Ayrshire and Arran NHS Board

Paper 22

Monday 27 May 2019

South Ayrshire IJB Strategic Plan 2018-21

Author: Sponsoring Director: Bill Gray, Senior Manager, Planning Tim Eltringham, Director of South Ayrshire and Performance Health and Social Care Partnership

Date: 9 May 2019

Recommendation

The Board is asked to note the South Ayrshire IJB Strategic Plan for the period 2018-2021 (Appendix 1) and recommends the NHS Ayrshire and Arran Board to give practical effect to the Vision, Mission, Values, Strategic Objectives and the Partnership Programme detailed within this strategic commissioning document.

Summary

The Strategic Plan is the Integration Joint Board’s primary strategic document setting out the Partnership’s Vision, Mission, Values, Strategic Objectives and Programme and forms the basis on which it commissions services from NHS Ayrshire and Arran and South Ayrshire Counci l and other providers.

Key Messages:

Funding pressures in the three year period covered by the Strategic Plan require significant transformational activity to achieve break even. The IJB will require further on- going consideration of the resourcing of demographic pressures which have been identified within the Strategic Needs Assessment (Appendix 2) as significant, and seek support from partners to address these needs.

Glossary of Terms

NHS A&A NHS Ayrshire & Arran IJB Integration Joint Board Strategic Needs Assessment Describes the current and future health, care and wellbeing needs of the local population to inform the local Strategy for Heath and Social Care.

1 of 4 1. Background Information

The South Ayrshire IJB Strategic Plan is the second plan for health and social care activity within South Ayrshire since the inception of health and social care integration in 2015. The Plan was created by a Strategic Plan Writing Group consisting of representatives from various organisations, services and sectors, including: NHS Ayrshire and Arran, Public Health, Partnership Senior Management, Third Sector, Independent Sector, South Ayrshire Counci l including Housing Policy, and the Trades Unions.

The IJB Strategic Plan was approved by South Ayrshire IJB on the 27th June 2018. The Plan establishes the Partnership’s Vision, Mission and Values; outlines the national and local context and current operating environment; sets out its Strategic Objectives and overarching priorities for ensuing delivery against the National Health and Wellbeing Outcomes; contains an Implementation Plan to manage delivery under each Strategic Objective; contains resource considerations and includes final budget figures; a summary of the strategic needs assessment work; performance monitoring information; information on the role of housing and other partners; locality planning priorities; and summary information on each locality.

2. Recommendation

However, funding pressures in the three year period covered by the Strategic Plan require significant transformational activity to achieve break even. The IJB require further on- going consideration of the resourcing of demographic pressures which have been identified within the Strategic Needs Assessment (Appendix 2) as significant, and seek support from partners to address these needs.

2 of 4 Monitoring Form

Policy/Strategy Implications The Strategic Plan is the Integration Joint Board’s primary strategic document setting out the Partnership’s Vision, Mission, Values, Strategic Objectives and Programme and forms the basis on which it will commission services from NHS Ayrshire and Arran and South Ayrshire Council. Workforce Implications The staffing establishment that will be within the scope of the Partnership is set out on page 39 of the 2018-21 Strategic Plan. Financial Implications The financial resources available to deliver Plan Objectives and the Plan Programme are detailed on page 39 of the 2018-21 Strategic Plan. Work is continuing to identify improved practice and transformation of service to increase the ability of the Partnership to deliver service within the funds available. Consultation (including As required by legislation, the Members of the Professional Committees) Strategic Planning Advisory Group have considered each draft and have been engaged in the development of the document. The undernoted stakeholders have also been consulted directly on the development of the Plan, or in some cases, have had the opportunity to attend si x public events held throughout South Ayrshire: • Health and Social Care professionals • Users of Health and Social Care • Carers • Providers of Health and Social Care • Partnership employees • Locality Planning Group members • Third sector • Independent Sector • Public Risk Assessment As noted in the current IJB strategic risk register, the current funding position remains the most significant risk to the successful delivery of IJB’s Strategic Outcomes and impacts negatively on progress against National Outcomes and the IJB Strategic Plan. Best Value Best value is an underpinning principle of all work carried out in actioning the IJB Strategic Plan and is discussed in the following pages within the Plan: - Vision and leadership Pages 26-37 - Effective partnerships Pages 8-13; 22-25 - Governance and Pages 5-7 accountability - Use of resources Pages 38-41 - Performance management Pages 14-17

3 of 4 Compliance with Corporate The IJB Strategic Plan supports all NHS Ayrshire and Objectives Arran corporate objectives. Single Outcome Agreement South Ayrshire Local Outcomes Improvement Plan and (SOA) Local Place Plans 2017 states that “The South Ayrshire Community Planning Partnership’s overall focus is on: • closing the poverty-related outcomes gap for children and young people in South Ayrshire • supporting older people to live in good health This will be supported by a partnership wide focus on four priority areas: • improving outcomes for looked after children and care leavers • Providing support for young people who are carers • Reducing social isolation and loneliness • Support for people living with dementia and their carers.” The IJB Strategic Plan supports all of the four priority areas listed above. Impact Assessment An Equality Impact Assessment (EQIA) has been carried out (Appendix 3)

4 of 4 Integration Joint Board: Strategic Plan 2018-2021

Working together for the best possible health and wellbeing of our communities. 02 |

Plan contents

Foreword 03 Who We Are 04 Introduction 06 Previous Plan Progress 14 Strategic Context: and the need for transformational change 18 Locality Planning And Local Priorities 24 Partnership Programme 26 Resource Overview 38 Strategic Plan Review 42 Glossary 43 Implementation Plan 44

Appendix 1 – Summary Needs 47 Appendix 2 – Locality Planning Groups: Priorities For The Plan Period 56 Appendix 3 – National Outcomes For Integration 64 Appendix 4 – Housing Contributions Statement 65 | 03

Foreword

Comprehensive governance arrangements have been put in place within the IJB and within the delivery vehicle – the South Ayrshire Health and Social Care Partnership.

Partnership working is at the heart of operational and planning arrangements and we need contributions from all stakeholders – patients, service users, carers, staff, professionals, locality planning groups and from partner organisations from across the sectors.

A summary of the key achievements over the 2015-18 planning period is included in this document. The progress made is in large part due to the dedication and commitment of staff within the Partnership and I would like to thank them This is the second full Strategic for their contribution. Many have taken on unfamiliar roles and demonstrated an ability to work collaboratively with Plan of the South Ayrshire Integration colleagues from other disciplines and with partner agencies Joint Board (IJB). In the three years since and the wider public. the Board was first established significant The planning period ahead will see a continuing drive for progress has been made, locally, on a wide transformational change in services and in the way that support is provided, with greater emphasis on care at home and support range of health and social care issues. in the community, rather than within a hospital setting. This will mean the further integration of services and different ways of working, not just within the public sector, but across all sectors.

The IJB will support the health and wellbeing of our children and young people as part of an integrated agenda with Community Planning Partners around the delivery of services with a particular focus on child protection, looked after children and care leavers.

Providing choice and control for service users is a key principle for the Integration Joint Board and this will mean changing the culture within our partnership and we will support staff from across the sectors to make this change.

Similarly, we will seek to support the changing role of GPs and Primary Care Services as the role of family doctors changes to be that of expert medical generalist supported by a full multi- disciplinary team of other health and care professionals.

All of the work that will be taken forward continues to be done within the context of a challenging financial and operational environment which will require transformational change in order to achieve the Board’s objectives. The overarching aim will be to ensure a continued focus on what is important to people and their lives in as fulfilling a way as possible. The IJB is committed to assisting people to achieve the personal outcomes to which they aspire. However, the Board is equally realistic in its assessment that statutory service provision can only go so far. Over the next planning period it will seek to engage further with communities and families to build resilience and a partnership approach to health and wellbeing.

Tim Eltringham Director of Health and Social Care 04 |

Who we are

The“ South Ayrshire Health and Social Care Partnership brings together a wide range of community and primary care health and social work services into a single operational delivery unit. | 05

The South Ayrshire Health and Social Care The IJB is a separate legal entity in its own right and has within Partnership brings together a wide range of its scope, staff from both South Ayrshire Council and NHS Ayrshire and Arran. It is responsible for planning and overseeing community and primary care health and social the delivery of a full range of community health and social work services into a single operational delivery work/ social care services. The IJB is responsible for allocating unit. In South Ayrshire the Integrated Partnership the integrated revenue budget for health and social care in includes Adult Services, Children’s Services and accordance with the policy priorities set out in its Strategic Plan. Criminal Justice Services. The Partnership is In practice, this means that services will work more closely governed by the Integration Joint Board (IJB). together to deliver streamlined and effective support to people The IJB has members from NHS Ayrshire and Arran, that need it. South Ayrshire Council, representatives of the 3rd Sector, Independent Sector, staff representatives and Service details are provided within the South Ayrshire South Ayrshire others representing the interests of patients, service Integration Scheme (available here or search for Integration Scheme). users and carers. 06 |

Introduction

The Public Bodies (Joint Working) (Scotland) Act which established integrated health and social care partnerships came into effect on 2 April 2014. The main purpose of integration is to improve the wellbeing of people who use health and social care services, particularly those whose needs are complex and require support from both health and social care.

Integration also aims to: • Improve the quality and consistency of services for patients, carers, service users and their families • Provide seamless, joined up, high quality health and social care services to care for people at home, or in a homely setting, where it is safe to do so; and • Ensure resources are used effectively and efficiently to deliver services that meet the needs of the increasing number of people with longer term and/or complex needs | 07

Integration Joint Boards with similar functions have been The East Ayrshire HSCP leads on Primary Care Services established in the North and East Ayrshire Council areas. across Ayrshire and Arran and the North Ayrshire HSCP is the lead Partnership for Specialist Mental Health Services, This Strategic Plan replaces the first Plan approved by the including in-patient services. Integration Joint Board on 2nd April, 2015 for the period 2015- 18. It aims to provide a 10-year vision for integrated health At the heart of this approach to strategic planning will be the and social care services and contains a three-year strategic provision of services and support across the sectors, including planning framework for 2018-21 which sets out priorities for the Third and Independent Sectors, in a way that meets the the Partnership and how it will use its resources to integrate needs of particular individuals, communities and localities. services in pursuit of National and Local Outcomes. To facilitate this, Locality Planning arrangements have been established in six areas of South Ayrshire. More information on Some hospital-based services are within the scope of the this is provided later in this Plan. Strategic Planning process, particularly those around unplanned emergency admissions. These are central to one of the primary objectives of Integration, which is to shift the balance of care from a hospital or institutional setting to the community. 1 Public Bodies (Joint Working) (Scotland) Act 2014, Scottish Parliament 2014 (available here or search for Public Bodies Joint Working Act) In addition, where specialist services are managed by a ‘Lead Partnership’ on behalf of all three Ayrshire based Health and Social Care Partnerships, this Plan will include reference to the vision and priorities for those services. Local priorities agreed between this Partnership and the Lead Partnership will be reflected in the respective strategic plans of both bodies.

The South Ayrshire Health and Social Care Partnership is the Lead Partnership for the following delegated functions:

• Allied Health Professions (AHPs) • Continence • Technology Enabled Care (TEC) • Joint Equipment Store • Falls Prevention • Health Visiting Services, Family Nurse Partnership, School Health and Looked After and Accommodated Children

Some“ hospital-based services are within the scope of the Strategic Planning process, particularly those around unplanned emergency admissions. 08 |

Lead Partnership – South Ayrshire Continence The Integrated Continence Service promotes continence by Lead Partnership arrangements continue to be in place across empowering patients to self-manage through behaviour and Ayrshire and Arran. The South Ayrshire HSCP manages lifestyle interventions. The objectives of the service are to offer and delivers the following services on behalf of the East and intermediate clinics across Ayrshire and to offer an advisory North Partnerships. service to patients, carers and voluntary organisations and Allied Health Professionals educational service to NHS clinicians.

South Ayrshire HSCP leads on Allied Health Professional Technology Enabled Care (TEC) (AHP) services across Ayrshire. Within this remit are the The Ayrshire and Arran strategy for TEC and Innovation following services: Dietetics, Orthotics, Occupational Therapy, outlines the need to harness the advances in technology Physiotherapy, Podiatry and Speech and Language Therapy. and to develop the use of TEC across Ayrshire and Arran AHPs are a distinct group of specialist and sub-specialist over the next three years. North, South and East Ayrshire practitioners who apply their expertise to diagnose, treat and Health and Social Care Partnerships and Acute Services are rehabilitate people of all ages within both mental and physical currently redesigning models of care and TEC will support health, education and social care and across acute and and further enable services, the workforce and infrastructure community settings. They work with a range of technical and transformational redesign. support staff to deliver direct care and provide rehabilitation, self-management, “enabling” and health improvement Joint Equipment Store interventions. The Active and Independent Living Programme provides a National Strategic framework for development South and East Health and Social Care Partnerships and of AHP services. Locally, four key work streams have been NHS Ayrshire & Arran have developed a proposal to establish identified to ensure that teams have the necessary support a joint store for the provision of equipment to people living in and infrastructure to contribute to the development of the community. services: Workforce; Staff support and development; Data for improvement and research and Development and evaluation The equipment referred to is wide ranging and intended to enable people to live safely within their own homes. Falls Prevention Family Nurse Partnership (FNP) A Falls Strategy Position Statement was developed in 2016 which outlined the local response to the national action The Family Nurse Partnership (FNP) is a licensed programme framework for The Prevention and Management of Falls in the where specially educated nurses work with first-time teenage Community (Scottish Government, 2014). Key areas for future mothers to develop their parenting capacity and support action by each of the Ayrshire Partnerships have been identified them to make positive choices for themselves and their to both reduce the numbers of people who fall and improve children. The FNP aims to prevent damage to a child’s brain the personal outcomes for those people who experience a development, behaviour, learning, and long-term health by fall. Further development of multi-agency, pan-Ayrshire falls having a specially educated nurse visit the homes of first-time pathways is required as well as improved access to community teenage mothers from early pregnancy (before 28 weeks) until services and local supports that will improve individual’s ability their child is two years old. The programme has been shown to perform daily activity and reduce anxiety around falling. to produce many benefits including improved early language development and academic achievement, reductions in Sensory Impairment children’s injuries, neglect and abuse and fewer subsequent pregnancies and greater intervals between births. Key priority areas have been identified by the Sensory Impairment service. A Pan-Ayrshire British Sign Language Plan is being developed and requires to be published by October 2018. Other key areas that will be prioritised include the development and provision of Sensory Impairment Awareness Training; the development of mechanisms to share service users confidential information across Council services; to improve access to service buildings; to provide a wider range of diagnostic procedures and specialist services in the community and to develop a structure where those with sensory loss are involved to improve services. | 09

Lead Partnership – East Ayrshire HSCP The East Ayrshire HSCP will continue to manage and deliver the following services on behalf of the North and South A“ strong local primary care Partnerships. service, supporting people in • Primary Care (General Medical Services, General Dental Services, General Ophthalmic Services, their day-to-day lives to get Community Pharmacy) the best from their health, • Public Dental Services with the right care available • Ayrshire Urgent Care Services • Contracting for GP services for settings such as in the right place when they Prison Service and Police Custody Services need it. The overall theme is of The agreed vision for primary care services across Ayrshire partnership between individuals, and Arran is to achieve: communities, the health and social care and with partners. 10 |

The Ayrshire and Arran vision aligns to the Scottish What this will mean for local residents is that GPs will focus Government’s vision for the future of primary care services, more on seeing patients who are unwell where a GP’s skills which is for multi-disciplinary teams, made up of a variety of are required for diagnosis and developing a treatment plan health professionals, to work together to support people in as well as caring for those who have complex care needs. the community. Other professionals such as Advanced Nurse Practitioners, Pharmacists and Community Link Workers or Connectors, In its Lead Partnership role, East Ayrshire is responsible for Physiotherapists and Mental Health workers will work alongside the development and implementation of the ‘Ambitious for GPs to assess and treat individuals in line with their own Ayrshire’ programme of transformational change for Primary expertise. People often know what care they need and in Care services. Good progress has been made in advancing future more people will be able to seek this directly, so that the key priorities outlined in the this programme, which for example a person with shoulder pain may choose to see includes the development of GP clusters and supporting the a Physiotherapist as a first point of contact, while individuals development of multidisciplinary team working in and with with minor ailments will increasingly find that Community GP Practices, increasing capacity to provide community- Pharmacists can provide a range of treatment. based services, improving workforce sustainability, improving primary care infrastructure and establishing These new changes will be brought in over the next 3 years an integrated Out Of Hours service. as part of a Primary Care Improvement Plan. East Ayrshire Integration Joint Board will have the responsibility to ensure the Going forward our work will be informed by key Scottish Plan is in place and delivered across Ayrshire. Government policies including the new GP Contract 2018, ‘Achieving Excellence in Pharmaceutical Care – A Strategy Some of the first areas for change will be the way local people for Scotland’, ‘Community Eyecare Review’, ‘Oral Health receive services such as vaccinations, repeat prescribing and Improvement Plan’ and ‘Realising Realistic Medicine’ as well medication reviews, community treatment and care services as addressing health inequalities. (e.g. minor injuries and dressings, phlebotomy, ear syringing, This work is being delivered in partnership between suture removal, chronic disease monitoring), urgent care and communities, Primary Care, the three Ayrshire Health out of hours being supported by advanced practitioners (nurses and Social Care Partnerships, Acute and Third Sector. and paramedics) including for home visits; physiotherapy, These partners are committed to working collaboratively and mental health services and more use of Community Connectors positively to deliver real change in local health and care systems and Link Workers attached to GP practices. that support people to receive the right care at the right time. The Plan will outline how these changes will be delivered before General Medical Services the end of the transition period at March 2021. General practice provides continuing, comprehensive, Community Pharmacy coordinated and person-centred healthcare to the communities of Ayrshire and Arran. A strong and thriving general practice is The publication of ‘Achieving Excellence in Pharmaceutical critical to sustaining high quality healthcare, which is available Care – A Strategy for Scotland’ in 2017 by the Chief to all and which can realise Scotland’s ambition to improve our Pharmaceutical Officer for Scotland, provides an opportunity population’s health and reduce health inequalities. to review and align community pharmacy services with the Ambitious for Ayrshire vision for multi-disciplinary team (MDT) A new General Medical Services (GMS) contract has been working in Primary Care. The Strategy makes a commitment to agreed with GPs and will be implemented across Ayrshire and increase access to community pharmacy as the first port of call Arran from April 2018. The way in which General Practice will for self-limiting illnesses and supporting self-management of work in the future will change in line with the new contract, the stable long term conditions, in and out of hours. guiding principles of which are to support: Through the Minor Ailment Service (MAS) community • accessible contact for individuals and communities pharmacies are increasingly becoming the first port of call • comprehensive care of people - physical and for eligible patients for a range of common clinical conditions mental health and NHS Ayrshire & Arran has added to the range of common clinical conditions treatable by community pharmacists under • long term continuity of care enabling an effective the Pharmacy First Ayrshire service. Women between 16 and therapeutic relationship 65 can now be treated for uncomplicated urinary tract infections • co-ordinating care from a range of service providers and patients aged 2 years and over, can also be treated for impetigo. Both conditions previously required prescriptions The benefits of the proposals are to develop partnerships through GP practices or OOH services. between patients, their families and those delivering healthcare services work to provide care which is appropriate and based We are also expanding the range of common clinical conditions on an assessment of individual needs and values and improves that can be treated by community pharmacists for other skin wellbeing, demonstrates continuity of care, clear communication infections and shingles, and intend to further expand the range and shared decision-making. | 11

of conditions that can be treated. Expanding the range of effectiveness of the triage/vetting process and patient care as common clinical conditions treated will improve outcomes for a consequence. NHS Ayrshire and Arran attain approximately patients and reduce the workload for GPs and other health and 80% referrals electronically which compares favourably to other social care professionals. Health Boards.

A number of community pharmacists are qualified as The Scottish Government Community Eyecare Review was Independent Pharmacist Prescribers (IPPs), providing published April 2017. The review considered care currently clinics from their community pharmacy, in conjunction with local provided within community optometry and identified examples GP practices. These clinics include respiratory clinics, as well of good practice across Scotland that could be replicated. NHS as hypertension and sexual health clinics. Further training and Ayrshire and Arran was commended in the report for the locally development of this workforce will unlock a further resource developed initiatives and examples of care already developed that can play a role in the MDT. Supporting patient self- within community optometry. management of long term conditions will improve outcomes for patients whilst reducing the workload of GPs and other health General Dental Services and social care professionals. The Scottish Government published the Oral Health Improvement Plan (OHIP) in January 2018. The plan sets The recent changes to the GP contract and development of the direction of travel for oral health improvement for the next the pharmacotherapy service over the next 3 years provides us generation and has a strong focus on reducing oral health with an opportunity to introduce a serial prescription service inequalities, moving to a preventive based approach for NHS to reduce the time spent in GP practices dealing with repeat dentistry and meeting the needs of the ageing population. prescriptions and to streamline the process at community pharmacies. If more patients have serial prescriptions in place The aims of the new plan are to focus on prevention, this will allow a greater range of activities identified within the encouraging a more preventive approach to oral health care pharmacotherapy service to be carried out by the practice for patients of all ages to ensure that everyone can have the based pharmacists. best oral health possible and that education and information sharing is specifically targeted at individuals and groups most The development of GP practice based pharmacists also at risk such as those who do not attend regularly for check-ups, provides an opportunity for better joint working between GP communities in low income areas and particularly those people practices and local community pharmacists. Their mutual who either smoke or drink heavily. New approaches will also be understanding of one other’s issues will provide opportunities introduced to make it easier for dentists to treat older people to provide better patient care and medicines management. who live in a care home or are cared for in their own home and to enable those dentists with enhanced skills to provide Optometry services that would otherwise be provided in a Hospital Dental Community optometrists provide a comprehensive eye Service i.e. oral surgery, treatment under intravenous sedation examination service model to care for an aging population. and complex restorative services. The eye examination is universally funded and therefore free of charge to all eligible patients. Geographical access to The aim of the NHS Ayrshire and Arran Oral Health Strategy eye care at optometrist practices across all HSCPs in NHS 2013-2023, closely aligns with the new national Plan with the Ayrshire and Arran is good. aim of ensuring the ‘best oral health possible for the people of Ayrshire and Arran’. The strategy covers stages of life (children The ‘Modern Outpatient Programme’ (2016) outlines the further and adults) and targets oral health promotion work for priority need for a collaborative approach to health care. In Ayrshire groups, such as the homeless and prisoners, people in care and Arran accredited optometrists provide locally enhanced homes and those with specific care needs. We are currently eye care services reducing the burden on secondary care. progressing the NHS Ayrshire and Arran Oral Health Action These include: Low Visual Aids (Visual Impairment); Bridge Plan 2016-2019 and have completed the second year of the 3 to Vision (Learning Disability); Post-Operative Cataract year Plan and will continue to deliver oral health improvement Surgery Assessment; Medical Contact Lenses and Diabetic activity over the remaining year of the Plan. Retinopathy Screening. Ayrshire Urgent Care Services Launched in February 2017, the ‘Eyecare Ayrshire’ re-direction NHS Ayrshire & Arran and East Ayrshire Health and Social Care initiative aims to shift the balance of care for eye problems Partnership have launched a new out-of-hours service which will from GP practices and EDs to local optometry practices and bring together the skills, expertise and capacity of existing out- promotes the use of the optometrist as first point of contact for of-hours services to enable the citizens of Ayrshire to access eye problems, advising people that eye drops will be available the right person, with the right skills at the right time. free of charge dispensed from community pharmacists. Launched in November 2017, the ‘Ayrshire Urgent Care Service’ Where needed electronic referrals are made directly from (AUCS) brings together Primary Care and Social Work services optometrists to the hospital eye service. These referrals into an ‘urgent care hub’, operating from the Lister Centre at allow for images to be attached which further enhance the University Hospital Crosshouse. 12 |

This will be supported by local urgent care centres and the Also included within the inpatient portfolio of services are: home visiting service as required. In partnership with NHS24 there will be continued promotion of self-care and redirection • Community Forensic Team to the most appropriate service, for example local pharmacist. Ayrshire Urgent Care Service includes: • Elderly, Psychiatric and Alcohol Liaison Services • Mental Health Advanced Nurse Practitioners • Doctors and Advanced Nurse Practitioners • Acorn – service based at Ailsa offering structured • Out-of-hours district nursing service activity, sheltered employment opportunity and • Crisis Resolution Team supporting individuals who have/are experiencing mental disorder to develop a range of skills. • Out-of-hours social work • East Ayrshire overnight emergency response Inpatient services are split between Woodland View personal carers (on Ayrshire Central Hospital site in Irvine) and Ailsa hospital (in Ayr) with the majority of adults services being based at the • Service support staff. new bespoke provision within Woodland View.

This redesign is in-line with national policy for urgent care Crisis Resolution Team services as set out in the report ‘Pulling Together: transforming urgent care for the people of Scotland, 2016’, which recognised The Ayrshire Crisis Resolution Team offers a home based the difficulty in sustaining GP involvement in out-of-hours alternative to in-patient care for adults (aged 16-65) services. The service will continue to test new ways of working experiencing acute and severe mental health crisis. The service to ensure a safe, high quality, effective and efficient out of hours offers short term support up to 21 days, in line with the national service is delivered to the communities of Ayrshire. standards for crisis services.

Ayrshire and Arran will continue to have an out-of-hours Learning Disability Assessment and Treatment Service primary care service which will include Doctors and Advanced People with a learning disability have a significant, lifelong Nurse Practitioners working as part of a wider team to ensure condition that affected their development and which means that members of the public will see the most appropriate they need help to; understand information, learn skills, and healthcare professional. cope independently. The Learning Disability Assessment and Treatment Service is a 16 bed inpatient admissions unit based at Arrol Park Resource Centre, Ayr. The unit provides access to Lead Partnership – North Ayrshire HSCP specialist a range of specialist professionals and intensive multi- disciplinary services for all adults living in Ayrshire who have a The North Ayrshire HSCP will continue to manage and learning disability. deliver the following services on behalf of the East and South Partnerships. The unit accepts both planned and unplanned admissions: Mental Health Inpatient Services • A planned admission to Arrol Park provides short- NA HSCP leads on a wide range Mental Health Inpatient term intensive assessment and treatment. Where services across Ayrshire, including: a planned admission is deemed appropriate, a pre-admission meeting will take place with the • Acute inpatient assessment for individuals individual and family members and a range of experiencing functional and/or organic presentation support staff including; Community Learning • Low Secure male inpatient services Disability Team, designated Social Worker, and • Intensive Psychiatric care provision Third sector representatives • Generic and forensic rehabilitation services • Emergency admissions to Arrol Park are facilitated by members of the Community Learning Disability • Hospital Based Complex Continuing Care for Team. Admissions are agreed with a Responsible individuals 65 and over on Ailsa site Medical Officer and members of the Community • Inpatient addiction service, offering inpatient Learning Disability Team will be in contact detoxification programme, residential and day with Arrol Park nursing staff to facilitate the attendance rehabilitation programme. admission process. | 13

The following is a list of criteria for why an individual would be In addition North Ayrshire has lead responsibility for the admitted to Arrol Park: following Early Years Services:

• The person requires a period of complex Child Immunisation Team nursing and therapeutic care which cannot be In East and South Ayrshire, the HSCP Immunisation Team met elsewhere delivers all immunisation clinics, where in North clinics • The person has severe emotional, behavioural are delivered by both the Immunisation Team and many or mental health difficulties which cannot be GP surgeries. The team is also responsible for the pupil immunisation programme in all Ayrshire schools. appropriately assessed or treated elsewhere • The person requires a period of sustained specialist Community Infant Feeding Service led support and rehabilitation The community infant feeding nurse works across Ayrshire to • Where risk evaluation indicates that hospital provide a specialist service to families experiencing complex admission is most likely to reduce short and challenges with infant feeding. The service supports health visiting staff with advice and provides direct support to families medium-term risks which are significant and likely via telephone, face to face discussions or home visits. to pose a hazard to the patient and/or others. Child Health Administration Psychology Services Child Health Administration team co-ordinates, manages Psychological Services are provided across Ayrshire and Arran and supports the delivery of Ayrshire’s child immunisation and are embedded within various specialist teams. Specialities programme and development screening programmes. The team covered are: maintains all records and information in relation to its remit and provides information to the Information Statistics Division (ISD) • Child Psychology via nationally established data systems. • Adult Mental Health Over the next three years, the early years teams will support • Older Adults, physical health and the implementation of the 3 year Vaccination Transformation neuropsychology, and Programme and will prepare for the replacement of the current • Learning disability services. Child Health & Community Health Index (CHI) system, expected by 2020. The service deploys a range of staff within these specialist roles to undertake focused work, such as primary care mental health, community mental health and eating disorders.

Child and Adolescent Mental Health Service (CAMHS) The CAMHS service is available to young people aged 5 to 18 “ years old and offers short term treatments for those with mild to North Ayrshire shall deliver moderate mental health problems; to more complex treatments for children and young people experiencing more severe and mental health services in line complex problems. with the 10 year National Mental North Ayrshire shall deliver mental health services in line with the 10 year National Mental Health Strategy 2017-2027. Health Strategy 2017-2027. This strategy aims to ensure that mental health problems are treated with the same commitment and passion as physical This strategy aims to ensure health problems. We will work to improve: Prevention and early that mental health problems intervention; Access to treatment, and joined up accessible services; the physical wellbeing of people with mental health are treated with the same problems; Rights, information use, and planning. commitment and passion as physical health problems. 14 |

In the period 2015-18 progress has been made in improving the development of integrated health Previous plan and social care supports across the sectors in South Ayrshire and a number of these have led to changes in the ways that services are delivered or provide progress examples of good practice: | 15

• Through a more co-ordinated approach we are identifying • Preventive work is central to ensuring people can live and meeting the needs of families who require support in good health in South Ayrshire. A range of Health during pregnancy, this includes the extension of the Improvement Strategies have been and continue to be Family Nurse Partnership to all young women of 19 delivered on a pan-Ayrshire basis. The Healthy Weight years and under Strategy, Oral Health Strategy, Tobacco Control Strategy, Mental Health and Wellbeing, Oral Health Strategy and • We have increased support to the families of children from Blood-borne virus framework are delivered across each birth to school age, through the implementation of the of the Health & Social Care Partnerships (HSCPs), Universal Health Visiting Pathway Community Planning Partnerships (CPPs) and acute services. The pan-Ayrshire children and young people’s • Funding has been secured from the Life Changes Transformational Change Programme provides key links to Trust to support the development of a South Ayrshire the South Ayrshire Children’s Services Plan. These were Champions Board. A Corporate Parenting Officer and care all delivered throughout the time-period of the previous experienced Participation Assistants are now in place. Strategic Plan The team have been in place since September 2017 and have been successful in raising awareness of Corporate • Healthy Active Rehabilitation Programme (HARP) is an Parenting and the development of a South Ayrshire Looked Ayrshire-wide tiered community rehabilitation programme after promise. A Champions for Change Workplan has supporting a range of morbidities in a more effective and been developed which is incorporated in the Corporate efficient manner. In the first instance the programme has Parenting Plan 2017-20 targeted cardiac, pulmonary, cancer and stroke patients

• South Ayrshire Sexual Exploitation Joint Action Group • The Integration Joint Board has approved an Adult has worked with the Multi-Agency Partnership (end Community Mental Health Strategy for 2017 – 22 Violence Against Women and Children), the Adult Protection Committee, the Child Protection Committee • A Care at Home Pharmacy Technician Service has been and key services to develop and deliver resources for introduced which is a medication compliance service staff, to support awareness and responses to child sexual mainly for elderly patients who have been identified by exploitation and produced South Ayrshire Strategy, health and social care professionals, as well as via hospital Response to Sexual Exploitation and Abuse 2017 – 2022 discharge, as requiring help to manage their medication, to undertake re-enablement and to manage their medicines • The IJB approved the ongoing development of the Concern independently. A home visit can be arranged, and the Hub based at Kilmarnock Police Station in September technician will carry out a comprehensive medicines 2016, on a Pan Ayrshire basis. This has allowed timeous check referring to a Pharmacist for a medication review, information sharing, impacting on the number of referrals to if required; assess the ability of the person to manage the Children’s Reporter and Adult Support and Protection medicines independently; organise appropriate aids, if required; and liaise with family and carers, as required • The Partnership has developed an approach based on four key priorities to manage care for those people most at risk of admission to hospital. These include the following priority areas: Anticipatory Care Planning, Community Rehabilitation and Enablement, Redesign of Services at Biggart Hospital and in 2017-18 the Interface with Combined Assessment Unit at Ayr Hospital which opened “ in June 2017. These align with the Older People and The HSCP has worked in a Unscheduled Care work streams being taken forward on a pan-Ayrshire basis multiagency way to improve

• Anticipatory Care Planning has been adopted in the responses and interventions majority of GP Practices in South Ayrshire. The initiative involves regular multi-disciplinary meetings within GP to support woman and their Practices focusing on the development of robust care families where there are plans for individual patients. The aim is to develop plans which will help maintain people within their own homes and significant vulnerabilities in enable a coordinated response to any deterioration to a person’s health and care pregnancy such as addictions and mental health. 16 |

• An Adult Learning Disability Strategy has been prepared for • The HSCP has worked hard to develop and enhance the period 2017-23 which is based on the National Strategy community capacity within the six localities that comprise – “The Keys to Life.” The development of the Strategy was South Ayrshire. For example, a Community Link Practitioner supported by the Scottish Commission for Learning Disability role within Primary Care has been established in a number the Government’s Centre of Excellence for Learning Disability of GP Practices to signpost people to local support and in Scotland activities available within their localities with the intention of having a direct impact on loneliness and social isolation. • New Commissioning Plans have been developed for Adult Crucial to the success of this has been the development of Learning Disability Services and Adult Community Mental real time information on what organisations, services and Health Services to give practical effect to the new strategies activities are available within localities, and the Partnership on the ground in South Ayrshire. Tenders have been issued has been pleased to support Voluntary Action South Ayrshire in 2017-18 for new 3rd and Independent Sector provided to develop “South Ayrshire Life” an on-line community services which will place more emphasis on the delivery information system of outcomes, innovation and improved opportunities for service users | 17

• Community capacity has been further enhanced by the work telehealth such as Apps to monitor progress and encourage of the six locality planning groups and the significant work that self-management they have undertaken to organise a number of Participatory Budgeting Events which has seen a significant sum of money • Carrick Opportunities Centre is a community hub providing allocated to support local groups and activities and to sustain day opportunities. Other partner organisations are also capacity in each of the six localities based there, including SAC Community Learning and Development, Job Centre Plus, Ayrshire College and the • The HSCP is one of a number of Partnership’s in Scotland local driving school. The services offered to people and to adopt the Community Led Support programme designed the classes provided have been requested by people with to provide the most appropriate support to people, locally, learning disabilities through consultation. The service has through “front doors” in their own communities by a range of recently been awarded a certificate of excellence by ASDAN agencies and volunteers for excellent practice in running ASDAN courses particularly in relation to the Inclusive Curriculum (ASDAN is an education • Following high profile episodes of people in rural South charity and awarding body). Carrick not being able to get a timeous response from the local Scottish Ambulance Service, with support from the • Rosie’s Retro is a social enterprise from Turning Point Girvan and South Carrick Locality Planning Group and the Scotland which provides workplace opportunities for adults Scottish Ambulance Service, a South Carrick Community with learning disabilities. It comprises of a gift shop in Ayr First Responder Service, comprising members of the local town centre selling a range of unique and quirky products, community, has been developed and became operational in many made locally, with studio space which is used for craft, December 2017 drama and adult learning workshops. Those using the service have noticed improvements in their own health, saying they • Given the age profile of the population in South Ayrshire the “felt fitter being out and about getting the bus to work”, prevalence of Dementia in South Ayrshire is greater than “it’s an active job working in a shop” and also ‘I’m growing in that for Scotland as a whole. The Partnership has supported confidence, meeting people and dealing with the public’. the establishment of Dementia Friendly Communities in Prestwick and Troon and is preparing a Dementia Strategy • My Home Life is a social movement that aims to enhance and Implementation Plan for South Ayrshire the quality of life for all who live, die, visit and work in care homes through transformational change and encourages • Local Alcohol and Drug Partnership (ADP) partners continue working in partnership through appreciative relationship to offer and further develop recovery focussed support for centered practice. The HSCP has been pleased to support individuals affected by alcohol or drug misuse. New recovery this programme which has been delivered by staff from the groups and activities have been embedded in communities University of the West of Scotland and demonstrates a strong across South Ayrshire offering peer support, social activities partnership arrangement between these bodies and Scottish and a pathway to mainstream community activities for Care, the representative body for Independent Care Providers individuals in recovery. The ADP has also established a successful Volunteer Peer Worker training project where • A Pan Ayrshire Community Hearing Service has been put in individuals in recovery and family members undertake place led by the South Ayrshire HSCP. The new Community volunteer work-based placements while working towards SVQ Hearing Service is based in 10 static locations across the qualifications. New Family & Carer support groups have been three Ayrshire Council areas. The new service is funded developed in Ayr, alongside specific support for family and equally by the 3 Ayrshire Health and Social Care Partnerships carers, offering vital support for families affected by someone else’s substance use. These activities all aim to reduce social isolation and stigma, provide information and advice, and promote self-management.

• By working in partnership with the South Ayrshire Carers Centre a range of information, advice and support services “ for carers are now in place in the South Ayrshire. These An Adult Learning Disability include face to face interviews, telephone contact, peer group support, health interventions, financial inclusion, short breaks, Strategy has been prepared respite provision for young carers and young adult carers for the period 2017-23 which • Ayr United Football Academy (AUFA) delivers a Weigh to Go programme which is a healthy lifestyle programme, is based on the National designed by NHS Ayrshire and Arran. The programme Strategy – “The Keys to Life.” focuses on self-management to achieve 5-10% weight loss and increase physical activity. The programme incorporates group education and support, individualised goal setting, and 18 |

Strategic context: and the need for transformational change

This section summarises the background to Key information from the Needs Assessment which will be current strategic planning in the Health and Social considered and addressed through this strategic planning process includes the following: Care Partnership. It explains why, going forward, traditional approaches to the provision of health and Population social care services across all sectors and across all age ranges is not an option for the Integration Joint The older population is projected to increase markedly by 2039: Board and explains why change is necessary. • People of pensionable age will increase by 21% • Those aged over 75 will increase by 82% Principally change is necessary as demand is rising significantly while, in real terms, available public spending is falling. Based on current patterns of demand, this will have major This makes it extremely challenging to give all children the consequences for older people’s services, including a need for best start in life and to meet the needs of a population which 40 more care at home places and 30 care home places each year is ageing significantly and which requires increasing levels of over the three year planning period. care to keep local people safe, well and content at home in their local communities. The projected change in the South Ayrshire population is not evenly spread and the 0-15 and working age populations will The need for transformational change in South Ayrshire is both decrease: clearly demonstrated by the established needs of the area. • By 2039 there will be a decrease of 8% in those These are set out in the Summary Needs Assessment and Area Profile at Appendix 1. This provides the context for the aged 0-15 objectives and policy priorities detailed in this Strategic Plan. • There will also be an 11% decrease in those of The full Needs Assessment and Area Profile is available( here or working age search for South Ayrshire Strategic Needs Assessment). • South Ayrshire has the highest proportion of those Updated profiles of each of the six localities in South Ayrshire aged 100+ in Scotland (available here or search for South Ayrshire Locality Profiles). | 19

This will change the dependency ratio: i.e. the number of those The Health and Social Care Partnership is working with the deemed as dependents (people who are too young or too old to Community Planning Partnership and the Ayr North Locality work) compared to those of working age. Planning Group to produce an Area Place Plan for Ayr North. New strategies approved by the IJB will be designed to The dependency ratio will increase from 67 to 87 between address inequality and to target resources to where they are 2016 and 2039, compared with 55 to 67 for same time period needed most. The Adult Learning Disability and Mental Health across Scotland. This will require all governance groups, Strategies approved in 2017 with their emphasis on inclusion including the IJB, to reassess how resources are allocated and participation are examples of this approach. The IJB will across service areas. continue to support the Alcohol and Drugs Partnership’s approach of early intervention, prevention and recovery to support individuals, families and communities. Deprivation and Inequality 12,888 people, which is 11.5% of the South Ayrshire population live within the 15% most deprived data zones. 32% of South Ayrshire residents spend more than 10% of their household income on heating costs and are said to be in fuel poverty.

South Ayrshire has the 8th highest level of child poverty in Scotland. 26% of children live in poverty after housing costs compared to 23% across Scotland. The rate of alcohol related hospital stays (708.5 per 100,000) and drug related hospital stays (232.4 per 100,000) in South Ayrshire are both higher than the national rates (680.8 and 162.2 per 100,000 respectively).

There has been an increase in drug related deaths between 2015 and 2016 from 15 to 22. 20 |

Population health as delayed discharge to be reviewed and increased through either additional resources, efficiencies or through a shift in the • Premature mortality has increased in South balance of care. Ayrshire from 422 to 451 per 100,000 and is now higher than the national average Carers • The main causes of death in South Ayrshire are • There are around 11,709 carers in South Ayrshire. Cancer and Circulatory Disease This equates to 10.4% of the South Ayrshire • The proportion of adults in South Ayrshire population compared to 9.3% across Scotland considered to be obese over a rolling three- • Unpaid carers in South Ayrshire are less likely to year period for men was 74% and women 66% be employed than in the rest of Scotland and more compared to the Scottish percentage of 69% and likely to be aged 65 and over 61% respectively Health and Local Authority responsibilities to support Carers • The percentage of last 6 months spent at home or and Young Carers under the provisions of the Carers (Scotland) in a community setting was 85% in South Ayrshire Act, 2016 are being delegated to the IJB from 1st April, 2018. compared to 87% across Scotland A new Carers Strategy is in preparation and the IJB will • The rate of people with learning disability in South shortly be asked to approve local eligibility criteria and a short Ayrshire Council is 6.4 per 1,000 adults, higher than breaks statement and short breaks and respite policy for the national average of 5.2 South Ayrshire. • South Ayrshire has higher levels of depression at Adult and child protection 7.6 per 100 compared to 6.3 per 100 across Scotland • Prevalence rates for diagnosis of Dementia in South • Adult Protection referrals continue to rise annually Ayrshire are 1.03 per 100 which is higher than the • Child Protection referrals are slightly above the national rate of 0.8 per 100 Scottish average • 20% of the South Ayrshire population is prescribed Priorities in this planning period will include implementing the drugs for anxiety, depression and or psychosis recommendations of the review of the Chief Officers Group, compared to the national rate of 18% early intervention initiatives to identify those at risk of harm , The Integration Joint Board is supporting the delivery of a ensuring effective risk assessment and outcomes, and improved range of public health initiatives on tobacco, alcohol and on performance management and quality assurance procedures. weight. A strategy on End of Life Care will be produced in 2018-19 with the aim of ensuring more people are at home Children and young people when they die. Primary Care is at the heart of much of the work that will be required to address these issues and the new GP • There are higher mortality rates for still births, Contract, which will be implemented over this planning period, perinatal and neonatal in South Ayrshire than will be a cornerstone of this, as will be the new Primary Care across Scotland. Infant mortality rates are in line Improvement Plan. A Dementia Strategy for South Ayrshire is in with the national average preparation. A review of prescribing led by the Clinical Director is in progress in South Ayrshire. • The percentage of babies exclusively breastfed at the 6-8 week review is considerably below than the Balance of care: national rate at 21.8% in South Ayrshire compared to 30.3% across Scotland • The rate of Emergency Admissions to hospital is higher in South Ayrshire than across Scotland • The number of children Looked After in • The length of stay in hospital (bed day rates) is also South Ayrshire has increased , and is higher higher in South Ayrshire than comparator authorities, however there has been a significant shift in the proportion of those • Bed Day rates for delayed discharges are also higher looked after in the community as opposed to than the national average residential accommodation. The IJB is supporting the Pan-Ayrshire Unscheduled Care Transformation Programme and is pursuing a number of locally Prevention and Early Intervention, Corporate Parenting, based initiatives under this banner. The effectiveness of the Permanence Planning and Participation and Engagement current programme is being reviewed in 2018 and the outcome have been identified as the priorities by the Health and of this, together with any required changes, will be reported to Social Care Partnership the IJB. Demographic changes as detailed above will require the level of resource that is available to support areas such | 21

The“ number of children Looked After in South Ayrshire has increased, and is higher than comparator authorities, however there has been a significant shift in the proportion of those looked after in the community as opposed to residential accommodation. 22 |

Partnership arrangement and links to • NHS Ayrshire and Arran other strategic level plans Objectives from its Transformational Change Improvement Plan 2017-20: Working together to: Through this Strategic Plan the Integration Joint Board will work –– deliver transformational change in the provision of health with Community Planning Partners to deliver agreed policy and social care through dramatic improvement and use of priorities across service areas: e.g. for Children and Young innovative approaches People by means of the Children’s Services Plan for South Ayrshire, where priorities are to: –– protect and improve the health and wellbeing of the population and reduce inequalities, including through • Ensure South Ayrshire’s children get the best start advocacy, prevention and anticipatory care in life, that South Ayrshire is the best place to –– create compassionate partnerships between patients, grow up, and all children are successful learners, their families and those delivering health and care services confident individuals, responsible citizens and which respect individual needs and values; and result in effective contributors the people using our services having a positive experience of care to get the outcome they expect; • Reduce the gap in outcomes between the most deprived and least deprived children and young –– attract, develop, support and retain skilled, committed, people in South Ayrshire adaptable and healthy staff and ensure our workforce is affordable and sustainable; and • Ensure children and young people who are looked after or are care leavers are cared for and supported –– deliver better value through efficient and effective use of all resources to improve their life experiences and life chances; • Ensure young people are supported to achieve The IJB will work with its fellow Community Planning Partners and maintain good emotional and physical to deliver the priorities of the October, 2017 Local Outcomes wellbeing; and Improvement Plan to: • Ensure children and young people have a voice in • improve outcomes for looked after children and influencing service delivery that affects their lives care leavers • provide support for young people who are carers The IJB will work with the other statutory bodies – South Ayrshire Council and NHS Ayrshire and Arran to deliver their • reduce social isolation and loneliness; and priorities which are: • provide support for people living with dementia and their carers • South Ayrshire Council Strategic Objectives from its Programme for Effective Governance 2017-22: The IJB will work with the other two Integration Joint Boards in –– Take direct and sustained actions that reduce poverty Ayrshire to deliver lead partnership services. and disadvantage; to close the poverty attainment gap by 2030 and adopt the use of schools for community and local use, using these assets to build strong community networks, provide partnership based community services and complement learning and development opportunities for children and families in need –– Create a better health and care system to suit local people’s needs; to adopt, support and encourage an approach to aged health that is community based, early interventionist and prevention oriented that encourages participation to overcome social isolation. By 2030, the average healthy age of older men and women will increase by 2 years | 23

The“ IJB will work with its fellow Community Planning Partners to deliver the priorities of the October, 2017 Local Outcomes Improvement Plan to Provide support for people living with dementia and their carers. 24 |

Locality Planning and Local Priorities

In South Ayrshire six localities based around “natural communities” have been created in which local people and professionals working locally meet to discuss local needs, to prioritise these and to monitor progress in meeting those needs by the Health and Social Care Partnership and by others from across the sectors. | 25

The six localities are: Each Locality Planning Group is also responsible for making decisions on the utilisation of a Small Grants Budget which • Troon & Villages can be used to build capacity within local communities. • Prestwick & Villages Locality Planning Groups have been instrumental in organising successful Participatory Budgeting events across South • Ayr South and Coylton Ayrshire. These offer support to local voluntary groups to • Ayr North and Former Coalfield Communities provide activities and supports to the local people living in each area, which amongst other things, is designed to combat • Maybole and North Carrick Villages loneliness and isolation. Information on these local supports and • Girvan and South Carrick Villages activities is now available through a locally run website – South Ayrshire Life – which is provided and managed by Voluntary Action South Ayrshire (VASA), the Third Sector Interface. The purpose of locality planning is: It will be a priority of the Integration Joint Board in this planning • To jointly assess need, prioritise and plan how all period to work with Locality Planning Groups to further enhance resources, irrespective of their origin, can best be and develop local involvement in planning and decision making deployed in pursuit of the delivery of the National on the provision of local supports. It will be a particular priority and Local Outcomes; and to extend this engagement to Children and Young People and to jointly explore with them how this can best be achieved. • To be the local focus for service delivery and support by organisations from across the sectors to the population or communities within the area • Locality Planning Groups have been established in each locality. Each has set its agenda and priorities for the period ahead and these are set out at Appendix 2

Each“ Locality Planning Group is also responsible for making decisions on the utilisation of a Small Grants Budget which can be used to build capacity within local communities. 26 |

Partnership Programme

This section sets out the Integration Joint Board’s Vision Statement, Mission, Values and Strategic Objectives for the plan period.

The Measurable Tasks outlined in the Implementation Plan (see page 44) are designed to deliver progress and continuous improvement against the Strategic Objectives and National and Local Outcomes (see Appendix 3) by means of the IJB’s agreed Policy Priorities and Strategies as set out on the next page. | 27

Vision Values

‘Working together for the best possible health and wellbeing of The following are the values to which those employed or our communities.’ contracted by the Partnership, or who are stakeholders in it, will be expected to adhere to: Mission for Plan Period The IJB through the Health and Social Care Partnership will We will be: express its mission in this planning period through an approach rooted in the following principles: • Caring • Support and services will be co-produced – • Positive ‘doing with’ not ‘doing to’ • Respectful • Partnership with communities sharing all resources • Safe • People will be treated as equals and assets and • Supportive strengths built upon • People will have access to good information and We will demonstrate: advice pre-crisis points • Engagement • The system will be outcome focused, proportionate • Integrity and responsive

• Bureaucracy will be the minimum it needs to be. 28 |

Strategic objectives The multi-agency South Ayrshire Adult Protection Committee undertakes a strategic and monitoring function in relation to the The Integration Joint Board’s Strategic Objectives designed to implementation of the Adult Support and Protection (Scotland) deliver against National and Local Outcomes and against which Act 2007, locally. the Partnership will measure and report on progress in this regard are: The Child Protection Committee and Adult Protection • We will protect vulnerable children and adults Committee report to the Chief Officers Group (COG), which is comprised of the Chief Executive of South Ayrshire Council from harm (Chair), the Chief Executive of NHS Ayrshire and Arran, and the • We will work to provide the best start in life for Divisional Commander, Ayrshire Police, Police Scotland. The children in south Ayrshire Chief Social Work Officer is the lead officer for the COG, and under their direction carried out a review of the function and • We will improve outcomes for children who are arrangements of the group. The following recommendations looked after in South Ayrshire were agreed which will be taken forward by the Partnership: • We will reduce health inequalities • Inclusion of a Standing item on • We will shift the balance of care from acute Performance Management hospitals to community settings • Annual learning and development session in order • We will support people to exercise choice to consider COG joint self-evaluation and control in the achievement of their • That the Alcohol and Drugs Partnership present personal outcomes its annual report to the COG • We will manage resources effectively, making best use of our integrated capacity South Ayrshire Health and Social Care Partnership have responsibility for delivering Community Justice services within • We will give all of our stakeholders a voice. South Ayrshire. Community Justice Ayrshire was set up under Scottish Government legislation – The Community Justice The Board will seek to meet its Strategic Objectives through the (Scotland) Act 2016. It is a pan-Ayrshire partnership involving policy priorities it has adopted and which are set out below: partners in East, North and South Ayrshire and reports to three Ayrshire Community Planning Partnership Boards. The We will protect vulnerable children and aims of the partnership are set out in the Community Justice Outcomes Improvement Plan, Beginnings, Belonging, Belief – adults from harm A Community Justice Plan for South Ayrshire 2017-18 The Partnership will ensure that its work is in line with Within South Ayrshire we will work toward improving the Scotland’s National Action Plan for Human Rights is assessment of Domestic Abuse areas , Introduce Risk of (available here or search for SNAP Rights) and the United Service User Serious Harm Assessment , and implement Nations Convention on the Rights of the Child (available here revised guidance and training on chronologies. or search for UNCRC.

The Child Protection Committee is the key local body for developing and implementing child protection strategy in South Ayrshire. The Integration Joint Board will support the work of the South Ayrshire Child Protection Committee. | 29

We“ will support people to exercise choice and control in the achievement of their personal outcomes 30 |

We will work to provide the best start in The Universal Health Visiting Pathway in Scotland pre-birth to pre-school, sets out a core home visiting programme to be life for children in South Ayrshire offered to all families by Health Visitors as a minimum standard. It is based on the following underlying principles: The Children’s Services Plan 2017-20 (available here or search for South Ayrshire Children’s Plan) sets out the South Ayrshire Community Planning Partnership’s vision and • Promoting, supporting and safeguarding the priorities. The planning, funding and operational oversight of wellbeing of children Children’s Community Health and Social Care Services are • Person- centeredness delegated to the IJB under the terms of the South Ayrshire Integration Scheme. In 2016 the Care Inspectorate carried out • Building strong relationships from pregnancy an inspection of Joint Children’s Services within South Ayrshire, • Offering support during the early weeks ,and the recommendations from this have provided a focus in planning future contacts with families delivering against the priorities contained within the Children’s Services Plan. • Focusing on family strengths, while assessing and respectfully responding to their needs | 31

We will build on the significant progress we have made in We will reduce health inequalities embedding these principles though continuing to improve information sharing between health visitors and early years Inequalities in health outcomes are directly linked to wider centre staff, and specific initiatives including Childsmile which socio-economic inequalities in society. The wider environments promotes dental registration, and smoking cessation services. in which people live ultimately shape their individual experiences and are more likely to result in people living in poor housing, South Ayrshire Getting it Right For Every Child (GIRFEC) group encountering poor access to health care, living on a low income have identified a number of key actions which will be taken and being unemployed or undertaking low paid work. This forward on a multi-agency basis around Named Person Service, ultimately results in unequal outcomes in health, illness and Lead Professional and Team around the Child. death across the population.

The IJB will support young carers through its new Carers Despite overall improvements in population health and Strategy. It has produced and consulted on a young mortality rates, health inequalities have persisted in South carers statement. Ayrshire and whilst South Ayrshire, overall, is considered to be a relatively wealthy community, there are areas of significant poverty and deprivation. We will improve outcomes for children Efforts to tackle inequalities will be reflected in everything the who are looked after in South Ayrshire Partnership does – from population public health to community Every child is unique, each with their own personality, needs, based care and more specialist services. The IJB’s policy focus experience and aspirations. Looked After Children are clearly in this area is on Early Intervention. no different – the main thing our Looked After Children have in common with each other is that even at young age, life has not The Integration Joint Board will work through the South Ayrshire been easy for them and many will have experienced some form Alcohol and Drugs Partnership and support it through its of trauma in their lives that impacts on their development. Strategic Commissioning and Delivery Plan to achieve its Vision that “The population of South Ayrshire are able to build on their A child may become Looked After for a number of reasons: strengths to reduce alcohol and drug misuse to the benefit of including neglect, abuse, complex disabilities which require individuals, families and communities.” additional supports and for some there will be needs of a specialist care nature. South Ayrshire Looked After Children’s The Partnership will take steps to ensure that its services Strategy 2013-18 has identified the following priorities: are distributed fairly and in proportion to need across its geographical communities and population groups. The • Early Intervention Partnership will improve the experience of individuals by exercising non-discriminatory practice on the grounds of • Achieving Permanence protected characteristics. The Integration Joint Board has • Balance of Care approved Equalities Outcomes for the period 2017-21 with a focus on 4 outcomes (available here or search for South • Children affected by a disability Ayrshire Joint Equality Outcomes). • Raising Achievement and attainment • Contract and Commissioning

In partnership with the Centre for Excellence for Looked After Children in Scotland (CELCIS) a mapping exercise was undertaken to develop a full understanding of the permanence system. This identified both strengths in current practice and areas for improvement, which are being taken forward through “ an improvement project, in particular to implement revised Every child is unique, each Permanency Planning protocols. with their own personality, South Ayrshire Corporate Parenting Plan 2017-20 (available here or search for South Ayrshire Corporate Parenting Plan) needs, experience and has been developed in partnership with all corporate parents in South Ayrshire. The focus of the plan demonstrates how as aspirations. Looked After Corporate Parents we intend to raise the expectations on care Children are clearly no different. experienced children and young people in South Ayrshire to achieve their potential. 32 |

The Integration Joint Board will resource and support the The South Ayrshire Integration Joint Board is committed implementation of the Pan Ayrshire and Arran Sensory Locality to the delivery of a Pan-Ayrshire devised Programme of Plan which has been developed to implement the Scottish Transformational Change in the way that Health and Social Care Government Sensory Impairment Strategy “See Hear” is delivered and it will do this locally through a focus on: published in 2014. • Building community capacity and opportunities New strategies approved by the IJB will be designed to for participation address inequality and to target resources to where they are • Flexible and responsive care at home needed most. • The prevention of falls and fractures The IJB will work with the Community Planning Partnership • Anticipatory Care Planning and Anticipatory and the Locality Planning Groups to develop Local Place Plans Care Plans for two of its localities where deprivation is most prevalent – Ayr North and Girvan. This will include giving consideration to • The provision of suitable housing for people outline plans to build a Health and Social Care Centre in Ayr of all ages North which will offer a full range of community and primary • The provision of a range of intermediate care health and social care services and services provided by the 3rd and Independent Sectors. alternatives to hospital admission • Access to Telehealthcare We will shift the balance of care from • The early diagnosis of dementia acute hospitals to community settings • Carer support and respite • Rapid access to equipment and access to aids The prevention of ill health and early intervention through effective and accessible community and primary health and and adaptations care services is a priority for the Integration Joint Board and • Responsive and flexible palliative care; and will be a cornerstone of its programme to shift the balance of care from acute hospital to the community and people’s homes. • The innovative recommissioning of services “Home First” will be the adopted philosophy as the HSCP The recently approved contract between the NHS in Scotland seeks to promote personal independence. for GPs, which will be implemented over the period 2018-21, will lead to a fundamental change in the way that Primary Care As a consequence of current funding constraints social care Services are provided. In South Ayrshire this will be taken services will be provided on a targeted basis by means of forward as part of the established agenda for Primary Care an assessment process which will see statutory services under the banner of “Ambitions for Ayrshire” led by the East being provided to those with “critical” or “substantial” needs. Ayrshire HSCP on behalf of the three Ayrshire Health and People with needs that do not fall into these categories will Social Care Partnerships. This will see a greater emphasis on be signposted to community based services provided by the 3rd Sector. This will be done by means of the Community Led Support programme and in some cases by utilising “South Ayrshire Life” (available here or search for South Ayrshire Life). | 33

the GP as an expert medical generalist supported by a multi- The Integration Joint Board shares the aspirations identified in disciplinary team of other professionals, including nurses, the 2016 National Clinical Strategy for Scotland. This indicates allied health professionals, pharmacists, and social workers. a change in focus for the NHS away from hospitals to primary This new and exciting agenda will be set out in a Primary Care care and the corresponding need to strengthen local multi- Improvement Plan which will be developed by the HSCP and its disciplinary primary care teams and to ensure that these are partners across Ayrshire and will be approved by the Integration better integrated with services provided by social care and the Joint Board. Third Sector. In other words, most of the care people need will be provided in local communities and they will be admitted to The IJB will take steps to reduce the number of delayed hospital only when absolutely necessary. An objective of the discharges at University Hospital Ayr by working through Strategy is to review the range of specialties hospitals provide primary and community care services to minimise the numbers by considering the provision of some complex and many of people requiring care in an acute setting and to put in less complex operations in specialist hospitals. This means place community based alternative provision. The HSCP will planning specialist hospital services on a regional basis and work with colleagues in the acute hospital sector to minimise in South Ayrshire, where this is appropriate, through West of the number of unscheduled patients being admitted. The IJB Scotland Regional Planning arrangements. The IJB will work to through the HSCP will also continue to redesign, modernise establish efficient and effective regional service commissioning and improve homecare and community nursing provision in arrangements for the people of South Ayrshire and will consider, South Ayrshire in a way that supports rapid discharge for specifically, how people in rural areas will access these services. people who are medically fit to go home. This will include the further development of the three community based service hubs The Integration Joint Board is working locally with partners to for health and social care services and the development of a give practical effect to the recommendations contained in a single point of contact. report by the Chief Medical Officer on “Realistic Medicine” which it says should be based around: The move towards the greater utilisation of technology in the provision of care (Technology Enabled Care) is an integral • Shared decision-making part of the Integration Joint Board’s approach to care planning • A personalised approach to care and will, for example, in some cases, be used to replace one to one sleepover services where these have been assessed by • Reducing harm and waste providers, carers and social workers as no longer being required • Reducing unnecessary variation in practice and will be replaced by a responder service. The Health and and outcomes Social Care Partnership will also take positive steps to deliver on TEC by expanding home health monitoring, expanding the • Managing risk more effectively, and use of video conferencing, expanding the take-up of Telecare • Encouraging improvement and innovation and by actively promoting the new National Digital Strategy. across the system.

The“ HSCP will work with colleagues in the acute hospital sector to minimise the number of unscheduled patients being admitted 34 |

From 1st April, 2018 the Integration Joint Board will oversee the We will support people to exercise choice implementation of the provisions of the new Carers (Scotland) Act 2016 in South Ayrshire. This is designed to support and control in the achievement of their carers’ health and wellbeing and includes a duty to provide support to carers based on their identified needs. The IJB has personal outcomes approved and published local eligibility criteria and an Adult The IJB believes that individuals being supported through Carer Support Plan and Young Carer Statement to identify the Social Care system should expect to be able to exercise carers’ needs and personal outcomes. The IJB will provide choice and control in the way that their support is provided an information and advice service for carers. The IJB will also and arranged. The main vehicle for this will be by means of its provide information on the short breaks that are available in line Self-Directed Support (SDS) policy. This will see all individuals with its eligibility criteria. assessed as requiring support being provided with four options for the provision of that support – a direct payment, an individual A new Carers Strategy for South Ayrshire will be approved and service fund, partnership arranged and contracted services published by the IJB in 2018-19. and/or a mixture of all three of these. The IJB is committed through recently approved strategy documents to the active The IJB will develop a local strategy to give effect to the promotion of choice and control and its new Commissioning Scottish Government’s Strategic Framework for Action on Plans for Third and Independent Sector provided services Palliative and End of Life Care (2016-2021). In this the IJB, seek the co-operation of provider organisations, appointed, through the Health and Social Care Partnership and with other to this approach and to work with it to increase flexibility in Partners from across the sectors, will take steps to ensure that: a way that better meets people’s outcomes through improved innovation. To this end it has commissioned a review of • Access to palliative and end of life care is available its current operation of its current SDS policy and it will to all who can benefit from it, regardless of age, implement the recommendations from this during this three- gender, diagnosis, social group or location; year planning period. • People, their families and carers have timely and focussed conversations with appropriately skilled The Health and Social Care Partnership is also investing heavily in building capacity within the communities of South Ayrshire as professionals to plan their care and support towards a way of helping people to meet their personal outcomes locally. the end of life, and to ensure this accords with their needs and preferences; and It is doing this through its Locality Planning Groups and also • Communities, groups and organisations of many through the work that they have all undertaken to support local organisations and community based activities by means of the kinds understand the importance of good palliative funds that have been distributed through Participatory Budgeting. and end of life care to the well-being of society. The Partnership will continue to support the 3rd Sector Interface Organisation, VASA, and a number of local third sector organisations to deliver a range of activities within communities designed to improve health, wellbeing and to combat loneliness and social isolation. The Partnership will continue to support the on-going development of South Ayrshire Life. | 35

The Partnership will seek to change the way that social work This approach will ensure that Partners, their staff and and social care services are provided through its Community volunteers are all working in a collegiate manner towards Led Support programme. This will take services closer to the attainment of National Outcomes and in pursuit of communities and will seek to utilise the skills and support Integration Principles. available through community based voluntary services, where access to statutory services is not required and where a The Partnership’s Transformation, Organisational Development preventative based approach would be more beneficial. and Training Plans will support managers and staff to undertake their roles in new and different ways. The Partnership will also The HSCP will seek to engage young people more fully in its put in place a Workforce Plan during this planning period. work during this planning period. It will seek to work with the South Ayrshire Youth Forum to jointly develop proposals in The Integration Joint Board will be an important advocate of this regard. integrated working within the broader Community Planning Partnership in order to deliver, for example, the vision and objectives of the Integrated Children’s Services Plan. We will manage resources effectively, making best use of our integrated capacity The Integration Joint Board is continuing to integrate health and social care services in a way that is joined up at the point of contact for patients and service users. It is doing this by The“ Partnership will take steps organising primary and community services around clusters of GP practices and, in conjunction with Locality Planning to further integrate staff Groups, will seek to develop service models across the sectors that meet the needs and priorities of local people, within the employed in the delivery of resources that are available. health and social care services, The Partnership will take steps to further integrate staff employed in the delivery of health and social care services, thus ensuring a seamless thus ensuring a seamless approach to provision. In developing approach to provision. this way of working the Partnership will seek to extend integration beyond those working within the public sector to include personnel from the Third and Independent Sectors. 36 |

We will give all of our stakeholders a voice. The Integration Joint Board is committed to the participation and engagement of all of its stakeholders in its work and to this end it has published a Participation and Engagement Strategy (available here or search for South Ayrshire Health Participation Strategy) which outlines how it will involve partners across South Ayrshire to develop services that meet the needs and improve outcomes for communities. It has agreed to adopt the National Standards for Community Engagement as part of its approach to participation and engagement.

The Partnership will also seek to communicate clearly with its stakeholders and it has produced a Communications Strategy and Plan (available here or search for South Ayrshire Health Communications Strategy). Good communication supports the planning, delivery and transformation of services, promotes effective professional practice and helps increase stakeholder satisfaction.

The Strategic Planning Advisory Group is the Integration Joint Board’s principal stakeholder group on which representatives from communities, professions and organisations from the different sectors sit, along with staff representatives and the Partnership Management Team. The SPAG reviews policy proposals before they are agreed by the IJB and advises on the contents of the Strategic Plan.

Local communities and local professionals have a voice in the development of policy priorities and in reviewing the effectiveness of initiatives and services on the ground through their involvement in Locality Planning Groups.

Looked after young people have a voice through the work of the Champions Board and the IJB will takes steps to further strengthen and develop this during this planning period.

Third and Independent Sector organisations are engaged through a range of Providers Forums in areas such as Older People, Learning Disability and Mental Health. In this planning period a Providers Forum will be established with organisations that provide services to looked after and vulnerable children and young people in South Ayrshire.

In 2018-19 Stakeholder Forums will be established with service users and carers in two key service areas – Mental Health and Learning Disability. The purpose of these will be to oversee and advise on strategy implementation, advise on the implementation of commissioning plans, consider future service developments and raise matters of concern. | 37

The“ Integration Joint Board is committed to the participation and engagement of all of its stakeholders in its work and to this end it has published a Participation and Engagement Strategy which outlines how it will involve partners across South Ayrshire to develop services that meet the needs and improve outcomes for communities. 38 |

Resource Overview

need neip eene de elegated nctions

The“ three year planning £22,062,000 £53,497,000

period 2018-21 will be £21,461,000 extremely challenging Other Services for the Integration Joint £22,052,000 Board as it seeks to balance South Ayrshire IJB Funding for Acute Hospitals £40,586,000 increasing demand against £25,050,000 Lead Partnership Services

diminishing resources £27,018,000 brought about nationally. Other Services Children's Health and Care and Justice South Ayrshire IJB Funding for Acute Hospitals Lead Partnership Services Children's Health and Care and Justice Mental Health/Learning Disability and Addiction Services Mental Health/Learning Disability and Addiction Services Primary Care Community Health and Care Primary Care

Community Health and Care | 39

Financial resources Staff resources Total available funding in 2018-19 will be £211,726,000 A summary of the staffing resources within the scope of the and over the Plan period, on this basis, is estimated at Partnership is provided in the table below. £635,178,000. However, actual funding in years 2 and 3 will be dependent on annual budget settlements. The Strategic Staff Numbers Plan will be updated on an annual basis to include the revised Service Area in Full Time amounts. As functions, strategies and services are reviewed Equivalents (FTE’s) and integrated, it is likely that the current pattern of spend will change as the IJB seeks to shift the balance of care Social Work & Social Care Staff 763.61 from institutional to community settings. The total figures Directorate 8 shown include the cost of those Acute Hospital Services which are within the scope of the Partnership for Strategic Health Care & Support Staff 931 Planning purposes. Total 1702.61 The Integration Joint Board will develop an indicative ten year financial plan using the information set out in the Strategic The Integration Joint Board will approve a Workforce Strategy Needs Assessment and Area Profile. for the service areas within the scope of the Partnership during this planning period. The three year planning period 2018-21 will be extremely challenging for the Integration Joint Board as it seeks to balance increasing demand against diminishing resources brought about by national financial context. All figures are indicative and subject to future changes in terms of the need for further savings and changes to funding allocations. 40 |

New ways of working, transformational accommodation for older people. A Housing Contribution Statement creating a link between this Strategic Plan and those change and organisational development of the Local Housing Strategy is set out at Appendix 4. The Integration Joint Board is overseeing a programme of new ways of working that will see all activity areas, strategies, policies and operational procedures reviewed and appraised. Commissioning of services from the third Through this process, decisions will be made on how resources and independent sectors will be deployed in future years. This work will be informed, in part, by the information detailed in the Strategic Needs Over one third of the IJB Integrated Budget is spent on the Assessment and Area Profile. commissioning and procurement of work from Third and Independent Sector providers to support service users in The Partnership is committed to the use of Self Evaluation South Ayrshire with health and social care needs. The HSCP to assess how it is performing, examining where there are has established Providers Forums and will use these to particular strengths to be built upon and where there is scope collaboratively plan and review services and service areas with for improvement. This approach will form one of the key pillars in commissioned providers. Work has started to recommission the drive for continuous improvement and Best Value along with social care contracts, many of which require to be updated its service review process which will see a number of service to provide new and innovative ways of meeting service user areas reviewed in this planning period. outcomes while at the same time, providing a correct balance with the need for the IJB and South Ayrshire Council to demonstrate Best Value in service provision. All contracts Information resources requiring to be updated in this way will be replaced and renewed during this strategic planning period. An Information Sharing Protocol for the Partnership has been agreed by the Council, Health Board and the Integration Joint Board. The Social Work Information System (SWIS) is being Equalities Impact Assessment replaced and this work will be completed during this planning period, as will the introduction of a work scheduling system An Equalities Impact Assessment of this Plan is available on and call monitoring system for the Care at Home Service. The the Partnership’s website (available here or search for South Director and the Senior Management Team working with the Ayrshire Strategic Plan). e-Health Team will seek to identify opportunities for improved information sharing and service user/patient access to information that will aid and support effective frontline service Performance management delivery. As a business improvement activity, this will be critical Reporting against the Partnership’s Performance Framework success factor for the Partnership. will provide information on current performance and explore shifts in performance trends over time. Performance information is (available here or search for South Ayrshire Property and housing resources Health Performance). Work is on-going to review the location, suitability, condition and operational effectiveness of the combined health and property estate currently used to deliver delegated services. Risk management This information will be used to develop a Property Asset Strategic level risks which, if not mitigated, would impact Management Plan for the Partnership which will have as one adversely on the implementation of this Strategic Plan of its objectives the development of an efficient and effective are reflected in the IJBs Strategic Risk Register which is property estate designed to support operational frontline (available here or search for South Ayrshire Health Strategic service delivery. This will have as one of its core objectives to Risk Register). deliver the South Ayrshire Council proposal to put schools at the hearty of communities and to see the provision of required suitable service access points in deprived areas with an initial focus being on Ayr North. Clinical and care governance The Integration Joint Board has put in place structures and Working jointly with South Ayrshire Council, the Integration processes to support clinical and care governance, thus Joint Board will seek to meet the strategic housing needs of the providing assurance on the quality of health and social care people it supports across a range of functional areas, including services that have been delegated to it by South Ayrshire Learning Disability, Mental Health, Young Care Leavers and Council and the NHS Ayrshire and Arran Board. Further Older People. Through the Strategic Housing Investment information is (available here or search for South Ayrshire Plan (SHIP), it will seek the resources necessary to build Clinical Governance). or acquire additional housing units in the form of supported accommodation, core and cluster developments and specialist | 41

An“ Equalities Impact Assessment of this Plan is available on the Partnership’s website. 42 |

Strategic plan review

This Strategic Plan has been written for the period 2018–21. It will be refreshed and rolled-on each year. It will be completely rewritten every three years and a new plan will, therefore, be prepared for the period 2021-24. | 43

Glossary

ADP Alcohol and Drugs Partnership

APC Adult Protection Committee

CLS Community Led Support

COG Chief Officers Group

CPC Child Protection Committee

EQIA Equalities Impact Assessment

GP General Practitioner

Healthy and Active Rehabilitation HARP Programme

HSCP Health and Social Care Partnership

IJB Integration Joint Board

LHS Local Housing Strategy

SG Scottish Government

SHIP Strategic Housing Investment Plan

SPAG Strategic Planning Advisory Group

SWIS Social Work Information System

TEC Technology Enabled Care

VASA Voluntary Action South Ayrshire 44 |

Implementation plan

Strategic objective:

Objective Action Responsible Officer Target National Number Date(s) Outcomes Delivered Appendix 3 1 Implementation of the Health Visitor’s Pathway and Head of Children‘s 31.03.19 k identification of outcomes. Health, Care and With 6 monthly Criminal Justice. progress updates. 2 Implementation of the High Risk Pregnancy Protocol Head of Children’s 31.03.19 k, l which will support Health Visitors and Social Health, Care and With 6 monthly Workers to be involved with families at an earlier Criminal Justice. progress updates. stage and provide pre and post pregnancy help when required. 3 Work with partners on the CPC to develop robust Head of Children’s 31.03.19 g, l, m systems for providing routine performance and Health, Care and With 6 monthly impact information on child protection. Criminal Justice. progress updates. 4 Continued development of GIRFEC Practice and Head of Children’s 31.03.19 j, k, l Principles through activity in line with South Ayrshire Health, Care and With 6 monthly Children’s Services Planning Group priorities. Criminal Justice. progress updates. 5 Continue to develop the capacity and talents of care Head of Children’s 31.03.19 c, j, l experienced young people, and raise awareness of Health, Care and With 6 monthly Corporate Parenting through the Champions Board. Criminal Justice. progress updates. 6 Continue to improve outcomes for Looked After Head of Children‘s 31.03.19 j, l children, through a range of interventions working in Health, Care and With 6 monthly partnership with Health and Education. Criminal Justice. progress updates. 7 Implement the recommendations of the CELCIS Head of Children’s 31.03.19 k, l report on Permanency Planning to improve Health, Care and With 6 monthly processes and practice. Criminal Justice progress updates. 8 Implement the IJB Adult Learning Disability Strategy Head of Community 31.03.23 a, b, c, d, e, i for 2017-23 and associated Commissioning Plan Care & Health With 6 monthly designed to deliver four Strategic Outcomes: progress updates. (1) A Healthy Life; (2) Choice and Control; (3) Independence; and (4) Active Citizenship. 9 Implement the ADP Alcohol and Drug Strategic Head of Community 31.03.21 a, b, c, d, e, g, m, Plan 2018-21. Health and Care With 6 monthly progress updates. 10 Implement the IJB Community Adult Mental Health Head of Community 31.03.22 a, b, c, d, e, g, i Strategy for 2017-22 and associated Commissioning Care and Health With 6 monthly Plan designed to deliver seven Strategic Outcomes: progress updates. (1) Flexible, tailored and Co-ordinated Approaches; (2) Prevention; (3) Recovery; (4) Addressing Social Stigma; Choice and Control; (6) Safety; and (7) Carers Needs. | 45

Strategic objective:

Objective Action Responsible Officer Target National Number Date(s) Outcomes Delivered Appendix 3 11 Implement the Pan Ayrshire and Arran Sensory Head of Community 31.03.21 a, b, c, d, e, i, j Locality Plan. Care and Health With 6 monthly progress updates. 12 Develop a South Ayrshire Dementia Strategy Head of Community 30.09.18 a, b, c, d, e and Implementation Plan and seek IJB approval. Care and Health With 6 monthly Following this, implement strategy and report on progress updates. progress six monthly to IJB Performance and Audit Committee. 13 Develop a Palliative and End of Life Care Strategy Director of Health 31.03.19 a, b, c, d, e, g, and Implementation Plan for South Ayrshire and seek and Social Care With 6 monthly IJB approval. Following this, implement strategy and progress updates. report on progress six monthly to IJB Performance and Audit Committee. 14 Develop a Carers and Young Carers Strategy and Director of Health 30.10.18 f, j Implementation Plan for South Ayrshire and seek and Social Care With 6 monthly IJB approval. Following this, implement strategy and progress updates. report on progress six monthly to IJB Performance and Audit Committee. 15 Develop a South Ayrshire Older People’s Strategy Director of Health 31.10.18 a, b, c, d, e, g, and Implementation Plan and seek IJB approval. and Social Care With 6 monthly Following this, implement strategy and report on progress updates. progress six monthly to IJB Performance and Audit Committee. 16 Develop and implement with Partners, a Primary Clinical Director 01.07.18 a, b, c, d, e Care Improvement Plan for South Ayrshire. With 6 monthly progress updates. 17 Implement a transformational strategy designed to Director of Health 30.09.18 a, b, c, d, e, g, i minimise unscheduled hospital admissions, reduce and Social Care With 6 monthly delayed discharges and transform care at home progress updates. services with the ultimate aim of shifting the balance of care. 18 Develop and implement a new TEC strategy for Director of Health 31.03.19 b, c, d, f, g the planning period based on the new National and Social Care With 6 monthly Digital Strategy. progress updates. 19 Put in place arrangement to commission regionally Director of Health 31.03.19 a, e, i provided acute hospital services as appropriate for and Social Care With 6 monthly the people of South Ayrshire. progress updates. 20 Review prescribing arrangement generally in South Clinical Director 31.03.20 a, b, c, d, e Ayrshire and specifically consider the development With 6 monthly of alternatives to anti-depressant prescribing and progress updates. implement through an agreed action plan. 21 Consider the findings of the “In Control” Review Director of Health 30.09.18 b, c, d, g of the Implementation of SDS in South Ayrshire and Social Care With 6 monthly and produce a plan to take forward agreed progress updates. recommendations and implement. 46 |

Strategic objective:

Objective Action Responsible Officer Target National Number Date(s) Outcomes Delivered Appendix 3 22 The HSCP will continue to implement its Community Head of Community 31.03.19 a, b, c, d, e Led Support Programme which will see more people Health and Care With 6 monthly receive the correct level of support that they need progress updates. close to their homes. 23 The IJB will seek to engage more with young people Head of Children’s 31.03.19 c, j across South Ayrshire and to involve them in its Health and Care With 6 monthly work. Services progress updates. 24 The HSCP will develop a Workforce Plan and Director of Health 31.03.19 h, i implement agreed action items. and Social Care With 6 monthly progress updates. 25 The HSCP will produce updated Organisational Director of Health 30.09.18 h, i Development and Training Plans and implement and Social Care With 6 monthly these. progress updates. 26 The HSCP will implement the agreed Participation Director of Health 01.04.18 c, d, e, f, g, h, i, l and Engagement and Communication Strategies and Social Care With 6 monthly agreed by the IJB. progress updates. 27 The Integration Joint Board will develop an indicative Director of Health 31.03.19 i ten year financial plan using the information set out in and Social Care With 6 monthly the Strategic Needs Assessment and Area Profile. progress updates. 28 The HSCP will implement a programme of self- Director of Health 31.03.19 h, i evaluation across all of its service areas based on and Social Care With 6 monthly the EFQM model. progress updates. 29 The IJB Performance and Audit Committee will Director of Health Annually h, i agree an annual programme of Best Value Service and Social Care With 6 monthly reviews. progress updates. 30 The HSCP will develop and implement a Property Director of Health 31.03.19 i Asset Management Plan. and Social Care With 6 monthly progress updates. 31 The IJB and South Ayrshire Council and their Director of Health 31.03.21 a, b, c, d, e, g, i partners will work to deliver the proposals set out in and Social Care With 6 monthly the Housing Contribution Statement at Appendix 4. progress updates.

Strategic Plan Needs Assessment

December 2017

Table of Contents

1.1 Area and Population ...... 6 1.1 Area ...... 6 1.2 Population Estimates ...... 6 1.3 Ethnic Minorities ...... 8 1.4 Population Density ...... 8 1.5 Overall Births and Deaths ...... 8 1.6 Migration ...... 9 1.7 Population Projections ...... 9 1.8 Centenarians in South Ayrshire ...... 12 2. Households and Dwellings ...... 14 2.1 Dwellings ...... 14 2.2 Dwelling by Type ...... 14 2.3 Household Tenure ...... 15 2.4 Households in South Ayrshire ...... 15 2.5 Household Type ...... 16 2.6 Household Projections ...... 17 2.7 Single Person Households ...... 17 2.8 Lone Parent Households ...... 18 2.9 Homelessness...... 18 2.10 Temporary Accommodation ...... 19 3. Deprivation in South Ayrshire ...... 21 3.1 Scottish Index of Multiple Deprivation (SIMD) ...... 21 3.2 Income Deprivation ...... 25 3.3 Employment Deprivation ...... 29 3.4 Geographic Access to Services ...... 33 3.5 Disabled Employment ...... 35 3.6 Lone Parent Employment ...... 35 3.7 Child Poverty ...... 35 3.8 Fuel Poverty ...... 36 4. General Population Health ...... 39 4.1 Life Expectancy and Healthy Life Expectancy ...... 39 4.2 General Health ...... 41

4.3 Long Term Conditions ...... 42 4.4 Mortality ...... 44 4.5 Smoking ...... 47 4.6 Obese Adults ...... 47 4.7 Physical Activity ...... 47 4.8 Palliative Care /End of Life ...... 48 5. Specific Health Conditions ...... 50 5.1 Learning Disabilities ...... 50 5.2 Mental Health ...... 52 5.3 Dementia ...... 55 5.4 Suicide Rates ...... 56 5.5 Risk Taking Behaviour ...... 56 5.5.1 Alcohol ...... 56 5.5.2 Drugs ...... 57 6. Unscheduled Care ...... 60 6.1 Accident and Emergency ...... 60 6.2 Inpatient Admission following Accident and Emergency Attendance ...... 62 6.3 Delayed discharges ...... 65 7. Community Services ...... 67 7.1 Carers in South Ayrshire...... 67 7.2 Care Homes ...... 68 7.2.1 Care Home Projections ...... 70 7.3 Home Care ...... 70 7.3.2 Care at Home Projections ...... 71 7.4 Adult Protection ...... 71 8. Children and Young People ...... 74 8.1 Mortality ...... 74 8.2 Maternity – Breastfeeding ...... 75 8.2 Maternal Smoking at Antenatal Booking ...... 76 8.3 Low Birth Weight ...... 76 8.4 Fertility ...... 77 8.5 Teenage Pregnancy ...... 78 8.6 Child Protection ...... 79 8.7 Looked After Children ...... 81

8.8 Child Health ...... 82 8.8.1 Developmental Milestones ...... 82 8.8.2 Dental Decay ...... 83 8.8.3 Healthy weight ...... 83 8.8.4 Children at Risk of Obesity ...... 84 9. Criminal Justice ...... 85 9.1 Crime ...... 85 9.2 Domestic Abuse ...... 86 9.3 Fires ...... 87 9.4 Violent Crime ...... 87 9.5 Road Safety ...... 88 9.6 Prison Statistics ...... 89 9.7 Community Safety ...... 89

1. DEMOGRAPHIC OVERVIEW

1.4% 112,470 ETHNIC MINORITY

South Ayrshire 48% 52% POPULATION Population 2016 Scotland = 4.1% 2011 Gender Split 2016

DEPENDENCY RATIO Age Structure 100% 24% 18% 2016 2039 80% 60% 60% 65% 67 -South 87 –South 40% Ayrshire Ayrshire 20% 16% 17% 55 - Scotland 67- Scotland 0% South Ayrshire Scotland Aged 0-15 Aged 16-64 Aged 65+

Population Projections (2014-Based) South Ayrshire has the highest Projected Change 2014 - 2039 proportion of people aged over 100% 100 in Scotland. 82% 85% 80% By 2025 the older age groups 60% will increase by the following:-

40% 28% 21% 35% + aged 75-79 20% 7% 1% 1% 0% 25% + aged 80-84 -2% -7% -20% -11% 34% + aged 85-90

38% + aged 90 plus

South Ayrshire Scotland

1.1 Area and Population

1.1 Area

South Ayrshire is set in the south west of Scotland. A large rural area of 472 square miles (1,222 square km) extends from Troon and Symington in the north to Ballantrae and Loch Ryan in the south.

Approximately 70% of the population live in the towns of Troon, Prestwick and Ayr. The rest of the population live in Maybole and Girvan and rural Kyle and Carrick.

1.2 Population Estimates

In 2016, the population of South Ayrshire is estimated to be 112,470, accounting for 2.1% of Scotland's total population. The population increased by 70 between 2015 and 2016.

Figure 1: South Ayrshire Total Population

113,500 113,000 112,500 112,000 111,500 111,000 110,500 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

The population is made up of 52% female and 48% male. The percentages of the population under the age of 16 years and of working age are both below average. The percentage aged 65+ is above the Scottish average.

Figure 2: Age Structure 2016

100% 18% 24% 80% 60% 65% 40% 60%

Percentage 20% 16% 17% 0% South Ayrshire Scotland

Aged 0 - 15 Aged 16 - 64 Aged 65+

The dependency ratio (children and older people aged 65 and over expressed as a percentage of people aged 16-64) is 67% in South Ayrshire compared with 55% in

Scotland. By 2039 this will increase to 87% in South Ayrshire compared to 67% across Scotland.

Figure 3 below shows the population of each of the localities within South Ayrshire. The largest locality is Ayr South & Coylton with 31,272 people, which is 28% of the South Ayrshire population. The next largest are Prestwick, with 22,010 people and Ayr North and Former Coalfield Communities, with 20,188. The two smallest are quite considerably smaller – Girvan and South Carrick Villages has 9,504 and Maybole and North Carrick Villages has 9,347 residents (8.5% and 8.3% of the South Ayrshire population respectively).

Figure 3: Population by Locality, 2015

Locality Total Population Ayr North & Former Coalfield Communities 21,170 Ayr South & Coytlon 30,454 Girvan & South Carrick Villages 9,504 Maybole & North Carrick Villages 10,697 Prestwick 22,028 Troon 18,547 Total 112,400

Figure 4 outlines the relative sizes of the population in the Ayrshire Health and Social Care Partnerships. It shows that the South Ayrshire population is relatively older than the population in North or East Ayrshire.

Figure 4: Estimated population by local authority and age group, 2016

0 0-15 16-29 30-49 50-64 65-74 75+

South Ayrshire North Ayrshire East Ayrshire

1.3 Ethnic Minorities

South Ayrshire has a relatively small ethnic minority community (1.4% of the population compared with 4.1% for Scotland).

1.4 Population Density

With a population of 112,470, South Ayrshire is in the mid-range of Scottish local authorities in terms of population and area size. However, South Ayrshire's population density of 92 persons per square kilometre is lower than neighbouring North and East Ayrshire areas reflecting the rural nature of the area.

1.5 Overall Births and Deaths

The number of births in South Ayrshire in 2016 was 976, 5.2% lower than was experienced in 2015 (1,030). The number of births in Scotland fell by 1.2% between 2015 and 2016.

Figure 5: Births in South Ayrshire and Scotland, 2015 and 2016

Births 2015 Births 2016

Male Female Male Female % change in total no. of births 2015-16 South Ayrshire 509 521 502 474 -5.2% Scotland 28,355 26,741 28,219 26,239 -1.2%

The number of deaths in South Ayrshire decreased from 1,498 in 2015 to 1,446 in 2016. Over the period 2014 to 2016 the overall death rate in South Ayrshire was slightly lower for males than for females. Compared to Scotland over the period 2014 to 2016, South Ayrshire had a higher death rate.

Figure 6: Deaths and age specific death rates by age group, the combined years 2014-2016

Age Age specific death rate per 1,000 Age specific death rate per 1,000 group people, South Ayrshire people, Scotland Male Female All Persons Male Female All Persons 0 1.9 4.1 3.0 3.5 3.2 3.4 1-14 0.1 0.1 0.1 0.1 0.1 0.1 15-29 0.7 0.5 0.6 0.6 0.3 0.5 30-44 2.7 1.6 2.1 2.0 1.1 1.5 45-64 5.9 4.3 5.0 6.6 4.3 5.4 65+ 46.3 45.4 45.8 48.4 45.3 46.7 All ages 12.7 13.1 12.9 10.5 10.4 10.5

1.6 Migration

On average over the three year period 2013-15, there was a net inflow of 273 people into South Ayrshire per year, meaning that more people entered South Ayrshire (3,635 per year) than left (3,362 per year). The 16 to 29 year olds age group accounted for the largest group of in-migrants into South Ayrshire. The largest group of out-migrants was also the 16-29 year olds.

Figure 7: Average migration in and out of South Ayrshire, 2013-15

Age Group In Out Net 0-15 610 477 133 16-29 1,028 1,287 -259 30-44 848 748 100 45-64 759 567 192 65+ 389 279 110 All ages 3,635 3,362 273

1.7 Population Projections

By 2039, the South Ayrshire population is projected to be 110,104, a decrease of 2% compared to the population in 2014. The population of Scotland as a whole is projected to increase by 7%. The projected change in South Ayrshire is not evenly spread across the different age groups. South Ayrshire’s younger population (0-15 years) is projected to decrease by 8% and its working age population by 11%. The pensionable age population is, however, projected to increase by 21% by 2039. More dramatically, the number of people aged 75 and over is projected to increase by 82% to 21,571 people, with major consequences for the demand for older people’s services (see Figure 8).

Figure 8: Population projections (2014-based) projected change (2014-2039)

100 82 85

50 21 28 7 1 1 0 -2 -7 -11 -50 All persons Children Working Age Pensionable age 75+ Population (0-15)

South Ayrshire Scotland

The Population Pyramids below highlight the changing structure within the South Ayrshire Population between 2014 and 2039. In 2014 there is a high proportion aged between 45 and 65. In 2039 the population age structure has shifted with the highest

proportion being aged between 65- 75 with increased numbers aged 75+ compared to 2014.

Between 2014 and 2024, it is predicted that the 85 years+ population in South Ayrshire will increase from around 3,257 to 4,382, an increase of 34.5%. Between 2014 and 2039, this age group is projected to increase to 7,556, an increase of 132.0%. The 90+ age group is projected to increase from 1,195 in 2014 to 3,426 in 2039, an increase of 187%.

Figure 9: Estimated population of South Ayrshire 2014

90 and over 85 80 75 70 65 60 55 50 45 Male

40 35 30 Female Age 25 20 15 10 5 0 1500 1000 500 0 500 1000 1500 Persons

Figure 10: Estimated population of South Ayrshire 2039

90 and over 85 80 75 70 65 60 55 50

45 Male 40 35 Female

Age 30 25 20 15 10 5 0 2000 1000 0 1000 2000 3000 Persons

Figure 11: Estimated 65+ population of South Ayrshire 2014

90 and over 85

80 Male Age 75 Female 70 65 1500 1000 500 0 500 1000 1500 Persons

Figure 12: Estimated 65+ population of South Ayrshire 2039

90 and over 85

Age 75 Male 70 Female 65 2000 1500 1000 500 0 500 1000 1500 2000 2500 Persons

Figure 13: Trend in South Ayrshire population projections (2016-2015): 65+; 70+

35000

30000

25000

20000

15000

10000

5000

0 Estimated population projection population Estimated 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 65+ 70+

The 65+ population is projected to increase by 17.5% overall between 2016 and 2025. Figure 14 below shows the projected changes within the older age bands broken down further.

Figure 14: Trend in South Ayrshire population projections (2016-2025): 65+

9000 8000 7000 65-69 6000 70-74 5000 75-79 4000 80-84 3000 85-89 2000 1000 90+ Estimated populationprojection 0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Amongst the older age groups there is a projected increase within all age groups between 2016 and 2025. Projections indicate that there will be a 35% increase in those aged 75-79, 25% in 80-84, 34% in 85-89 and 38% in those aged 90+.

1.8 Centenarians in South Ayrshire

Within Scotland, South Ayrshire has the highest proportion of centenarians with 3.1% of those aged 90+ being aged over 100 (38 people aged 100+). Figure 15 shows the proportion split of those aged 90 and over.

Figure 15: Population in South Ayrshire (2015) aged 90 and over.

South Ayrshire also has a higher percentage of the total population aged 80-89 (5,598 people) than the national average at 5.0% compared to national average of 3.9%

2. HOUSEHOLD AND DWELLING OVERVIEW

Households headed by those aged 75+ will increase in number by 78% (between 2014 and 2039).

Households containing just one adult with children are projected to increase by +30% (between 2014 and 2039).

2. Households and Dwellings

2.1 Dwellings

In 2016, there were 54,942 dwellings in South Ayrshire, an increase of 307 (+0.6%) on the previous year and by 2,277 (+4.3%) over the last 10 years. Similarly across Scotland as a whole there was also an increase on the previous year of +0.7% and over the last 10 years was +6.6%1.

Figure 16: South Ayrshire dwelling estimates

56,000

55,000

54,000

53,000

52,000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

2.2 Dwelling by Type

The housing stock in South Ayrshire is fairly evenly split between detached houses (25%), semi-detached (24%), terraced (23%) and flats (27%). South Ayrshire has a larger proportion of detached, semi-detached and terraced houses than Scotland as whole1.

The proportion of dwellings in South Ayrshire with a single adult Council Tax discount applied is 36%. For Scotland, this figure is 37%2.

Figure 17: Dwellings by type – 2016

40% 38%

27% 30% 25% 23% 24% 21% 20% 21% 20%

10%

0% Flats Terraced Semi-detached Detached

South Ayrshire Scotland

1 National Records of Scotland, 2016 Estimates in Households and Dwellings 2 National Records of Scotland, 2016 Estimates in Households and Dwellings

2.3 Household Tenure

According to the 2011 Census, around 69% of South Ayrshire households own their home, which is higher than the Scottish average of 62%. Around 16% of households rent their accommodation from the Council compared to 13% nationally, 3% rent from one of the other Registered Social Landlords compared with 11% nationally, and 11% rent from private landlords which is similar to the national level at 12%. Source Census: 2011

Figure 18: Households by tenure

Households by Tenure (2011) 80% 69%

62%

60% 40% 16% 13% 11% 11% 12%

Percentage 20% 3% 1% 1% 0% Owned Rented from Other social Private rented Living rent free Council rented

South Ayrshire Scotland

2.4 Households in South Ayrshire

In 2016, there were estimated to be 51,923 households in South Ayrshire, a very small increase of 11 (+0.02%) over the previous year and 1,607 households (+3.2%) over the last 10 years. South Ayrshire’s percentage of change in number of households (+3.2%) over the last decade is the fourth smallest of all 32 Scottish council areas. Across Scotland there was an increase on the previous year of +0.7% and over the last 10 years an increase of +6.8%.

Figure 19: Household estimates for South Ayrshire

Estimated Nr of Households

2,500,000 52,500

Scotland South Ayrshire 2,450,000 52,000

2,400,000 51,500

2,350,000 51,000

2,300,000 50,500

Nr h'holdsNrScotland in Nr h'holds in South h'holdsin NrAyrshire

2,250,000 50,000

2006 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007

2.5 Household Type

South Ayrshire' population is projected to decrease by -2% over the same period. Much of the projected increase in households is therefore the result of more people living alone or in small households. South Ayrshire's population is ageing, the number of people aged 65 or over is increasing much faster than the number of children and younger adults. This has an impact on household structure as children tend to live in larger households and older people in smaller ones. The average household size in South Ayrshire is projected to decrease from 2.14 people in 2016 to 1.98 people in 2039 (-8%).

The number of households containing just one adult is projected to increase by +23% from 18,204 in 2014 (35% of all households) to 22,399 in 2039 (41% of all households). The number of one adult households in Scotland as a whole is projected to increase by +31%.

Households containing just one adult with children are projected to increase by +30%, from 3,129 households in 2014 (6% of all households) to 4,060 households in 2039 (7% of all households).

The number of two adult only households is projected to rise by +7% from 17,374 in 2014 (33% of all households) to 18,555 in 2039 (34% of all households).

In contrast, the number of larger households is projected to fall. Those containing two or more adults with children are projected to decrease by -24% from 8,941 (17% of all households) in 2014 to 6,825 (13% of all households) by 2039.

Those households containing three or more adults without children are projected to decrease by -35% from 4,225 (8% of all households) in 2014 to 2,733 (5% of all households) by 2039.

Figure 20: Projected Household Split between 2014 and 2039

2.6 Household Projections

Despite the anticipated fall in population, the number of households in South Ayrshire is expected to change from 51,874 in 2014 to 54,573 in 2039, which is an increase of 5% (2,699) over the next 25 years. In Scotland, as a whole, the projected number of households is set to increase by 14% over the same 25-year period.

In Scotland, the number of lone adult households is projected to increase by 31% over the 25-year period. In South Ayrshire, the number of lone adult households is projected to increase by 23%. In contrast, the number of larger households in South Ayrshire is projected to fall, with the number of households of 2 or more adults with children decreasing by 24% over the 25-year period.

In South Ayrshire, households headed by those aged 75+ are projected to increase in number by 78% between the years 2014 and 2039. Households headed by those falling within the younger categories are all set to decrease over the same period.

Figure 21: Projected percentage change in household, by age of head of household, 2014-2039

Projected Percentage Change in Household, By Age of Head Household 2014-2039 100% 78% 79%

80%

60%

40%

20% 11% 6% 0% 1%

0% Percentage Change -1% -20% -6% -7% -18% -40% 16-29 years 30-44 years 45-59 years 60-74 years 75+ years

South Ayrshire Scotland

2.7 Single Person Households

The household composition in a geographical area can have a marked effect on the health and wellbeing of the population. Given the projected increase in the older population, alongside the reduction in the working age population, it is likely that the household composition in South Ayrshire will change considerably in the coming years.

Figure 22: Single person households.

Scotland 16-24 25-49 50-64 South Ayrshire 65+

0% 20% 40% 60% 80% 100%

Figure 22 shows that the age composition of those living in single person households is older in South Ayrshire than Scotland overall. Of those living in single person households in South Ayrshire, 47.3% are 65 or over, compared to 38.4% nationally. Due to changes in the population structure, it is likely that this will increase in the coming years.

2.8 Lone Parent Households

Another consideration of household composition is lone parents. In South Ayrshire, there are 3,129 households with a lone parent and one or more dependent children. This is 6.0% of South Ayrshire households, compared to 6.5% nationally.

2.9 Homelessness

The number of people presenting as homeless in South Ayrshire has decreased from 742 in 2015/16 to 724 in 2016/17 and is at its lowest number throughout the five year time period (see Figure 23 below).

Figure 23: People presenting as homeless in South Ayrshire

1000 946 857 743 742 800 702 724

600 Annual No. o f Homeless 400 Presentations

200

0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Source: SAC, Covalent SO5.2 04

In comparison with the other two Ayrshire Councils, South Ayrshire Council received the highest number of homeless applications for the period 2012/13 to 2016/17 (see Figure 24).

Figure 24: Homeless applications received 2012/13 to 2016/17

3,752 3,683 4,000 3,500 3,000 2,404 2,500 2,000 1,500 1,000 500 0 SouthAyrshire North Ayrshire East Ayrshire

2.10 Temporary Accommodation

The Council provides approximately 253 units of temporary accommodation. Temporary accommodation is provided by way of hostel and temporary furnished accommodation dispersed across South Ayrshire. The Council no longer uses Bed & Breakfast accommodation, except in exceptional circumstances.

The number of households in temporary accommodation accounts for 0.36% of all South Ayrshire households compared to 0.44% across Scotland.

3. DEPRIVATION OVERVIEW

32% 12,888 people (11.5%)

LIVE WITHIN 15% MOST FUEL POOR OVERALL DEPRIVED DATA

ZONES Scotland = 34% 2016 2016

(12.4%) OF 153 DATA ZONES IN 19 15% MOST DEPRIVED DATA ZONES

of SCOTLAND 2016

th o South Ayrshire has the 8 highest level of child poverty in Scotland.

o 26% of Children live in poverty

after housing costs compared to 23% across Scotland ( 2015).

o 38% of Children in Ayr North live

in poverty after housing costs

compared to 18% in Troon and Prestwick

3. Deprivation in South Ayrshire

3.1 Scottish Index of Multiple Deprivation (SIMD)

The SIMD is the Scottish government’s official too for identifying concentrations of deprivation throughout Scotland. However, this does not mean everyone living in that concentrated deprived area is deprived and not all deprived people live in deprived areas. The SIMD looks at multiple domains of deprivation. ‘Deprived’ does not just mean ‘poor’ or ‘low income’. It can also mean people have fewer resources and opportunities, for example in health and education. The SIMD ranking is a measure of relative, not absolute deprivation. An area’s deprivation is assessed in terms of 38 indicators of deprivation grouped into seven deprivation domains. They are employment, income, education, health, geographic access to facilities, crime and housing. SIMD 2016 splits Scotland into 6,976 small areas called datazones with each having a similar population based on the 2011 Census. The seven domains are combined into one SIMD, ranking each datazone in Scotland from 1 the most deprived to 6,976 the least deprived. Previous SIMD publications were split into 6,505 datazones derived from the 2001 Census. Therefore, direct comparisons between SIMD 2016 and previous SIMD publications are not advised. Also while the methodology has remained fundamentally the same, in the latest edition there were some changes to the indicators to reflect the introduction of Universal Credit, changes to the school examination system and improvement in data quality.

Figure 25 below provides a summary of the number of South Ayrshire datazones that are in the 15% most deprived in Scotland for each of the five SIMD publications since 2004 for the overall SIMD ranking and for each deprivation domain that make up the index.

Figure 25: Number and share of South Ayrshire datazones in Scotland’s 15% most overall deprived datazones in each of the five SIMD publications

Scotland’s 15% Most Deprived Datazones

2004 2006 2009 2012 20163

Domain

Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Overall 13 1.3 8.8 13 1.3 8.8 18 1.8 12.2 17 1.7 11.6 19 1.8 12.4

Income 13 1.3 8.8 14 1.4 9.5 16 1.6 10.9 16 1.6 10.9 19 1.8 12.4

Employment 13 1.3 8.8 15 1.5 10.2 18 1.8 12.2 17 1.7 11.6 23 2.2 15.0

Health 19 1.9 12.9 15 1.5 10.2 22 2.2 15 21 2.2 14.3 27 2.6 17.6

Education 11 1.1 7.5 12 1.2 8.2 19 1.9 12.9 17 1.7 11.6 15 1.4 9.8

Geographic 25 2.6 17 18 1.8 12.2 18 1.8 12.2 28 2.9 19 18 1.7 11.8 Access

Crime N/A N/A N/A 16 1.6 10.9 17 1.7 11.6 17 1.7 11.6 18 1.7 11.8

Housing 0 0 0 0 0 0 0 0 0 0 0 0 6 0.6 3.9

There continues to be disparities in affluence across South Ayrshire with 19 datazones included in Scotland’s 15% most overall deprived datazones. This equates to an estimated 12,888 people or 11% of South Ayrshire residents living in the 15% most deprived datazones of Scotland. South Ayrshire now has a larger local share of the 15% most overall deprived datazones in Scotland than in the previous SIMD, 11.6% in 2012 compared with 12.4% in 2016 (a rise of 0.8 percentage points). There are a number of outlier datazones in Girvan (3), Maybole (1) and Troon (1) but most of the 15% most overall deprived datazones are in and around Ayr particularly Ayr North and Whitletts where the severest deprivation is evident. There are six datazones that suffer the severest (5% most deprived) level of overall deprivation. All are within the Ayr North area.

Based on the number of data zones in South Ayrshire and the total number of datazones across the whole of Scotland, if deprivation was uniformly distributed across Scotland, South Ayrshire’s expected national share 2.2%4. With this in mind the bulk of South Ayrshire’s national share of datazones for overall and individual deprivation domains are below the expected national share of the 15% most deprived – indicated by green

3 Change in the total number of datazones in Scotland for 2016 SIMD from previous 6,505 to 6,976 and in South Ayrshire from 147 to 153. 4 This is the same for all years. 2004 – 2012 publications there were 147 South Ayrshire DZs out of total 6,505 Scottish DZs = 2.26% while 2016 publication has 153 South Ayrshire DZs out of total 6,976 Scottish DZs = 2.19%

shaded cells. In the last SIMD publication, South Ayrshire had a higher than expected share of datazones considered to be in the 15% most health deprived in Scotland – indicated by pink shaded cells. Health or geographic access have consistently been the most deprived domains and housing the least in South Ayrshire at this level of deprivation for all SIMD publications.

Figure 26: Scotland’s 5%, 10%, 15% and 20% most overall deprived datazones in South Ayrshire (2016)

3.2 Income Deprivation

The Scottish Index of Multiple Deprivation income domain identifies areas where there are concentrations of individuals and families living on low incomes. The income domain is constructed by counting the number of people claiming relevant benefits, and dividing by the total population from the 2014 Small Areas Population Estimate rather than looking at actual income which is not available at datazone level. Thus the domain score is a simple percentage. The five income deprivation indicators are:

 Number of adults (aged 16-59) receiving Income Support (IS) or income based Employment and Support Allowance (ESA), and the number of adults (all ages) receiving Jobseeker’s Allowance (JSA)  Number of adults (aged 60 plus) receiving Guaranteed Pension Credit  Number of children (aged 0-15) dependent on a recipient of IS, JSA or ESA  Number of adults (all) not in paid employment receiving Universal Credit  Number of adults and children in Tax Credit families on low incomes

In SIMD2016 there are 19 South Ayrshire datazones that are part of Scotland’s 15% most income deprived. A direct comparison of the number of datazones income deprived between SIMD 2012 and SIMD 2016 cannot be made because of changes to the datazone boundaries and total number. However, it is an increase in terms of national and local share from 1.6% and 10.9% respectively to 1.8% and 12.4%.

There are an estimated 14,230 people or 12.6% of residents living throughout South Ayrshire who are income deprived which is a slightly higher percentage than that for Scotland as a whole at 12.3%.

Of the 12,888 people living in the 15% most overall deprived datazones in South Ayrshire, just under one third (31.5% or 4,055) of adults and children are ‘income deprived’ in the sense that they are dependent on key benefits. This means that there are more than twice as many adults and children, 8,833 (12,888 – 4,055) living in low- income households outside the so-called ‘core’ deprivation or 15% most overall deprived datazones.

There are eight income deprived datazones in the 5% most income deprived vigintile with four of these ranked equal or worse than 50th in Scotland. The most income deprived data zone in South Ayrshire is in the area of Ayr North Harbour, Wallacetown and Newton South – it’s ranked 30th.

Datazone level indicator scores and hence numbers of income deprived CANNOT be directly compared to previous SIMD publications due to the introduction of a new indicator and also the changed datazone boundaries used in SIMD 2016. However, the table below shows the population and percentage of those income deprived and that South Ayrshire’s percentage of income deprived was 0.2 percentage points lower than

that across the whole of Scotland in SIMD2012 whereas in SIMD2016 South Ayrshire’s percentage is 0.3 percentage points higher than Scotland’s.

Figure 27: Income deprivation SIMD 2012 and 2016 SIMD2012 SIMD2016 South Ayrshire Number 14,765 14,230 South Ayrshire Percentage 13.2% 12.6% Scotland Percentage 13.4% 12.3%

The table below lists the percentage of the population that is considered income deprived within each locality and neighbourhood. The 15% most income deprived datazones are clustered in Ayr, particularly the Ayr North and Whitletts area. There are also outlier datazones in Girvan (2), Maybole (1) and Troon (1).

Figure 28: Income deprivation by locality and neighbourhood

% Income Deprived % Income Deprived Locality 2012 2016

Ayr North and Former Coalfield Communities 23.6% 23.4%

Ayr South & Coylton 9.9% 8.6%

Girvan & South Carrick Villages 17.0% 17.6%

Maybole & North Carrick Villages 13.3% 12.7%

Prestwick 10.1% 9.3%

Troon 9.6% 9.3%

% Income Deprived % Income Deprived Neighbourhood 2012 2016

Alloway and Doonfoot 4.5% 3.4%

Annbank, Mossblown & Tarbolton - the Coalfields 14.8% 13.8%

Ayr North Harbour, Wallacetown and Newton 29.0% South 30.0%

Ayr South Harbour and Town Centre 15.5% 13.1%

Barassie 15.8% 15.2%

Belmont 10.0% 8.7%

Castlehill and Kincaidston 15.0% 13.9%

Coylton 7.7% 7.0%

Dalmilling and Craigie 23.2% 23.0%

Dundonald & Loans 9.6% 10.3%

Girvan 19.2% 19.2%

Heathfield 13.7% 13.0%

Holmston and Forehill 9.0% 8.3%

Lochside, Braehead and Whitletts 30.6% 30.5%

Maybole 16.5% 16.1%

Muirhead 7.0% 6.4%

Newton North 10.8% 10.6%

North Carrick Villages 10.0% 9.5%

Prestwick Airport and Monkton 10.2% 8.6%

Prestwick East 8.9% 7.3%

Prestwick West 6.2% 5.8%

South Carrick Villages 13.1% 14.2%

Symington 10.2% 10.0%

Troon 7.8% 7.1%

South Ayrshire 13.2% 12.6%

Scotland 13.4% 12.3%

Figure 29: SIMD 2016 Income Deprivation in South Ayrshire

3.3 Employment Deprivation

The Scottish Index of Multiple Deprivation employment domain is constructed by counting the number of people claiming relevant benefits and dividing by the working age population taken from the 2014 Small Area Population Estimate. The domain score is a simple percentage. The three employment deprivation indicators used are:

 Working age unemployment claimant count averaged over 12 months;  Working age Incapacity Benefit recipients or Employment and Support Allowance recipients; and  Working age Severe Disablement Allowance recipients

In SIMD2016 there are 23 South Ayrshire datazones that are part of Scotland’s 15% most employment deprived. A direct comparison of the number of datazones employment deprived between SIMD 2012 and SIMD 2016 cannot be made because of changes to the datazone boundaries and total number of datazones. However there is an increase in terms of national and local share from 1.7% and 11.6% respectively to 2.2% and 15.0%. There are an estimated 7,900 people or 11.7% of South Ayrshire’s working age population who are employment deprived which is higher than the 10.7% for the whole of Scotland. Of the 12,888 people living in the 15% most overall deprived datazones in South Ayrshire, an estimated 8,254 are of working age of which 2,295 are employment deprived. In other words, 27.8% or just over 1 in 4 working age people living in the 15% most overall deprived datazones in South Ayrshire are employment deprived. That means there are 5,605 employment deprived people (7,900 – 2,295) living outside the so-called ‘core’ deprivation or 15% most overall deprived datazones.

There are seven employment deprived datazones in the 5% most employment deprived vigintile with two of these ranked worse than 50th in Scotland. The most employment deprived data zone in South Ayrshire is in the area of Ayr North Harbour, Wallacetown and Newton South – it’s ranked 24th.

The table below shows the number and percentage of employment deprived in South Ayrshire has decreased 1.6 percentage points but still remains 1.0 percentage points above the whole of Scotland share which has also decreased 2.1 percentage points in comparison to SIMD2012.

Figure 30: Employment Deprivation SIMD 2012 and 2016

SIMD2012 SIMD2016 South Ayrshire Number 8,805 7,900 South Ayrshire Percentage 13.3% 11.7% Scotland Percentage 12.8% 10.7%

The table below lists the percentage of the working age population that is considered employment deprived within each locality and neighbourhood. The 15% most employment deprived datazones are clustered Ayr, particularly the Ayr North and Whitletts area. There are also outlier datazones in Girvan (3), Maybole (2) and Troon (2).

Figure 31: Employment deprivation by locality and neighbourhood

% of Working Age Locality Population Employment Deprived 2016

Ayr North and Former Coalfield Communities 20.6%

Ayr South & Coylton 8.8%

Girvan & South Carrick Villages 14.0%

Maybole & North Carrick Villages 1 1.5%

Prestwick 8.7%

Troon 8.7%

% of Working Age Neighbourhood Population Employment Deprived 2016

Alloway and Doonfoot 4.5%

Annbank, Mossblown & Tarbolton - the Coalfields 11.4%

Ayr North Harbour, Wallacetown and Newton South 28.4%

Ayr South Harbour and Town Centre 14.2%

Barassie 14.6%

Belmont 7.9%

Castlehill and Kincaidston 12.6%

Coylton 7.2%

Dalmilling and Craigie 19.6%

Dundonald & Loans 9.4%

Girvan 15.7%

Heathfield 11.4%

Holmston and Forehill 7.7%

Lochside, Braehead and Whitletts 25.3%

Maybole 15.0%

Muirhead 5.3%

Newton North 10.6%

North Carrick Villages 8.2%

Prestwick Airport and Monkton 7.1%

Prestwick East 7.4%

Prestwick West 5.5%

South Carrick Villages 10.4%

Symington 10.3%

Troon 7.4%

South Ayrshire 11.7%

Scotland 10.7%

Figure 32: SIMD 2016 Employment Deprivation in South Ayrshire

3.4 Geographic Access to Services

The Scottish Index of Multiple Deprivation (SIMD) measures geographic access using a number of public transport and drive times to essential services, such as a GP surgery, a post office, a primary and a secondary school, a petrol station and shopping facilities.

In South Ayrshire 18 (11.8%) of its 153 data zones are in the 15% most deprived nationally with regards to accessing services. The main clusters, in terms of the 15% most access deprived, are mainly in the more rural areas of Carrick South, Carrick North, around Coylton and Dundonald. In total this equates to around 14,674 people in South Ayrshire living in areas that are regarded as having insufficient/deprived access to services..

Figure 33: SIMD 2016 Access Deprivation in South Ayrshire

3.5 Disabled Employment

The employment rate of disabled people over the last four years has ranged from 37.5% in FY 2015/16 to a high of 46.4% in the latest FY 2016/17. Apart from the dip in 2015/16 it has remained slightly higher than the disabled employment rate across the whole of Scotland. However, the disabled employment rate remains well below the non-disabled employment rate for South Ayrshire and Scotland.

Figure 34: Employment rates 16-64 years by Disabled vs Non-Disabled

3.6 Lone Parent Employment

In 2011, 61% of male lone parents and 61% of female lone parents in South Ayrshire aged 16 to 74 were in employment compared with 55% of male lone parents and 50% of female lone parents in 20015. Of those lone parents in employment in South Ayrshire, 62% work part-time and 38% work full-time.

3.7 Child Poverty

In South Ayrshire, 16% of children6 are classified as living below the poverty line7 before housing costs (BHC), while 26% of children are classified as living in poverty after housing costs (AHC) have been deducted from their income. This level is the 8th highest level of child poverty in Scotland8.

5 2011 Census 6 Child - dependent children under the age of 20. A dependent child is defined as an individual aged under 16 or an individual aged 16 to 19 years who is: not married nor in a Civil Partnership nor living with a partner; and living with parents; and in full- time non-advanced education or in unwaged government training (http://www.hmrc.gov.uk/statistics/child-poverty/measure.pdf). 7 The proportion of children living in families in receipt of out of work (means-tested) benefits or in receipt of tax credits where their reported income is less than 60 per cent of median income (http://www.hmrc.gov.uk/statistics/child-poverty/measure.pdf). 8End Child Poverty, October – December 2015 35

The results show that there is variation across South Ayrshire’s eight multi member wards. In Ayr North ward, 38% of children are living in poverty (AHC) and 35% in Girvan & South Carrick ward compared with 18% in Prestwick and Troon wards. The table below summarises the South Ayrshire results by multi member ward.

Figure 35: Child Poverty across Multi-Member Wards

3.8 Fuel Poverty

32% of South Ayrshire residents spend more than 10% of their household income on heating costs and are said to be in fuel poverty9. This level rises to 42% of those residents that are of pensionable age10. The Scottish average for all residents is 34% and 49% for those of pensionable age.

Some of the highest percentages of fuel poverty in areas can be found in Girvan, South Carrick Villages, North Carrick Villages, Maybole and Annbank, Tarbolton and Mossblown.

9 Scottish House Condition Survey published feb 2017 10 Pensionable age defined as 60+ females, 65+ males. Since 6 April 2010 women's State Pension age has been increasing for those born on or after 6 April 1950. As at April 2015, women's State Pension age is 62.5 and it will be 63 by April 2016. State Pension age is due to be equalised at 65 for both men and women by November 2018. It is then scheduled to increase again to 66 by October 2020 and 67 by April 2028

Figure 36: Estimated Households in Fuel Poverty

4. GENERAL POPULATION HEALTH OVERVIEW

Life Expectancy (2013-2015)

Premature mortality has 77.7 81.0 increased from 422 (2015) to 451 (2016) and is now higher

than the national average.

Main cause of death Females: 27% Circulatory Disease/ 26% Cancer

Males: 30% Circulatory

Disease/ 30% Cancer 18% People Smoke

Scotland – 21% (SHeS 2013-16) ADULTS OVERWEIGHT or OBESE (2012-2015) 74% Males

Scotland =69%

76%

Assess their health

as good or very good 66% Females Scotland = 74%

2015 Scotland =61%

4. General Population Health

4.1 Life Expectancy and Healthy Life Expectancy

Life expectancy in 2013-2015 in South Ayrshire was 77.7 years for males and 81.0 years for females. The 2013-2015 life expectancy estimate for South Ayrshire for males of 77.7 was higher than the average for Scotland as a whole. Life expectancy in Scotland was 77.1 years for males. The 2013-2015 life expectancy estimate for South Ayrshire for females of 81.0 was slightly lower than the average for Scotland as a whole. Life expectancy in Scotland was 81.1 years for females11.

The gap between male and female life expectancy at birth in South Ayrshire has decreased from 5.2 years in 2001-2003 to 3.3 years in 2013-2015. Male life expectancy has been increasing at a faster rate than for females since 2001-2003.

Extended life expectancy means that more people are living to over 75, but healthy life expectancy (i.e. the number of years of good health enjoyed by people) is not increasing as fast. As a result, those aged over the age of 60 are likely to spend more years in poor health, requiring care and support.

Figure 37: Life Expectancy between 2001 and 2015

The table below is the latest information for Intermediate zones in South Ayrshire. It’s based on a 5 year span centred on 2011 hence the slight difference in the life expectancy for South Ayrshire.

11 National Records of Scotland via ScotPHO profiles

A boy born in Prestwick Airport and Monkton area can expect to live to around 82.5 years while one born in Ayr North Harbour, Wallacetown and Newton South area might live to 72.1 years of age. A new born girl in Muirhead can expect to reach 85.7 years but her peer in Annbank, Mossblown & Tarbolton area might live to around 77.0 years of age.12

Figure 38: Life expectancy of males and females by Intermediate Zone

2010-2012 Intermediate Zone Males Females Alloway & Doonfoot 80.8 84.3 Annbank, Mossblown, Tarbolton 75.8 77.0 Ayr North Harbour, Wallacetown & Newton South 72.1 78.1 Ayr South Harbour & Town Centre 74.1 81.8 Barassie 78.0 79.0 Belmont 80.2 84.0 Carrick North 79.4 78.4 Carrick South 78.5 82.6 Castlehill & Kincaidston 75.7 84.3 Coylton 77.6 81.2 Dalmilling & Craigie 72.3 78.1 Dundonald, Loans & Symington 75.8 79.9 Girvan Ailsa 75.9 79.4 Girvan Glendoune 74.8 81.8 Heathfield 79.0 81.6 Holmston & Forehill 80.6 83.6 Lochside, Braehead & Whitletts 76.3 78.5 Muirhead 81.4 85.7 Newton North 78.4 82.4 Prestwick Airport & Monkton 82.5 82.0 Prestwick East 79.9 82.5 Prestwick West 80.6 81.9 Maybole 77.7 80.2 Troon 77.5 80.7 South Ayrshire 77.3 81.2 Scotland 76.6 80.8

12 ISD, Scotland Community Health profiles

4.2 General Health

This section examines the general health of the residents of South Ayrshire. Naturally, there are many different factors which could be considered here. One important aspect is self-perception of general health.

Figure 39 shows the self-reported general health of people living in this area compared to Scotland as a whole.

Figure 39: General health of residents 2011 census

This chart illustrates that a marginally lower proportion of South Ayrshire residents reported feeling in ‘very good health’ than in Scotland overall (50.8% of residents compared to 52.5% for Scotland). Looking at the first two categories combined, within South Ayrshire, almost 81% of residents stated their health was very good or good, compared to 82% of the Scottish population. This indicates that the perception of general health in South Ayrshire is similar to that in Scotland.

Figure 40: General health of residents by age and sex

Figure 40 above looks at the self-reported perception of general health by age and sex. It is clear from this that feelings regarding general health are very similar for males and females, but they are very different across age groups. This is not surprising given the differences in health and care need across age groups. For the 0-15 and 16-44 age groups, the percentage of residents who reported feeling in very good health is highest, at around 85% for the former and 65% for the latter. This declines throughout the age groups, with only around 15% of the 70+ population reporting that they feel in very good health.

Figure 41: Long term health problem or disability by age – extent to which day to day activities are limited

Another aspect of the health profile of South Ayrshire relates to the extent to which people feel their day-to-day activities are limited by a long-term health problem or disability. Here there is a clear association with age, with a greater number of people in each age group reporting that their day-to-day activities are limited by long-term health problems or disabilities.

4.3 Long Term Conditions

Long-term conditions are health conditions that last a year or longer, impact on a person’s life, and may require on-going care and support. The definition does not relate to any one condition, care-group or age category. Around two million people, 40% of the Scottish population, have at least one long-term condition and one in four adults over 16 reports some form of long-term illness, health problem or disability.

Long-term conditions become more prevalent with age. According to Audit Scotland, the number of people aged 75 and over will rise by 60% between 2004 and 2031. By the age of 65, nearly two-thirds of people will have developed a long-term condition.

Older people are also more likely to have more than one long-term condition: 27% of people aged 75-84 have two or more. There is a predicted rise of 38 per cent in the

number of people who will be over 85 in the population by 2016, and a 144% in the over 85s by 2031.

The human costs and the economic burden for health and social care are profound. 60% of all deaths are attributable to long-term conditions and they account for 80% of all GP consultations. There are clear links between long-term conditions, deprivation, lifestyle factors and the wider determinants of health. People living with a long-term condition are likely to be more disadvantaged across a range of social indicators, including employment, educational opportunities, home ownership and income.

Someone living in a disadvantaged area is more than twice as likely to have a long-term condition as someone living in an affluent area, and is more likely to be admitted to hospital because of their condition11.

There is no straightforward way to capture the number of residents living with a long- term condition in Scotland. The best proxy for this is the Quality Outcomes Framework (QOF), which is a scheme in which GP practices are funded to keep up-to-date registers of patients living with certain conditions. Figure 42 shows the number of people on QOF registers in South Ayrshire across a range of conditions.

Figure 42: Number of South Ayrshire residents on QOF Registers

25,000 20,000 15,000 10,000 5,000 0

This shows that hypertension is the most common of long term conditions, with 19,098 residents in South Ayrshire living with this condition. This is followed by depression (8,806), asthma (7,463) and diabetes (6,427).

Figure 43: Percentage of patients in QOF practice

18 16 14 12 10 8 6 4 2

0 %of QOF patients in practice

South Ayrshire Scotland

This chart shows a comparison of the percentage of patients listed on QOF registers for South Ayrshire and Scotland. For each of these conditions (apart from Mental Health and Osteoporosis where the rates are the same), the rate is higher in South Ayrshire than Scotland. For example, in relation to hypertension the rate is 16.9% in South Ayrshire compared to 13.9% in Scotland. Given the link between age and long-term conditions, this is likely due to the older population living in South Ayrshire than in Scotland as a whole.

4.4 Mortality

In 2015, the main cause of death in South Ayrshire was circulatory disease, followed by cancer. In 2015, the main cause of death in South Ayrshire for men was circulatory disease followed by cancer. In 2015, the main cause of death in South Ayrshire for women was circulatory disease followed by cancer.

Figure 44: Cause of death in males, South Ayrshire, 2015

Cancer

16% Circulatory 30% 6% Disease 5% Respiratory Disease 14% Digestive Disease 30% External Causes

Figure 45: Cause of death in females, South Ayrshire, 2015

Cancer 24% 26% Circulatory Disease Respiratory Disease 3% Digestive Disease 4% External Causes 15% 27% Other

In South Ayrshire, the premature mortality rate (age-standardised) for under 75’s per 100,000 population increased from 422 in 2015 to 451 in 2016. The South Ayrshire rate in 2016 is higher than the Scottish average at 440 (see Figure 46 below).

Figure 46: Premature mortality rate per 100,000 (people aged under 75)

500 440 400

300

200

100

Rate per 100,000 population 0 2010 2011 2012 2013 2014 2015 2016 South Ayrshire Scotland

In South Ayrshire, the premature mortality rate for under 75’s from cancer per 100,000 using three-year aggregates from 2013 - 2015 was 157.7 which is lower than the Scottish average of 167.1 (see Figure 47 below). Although the South Ayrshire rate was below that of Scotland for 2013 – 2015, it can be seen that the gap has shortened between them due to the increase in the South Ayrshire rate from 2012 – 2014 to 2013 – 2015.

Figure 47: Premature mortality from cancer, rate per 100,000 (people aged under 75)

190

180

170

160

150

Rate per 100,000 population 140 2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

In South Ayrshire, the premature mortality rate for under 75’s from coronary heart disease per 100,000 has gradually improved between 2006 and 2015. The rate decreased from 83.3 in 2006-2008 to 53.9 in 2013-2015. The South Ayrshire rate has been very similar to the Scottish average since 2011 and for the first time throughout the time period was slightly lower than the Scottish average in 2013-2015 (see Figure 48 below).

Figure 48: Premature mortality from coronary heart disease, rate per 100,000 (people aged under 75)

Rate per 100,000 Rateper 100,000 population 2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

4.5 Smoking

According to the 2014 Scottish Household Survey (SHS), smoking prevalence in South Ayrshire adults dropped from 26% in 2005/06 to 22% in 2014. Meanwhile the level of smoking prevalence in adults across Scotland was at 21%. The Scottish Health Survey (SHeS) covering the period 2013-2016 has smoking prevalence for all adults at 18% in South Ayrshire and 21% across Scotland. Note SHS no longer including smoking.

Figure 49: Percentage of adults who are regular smokers.

4.6 Obese Adults

The proportion of adults in South Ayrshire considered to be obese over a rolling three- year period for men was 74% and women 66% compared to the Scottish percentage of 69% and 61% respectively.13

4.7 Physical Activity

Data from the Scottish Health Survey shows that the percentage of adults in South Ayrshire who reported meeting physical guidelines has risen since 2008. In 2013-16 69% of men and 59% of women did 150 minutes of moderately intensive physical activity per week, compared to 44% of men and 31% of women in 2008-11.

13 Scottish Health Survey

4.8 Palliative Care /End of Life

Palliative and end of life care are integral aspects of the care delivered by any health or social care professional to those living with and dying from any advanced, progressive or incurable condition. Palliative care is not just about care in the last months, days and hours of a person’s life, but about ensuring quality of life for both patients and families at every stage of the disease process from diagnosis onwards. A palliative care approach should be used as appropriate alongside active disease management from an early stage in the disease process.

Palliative care focuses on the person, not the disease, and applies a holistic approach to meeting the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement.

There is little systematic data recorded on a person's preferred place of care at end of life. A surrogate measure for this is the: "Percentage of last six months spent in home or a community setting". Although this is not a direct measure of compliance with people's preferred place of death, it can serve to provide a broad indication of progress in implementation of the national action plan.

Figure 50: Percentage of last 6 months at home or in a community setting

Percentage (%) 84

83 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

South Ayrshire Scotland

The above figure shows that in 2013/2014, the South Ayrshire percentage fell below the national rate to 85% compared to 86% for Scotland overall. This gap has widened in 2016/17 where the South Ayrshire percentage is 2% below the Scotland figure at 85% compared to 87.

5. SPECIFIC HEALTH CONDITIONS OVERVIEW

6.4 people per 1,000 adult population in South Ayrshire have a Learning Disability. DEMENTIA Scotland = 5.2 (2017) Prevalence Rate

for diagnosis 93 people with an Autism Spectrum 1.03 South Diagnosis were known to the Health and Social Care Partnership (2017) Ayrshire

0.8 Scotland

(2015/16)

HIGHER LEVELS OF DEPRESSION IN SOUTH AYRSHIRE AT 7.6 COMPARED TO 6.3 ACROSS SCOTLAND

20% of South Ayrshire population prescribed drugs for anxiety, depression, and psychosis. Scotland = 18% (2015/16).

South Ayrshire has higher levels of alcohol related hospital stays than nationally.

Increase in drug related deaths between 2015 and 2016 from 15 to 22.

5. Specific Health Conditions

5.1 Learning Disabilities

The population of adults with learning disabilities, in 2017, is 602, based on the number of people known to South Ayrshire Council who are:

 Aged 16-17 and not in full-time education;  Aged 18 or over; or  Who have had contact with South Ayrshire Council in the past year.

From these data, the rate of people with learning disability in South Ayrshire Council is 6.4 per 1,000 adults, higher than the national average of 5.2. There has been an increase in the total number of people with learning disabilities known to Local Authorities since 2011, in line with the national trend, and a marginal (non-significant) rise from 5.4 in 2010.

The GP register for South Ayrshire indicated a total of 655 people with a learning disability registered in 2013-2014, this is a rate of 0.56 per 100 patients, which is higher than the national rate across Scotland of 0.48 per 100 patients. (NOTE THE LD indicator has not been in the 2014/15 and 2015/16 QOF’s).

The age breakdown of the adult learning disability population in South Ayrshire is shown in the table below. There are significantly more males in the younger groups and roughly the same in the older age range. There could be a number of explanations for this, including the improved recognition and recording of Autistic Spectrum Disorder (ASD) which is more common in males. In 2017, there were 93 adults diagnosed with ASD compared to 90 in 2015.

Figure 51: Adults with learning disabilities known to South Ayrshire Council in 2017

16-17 18-20 21-34 35-44 45-54 55-64 65 and Unknown Total Gender over split Males 1 27 131 48 65 53 36 0 361 60% Females 0 10 73 33 45 44 36 0 241 40% Total 1 37 204 81 110 97 72 0 602 % males 100% 73% 64% 60% 59% 55% 50%

Data Source : https://www.scld.org.uk/evidence-and-research/statistics-learning-disability-scotland/2017-report/

Figure 52: Percentage of adults with an AS diagnosis as a proportion of all adults with a Learning Disability and or an AS diagnosis known to South Ayrshire Local Authority 2009-2017

0 2009 2010 2011 2012 2013 2014 2015 2017

Monitoring of people with autism using statutory services is limited and will only record members of the population currently in contact with services. The increase demonstrated above may reflect better diagnosis and/or more effective data recording by service providers.

Of the 602 adults with learning disabilities:

 Around 80.1% have a personal life plan (well above the national average of 64.2%);  42% live with a family carer, compared to 31% nationally;  3.6% are in some sort of employment, compared to 6.2% nationally;  16.6% attend a day centre compared to 19.0% nationally;  5.8% live in care homes, compared to 7.6% nationally; and  13.1% live in supported accommodation compared to 15.9% nationally.

Evidence from a variety of sources suggests that there has been an increase of around 1% per annum in the prevalence of learning disability (LD) in adults over the past 35 years, due mainly to increases in survival17. Among young people with severe and complex learning disabilities, and the reduced mortality of older adults with learning disabilities, this increase may have fallen in recent years.

For older people (aged 60+), two-thirds with learning disabilities have additional mental disorders, such as dementia. Therefore, the most significant challenge in the future will be the ageing of the learning disability population and the additional and focussed support needs that will be required.

In particular, for adults with profound learning disabilities, it is reported that there is a higher incidence of epilepsy, sensory impairments, and gastrointestinal, respiratory and mobility problems than in the population as a whole.

About 20-25% of children diagnosed with learning disabilities have epilepsy, but this rises to 50% in children assessed as having profound learning disabilities. Among this group is a significant proportion that may need help with emotional and behavioural problems.

The key future issues for learning disability include:

 Increasing survival of pre-term infants with multiple disabilities leading to long- term increasing numbers of people with complex physical disabilities;  Increasing recognition of conditions such as Foetal Alcohol Syndrome Disorder, Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder;  Increasing numbers of older people with complex needs and end of life care needs; and  Ageing of carers.

5.2 Mental Health

Prevalence of diagnosed mental health conditions NHS Quality and Outcomes Framework (QOF) data14 for GP practices in South Ayrshire gives a profile of patients on GP registers with a diagnosed mental health condition.

 There are 20 GP practices in South Ayrshire with a total of 116,844 registered patients at April 2015.  In 2014/2015 there were 1,029 patients with a serious mental illness such as schizophrenia, bipolar affective disorder or other psychoses.  In 2014/2015 there were 8,915 people newly diagnosed with depression and whose severity of depression has been assessed.  In 2014/2015 there were 1,170 people diagnosed with dementia.

Figure 53: Prevalence of serious mental illness, diagnosed depression and dementia

Patients Prevalence Scottish Indicator Explanation on QOF (per 100 prevalence register patients) Serious Since April 2006, the definition has 1,029 0.9 0.9 mental included only patients with serious illness (MH) mental illness, defined as schizophrenia, bipolar affective disorder or other psychoses Depression The register for the depression 2 8,915 7.6 6.3 (DEP2) indicator counts patients with newly diagnosed depression and then measures the severity of the depression using a validated primary care assessment tool Dementia The definition of this indicator applies to 1,170 1.0 0.8 all people diagnosed with dementia either directly by the GP or through referral to secondary care Source: NHS QOF, 2014/15

14 NHS QOF data, 2014. http://www.isdscotland.org/Health-Topics/General-Practice/Quality-And- Outcomes-Framework/

The prevalence of serious mental illness in South Ayrshire is roughly comparable to the average prevalence for Scotland. The prevalence of diagnosed depression and dementia per 100 patients in South Ayrshire are higher than the Scottish average.

Figure 54: Prevalence of diagnosed mental illness 2009/10 – 2014/15

Prevalence of diagnosed mental illness 2009/10 - 2014/15 0.88

0.87 0.86 0.85 0.84 0.83 0.82 0.81

0.8 Prevalenceper 100 people 0.79 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

South Ayrshire Scotland

Figure 54 shows the prevalence rates for diagnosed mental illness in South Ayrshire and Scotland for 2009/10 to 2014/15. The prevalence in South Ayrshire remained consistent with the Scottish average over the period.

Figure 55: Prevalence of diagnosed depression 2009/10 to 2014/15.

Prevalence of diagnosed depression 2009/10 - 2014/15

2 Prevalenceper 100 people 0 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

South Ayrshire Scotland

Figure 55 shows that the prevalence of diagnosed depression in South Ayrshire has remained above the Scottish average for the period. The rate of decreasing prevalence is consistent with the national picture.15

Other local mental health indicators A number of other mental health indicators are collected nationally, including measures relating to prescribed drugs, psychiatric hospitalisation and deaths from suicide.

Figure 56: South Ayrshire Mental Health Indicators, 2015

Indicator South Scottish Ayrshire Average Average Patients prescribed drugs for 20% 18% anxiety/depression/psychosis – estimated number and percentage of population being prescribed drugs for anxiety, depression or psychosis Patients with a psychiatric hospitalisation – Patients 283.2 286.2 discharged from psychiatric hospitals – 3-year total number and 3 year average annual measure* Suicide rates per 100,000 population (All ages) 9.9 13.2 (2012-2016)

Source: South Ayrshire CHP Health and Wellbeing Profile 2015/16 *3-year age-sex standardised rate per 100,000 population per year

The CHP profile found that, in 2015:

 The number of patients prescribed drugs for anxiety, depression or psychosis was significantly “worse‟ in South Ayrshire than the Scottish average.  The 3-year average for patients with a psychiatric hospitalisation was higher than the Scottish average but not considered to be significantly different statistically.  The 5-year average suicide rate was lower than the Scottish average but not considered to be significantly different statistically.

15 In 2012/13, a change was introduced to the technical business rules for this indicator that excluded all patients identified prior to April 2006, which means that the latest figure is not comparable to previous years. The prevalence figure for 2012/13 has been steadily increasing, and is often not seen as reliable due partially to the cumulative nature of this register. Individuals with resolved depression will only be taken off the register if this is recorded by the practice and this is not done in all cases.

WEMWBS

Wellbeing is measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) questionnaire16. It has 14 items designed to assess: positive affect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy. The scale uses positively worded statements with a five-item scale ranging from '1 - none of the time' to '5 - all of the time'. The lowest score possible is therefore 14 and the highest score possible is 70; the tables present mean scores.

Figure 57: WEMWBS variable mean score by sex, 2008 – 2015

South Ayrshire 2008 – 2011 Mean 2012 – 2015 Mean Difference from Score Score earlier to recent period Men 49.5 50.8 1.3 Woman 49.0 49.2 0.2

Figure 58: WEMWBS variable mean score by sex, 2008 - 2015

Scotland 2008 – 2011 Mean 2012 – 2015 Mean Difference from Score Score earlier to recent period Men 50.1 50.2 0.1 Woman 49.7 49.8 0.1

5.3 Dementia

The number of people with a diagnosis of dementia on the Quality and Outcomes Framework Register has increased from 697 in 2006/07 to 1,160 in 2015/1618. It is important to note that this relates only to people who have been diagnosed as having dementia. It is likely, therefore, to be an underestimation of the number of people actually living with dementia.

Figure 59: Number of people with a diagnosis of dementia on the QOF Register – South Ayrshire

1400 1143 1159 1195 1170 1160 1200 1107 1000 818 728 800 697 699 600 400 200 0 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

16 Note that this analysis has used the questionnaire with 14 questions with a highest score of 70. The WEMWBS short version with seven questions has not been used here.

Over the period, the prevalence rate for diagnosis in South Ayrshire has risen from 0.59 in 2006/07 to 1.03 in 2015/16. This rise is much greater compared to Scotland as a whole which has risen from 0.55 in 2006/07 to 0.80 in 2015/16. Moreover, the population structure in South Ayrshire means that the increase is likely to become greater in the coming years.

Figure 60: Raw prevalence rate (per 100 patients) for diagnosis of dementia – South Ayrshire

1.20 1.00 0.80 0.60 0.40 0.20 0.00 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

South Ayrshire Scotland

Data source: http://www.isdscotland.org/Health-topics/General-practice/Quality-and-outcomes-framework/2015-16/Register- and-prevalence-data.asp

5.4 Suicide Rates

In 2012-16, the rate in South Ayrshire was significantly low compared to Scotland overall.

Figure 61: Suicide Crude rates per 100,000 population (all ages): Persons, 5-year periods from 1997-2001 to 2012-16, by local authority area.

20 15 10 5 0 1997-2001 2002-2006 2007-2011 2012-2016

South Ayrshire Scotland

Data Source: http://www.scotpho.org.uk/health-wellbeing-and-disease/suicide/data/local-authority

5.5 Risk Taking Behaviour

5.5.1 Alcohol

Alcohol problems are a major concern for public health in Scotland. Short-term problems such as intoxication can lead to risk of injury and is associated with violence and social

disorder. Over the longer term, excessive consumption can cause irreversible damage to parts of the body such as the liver and brain. Alcohol can also lead to mental health problems, for example, alcohol dependency and increased risk of suicide. In addition, alcohol is recognised as a contributory factor in many other diseases including cancer, stroke and heart disease. Wider social problems include family disruption, absenteeism from work and financial difficulties.

Figure 62: Rate of alcohol related hospital stays

850 793.8 800 777.4 750 722.9 702.9 700 650 2012/13 2013/14 2014/15 2015/16

The rate of alcohol related hospital stays continues to show a downward trend, however it is too early to confirm if this is a long-term trend. Although there has been an improvement in South Ayrshire the rate is still higher than the national average of 664.5.

In 2015/16 the rate of stays was 702.9 (n=785). The number of patients was 526, of which 229 (44.5%) were new patients. The average number of stays per patient was 1.5.

5.5.2 Drugs

The illicit use of drugs and particularly opiates, benzodiazepines and psychostimulants, causes significant problems within Scotland as it does in other parts of the UK and Europe. Some of these problems are primarily social in nature, involving, for example, increases in acquisitive crime, prostitution, unemployment, family breakdown and homelessness. Others are more clearly associated with health problems, for example, the transmission of communicable diseases (HIV, hepatitis), injecting related injuries and increased demands upon health care services.

Figure 63: Rate of drug related hospital stays per 100,000 population

250 232.4 200 176.5 150 152.9 168.4 100 112.4 50 0 2012/13 2013/14 2014/15 2015/16 2016/17 South Ayrshire Scotland

https://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2017-09-26/DRHS_dashboard.swf

Data in 2015/16 had shown a positive decrease locally however an increase was seen in 2016/17. This increase is comparable to the increase in drug related deaths both locally and nationally.

It is worth noting the actual numbers (n = 217 in 2016/17) are low and variations can have a significant impact on the rate.

The majority of stays were emergency admissions (91.2% for 2016/17) and the stays were for less than one week (83.9% in 2016/17). 70.5% of admissions were for opioids (n = 153).

Drug related deaths increased significantly in 2016 to the highest level seen, both locally (n = 22) and across Scotland (n = 867, NRS 2016). The increase has been particularly among older drug users (over 35 years) who may have a range of underlying health conditions.

Reducing drug related deaths remains a priority for the ADP. The local Drug Death Prevention Group continues to meet to develop actions to improve engagement with individuals at risk, including the provision of Naloxone Kits. The DDPG established a baseline position in line with the good practice guidelines in the Staying Alive in Scotland report and are taking forward local improvement actions.

Figure 64: Drug Related Deaths

25 22 20 14 15 15 12 10

0 2013 2014 2015 2016

Data Source: National Drug Related Deaths Database 2016

6. UNSCHEDULED CARE OVERVIEW

EMERGENCY HOSPITAL ADMISSION RATES AND BED DAY RATES ARE INCREASING AND ARE HIGHER THAN THE RATE ACROSS SCOTLAND

500

400

1,000 300

A&E A&E attendancesperrate 200 2011 2012 2013 2014 2015 2016 Ayr North and Former Coalfield Communities Ayr South and Coylton Girvan and South Carrick Villages Maybole and North Carrick Communities Prestwick Troon

A & E attendances by Locality 2011 to 2015

Conversion rates are improving following the opening of the CAU. 30% in August 2017.

Bed Day Rates for Delayed Discharges are higher in South Ayrshire than the national average.

6. Unscheduled Care

A key consideration in the health of a population is the extent to which they require unscheduled care. This typically relates to unplanned care and treatment which takes place in a hospital setting in an emergency. One of the key priority areas to emerge from the Public Bodies (Joint Working) (Scotland) Act, 2014 is to achieve a reduction in unscheduled care and an increase in anticipatory and planned care, working in partnership with social care and third sector services. This is required because the current pressure on the acute sector and the aging population mean that the current system is unsustainable in the future.

6.1 Accident and Emergency

Figure 65: Rate of A&E attendances (per 1,000 population)

400 300 200 100 0 2012 2013 2014 2015 2016

South Ayrshire Scotland

Figure 65 above shows that the rate (per 1,000 population) of attendances at Accident and Emergency in South Ayrshire is higher than for Scotland as a whole. This has been the case since 2012. In 2016, the rate of A&E attendances for South Ayrshire was 350.2 per 1,000 population, compared to 303.1 for Scotland as a whole.

Figure 66 shows a breakdown of A&E attendances by age. In 2016, residents in the 0-4 and 85+ age groups generated the highest number of attendances with 2,997 and 2,644 respectively. The age group with the fewest A&E attendances both years was the 5-9 age group, with 1,522 in 2015 and 1,686 in 2016.

Figure 66: Number of A&E attendees by age band 2015/2016

3500 3000 2500 2000 1500 1000 500

0 Number of A&E NumberofA&E attendances

2015 2016

Ayr South has the highest number of A and E attendances across the localities, as shown in figure 66 below. However, the actual attendance rates as shown in figure 68 are highest in Ayr North and have been so over the past 6 years.

Figure 67: Number of A & E attendances by locality 2016

Ayr North and Former Coalfield Communities 5711 Ayr South and Coylton 9076 Girvan and South Carrick Villages 7364 Maybole and North Carrick 11133 Communities 3623 Prestwick

Troon 2476

The main presenting reason for attendance in 2016 for Ayr North residents was for Trauma, Injury and Poisoning as was with the rest of South Ayrshire. There is an assumption that areas with closer proximity to hospitals will have higher attendance rates than those areas further away particularly those which are rural in nature.

Figure 68: Attendance rates per 1,000 by locality 2011 -2016

500 450 400 350 300 250 200 2011 2012 2013 2014 2015 2016

Ayr North and Former Coalfield Communities Ayr South and Coylton A&E A&E attendancesperrate1,000 Girvan and South Carrick Villages Maybole and North Carrick Communities Prestwick Troon

Figure 69: % of A & E attendances by age group and locality 2016

100.0

80.0

60.0 40.0 20.0

group(2016) 0.0 Ayr North and Ayr South and Girvan and South Maybole and Prestwick Troon

A&E A&E Attendances age by Former Coalfield Coylton Carrick Villages North Carrick Communities Communities 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

6.2 Inpatient Admission following Accident and Emergency Attendance

An important factor in emergency care is the proportion of attendances at A&E which result in an emergency inpatient stay. Naturally this impacts upon the number of admissions and bed days in the acute setting. Figure 70 involves Ayr Hospital and shows the percentage of emergency admissions which resulted in discharge to place of residence or emergency admission into Ayr Hospital as an inpatient stay. It shows that, for Ayr Hospital, 56.0% of A&E attendances result in the patient being discharged to their place of residence. 38.3% of patients were admitted to Ayr Hospital. This conversion rate is higher than for Scotland as a whole, which is 25.2%.

Figure 70: Inpatient admission following Ayr Hospital A&E attendance (year ending March 2017)

80 70

50 40 30

attendances 20 10

Discharge destinationof as % 0 Place of Residence Admission to same hospital Other

Ayr Hospital Scotland

The conversion rate for admission following A&E attendance varied by locality during 2016. The figure below shows that the highest conversion rate was for patients who reside in Girvan and South Carrick villages followed by those residing in Troon. Ayr North and Former Coalfield communities had the lowest conversion rates.

Figure 71: Conversion rate (%) by locality 2016

50.0 45.0

40.0 35.0 30.0 25.0 20.0 15.0

Conversion rate 2016 (%) 10.0 5.0 0.0 Ayr North and Ayr South and Girvan and Maybole and Prestwick Troon Former Coalfield Coylton South Carrick North Carrick Communities Villages Communities

The rate at which those who attend A&E are admitted varies by age group with around 73% of those aged 85+ being admitted. Around 40% of those aged 0-4 are admitted. The lowest conversion rate is for those aged between 10-14.

Figure 72: Conversion rate (%) by age group 2016

80.0 72.7

70.0 60.0 50.0 39.4 40.0 30.0 20.0

10.0 Conversionrates (%) 2016 0.0

The next chart shows the rate of emergency inpatient admissions (per 100,000 population). Between 2011/12 and 2015/16, it is clear that this rate is considerably higher in South Ayrshire than in Scotland as a whole. This may be explained, at least partly, by the older age profile of South Ayrshire residents.

Figure 73: Rate of emergency inpatient admissions (per 100,000 population)

16,000

14,000 12,000 10,000 8,000 6,000 4,000

Rate per 100,000 population 2,000 0 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

Figure 74: Rate of emergency inpatient bed days (per 100,000 population)

120,000

100,000

80,000

60,000

40,000

20,000 Rate per 100,000 population

0 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

Figure 74 (above) shows the rate of emergency inpatient bed days per 100,000 population. Similar to emergency admissions, the rate of bed days is higher in South Ayrshire than in Scotland as a whole. The Scotland rate has decreased slightly from 2011 to 2016 but the South Ayrshire rate has increased each year. Figure 75 (below) shows the rate of emergency inpatient bed days for the 65+ population. This suggests that the higher rate of emergency inpatient bed days seen previously is due to the older population living in South Ayrshire. However, this chart also suggests that since 2013/14, the rate for the older age group is higher in South Ayrshire than Scotland, even when taking into account the size of the older population.

Figure 75: Rate of emergency inpatient bed days for 65+ (per 100,000 population)

340,000

330,000 320,000 310,000 300,000 290,000 280,000 270,000

Rate per 100,000 population 260,000 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

6.3 Delayed discharges

A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available, for example to purchase a care home place.

Figure 76 below shows the rate of bed days occupied by delayed discharges for patients aged 75+. This is shown by 1,000 population.

Figure 76: Delayed discharges from inpatient care, rate of bed days occupied per 1,000 population, 2016/17

2,500

2,000

1,500

1,000 Scotland

500

Rate population perRate 1,000

Fife

Angus

Falkirk

Moray

Stirling

Orkney

Shetland

Highland

Inverclyde

Midlothian

EastLothian

Dundee City Dundee

Glasgow City Glasgow

EastAyrshire

Argyll & Bute & Argyll

West Lothian West

Renfrewshire

Aberdeen City Aberdeen

South Ayrshire South

NorthAyrshire

Aberdeenshire

PerthKinross &

Scottish Borders Scottish

City of City Edinburgh

South Lanarkshire South

NorthLanarkshire

EastRenfrewshire

Clackmannanshire

EastDunbartonshire

Dumfries & Galloway & Dumfries

West Dunbartonshire West Comhairle nan Eilean Siar Comhairlenan

In 2016/17, the number of bed days occupied by patients aged 75+ experiencing delayed discharges was 1,273 per 1,000 population. This is higher than the Scotland rate for the same time period, which was 842 per 1,000 population.

7. COMMUNITY SERVICES OVERVIEW

11,709 Carers in South Ayrshire. 10.4% of South Ayrshire Population compared to 9.3% across Scotland .

(Census 2011)

2000 CARE AT HOME 1800 1600 1400 1200 1000 By 2027 it is expected that there will be a 800 requirement for an additional 414 clients 600 age 65+ receiving care at home . An 400 increase of 31% compared to 2017. 200 0 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027

Actual Projected

By 2027 it is also estimated that there will be a requirement for an ADDITIONAL 306 Care Home Places.

Adult Support and Protection

Referrals increased from 845 in 2015/16 to

885 in 2016/17.

7. Community Services

7.1 Carers in South Ayrshire

Carers make a valuable contribution to our society and play a key role in the delivery of health and social care services. Within South Ayrshire, there are 11,709 individuals providing care. This is 10.4% of the population, compared to 9.3% for Scotland overall. Figure 77 below shows a breakdown of the carers in South Ayrshire by the number of caring hours they provide in a week. Of the 11,709 carers identified, 6,424 provide between 1 and 19 caring hours in a week (54.9%). 3,244 (27.7%) of South Ayrshire carers provide more than 50 caring hours in a week. The pattern identified in South Ayrshire is very similar to that in Scotland as a whole.

Figure 77: Number of caring hours provided in a week

Data Source: Scottish Census 2011

While the number of caring hours provided in South Ayrshire is similar in distribution to Scotland as a whole, the age profile of those providing care is slightly different. Figure 78 shows the age profile of carers below. For the first four age categories, from children to adults aged 49, the proportion of carers is lower in South Ayrshire than in Scotland as a whole, at 38.9% and 44.9% respectively. This means that, in general, South Ayrshire carers are older than they are across the rest of the population.

This is an important consideration given the changing structure of the population over the coming years, the increase in the older population and the decrease in the working age population.

Figure 78: Age profile of carers in South Ayrshire and Scotland

Figure 79: Characteristics of unpaid carers

Unpaid Carers in South Ayrshire are less likely to be employed than in the rest of Scotland and more likely to be aged 65+. There are approximately the same percentage of female carers and young Carers in South Ayrshire as across the rest of Scotland.

7.2 Care Homes

The number of Registered Care Home Places for Older People in South Ayrshire has increased by 23% between 2006 and 2016 from 913 to 1,126 (see Figure 80 below). The total number of Residents has increased by 13% over the same time period. The

number of registered places per 1,000 population in South Ayrshire is 42 which is higher than the national rate of 38.

Figure 80: South Ayrshire registered Care Home places and total number of residents, 2006-2016

1,200

1,000

800

600

400

200

0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total number of registered places Total number of residents

The mean age on admission to a care home in South Ayrshire was 83 in 2016 compared with 81 across Scotland. The mean age on discharge in South Ayrshire was older than the national average at 87 in South Ayrshire compared with 84 across Scotland. The average length of stay in 2016 was 2.2 in South Ayrshire compared with 2.3 across Scotland.

Between May 2016 and July 2017 there have been 798 emergency admissions to hospital for residents in Care Homes within South Ayrshire (see Figure 81 below). The average length of stay is around 6.8 days. On average there were around 53 emergency admissions per month. The most common reasons for emergency admissions were for Urinary Tract Infections and Pnuemonia.

Figure 81: Emergency Admissions to hospital from Care Homes

90 79 80 67 67 70 59 55 56 60 53 51 52 47 48 48 50 46 40 34 36 30 20

NumberofAdmissions 10 0 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2016 2016 2016 2016 2016 2016 2016 2016 2017 2017 2017 2017 2017 2017 2017 Year & Month of Admission

Data Source: NHS Ayrshire and Arran , Symphony , BI Team

7.2.1 Care Home Projections

By 2026 given the projected population changes and the care home admission rate and the proportion split between Nursing and Residential remains the same rate as January 2017- in the over 65’s – there will be an estimated requirement for an additional 306 care home places (Total of 1210 Care Home Places in over 65s).

Figure 82: Population projections for those requiring a Care Home (2016- 2026)

1300 1210 1200 1183 1151

1119 1100 1083 1041 1000 1013 957 983 By 2026 it is expected that there 900 904 928 will be a requirement for an 800 additional 306 care home places. An increase of 34% compared to residentsonly 65+ 700 January 2017.

600 Projectednumber ofstay long 500 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026

7.3 Home Care

Around 1,730 people currently receive a care at home service as at 31st March 2017. The introduction of Eligibility Criteria to access services and the rollout of the Reablement service had an impact on the overall number of people in receipt of Care at Home over the past 5 years. Over the past year there has been additional demand for Care at Home which has resulted in the numbers rising in 2017. This trend has also been observed on a national level.

Figure 83: No. of people in receipt of Care at Home as at 31st March (all ages)

2500 2250

2000 1830 1730 1720 1620 1500

1000

500

0 2013 2014 2015 2016 2017

Ayr South and Coylton has the highest number of people receiving home care overall, and the highest proportion of those aged 85+ in receipt of home care.

Figure 84: Number of people receiving home care by locality and age group (as at 31st March 2017)

500 450 400 350 300 Total 85+ 250 Total 75-84 200 150 Total 65-74 100 Total Under 65 50 0 Troon Prestwick Ayr S and Girvan and Maybole and Ayr North and Coylton South Carrick North Carrick Former Coalfield

7.3.2 Care at Home Projections

It is projected that there will be a requirement of an additional 414 clients aged 65 who will require a home care service by 2027. This represents an increase of 31% compared to 2017.

Figure 85: Projected number of clients receiving care at home (2015-2027) aged over 65

2000

1671 1708 1750 1590 1631 1500 1546 1421 1457 1492 1336 1388

1000 By 2027 it is expected that there will be a requirement for an additional 414 clients age 65+ receiving care at home . An 500 increase of 31% compared to 2017.

0 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027

Actual Projected

7.4 Adult Protection

Adult Protection cases are defined as persons aged 16 years or over who are unable to safeguard their own well-being, property, rights or other interests; are at risk of harm and

because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected. Adult Protection Referrals have increased year on year with an overall increase of 234% between 2011 and 2017. Analysis of referrals indicates that this sharp increase can partly be attributed to the introduction of new adult support and protection procedures and awareness.

Figure 86: South Ayrshire annual adult protection referrals 2011-2017

1000 885 900 845 800 736 700 549 600 500 South Ayrshire 400 275 265 Annual 300 Referrals 200 100 0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Data Source: SWIS Referrals

8. CHILDREN AND YOUNG PEOPLE

75.2% of Children are reaching Developmental Milestones at 27 – 30 Low Breast feeding rates month review

at 21.8% compared to Scotland = 72.4% Scottish rate of 30.3%

8.4 10 4.2 5.6 5.9

S 2.3 3.2 3.5 3.5

0 Stillbirth Perinatal Neonatal Infant

Estimated Four -year death Rates or live live orbirths

Rate per 1,000 total Scotland SAC

Rates of Stillbirth, Perinatal and Neonatal deaths higher in South Ayrshire than across Scotland.

Rate of Infant deaths the same as Scotland at 3.5 per 1000 live births.

3.2 per 1000 Children in South Ayrshire on Child Protection Register. (3.0 per 1000 Children in Scotland).

370 Children in South Ayrshire are Looked

. Increased numbers are being looked After after in their own homes.

Children in South Ayrshire have higher than average levels of NO dental caries. P1 (76.7% SA /69.4% Scotland) and P7( 85.5% SA/77.1% Scotland).

8. Children and Young People

8.1 Mortality

A stillbirth is a baby born dead after 24 completed weeks of pregnancy. If the baby dies before 24 completed weeks, it is known as a miscarriage or late foetal loss. During 2012, the most recent time period for which there is data available, there were 274 stillbirths in Scotland which is 4.7 stillbirths per 1,000 births, similar to the rate seen in England for the same period. Although this rate has decreased from 5.6 stillbirths per 1,000 births in 2007, one in every 210 births in Scotland still end in stillbirth. Due to the relatively small number of pregnancies affected, it is necessary to combine the data into three-year periods to enable monitoring of the situation. Since 2003/05 there has been a variation in the number of stillbirths in South Ayrshire of between 13 to 23 stillbirths with a slight increase over the past 3 years from 13 to 17.

Figure 87: The number of stillbirths in women from South Ayrshire, summed over three-year periods.

20 23.0 17.0 17.0

10 13.0 Stillbirths Numberof 0 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 2009/11 2010/12 2011/13 Three-year period

While the majority of births in South Ayrshire had a positive outcome, a certain number of pregnancies resulted in a stillbirth of neonatal death. The crude rates for these mortality measures in South Ayrshire were higher compared to the Scottish Levels. Infant mortality is the death of a baby who dies before their first birthday. The rate of infant mortality in South Ayrshire was 3.5 per 1,000 births, which matches the rate for Scotland in the same time period. Infant mortality is closely associated with all aspects of health inequalities and deprivation. Over half of infant deaths are attributed to conditions originating in the perinatal period, with the leading cause being short gestation and low birth rate.

Figure 88: Rates of stillbirth, perinatal, neonatal and infant mortality per 1,000 births* in South Ayrshire, compared to the Scottish average. Data are four-year averages (NRS, 2017).

8.4 10 5.6 5.9 4.2 2.3 3.2 3.5 3.5 0 Stillbirth Perinatal Neonatal Infant

Estimated Four-year death Rates Rate per 1,000 total or live totallive or births Scotland SAC

Data source: (https://www.nrsscotland.gov.uk/statistics-and-data/statistics-by-theme/vital-events/general-publications/births- deaths-and-other-vital-events-preliminary-annual-figures/2015

8.2 Maternity – Breastfeeding

The most up to date validated information from ISD for 2016/17 indicates that 21.8% of women in South Ayrshire were exclusively breastfeeding at the 6-8 week review. This has shown a reduction between 2013/14 to 2015/16 with a slight rise in 2016/17. The percentage exclusively breastfed at the 6-8 week review is considerably lower than the national position of 30.3% in 2016/17. Figure 89 also shows that South Ayrshire is below the national average for all years shown. Breast feeding rates are known to be lower in younger mothers compared to older mothers and are also lower in women who smoke compared to those who do not.

Figure 89: Breastfeeding at 6-8 week review

35 30.3 28.2 30 26.1 27.1 27.2 23.8 21.8 25 22 22.5 21 South Ayrshire 20 15 10 5 Scotland 0 2012/13 2013/14 2014/15 2015/16 2016/17

Data source: https://www.isdscotland.org/Health-Topics/Child-Health/Publications/2016-10-25/2016-10-25- Breastfeeding-Report.pdf

Figure 90 below shows the differences in breastfeeding at the 6-8 week review by Locality. Rates are lowest in the Ayr North and Former Coalfield Locality at 13% compared to 29% in Prestwick.

Figure 90: Breastfeeding at 6-8 week review by Locality

40% 27% 29% 30% 25% 19% 21% 20% 13% 10% 0% ANFCC ASC GSCV MNCC Prestwick Troon

Data Source: ScotPho Locality Profile ( 3 year aggregate 2014 to 2016)

Work is underway during 2017/18 to increase support from Assistant Nurse Practitioners during pregnancy and the antenatal period. The SAHSCP also increasing the uptake of premises signed up to Breastfeeding Happily Here, in conjunction with Public Health. From 2018 onwards, Health Visitors will determine feeding intention at the 32-34 week

antenatal visit. Where breast feeding is undecided, previous poor experience or first- time breast feeder then support will be offered from an assistant Nurse Practitioner.

8.2 Maternal Smoking at Antenatal Booking

Parental smoking during pregnancy is a significant factor in child healthy weight and future health. There is clear evidence that maternal smoking can directly lead to low birth weight (as much as 5% lower than non-smokers) and stillbirth. There is also some evidence that smoking during pregnancy could increase the risk of cot death and developmental delay.

The percentage of pregnant women recorded as smokers decreased from 24.1% in 2009-2011 to 19.6% in 2013-2015. The level recorded across Scotland was 17.3% in 2013-2015.

Figure 91: Percentage of women smoking at booking

30 25 20 15 10 5 0 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp?id=1791#1791

8.3 Low Birth Weight

Babies are defined as having a low birth weight when they weigh less than 2,500 grams at birth. Low birth weight is linked to infant mortality and is also strongly linked to socio- economic status and to smoking in pregnancy. In older children, low birth rate has been found to be significantly associated with delay in achieving developmental milestones. The proportion of births that are deemed to be low birth rate is generally lower in South Ayrshire compared to the Scottish level.

Figure 92: Low weight live singleton birth percentage of live singleton births

3 2.5 2 1.5 1 0.5 0

South Ayrshire Scotland

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/

The number of births deemed to be of low weight has decreased over the past two years (see Figure 93 below).

Figure 93: Number of low birth weight live singleton births (under 2500g)

70 64 57 60 52 51 53 53 52 52 54 47 50 48 50 43 45 42 40 30 20 10 0

8.4 Fertility

Fertility in South Ayrshire increased from 55.3 births per 1,000 women aged 15 to 44 in 2014, to 56.2 in 2015. For Scotland as a whole, the general fertility rate decreased from 54.7 births per 1,000 women aged 15 to 44 in 2014, to 53.2 in 2015.

Data Source: National Records of Scotland, Vital Events Reference Tables, https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths- and-other-vital-events-quarterly-figures

8.5 Teenage Pregnancy

There were 981 pregnancies in South Ayrshire from April 2016 – March 2017. Of these, 44 (4.5%) involved mothers under the age of 20. This is a slightly higher proportion than across Scotland as a whole (3.9%). The overall trend in the number of pregnancies in those aged under 20 has shown a reduction in the past 6 years.

Figure 94: Pregnancies in those aged under 20 in South Ayrshire (2010-2016)

100 87 80 84 72 60 57 57

40 44 44

0 2010 2011 2012 2013 2014 2015 2016

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp?id=1791#1791

Breaking this down further, teenage pregnancy rates in the under 16 age group in South Ayrshire are showing a downward trend from the 2008/10 position and are below the Scottish average.

Over the aggregated 2012-2014 period, the teenage pregnancy rate per 1,000 women aged under 16 years in South Ayrshire was 3.5 which was somewhat lower than the rate for Scotland as a whole at 4.9. The South Ayrshire rate had been reducing steadily from 2006-2008 when it was at a level of 11.0, although the 2012-2014 figure has increased from the 2011-2013 figure of 2.8.

Figure 95: Teenage rates for South Ayrshire and Scotland – Under 16 years

4 Rateper 1,000

0 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 2009/11 2010/12 2011/13 2012/14

South Ayrshire Scotland

8.6 Child Protection

Children are placed on the child protection register when there are significant concerns for their safety. Children on the register will be subject of close monitoring and support with a multi-agency plan to effect changes to reduce risk.

On 31 July 2017, in South Ayrshire, there were a total of 60 children on the child protection register:

 50% of registrations are for unborn babies or children under four years of age.

 35% of these are children under two years of age.

The South Ayrshire profile is similar to the national picture.

Figure 96: Number of children on the child protection register as at 31st July 100 91 80 70 64 61 60 60 49 49 40 20 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

The rate per 1,000 population aged 0-15 on the Child Protection Register increased steadily in South Ayrshire from 2007 to 2012 but in the last four years has seen falls and rises. In 2016 South Ayrshire had 3.9 children per 1,000 population aged 0-15 on the Register compared with 3.0 across the whole of Scotland.

Figure 97: Children on the child protection register rate per 1,000 population aged 0-15, 2007-2016

6 5 4 3 2 1 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

South Ayrshire Scotland

The number of children aged 0 to 16 years referred to the Children's Reporter on care and protection grounds decreased from 693 in 2015/16 to 454 in 2016/17.

Figure 98: Number of children referred to the Children’s Reporter on Child Protection Grounds

In 2016/17, the rate of children referred to the Children's Reporter on Child Protection Grounds within South Ayrshire was 24 per 1,000 children aged under 16 years compared to the Scottish average of 16 per 1,000 children.

Figure 99: Rate of Children referred to the Children’s Reporter on child protection grounds.

8.7 Looked After Children

The number of children looked after has reduced over the past year from 384 to 370.

Figure 100 : Overall number of children looked after as at 31st July .

400 384 380 365 370 352 360 343 340 330 320 300 2012 2013 2014 2015 2016 2017

Trends in terms of the age of children looked after show that there has a reduction in those aged between 5 to 11 and an increase in those aged 12 to 15.

Figure 101 : Age profile of children looked after as at 31st July.

200 2012 150 2013 100 2014 50 2015 0 2016 Under 1 1 to 4 5 to 11 12 to 15 16 to 17 18+

The majority of children in 2017 ( 94%) are being looked after in the community either at home with their parents, with friends/relatives or with foster carers. 6% of children looked after are in residential accommodation.

Figure 102 : Looked after Children by Status as at 31st July 2017

140 120 100 80 60 40 20 0

8.8 Child Health

8.8.1 Developmental Milestones

The overall percentage of those reaching the developmental milestones at the time of their 27-30 month review has decreased. The overall number of reviews has increased and the number of those reaching milestones has risen from 726 in 2014/15 to 738 in 2015/16. South Ayrshire performance is higher than both the national and Ayrshire and Arran level.

Figure 103 : Percentage of children reaching developmental milestones at the time of their 27-30 month review.

78 78.2 76.8 76 75.2 74 South Ayrshire 72.4 72 71.6 70.9 70 Scotland 68

66 2013/14 2014/15 2015/16

Data source: https://www.isdscotland.org/Health-Topics/Child-Health/Publications/2017-02-07/2017-02-07-Child- Health-27m-review-Report.pdf

Speech, Language and Communication is the domain where the least number of children are reaching their milestones and this area has shown a decrease over the past two years. This pattern is evident across Scotland with SLC being the lowest area where children are reaching milestones nationally.

Figure 104 : Percentage of children reaching developmental milestones at the time of their 27-30 month review by domain.

100 75 50 25 0

2013/14 2014/15 2015/16

8.8.2 Dental Decay

The percentage of Children in Primary 1 with no obvious dental decay in South Ayrshire has risen in the past two years from 66.8 to 76.7%. This is above the national average across Scotland of 69.4%.

Figure 105: Percentage of children in primary 1 with no obvious dental decay experience

80 76.7 75 70 66.8 65 64.1 60 55 2012 2014 2016 South Ayrshire Scotland

Data source: National Dental Inspection Programme (NDIP) 2017 http://www.isdscotland.org/Health-Topics/Dental- Care/Publications/data-tables.asp?id=1767#1767

The percentage of children in Primary 7 with no obvious decay in permanent teeth has also risen over the past two years from 84.2% to 85.5%, and is consistently above the national average.

Figure 106: Percentage of children in primary 7 with no obvious dental decay experience

100 82 84.2 82.5 85.5 72.4 80 65.2 59.3 60 South Ayrshire 40 Scotland 20 0 2005 2007 2009 2011 2013 2015 2017

Data source: National Dental Inspection Programme (NDIP) 2017http://www.isdscotland.org/Health-Topics/Dental- Care/Publications/data-tables2017.asp?id=2026#2026

8.8.3 Healthy weight

The percentage of children with a Healthy Weight in P1 has fluctuated above and below the national average over the past few years. Performance in South Ayrshire for 2016/17 was above the national average at 77.0 for South Ayrshire compared to 76.1 nationally.

Percentage of children in Primary 1 receiving a review, with valid height and weight data recorded, who are a healthy weight (epidemiological). These statistics have been calculated using the UK 1990 growth reference standards. These are widely accepted as the reference

for growth screening in children over four years of age in the UK. These define healthy weight as children whose BMI is greater than the 2nd centile and less than the 85th centile.

Figure 107: Percentage of primary 1 children healthy weight

82.0

80.0 78.6 78.0 South 77.0 Ayrshire 76.0 Scotland 74.0

72.0

70.0 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17

Data source: ISD Scotland : Body Mass Index of Primary 1 Children in Scotland - School Year 2015/16http://www.isdscotland.org/Health-Topics/Child-Health/Publications/data-tables.asp?id=1773#1773

8.8.4 Children at Risk of Obesity

The percentage of children at risk of obesity in P1has also fluctuated above and below the national average for the past few years. Performance in South Ayrshire for 2016/17 was 10.0% compared to 10.5% nationally.

Percentage of children in Primary 1 receiving a review, with valid height and weight data recorded who are at risk of obesity (epidemiological). These statistics have been calculated using the UK 1990 growth reference standards. These are widely accepted as the reference for growth screening in children over four years of age in the UK. These define at risk of obesity as children whose BMI is greater than or equal to the 95th centile.

Figure 108: Percentage of primary 1 children at risk of obesity

14.0 13.0 12.0 South 11.0 Ayrshire 10.5 10.0 9.0 10.0 Scotland 8.0 7.0 6.0 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17

Data source: ISD Scotland : Body Mass Index of Primary 1 Children in Scotland - School Year 2015/16http://www.isdscotland.org/Health-Topics/Child-Health/Publications/data-tables.asp?id=1773#1773

9. Criminal Justice

9.1 Crime Generally, crime levels in South Ayrshire have fallen over the period 2013/14 to 2015/16. The overall rate of reported crimes and offences per head of population in 2013-14 was 1,428 per 10,000 population compared with 1,024 per 10,000 population in 2015-16.

Figure 109: Total crimes and offences per 10,000 population

Within Ayrshire, the number of crimes recorded per 10,000 population in 2015-16 indicates that overall South Ayrshire has a lower crime rate than the national average. Crimes of dishonesty were slightly higher than Scotland.

Figure 110 : Crimes recorded by police per 10,000 population and Partnership area 2015-16

East North South Ayrshire Ayrshire Ayrshire Scotland Non sexual violence 12 12 11 13 Sexual Offences 16 15 15 19 Crimes of dishonesty 218 217 219 216 Vandalism including fire raising 112 112 93 101 Other Crimes 119 110 94 110 Total Crimes 477 467 432 458 Crime Index 104 102 94 100

9.2 Domestic Abuse

Since 2014/15, the number of domestic abuse incidents recorded by Police in South Ayrshire has reduced from 1,294 to 1,011 in 2016/1717. That’s a reduction of 22% in two years. Consequently the rate of reported domestic abuse incidents per 10,000 population in South Ayrshire has also reduced and is now well below the Scottish rate – 90 per 10,000 population vs 110.

Figure 111: Reported number of domestic abuse incidents 2010-2017

Figure 112: Reported rate of domestic abuse incidents per 10,000 population 2010-2017

Scot Government - Domestic abuse in Scotland: 2016/17 statistics

9.3 Fires

The rate of deliberately set dwelling fires per 100,000 population in South Ayrshire decreased from 199 in 2014/15 to 192 in 2015/16. The rate for Scotland was 281 in 2015/16.

Figure 113: Fires per 100,000 population

The number of accidental dwelling fires per 100,000 population in South Ayrshire increased from 68 in 2014/15 to 79 in 2015/16. The rate for Scotland was 96 in 2015/16. The Locality Profiles contain some additional information against both accidental dwelling fires and deliberate fires broken down to each locality for the period 2013-2017.

9.4 Violent Crime

The rate of violent crimes of 11 per 10,000 population in 2015/16 decreased from the previous year but has hovered between 10.8 and 13.8 for the last five years after a significant reduction from 22.9 in 2010/11.

Figure 114: Violent crimes recorded rate per 10,000 population 2010-2016

9.5 Road Safety

The overall rate of dangerous and careless driving offences recorded per 10,000 population in South Ayrshire has been increasing over recent years. The rate recorded in 2015/16 was 20 compared with 13 in 2012/13. The 2015/16 level was below the Scottish average at 22.

Figure 115 : Dangerous and careless driving offences recorded per 10,000 population

0 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

South Ayrshire Scotland

The number of people killed and seriously injured in road traffic collisions per 10,000 population had been steadily reducing each year from 5.3 per 10,000 population in 2010 to 2.3 per 10,000 population in 2013, although 2014 has seen an increase to 3.6. This 2014 rate is in line with Scotland overall.

Figure 116 : Rate of people killed or seriously injured in road traffic collisions per 10,000 population

0 2006 2007 2008 2009 2010 2011 2012 2013 2014

South Ayrshire Scotland

9.6 Prison Statistics

The Prisoner population aged 16+ per 100,000 population in South Ayrshire was 207.7 compared to 161.9 in Scotland.

(Source: SPS via Scottish Government, Snapshot at 31 March 2014)

9.7 Community Safety

The 2016 South Ayrshire Quality of Life Survey asked respondents how safe they feel when walking alone in their neighbourhood during the day and at night. The charts below show that:

 The majority of people (98%) stated that they feel either fairly safe or very safe when walking alone outside in their neighbourhood during the day which is slightly higher than the findings from the 2014 SA1000 Quality of Life survey (97%). In 2016, two per cent stated that they felt a bit unsafe or very unsafe compared to 3% in the 2014 findings.

 In contrast to feeling safe during the day, a marked difference in responses occurs when people are asked how safe they feel when walking alone in their neighbourhood after dark. Eight out of ten of respondents (82%) said that they feel either very or fairly safe. The same result was experienced in 2014 when panel members were consulted but a lower result was found in the 2012 Quality of Life Survey (77%). The 2016 level is lower than the SHS figure for South Ayrshire (89%) and Scottish average (85%).

Figure 117: Results from SA Quality of Life Survey Question “How safe or unsafe do you feel when walking alone in your neighbourhood after dark?

100 82 82 77 80

60 2012

40 2014 23 18 18 2016 20

0 Very safe/Fairly safe A bit unsafe/ Very unsafe

Those groups more likely to feel unsafe walking alone in their neighbourhood after dark were: • Females • Those unemployed • Those living in deprived areas • Those living in privately or social rented accommodation • Those living in Ayr North, Ayr West, Kyle or Girvan and South Carrick wards • Those living in Ayr North and Former Coalfield Communities or Girvan and South Carrick Villages localities.