Community & Social Care Seven Kings Cluster Profile 2015

Community & Social Care Seven Kings Cluster Profile

2015

Community & Social Care Seven Kings Cluster Aldborough Road North, Newbury Park, Ilford, Essex IG2 7SR

Developing a sustainable preventative quality health and adult social care service delivered locally for the residents of Redbridge

Contents

Summary ………………………………………………………………… 3 6 Commissioning implications……………………………………. Introduction……………………………………………………………. 10

1. Demography……………………………………………………… 10 Population structure and population change Age Ethnicity Household structure

2. Social Indicators…………………………………………………. 16 Deprivation Income and employment Political engagement

3. A healthy environment ……………………………………… 19 Green spaces Crime Housing

4. Health Indicators ………………………………………………. 22 Self assessed health Mortality rates Life expectancy Long term illness Emergency care Children’s health

5. Well being and lifestyle …………………………………….. 34 Childhood obesity Adult obesity Smoking

6. Social care – Keeping people independent ………. 36 Need for social care Learning disability Carers Residential care

7. End of Life care …………………………………………………. 40

References 41 Appendix 1 Practice codes 42

2 Summary

Population

 The locality has a slightly younger population structure than Redbridge population with only 10% aged 65+ years compared to 12% for Redbridge  The population is increasing and is projected to further increase by 10% by 2025 with the biggest increases in Seven Kings and Aldborough wards and in older age groups, with the number of people aged 65+ years projected to increase by 25%.  International migration is a key driver for population increase in Redbridge with people from the Indian subcontinent having been the main migrant groups. More recently Romanians have been the most numerous.  Births have increased by nearly 50% in the locality since 2002. Although the increase in the birthrate appears to have levelled off there will continue to be an increase in the 0- 14 year population for the next 10 years.  The ethnic composition of the locality is mixed; the largest group is Asian (40%) and the second largest is white (32%). The proportion of older Asian people is projected to increase.

Socio-economic circumstances  Seven Kings locality has a slightly more deprived profile than the Redbridge average. Goodmayes ward in particular has levels of deprivation in the most deprived 40% in the country and a majority (60%) of Seven Kings ward is in the most deprived 40%. There are lower levels of employment and a higher proportion of people claiming out of work and housing benefits in these two wards than Redbridge average. Nearly a quarter of children in these wards are living in poverty  Fewer people are home owners and more are in privately rented accommodation in Goodmayes and Seven Kings wards than the Redbridge average.  The locality is built up and, with the exception of Aldborough ward which has a majority of land that is green space although not all publicly accessible, has a low amount of green space. Access to green space is known to enhance health and well being.  Crime rates are the similar to or lower than the Redbridge average with the exception of Seven Kings ward which has much higher total crime and violence against the person crime rates  Levels of local political engagement are similar to the London average, however turnout in local elections was only around 40% suggesting that people do not feel they have much of a stake in their local communities.

3 Health indicators  The proportion of people who said that their health was bad or very bad was higher in Goodmayes, Seven Kings and Aldborough wards than Redbridge average  Life expectancy in Aldborough ward is significantly lower for men and women than London and Redbridge averages, and mortality rates higher than the London average. However life expectancy has increased by 5 years for men in Seven Kings ward, higher than Redbridge and London averages  The prevalence of diagnosed long term illness is generally lower than the Redbridge and national average and this is likely to be due to the younger age profile. Rates of Coronary Heart Disease are lower than the Redbridge average but rates of diabetes are much higher than Redbridge and national rates. The numbers of people who report that they have a limiting long term illness is expected to increase significantly over the next 20 years.  The numbers of people with diabetes has increased by 25% in the period 2009/10 to 2014/15 and is projected to continue to increase. In a majority of locality practices control of diabetes (as measured by levels of HbA1c) is similar to the Redbridge average of 57%. This is likely to lead to more complications in the long term.  Rates of diagnosed depression were lower than the borough average but severe mental illness in adults and dementia in the locality were similar to the borough average. Dementia is likely to increase in the locality with the increase in the number of people aged 65+ years in the near future  Although incidence and mortality from cancer in Redbridge is lower than national averages one year survival is worst and survival rates have not improved in line with national and London trends. The main reason for poor one year survival is late diagnosis. Practices in the locality have better than average rates for fast tracking suspected cancer patients but over one third (37%) of cancer patients in the locality have not been fast tracked.  Emergency admissions have been increasing across London. The ratio of emergency to elective planned admission can give an indication of the way people use the services. In Seven Kings locality this ratio was similar to the Redbridge average.

Children’s health  Births increased by 50% between 2002 and 2012 and the general fertility rate (number of births/1,000 women 15-44yrs) also increased in the locality. However this has now levelled off or started to decline in all wards in the locality  Immunisation is an effective way of preventing disease. Redbridge has significantly lower uptake of MMR vaccine at 2 and 5 years and vaccination rates are not high enough to create ‘herd immunity’. This puts children at risk of preventable disease. In the locality no practice met the 95% threshold for any vaccinations. Only three practices met the immunisation target of 90% for at all vaccinations at 12 months

4  Goodmayes ward has significantly higher rates of teenage pregnancy than the national average. Teenage mothers are more likely to suffer post natal depression, less likely to breast feed and more likely to live in poverty.  Rates of attendance at and admission to A&E by children <18yrs are the highest in the borough. It is likely that the location of the A&E facility in the locality is a significant influence on this.  Childhood obesity remains a problem and obesity rates for children ages 4-5yrs and 10- 11yrs are higher than the London average. Although there has been a general decrease in levels of obesity in 4-5 yr olds in the locality, in 10-11yr olds obesity has increased in all wards except Goodmayes and obesity levels double between reception and year 6. This suggests that more could be done in schools serving these wards.

Adult risk factors  Adult obesity is high in the locality with a fifth of people being obese and a further 30% being overweight. Obesity is a major contributory factor for increasing prevalence of diabetes and hypertension.  Smoking rates are lower in Redbridge than the national and London rates. There were 254 deaths attributable to smoking in 2013. Redbridge has a successful smoking cessation programme with 50% of service users meeting the 4 week quit target in 2014/15. Rates of smoking in Seven Kings are slightly higher than the Redbridge average. Quit rates are 60% in Aldborough and Chadwell wards

Social Care indicators - Supporting Adults, maintaining independence  The need for social care for older adults is likely to increase as the numbers people aged 65+ years increases  Over 1140 adults were receiving long term care in the locality in 2015, 78% of whom were 65+ years  Around 190 people were receiving support for learning disability, over half of whom are receiving care at home  A higher proportion of people receiving long term care in Seven Kings locality are 18-64 years than the Redbridge average and this reflects the greater needs of this population.  Fewer people receiving care were getting direct payments (14%) than in other localities.  A majority of carers (73%) are receiving direct payments, this is one of the highest in Redbridge  The locality has a number of large residential care homes and this is reflected in the higher numbers of people in residential care.  The community meals service provides meals every day of the year to people assessed to be in need and enables people to stay in their own home. Fifty seven per cent of users are aged 85+years. In Seven Kings 110 people use the service. Day centres also provide opportunities for support and to reduce loneliness.

5 End of Life care  Although most people say they would prefer to die at home the great majority of people (63%) in Redbridge die in hospital.  The proportion of people dying at home in Redbridge in 2011/13 (18%) was the second lowest in the country. This has improved slightly to 20% in 2014 but it is still very low comparatively.  The pattern in the locality reflects the broader Redbridge picture with nearly 60% of deaths in hospital but fewer people (16%) die at home.

Commissioning implications

1. Demographic change

The overall projected population increase of 10% by 2025 will increase need and demand for all services. The projected 25% increase in the older population will have major impacts on the numbers of people in need of both health and social services, particularly in Seven Kings and Aldborough wards

1.1 Increase in child population The birth rate has started to decline in most wards and it is unlikely that there will be a further increase in demand for maternity and postnatal services.

The large increase in births in the period 2003-13 will increase need for children’s services for the next 10 years at least, particularly for health and education services, resulting in:

 Increased need for school places  Increased need for health visitors and school nurses  Increased need for paediatric health services, including Child Mental Health Services  The increased fertility rate suggests larger family sizes. This will impact on need for larger housing units to accommodate larger families.

Consideration should be given to developing specific urgent care services or centres for children with integrated services in areas where there is high need.

1.2 Increase in the older population  The projected 25% increase in people aged 65+years in the locality, and particularly those aged 85+years, will increase the number of frail elderly who will be in need of social care support, either to maintain independent living or for residential care.

6  There is likely to be an increase in age related illnesses. The rapid increase in diabetes will increase the need for patient awareness and support for self management and for treatment services

 Dementia numbers are likely to increase, with consequent need for support for this vulnerable group

1.3 Changes in ethnic composition  With continuing migration from SE Asia, and the aging of the resident Asian population there will be an increase in illnesses for which those population groups have higher risk. This includes, diabetes, heart disease and TB. Services will need to be able to respond to this.

2. Socio-economic factors

 Government welfare and housing benefit changes have increased overcrowding and homelessness in the borough, and particularly in the locality which has a high percentage of people living in privately rented accommodation vulnerable to insecurity of tenure.

 The housing situation throughout the borough gives little flexibility to deal with increasing pressures in the market due to the low proportion of social housing. The increase in numbers of households in temporary accommodation is expensive and unsuitable. New solutions will need to be found

 The locality has a poor physical environment with lack of green space except in Aldborough ward. Road accidents are increasing. There are significant levels of poverty and unemployment and economic vulnerability. These situations are particularly focussed in Goodmayes, Seven Kings and Chadwell wards

 Poor physical, social and economic environments increase the likelihood of mental and physical ill health

It is recommended that:  More green spaces be provided for leisure activity to improve the physical environment and increase opportunities for physical activity  Support is provided for people to find work and/or improve their skills  Attention is paid to improving road safety to reduce accidents  Innovative housing solution be sought to increase the availability of affordable housing to ensure that people are housed in suitable conditions

7 3. Health

Early intervention – older people  The largest ethnic group in the locality is the Asian population and the proportion of older people who are Asian will increase as the population ages. Asian people have a much higher risk of CHD and diabetes. Need for both preventative and treatment services for these conditions is likely to increase substantially in the coming decade as this population group gets older

 Goodmayes, Seven Kings and Aldborough wards already have a higher proportion of people with poor health than the borough average. The projected 25% increase) in people aged 85+ is likely to result in a corresponding increase in people who have conditions that limit their daily activities, and who are likely to need support to live independently, or in more severe cases, residential care. This will have consequences for commissioning and providing home care services.

 Increased work on falls prevention will be needed to reduce the numbers of elderly people who fall and need hospital care. This should include vitamin D supplementation where individuals are vitamin deficient and at risk of osteoporosis. In particular in the older Asian population will be more at risk because of darker skin and less sun exposure.

 Early intervention to keep older people healthy and independent will help reduce and/or delay the need for health and social care services. Such interventions may be better provided by a vibrant voluntary sector who are often closer to communities. Developing and maintaining the voluntary sector will need robust funding mechanisms.

 The burden of diabetes is rapidly increasing. This will affect the health and lives of thousands of local residents and will also present an increasing need for both primary and secondary health care. It is estimated that diabetes accounts for 10% of the NHS budget (Diabetes UK), it is likely that proportion in much greater in Redbridge and in Seven Kings locality. Preventing diabetes and reducing its effects should be a key priority for the locality through: o Improving access to leisure services and facilities to reduce obesity o Increasing opportunities and programmes for physical activity o Improved diabetic control through Expert patient programmes and improved primary care services for people with diabetes

 Although survival from cancer is improving, incidence is increasing as the population gets older. Redbridge has worse survival rates than the national average. Improving early detection of cancer through raising awareness of symptoms in the population and encouraging GPs to audit their referrals will save lives.

 Too many people die in hospital and too few die at home in the locality and Redbridge as a whole. The Gold Standards Framework in Primary care can facilitate and enable people to die at home and this should be rolled out in the practices in the locality.

Maternity and Children’s services

 It seems likely on the basis of current trends in fertility that the need for maternity services will not continue to increase.

 However the rapid increase in births since 2002 will continue to increase the need and demand for paediatric health services and school places. The highest numbers of children are predicted to be in Seven Kings ward by 2015. This is also one of the poorest wards with the highest needs

 Goodmayes ward has the largest numbers of teenage parents, who are generally in greater need of educational and social support. It is recommended that children’s services, including health visiting services, are concentrated in children’s centres to facilitate client access and joint working, and that the numbers of health and social care professionals reflect that need.

 Obesity rates have continued to increase in primary school children in all wards except Goodmayes. Levels of obesity double during primary school. Focused work in schools and with parents in this area is recommended

 Immunisation uptake rates in all practices in the locality are well below target and put children at risk. Further action should be taken to improve uptake.

9 Seven Kings Locality Profile 2015

Introduction

Seven Kings locality is comprised of 5 wards in the east of Redbridge. It is bordered on the east by Barking and Dagenham. There are good transport links; the locality is served by the overground train lines from Liverpool St to Shenfield. Fairlop water and Golf Course within the locality providing leisure opportunities.

No Code Practice name There are 11 GP 4 F86642 Dr M Quraishi - Castleton Road Health Centre surgeries in the locality 5 F86028 Dr D Kana - Chadwell Heath Surgery and 12 pharmacies. 14 F86087 Dr Ak Shah & Partner - Goodmayes Medical Centre King George Hospital is 15 F86034 Dr Patel - Goodmayes Medical Practice located in the locality 17 Y00155 Dr Z Moghul - Grove Surgery with an A&E 23 F86060 Dr Clarke & Partners - Newbury Group Practice department. 25 F86704 Dr E Paul - Paul'S Surgery 28 F86637 Dr Price & Partner - Seven Kings Practice 30 F86635 Spearpoint Surgery - Pooled List 34 Y00090 Dr Spiteri & Partners - The Doctors House 41 F86009 Dr Mackenzie & Ptners - The Palms Medical Centre

10 1. Demography

Population structure

The population structure of Seven Kings locality is slightly younger than the Redbridge population structure with 10% aged 65+ years (cf 12% Redbridge) and 23% (cf 22%) under 15 years (Fig 1).

Fig 1.Population age distribution, Redbridge (line) and Seven Kings locality (bars)

90+ Males Females

85-89

80-84

75-79

70-74

65-69

60-64

55-59

50-54

band

45-49

A 40-44

35-39

30-34

25-29

20-24

15-19

10-14

5-9

0-4

8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8 Population (%)

Population change

Redbridge has experienced annual population increases of around 5,000 (1-2%) for the past decade. Population change is comprised of 3 elements, in-country migration in or out, international migration and natural change (balance between births and deaths). In 2014 the key drivers in Redbridge were international migration and natural change (Table 1) Fig 2

Table 1. Types of population change NI registrations to international migrants 2014, Redbridge

5000 Type of change Change 4500 n 4000 Cranbrook & Internal migration -1622 3500 Loxford

International 3403 3000 Fairlop

migration n 2500 Seven Kings Natural change 3003 2000

1500 Wanstead Source: GLA Borough Profiles 1000

500

0 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Source: GLA ward atlas. NI = registration for eligibility to work in UK

11 Net internal migration was negative, indicating that more people moved out of Redbridge than moved in from other parts of the country. India, Pakistan and Bangladesh were the most frequent sources of migration. In 2011/12 a third of international migrants registering for work in Redbridge came to Seven Kings locality (Fig 2) indicating that more people moved out of Redbridge than moved in from other parts of the country. India, Pakistan and Bangladesh were the most frequent sources of migration

Age

Seven Kings locality had an estimated population of nearly 80,000 (GLA population estimates) in 2015. This is projected to increase by 10% overall by 2025, with the largest percentage increases, of 25% in the older age groups (Table 2).

Table2. Projected population change, 2015-2025, by age group, Seven Kings locality

0-4 5-14 15-44 45-64 65-84 85+ All ages Aldborough 2015 1121 2185 6864 3420 1624 340 15554 Chadwell 2015 1505 2331 6960 3232 1191 304 15523 Goodmayes 2015 1278 1938 6582 2863 1057 105 13823 Newbury 2015 1441 2897 8071 3729 1470 154 17762 Seven Kings 2015 1417 2430 7979 3165 1282 212 16485 Locality 2015 6762 11781 36456 16409 6624 1115 79147

Aldborough 2025 1137 2559 7518 4156 1885 458 17713 Chadwell 2025 1436 2850 7237 3485 1366 345 16719 Goodmayes 2025 1228 2109 6402 3023 1489 141 14392 Newbury 2025 1266 3136 7858 4217 1845 173 18495 Seven Kings 2025 1706 3115 9515 3680 1659 276 19951 Locality 2025 6773 13769 38530 18561 8244 1393 87270 % change 2015-2025 0.2 16.9 5.7 13.1 24.5 24.9 10.3 Source: GLA population projections 2014 based

However there is considerable variation by ward. Aldborough and Seven Kings are predicted to have population increases of 14% and 21% respectively by 2025 (Table 3). All wards are projected to have big increases in the numbers of people over 65 years from 14% in Chadwell to 40% in Goodmayes. Seven Kings is predicted to have a 25% increase in children aged 0-14 years.

12 Fig 3

Projected trends in population numbers by age, Seven Kings locality

50000 Table 3. % change, 65+, all ages. by 45000 ward, 2015 to 2025 All 40000 0-14 65+ ages 35000 Aldborough 11.8 19.3 13.9 Chadwell 11.7 14.4 7.7 30000 0-4 Goodmayes 3.8 40.3 4.1 5-14 Newbury 1.5 24.3 4.1 25000 15-44 Seven Kings 25.3 29.5 21.0 45-64 20000 Locality 10.8 24.5 10.3 65-84 85+ 15000

10000

5000

2014 2016 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 2012 Source: GLA Population projection 2014 based

Births

Both the number of women of childbearing age and the fertility rate have been rising over the last 10 years and there has been a large increase in births (Fig 4). All wards except Aldborough in Seven Kings locality have had a higher fertility rate than the Redbridge average (Fig 5). The number of births in the locality increased by nearly 50% from 880 in 2002 to 1322 in 2013. It appears from the trend data that the fertility rate has now started to decrease and the number of births has evened off and population projections suggest further declines in all wards except Seven Kings.

Fig 4 Fig 5

Trends in the number of births, by locality Trends in General Fertility rates in Seven Kings locality wards 1,800 1,600 120.0 Aldborough 1,400 100.0 1,200 Newbury Cranbrook & Loxford 80.0 1,000 Chadwell Fairlop 800 60.0 Seven Kings 600 Seven Kings 40.0 Goodmayes 400 Wanstead 20.0 Redbridge 200 0.0

03 04 05 06 07 08 09 10 11 12 13

0 0 0 0 0 0 0 0 0 0 0 0

2 2 2 2 2 2 2 2 2 2 2 2 Source: GLA Ward profiles

13 Ethnicity

Redbridge is a very ethnically diverse borough, Ethnic projections for the borough show that in 2015 38% were identified as white, and the next largest group Asian (Indian/Pakistani/Bangladeshi). There is considerable variation by age with much greater diversity in the younger age groups than in the 65+ years age group (Fig 6).

Fig 6 Fig 7

Ethnic distribution by age, 2015 Ethnic distribution by age, projectioned Redbridge 2025 100% 100% 90% 90% 80% Other 80% 70% Other Other Asian 70% Other Asian 60% Chinese 60% Chinese 50% Asian Asian 50% Black Other 40% Black Other 40%

Black African Black African 30% Black Caribbean 30% Black Caribbean 20% White 20% White

10% 10%

0% 0% 0-14 15-44 45-64 65+ All ages 0-14 15-44 45-64 65+ All ages Source: Census 2011

The white population is expected to decrease proportionately and the Asian population to increase between 2015 and 2025 (Fig 7). This is most noticeable in the older population 65+yrs in which 29% projected to be Asian by 2025 compared to 19% in 2015 (Fig 7, Tab 4).

Fig 8

Table 4. Change in % distribution of ethnic Projected changes in ethnic composition, Redbridge, 2015 to 2025 populations 2015 to 2025, by age

50.0 45.0 0-14 15-44 45-64 65+ 40.0

e 35.0 White 2015

g 23.0 33.1 46.4 68.7

n 30.0

a 25.0 ch

20.0 White 2025 19.3 29.1 36.4 53.9 % 15.0 2015 10.0 5.0 2025 Asian 2015 42.2 43.0 30.2 19.5 0.0 Asian 2025 46.8 47.6 39.7 29.3

Fig 9

There is also considerable variation across Ethnic distribution, Seven Kings the borough, with BME communities locality Other concentrated in Seven Kings, Newbury and Black Other Black Caribbean Goodmayes wards (Fig 10). In 2011 10-15% Black African white of the population in the locality was from Other Asian black communities (Fig 9). This may change Chinese as international and internal migration

Mixed patterns change (Fig 9). Asian

14 Fig 10

Ethnic distribution by ward Census 2011)

100%

90%

80%

70% other

60% Other Black Black Caribbean 50% Black African 40% Other Asian

30% Chinese Asian 20% Mixed 10% White

Changes in the ethnic composition of the population can affect the need for health care where particular ethnic groups have higher risk for particular conditions, eg. Sickle cell disease is primarily found in people of West African or Caribbean origin; South Asian communities have higher risk than other communities of developing diabetes and CHD; black men have higher risk of prostate cancer; cultures where consanguineous marriage is common tend to have higher rates of congenital abnormalities.

Household Structure

Lone parents

Around a fifth (21%) of households with dependent children in Redbridge are headed by a lone parent.

Fig 11

Chadwell ward had the highest % of households with dependent children percentage with 26% lone parents. headed by a lone parent Overall in the locality 22% of families 30 25

were headed by a lone parent. 20

Over 50% of lone parents were not in % 15 10 employment in Chadwell (50%), 5 Goodmayes (53%) and Seven Kings 0 (60%).

Source: 2011 Census

15 Older people living alone

Older people have greater need for health and social care which increases as they get older. Older people living alone are more vulnerable and likely to be in need of support from statutory or voluntary services if they have not got close family support.

Fig 12

% of people aged 65+yrs who live alone, Overall the locality has a younger population than Seven Kings Redbridge (Fig 12) with 10% aged 65+ years. In the

s 30

y 2011 census, there were 7360 people aged over

+ 25

e 20 l 65 years (9.5%). Of those 1,890 (26%) said they op 15

f 10

o were living alone. This is below the Redbridge

% 5 0 average. However, the older population 65+ yrs is

projected to increase by 25% by 2025 and it is likely that the number of elderly living alone will Source: 2011 Census increase proportionately.

2. Social Indicators

Deprivation

Deprivation scores are derived from a range of indicators for each small area (lower super output area – LSOA; there are 6-8 LSOAs per ward). Scores have been grouped into national quintiles across the country. Distribution of local scores by these quintiles enables a comparison of the local with the national deprivation profile.

Seven Kings is the second most deprived locality in Redbridge. Data from the 2015 Index of Deprivation show that 50% of LSOAs in the locality are in the most deprived 40% (Fig 13). Goodmayes is the most deprived ward with all the LSOA in the worst 40% (Fig 13).

Fig 13. Deprivation Profile by national quintile. Index of Deprivation 2015*

100% 100% 90% 90% 80% 80% 70% 70% 5 60% 5 60% 50% 4 4 50% 40% 3 3 40% 30% 2 20% 2 30% 1 10% 1 20% 0% 10%

0% Locality Redbridge

*Proportion of LSOAs that fall into each deprivation quintile. 1= most deprived. Source:......

16 However, the proportion of children under 16 years living in poverty (children living in families where income is less than 60% of median income) declined in all wards by much more than the national and London averages between 2006 and 2012 (Fig 14), although it remains higher in Goodmayes ward than the London average (Fig 15). In the light of recent welfare changes this trend may have recently changed.

Fig 14 Fig 15

Trends in % of children <16 living in poverty % of children <16 living in poverty, 2012 40 30

35 25 Aldborough 30 20 Chadwell 25 Goodmayes 15 20 Newbury 10 15 Seven Kings 5 10 London 0 5 England 0 2006 2007 2008 2009 2010 2011 2012 Source: GLA Ward profiles

Income and employment

Employment rates in Redbridge in 2011 (67%) were slightly below the London (69%) and national (71%) rates.

Fig 16

Employment rates by ward Seven Kings locality All wards in Seven Kings locality had 72.0 below the national and London averages,

70.0

r 68.0 y

66.0 (Fig 16), Seven Kings and Goodmayes

64 -

64.0 rd th

62.0 had the 3 and 4 lowest rates in the pop

60.0 of borough. % 58.0 56.0 54.0

Source 201 Census

Correspondingly, these wards along with Chadwell also had the highest rates of benefit claims for Housing Benefit (Fig 17), Job Seekers Allowance (Fig 19) and Out of Work Benefits (Fig 18) in 2014/15. Over 15% of dependant children in Goodmayes were in out of work households (Fig 20).

17 Fig 17 Fig 18

Rate of Housing Benefit claims, 2015, Claimant rate for out of work

by ward benefits, 2014

14.0 16.0 12.0 14.0 10.0 12.0 8.0 10.0 8.0 6.0 6.0 4.0 4.0 2.0 2.0 0.0 0.0

Fig 19 Fig 20

Claimant rate for Job Seekers % of dependant children in out of Allowance, 2015 work households, 2014

4.0 20.0 3.0 15.0 2.0 10.0 1.0 5.0 0.0 0.0

Source: GLA Ward profiles

In 2014 there were 2,800 children 0-18 years living in out of work households, with the largest numbers in Chadwell and Goodmayes wards

Political engagement

People’s willingness to participate in local and regional elections can be seen as a measure of political engagement and the extent to which people feel that they have a stake in their society.

Fig 21

Data from the 2012 London Mayoral % Turnout in local and London Mayoral elections 50.0 elections show that turnout in Seven Kings 45.0 40.0 locality was lower in all wards than the 35.0 Redbridge average (Fig 21), with 30.0 25.0 Local election 20.0 2014 Goodmayes and Chadwell wards having the 15.0 10.0 Mayoral 2012 third and fourth lowest turnouts in 5.0 0.0 Redbridge. However turnout in local elections in 2014 was generally higher than the London average, but still less than 40%

Source: GLA ward profiles

18 3. A Healthy Environment

Green spaces

The importance of the environment in which people live to people’s health is increasingly being recognised. Much research shows that when people have access to open green spaces or green environments they are happier and healthier (Mitchell 2008). Good planning in urban areas to maximise availability of green space for residents should therefore be a priority.

Fig 22

% of the area that is open space, 2014 Apart from Alborough ward, which has a

90.0 majority of land that is green space and 80.0 70.0 contains a golf course and a lot of farm 60.0 50.0 land, there is much lower levels of open 40.0 30.0 space than in Redbridge as a whole or 20.0 10.0 than in London (Fig 22). Creation of more 0.0 green spaces for leisure and pleasure would have health and well being benefits Source: GLA ward profiles

Crime

Levels of actual and perceived crime and violence can impact directly on health and indirectly on people’s sense of safety and security. Fear of crime can increase social isolation by preventing people from going out. Although Redbridge has higher crime rates than the national average it has lower rates than the London average.

There is wide variation in rates across the Fig 23 borough but except for Seven Kings ward, Crime rate, by ward, 2014/15 the total crime rate (crimes per 1,000 100.0 population) in Seven Kings locality was 80.0 similar to or lower than Redbridge and 60.0

London averages (Fig 23). This pattern is 40.0 largely reflected in the rate of Violence 20.0 against the person rate which is highest in 0.0 Seven Kings and Goodmayes (Fig 24). Trends show that total crime rates are lower than the London rate and have decreased in all Source: GLA ward profiles wards except Chadwell over the last 10 years (Fig 25).

Fig 24 Fig 25

Violence against the person, rate, Trends in total crime rate, by ward 2014/15 160.0 140.0 35.0 120.0 30.0 Aldborough 25.0 100.0 Chadwell 20.0 80.0 15.0 Goodmayes 10.0 60.0 Newbury 5.0 40.0 0.0 Seven Kings 20.0 0.0 London

Source: GLA Ward profiles

Housing

Redbridge has the highest proportion of privately owned properties in London and the 2nd lowest proportion of social rented housing in London with only 11% of properties in this sector compared to 24% in London. Owner occupation decreased by 11% in Redbridge between 2001 and 2011 with a corresponding rise in private renting. In 2015 there were 4,500 houses in the social rented sector in the borough. There is variation across the borough. Data from the 2011 Census show that Goodmayes and Seven Kings wards have the lowest proportion of owner occupied properties and correspondingly the highest proportion of rented properties, the majority of which are privately rented (Fig 26).

Fig 26

Housing tenure, wards in Seven Kings locality

100% 90% 80% 70% 60% 50% Private rented 40% 30% Social rented 20% Owned 10% 0%

Source: Census 2011

Increasing population has put considerable strain on the housing market and, as for the rest of London this has caused market pressure on rents. Decreasing security for private tenants and increasing rents has resulted in a substantial increase in the numbers of people who are homeless due to evictions and evictions are now the cause of 50% of reasons for

20 homelessness. The low stock of social housing in the borough means that there is very little capacity to house homeless people in permanent housing.

In 2015 the number of people on the housing list was 7812 of which 29% were due to homelessness and nearly half due to overcrowding.

A consequence of the severe pressure in the housing market has been the illegal renting of outbuildings as residential accommodation (‘beds in shed’). A recent review in Redbridge (Beds in Sheds 2015) found 168 such illegal structures. Over a quarter (n=46) of these structures were in Seven Kings locality, and 16 of these were occupied. Across Redbridge 65% of the occupants were found to be Asian, 18% were Eastern European. Many of these structures provided poor and inadequate housing with health and safety risks.

The number of people who were in temporary accommodation due to homelessness has increased and in June 2015 was 2174 households, 366 of which were in B&B (299) or hostels (67). Redbridge has the 9th highest number of households in temporary accommodation in London

Amongst homeless households in temporary accommodation there is particular over- representation of single mothers. Many homeless applicants have also experienced changes in welfare benefits and increasing poverty. Being homeless and living in temporary accommodation can itself cause considerable stress for individuals and families. Where families are housed out of borough there can be considerable disruption to family and social networks, children’s schooling and accessibility to workplaces. This may cause or exacerbate mental and physical health problems.

Road accidents

Seven Kings has around 250 road accidents a year. After declining for some years road accidents have increased in 2014 (Fig 27).

Fig 27

Total road casualties, trend by locality 350

300

250 Cranbrook & Loxford 200 Fairlop 150 Seven Kings

100 Wanstead

0 2010 2011 2012 2013 2014

Source: GLA ward profiles

21 4. Health indicators

Self assessed health

Two questions in the census can give a general snapshot of health of the population; one question is about general state of health, the other is whether the respondent has a long standing illness that limits their activity. In 2011, 5% of the Redbridge population said they were in bad or very bad health and over 41,000 people (15%) said that they had a limiting long term illness (LLTI), of which nearly half (47%) said that it limited their activities a lot. This was a 6% increase on 2001, although this was a lower increase than the population increase reflecting the fact that the population increased faster in the younger age groups who are less likely to have a long term illness. Seven Kings locality had lower rates of LLTI in all wards but higher levels reporting they were in bad or very bad health in Aldborough, Goodmayes and Seven Kings wards than the Redbridge average (Table 5).

Table 5. Numbers and % of people who said they had limiting long term illness (LLTI), and who described their health as poor or very poor

No with LLTI % with LLTI No with bad/v % with bad/v bad health bad health Aldborough 2261 15.5 737 5.1 Chadwell 1984 13.9 584 4.1 Goodmayes 1869 14.3 667 5.1 Newbury 2254 13.4 740 4.4 Seven Kings 2179 14.4 778 5.1 Locality 10547 14.3 3506 4.8 Redbridge 41372 14.8 13675 4.9 London 4.9 England 5.4 Source: 2011 Census

Numbers of people with LLTI are expected to increase significantly over the next 20 years, resulting in extra needs for care and support (Fig 28). Numbers of people in Redbridge with LLTI aged 85+ are projected to increase 51% by 2030, and those aged 65-74 years to increase by 39% (Fig 28). (Source: www.poppi.org.uk version 9.0, based on 2011 Census data)

Fig 28 Fig 29

Projected number of people whose Projected Number of older people whose activites are limited a lot, by age Redbridge activities are limited a little by illness, by

age, Redbridge 6,000

8,000 5,000

4,000 6,000 65-74 65-74 3,000 4,000 75-84 75-84 2,000 85+ 2,000 1,000 85+ 0 0 2014 2015 2020 2025 2030 2014 2015 2020 2025 2030

22 Mortality rates

There were 1809 deaths in Redbridge in 2013, a decline from 2073 in 2002; of which 448 were in the locality

Mortality rates in Redbridge have been consistently around or below the national and London averages but have declined slightly more than the London and national rates since 2002.

Fig 30

Trends in Mortality, Seven Kings wards (SMR: England =100)

130

i 120

a R

110 Aldborough

y t

li 100 a

t Chadwell r

o 90 M

Goodmayes

d 80 e

is Newbury

d 70

r a

d 60 Seven Kings

a t S 50 London 40 Redbridge

Source: ONS

In Seven Kings locality mortality rates for most wards are above the Redbridge average but have declined in line overall in line with borough trends except for Aldborough and Chadwell wards where mortality rates have been increasing since 2006/8 (Fig 30). Mortality rates in Aldborough ward are 30% higher than Redbridge average and 20% higher than the national average.

Life expectancy

Life expectancy is a very broad indicator of overall health and trends in life expectancy can be useful in identifying underlying issues. Life expectancy in Redbridge is higher for both men (Fig 31) and women (Fig 32) than the London and National averages. However the rate of increase over 10 years 1999/2003 to 2009/13 has been slightly slower.

23 Fig 31 Fig 32

Trends in male life expectancy Trends in Female life expectancy

85 85

83 83

81 81

s r

79 Redbridge 79 Redbridge

Yea Yea 77 London 77 London 75 England 75 England

73 73

2004 2005

2003 2006 2007 2008 2009 2010 2011 2012 2013

2003 2005 2006 2007 2008 2009 2010 2011 2012 2013

2004

------

99 00 01 02 03 04 05 06 07 08 09

9 0 0 0 0 0 0 0 0 0 0

1 2 2 2 2 2 2 2 2 2 2

2 2 2 2 2 2 2 2 2 2 1 Source: GLA borough profiles

In 2009-13 life expectancy for males and females was lower than the Redbridge average in all wards except Newbury (Fig 33a, 33b) and significantly lower for males in Aldborough ward and females in Aldborough and Chadwell wards than Redbridge and London averages (Fig 30).

Table 6. Males and female life expectancy 2009-13, Seven Kings Locality wards

Male Female Increase 1999- Increase 1999- 2013 males 2013 females Aldborough 78.5 81.7 2.2 1.7 Chadwell 79.2 81.5 1.9 0.5 Goodmayes 78.8 84.0 1.8 2.7 Newbury 80.9 87.4 2.0 5.7 Seven Kings 79.9 83.5 5.1 4.0 Redbridge 80.7 84.2 3.4 2.7 London 79.7 84.1 3.9 3.2

Redbridge has had a lower increase in female life expectancy (2.7 years) than London (3.2 years) in the period 1999-2013 (Table 6). Newbury and Seven Kings wards experienced the largest increase in life expectancy for both men and women over the period.

Fig 33a. Male life expectancy 2009-13, Fig 33b. Female life expectancy, 2009-2013, Seven Kings locality wards Seven Kings locality wards 90 90 88 88 86 86

84 84

82 82

s r

80 r 80 Yea 78 Yea 78 76 76 74 74 72 72 70 70

Source: GLA

24 Over 10 years male life expectancy in the locality increased in line with trends in London, although life expectancy in Aldborough has shown a decline since 2006. Female life expectancy has generally been lower than the London average, and, as for males, there appears to have been a decrease in some wards since 2006

Fig 34a. Trends in male life expectancy Seven Fig 34b. Trends in female life expectancy Seven Kings locality wards Kings locality wards 90 90 88 88 86 Aldborough 86 Aldborough 84 Chadwell 84 Chadwell 82 Goodmayes 82 Goodmayes 80 80 78 Newbury Newbury 76 Seven Kings 78 Seven Kings 74 London 76 London 72 Redbridge 74 Redbridge

Source: GLA ward profiles

Long term illness

Information about the prevalence of major diseases comes from GP disease registers (QOF). It is likely that there will be some undetected or undiagnosed illness in communities so these data are likely to be underestimates. Another source of data are calculated estimates derived from expected prevalences based on demographic factors. These estimates do not always take account of specific local factors. Admissions to hospital and death rates can also provide further detail of major illness.

The major illnesses considered here are coronary heart disease, diabetes, stroke, respiratory disease and serious mental illness.

Prevalence data come from the National GP database and rates are not age standardised. Redbridge has lower rates of Cardiovascular Disease (Stroke and CHD), Chronic Obstructive Pulmonary Disease (COPD) and hypertension than England (Fig 35). As these are all age related diseases lower rates are likely in part to be due to a younger age profile in the population. However there are much higher rates of diabetes.

Fig 35

Prevalence of selected long term condtions, Table 7. Number of people with condition diagnosed in locality 2014/15 2014/15, Seven Kings locality (QOF data) 16.0 Condition n CHD 1717 14.0

12.0 Hypertension 6958 10.0 ation Stroke/TIA 649 l pu 8.0 o COPD 510

p England

f 6.0 o Redbridge Diabetes 4817 % % 4.0 Seven Kings SMI/1000 582 2.0 Depression 2037 0.0 Dementia 345

Source: National GP Practice Profiles

Diabetes is a major disease. Obesity is the main risk factor for Type 2 disease. It can be controlled by drugs and lifestyle. Poor control can result in major complications which may require hospital admissions and can affect life expectancy.

In Seven Kings locality there are higher rates of diabetes than the Redbridge average (Fig 35). Diabetes rates have increased substantially in the 5 years 2009 to 2014/15 and numbers have increased by 25% in the locality, less than Redbridge rates (37%). Change in prevalence for individual practices varies between 2 and 48% (Fig 36).

The numbers of people with diabetes in the locality have increased by 25% between 2009/10 and 2014/15 and are likely to continue to increase in the near future. Some of this increase may be increased detection and diagnosis through health checks, most will be lifestyle related or due to population changes.

Fig 36

% of diabetic patients with HbA1c is a marker of control of blood HbA1c<59mmol/mol, Seven Kings practices, sugars. Only 60% of the diagnosed 2014/2015 population in the locality had good Redbridge diabetes control (HbA1c<50mmol/mol), F86087 F86034 although the variation between F86642 F86637 practices was 47% to

F86635 68%. All except two of the practices in F86060 the locality had diabetic control rates Y00155 Y00090 similar to the Redbridge average (Fig F86009 F86704 36). However these rates represent a F86028 risk of developing complications 0 20 40 60 80

Source: National GP Practice Profiles, QOF data

26 Coronary heart disease is one of the main causes of premature mortality. Key risk factors include smoking, inactivity, poor diet, hypertension.

The rates of diagnosed CHD have not increased in the locality between 2009/10 and 2014/15.

Chronic Obstructive Pulmonary Disease (COPD) is mainly caused by smoking and is a significant cause of death and morbidity. Treatment and stopping smoking can reduce the severity of symptoms and reduce the likelihood of needing emergency admission to hospital. Rates of COPD (crude rates) in Redbridge are significantly lower than the national rates.

Seven Kings locality has lower crude prevalence of COPD than the Redbridge average (Fig 37). This is likely to be due the younger age profile of the population. COPD is mainly a disease of people 75+ years.

Fig 37 Fig 38

% prevalence of COPD, 2014/15, by locality COPD rates per 1,000 and Smoking prevalence 2.0 %, Seven Kings locality, 2014/15 1.8 Redbrid… 1.6 F86034

1.4 Y00155

ion t 1.2 la Y00090 1.0 F86704 Smoking %

popu

o 0.8 F86635 % COPD/1000 0.6 F86028 0.4 F86642 0.2 F86060 0.0 F86087 Cranbrook Fairlop Seven Wanstead Redbridge England F86009 & Loxford Kings F86637 Source: National GP Practice Profiles, QOF 0 5 10 15 20

Source: National GP profiles, QOF data

COPD is often under-diagnosed, particularly in the early stages. In the locality practices the highest prevalence rates are not found in populations with the highest smoking rates (Fig 38). It is likely that there is some under-diagnosis in practices which have high smoking prevalence and lower COPD prevalence.

Hypertension increases the risk of heart disease, stroke and kidney disease. Blood pressure generally increases as people get older and less active; body weight and diet are also significant factors. Effective treatment can reduce the risk of developing disease.

Rates of hypertension are lower in Redbridge than the national average (Fig 39). As hypertension is an age related disease this is likely to be due in part to the younger age profile of the population. Prevalence of diagnosed hypertension was similar in Seven Kings locality to the Redbridge average. In a majority of practices over 80% of patients with diagnosed hypertension had their blood pressure well controlled; four practices had significantly better rates of hypertension control, one had significantly worse (Fig 40).

27 Fig 39 Fig 40

Prevalence of hypertension, by locality, 2014/15 % of patients with diagnosed hypertension whose BP 16 was < 150/90 mmHg, 2014/15, Seven Kings Practices

14 England Redbridge 12 Y00090

F86635

10 ation l F86087

pu 8 F86637

o p

f F86034 o 6 % F86028 4 F86642 F86009 2 F86704

0 F86060 Cranbrook Fairlop Seven Wanstead Redbridge England Y00155 & Loxford Kings 0 10 20 30 40 50 60 70 80 90 100 Source: National GP Practice Profiles

Mental Illness

Around 4% of patients in Redbridge have a diagnosis of depression recorded on the GP disease register, according to QOF data. This is significantly below national rates (Fig 41). Seven Kings locality has a lower proportion of adults diagnosed with depression than the borough average, levels of severe mental illness (Fig 42) and dementia (Fig 43) are comparable to the Redbridge average.

Fig 41 Fig 42

Prevalence of depression, people 18+ yrs, Prevalence of severe mental illness, per by locality, 2014/15 1,000, by locality 2014/15 6.0

5.0

10 s

t y

a l

+ 4.0

u 8 18

pop

on 0 i 3.0

t 6

l 100

r e

popu 4 p

2.0

e % t Ra 2 1.0 0 0.0 Cranbrook & Fa irlop Seven King s Wanstead Redbridge Cranbrook Fairlop Seven Wanstead Redbridge Loxfo rd & Loxford Kings Fig 43

Prevalence of dementia, by locality, per As the population ages the number of 1,000, 2014/15 people diagnosed with dementia is likely to 7.0

6.0 increase. The number of people aged 65+ on i

t a l 5.0 years is projected to increase by 25% in the u

pop 4.0 locality by 2025. A comparable increase in

0 00

, 3.0

r the number of people suffering from

e p

2.0 e e

a dementia is likely.

R 1.0

0.0 Cranbrook & Fairlop Seven King s Wanstead Redbridge Loxfo rd Source: National GP Practice Profiles

28 Cancer

Redbridge overall has slightly lower incidence of and mortality from cancer in both men and women. However, one year survival from cancer is lower in Redbridge and is the fourth lowest in London and one year survival rates have not improved as much as national survival rates (Fig 44).

Fig 44

One year survival is determined largely by Trends in one year survival, all cancers, 15 - how soon the cancer is diagnosed and 99yrs. Cancer survival index*

75 x

treated – earlier diagnosis and treatment e

d 70

n i

l l 65

gives a much better prognosis. England a v

i 60

v r

u 55 has lower survival than many other S Redbridge

d d 50

e s similar countries and the government has i

d 45 London

r a

d 40 n put in place actions to improve early a

t 35

g 30

diagnosis. Fast tracking patients with A suspected cancer through the ‘Two week wait (TWW)’ route can aid earlier Source: NCIN Cancer Commissioning Toolkit diagnosis.

However, across the country, still the majority of people who turn out to have cancer are not fast tracked through this route. The proportion of people who go through the TWW route was higher in Redbridge (58%) in 2014 than England (48%). In Seven Kings locality there were 150 new cancer cases diagnosed in 2014/15 of which 94 (63%) were referred through TWW; this was the highest proportion in the borough however practice rates ranged from 44% to 79%. These data should be treated with caution as numbers are small and there are recognised data quality issues.

Fig 45 Fig 46

% of people diagnosed with cancer who % of people diagnosed with cancer who were referred through TWW by practice, Seven Kings locality, 2014/15 were referred through TWW, by locality, 2014/15 Redbridge F86060 70 F86028 60 F86704 50 40 F86637 30 F86009 20 F86642 10 Y00090 0 F86635

F86087

Y00155

F86034

.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 Source: GP Practice profiles, data from NCIN

29 Emergency care

The use of emergency care has been increasing across London. The reasons for this are complex. People over 65 years and children under 5 years have the highest rates of hospital admissions so practice population age distribution will affect the number of admissions for the practice.

Fig 47

The proportion of hospital admissions that % of hospital admissions that were emergencies, by are emergencies can give an indication of locality, 2012/13 50 need and of the way that people and GPs 45 use local services. In Seven Kings locality 40 35 overall this proportion was similar to the 30 25 Redbridge average (42.8%) in 2012/13 (Fig 20 47). These data are no longer reported in the 15 10 Practice profiles. 5 0 Cranbrook & Fairlop Seven Kings Wanstead Redbridge Loxford Source: National GP Practice Profiles 2014

An A&E audit of people aged 75+years attending Queen’s Hospital A&E department was conducted in 2013. Sixty five per cent of attendees were female with a median age of 83 years. A majority (66% of respondents) were admitted.

Key findings were:  The most common presentations (25%) were as a result of a fall  91% were brought by ambulance  Over 50% ambulances were called by carers  Professional carers often called an ambulance as a default reaction to an incident  A significant number of attendances were repeats for the same condition (especially falls) or as a result of lengthy symptoms not addressed in the community

The key reasons cited for attendance were:  Most patients & carers were unaware of alternatives to A&E attendance and few had used such alternatives before  A significant proportion of patients and carers felt A&E attendance was the only suitable option  Easier access to home visits and urgent GP advice or appointments were cited as potential alternatives to A&E attendance

30 Reducing A&E use

The Redbridge First Response Service (ReFRS) was established by Adult Social Services to help postpone or prevent crisis in people with long term needs. People are referred to the service from a variety of organisations in the borough, are assessed by the ReFRS team and then referred on to an appropriate agency to meet their needs. The project has been running over a year. In the period Dec 2013 to November 2014 there were 506 referrals received. Nearly half of initial referrals came from GPs, the remainder from voluntary or statutory organisations. Forty one per cent of referrals to the service were from Seven Kings locality.

Children’s Health

Prevention – childhood immunisations

Immunisation against Measles, Mumps and Rubells (MMR) in children aged 2 years in Redbridge is lower than the national average but similar to the London average (however London has the lowest uptake of vaccinations in the country) (Fig 48). The proportion of children aged 5 who have had both MMR jabs is significantly lower in Redbridge than both the London and national averages and is the 7th lowest in London.

Fig 48

Uptake of of MMR1 and MMR2 at 2 and 5 years,

2014/15 95 90 85 80 75 Redbridge 70 England 65 London 60 55 50 MMR1 MMR2 Source: HSCIC

These levels are well below the levels required to create herd immunity in the population (95%) and create a significant risk of infectious disease, which can have long term consequences. There have been a number of outbreaks of these diseases in London in recent years.

No practice met the 95% threshold for all vaccinations (Table 8). Only three practices met the immunisation target of 90% for at all vaccinations at 12 months. Two practices met that target for the vaccination rounds for MMR at 5 years

31 Table 8. Uptake of selected immunisations, 2014/15, by practice, Seven Kings locality 12 months 24 months 5 years

Dtap/IPV/Hib Men C Dtap/IPV/Hib MMR MMR 1 MMR 2 F86009 87.4% 89.7% 82.9% 73.9% 84.1% 71.0%

F86028 83.7% 84.1% 86.1% 81.2% 82.1% 65.0%

F86034 87.1% 92.1% 81.0% 70.8% 79.2% 66.4%

F86060 93.3% 92.8% 88.3% 84.8% 89.6% 78.3%

F86087 92.7% 92.7% 83.6% 80.7% 81.8% 58.8%

F86635 82.9% 88.6% 88.9% 86.1% 93.8% 66.7%

F86637 90.0% 93.3% 85.2% 83.3% 86.2% 70.8%

F86642 83.3% 87.5% 77.0% 79.3% 90.1% 65.4%

F86704 77.8% 77.8% 93.1% 89.7% 81.0% 69.0%

Y00090 86.1% 90.1% 85.2% 77.3% 83.7% 62.5%

Y00155 59.2% 76.1% 63.9% 55.0% 78.1% 48.8%

Source: COVER data

Children’s use of A&E services

Children are high users of A&E services, particularly children under 5 years. Rates of attendance at A&E by children under 5yrs (Fig 50 children under 18yrs (Fig 51) were higher in Seven Kings locality compared to the Redbridge average. All but two practices in Seven Kings had significantly higher attendance rates than the Redbridge average (Fig 49). This may be due to the proximity of the A&E at King George Hospital. However there is considerable variation between practices.

32 Fig 49 Fig 50

A&E Attendance rates, 0-4 years, by practice, 2011-13 A&E attendance rates, 0-4 years, by locality, 2011/14

Redbridge 600

F86066 s r

F86675 4 500 -

0 F86023

400

F86064 p

ad F86013 300

000

t ,

F86691 1 n 200

F86020 er Wa

F86658 100

F86032 Rate F86641 0 F86731 Cranbrook Fairlop Seven Wanstead Redbridge F86012 & Loxford Kings F86704 F86034 F86009

F86635

gs Fig 51 n

i F86642 K Y00155 A&E attendance rates 0-17 years, by

ven F86028 e

S locality, 2011/14 F86087

Y00090 400

F86637 r

y 350

F86060

18 ,

300

F86057 op

p 250

F86707 F86010 200

000

F86083

150

p er

o F86007

l p

r 100

a F86081 F 50

F86085 Rate F86612 0 F86624 Cranbrook Fairlop Seven Wanstead Redbridge Y02987 & Loxford Kings Y00918 F86025 F86692

r F86082 o f

x F86008

o L

F86022

k F86698

o F86042

ro b

n F86652 F86657 Cra F86703 F86702 F86655 0 100 200 300 400 500 600 700 800 Source: National GP Practice Profiles These data are no longer reported in the national profiles

Teenage pregnancy

Fig 52

Teenage pregnancy rates (conceptions in Rates of Teenage pregnancy, Seven Kings, 2011/13 women <18 years) are lower in Redbridge 45 40

than the London and national rates, 35

000 ,

however there is significant variation by 1

er p

ward. There were nearly 100 conceptions 15 Rate 10 in your women < 18years in the period 5 2011-13, nearly a thirdof the Redbridge 0 total. Goodmayes has the highest rates

and the highest number in the locality. Source: ONS

33 5. Well being and Lifestyle

Childhood Obesity

Increasing rates of childhood obesity have caused concern for many years. A worrying consequence of increasing obesity has been the development of diabetes type 2 in children – normally seen in middle aged people. As part of the National Child Measurement Programme, the heights and weights of all children are measured in reception and year 6 annually. Of major concern is the fact that obesity rates double between the ages of 4-5 and 10-11years. Rates of obesity in Redbridge are similar to London rates.

Fig 53

Childhood obesity rates are Trends in childhood obesity, Seven Kings wards above the Redbridge and 30 Aldborough Recep London averages in most

25 Chadwell Recep wards (Fig 53). There is

Goodmayes Recep 20 evidence that levels of Newbury Recep

obesity are starting to

% 15 Seven Kings Recep decrease in reception year London Recep 10 in Goodmayes and Seven Aldborough yr 6 Kings. However rates have 5 Chadwell yr 6 risen in Yr 6 in all wards Goodmayes yr 6 0 except Goodmayes. Newbury yr 6

Seven Kings yr 6

London yr 6

Source: NCMP

The continuing increase in obesity levels by year 6 and the wide gap between rates of reception and year 6 children suggests that more should be done in primary schools to address this issue.

Adult Obesity

Levels of adult obesity are increasing across the country; national data from the Health Survey for England 2013 showed a national prevalence of obesity of 25%. Adult obesity, particularly when coupled with lack of physical activity, is associated with an increased risk of diabetes, heart disease, hypertension, some cancers, musculoskeletal problems and other illnesses.

In Seven Kings locality practices the proportion of people measured as being obese or overweight was 20% and 32% respectively (Fig 54), although these proportions by practice ranged between 16%-20% and 21%-32% (fig 55). These are generally higher than the

34 Redbridge rates. However these data should be treated with caution as around 10% (range 3% to 38% by practice) of patients had no record of weight measurement. These levels represent increased risk.

Fig 54 Fig 55

% of adults who are overweight or obese, % of adults who are overweight/obese, by by locality, 2015 practice, Seven Kings locality, 2015 Redbridge 60% F86028

50% Y00090 F86635 40% F86034 30% F86009 % Overweight 20% % Obese F86642 % Obese 10% % Overweight F86060 0% Y00155 F86637 F86087 F86704

0% 10% 20% 30% 40% 50% 60% Source: Health Analytics 2015

Smoking

Smoking is a major cause of death and disease. In 2013 there were 254 deaths in Redbridge that were attributable to smoking, around 14% of all deaths. The main sources of data about smoking behaviour are from patient information from GPs (QOF) and estimates derived from national surveys. These give slightly different prevalence figures. For consistency estimates have been used here. Smoking rates in Redbridge are significantly lower than the London and National averages. Fig 56

Estimated prevalence of smoking by ward, 2015

a r

ENGLAND

a rs p

o LONDON t m

Co REDBRIDGE Bridge

Roding

e Wanstead t s n Church End a W Snaresbrook Monkhams

Goodmayes s

n Seven Kings

i K Newbury

en v Chadwell Se Aldborough Hainault

p Fullwell

lo Fairlop ir

a F Barkingside Clayhall

Loxford

k Clementswood

o o o

r Mayfield

xf o

nb L Valentines

Cra Cranbrook

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0% 18.0% 20.0% Source: ASH

Smoking rates in Seven Kings locality are higher in all wards than the Redbridge average (Fig 56).

Fig 57

Redbridge has had a successful Quit Quit rates by ward, 2014/15 Smoking service for a number of years, with

70 s r 60

around 1000 people per year meeting a 4 se u

ce 40

week quit target; in 2014/15 50% of people vi

r 30

who set a quit date were still quit at 4 f 20 o 10 weeks. This is similar to the England (51%) % 0 rate. In 2014/15 286 people in Seven Kings locality met the four week quit target,

representing a quit rate of 50% for the Source: Smoking Cessation service locality. This was similar to the borough rate. Quit rate = % of people who are still quit 4 weeks after having set a quit date and Quit rates were higher in Alborough and Chadwell wards than the Redbridge average.

6. Social Care - Keeping people independent

Need for social care

As people get older they are more likely to need support in managing daily life. Appropriate support can help people to stay in their home and reduce the likelihood of hospital admission or the need for residential care. In Redbridge in 2015 there were 4706 receiving long term social care, of whom 80% (n=3759) are 65+ years (Table 9) . Around 8% of people receive care out of borough. Seven Kings locality had a similar proportion of adults receiving long term care to the borough rates (Fig 58). Rates of people aged 18-64 years receiving care were higher than in Wanstead and Fairlop localities and this is likely to reflect higher needs in the population (Fig 60). The numbers of older people (65+ years) receiving long term care are fairly consistent across each of the localities (Table 9).

Table 9. Number of people in receipt of social care, 2015, by locality and category

Receiving long term care Receive Adults In receipt Receiving residentia with of short all direct l/ nursing learning term care Locality adults payments (%) 65+ 18-64y care 65+y disability n (%)** Cranbrook & Loxford 1104 128 (12) 848 256 187 157 257 (19) Fairlop 1044 177 (17) 880 164 93 132 299 (22) Seven Kings 1142 164 (14) 889 253 209 193 231 (17) Wanstead 967 271 (28) 836 131 89 83 352 (27) Redbridge* 4706 762 (16) 3759 947 769 652 1182 (25) *359 people received care out of borough and 90 had no locality recorded ** As % of all receiving care Source: ASCOF indicators, Care First database

Fig 58 Fig 59

Adults receiving long term care, by % of people aged 65+years receiving locality, 2015 long term care, 2015, by locality 25.0 14.0

12.0 op 20.0 p

10.0 18+ 15.0 8.0

% 000 ,

1 10.0 6.0

er p

4.0 5.0 Rate 2.0 0.0 0.0 Cranbrook Fairlop Seven Wanstead Redbridge Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford Kings & Loxford

Fig 60 Fig 61

Adults 18-64years receiving long term People receiving short term care, by care, 2015, by locality locality, 2015 rate per 1,000

6.0

7.0

s r 64y - 5.0

8 6.0 +y

5.0

ed 4.0

g 1

po 4.0

op p

3.0 000 ,

2.0 1

000

, 2.0

er p

er 1.0 1.0

0.0 0.0 Rate Rate Cranbrook Fairlop Seven Wanstead Redbridge Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford Kings & Loxford

Source: Care First database

Only 14% of people in the locality were receiving direct payments to pay for their care; this is one of the lowest for the borough and half the rate in Wanstead locality. Seven Kings also had the lowest proportion of people receiving short term care (Fig 61).

Learning Disability

There were 652 people receiving support for learning disability in Redbridge in 2015, and 193 in the locality. In 2013/14 there were 804 adults on GP registers with learning disability. Not all people with learning disability will be eligible for or receiving care.

Fig 62

Prevalence of people with learning The proportion of people receiving care for diability receiving care, 2015, by locality learning disability in the locality is much 4.0

higher than other localities and the s r 3.5 +y

18 3.0 Redbridge average (Fig 62). Of those

op 2.5

p receiving care, 52% are living at home with

2.0

000 ,

1.5 family. This is the lowest level in the borough er

p 1.0 Because of recent changes in a number of

0.5 Rate 0.0 eligibility criteria it is not possible to look at Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford the trends for these data. Source: Care First Redbridge

Carers

Redbridge supports 675 carers across the borough, of which 183 are in Seven Kings locality. The majority (73%) of this support in the locality is through direct payments; this is one of the highest in Redbridge.

Residential care

There were 769 people receiving Local Authority support in residential or nursing homes across the borough. There are 75 nursing homes in the borough and people will be placed in a particular home according to need and availability so the distribution of people in homes does not indicate need in any given locality. However, people living in residential care are likely to have higher needs for health care which will fall on the local health providers. Neighbouring boroughs have considerably less capacity for residential care than Redbridge so quite a number of people are placed in Redbridge by other boroughs. This will also increase the health need. Conversely 20% of people supported in residential care are in homes out of borough. Seven Kings has the highest numbers of people receiving residential care support in the borough.

Falls prevention

Having an accidental fall can result in major injury requiring surgery and long term rehabilitation. The risk of falls increases as people get older and develop cognitive and/or physical impairments. As the population ages the numbers of falls are likely to increase unless active intervention and prevention programmes are put in place.  The numbers of people admitted to hospital as a result of falls increased by 8% over the period 2010/11 to 2012/13.

38  Projecting Older People Population Information (POPPI) forecasts that the number of admissions in Redbridge is likely to increase by 28% over the period 2010 to 2030, with a corresponding increase in costs.  The cost of falls in people aged 65+yrs in Redbridge in 2012/13 was nearly £3m.  A recent audit at Queens Hospital showed that 25% of people aged 75+ attending A&E did so as a result of a fall.

Community services – Meals

The community meals services aims to help people to live independently for longer by delivering meals to people at home who struggle to cater for themselves. It provides a nutritionally balanced two course meal and is available 365 days of the year. Clients pay a flat rate for the meal. This service is not means tested.

The great majority (83%) of clients are aged over 75 years with 57% aged 85+ years (Table 10). Most clients use the service nearly every day. In 2014/15 there were 110 clients who used the service in Seven Kings locality, the second lowest number of people using the service in the borough (Table11).

Table 10. Current users of community meals Table 11 Community meals service users , service, as at Nov 2015, by age and gender 2014/5 by locality Age group n % Locality n 18 - 64y 14 5.1% Cranbrook & Loxford 101 65 - 74y 33 12.1% Fairlop 154 75 - 84y 71 26.1% Seven Kings 110 85+ 154 56.6% Wanstead 156 All ages 272 Total 521

Gender Male 37% Female 63% Source: Community Meals service

Day centres

There are a number of day centres across the borough which cater for older adults with specific needs. These can be accessed by people across the borough. They provide a means tested service and include lunch, day activities and often transport. Attendance at day centres can reduce the need for health and social care by reducing social isolation and loneliness. Older people: two day centres, one in Hainault and one in Goodmayes cater for older people;

39 People with disabilities: three centres, in Hainault, Aldborough and Snaresbrook, cater for people with disabilities, Dementia sufferers: two centres provide day services for people with dementia, in Monkhams and Chadwell

7. End of life care

In surveys a majority of people say that they would prefer to die at home (Gomes, 2011). In recent years there has been a national focus on and investment in palliative care to enable people to die at home, or in their usual place of residence, eg. a residential home.

In Redbridge there are a large number (n=75) of residential care homes. There is also a hospice in Havering, and hospice care is commissioned from St Joseph’s Hospice in Hackney. The Margaret Centre at Whipps Cross Hospital is a specialist palliative care unit within the hospital site. Unfortunately data relating to the Margaret Centre is coded as Whipps Cross hospital so the numbers of deaths in hospital are slightly overestimated and the number of deaths in Hospice are slightly underestimated in Redbridge.

The most recent comparative data for Redbridge (2011/13) show that the proportion of people dying at home (17.9%) was significantly lower than the national average, and was the second lowest in the country. Although local data for 2014 show that this has increased to 20.2% this would still be in the lowest 15% in the country. Similarly the proportion of people who die in residential care homes is significantly lower than the national average and in the lowest quintile in the country.

Fig 63 Fig 64

Place of death Redbridge and England, 2011/13 Place of death, Seven Kings locality, 2014 70.0 70

60.0 60

50 50.0

40.0 Seven Kings

% Redbridge 30 Redbridge 30.0 England 20 England 20.0 10

10.0 0

0.0 Hospital Care Home Hospice Hospital Home Care Home Hospice home

Source: End of Life Care profiles; endoflifecare-intelligence.org.uk Source: Primary Care Mortality Database

The proportion of people dying in hospital in Redbridge was the 3rd highest in the country in 2011/13. Even allowing for the people who die at the Margaret Centre, this is still very high.

40 There is some variation between localities. In Seven Kings locality fewer people died at home and more died in care homes than the Redbridge average. This will reflect the larger numbers of people in residential homes in the locality.

References Mitchell, R. and Popham, F. (2008) Effect of exposure to natural environment on health inequalities: an observational population study. The Lancet 372(9650):pp. 1655-60.http://eprints.gla.ac.uk/4767/ 25th November 2008

Beds in shed Report, April 2013-March 2015. London Borough of Redbridge

Gomes B, Calanzani N, Higginson I;Local preferences and place of death in regions within England 2010. Cicely Saunders International. August 2011

41 Appendix 1

GP practice codes Practice code Practice name F86009 Dr Mackenzie & Partners - The Palms Medical Centre F86028 Dr D Kana - Chadwell Heath Surgery F86034 Dr Patel - Goodmayes Medical Practice F86060 Dr Clarke & Partners - Newbury Group Practice F86087 Dr Ak Shah & Partner - Goodmayes Medical Centre F86635 Spearpoint Surgery - Pooled List F86637 Dr Price & Partner - Seven Kings Practice F86642 Dr M Quraishi - Castleton Road Health Centre F86704 Dr E Paul - Paul's Surgery Y00090 Dr Spiteri & Partners - The Doctors House Y00155 Dr Z Moghul - Grove Surgery