employment deprivation has a distribution similar to overall deprivation levels, with the most deprived areas being Thrybergh, East Herringthorpe, Eastwood,
Canklow, East Dene and East Maltby. The areas with the highest levels of employment deprivation have 28% of all working age people on long term sick or unemployed. However, even in the most affluent areas in Rotherham, around 5.1% of people are employment deprived43.
The main reason for high worklessness rates are the high levels of long-term sickness. These high numbers are a legacy from the old heavy and mining industries. Local regeneration has made a great impact in Rotherham in recent years and the local economy has recovered strongly, creating jobs and prosperity, particular in the Manvers area. However, due to the impact of the recession overall unemployment has risen and there are still some neighbourhoods in Rotherham where unemployment remains very high.
There is substantial evidence that work leads to better physical, mental health and well-being. Conversely, worklessness can lead to poorer health, shorter life expectancy and loss of other health-related aspects of life such as daily routine, social contact and self-esteem. However, the nature of the work must be taken into consideration. Work can cause negative health impacts if, for example, it is stressful or performed in an unhealthy environment. Lack of secure and stable job opportunities cause anxiety through poor living standards and feeling deprived and isolated.
In Rotherham the rates of worklessness decreased over the period February
2001 to February 2008, with a 7% reduction and a fall of just over 2,000. This is made up of a reduction in the numbers on long-term sickness benefits
(15,270 in 2001 reducing to 14,120 in 2008), and a larger fall in people on Job
Seekers Allowance from 5,450 in 2001 to 3,910 in 2008. There has been progress in areas such as the Town Centre and Eastwoo d in reducing
43
Rotherham State of the Borough 2008, A Statistical Portrait, p8
- 49 unemployment levels, but long-term sickness levels remain high in the most deprived areas of Rotherham44.
Since 2008 the position has worsened with worklessness increasing again.
Whilst long-term sickness benefits have remained broadly similar the numbers on Job Seekers Allowance had risen to over 8,000 by the end of 2009.
People who are not working but seeking work are unemployed and unemployment rates are calculated as a percentage of the economically active population (those working or seeking work). The unemployment rate in 2001 averaged 6.2% for Rotherham as a whole but for BME groups overall, unemployment is twice as high. For non-White groups 14.4% were unemployed in 2001, rising to over 20% for people who originated from Kashmir/Pakistan.
This contrasts with the below average levels of unemployment for Chinese and
Indian people45.
Unemployment in 2001 was higher for men than women although this was not the case in every ethnic group. Although unemployment for Kashmiri and
Pakistani men was high at 18.9%, women had an even higher rate of 23.2%.
Men of “Other” ethnic groups and women of “Other Asian” groups also had unemployment rates over 20%. Chinese and Indian men had very low unemployment rates, as did Black women45.
2.22
Claimant Count
The number unemployed at September 2009 was 8,838 according to the claimant count but, according to the Annual Population Survey (APS), was
12,300. The APS unemployment rate takes account of people not entitled to benefits. The APS unemployment rate for Rotherham in September was
10.2%, above the regional rate of 8.2% and national rate of 7.4%.
According to NOMIS Official Labour Market Statistics there were 7,498 people claiming Job Seekers Allowance in June 2010. 75.0% are males and 25.0% are females. 55.0% of claimants are between the ages of 25 -49, 31.5% between 18-24 and 13.3% aged 50 and over. 73.0% have been claiming this allowance up to 6 months with only 12.7% claiming over a 12 month period 46.
Across Rotherham 28,450 people were receiving means-tested benefits Income Support, Jobseekers Allowance or Pension Credit in 2008, which equates to 14% of all people aged over 16. This is made up mainly of Income
Support claimants (10,270) and Pension Cred it claimants (14,270). The numbers of people living in income deprivation has been fairly static since
2001, with a fall in younger age groups being matched by a small rise in the older age groups44.
2.23
Recent National Economic Down-Turn
The UK economy is only just beginning to recover from the severe recession experienced since the middle of 2008. Rotherham has been severely impacted upon with significant job losses and increasing levels of unemployment. Most
44
Rotherham State of the Borough 2008, A Statistical Portrait, p11
Health Needs Assessment 2008, BME Populations in Rotherham, p17
46
NOMIS Official Labour Market Statistics (2009), Working Age Client Group – Benefit Claimants
45
- 50 analysts expect the recovery to be slow with little significant improvement in employment numbers until 2011 at the earliest and employment numbers not getting back to pre-recession levels for a number of years.
The chart below shows how the claimant rate increased more quickly in
Rotherham compared to regionally and nationally, although there have been some recent encouraging signs with falls in the claimant count locally in five of the first six months of 2010 and the overall rate falling faster than other are as.
Claimant Count Rates : June 08 - June 10
6.5%
5.9%
5.9%
5.7%5.7%
5.7%5.6%
5.7%5.6%
5.6%5.5%
5.6%
5.5%
5.5%
5.4%
5.2%
5.2%
6.0%
5.5%
5.0%
4.5%
4.5%
4.0%
3.5%
3.0%
2.5%
2.0%
4.0%
4.8%
5.1%
5.0%
4.9%4.8%
4.8%4.8%
4.8%4.8%
4.8%
4.7%4.7%
4.7%
4.6%4.7%
4.6%
4.4%
4.4%
3.6%
4.3%
4.3%
3.9%
4.2%4.2%
4.2%4.1%
4.1%4.1%
4.1%
4.1%4.1%
4.1%
4.0%4.1%
3.2%
3.9%3.8%
3.5%3.8%
3.0%3.0%
3.2%
3.4%
2.6%2.7%
2.9%
2.8%2.9%
3.0%
2.5%2.6%
2.8%
2.5%
2.4%2.5%
2.2%2.3%
Ju n -0
Ju 8 l Au -08 gSe 08 pO 08 ct No -08 v De -08 c Ja -08 nFe 09 b M -0 9 ar Ap 0 9 rM 09 ay Ju 09 nJu 0 9 l Au -09 gSe 09 pO 09 ct No -09 v De -09 cJa 09 n Fe - 10 b M -1 0 ar Ap 1 0 r M - 10 ay Ju 10 n10 1.5%
Great Britain
Yorkshire & Humber
Rotherham
In the long-term the latest forecasts from Yorkshire forward suggest that employment levels in Rotherham may not recover to pre -recession levels until around 2020, particularly taking into account the expected job losses in the public sector over the next few years, but this will depend to a large extent on the speed/strength of recovery in the national economy.
2.24
Average Incomes
Levels of income deprivation across Rotherham are relatively high, with the
Borough ranked 70th most deprived of the 354 English Districts. There is a close relationship between multiple deprivation and income deprivation. This is evident in parts of East Herringthorpe and Canklow where half the population are affected by income deprivation, whilst in the least depri ved areas only 4% of people are similarly affected44.
The Indices of Deprivation 2007 showed that 18% of people over 60 in
Rotherham live in very low income households but in the most deprived areas such as East Herringthorpe and Canklow this can rise to over 50% of people living in income deprivation44.
Median average hourly earnings for full time workers (including overtime) in
Rotherham were £11.24 in 2009, compared to £11.37 regionally and £12.43 in the UK. This represents a rise of 11.8% from the 2008 figure in Rotherham, compared to a 3.6% rise in the region and a 3.8% rise in the UK. However,
- 51 when comparing earning rates it should be noted that there is a lower cost of living in Rotherham.
In 2009, men earned an average of £11.40 per hour compared to £10.62 for women. W omen‟s hourly pay was 93.2% of men‟s pay in Rotherham, slightly higher than the regional figure of 89.1% and the national figure of 87.1%.
Weekly average full time earnings were £450.90 in Rotherham, compared to
£490.20 nationally. Male earnings were 20.4% higher than female earnings, below the national figure of 25.1%47.
Historically the earnings of Rotherham‟s employed population have been above the level of the earnings of employees working within Rotherham. People from
Rotherham have taken advantage of higher earnings outside the borough, particularly Sheffield. This gap has shrunk over the last few years and work place/residence based earnings are now broadly at similar levels. This is an indication that higher paid jobs have been created in Rotherham48.
Average household income in Rotherham is estimated at £30,100 (2007), 88% of the national average of £34,166. Average household income varies greatly from £14,360 in the poorest 1% of the Borough, to £58,975 in the most affluent
1%, over four times higher48.
2.25
Access to Services
According to the Index of Multiple Deprivation (IMD 2007), Rotherham is currently ranked as 285th most deprived out of 354 English districts for Barriers to Housing and Access to Services. This means that Rotherham has relatively good access to housing and services and is in the top 20% nationally. 0% of the Rotherham population live in areas where it is most difficult to access services. Rotherham has excellent transport links to the rest of the country, being served by the M1 motorway which provides access to Leeds and Nottingham and the
M18 which gives access to the Humber ports. There is an extensive network of rail and bus services, providing good links with Sheffield and other neighbouring towns.
The Department of Transport has produced a range of Core Accessibility
Indicators which measures accessibility either by public transport, walking or cycling to primary schools, secondary schools, further education, GP surgeries, hospitals, supermarkets and employment. The findings from the indicators for
Rotherham are as follows:
Access to GP Surgeries - 88.32% of households who do not have access to a car are able to access a GP surgery within 15 minutes. This is below the regional average of 92.29%. 100% of households with no car have access within 30 minutes in Rotherham49.
Access to Hospital - 88.56% of households who do not have access to a car are able to access a hospital within 30 minutes for routine appointments. This
47
ONS Annual Survey of Hours & Earnings (2009)
Rotherham State of the Borough 2008, A Statistical Portrait, p13
49
Department of Transport 2005, GP Indicators
48
- 52 is above the regional average of 85.91%. 100% of households with no car have access within 60 minutes in Rotherham50.
Access to Employment - 95.2% of the local population can get to work by public transport within 20 minutes. This is above the regional average of
94.84%. 100% of the population have access within 40 minutes. 96.5% of Job
Seekers can travel to work within 20 minutes, 100% within 40 minutes 51.
Access to Primary Schools - 96.46% of target population have access to a local primary school within 15 minutes. This is above the regional average of
95.78%. 100% have access within 30 minutes52.
Access to Secondary Schools - 94.38% of target population have access to a secondary school within 20 minutes. This is above the regional average of
92.05%. 100% have access within 40 minutes53.
Access to Further Education - 99% of target population have access to
Further Education facilities within 30 minutes. This is above the regional average of 96.51%. 100% have access within 60 minutes54.
Access to Supermarkets - 92.63% of households who have a car can access a local supermarket within 15 minutes. 92.66% of households who do not have a car can access a local supermarket. This is below the regional average of
95.06%. 100% of households have access within 30 minutes55.
In summary, in comparison to other regional areas, Rotherham scored above average in 5 out of 7 areas for accessibility, in particular to primary and secondary schools, further education, hospitals and employment. This is as expected as Rotherham has low levels of deprivation in barriers to Housing and
Access to Services.
The two areas that were slightly under average were access to a GP surgery
(3.97% below the regional average). However, two new GP surgeries are currently being commissioned and will be fully operational by the summer of
2009. The first one, located in the Wentworth North Area Assembly, will register patients from Wath, Swinton, Mexborough and Bolton-on-Dearne. The second, located in the Town Centre of Rotherham at the Community Health
Centre, will take patients from across the borough. Both GP practices will be registering around 6,000 new patients and will be offering extended evening and weekend opening hours. This will improve accessibility rates for the local population, especially for the working age population.
The other area where accessibility rates were lower than the regional average was access to a local supermarket (2.43% below the regional average). Better transport links need to be established for some areas where access is difficult in remote areas such as Braithwell, Wentworth and Hooton Roberts. There may be more isolated communities who may not have access to a car.
50
Department of Transport 2005, Hospital Indicators
Department of Transport 2005, Employment Indicators
52
Department of Transport 2005, Primary School Indicators
53
Department of Transport 2005, Secondary School Indicators
54
Department of Transport 2005, Further Education Indicators
55
Department of Transport 2005, Supermarket Indicators
51
- 53 2.26
Satisfaction of People Over 65 with Home and Neighbourhood (NI 138)
The National Indicator (NI138) measures the satisfaction of how people who are over 65 years within their home and their local neighbourhood. The biannual Place survey was sent out to a random sample of around 5,200 households (about 1 in 20) in Rotherham in the autumn of 2008 in order to capture their views. The results of the survey identified that 80% of Older
People were satisfied with their home and local neighbourhood.
- 54 3.
Lifestyle and Risk Factors
3.1
Smoking
Smoking is a major contributor to ill health, particularly in relation to coronary heart disease and cancer.
A Smokefree Future, A Comprehensive Tobacco Control Strategy for England gives aspirations to reduce smoking rates among adults to 10% or less and to halve smoking rates among routine and manual workers, pregnant women and in the most disadvantaged areas by 2020.
The 2008 General Lifestyle Survey (formally the General Household Survey
(GHS)) shows that overall smoking prevalence in England has decreased from
39% of adults in 1980 to 21% in 2008. Reported prevalence was highest in the age groups 20-24 and 25-34 (32% and 27% respectively) and lowest (12%) for those aged 60+ (see Figure 3.1 below)56. 66% of current or former regular smokers state that they started before the age of 18 and 39% before the age of
1657.
Figure 3.1
Prevalence of smoking by age group for adults 2000 and
2008
40%
2000
2008
35%
30%
25%
20%
15%
10%
5%
0%
16-19
20-24
25-34
35-49
50-59
60+
Source: General Lifestyle Survey 2008, GLS 2008 data
Prevalence of smoking in England is slightly higher amongst men (21%) than women (20%), but the gap has decreased since 1980 when 42% of men reported smoking compared with 36% of women. The main reason for the decrease appears to be an increase in adults who have never or only occasionally smoked. This has risen from 42% in 1982 to 53% in 2008. The increase in those never smoking has been much larger amongst men t han women, increasing from 32% in 1982 to 48% in 2008 for men, whereas the increase for women was from 51% to 58%56.
Prevalence rates vary significantly with marital status. Those who are divorced or separated are most likely to smoke (33%) whilst those who are widowed are least likely to smoke (12%). In every age group, apart from the youngest and oldest, married people were less likely to smoke56.
56
NHS Information Centre 2010, Statistics on Smoking 2010
(http://www.ic.nhs.uk/webfiles/publications/smoking%2010/Statistics_on_Smoking_England_2010.Report.pdf )
57
General Lifestyle Survey 2008, GLS 2008 data
(http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=5756&Pos=&ColRank=1&Rank=272 )
- 55 29% of those in manual employment groups are cigarette smokers, compared with 33% in 1998, confirming progress towards the targets. Routine and manual employment groups report the highest level of smoking. Those in managerial or professional households are the most likely to have never or only occasionally smoked56.
People who live in an area of deprivation are more likely to smoke. Rates of smoking also increase for men and women in households with low household income56. The Health Survey England (HSE) 2004 reported on the proportion of people from the Black and Minority Ethnic (BME) Community that smoked. This
Survey reported on smoking prevalence among BME men. 20% of Indian men smoke, 21% of black African, 21% Chinese and 40% of Bangladeshi men.
Men in Bangladeshi and Irish groups were more likely to report smoking than men in the general population. With the exception of Bangladeshi and Irish men, men from BME groups were more likely than those in the general population to report that they had never smoked. Chewing tobacco is quite widely used amongst specific BME groups58.
The reported pattern of smoking amongst ethnic minority groups was very different to that from women. The reported prevalence amongst women ranges from 2% of Bangladeshi women to 24% of Black Caribbean women and 26% of
Irish women. This compares with 23% of the general female population58.
The latest modelled estimate, based on the Health Survey England 2006 -08, of adults that smoke in Rotherham (26.4%) is above the England average
(22.21%)59. The responses to the latest Lifestyle Survey conducted in 2008 show a decrease in reported smoking from 24% to 21%. Information from GP registers tends to be more reliable, data for Q1 2010-11 shows the prevalence rate in persons 16+ 18.1%60. Information is available from 22 Rotherham GP practices on the numbers of BME patients who smoke and this suppo rts the national data that suggests a higher smoking prevalence particularly amongst
Pakistani males and the Irish community.
During 2006-08 there were on average 481 deaths each year from smoking in
Rotherham. This equates to a directly age-standardised rate of 254.8 per
100,000 of the population aged 35+. This is above the national average of
206.859.
The prevalence of smoking at the time of delivery in Rotherham in Q1 2010 -11 is 22.6%. This is well above the England average of 13.6%, the Y&H average of 17.4% and the national target for 2010 of below 15%60&61. Rotherham has met the target of reducing the number of mothers whose smoking status is not known at delivery to less than 5%. However this is near the lower end of performance with 4.9% in Q1 2010-11 on this indicator when compared with other PCTs60.
58
NHS Information Centre 2008, Statistics on Smoking: England 2008, p7
Rotherham Health Profile 2010, Health Summary for Rotherham (http://www.apho.org.uk/resource/view.aspx?RID=92295)
Department of Health (2010) Statistical Release: Smoking at delivery, GP recorded smoking and GP recorded obesity, Q1 2010/11
61
Department of Health (2010) Statistical Release: Smoking at delivery, GP recorded smoking and GP recorded obesity, Q4 2010/11
(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_116059)
59
60
- 56 There is evidence that younger mothers are more likely to smoke throughout pregnancy. 45% of mothers aged 20 or under reported smoking throughout pregnancy, compared with 9% of mothers aged 35 and over. Between 2000 and 2005 the proportion of mothers who smoked throughout pregnancy fell for all but the under 20 age group62.
The HealthCare Commission carried out an improvement review of tobacco control by Rotherham PCT in 2006 and gave the PCT an excellent rating on the work it was doing to reduce smoking prevalence. This was despite the fact that
NHS Rotherham was one of 40% of PCTs which failed to meet national targets on reducing smoking in 2006-7.
Rotherham‟s Tobacco Control Alliance is working to deliver a revised action plan based upon the new national strategy, A Smokefree Future. Work is based around four key themes:
Prevention
Cessation
Protection
Communication
2,763 people achieved 4-week quit success in Rotherham in 2009/10. This exceeds the SHA target of 1,458 and the PCT stretch target of 2,550 63.
There are wide variations in smoking rates across Rotherham64. Recorded smoking rates per GP practice vary from 15% to 56%. The rates at which people quit smoking varies dramatically according to the GP practice patients are registered with. Some practices in high prevalence areas have high quit rates, other practices do not. Some of the variation is related to whether or not practices offer patients a locally enhanced service (LES) for smoking cessation.
Another factor includes how accessible the NHS Rotherham Stop Smoking
Service is to the local population65.
3.2
Eating Habits
Poor diet and nutrition are major contributory factors to ill health and premature death. A significant proportion of the population are not eating the recommended daily intake of five or more fruit and vegetables a day although this is steadily increasing.
Research indicates that eating habits vary with gender and age. Men tend to eat larger quantities of most food groups and are more likely to consume fats, meat dishes, sugars, preserves, non-diet soft drinks and alcohol. Women are more likely to consume yogurts, fruit and diet soft drinks66.
Similar patterns have also been found among the low income population, with men from low income households being more likely to consume foods such as
62
NHS Information Centre 2008, Statistics on Smoking: England 2008, p25
NHS Information Centre 2010, Statistics on NHS Stop Smoking Services, April 2009 to March 2010
NHS Rotherham Stop Smoking Services 2008, Latest updates on targets
65
NHS Rotherham 2008, Strategic Plan v 5 Annex A
66
NHS Information Centre 2008, Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08
63
64
- 57 sausages, beer/lager and table sugar. Women are more likely to consume salad vegetables, dairy desserts and fruit66.
Model-based estimates using HSE data for 2006-08 predicted that 28.7% of adults in England eat healthily. Rotherham had the third worst prediction for the region at 19.8% compared with a regional average of 24.5% 59.
Figure 3.2 Model-based estimates of fruit and vegetable consumption
Source: NHS Information Centre 2008, Model Based Estimates of Fruit and Vegetable
Consumption for PCOs in England 2003-5
The HSE Survey (2008) reports that the proportion of men consuming 5 or more portions of fruit and vegetables a day has increased from 22% in 2001 to
25% in 2008 and for women from 25% to 29%. For both males and females, the number of portions of fruit and vegetables consumed per day was lowest in the 16-24 age group with an average of 2.9% (men) and 3.1% (women). This increases with age, peaking at an average of 4.0 portions per day for men aged
55-74 and 4.3 portions a day for women aged 55-6467.
There is a correlation between consumption of the recommended amounts of fruit and vegetables and household income. In 2006 both men and women i n the highest income quintile were more likely to consume 5 or more portions per day than those in the lowest income quintile68.
3.3
Alcohol
The Alcohol Harm Reduction Strategy sets out the government‟s strategy for tackling the harms and costs of alcohol misuse in England. In 2008, the government produced a report that estimated alcohol misuse costs to NHS
67
NHS Information Centre (2009), Health Survey for England 2008 – Trend Tables ( http://www.ic.nhs.uk/statistics-and-datacollections/health-and-lifestyles-related-surveys/health-survey-for-england/health-survey-for-england--2008-trend-tables)
68
NHS Information Centre (2008), Health Survey for England 2008 Volume 1, Physical Activity and Fitness
(http://www.ic.nhs.uk/webfiles/publications/HSE/HSE08/Volume _1_Physical_activity_and_fitness_revised.pdf)
- 58 England at 2.7 billion in 2006/07 prices69, while the cost associated with alcohol-related crime and anti-social behaviour was estimated to be up to £7.3 billion each year. The strategy also estimated that workplace costs of alcohol misuse are as high as £6.4 billion per year through loss in productivity70.
Alcohol misuse can be directly related to deaths from certain types of conditions such as cirrhosis of the liver and stroke. The Alcohol Harm
Reduction Strategy for England estimates that up to 22,000 premature deaths per year are associated in some way with alcohol misuse. The total number of deaths linked to alcohol consumption has increased each year since 2001.
This is mainly due to the increase in the number of deaths from alcoholic liver disease in each year70.
In England, the directly standardised death rates from alcohol-specific conditions (all ages) per 100,000 of the population for 2005-07 were 12.7 for males and 5.9 for females and the regional averages were similar at 13.9 for males and 5.9 for females. The death rates in Rotherham were higher at 15.5 for males and 6.2 for females. Rotherham MBC is ranked 251 and 209 respectively on this indicator out of 326 Local Authorities. Figure 3.3 sets out a full profile of alcohol related indicators for Rotherham 71. The most common cause of death directly related to alcohol is alcoholic liver disease; other main causes are fibrosis and cirrhosis of the liver and mental and behavioural disorders. In Rotherham the death rates in 2007 for alcohol-attributable conditions are higher than the national average for both males at 51.1 compared with 36.1 and females at 19.0 compared with 15.2. The rate for both males and females was higher than the regional averages of 37.3 and 15.7 respectively.
Rotherham MBC is ranked 310 on this indicator for males and 268 for females out of 326 local authorities71. Mortality from chronic liver disease (including cirrhosis) in Rotherham in 2006-08 was 18.3 for males and 5.8 for females.
The rate for males is higher than for England (14.10) and Yorkshire and
Humber (14.1). The rate for females is lower than national (7.3) and regional rates (7.3). Rotherham MBC is ranked 203 and 231 respectively on this indicator71. There is evidence that men are more likely to exceed daily and weekly guidelines on alcohol consumption than women. Men and women who drink above the daily recommended guidelines also have a higher weekly consumption of alcohol. The youngest and oldest age groups are less likely to report drinking alcohol in the previous week, although older people reported drinking more frequently than younger people. There are some indications that consumption may be declining, particularly among men72.
According to the Rotherham Lifestyle Survey 2008, 34% of males and 22% of females reported that they had exceeded the recommended number of units in the previous week. This is the same proportion as the previous survey in 2005 for males, but an increase of 5% for females. For females there have been
69
Department of Health (2008), The cost of alcohol harm to the NHS in England
(http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_0864 21.pdf)
70
NHS Information Centre 2008, Lifestyles Statistics: Statistics on Alcohol England 2008
71
North West Public Health Observatory: Local Alcohol Profiles England (http://www.nwph.net/) and Rotherham Alcohol Profile
72
NHS Information Centre (2010) Lifestyle Statistics, Statistics on Alcohol, England 2010-Tables (http://www.ic.nhs.uk/statistics-and-datacollections/health-and-lifestyles/alcohol/statistics-on-alcohol-england-2010)
- 59 increases of 8% in the percentage of females aged 16-34 and 55-70 reporting that they exceeded the guidelines. For males, the most significant change was a decrease of 16% for the 16-34 age group.
Binge drinking is defined as drinking more than twice the daily recommendations, i.e. more than 8 units for men and 6 units for women. GHS reported that in 2008, 22% of men and 15% of women reported binge drinking on at least 1 day in the week72. The proportion was greatest amongst younger age groups with 32% of men aged 16-44 reporting binge drinking compared with 7% of those aged 65+. For women, 25% of those aged between 16 and
24 reported drinking over 6 units compared with 2% of people aged 65+72. In
Rotherham the estimated prevalence of binge drinking is 27.8% of the adult population, which is significantly above both the regional average of 24.5% and the England average of 20.1%73. 18% of male and 11% of female respondents to the 2008 Rotherham Lifestyle Survey reported that they had drunk more than
6 units of alcohol more than 4 times in the previous month. This is a significant reduction for males since the last survey in 2005, when the results were 36% for males and 14% for females. Skilled manual workers and the unemployed were most likely to be in this category of respondents.
73
Association of Public Health Observatories (2010), Rotherham Health Profile 2010
(http://www.apho.org.uk/resource/view.aspx?RID=50215&SEARCH=R*)
- 60 Figure 3.3 Alcohol Profile Rotherham
Source:
North West Public Health Observatory, Local Profiles England and Rotherham Alcohol Profile
In 1992 the Government defined sensible drinking as no more than 21 units of alcohol per week for men and 14 units for women70. Hazardous drinking is defined as drinking between 22 and 50 units of alcohol pe r week for men and between 15 and 35 units of alcohol per week for women. In 2005, the estimated proportion of the adult population in Rotherham who were a regional average of 6.0% and a national average of 5.0%. Rotherham ranks 242 on this indicator compared with other local authorities71.
- 61 Figure 3.4
Proportion of men and women in England consuming more than the recommended weekly guidelines by age
Source: NHS Information Centre (2008), Lifestyles Statistics: Statistics on Alcohol England 2008
Alcohol dependence is defined as people drinking above sensible levels and experiencing harm and symptoms of dependence. In 2004 the overall prevalence of alcohol dependence in England was 3.6%, with 6% of men and
2% of women meeting the criteria equating to 1.1 million people. 2% of male and female respondents to the 2008 Rotherham Lifestyle Survey said they relied on alcohol compared with 2% and 1% respectively in the previous survey in 2005. Out of the English regions, Yorkshire and Humberside has the second largest gap between the number of alcohol dependent people and the number accessing treatment, with only 2.2% of the „in need‟ population accessing treatment compared with a national level of 5.6%74.
Figure 3.5
Percentage of people in England with an alcohol use disorder broken down by category of problem drinking and gender Source: Department of Health (2005), 2004 Alcohol Needs Assessment Research Project
People from ethnic minority groups were found to have considerably lower prevalence of hazardous/harmful drinking use but a similar prevalence of alcohol dependence compared with the white population 70.
NI39 is a national indicator which measures alcohol-harm related hospital admission rates per 100,000 of the population. It measures all admissions that are attributable to alcohol. In 2007-08 in Rotherham 1,552 admissions were
74
Department of Health (2005), 2004 Alcohol Needs Assessment Research Project
- 62 reported, which is higher than the regional average of 1,413 and significantly worse than the national average of 1,47371.
There is evidence that drinking behaviour is affected by socio-demographic factors. People in employment are more likely to have drunk alcohol on f ive or more days in the previous week. They are also more likely to binge drink than unemployed people. Those in managerial and professional households are more likely to drink more frequently and drink above the daily recommendations than those in routine and manual households72.
Married adults (including those cohabiting) are more likely to have drunk alcohol in the week previous. They are also most likely to report drinking on five or more days in the previous week and single adults least likely. Single people are more likely to drink more than the recommended daily amount of units and to binge drink72.
Figure 3.6
Adults who drank alcohol in the last week by marital status
2006
Analysis shows that variation in drinking in the last week ranged from 4% to 5% of those of Bangladeshi or Pakistani origin to 67% to 68% of those recording their ethnicity as White British or White Other. Adults of mixed eth nicity were more likely to drink over the recommended daily limits on at least one day in the previous week as were the White British and the White Other ethnic groups.
The same pattern is seen for binge drinking. It should be noted that this analysis was carried out using the original method of unit conversion and it is unclear whether or not the same patterns would emerge using the improved method70. Over half of pregnant women in the UK reported drinking during pregnancy in
2005, although this proportion has decreased from 66% in 1995 to 55% in
2005. There has also been an increase in the percentage of mothers who gave up drinking when pregnant from 24% in 1995 to 34% in 2005. Older women are more likely to report drinking during pregnancy than younger women. The proportion who gave up drinking during pregnancy decreased with age while the proportion reporting they drank less increased with age 70.
Overall a higher percentage of adults across all age groups in England reported
Saturday as their heaviest drinking day (28%), followed by Sunday (23%) and
- 63 Friday (14%). For 16 to 24 year olds however, 38% reported Saturday as their heaviest drinking day followed by Friday (23%) and Sunday (13%).
Respondents over 65 were more likely to drink most on a Sunday (32%)72.
In 2009, there were 139,584 prescription items for drugs for the treatment of alcohol dependency prescribed in primary care settings and dispensed in the community in England. This is a big increase since 2003 when there were
93,241 prescription items. The Net Ingredient Cost (NIC) was £1.6 million in
2003 but has now increased to £2.4 million in 2009. The NIC per item has decreased from £17 in 2003 to £16 in 200972.
These drugs are also prescribed in hospitals for dispensing in the community, though in smaller numbers than those prescribed in primary care settings. In
2009, 10,861 prescription items were prescribed in hospitals. This has increased by over 10% since 2003 when there were 9,500 prescription items for the treatment of alcohol dependency72.
3.4
Physical Activity
Physical activity contributes to a wide range of health benefits and can reduce the incidence of many chronic conditions. Regular physical activity can improve health outcomes irrespective of whether individuals lose weight.
Current recommendations are:
Adults: To encourage participation in at least 30 minutes of moderate intensity* activity five times (or more) a week.
Children: To encourage participation in at least 60 minutes of moderate intensity activity per day, and at least twice a week exercise befitting bone health, muscle strength and flexibility.
Active Living: To encourage the majority of the population, who do not exercise on a regular basis, to build physical activity of moderate intensity into their daily routines**.
*
Moderate intensity activity will raise the heart rate and leave the individuals a little out of breath.
** The 30 minutes target can be accumulated during the course of the day by undertaking a variety of activities in bouts of 10 minutes or more, these can include brisk walking and gardening75
The Health Survey England (HSE) indicates that for both men and women, the proportion achieving the physical activity recommendations has increased overall, from 32% in 1997 to 42% in 2008 for men and from 21% to 31% for women68. In 2006, for both men and women, the proportion meeting the guidelines decreased with age. For men, over 50% of 16 to 34 year olds met the guidelines compared to 9% for those aged 75 and over. The proportion of women meeting the guidelines remained stable for those between the ages of
16 and 54 (between 33% and 36%) and decreased thereafter to 4% among those aged 75 and over76.
75
76
NHS Information Centre (2008). Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08 p 53
- 64 52% of respondents to the 2008 Rotherham Lifestyle Su rvey reported doing no moderate or strenuous exercise compared with 50% in 2005, and only 9% reported an optimal activity level (as defined by the Allied Dunbar Survey) compared with 15% in 2005. 56% of respondents to the 2008 survey reported a total of 30 minutes or more energetic exercise per day compared with 58% in
2005. 65% of respondents said they would like to increase their activity and fitness levels compared with 70% in 2005. Of these 52% said they needed more time, 48% said they needed more willpower and 34% thought they needed better health.
In England between 41% and 42% of men in the 3 highest household income quintiles met the recommendations for physical activity in 2006, falling to 31% in the lowest income quintile. For women, 34% of those in the highest income quintile met the recommendations compared to 26% of those from the lowest income group. There is a clear trend in the prevalence of low activity levels for both men and women, with those in the lowest income quintile more likely to be low participators than those in the highest income quintile77. Results from the
“Taking Part” household survey (TPS) show that those with the highest incomes were more likely to take part in active sport. 89% of those earning over £50,000 had done so at least once in the previous twelve months compared with 61% of those with an income of less than £10,00078.
16.6% of the adult population in England (7 million people) takes part regularly in sport and active recreation (figures from the 12 month period up to April
2010)79. Regular participation in sport and recreation is defined as taking part on at least 3 days a week in moderate intensity sport and active recreation (at least 12 days in the last 4 weeks) for at least 30 minutes continuously in any one session80.
Results from the 2009-10 Active People survey show Rotherham to be in the bottom 25% of Local Authorities with 13.6% of adults taking part regularly in sport and active recreation81. For the active people 3 survey the rate was
19.2%. Participation is slightly higher for males with 21.9% participating compared with 16.6% of females. Participation is highest amongst individuals aged 35-54 at 26.8% and lowest amongst those over 55 at 9.2%82.
The HSE 2004 reported that within minority ethnic grou ps Irish (39%) and Black
Caribbean (37%) men had the highest rates for meeting physical activity recommendations, similar to the proportion of men in the general population
(37%). Black Caribbean, Black African and Irish women reported the highest rates of meeting current physical activity guidelines (31%, 29% and 29% respectively), compared with 25% of women in the general population. Only
11% of Bangladeshi and 14% of Pakistani women did the recommended amounts of physical activity in the four weeks prior to interview78. In
Rotherham, the Active People survey 3 indicated a higher percentage of
77
NHS Information Centre (2008), Health Survey for England 2008 Volume 1, Physical activity and fitness, p46
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08 p 55
79
Sport England, Active People Survey 4 – 2009-10. Sports Participation Factsheet: Summary of results for England, Quarter 2, 2009/10
80
Sport England, Active People Survey 2005-6 Headline Results
81
Sport England, Active People Survey 4 – 2009-10. Sports Participation: England, regions, counties and districts. Quarter 2, 2009/10
(http://www.sportengland.org/research/active_people_survey/active_people_survey_4/aps4_quarter_2.aspx)
82
Active People Survey 3 Results
78
- 65 non-white adults (47.1%) take part regularly in sport than the general population (19.2%)82.
The TPS indicated that adults living in single adult households with no children had significantly lower rates of participation (50%) in active sport than any other group in 2005-6. Adults living in households with adults and children had the highest rates with 82% reporting participation in at least one active sport in the last twelve months. The TPS also showed significant variations in participation in active sport between those with no formal qualifications (41%) and those with
A-levels or above (83%)83.
The TPS is used to monitor the Public Service Agreement 3 (PSA3). Part of this PSA is, by 2008, to increase the number who participate in active sport at least twelve times a year by 3%, among those in priority groups (black and minority ethnic group, limiting disability, lower socio-economic groups and women). Results from the TPS 2009-10 showed that 53.4% of all adults participated at least once in active sport during the past 4 weeks. The report also states than men are more likely than women to have done active sport in the last 4 weeks (59.4% and 47.7% respectively). 60.7% of people without a long-term limiting illness or disability compared to 33.6% of people with a long-term limiting illness or disability reported to have done active sport in the last 4 weeks84. The proportion of those participating from all of the priority groups fell slightly between Year 1 and Year 2, with the largest decrease being in participation by females which fell by 1.5%85.
The second part of the PSA indicator relates to participation in moderate intensity level sport for at least 30 minutes on at least three separate days during the past week. The TPS reported that overall the percentage of adults meeting this indicator increased from 20.9% in Year 1 to 21.5% in Year 2. The
TPS 2009/10 reports that “between 2005/06 and 2009/10, the proportion of adults doing active sport in England for more than 30 minutes at a time increased from 49.9% to 52.9%”84. Participation from black and minority ethnic groups rose from 19.2% to 19.6% and from lower socio -economic groups from 15.2% to 15.3%. Participation by women fell from 18.5% to 18.3% and by those with a limiting disability from 9.5% to 9.4%85. In Rotherham only
11.8% of people with a limiting disability take part in sport compared with
21.1% of people with no limiting disability82.
83
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p56
Taking Part: The National Survey of Culture, Leisure and Sport, Adult and Child Report 2009/10 (2010)
(http://www.culture.gov.uk/publications/7386.aspx)
85
Department for Culture, Media and Sport (2007), Taking Part Progress Report on PSA3: Final Estimates from Year 2
84
- 66 3.5
Obesity
The national obesity strategy “Healthy Weight, Healthy Lives” sets out measures to meet the challenge of excess weight in the population. In England almost two thirds of adults and a third of children are either overweight or obese and without effective action this could rise to almost nine in ten adults and two thirds of children by 2050. Overweight and obesity increase the risk of a wide range of diseases and illnesses, including coronary heart disease and stroke, type 2 diabetes, high blood pressure, metabolic syndrome, osteoarthritis and cancer. In 2007 it was estimated that the total annual cost to the NHS was
4.2 billion and to the wider economy 15.8 billion. By 2050 it has been estimated that overweight and obesity could cost the NHS 9.7 billion and the wider economy 49.9 billion (at 2007 prices)86.
NICE guidance currently states that assessment of health risks associated with overweight and obesity should be based on both Body Mass Index (BMI) and waist circumference68. Using both BMI and waist circumference to assess risk of health problems, in 2008 20% of men were estimated to be at increased risk,
14% at high risk and 21% at very high risk. Equivalent figures for women were
15% at increased risk, 17% at high risk and 24% at very high risk68. The proportion of both men and women at very high risk of the health effects of obesity increased with age peaking in the 65 to 74 age group, where 30% of men and 34% of women were in this category87.
In 2008, 24% of men and 25% of women (over 16) in England were classified as obese (BMI>30)88. Women are more likely than men to be morbidly obese
(3% compared with 1%). 37% of adults were overweight (BMI >25), with men more likely to be overweight than women (42% compared with 32%). Overall
66% of men and 57% of women were either overweight or obese in 2008 68.
The estimated prevalence of obesity for adults in Rotherham, based on Health
Survey England (HSE) - 2006-08, is 28.3%. This is slightly above the national estimate of 24.2% and the regional estimate of 26.3%89. QUEST and QOF data indicate that 32% of people in Rotherham with a recorded BMI are overweight, compared with 37% of people in the HSE 2005 and 23% are obese
(HSE 24%). In Rotherham the number of people in the extreme BMI categories is of particular concern: 4,286 people are identified on GP practice registers with a BMI of over 40 (2.7% of the whole population compared with 1.8% in
HSE 2005) and 614 of these have a BMI over 50 which equates to 0.3% of the population. There are also likely to be more cases of extreme BMI in the 22% of the population that have not had their BMI recorded. It is predicted that by
2050 there will be 142,000 people who are obese which equates to 50% of the population90. 86
National Heart Forum (2008), Healthy Weight Healthy Lives
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p5
NHS Information Centre (2010), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet, England February 2010
(Chapter%201%20(withhttp:/www.ic.nhs.uk/statistics-and-data-collections/health-and-lifestyles/obesity/statistics-on-obesity-physicalactivity-and-diet-england-2010%20footnotes).doc)
89
NHS Information Centre (2010): Estimates of Obesity for PCOs in England 2006-8
(http://www.apho.org.uk/resource/view.aspx?RID=71961))
90
NHS Information (2008): Transformational Initiatives for Strategic Plan Obesity
87
88
- 67 QOF estimated raw obesity prevalence for Rotherham for 2009/10 is 13.7%, calculated from an obesity register total of 28,463 for persons over 16 91. The obesity prevalence in England in 2009/10 based on GP obesity registers was
9.9%. However, the HSE 2008 reported obesity in adults to be 24.5%88.
34% of respondents to the 2008 Rotherham Lifestyle Survey reported they were of normal weight, 38% overweight and 19% obese. This compares with
38%, 35% and 18% respectively to the 2005 survey. 57% of respondents in
2008 said they had tried to lose weight, but only 25% had been successful.
The HSE 2006 found overweight and obesity are more common in lower socioeconomic and socially disadvantaged groups, particularly among women.
Women‟s obesity prevalence is far lower in managerial and professional households (18.7%) than in households with routine or semi-routine occupations (29.1%). The prevalence of morbid obesity (BMI over 40kg/m2) among women is also lower in managerial and professional households (1.6%) than in households with routine or semi-routine occupations (4.1%). However the proportion overweight was generally directly proportional to income in men92. Among ethnic minority groups, obesity prevalence was highest among the
Black Caribbean and Irish groups for men with 25% classified as obese in each ethnic group.
Bangladeshi and Chinese men had the lowest obesity prevalence at 6% each.
Obesity prevalence was highest in Black African (38%), Black Caribbean (32%) and Pakistani
(28%) groups for women and lowest in Chinese women (8%)93.
Figure 3.7 Obesity Prevalence by Ethnic Group
There are also regional variations in obesity and it is estimated that incidence will generally be greater in the north of England than the south -west. In
91
NHS Information Centre (2010), Quality and Outcomes framework (QOF) for April 2009-March 2010. Numbers on age-specific QOF disease registers and estimated raw prevalence rates by PCT
92
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p16
93
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p6
- 68 Yorkshire and Humberside, obesity levels amongst women are predicted to reach 65% by 2050, compared with 7% in the southwest which is a reduction from the current 17%. Among men in Yorkshire and Humber, the West
Midlands and north-east England obesity levels are predicted to reach 70% by
2050 compared with London where the predicted level is 38%94.
The HSE report 2003 showed that men who were co-habiting were most likely to be overweight or obese. Among women, those who were widowed were most likely to be overweight or obese. For both men and women, those who were single were least likely to be either obese or overweight95.
The proportion of men who were obese was higher among ex-regular smokers
(31%) and non-smokers (21.2%) than current smokers (15.1%). Among women, those who were ex-regular smokers showed the highest prevalence of obesity (29.1%), whereas the proportion of those who were obese was similar for current smokers (19.9%) and non-smokers (22.2%). The HSE report 2006 found that overall, amongst both men and women, the odds of a raised waist circumference were higher for ex-smokers than for non-smokers (odds ratio 1:6 in men and 1:2 in women)95.
The HSE report 2003 found that women who did not drink (61.3%) or drank within recommended limits (55.9%) during the week prior to interview had a higher prevalence of being overweight or obese than women who drank more than twice the recommended limits (48.8%)96.
Both men and women had a higher prevalence of obesity among those with low levels of activity than those with high activity levels. Adults with low physical activity levels were twice as likely to have a raised waist circumference as those with high physical activity levels96.
Results from the HSE 2008 show that in England prevalence of both obesity and raised waist circumference has shown an overall increase since 1993, however overweight prevalence has remained relatively similar68.
Weight loss in overweight and obese people can improve physical, psychological and social health. Evidence suggests that a moderate weight loss of 5-10% of body weight is associated with important health benefits, particularly in a reduction in blood pressure and a reduced risk of developing type-2 diabetes and coronary heart disease. However, it is important to recognise that for very obese people, such changes will not nec essarily bring them out of the “at-risk” category, but there are nevertheless worthwhile health gains. A continuous programme of weight reduction should be ma intained to help continue to reduce the risks97.
Rotherham PCT recognises being a healthy weight, healthy eating and physical activity are important to prevent overweight and obesity in the short and longer term. The PCT have invested in a range of obesity services including community weight management programmes, a Multi Disciplinary Team of
94
National Heart Forum (2008), Healthy Weight Healthy Lives, p13
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p7
96
NHS Information Centre (2008), Lifestyles Statistics: Statistics on Obesity, Physical Activity and Diet: England January 08, p8
97
National Heart Forum (2008), Healthy Weight Healthy Lives, p28
95
- 69 health professionals and Bariatric surgery to support 2,000 adults over the next
3 years to have a healthier lifestyle and healthier future90.
The evidence from published papers on community weight management programmes (Tier 1) is consistent, reporting reduced incidence of Type 2 diabetes in the population of 58% compared to a control group. The local
Yorkshire and Humber programmes, which follow the same proposed model, report an average of 5% body weight loss in those completing the programme and one could assume the well-documented health benefits this weight loss infers. In addition to the physical health benefits, there are other less well-documented benefits, such as: increasing self -esteem and self-confidence; and beneficial knock on effects upon family members. These programmes also address other lifestyle issues such as: alcohol; smoking and issues of social support and social capital90.
Estimate annual costs to the NHS in Rotherham of diseases related to overweight and obesity are £72.2 million in 2007, rising to £74.9 million by 2010 and £80.1 million by 201598. If the planned interventions prove successful the investment will pay for itself by preventing the ill health associated with overweight and obesity in the future.
98
National Heart Forum (2008), Healthy Weight Healthy Lives, p97
- 70 -
4.
Burden of Ill Health
4.1
General profile of burden of ill health
The Government has set Public Service Agreement (PSA) targets for life expectancy and infant mortality. The target to be achieved for average life expectancy in England by 2010 is 78.6 years for men and 82.5 years for women. The target for reduction in health inequalities is 10% by 2010, as measured by infant mortality and life expectancy. By 2010, PCTs are expected to reduce by at least 10% the gap in life expectancy between the 20% most deprived areas (the Spearhead Group) and the population as a whole. For children under one year, it is expected that there is a reduction of at least 10% in the gap in mortality between the “routine and manual” socioeconomic group and the population as a whole99.
4.1.1 Mortality
All-age all-cause mortality rate is a national indicator which supports government targets on increasing life expectancy and decreasing health inequalities. Over the last ten years, all-age all-cause mortality rates have decreased in Rotherham, but remain higher than the England average. The following charts compare the mortality rates in Rotherham against the national average for the general population. They also compare mortality rates between males and females, using age-standardised rates based on the number of deaths from all causes per 100,000 of the population. Figure 4.1 All-Age All-Cause Mortality Rates Rotherham and
England for all persons 1993-2008
1000
England
900
Rotherham
800
700
600
500
400
300
200
100
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The mortality rate in Rotherham has generally been decreasing since
1993. However, since 2006 the mortality rate has increased. The gap in mortality rate between Rotherham and England is larger in 2008 than it was in 1993.
99
HM Government 2007, PSA Delivery Agreement 18: Promote Better Health and Wellbeing for All, p19
- 71 -
Figure 4.2
All-Age All-Cause Mortality Rates for Males,
Rotherham and England 1993-2008
1200
England
Rotherham
1000
800
600
400
200
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The Rotherham mortality rate for males has been on a general decreasing trend since 1993. However, since 2006 it appears to be levelling off. The gap between the local and national average remains much higher for males than females.
Figure 4.3
All-Age All-Cause Mortality Rates for Females,
Rotherham and England1993-2008
800
England
Rotherham
700
600
500
400
300
200
100
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2009), Compendium of Clinical and Health Indicators,
Mortality from all Causes
The mortality rate for Rotherham females fell in 2006 but has risen to higher rates again in 2007 and 2008. The gap between local and national rates is still prominent.
4.1.2 Infant Mortality
Infant mortality rate is calculated from the number of deaths per 1,000 live births. Figures from the National Centre for Health Outcomes show
- 72 that infant mortality rates in Rotherham for 2008 are above the national and regional averages100.
Figure 4.4
Infant mortality rates 2008 for England, Yorkshire and
Humber and Rotherham
9
England
Yorkshire & Humber
Rotherham
Mortality rate per 1000 live births
8
7
6
5
4
3
2
1
0
Under 1 yr
Under 28 days
Under 7 days
Source: NHS Information Centre (2009), Clinical and Health Indicators, Infant Mortality
The infant mortality rate in England and Wales for the period 2006-08 was 4.8 per 100,000 based on 9,866 deaths overall 101. Although infant mortality rates are at an all time low, the government remains concerned that a gap remains between different social groups. For example, for the same period the IMR for routine and manual groups was 5.2 per
100,000. This confirms that whilst IMRs continue to be higher in routine and manual (R&M) households, the gap has narrowed between this group and the population from 19% in 2002-04 to 16% in 2006-08101.
Data from 2002-4 shows that infant mortality rates (IMR) were likely to be higher in “Spearhead Groups” indicating a correlation between infant mortality and deprivation. Rotherham was one of 43 Local Authorities identified with more than 20 infant deaths in the R&M group between
2002-04102.
.
The Government target does not reflect other inequalities relating to infant mortality. During the period 2002-04 infant mortality for mothers born in Pakistan (10.2/1,000) was double the overall IMR. For mothers born in the Caribbean (8.3/1,000), the IMR was 63% above the national average. For mothers aged under 20 years (7.9/1,000), the IMR was
60% higher than for mothers aged 20–39103. In 2008 the IMR for sole registrations was 6.9 per 100,000 which is up on the previous two years‟ figures. Tackling health inequalities relating to infant mortality at local level is complicated by the relatively small numbers of infant deaths. A research
100
NHS Information Centre (2009), Clinical and Health Indicators, Infant Mortality
Department of Health (2009), Mortality Target Monitoring (Infant Mortality, Inequalities) update to include data for 2008 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_109444.pdf 102
Department of Health (2007), Review of the Health Inequalities Infant Mortality PSA Target, p14
103
Department of Health (2007), Review of the Health Inequalities Infant Mortality PSA Target, p5
101
- 73 project has been undertaken in Rotherham to try and identify if infant mortality is higher in BME groups. It compared the percentage of live births with the percentage of infant deaths (under 1 year) for the years
2004 and 2005 combined. The analysis indicated that BME groups have a higher proportion of infant deaths than the general population. Even when it was assumed that non-declaration of ethnicity meant ethnic origin was White British this pattern still applied104.
Evidence about the effectiveness of interventions to reduce infant mortality is inconclusive, particularly interventions that will narrow the gap between the R&M group and the overall population. There are four potential strategies which could have an impact on infant mortality rates and for which predictive modelling exists;
Reducing prevalence of obesity in the R&M population Reducing smoking in pregnancy from 23% to
15% for R&M
Reducing no. of women in the R&M group who share a bed with their baby or put it to sleep on its front
Achievement of teenage pregnancy target105
2.8% reduction
2.0% reduction
1.4% reduction
1.0% reduction
An Infant Mortality Summit was held in February 2007 and NHS
Rotherham and Rotherham Foundation Trust have worked together to implement and refresh the action plan that was developed as a result.
Recent data shows the 2008 rate as 7.7 deaths per 1,000, up on the previous figure of 5.9 although large fluctuations in rates are possible with low numbers. A Child Death Review Panel chaired by the Director for Public Health and a Designated Doctor for Death in Childhood are now in place to build upon existing strong SUDI arrangements.
4.1.3 Life Expectancy
Life expectancy at birth in England has reached its highest level to date for both males and females. The latest ONS statistics for 2006-2008 are
77.9 for males and 82.0 for females. In Rotherham life expectancy is significantly lower for males and females at 76.5 and 80.7 respectively
(see figure 4.5)106.
Females continue to live longer than males, but the gap has been closing. Although both sexes have shown annual improvements in life expectancy at birth, over the past 25 years the gap has narrowed from
6.0 years to 4.1 years nationally. The current gap regionally and in
Rotherham is similar at 4.2 years106.
Figure 4.5
104
Rotherham Life Expectancy at Birth Compared with
Regional and National Averages 2006-08
UK Statistics Agency (2008), UK Snapshot, Life Expectancy at www.ukstatistics.gov.uk
Department of Health 2007, Review of the Health Inequalities Infant Mortality PSA Target, p30
106
APHO 2010, Health Profile Rotherham 2010
105
- 74 83
Male
82
Female
81
80
79
78
77
76
75
74
73
England
Yorkshire & Humber
Rotherham
Source: APHO 2010, Health Profile Rotherham 2010
Life expectancy at 65 years is higher for women than for men. From
2006-08 a man aged 65 could expect to live another 17.7 years and a woman another 20.4 years107.
The relative gap in life expectancy from 2004-06 between the overall population and the 20% most deprived areas of England was wider than in the period 1995–97 for both males and females108. There is evidence that health improvements among higher socio-economic groups may have occurred at a faster rate than in other groups in the population. The result has been that the gap has not narrowed for life expectancy in disadvantaged areas; indeed, the gap has widened, particularly for women. This is a challenge for health inequality strategies when seeking to improve the relative health of disadvantaged groups. In Rotherham men in the least deprived areas have nearly 8 years longer life expectancy than those in the most deprived areas106.
The latest data on life expectancy and ethnicity shows life expectancy for
South Asians in Rotherham between 2001 and 2005 was lower than that of the general population. Less than a quarter of South Asians lived beyond the age of 75 compared with two thirds of the general population.
Average life expectancy for this period was 74.6 years compared with a
Rotherham average of 77.4104.
The target for inequalities in life expectancy is to reduce the relative gap in life expectancy at birth between Spearhead Group and the England average by at least 10% by 2010. Life expectancy at birth in the
Spearhead Group for 2006-2008 is 75.8 for males and 80.4 for females.
Rotherham is part of the Spearhead Group but has above average life expectancies at birth than the average for this group109. Although life expectancy at birth has improved for both the Spearhead Group and for
England as a whole, it has improved more slowly in the Spearhead
Group. As a result of this the gap in life expectancy has actually widened
107
Department of Health (2008) Tackling Health Inequalities: 2007 Status Report on the Programme for Action
Information Centre for Health and Social Care (2010), Compendium of Clinical and Health Indicators, p5
109
Department of Health (2009) Mortality target monitoring (life expectancy and all -age all-cause mortality, overall and inequalities. Update to include data for 2008.
108
- 75 to 7% for males and 14% for females 14% in 2006-08 compared to at baseline in 1995-97109. There is a significant variation within the
Spearhead Group of PCTs. In some areas life expectancy is increasing faster than average. If their trends were replicated in all Spearhead
Areas the Government‟s life expectancy targets for 2010 would be met110.
However, in general if current trends were to continue then 2010 targets will not be met109.
To meet the life expectancy target it is important to focus on preventing deaths from early middle age in Spearhead areas, including those at older ages. Deaths from CVD, cancer and respiratory disease account for approximately two-thirds of the gap between Spearhead Areas and the national average. There is substantial evidence that smoking reduction strategies will have an impact on the number of premature deaths from these conditions. Figures 4.6 and 4.7 predict the effect of interventions to narrow the life expectancy gap111.
4.1.4 Main Causes of Death
Ranking leading causes of mortality can provide a useful picture of mortality patterns in England and Wales. The main causes of death should be viewed in the context of other indicators such as age, sex and cause-specific mortality rates. There are more deaths from cancer than from ischaemic heart disease (see Figure 4.8). However, no single cancer is a more common cause of death than ischaemic heart disease.
In children, there are now more deaths from cancer than from accidents.
Ranking leading causes of death is limited by the nature and quality of the information available through death registration112.
The figures below illustrate the effects of the selected interventions to narrow the life expectancy gap.
110
APHO (2010), Health Profile Rotherham 2010, p9
APHO (2010), Health Profile Rotherham 2010, p14
112
Office for National Statistics (2005), Health Statistics Quarterly, Leading causes of death in England and Wales – how should we group causes? 111
- 76 Figure 4.6
Interventions Model for Males
- 77 Figure 4.7
Interventions Model for Females
Figure 4.8
10 leading causes of death in England and Wales, by
Figure 4.8ender, all ages of death in England and Wales 2008 by gender, all ages g : 10 leading causes
24.7%
Malignant neoplasms
29.7%
12.6%
Ischaemic heart diseases
17.9%
10.8%
Cerebrovascular diseases
7.3%
6.6%
4.8%
Influenza and pneumonia
Chronic lower respiratory diseases
4.7%
5.5%
Heart f ailure, complications and ill-def ined heart disease
5.5%
4.2%
Dementia and Alzheimer's Disease
6.1%
2.8%
Accidents
2.1%
2.7%
Diseases of the urinary system
2.7%
2. 0%
Cirrhosis and other liver diseases
0.0%
Females
Males
1. 0%
1.9%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Figure 4.9 compares the causes of premature mortality in Rotherham with England and Wales for 2006-08 (3 years). It shows the number of years lost broken down by individual conditions and assumes that the timely age for death is 75 years. For example if one person dies of
35.0%
- 78 cancer at 65 this accounts for 10 years of life lost. The chart shows that overall there are more premature deaths in Rotherham than nationally.
The three most significant causes of years of life lost are cancer, circulatory disease and diseases of the digestive system113.
Figure 4.9
Years of life lost by conditions 2006-08 (3 years)
Figure 4.9: Years of life lost by conditions 2006-08 (3 years)
600
Total 486.9
500
Total 445.4
Years of Life Lost per 10,000
48.6
Other
400
24.8
30.7
55.3
49.6
300
Suicide/Injury Undetermined
Diseases of Digestive System
36.1
Diseases of Respiratory System
28.5
Accidents
38.2
35.7
36.3
200
Diseases of Nervous System
18.8
25.4
Diseases of Circulatory System
Malignant Cancers
96.7
92.9
100
164.5
150.1
0
Rotherham
113
England and Wales
Area
Source: Office for National Statistics.
Figure 4.10 looks at the difference in life expectancy between the most deprived 20% of Rotherham compared with the Rotherham average by cause of death. From 2003-05 cancer, accidents and circulatory disease have been the three conditions which have had the greatest impact on life expectancy gap. Since 2005 Rotherham‟s position with regard to circulatory disease has improved. The gap on circulatory disease mortality has virtually been eliminated. However this does not mean that circulatory disease should become less of a priority.
Circulatory conditions are still a major contributor to premature mortality and there are cost effective interventions which, if made available to everyone at high risk, could have a substantial impact on life expectancy113. Figure 4.10a: Breakdown of life expectancy gap between most deprived quintile in Rotherham and Rotherham average by cause of death
Source: London Health Observatories (2008), Health Inequalities Intervention T ool
(www.lho.org.uk)
113
London Health Observatories (2008), Health Inequalities Intervention Tool (available at www.lho.org.uk)
- 79 Figure 4.10b: Breakdown of life expectancy gap between
Rotherham and England, by cause, 2006-08
Source: London Health Observatories (2008), Health Inequalities Intervention Tool
(www.lho.org.uk)
4.1.5 Hospital Admissions
NHS Rotherham had the second highest rate of hospital admissions in the region in 2008-09. The rate was 278.9 admissions per 1,000 population, significantly higher than regional (237.3) and (218.6) national averages. This suggests either a higher level of morbidity in the population, a lack of community care provision or reduced effectiveness in primary care114.
The needs weighted total cost of acute admissions is higher than the regional and national rates. It is possible that the needs weighted adjustment under-compensates for actual need. Assuming that it does not, the possible causes of the relatively high needs weighted total cost could be due to; low provider admission threshold, lack of community care provision, high levels of inappropriate referrals, lack of post discharge community support and ineffective discharge planning115.
In 2008/09 Rotherham had a significantly higher rate of emergency hospital admission per 1,000 than the regional and national averages.
The rate in Rotherham was the highest of all PCTs in the region.
Rotherham also has a significantly higher rate of A&E emergency admissions per 1,000 than the regional and national averages.
Rotherham had the second highest rate in the region115.
Rotherham has the 2nd highest rate of emergency admissions for ambulatory care conditions in the region. These 19 conditions have been identified as those which could be prevente d by effective
114
115
NHS Comparators (2010), Total Admissions per 1,000 population
NHS Comparators (2010) available at https://www.nhscomparators.nhs.uk
- 80 community care. The rate of admission for these conditions in
Rotherham is significantly higher than regional and national rates. This could be due to factors such as higher levels of morbidity and a more complex case mix. However other factors could include; lack of appropriate community care provision, post discharge support and effective discharge planning115.
Rotherham had the second highest regional percentage of emergency admissions discharged home with no overnight stay in 2009-10. This suggests low provider threshold for admissions, high level of inappropriate referrals and/or classification of A&E observation beds as inpatients115. In 2009/10 the standardised cost rate for emergency admissions per
1,000 Rotherham was the 4th highest in the region and higher than the national and regional averages115.
4.1.6 Self-Reported Measure of Health and Well-being
According to the Lifestyle Survey 2008 77% of respondents across
Rotherham regard themselves as being in “good health”. Only 7% consider themselves to be in “poor health”. This compares with 65% and 11% of respondents in the most deprived areas116.
4.1.7 Healthy Life Expectancy at 65
The UK population has been living longer over the last 20 years, but the additional years have not necessarily been in good health or free from disability or limiting illness. Healthy life expectancy (expected years of life in good or fairly good health) and disability free life expectancy
(expected years of life free from disability or limiting illness) have all increased between 2000-02 and 2005-07117.
The gap in healthy life expectancy between men and women is smaller than for total life expectancy. In 2005-07, healthy life expectancy at birth was 68.4 years for men and 70.4 years for women, a gap of 2 years.
The gap in disability-free life expectancy between men and women is also smaller than for total life expectancy and healthy life expectancy. In
2005-07, disability-free life expectancy at birth was 62.5 years for men and 63.7 years for women, a gap of 1.2 years117.
The latest local comparative figures on health and disability free life expectancy for men and women 65+ are from 2001 but the latest figures on life expectancy at 65 are from 2006-08. Figure 4.11 below shows the difference between rates for Rotherham, Yorkshire and Humberside and
England. The graph shows Rotherham rates to be lower than the regional or national averages118.
116
Rotherham Lifestyle Survey (2009)
Office for National Statistics (2010), Healthy life expectancy at birth 2000-02 to 2005-07 for England and Wales (experimental statistics)
118
HM Government (2008), National Indicators for Local Authorities and Local Authority Partnerships: Handbook of Definitions Ann ex 3
117
- 81 Figure 4.11 Life expectancy for people over 65 years
25
20.4
19.4
20
19
17.7
1 6.5
15.7
15
10.65
11.7
10
7.2
14.51
13.6
12.53
12.33
9.06
8.3
8.08
6.71
5.95
5
0
Rotherham
Y&H
England
Rotherham
Males
Life expectancy
Healthy life expectancy
Y&H
England
Females
Disability free life expectancy
Source: HM Government (2008), National Indicators for Local Authorities and Local Authority
Partnerships: Handbook of Definitions Annex 3
4.1.8 Mortality Rate from Causes Considered Amenable to Health Care
Many determinants of health lie outside healthcare and therefore it can be difficult to measure the effectiveness of health care systems.
Mortality data that is based on the concept that deaths from certain causes should not occur in the presence of timely and effective health care is one way of trying to measure health system effectiveness.
Amenable mortality, according to the Nolte and McKee definition118, is defined as deaths occurring before age 75 from causes that are considered amenable to medical intervention. Examples include: breast cancer, cancer of colon, leukaemia, gastric and duodenal ulcer and hypertensive diseases. Deaths from these causes may be avoidable through treatment of the condition after onset. Using this definition 43% of male and 47% of female deaths before age 75 were considered avoidable in 2005119.
The leading cause of amenable mortality for males in 2005 was ischaemic heart disease (IHD). The picture was slightly more complex for females, where IHD was the largest contributor to amenable mortality based on age-standardised rates, but breast cancer was the largest contributor when standardised years of life lost were used. This indicates that, although mortality from both IHD and breast cancer increases with age, significant numbers of deaths from breast cancer begin to appear in women at younger ages than IHD119.
There have been considerable reductions in levels of avoidable mortality between 1993 and 2005. The age-standardised mortality rate for causes considered amenable to medical intervention fell by 43% for males and 38% for females in this period. Mortality from causes not considered avoidable decreased by 14 per cent and 8 per cent for males and females respectively over the same period. Results indicate that medical interventions are likely to have contributed positively to reductions in amenable mortality, since the decreases are unlikely to be
119
Office for National Statistics (2007), Health Statistics Quarterly issue 34
- 82 the result of a general decrease in mortality rates. The biggest reduction in amenable mortality has been deaths from IHD119.
Directly standardised mortality data from 2006-08 show that mortality rates for causes considered amenable to health care are higher in
Rotherham than nationally and regionally. Mortality rates are higher for both males and females, but the difference is much narrower for females than males120. The ratio of deaths in Rotherham that are considered amenable to health care compared with those considered non -amenable to health care decreased faster than the national and regional averages between 1993 and 2006 and in 2006 was virtually the same (36% in
Rotherham and regionally and 35% nationally). This suggests that differences in death rates are not related to variations in the quality of health care119.
Figure 4.12 Mortality rates for causes amenable to health care
2006-2008
DSR mortality rate per 100,000
160
Rotherham
140
Yorkshire & Humber
England
120
100
80
60
40
20
0
Males
Females
Persons
4.1.9 Deaths attributable to smoking
Please see under section 1 of Lifestyle and Risk Factors
4.1.10 Long Term Conditions/Physical Disability
It is estimated that in 2015 there will be 28,199 people over 65 in
Rotherham with a limiting long-term condition. By 2025, it is estimated that the number will have risen to 33,831121.
Statistics from the Department of Work and Pensions show 10,540 people in Rotherham claimed Incapacity Benefit in February 2010 which equates to 6.5% of the working age population, compared with 5% nationally. Incapacity Benefit is generally claimed by adults of working age122. The 2001 census shows that 22.4% of the population considered themselves to have a limiting long-term illness or disability compared
120
Information Centre for Health and Social Care (2010), Compendium of Clinical Health Indicators
POPPI (2008) People aged 65 and over with a limiting long-term illness by age (65-74, 75-84, 85 and over) projected to 2025
122
Department of Work and Pensions tabulation tool (http://www.dwp.gov.uk/asd/tabtool.asp)
121
- 83 with 17.9% nationally123. It is clear therefore that Rotherham has a higher prevalence of long-term conditions than the national average and this seems likely to increase as the population continues to age. Figure
4.13 shows the range of long term conditions experienced by working age adults in Rotherham, Yorkshire and Humber and England, based on information relating to incapacity benefit claimants from 2007 122.
Figure 4.13: Types of long term conditions using data on Incapacity
Benefit Claimants-May 2007
Source: Department of Work and Pensions tabulation tool
Mental health disorders, although slightly lower than the England and regional averages, are still by far the highest cause of disability, followed by musculoskeletal problems. Using data from the 2008 Lifestyle
Survey for Rotherham it is estimated that 35% of the population consider themselves to have a long term condition, an increase of 5% since the previous survey in 2005124. This increases to 39% of respondents in areas of deprivation, but this is a decrease of 3% since the last survey in
2005, which suggests that health is improving in NRS areas and the gap between NRS areas and the general population is decreasing125.
PANSI estimates that 16,115 people in Rotherham aged 18 -64 had a moderate or serious physical disability in 2010. This equates to 6.4% of the total population or 9.9% of the working age population. PANSI predicts that by 2025 this number will have increased to 16,476125.
PANSI estimates that in 2010, 4,202 males and 2,585 females in
Rotherham were permanently unable to work due to physical disability.
This equates to 5.2% of working-age males and 3.2% of females. By
2025 the numbers in Rotherham are predicted to rise to 4,361 males and 2,610 females126.
Figure 4.14 shows predicted change in numbers of working-age adults in
Rotherham who are permanently unable to work due to physical
123
Census 2001 Table UV22 (http://www.statistics.gov.uk/)
NHS Rotherham (2005), Rotherham Lifestyle Survey
125
PANSI (2008)
126
Health Care Commission (2008), Patient Survey Report 2008 Rotherham PCT
124
- 84 disability, broken down by age and gender. There is a significant decrease predicted in the number of people aged 45 -54 years but increases in the number of people permanently out of work up to 2025 who are aged between 55 and 64 years126.
Figure 4.14 Predicted numbers of working age adults permanently unable to work due to physical disability in Rotherham,
2010-2030
3000
2010
2015
2020
2500
2025
Number of working age adults
2030
2000
1500
1000
500
0
Males
Females
18-34
Males
Females
35-44
Males
Females
45-54
Males
Females
55-64
Source: PANSI (2008)
National Indicator NI124 measures the percentage of people with a long term condition who report that they have had enough support from local services or organisations to help manage their long-term health condition(s). This data is sourced from the Health Care Commission PCT patient survey which is a random sample of adults registered with GP practices in England. In 2008, 63% of the 115 Rotherham respondents to this question in the National Patient Survey reported they got enough support from local services and organisations to manage their long-term condition (includes health and social care services)127. This suggests services are working quite well together to support people with long term conditions but there is further improvement to be made.
4.2
Diabetes
According to the APHO Diabetes Prevalence Model there were an estim ated
3.1 million people in England with diabetes in 2010, 7.4% of the population. 1 in 4 of these is estimated to be undiagnosed. The prevalence rate is predicted to rise to 4.6 million by 2030, 9.5% of the population128.
Life expectancy is reduced by at least fifteen years for someone with Type 1 diabetes. In Type 2 diabetes, which is preventable in two thirds of cases, life
127
128
Quality and Outcomes framework (2010), PCT indicator group level summary of achievement submission detail, DM19
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 (www.yhpho.org.uk/resource/view.aspx?RID=81090)
- 85 expectancy is reduced by up to 10 years129. It is estimated that around 90% of people with diabetes have type 2 diagnosis. Diabetes is the leading cause of blindness in people of working age in the UK129.
Diabetes prevalence increases sharply with age. The diabetes prevalence rate in persons aged 55-74 years and 75+ years was 14.3% and 16.5% respectively. By 2030, approximately half of the increase in diabetes prevalence will be due to the changing and ethnic group structure of the population and about half will be due to the projected increase in obesity 130.
Assuming a continuing trend of rising obesity, the PBS prevalence model predicts that the number of people in Rotherham with diabetes will have risen to 18,164 by 2025 equating to 6.7% of the population131.
The main contributing factors to rising rates of diabetes are;
Increases in population of older people
Increases in rates of obesity
Figure 4.15 illustrates how much of the forecasted increase in diabetes is likely to be due to population change and how much is likely to be due to rising obesity levels. The graph summarises the diabetes prevalence rate and number that would occur under two different scenarios of obesity (both use the same ONS population projections). The first and most likely scenario is that the 1991-2006 obesity rise continues at the same rate. The second sce nario is based on obesity being maintained at 2005 levels.
Figure 4.15: Diabetes prevalence forecast based on 2 scenarios of obesity levels
Source: APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 -3
In Rotherham there were 11,084 patients registered with diabetes in Q4
2009/10127. This is equivalent to 4.6% of all Rotherham registered patients. Of these 1,004 are Type 1 and 10,080 are Type 2 which is 0.4% and 4.2% of
Rotherham registered patients respectively. 15% of those diagnosed with Type
2 diabetes are prescribed insulin. 16% of diabetes patients are recorded as current smokers (of those with a smoking status ever recorded)132.
129
Diabetes UK (2007), Diabetes: State of the Nations 2006, p5
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p2 (www.yhpho.org.uk/resource/view.aspx?RID=81090)
131
NHS Rotherham (2008), Practice Based HNA: table of supporting data
132
NHS Rotherham (2010), QUEST diabetes data 2009/10 Q4
130
- 86 As mentioned above prevalence of diabetes is higher in older age groups. This is reflected in the Rotherham data. 9% of registered patients over 40 have a diabetes diagnosis. Of these 85% are prescribed a statin for 6 months and
52% are prescribed an aspirin for 6 months132.
Prevalence and mortality rates for diabetes are greater in areas of deprivation and for people in lower socio-economic groups. One likely reason is that obesity prevalence is higher in areas of deprivation. In addition, people from
BME communities are concentrated in areas of deprivation and African
Caribbean and South Asian communities have a higher prevalence of Type 2 diabetes (4 times higher in African Caribbean and 6 times higher in South
Asian). This is a result of genetic predisposition and lifestyle factors such as overweight or obesity and limited physical activity. Type 2 diabetes occurs at an earlier age in these communities and complications resulting from this condition are more likely in this population. Several studies report inadequate quality of health care for Asian, Black African and Black Caribbean diabetics and poor treatment compliance, which may lead to higher than average hospital admissions104.
The all age all persons mortality rate from diabetes in Rotherham for 2006 -08 was 5.9. This is slightly lower than regional and national rates which were 6.2 and 6.1 respectively. Locally, regionally and nationally the mortality rate from diabetes is higher in men than women. In Rotherham the rates for men and women are 8.0 and 4.1133.
Hospital admissions data shows levels of diabetes are higher in the Rotherham
BME community. The data shows that 88.4 per cent of the 1,400 people admitted to hospital in Rotherham with diabetes were White British. Just under
2% (1.86 per cent) reported being of Black or Minority Ethnic origin104. This latter figure seems low compared to the proportion of the population from BME groups (over 5 per cent). However, when the younger age structure of the
BME population and the large number of people not stating their ethnicity are considered, diabetes may be more significant, particularly considering the high rates of obesity in some BME groups104.
Admissions due to diabetes amongst the Pakistani community increased from
87 in 2002/03 to 154 in 2006/07, an increase of approximately 77 per cent.
The overall increase in admissions for all minority ethnic groups was 12% for the same period which suggests that other ethnic groups experience significantly lower rates of diabetes, moderating the overall increase for BME communities104. Figure 4.16134 shows the national variation in prevalence by ethnic group. A comparison of the local authorities with the highest and lowest prevalence rates of diabetes shows that those with the highest rates had correspondingly higher rates either of people over 65 or ethnic minorities in their populations134.
133
NHS Information Centre for Health and Social Care (2009), Compendium of Clinical and Health Indicators, Mortality from Diabet es, All ages 134
APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1-2
(www.yhpho.org.uk/resource/view.aspx?RID=81090)
- 87 Figure 4.16 Diabetes Prevalence by Ethnic Group
Source: APHO Diabetes Prevalence Model: Key findings for England, June 2010 (2010), p1 -2
People with diabetes have a higher risk of dying at all ages under 80. The relative increase in risk of death is higher for women than men. For example, women aged between 40 and 59 years with diabetes are 2.54 times more likely to die than women of the same age without diabetes, compared with 2.17 times for men135.
In England 26,300 deaths between the ages of 20 and 79 years in 2005 can be attributed to diabetes. This equates to 11.6% of all deaths in this age group. If current trends in diabetes prevalence and mortality rates continue, 12.2% of deaths between 20 and 79 years will be attributable to diabetes in 2010. The percentage of diabetes attributable deaths in 2005 varies from 17.08% to 9.25% between Local Authorities135. In Rotherham the proportion of diabetes attributable deaths was 11.57%, which is close to the national average 136.
4.2.1
Impact on services
Nationally around 5% of total NHS spend is used for the care of people with diabetes137. Up to 9% of hospital expenditure is used for the care of people with diabetes. In Rotherham, during 2007/08, 0.5% of all A&E attendances were for diabetic related conditions138. 61% of these were by people aged 18-64 years139. There were 203 unplanned admissions where diabetes was the primary diagnosis and 2,680 unplanned admissions where diabetes was listed as a secondary diagnosis140.
Prescribing costs for diabetic drugs was £2.8 million, 7% of the total prescribing budget141. Rotherham has the highest prescribing costs for insulin in NE England and is well above the regional and national average141. Rotherham also has the third lowest costs for prescribing anti-diabetic drugs141.
135
Yorkshire and Humber Public Health Observatory (2008), Diabetes Attributable Deaths
Yorkshire and Humber Public Health Observatory (2008), Diabetes Attributable Deaths for Primary Care Trusts
137
Diabetes UK (2007), Diabetes: State of the Nations 2006, p5
138
NHS Rotherham (2008), Diabetes A&E Attendances at All Providers (spreadsheet)
139
NHS Rotherham (2008), A&E Attendances Patients aged 18+ 05-08 (spreadsheet)
140
NHS Rotherham (2008), Diabetes Spells at all Providers (spreadsheet)
141
NHS Rotherham (2008), 07-08 Diabetes Expenditure NHS Rotherham
136
- 88 4 .3
Circulatory Diseases
4.3.1 General
Circulatory disease is one of the main causes of premature death in
England. It is therefore a significant condition when considering strategies for increasing life expectancy. The Department of Health has set the following PSA target:
To substantially reduce mortality rates by 2010 from heart disease and stroke and related diseases by at least 40% in people under 75, with at least a 40% reduction in the inequalities gap between the fifth of areas with the worst health and deprivation indicators and the population as a whole142. The Coronary Heart Disease (CHD) National Service Framework (NSF)
Progress Report for 2008 stated that the Government target to reduce deaths from circulatory diseases by 40% for people unde r 75 had been met 5 years early. Inequalities in the death rate for circulatory diseases among the under 75s have been narrowing and the absolute gap between the England average and the 20% most deprived areas of
England has reduced by 32% since 1995-7143.
Deaths from cardiovascular diseases (CVD) in Rotherham have more than halved since 1991 and rates have been falling more than the national rates. It is expected that by 2010 mortality rates in Rotherham will have fallen to below the national average. Although mortality rates continue to be higher in NRS target areas, improvements have occurred at the same rate as for the rest of the population (see Figure 4.17 below)144. National Indicator NI121 measures the mortality rate from all circulatory diseases per 100,000 of the population for people aged under 75 142.
Between 2006-08 the local mortality rate was 81.6, just below the regional rate of 82.8 but above the national rate of 74.8145.
142
NHS Rotherham (2005), Lifestyle Survey – most deprived 20% of residents, p10
Department of Health (2008), The CHD National Service Framework Progress Report for 2007
NHS Rotherham (2007), Director of Public Health Annual Report 2006-7, p41
145
NHS Information Centre (2009), Compendium of Clinical and Health Indicators, Mortality from circulatory diseases (under 72, 20062008)
143
144
- 89 Figure 4.17: Circulatory Diseases Mortality Rates 1993/5-2006/8:
Persons Aged Under 75 Neighbourhood Renewal
Strategy Areas Compared /with Rotherham and
Circulatory Diseases Mortality Rates 1993/95-2006 08: Persons Aged Under 75
Neighbourhood Renewal(+ 95% CIs)
England Strategy areas compared with Rotherham and England (+ 95% CIs)
300
2009-11 Forecast
Age-standardised rate per 100,000
250
200
150
100
50
0
93/95 94/96 95/97 96/98 97/99 98/00 99/01 00/02 01/03 02/04 03/05 04/06 05/07 06/08 2008 2009 2010 2011
3 Year Average
NRS Areas
All Rotherham
CI = Confidence Intervals
England
NRS 95% CI
* 40% reduction by 2010
Roth 95% CI
Roth Target*
Source: London Health Observatories (2008), Health Inequalities Intervention Tool
Within the broad category of cardiovascular disease are a number of more specific health problems of which the two most important, in terms of causes of death, are Coronary Heart Disease (CHD, also known as
Ischaemic Heart Disease - IHD) and Cerebrovascular Disease (stroke).
Other significant conditions include angina and hypertension (high blood pressure). Cardiovascular disease is linked with other conditions, notably respiratory problems and diabetes. CVD is more common in men than women. 4.3.2 CHD and Heart Failure
Mortality from CHD in the UK is declining but it remains the most common cause of death146. The mortality rate for CHD has decreased both in Rotherham and nationally between 1993 and 2007. Up to 2007, the mortality rate for CHD in Rotherham has been falling faster than the national and regional averages (Figure 4.18 below147). In 2008 the mortality rate for Rotherham increased slightly pushing Rotherham back above regional and national rates.
146
147
SEPHO (2009) Coronary Heart Disease
NHS Information Centre (2007), Compendium of Clinical and Health Indicators, Mortality from coronary heart disease
- 90 Figure 4.18: CHD mortality rates between 1993 and 2008 for
Rotherham, Yorkshire & Humberside and England.
Persons Under 75
160
Rotherham
Y&H
Enlgand
140
120
DSR per 100,000
100
80
60
40
20
0
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Source: NHS Information Centre (2007), Compendium of Clinical and Health Indicators,
Mortality for coronary heart disease
The national rate of decrease in premature deaths from corona ry heart disease in people under 45, particularly women, has started to slow and may be starting to rise. This is due to lifestyle factors such as young people smoking, low levels of exercise and an increase in obesity prevalence. The latest report from the British Heart Foundation suggests that unless these risk factors are tackled aggressively in the younger age groups there is likely to be a reversal of the benefits achieved so far148.
More deaths from CHD occur in winter months than the rest of the yea r.
Excess winter mortality is the increase in mortality over and above the rate of mortality in the rest of the year. For example in 2004-5 19% more deaths occurred in winter than would be expected based on the average mortality for the whole year. Excess winter mortality is more than double the rate for over 85s compared to those under 65s148.
The CHD prevalence model estimates that in 2010 there are 6.4% of people all ages in Rotherham with CHD compared to 5.7% in
England149. In July 2010 there were 11,301 patients on Rotherham GP registers with CHD. This is 4.4% of the registered population giving a difference of 2% between numbers on GP registers and estimated prevalence150. There were 2,086 patients on GP registers of all ages with heart failure which is 0.8% of registered patients150. It is estimated that the percentage of the Rotherham population with CHD will rise to
7.2 % by 2020 compared with 6.2% nationally151.
CHD is more prevalent among males than females. The CHD prevalence model estimates that in 2008 in England 6.8% of males and
4.5% of females have CHD. This compares with 7.6% and 5.0% respectively in Rotherham151. CHD is more prevalent amongst the white population in Rotherham at 6.4% in 2008, followed by the Asian population at 3.6% and the Black population at 1.4%. This compares with 5.9%, 3.9% and 2.1% respectively nationally. This suggests that
148
British Heart Foundation (2008), Heart Statistics 2008 - General
Association of Public Health Observatories (2009), CHD Model and Benchmarking Tool (www.apho.org.uk)
150
Quality and Outcomes framework (2010), PCT indicator group level summary of achievement and submissio n detail, CHD1
151
Yorkshire and Humber Public Health observatory (2009), CVD prevalence – observed and expected - spreadsheet
149
- 91 CHD is less prevalent amongst ethnic minority groups in Rotherham than it is nationally, but this is likely to be due to the young age profile of
BME groups in Rotherham and the prevalence is likely to increase as their average age increases152.
Figure 4.19 compares the predicted trend in prevalence of CHD for different ethnic groups in Rotherham between 2008 and 2020. This suggests that CHD prevalence is likely to remain fairly stable among black, mixed and other ethnic groups and increase amongst whi te and
Asian groups151.
Figure 4.19: Predicted CHD prevalence in Rotherham by Ethnic
Group between 2008–2020
Source: Yorkshire and Humber Public Health Observatory (2008), CVD prevalence – observed and expected - spreadsheet
Prevalence rates for CHD increase as people get older. In Rotherham in
2008 CHD rates were; 23.2% (75+ years), 17.0% (45-64) and 6.3% (all adults). The rates are higher than the estimated national prevalence for each group at 21.3%, 15.6% and 5.6% respectively. Figure 4.20 compares the predicted trend for CHD prevalence for different age groups in Rotherham and England between 2008 and 2020 151.
Figure 4.20a: Predicted prevalence of CHD in different age groups between 2008 and 2020 for Rotherham and England
Source: Association of Public Health Observatories (2008), CHD Model and Benchmarking Tool
152
NHS Rotherham (2007), CHD in South Asians Equity Audit
- 92 CHD is more prevalent in areas of high deprivation for both men and women. Towards the end of the 1990s the premature death rate for female manual workers was 73% higher than for female non -manual workers. For males premature death rates were 50% higher. Since the introduction of inequalities targets there has been clear progress in reducing the gap between the most deprived areas and the nation as a whole. NHS Rotherham has carried out a series of CVD equity audits focusing on ensuring that practices in deprived areas have maximised case finding. In the 1990s there was evidence that patients from deprived areas were less likely to receive specialist procedures such as coronary artery bypass grafts even though they had much higher CVD mortality113. By 2005 this trend had been reversed and the use of specialised cardiac services by patients in deprived parts of Rotherham is now higher than the overall average. However it is likely that uptake is still not completely proportionate to the prevalence of disease153. Figure
4.2.2 below shows that the CHD mortality rates in the 20% most deprived areas are higher than the rest of Rotherham. However, the gap has narrowed since 1991.
Figure 4.20b: CHD mortality rates for Rotherham residents 19912008: Persons under 75, 20% most deprived areas compared Rates the rest of Rotherham (with under
A2(i): CHD Mortalitywithfor Rotherham Residents 1991-2008: Persons aged95%75
20% most deprived areas compared with the rest of Rotherham (with 95% confidence intervals) confidence intervals)
350
< 2009-2012 >
Forecast
Age-standardised rate per 100,000
300
250
200
150
100
50
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
20% most deprived areas
Rest of Rotherham
95% CI
95% CI
National evidence has shown that South Asians living in the UK have a higher premature death rate from CHD than the population average.
The rate is 46% higher for men and 51% higher for women (British Heart
Foundation). There is also evidence that people from ethnic minorities have less access to these services as a result of language barriers and cultural differences etc152.
In Rotherham people of South Asian origin are more likely to be admitted to hospital with cardiac complaints and receive cardiac interventions (heart bypass and angioplasty) than the population
153
London Health Observatories (2008), Health Inequalities Intervention Tool, p23
- 93 average, once age differences in the populations are adjusted for. It indicates that the South Asian community has access to hospital services but it highlights the need for targeted health promotion and risk management for this population153.
The South Asian population age profile is much younger than that of the general population. Over 50% of the South Asian population are under
25 years of age. As this population ages there is likely to be a sharp increase in the number of South Asians at risk of CHD154.
In Rotherham, South Asians appear to be admitted for treatment for
CHD around 6-7 years earlier than the general population. A substantial proportion of South Asian secondary care admissions occur in the 45 -54 age group. There is then a dip in the proportion of South Asian admissions between ages 55-64. This pattern is not seen in the general population where a gradual rise in admissions with age is observed155.
The BME community in Rotherham had twice the rate of hospital admissions for congestive heart failure (CHF) between 2000 and 2005 than for the general population. The Pakistani community had two and a half times the rate of hospital admissions for this condition compared to the general population. Consultation with BME groups suggests that raising awareness of the importance of taking medication to control the condition would be of benefit104.
Rotherham has one of the highest hospital admission rates for coronary heart disease. Rates are high for all types of admissions but especially for emergency admissions. In Rotherham 2007/08 there are 331 admissions per 100,000 population compared with 242 regionally and
222 nationally156. Although the prevalence rate in Rotherham is in the top 25%156, the level of hospital admissions is still much higher than other areas where there are high prevalence rates156. The number of emergency admissions for myocardial infarction (MI) in Rotherham in
2005-6 was 124.7 per 100,000 of population. This is higher than the regional rate of 106.7 and the national rate of 101 but the gap is less than for other types of heart conditions156. Further investigation may be required to look at the impact of avoidable admissions, hospital admission thresholds and availability of appropriate community based services. In Rotherham, the revascularisation rate in 2007/8 was 105.1 per
100,000 of the population. This is a big drop from the previous years which had a rate of around 140 per 100,000. Therefore for 2007/08 the
Rotherham revascularisation rate is below regional and national rates of
129 and 136 per 100,000 population. 160 revascularisations were carried out in 2008/09 in persons 65 and over, which equates to a rate of
413.9 per 100,000 of population in this age group157.
154
NHS Rotherham (2007), CHD in South Asians Equity Audit, p6
NHS Rotherham (2007), CHD in South Asians Equity Audit, p7
156
Yorkshire and Humber Public Health Observatory (2008), Local Authority Maps
(www.yhpho.org.uk/atlas/0Local_Authorities_Eng/singlemap%20england2/atlas.html )
157
London Health Observatory (2010) Age standardised hospital episode rate for revascularisation procedures, people aged 65 yea rs and over 155
- 94 The CHD National Service Framework recognises the importance of cardiac rehabilitation services in reducing mortality and morbidity and set a goal that in every hospital over 85% of people diagnosed with a primary diagnosis of heart attack or after cardiac revascularisation should be offered cardiac rehabilitation. The 2008 National Audit of
Cardiac Rehabilitation reports that only 43% of people who suffer a heart attack in England are accessing treatment, with major regional variations. The report also reveals no cardiac rehabilitation programme meets minimum staffing levels set out for the NHS. Also, rehabilitation is also only routinely offered to 3 of the many diagnostic groups that could benefit and therefore only reaches a small proportion of the people who need to attend158.
4.3.3 Hypertension
The APHO hypertension prevalence model estimates that 25.5% of the
Rotherham population has hypertension compared with 24.2 % in
England. It is estimated that 10.2% of the Rotherham population is currently receiving treatment for hypertension compared with 9.8% nationally, which equates to 42% and 41.2% of hypertensives respectively. The model estimates that 18.9% of the hypertensives receiving treatment in Rotherham have the condition controlled compared to 18.6% nationally159.
38,666 patients on Rotherham GP registers were diagnosed with hypertension in March 2010, 32 compared with the expected p revalence of 65,027159. This equates to 15.2% of the population or 59.5% of expected prevalence. This indicates that NHS Rotherham is better at case finding than the prevalence model predicts.
4.3.4 Stroke
Every year approximately 110,000 people in England have a stroke. It is the third largest cause of death in England. 25% of strokes occur in people who are under the age of 65. There are over 900,000 people living in England who have had a stroke and it is the single largest cause of adult disability. 300,000 people in England live with moderate to severe disability as a result of stroke160.
In March 2010 there were 5,474 patients on Rotherham GP registers with stroke and TIA. This is very close to the estimated prevalence of
5,420161. The average recorded incidence of stroke is approximately
530/year and of TIA approximately 150/year. This compares with estimated rates of 550 and 260 respectively, suggesting that TIAs may be under-diagnosed161. The National Stroke Strategy reports that too few people understand what a stroke is or that it needs to be treated as medical emergency when the symptoms occur. The strategy suggests
158
British Heart Foundation (2008), National Audit of Cardiac Rehabilitation
Association of Public Health Observatories (2008), Hypertension Model (www.apho.org.uk)
160
Department of Health (2007), National Stroke Strategy, p31
161
Department of Health (2007), ASSET2 for Commissioners
159
- 95 that this is a likely reason for the discrepancy between actual and predicted incidence162.
It is estimated that 1,550 people in Rotherham have moderate or severe disability following a stroke and 201 deaths per year are due to stroke 161.
POPPI predicts that 986 people aged over 65 in Rotherham in 2010 had a long-standing health condition caused by stroke, and that this will have risen to 1,504 by 2030163. This represents a 53% increase.
PANSI estimates that in Rotherham 60 males and 99 fema les of working age require help with daily activities due to stroke. PANSI predicts these numbers will increase to 67 males and 108 females by 2025, an increase of 12% and 9% respectively125. Local data sources do not record actual numbers of people receiving assistance with daily living due to particular conditions, so it is currently hard to test how accurate these estimates are. Although the number of females disabled by stroke remains significantly higher than the number of males, the predicted increases in Rotherham follow the predicted national pattern of higher increases in the number of males. Overall the predicted rate of increase is lower in Rotherham than the national average of 16% for males and
12% for females125.
More women who have strokes die from them compared with men.
However, stroke is more common in men compared with women by the age of 75. People who are economically disadvantaged have a higher rate of stroke. People of African or Caribbean ethnicity are at higher risk of having a stroke, whilst people of South Asian origin are less likely to have hypertension managed. Incidence rates, adjusted for age and sex, are twice as high in black people as for white people. People who are overweight or obese, and who also suffer from hypertension, have a higher risk of stroke. Targeting prevention work at these groups is likely to yield significant results162.
In Rotherham between 2005-06 and 2009-10 2.6% of hospital admissions for stroke were from the BME community (i.e. non-White
British) although for about 7% ethnicity was not stated. People of
Pakistani origin accounted for 0.8% of hospital admissions and data suggests that stroke is a significantly greater issue for BME groups than the general population104. Stroke is primarily a condition that affects older people and the low proportion of BME strokes in Rotherham reflects the younger age structure of the BME community. Stroke is likely to become a significant issue as these populations get older104.
Rotherham has a higher rate of emergency episodes for stroke for both males and females than the regional and national rates. In 2006-7 there were 115.4 episodes in Rotherham per 100,000 of the population compared with 97.4 regionally and 99.4 nationally156.
The Asset 2 model indicates that in 2007-08 67% of 382 acute hospital admissions due to stroke returned to their usual place of residence. This
162
163
Department of Health (2007), National Stroke Strategy
POPPI (2008)
- 96 is significantly higher than the national average of 52% and rates in the
90th to 95th centile nationally. 12% of stroke survivors were discharged to care homes or another hospital, significantly lower than the national average of 21%. Average length of stay was higher than the national average at 20.5 days compared with 18.1 days for people discharged to their usual place of residence, but lower at 28.2 days compared with
32.0 days for those discharged to residential care or another hospital.
The high lengths of stay suggest a lack of early supported discharge services/community based rehabilitation, although they may contribute to the success in returning people to their usual place of residence . The model also highlights the lack of community based services in
Rotherham for stroke survivors such as dysphasia or family and carer support services161.
4.3.5 Impact on services
Rotherham resident hospital admissions 2009/10
3,169 (8%) non-elective admissions are due to cardiovascular illness164 5143 (9%) attendances at A&E (20% of attendances by people
65+)139
2,107 (5% ) elective admissions are due to cardiovascular illness165 Prescribing costs were £8,814,822166
CVD prescribing costs constitute 23% of the total prescribing costs for the PCT167.
Programme budget costs for CVD in 2007-8 were £29,409,000168
The ASSET2161 model suggests the following preventive measures which would reduce the incidence of CVD and the likely number of strokes prevented per year by the following amounts in Rotherham:
Managing all individuals with hypertension to below 140mmHg systolic BP - 47
Warfarin for all patients with atrial fibrillation - 50
Statins for all people with >20% risk CVD in 10 years - 22
Smoking cessation for all patients who have suffered a stroke or
TIA - 10
4.4
Cancer
4.4.1 Mortality
Cancer is one of the biggest killers in England – 1 in 3 people will be diagnosed with cancer in their lifetime and it is the cause of 1 in 4
164
NHS Rotherham (2008), Unplanned Hospital Admission 2007-08 (spreadsheet)
NHS Rotherham (2008), All Elective Admissions 2007-08 (spreadsheet)
NHS Rotherham (2008), Prescribing Costs CVD
167
NHS Rotherham (2008), Total Prescribing Costs 2007-08
168
NHS Rotherham (2008), Programme budget costs 2007-08
165
166
- 97 deaths169. In 2008 there were approximately 128,800 cancer deaths equating to 172.2 deaths per 100,000 of the population170.
During the 1980s and 1990s the UK had one of the poorest cancer survival rates in Western Europe and patients often waited long periods for diagnosis and treatment. This led to the introduction of government targets to reduce mortality rates from cancer overall and within areas of deprivation171. Between 1996 and 2008 cancer mortality in people under 75 fell by over
13%170. Since the implementation of the NHS Cancer Plan in 2000, there has been a significant fall in smoking rates, improved screening and faster diagnosis/treatment, all contributing to significant progress on mortality rates172.
The Government target is to reduce cancer mortality in people under 75 by 20% by 2010 from the 1995/1997 rate (see figure 4.21)173.
Considerable progress has been made towards this target and the latest data for 2006-08 shows a 19.3% fall in rates since 1995/97174. Survival rates for some cancers, such as colorectal and breast cancer, are improving year on year in line with other European countries175. In 2006 the UK ranked 9th out of 28 European countries for male cancer mortality (where first has lowest rate) and 22nd out of 28 for female mortality. The higher comparative mortality rate for females reflects higher smoking prevalence in the 1980s and 1990s compared with other
European countries175.
In 2006, cancer accounted for 29% of all deaths in m ales and 25% in females170. Mortality rates are higher for men than women although differences in mortality rates are not fully understood170. In some cases such as lung and oesophageal cancer, it may be due to high levels of smoking prevalence, later presentation, unidentified risk factors or biological predispositions176.
169
UK Statistics Agency (2008) www.statistics.gov.uk/cci/nugget.asp?id=915
NHS Information Centre (2009), Compendium of Clinical and Health Indicators, Mortality from all cancers
Department of Health (2007), Cancer Reform Strategy, p17
172
Department of Health (2007), Cancer Reform Strategy, p17-18
173
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p6
174
Department of Health (2009), Cancer Reform Strategy. Achieving Local Implementation Second Annual Report http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_109338 175
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p18
176
Department of Health (2008), Cancer Reform Strategy – First Annual Report 2008, p90
170
171
- 98 Figure 4.21: Cancer mortality (persons under 75) from all cancers in England, 1993-2007
Source: Department of Health, Cancer Reform Strategy – Achieving local implementation,
Second Annual Report
In 2008 Rotherham had an all age cancer mortality rate of 202.1 per
100,000. This is higher than the regional rate of 181.3 and England rate of 172.2170. The under 75 cancer mortality rate for Rotherham residents in 2006-08 was 131.5. This is above the national rate of 114.0. The rate of reduction in cancer mortality for people under 75 decreased faster than the national and regional averages between 2002 and 2006. This is mainly due to larger than average decreases in the female mortality rate (Figure 4.22)177.
Figure 4.22a: National, Regional and Rotherham age-standardised mortality rates for all cancers, all persons aged under
75, 2004-2008
160
Rotherham
Y&H
Age-standardised mortality rate per 100,000
140
England
120
100
80
60
40
20
0
2004
177
2005
Health Care Commission (2008), Data Set for the 2007-08 New National Targets
2006
2007
2008
- 99 Figure 4.22b: Rotherham age-standardised mortality rates for under 75’s, all cancers by sex, 2004-2008
180
Males
Females
160
Age-standardised mortality rate per 100,000
140
120
100
80
60
40
20
0
2004
2005
2006
2007
2008
Vital Sign VSB03 measures the age standardised mortality rate for all cancers for people under the age of 75 against the planned target for reducing mortality178. The most up-to-date performance report (2007-8) shows that NHS Rotherham has achieved its planned reductions in cancer mortality for the last 3 years. However, the data also shows that cancer death rates increased in 2006 and 2007 and NHS Rotherham may be struggling to reach their current target177.
Comparative data for 2003-5 suggests that Rotherham has particularly high mortality rates for stomach cancer and cervical cancer when compared nationally, although they are comparable regionally156. Data from the Trent Cancer Registry does not indicate any significant statistical differences in age standardised cancer mortality rates for
Rotherham, in comparison with other PCTs in the cancer network, between 2002-6 for any of the top 10 cancer sites179.
In 2006-08 there were 381 early deaths from cancer in Rotherham. This is a rate of 132 per 100,000, significantly worse than the England average and in the worst quartile of regional local authorities.
4.4.2 Incidence
In 2007 there were 297,991 new cases of cancer in the UK, equating to an age standardised rate of 377 per 100,000 of the population180. The increase in the incidence between 2005 and 2006 for both males and females was less than 1%.
The incidence of new cases was higher in men at 409 per 100,000 compared to 357 per 100,000 in women. In the UK in 2007 the 3 most common sites for new cancer types in males were prostate, lung and
178
Health Care Commission (2008), New National Target Indicators for Primary Care Trusts 2007-08
Trent Cancer Registry(2008), Cancer Fact Sheet for Rotherham PCT
180
NHS Information Centre for health and social care (2009), Incidence for all cancers 2006
179
- 100 colorectal and for females, breast, colorectal and lung181. Figure 4.23 shows the UK prevalence rates of the most common cancer types in
2007181.
Cancer incidence in Rotherham follows the national pattern for the most common cancer sites, but there are some significant variations when compared regionally. Figure 4.24 shows the age standardised incidence rates for the most prevalent cancer sites in Rotherham for 2003 -7 compared with the North Trent Cancer Network. The most significant exceptions to the regional averages are the lower rate of prostate cancer in Rotherham and the higher rate of bladder cancer in men 179.
Figure 4.23: The 20 most commonly diagnosed cancers (excluding
Figure 1.1: The -melanoma skin cancer), UK 2007 non20 most commonly diagnosed cancers
(excluding non-melanoma skin cancer), UK, 2007
Breast
Lung
Colorectal
Prostate
N-H-L
Malignant melanoma
Bladder
Kidney
Oesophagus
Stomach
Pancreas
Uterus
Leukaemias
Ovary
Oral
Brain with CNS
Multiple myeloma
Liver
Cervix
Mesothelioma
Other
Male
0
10,000
20,000
Female
30,000
40,000
50,000
Number of new cases
Source: Cancer Research UK – Cancer Stats Key Facts (http://info.cancerresearchuk.org)
181
UK Statistics Agency (200( (www.statistics.gov.uk/downloads/theme_health/2006cancerfirstrelease.xls )
- 101 Figure 4.24: Comparison of cancer incidence by site between
Rotherham and North Trent Cancer Network for males and females, 2003-07
Lung
Colorectal
Prostate
Bladder
Head & Neck
Stomach
Oesophagus
Melanoma
Leukaemia
Trent
Rotherham
0
20
40
60
80
100
Breast
Lung
Colorectal
Ovary
Melanoma
Cervix
Head & Neck
Stomach
Bladder
Trent
Rotherham
0 20 40 60 80 100 120 140
Source: Trent Cancer Registry (2010) Cancer Data. Local incidence. mortality and survival data by cancer site (http://www.empho.org.uk/tcr/data.aspx)
Approximately 1 in 10 cases of cancer occur in people aged 25 –49 years. Breast cancer is the most common cancer in this age group accounting for over 30% of all cancers. Malignant melanoma, bowel, testicular and cervical cancers are the next most likely. There are almost twice as many females diagnosed with cancer than males in the
25–49 year group, while in the over 65s the number of diagnoses is higher in males even though the female population is much larger182.
Cancer occurs predominantly in older people. Around two thirds of cancer deaths occur in people aged 65+ and more than one third (36%) in people 75+. Less than 1% of all newly diagnosed cases (0.5%) occur in children under 15, 1,400 new cases in 2004. The risk of a child in the
UK being diagnosed with cancer under age 15 is approximately 1 in 500.
Leukaemia is the most common form of childhood cancer, responsible for nearly one third of all cases, and tumours of the brain or central nervous system account for approximately one quarter.
4.4.3 Inequalities
Cancer incidence varies according to socioeconomic group. This is probably the result of environmental and lifestyle factors, differences in access to health care and health seeking behaviour. Evidence indicates that incidence of lung and cervical cancer is highest in patients from deprived backgrounds, whereas the opposite is true for malignant melanoma and breast cancer. The difference in incidence rates between the most and least deprived groups was higher for lung cancer patients aged under 65183.
The higher incidence of breast cancer in women from higher socioeconomic groups could be connected to increased likelihood of having a first child at a later age, having fewer children and increased take-up of hormone replacement therapy. Breast cancer in post
182
Cancer Research UK – Cancer Stats Key Facts (http://info.cancerresearchuk.org)
BMC Cancer (2008), variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England
183
- 102 menopausal women is linked with obesity with the association particularly strong for women in more deprived areas183.
People in deprived areas, older people (particularly for breast cancer) and those from ethnic minority groups are more likely to delay seeking help. There is evidence that awareness of risk factors associated with cancer is particularly low in deprived groups183.
Incidence of cancer varies between different ethnic groups. Compared to the general population, prostate cancer incidence is higher in African
Caribbean men. Mouth cancer has a higher incidence in the South
Asian community and liver cancer is higher in the Bangladesh and
Chinese communities. Some differences are due to lifestyle factors and exposure to infections. Others may be due to genetic factors183.
People with learning disabilities have the same overall risk of cancer as the general population, but a higher risk of some cancers such as gall bladder, thyroid and leukaemia. There is a lower risk of prostate, lung and urinary tract cancers183.
If the incidence of lung and cervical cancer were decreased to that of the least deprived group it would prevent 36% of lung cancer cases in men,
38% of lung cancer cases in women and 28% of cervical cancer cases.
Incidence of breast cancer and melanoma was highest in the least deprived group. If all socioeconomic groups had incidence rates similar to the least deprived group it is estimated that the number of cases would increase by 7% for breast cancer, 27% for melanoma in men and
29% for melanoma in women183.
Figure 4.25 shows that in Rotherham people in more affluent areas are almost as likely as those in more deprived areas to contract cancer.
However they are less likely to die from cancer179. This is partly due to the fact that there are higher incidences of lung cancer in areas of deprivation, for which mortality rates are higher. Breast cancer, which is more common in affluent areas, has a lower mortality rate. Cancer mortality rates in Rotherham NRS areas are decreasing faster than the national average which indicates that targeted interventions are proving successful (see Figure 4.26)113.
Figure 4.25: Incidence of All Cancer in NHS Rotherham: by ward
2002-06
- 103 Figure 4.26: Malignant Cancer Mortality Rates 1993/1995-2006/08:
Neighbourhood Renewal Strategy Areas Compared with Rotherham and England (+ 95% CIs)
250
Age-standardised rate per 100,000
2009-11 Forecast
200
150
100
50
0
93/95 94/96 95/97 96/98 97/99 98/00 99/01 00/02 01/03 02/04 03/05 04/06 05/07 06/08 2008 2009 2010 2011
3 Year Average
NRS Areas
Rotherham
CI = Confidence Intervals
England
NRS 95% CI
* 20 % reduction by 2010
Roth 95% CI
Roth Target*
Source: NHS Rotherham (2007), Director of Public Health Annual Report 2006 -07
4.4.4 Prevention184
Over half of all cancers could be prevented by changes to lifestyle.
Improving awareness and encouraging people to adopt healthy lifestyles is therefore a key factor in improving cancer outcomes.
Smoking is the single largest preventable risk factor, being a factor in a third of all cancer deaths and up to 90% of lung cancer cases.
Differences in smoking rates between the most and least affluent groups account for around half of the inequalities gap in cancer mortality. Much of the improvement in cancer death rates can be attributed to reductions in smoking amongst adults. There is evidence that, since smoke free legislation was introduced in Scotland in March 2006, there has been a dramatic improvement in air quality in pub, no increase in smoking in the home and reduced tobacco consumption, particularly in disadvantaged communities. Smoking rates remain comparatively high in routine and manual workers, the North of England and in some very deprived groups. Obesity increases the risk of many cancers including those of the uterus, kidney, gallbladder, colon and oesophagus. There is evidence that obesity is associated with breast cancer in post menopausal women.
Obesity is now the most significant cancer risk factor besides smoking.
There is evidence that for middle aged and older women in the UK, around 5% of cancers (6,000 per annum) are caused by being overweight or obese and 66% of these were cancers of the breast or womb. 184
Department of Health (2007), Cancer Reform Strategy, p33-39
- 104 Excess alcohol consumption is linked to the development of several cancers, particularly the mouth, larynx, oesophagus, liver and breast.
This risk is further increased when combined with smoking.
Melanoma is one of the fastest growing types of cancer, and although it is more common in women, the death rate is higher amongst men at 3.1 per 100,000 compared with 2.0 amongst women (2006-08 data). A particular concern is the use of cosmetic tanning salons with risks of excessive exposure amongst young people and lack of adequate health information provided to customers about health risks.
4.4.5 Treatment and survival
Evidence suggests that late diagnosis of cancer has been a major fact or in the poorer survival rates in the UK compared with other countries in
Europe. The Cancer Reform Strategy states that improving access to diagnostics was the single most important priority in primary care to improve outcomes in cancer treatment185. There has been a significant improvement in diagnostics in recent years. In 2005, the DH set out milestones for the NHS to reduce waits for diagnostic tests to a maximum of 13 weeks by March 2007 and to six weeks by March
2008185.
NHS Rotherham met the national target of having less than 2% of cases waiting more than 6 weeks for diagnostic tests by March 2008 with only
1.1% having to wait longer177. NHS Rotherham also significantly exceeded the national targets for breast screening in 2007 -8, with 83.4%
(nat. target 70%) of women aged 53-64 being screened and 78.5% (nat. target 55%) aged 65-70. NHS Rotherham also met all the national targets in 2007/08 on waiting times between referral and diagnosis/treatment and on improving cancer services 186.
The Radiotherapy Advisory Group suggests that demand is likely to grow over the next 10 years for radiotherapy services. On average
30,000 fractions are currently delivered per million population and it is anticipated that this will grow to 54,000 by 2016, requiring more staff and equipment, particularly if new Government targets are to be achieved185.
Nationally, there is a wide variation in radiotherapy activity, which cannot be explained by need alone. The number of fractions delivered varies from between 17,000 and 48,000 per million population187. There is some evidence to show that older people are likely to receive le ss intensive treatment than younger people e.g. older women may not be offered radiotherapy for breast cancer. Also older people are less likely to be offered radical treatment for lung cancer and there is low screening uptake for people with learning disabilities188.
1 and 5 year survival rates for breast, colon, rectum and prostate cancer have shown big improvements since the publication of the Cancer Plan.
185
Department of Health (2007), Cancer Reform Strategy
Health Care Commission (2008), Data Set for 2007-08 Existing National Targets
187
Department of Health (2007), Cancer Reform Strategy, p60
188
Department of Health (2007), Cancer Reform Strategy, p89-91
186
- 105 The 5 year survival for breast cancer has risen from 80.6% in 2000 to
86.0% in 2007. For colon cancer the figures for men are 47.6% to
53.4% and for women 47.6% to 52.7%174.
1 and 5 year survival rates for breast, colon, rectum and prostate cancer in England have shown big improvements since the publication of the
Cancer Plan. The 5 year survival for breast cancer has risen from
80.6% in 2000 to 86.0% in 2007. For colon cancer the figures for men are 47.6% to 53.4% and for women are 47.6% to 52.7%174.
4.4.6 Trends
Nationally it is projected that there will be about 262,000 new cancer cases in 2011 and 283,000 in 2016. This represents increases of around 8% and 16% since 2006. For many types of cancer the projected increase to 2016 exceed 20%. However, the number of lung cancer and stomach cancer cases will remain broadly stable and the number of cases of cervical cancer is predicted to fall189.
Table 4.1 shows the predicted national increases in different types of cancer189. Figures 4.27 and 4.28 show how these trends will affect cancer incidence in Rotherham179.
Table 4.1: Predicted increase/decrease in incidence of the 10 key cancer sites for males and females nationally, 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13
189
National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class Service for England, p13
- 106 Figure 4.27: Predicted increase in case numbers for top 10 cancer sites for Rotherham males 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13 and Trent Cancer Registry (2008) Cancer Fact Sheet for
Rotherham PCT
Figure 4.28: Predicted increase in case numbers for top 10 cancer sites for Rotherham females 2006-2016
Source: National Radiotherapy Advisory Group (2007), Radiotherapy: Developing a World Class
Service for England, p13 and Trent Cancer Registry (2008) Cancer Fact Sheet for
Rotherham PCT
4.4.7 Costs
Expenditure on cancer care in England has risen by 27% over recent years and cancer is the third largest disease programme in the NHS behind mental health and circulatory diseases, costing the NHS £4.35 billion per year. Approximately 80% of this is spent on acute services
(outpatients, diagnostics, treatment, and emergency care) and the other
20% is spent on community care (screening, GP consultations and palliative care). This estimate does not include preventative services, pre-diagnosis assessment and diagnostics and palliative care provided by the voluntary sector190. Expenditure per head of population is £80 compared with £121 in France and £143 in Germany. Figure 4.29 provides a breakdown of spend on cancer nationally.
190
Department of Health (2007), Cancer Reform Strategy, p118-120
- 107 Inpatient care for patients diagnosed with cancer accounts for around twelve percent of all inpatient bed days in England. Cancer patients account for approximately 5.3 million bed days/year. This equates to approximately 14,550 cancer patients being in a hospital bed on any one day191. Figure 4.29: Estimated Total NHS Spend on Cancer Care 2005-6
Source: Department of Health (2007), Cancer Reform Strategy, p119
From 2000-2008 inpatient admissions for cancer nationally have risen by
25% from 625,000 to 785,000 per annum. Bed days are rising by 1% each year. Much of the increase relates to emergency inpatient episodes, which have increased by 47% as opposed to elective inpatient episodes which have only increased by 8.6%. Over the same time period elective day case episodes have risen by 50% (from around 520,000 per annum to around 780,000 per annum)192.
Cancer incidence in England is projected to increase by 25% over the next 15 years, mostly due to the anticipated effects of population growth and ageing. Given the projected increase in the incidence of cancer within the population, bed utilisation for cancer is likely to increase rapidly unless action is taken. Department of Health analysis suggests that, unless actions are taken to reduce lengths of stays and avoidable admissions, inpatient costs for cancer are expected to increase by 24% in the same period. The increase will differentially affect certain groups.
For example, inpatient costs for the over 70s are expected to increase by
37% compared to 13% for the under 70s192.
To maintain inpatient costs at current levels, it is estimated that average length of stay would need to reduce by a third. Alternatively emergency admissions would need to reduce to 50% of current levels192.
The programme budget cost for NHS Rotherham for all cancers and tumours in 2007-8 was £23,722,000.
191
192
Department of Health (2007), Cancer Reform Strategy, p96
Department of Health (2007), Cancer Reform Strategy, p97
- 108 4.5
Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic condition, which is usually symptomatic from middle age.
18% of male smokers and 14% of female smokers in the UK have COPD. It is a significant reason for hospital admissions and lost working days 193. It is currently the 5th leading cause of death in the UK, with over 30,000 people dying each year from end stages of the disease. The direct cost to the NHS of
COPD is almost £500 million per year and the estimated annual cost of treating a patient with severe COPD is £1,307194.
A recent American Lung Association survey revealed that 51% of all COPD patients say that their condition limits their ability to work. 70% are limited in normal physical exertion, 56% in household chores, 53% in social activities,
50% in sleeping and 46% in family activities193. Although the level of COPD in males appears to have peaked in the UK, it continues to rise in females. The cumulative effect of an ageing population and the higher smoking levels amongst women is likely to increase the present burden of COPD in the UK 194.
In Rotherham 121 people died from COPD in 2008, which equates to an age standardised mortality rate of 28.7 deaths per 100,000 of the population. This was higher than the national rate of 27.2 but less than the regional rate of 31.1.
Mortality rates are higher in men than women195.
There were 5,821 patients on Rotherham GP registers with COPD in July
2010196. This is below the predicted prevalence of 7,355197. This indicates significant levels of under-reporting. The British Lung Foundation reports that there may be as many as 3.7 million people with the disease in the UK compared with the 900,000 on GP registers194. According to QOF data the recorded prevalence is 1.5% in England in 2008/09198, compared with an expected prevalence of 3.6% in adults over 16 years)197.
In 2009/10 there were 1,509 hospital admissions from Rotherham registered patients. Of these 1,127 were emergency admissions. These figures equate to
4.2 and 3.1 per 1,000 patients199. Examination of data on hospital admissions for Rotherham from 2002-06 shows an increase in COPD admissions for BME groups. Hospital admissions from BME groups for COPD rose by 42% from
2002-06. The standardised admission ratio for BME groups in Rotherham was
113.2 (Rotherham = 100). For the Pakistani community this rises to 182.2 demonstrating that COPD is a significant risk for this group104.
The Disease Management Information Toolkit (DMIT)200 indicates that the number of emergency bed days used in Rotherham was 118 per 100 people on the QOF COPD (2006-07). NHS Rotherham was ranked 96 out of 152 PCTs, which suggests Rotherham performs fairly poorly against other PCTs. The hospital admission rate in Rotherham was 15.8 per 100 people on the disease
193
DWP (2008), Prevalence of COPD (www.dwp.gov.uk/medical/med_conditions/major/copd/prevalence_copd.asp)
British Lung Foundation (2007), Invisible Lives – COPD Finding the Missing Millions
195
NHS Information Centre (2009), Mortality from bronchitis, emphysema and other chronic obstructive pulmonary disease
(www.nchod.nhs.uk)
196
Quality and Outcomes Framework (2010) COPD register size (www.qmas.nhs.uk)
197
Eastern Region Public Health Observatory (2008) Modelled estimated and projections of COPD for local authorities in England
(http://www.erpho.org.uk/ViewResource.aspx?id=18024)
198
NHS Information Centre, QOF Disease Prevalence 2008-09 (www.ic.nhs.uk)
199
Hospital Episode Statistics, Inpatient Minimum Data Sets via Secondary Uses Services (SUS) (2010)
200
Department of Health (2008), Disease Management Information Toolkit
194
- 109 register, which is above the national average of 13.6. The average length of hospital stay in Rotherham was 7.7 days, slightly below the national average of
7.9 days. Rates of admission increased by 3.8% over the previous year compared with a national average decrease of -0.4%. DMIT estimates that a reduction in Rotherham‟s admission rate to the national average would save
£213,367/year. The number of emergency bed days and length of stay are decreasing but at a rate that is 3-4% less than the national average.
4.6
Infectious Diseases
4.6.1 Tuberculosis
Tuberculosis is the world‟s leading cause of death by a curable infectious disease. About 9 million new cases and 2 million deaths are estimated to occur around the world every year. Around 9,000 cases of
TB are currently reported each year in the United Kingdom. Most cases occur in major cities, particularly in London201.
In 2009 in the UK, 9,153 TB cases were provisionally reported to enhanced national surveillance, a rate of 14.9 per 100,000 population.
This represents a 5.5% increase compared with the number of cases provisionally reported in 2008.
In England, London continues to account for the largest proportion of cases reported (41%), followed by the West Midlands (12.3%). A rise in cases was seen in eight out of nine regions, with only the North East showing a decrease (-2%). 73% of cases were in persons who were born outside the UK, of whom the majority were from South Asia (55%) and sub-Saharan Africa (30%). Only 21% of non-UK born cases were diagnosed within two years of entering the UK. Individuals aged 15-44 years accounted for 60% of reported cases; 21% were 45-64 years old,
15% were 65 years and over and 5% of cases were aged under 15 years. Overall, 55% of cases were male, though females made up 54% of cases aged less than 15 years. 53% of cases were reported to have pulmonary disease. Of these, 57% had a reported smear result, of which 57% were sputum-smear positive202.
One of the biggest issues relating to tuberculosis treatment is the increase in drug resistant strains of the disease. Levels of drug resistance remain stable and resistance is more common amongst younger people and those born outside the UK.
In Rotherham there were 16 new cases of tuberculosis diagnosed in
2006-08 which equates to 6.0 cases per 100,000 of the population203.
201
Tuberculosis, Health Protection Agency (2010) (www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis )
Tuberculosis Update, Health Protection Agency (2010)
203
Table 2a, Three year average tuberculosis case reports and rates by Primary Care Trust, England 2006-2008. TB Tables and Figures
[Online] Health Protection Agency, September 2009
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Tuberculosis/EpidemiologicalData/TBUKSurveillance/TBTablesAndFig ures/t btable2a/) 202
- 110 4.6.2 Sexually Transmitted Infections and HIV
4.6.2.1 Overview
New figures released today by the Health Protection Agency show that 15 to 24 year olds, particularly young women, continue to be the group most affected by sexually transmitted infections (STIs) in the UK.
In 2009 a total of 482,696 new STI diagnoses were reported to the agency from sexual health clinics across the UK and community based Chlamydia testing. This is almost 12,000 more cases than were reported in 2008 when there were
470,701 new diagnoses, continuing the steady upward trend we have seen over the past decade as illustrated in figure 1.
Figure 30: Number of new STI episodes seen at genitourinary medicine clinics by gender: 2000-2009
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
Last year around two thirds of new STI diagnoses in women were in those under 25. In women, 73% (3,955 out of 5,434) of all new gonorrhoea diagnoses and 66% (27,626 out of 42,095) of all new genital warts were in the under 25s. Of all women diagnosed with Chlamydia 88% (112,334 out of 127,741) were under 25 – this is in part due to more sensitive tests and community based testing targeting the under 25s in England.
In men, over half of new STI diagnoses were in those aged under 25. They accounted for 41% (4,683 out of 11,541) of male gonorrhoea diagnoses, 47% (22,972 out of 49,105) of male genital warts and 69% (58,170 out of 84,863) of male
Chlamydia diagnoses. High rates of STI diagnoses have also been found among men who have sex with men.
The peak age for an STI in women is between 19 and 20 years and in men between 20 and 23 years. Of all the 15-24 year
- 111 olds diagnosed with an STI last year around one in ten of these will become re-infected within a year204.
Sexually Transmitted Infections (STIs) are diseases that can be transmitted through unprotected sex. Sexual health problems are more prevalent in low-income groups and those that are hard to reach. The most vulnerable groups include; asylum seekers and refugees, sex workers and their clients, homeless people and young people in or who are leaving care. Other high risk groups include gay men, some black and minority ethnic groups and young people.
The latest overall UK-wide figures show:
Chlamydia diagnoses increased by 7% (from 203,773 in
2008 to 217,570 in 2009)
Gonorrhoea diagnoses increased by 6% (from 16,451 in
2008 to 17,385 in 2009)
Genital herpes diagnoses increased by 5% (from 28,807 in
2008 to 30,126 in 2009)
Genital warts diagnoses stabilised decreasing by just 0.3%
(from 91,503 in 2008 to 91,257 in 2009)
Syphilis diagnoses also stabilised decreasing by just 1%
(from 3,309 in 2008 to 3,273 in 2009)204
In 2009 Rotherham saw a higher rate of diagnoses for all of the major STIs, with the exception of gonorrhoea, than England.
The rate of Chlamydia diagnoses in the 15-24 age group was particularly high for Rotherham compared to the national average (Figure 2).
Figure 31: Rates of selected STI & acute STI diagnoses per
100,000 population for Rotherham and England
(2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
204
Sexually transmitted infections reach almost half a million. Health Protection Agency. [Online] August 2010.
(http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1281953109509 )
- 112 4.6.2.2 Chlamydia
Genital Chlamydial infections were the most common form of
STI diagnosed in GUM clinics in the UK in 2009. In Rotherham, the male group aged 20-24 has the highest number of diagnoses and lower numbers in the 16-19 and 35+ groups.
There are higher numbers amongst younger women (16-19 and
20-24 year olds), with a sharp increase in these groups between
2006-07.
Figure 32a: Numbers of diagnosis of uncomplicated genital chlamydial infection by sex (males) and age group in Rotherham (1995-2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
- 113 Figure 32b: Numbers of diagnosis of uncomplicated genital chlamydial infection by sex (females) and age group in Rotherham (1995-2009)
Source: STI Epidemiology in 2009 (England). STI Annual Data Tables. [Online] 2010.
(http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/STIs/STIsAnnualData/ )
Approximately 50% men and 70% women with Chlamydia do not have any symptoms. If left untreated, genital Chlamydial infection can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Due to the high proportion of asymptomatic infection, the National Chlamydia Screening
Programme (NCSP) offers opportunistic screening for
Chlamydia, with the aim of detecting asymptomatic infection in sexually active men and women under the age of 25 who would not otherwise access, or be offered a Chlamydia test. The Vital
Signs Indicator, VSB13: Chlamydia Prevalence (Screening), measures the proportion of the 15-24 year old population tested for Chlamydia and for the first time will include screening that takes place outside GUM clinics. The Government has set a target for the 2008/09 period of screening 17% of the target population. In 2008/09 Rotherham achieved this target by screening 19.7% of the target population. In 2009/10 the percentage screened increased to 25.7%205.
4.6.2.3 HIV
The number of people living with HIV in the UK continues to rise, with an estimated 83,000 infected at the end of 2008, of whom over a quarter (27%) were unaware of their infection.
During 2008, there were 7,298 new diagnoses of HIV in the UK.
This represents a slight decline on previous years, predominantly due to fewer diagnoses among black African women who acquired their infection abroad. New diagnoses
205
Department of Health. Vital Signs 2010/11 refresh documents. Tiers 1 and 2 Technical Guidance : Unify, 2010
- 114 among men who have sex with men remained high in 2008 and an estimated four out of every five acquired their infection in the
UK.
New HIV diagnoses among those who acquired their infection heterosexually within the UK have risen, from an estimated 740 in 2004 to 1,130 in 2008.
The number of deaths among HIV-infected people has remained stable over the past decade and the number of AIDS diagnoses has continued to decline. A total of 525 people (387 men and 138 women) infected with HIV were reported to have died in 2008. Of these, 57% and 73% had been diagnosed with a CD4 cell count
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In modern organizations such as: Tesco, and Marks & Spencer, there has the significant affects of the global politics. The activities of global politics for example: the incident of 9/11, Soviet Union collapse, Germany’s reunification, WTO policies, have significant effect on the Tesco, and Marks & Spencer’s business operation and the results of which may impede the development of the organization.…
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For the purpose of this report of ‘Strategic Planning’ for the Ed-excel Level 7 Extended Diploma in Strategic Management & Leadership I have selected Unilever United Arab Emirates Ltd.…
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DEPARTMENT OF BUSINESS MANAGEMENT STRATEGIC PLANNING (MNG301-A) Module Overview: Topics 1-7 2013 Semester 2 1 Open Rubric Contents 1. Administrative matters 2. Course overview per topic 3. Interactive exercises 4.…
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