Health & Social Care Maps

Swale Local Authority

Overview Chapter

Health and Social Care Map – Swale Overview 1 Introduction

Welcome to locality health and social care maps overview. This chapter sketches an overall picture of the Swale area. For more detail please visit the remaining chapters on children, older people, key killers, inequalities, mental health & well-being, service provision or prevalence & activity.

This document contains information, data and commentaries that together provide a picture of health and social care in the Swale locality, and includes the following:

 Transport links  Locality map with Mosaic groupings  Resident population by Mosaic public sector group  Key to electoral wards  Population and distribution (various breakdowns)  Projected population  Ethnicity  Fertility  Teenage conception  Life expectancy  Care homes  Disability prevalence  Indices of Multiple Deprivation (IMD)  Unemployment/benefits/income  Causes of death  Admissions for assaults/mental and behavioural disorders  Crime  Housing tenure/occupancy  Adult obesity  Binge drinking  Smoking prevalence  Fruit and vegetable consumption

Please note this is a top-level look at the locality and much of the information included here can be found, together with more detail, elsewhere in the full chapters of the Swale locality map.

Health and Social Care Map – Swale Overview 2

Transport links

The main transport link in Swale is the M2 which runs from down to pass and before reaching on to and beyond. The A249 also links on the through to Sittingbourne and on to the M20. The A299 connects Faversham to and the Thanet towns and the A2 allows easy access directly into the Medway towns.

The main line railway runs from Canterbury, through both Faversham and Sittingbourne, where a branch line connects the Isle of Sheppey, and continues through Medway and on into London.

The benefits of good transport links to public health are increased access to a range of services including employment, education, health facilities and leisure opportunities both within Swale and further afield.

The downside of having good transport links can be an increase in traffic and congestion. This can lead to increased noise pollution, accidents and higher levels of air pollution such as PM10s that are associated with circulatory and respiratory disease.

Health and Social Care Map – Swale Overview 3

Mosaic Public Sector – and Medway groupings by location

Mosaic Public Sector is a population segmentation tool, designed specifically for use by the public sector. It focuses on the needs of citizens and provides a detailed and accurate understanding of population location, their demographics, lifestyles and behaviours.

Mosaic Public Sector provides a common currency that enables the same population to be viewed in the same way by all public bodies, thereby assisting joined-up government and partnership working.

To help support the understanding of the population and their service needs, Mosaic Public Sector is linked to a number of specific public sector data sources from criminal justice, education, the environment and health, as well as central and local government. This gives a considerable insight into the UK population and their requirements enabling agencies to deliver better value for money by focussing services around the needs of the individual.

The rural areas are predominantly populated by people who fall into group K (people living in rural areas far from urbanisation). In Faversham there are mix of people with groups D (close knit, inner city and manufacturing town communities), C (older families living in suburbia) and H (upwardly mobile families living in homes bought from social landlords) being the most prevalent.

There is a similar pattern in Sittingbourne with groups C and D being prevalent. Sittingbourne also has a large section of group B (younger families living in newer homes) and group I (older people living in social housing with high care needs).

The groups of people who live on the Isle of Sheppey fall into three main categories. There are those from groups D and G (low income families living in estate based social housing) who live in Sheerness and people from group C in Minster.

Health and Social Care Map – Swale Overview 4

This data is useful because it gives an enhanced definition of deprivation in comparison to using the Indices of Deprivation alone. This shows where the projected health need is likely to be according to the local population and highlights the types of commissioning priorities. Commissioning services that target reducing poverty in families would be best placed in areas where D, F and G groups live. This would include parts of Sheerness, , Leysdown and Warden, , , areas in the east, north and south west of Faversham. There may be greater levels of isolation and a decreased level of people being able to access services in rural areas. The majority of the Swale geographical area is rural.

Swale Families - a ‘vignette’ profile

 K&M 8 - families with young children living in social housing (29%)  K&M 2 - families in comfortable homes in suburbia (24%)  K&M 4 - middle income couples with young children (13%)

Three dominant groups in Swale are K&M 8 and K&M 9 and K&M 2. This represents 66% of the population.

Resident population of Swale Local Authority by MOSAIC Kent & Medway Group 35 K&M2: Attitude to lifestlyes tends to be Kent Area everything in moderation. Moderate Swale 29.37 30 levels of exercise, smoking and drinking. K&M8: Fairly active but with poor diet and heavy alcohol and tobacco consumption. Teenage conceptions are an 25 24.43 issue.

K&M4: Good general 20.09 19.23 20 health, active lifestyles and low rate of hospital admissions 15.69 15 13

10.31 9.31 9.7

10 8.8 Percentage of population resident Percentage 7.54 6.34 5.37 5.55 5 4.43 2.8 3.13 1.65 0.71 0.9 0.02 0.06 0 K&M1: Successful K&M2: Families in K&M3: Young K&M4: Middle K&M5: Diverse K&M6: Young K&M7: Young adults K&M8: Families with K&M9: Low Income K&M10: Early K&M11: Rural Citizens Comfortable Homes Aspirational Adults Income Couples Minorities Professionals on Low Income Young Children Pensioners Retirees & Active Communities with in Suburbia with Young Children living in Social Pensioners High Number of Housing Commuters Mosaic Group Source: Experian, Mosaic Public Sector, 2008 populations (ONS)

Health and Social Care Map – Swale Overview 5

Health and Social Care Map – Swale Overview 6

Swale has a higher percentage of under 19s than the national profile but a much smaller proportion of 20 to 34s. The pyramid also highlights the largest section of the local population are aged 35 to 49.

The proportion of the population in all categories between the ages of 60 and 75 is also higher than the national average. This will have an impact on health services because people over 60 will generally have greater health needs and service usage.

Health and Social Care Map – Swale Overview 7

There are high numbers of 0 to 4 year olds in the , Sheerness east and Grove wards. The wards with the fewest number of children aged between 0 and 4 are Borden, West Downs and East Downs. There are approximately 8,700 children aged 0 to 4 in Swale LA.

Health and Social Care Map – Swale Overview 8

There are high numbers of 0 to 19 year olds in the Kemsley, Sheppey Central and Grove wards. The wards with the fewest number of children aged between 0 and 19 are Borden, West Downs and East Downs. There are approximately 33,800 children aged 0 to 19 in Swale LA.

Health and Social Care Map – Swale Overview 9

There are high numbers of working age people in the Kemsley, Sheppey Central and Queenborough & Halfway wards. The wards with the fewest number of working age people are Borden, West Downs and Priory. There are approximately 84,500 working age people in Swale LA.

Health and Social Care Map – Swale Overview 10

There are high numbers of people aged 65+ in the Minster Cliffs, Sheppey Central and Queenborough & Halfway wards. The wards with the fewest number of people aged 65+ are Borden, West Downs and & . There are approximately 22,000 people aged 65+ in Swale LA.

This will have implications for commissioners and those providing services because the 65+ age group use health services at a higher rate than others, so more provision will be needed by health services in the area. Acute service usage by individuals from these areas will be based predominately in Medway.

Health and Social Care Map – Swale Overview 11

There are high numbers of people aged 85+ in the Minster Cliffs, Abbey and Queenborough & Halfway wards. The wards with the fewest number of people aged 85+ are Kemsley, West Downs and Davington Priory. There are approximately 2,500 people aged 85+ in Swale LA.

Health and Social Care Map – Swale Overview 12

The three most densely populated wards in Swale are Sheerness east, St Ann’s and Roman. The three least densely populated wards are West Downs, East Downs and Boughton & Courtenay.

Health and Social Care Map – Swale Overview 13

Projected Population Change in 2012-2016 from 2011* for Swale Local Authority by Broad Age Groups 25.0%

20.0%

15.0%

10.0%

5.0% Percentage Change from Percentage 2011* 0.0%

-5.0% 2012 2013 2014 2015 2016 0-4 0.0% -1.2% -1.2% -1.2% -1.2% 5-19 0.3% 0.0% 0.3% 0.9% 0.9% 20-64 0.3% 0.1% 0.6% 1.2% 1.5% 65+ 5.8% 9.3% 13.3% 16.8% 19.9% 85+ 3.8% 7.7% 11.5% 15.4% 23.1% All ages 1.1% 0.3% 1.0% 1.0% 0.7% * derived from ONS 2008 based projections Projected Populations in Swale Local Authority by Broad Age Group - figures in thousands

AGE GROUP 2012 2013 2014 2015 2016 0-4 8.6 8.5 8.5 8.5 8.5 5-19 33.7 33.6 33.7 33.9 33.9 20-64 78.1 78.0 78.4 78.8 79.1 65+ 23.9 24.7 25.6 26.4 27.1 85+ 2.7 2.8 2.9 3.0 3.2 ALL AGES 144.3 144.8 146.2 147.6 148.6 Columns may not sum due to rounding *Derived from 2008-based ONS sub-national projections

Population projections from the Office for National Statistics (ONS) show a rise in all age groups over the next five years with the largest percentage rises occurring in the 65+ age group. The rise in this group is predicted to increase by 19.5% in 2015. The overall population projected increase for Swale for 2015 is around 4.5% and would result in the size of the population being 139,000.

Commissioners will need to take account that planning will be necessary for an increased population capacity, particularly regarding older people’s health services. Older people have the greatest need to use health services and it may be necessary to expand the capacity of certain health services such as general practitioners in areas where there will be the greatest population increases.

If the population continues to increase, there will also be an increased pressure on other services such as housing, environmental sustainability and transport.

Health and Social Care Map – Swale Overview 14

Ethnicity of Swale Local Authority, 2007 Persons by Age Group Source: ONS 140,000

120,000

100,000

80,000

60,000 Numberof Persons

40,000

20,000

- Age 0-15 Working Age Retirement Age All Ages Other 100 600 100 800 Black or Black British 400 1,300 100 1,800 Asian or Asian British 500 1,400 200 2,100 Mixed 700 700 100 1,500 White 24,700 75,200 24,200 124,100

Figures from ONS show that the population of Swale is predominantly white. Swale has the lowest proportion of the black and ethnic minority (BME) population in the eastern and coastal Kent area, although the proportion of the BME population in Swale is expected to increase. The graph shows that the percentage of the BME population is negligible among the retired population. This data does not take into account that there are a considerable number of the population from the Gypsy and Traveller community in Swale that have health service usage and cultural needs that are different from the White British population.

Health and Social Care Map – Swale Overview 15

General Fertility Rate by Local Authority 1998 - 2010 Live Births per 1,000 Women Aged 15-44 Source: Compendium of Clinical and Health Indicators

75

70

65

60

55

General Fertility Rate Fertility General 50

45

40 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Ashford LA 61.5 61.2 58.2 61.6 62.0 63.4 61.4 61.0 64.4 63.3 70.1 68.5 69.7 Canterbury LA 49.9 50.1 46.4 45.7 47.0 47.8 44.9 46.8 44.8 42.0 45.6 45.5 44.6 Dover LA 59.8 53.8 53.4 55.3 51.7 53.2 55.3 59.3 58.7 62.3 63.7 65.6 68.2 Shepway LA 58.0 54.1 51.1 55.9 56.2 56.1 58.3 58.8 64.1 62.0 67.8 67.9 68.0 Swale LA 63.8 62.2 59.7 59.0 59.7 57.8 60.2 60.2 63.0 64.2 66.7 67.4 72.0 Thanet LA 63.4 59.6 61.4 56.4 56.1 58.8 60.8 61.4 63.6 66.7 69.0 70.0 69.5 Kent County 61.2 58.8 56.2 56.4 56.0 57.2 57.8 58.5 60.0 61.1 63.0 63.9 65.3

The General Fertility Rate (GFR) measures the ratio between the number of new born babies to the number of females aged 15 to 44 in each year.

The GFR for Swale has risen steadily in recent years to a high of 72.0 in 2010, the highest rate in east Kent in the last 13 years. The trend in rising GFRs is also seen across the other local authorities in the area with the exception of Canterbury.

General Fertility Rate 2006-2010 by Electoral Ward. Swale Local Authority Numbers of Live Births per 1,000 Female Population Aged 15-44 Sources: ONS ADBE, Mid-Year Ward Population Estimates

120

100

80

60

40 General Fertility Rate Fertility General

20

0

Grove Swale

Abbey

Borden

Roman

Watling

Murston

St Ann's

Kemsley

Chalkwell

Woodstock

St Michaels

East Downs

Milton Regis

Halstow

West Downs

Minster Cliffs

Halfway

Sheerness EastSheerness

Upchurch

Davington Priory Davington

Sheerness West Sheerness

Sheppey Central Sheppey

Iwade and Lower and Iwade

Queenborough and Queenborough

Teynham and and

Hartlip, Newington and Newington , Leysdown and Warden and Leysdown Boughton and Courtenay and Boughton There are considerable differences in the General Fertility Rates (GFRs) for each electoral ward over a five year period. The slide shows that the highest rates are in Sheerness East, Murston and Abbey. The lowest rates are found in East Downs, Woodstock and West Downs.

Health and Social Care Map – Swale Overview 16

The implications of the GFRs at a localised level are that it shows where there the infant population will increase most in the future. This will show where the greatest need is to target interventions aiming to ensure that children are given a healthy start in life. This is particularly important if the area has relatively higher deprivation such as Sheerness East.

Health and Social Care Map – Swale Overview 17

The teenage conception rate for Roman and Leysdown & Warden are relatively high in comparison to most areas of eastern and coastal Kent.

This data fits with the notion that women from poorer backgrounds are more likely to become mothers as a teenager, young women from social class V being ten times more likely to become teenage parents than those from social class I. Teenage pregnancy reflects limited aspirations and often culturally determined notions of self-worth. It is important to aim to reduce teenage conceptions because evidence suggests that teenage mothers and their children face poorer social, economic and health outcomes than their older peers. Clinically, such outcomes include an increased risk of premature birth, low birth weight and infant death. Teenage mothers are more likely to suffer from poorer mental health in the three years after giving birth compared with older mothers, more likely to have male partners who are poorly qualified and suffer unemployment and more likely to be single parents, again at increased risk of being unemployed and economically and socially deprived. A high teenage conception rate in an area with existing deprivation makes it more difficult to break the cycle of health inequalities.

Health and Social Care Map – Swale Overview 18

Life expectancy at birth - 2006-2010, Swale Borough Council Source: PHMF, SEPHO and ONS CAS estimates 86.0 Wards Swale NHS Eastern and Coastal Kent 84.0

82.0

80.0

78.0

76.0

74.0

72.0 Life expectancyLife (years) 70.0

68.0

66.0

Grove Roman Abbey MurstonSt Ann's Borden Watling Kemsley Chalkwell East DownsWoodstock St Michaels West Downs Minster Cliffs Milton Regis Davington Priory Sheppey SheernessCentralSheerness East West

Teynham and Lynsted Leysdown and Warden Iwade and Lower Halstow Boughton and Courtenay Queenborough and Halfway

Hartlip, Newington and Electoral ward

The life expectancy at birth in Swale’s electoral wards was calculated using five years worth of mortality information (2006-10). The ward with the highest life expectancy is Iwade and Lower Halstow (85.1). This is 11.7 years more than the lowest life expectancy which is in Leysdown and Warden (73.4).

Swale is similar to all local authorities and highlights health inequalities in that there is a gap in life expectancy between the affluent and those living in relative deprivation. Life expectancy shows an association with deprivation in Swale. The pattern in Swale is likely to change over time in certain wards because a considerable number of newer homes that attract relatively affluent young families have been built in Iwade & Lower Halstow, Grove and Kemsley.

Swale, as a local authority, has the second lowest life expectancy at birth in eastern and coastal Kent. Life expectancy at birth for Swale is estimated to be 79.4 years.

Health and Social Care Map – Swale Overview 19

Health and Social Care Map – Swale Overview 20

Estimated Disability Prevalence by Type of Disability, Age and Gender - Swale Derived from Household Survey from

Men number of people Type of Disability 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Locomotor Moderate 77 156 365 789 1287 1199 739 277 Serious 0 78 91 197 343 379 322 185 Personal Care Moderate 0 779 274 493 772 631 354 202 Serious 0 78 91 99 172 189 129 50 Sight Moderate 77 78 91 99 86 126 129 92 Serious 0 0 0 0 86 63 96 84 Hearing Moderate 77 78 183 395 600 758 450 193 Serious 0 0 0 0 86 63 32 42 Communication Moderate 77 78 91 99 86 63 96 42 Serious 77 0 91 0 86 63 32 8 All Types Moderate 306 1168 1004 1874 2831 2778 1768 806 Serious 77 156 274 296 772 758 611 370 Totals may not sum due to rounding errors

Women number of people Type of Disability 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Locomotor Moderate 143 246 467 780 1034 1114 1103 671 Serious 0 82 93 195 431 393 654 596 Personal Care Moderate 72 164 280 487 775 655 613 466 Serious 0 0 93 97 86 197 123 112 Sight Moderate 72 82 93 97 172 197 286 168 Serious 0 0 0 0 86 66 123 186 Hearing Moderate 72 82 93 292 345 524 490 429 Serious 0 0 0 0 0 0 82 130 Communication Moderate 72 82 93 97 86 66 41 56 Serious 0 0 0 0 0 0 41 37 All Types Moderate 430 657 1028 1754 2412 2556 2534 1789 Serious 0 82 187 292 603 655 1022 1062 Totals may not sum due to rounding errors

The figures in the tables above are derived from the household survey for England. Therefore it reflects national prevalence applied to local populations.

Health and Social Care Map – Swale Overview 21

Care homes for older people in Swale are found in Sittingbourne, Faversham and Sheerness.

Residential and Nursing Homes for Older People in Swale Local Authority Area

Number of People with People with a People with Index Type Of Service Name registered Learning physical Dementia places disability disablity 1 Residential home Alma Rest Home 22 Y 2 Residential home Barton Court 41 Y 3 Residential home Beechfields 9 4 Residential home Blackburn Lodge LSC 35 5 Residential home Blair Park Residence For The Elderly 47 Y 6 Residential home Bromfield House Residential Care Home Ltd 10 7 Residential home Carnalea Residential Home 43 8 Nursing home Cooksditch House Nursing and Residential Home 55 9 Residential home Court Regis 54 Y Y 10 Residential home Doubleday Lodge LSC 36 11 Nursing home Elvy Court Nursing Home 57 Y 12 Residential home Hanningfield Retirement Home 27 13 Residential home Kiln Court 30 14 Nursing home Kingsfield 90 Y Y 15 Residential home Mill House 24 Y 16 Nursing home Newington Court Nursing Home 58 Y Y 17 Residential home Oakdene Rest Home 26 Y 18 Residential home Pine Lodge Retirement Home 57 Y 19 Residential home The Willows Residential Home For The Elderly 10 20 Residential home Woodstock Residential Home 60 Y Index refers to map on previous slide Source: Care Quality Commission

NB: Index refers to points on previous map.

Health and Social Care Map – Swale Overview 22

Socio-Economic

Indices of Multiple Deprivation (IMD)

The Indices of Multiple Deprivation are constructed using 36 variables across seven domains. These domains are income, barriers to housing, health and disability, crime, education, living environment and employment. Scores are present at lower super output areas (LSOAs). LSOA areas are constructed using populations from communities or naturally bounded areas. The number of people in an LSOA is between 1,000 and 1,500 and they are aggregated together to form electoral wards. The number of LSOAs in an electoral ward can vary from one to five depending upon the original size of the electoral ward. For each map in this section the overall and domain scores have been split into local quintiles (five equal parts) with the fifth quintile being the most deprived and the first being the least deprived for the area.

The overall index shows that the 20% most deprived areas of Swale are found mostly on the Isle of Sheppey in all of Sheerness, Leysdown, Queenborough and in the Sheppey Central ward. There are also several areas of Sittingbourne that fall into the worst 20%; parts of Murston, Milton Regis and Kemsley. There is also a small pocket of deprivation in Davington Priory ward in Faversham. The least deprived areas of Swale are Woodstock and West Downs ward areas, Upchurch, parts of grove and Kemsley wards in Sittingbourne and parts of the Davington Priory and Watling wards in Faversham. Knowledge of the location of the most deprived communities is important in order to understand where the varying health need may be greatest. For example, there is an association between deprivation and a multitude of lifestyle choices such as smoking and poor diet.

Health and Social Care Map – Swale Overview 23

The Income Deprivation Affecting Children Index, or IDACI, is made up from a subset of the income domain (discussed later). The index gives the percentage of children living in income deprived families in each LSOA.

Health and Social Care Map – Swale Overview 24

The Income Deprivation Affecting Older People Index, or IDAOPI, is made up from a subset of the income domain (discussed later). The index gives the percentage of older people living in income poverty in each LSOA.

Health and Social Care Map – Swale Overview 25

Deprivation data for lower super output areas (LSOAs) in Swale Borough Council area - IMD 2007

LLSOA Wardname IMD Score IDACI Score IDAOPI Score E01024609 Sheerness East 64.38 0.44 0.37 E01024590 Murston 61.30 0.52 0.37 E01024580 Leysdown and Warden 60.76 0.44 0.28 E01024614 Sheerness West 57.31 0.57 0.48 E01024615 Sheerness West 56.23 0.53 0.31 E01024613 Sheerness West 52.30 0.46 0.34 E01024621 Sheppey Central 48.15 0.45 0.42 E01024597 Queenborough and Halfway 47.31 0.43 0.26 E01024563 Davington Priory 42.96 0.42 0.36 E01024610 Sheerness East 42.44 0.51 0.32 E01024616 Sheerness West 41.46 0.31 0.26 E01024618 Sheppey Central 40.80 0.24 0.28 E01024581 Leysdown and Warden 40.34 0.37 0.18 E01024584 Milton Regis 39.39 0.42 0.32 E01024612 Sheerness East 37.78 0.30 0.21 E01024627 Watling 36.42 0.37 0.22 E01024611 Sheerness East 36.03 0.32 0.31 E01024596 Queenborough and Halfway 33.31 0.42 0.22 E01024552 Abbey 32.63 0.22 0.34 E01024579 Kemsley 31.39 0.30 0.21 E01024600 Roman 31.31 0.35 0.21 E01024585 Minster Cliffs 31.00 0.27 0.25 E01024591 Murston 30.69 0.37 0.25 E01024604 St Ann's 30.18 0.43 0.26 E01024599 Roman 29.17 0.28 0.22 E01024582 Milton Regis 25.50 0.12 0.21 E01024559 Chalkwell 25.11 0.29 0.22 E01024622 Teynham and Lynsted 25.02 0.24 0.12 E01024608 St Michaels 24.34 0.14 0.17 E01024624 Teynham and Lynsted 24.29 0.23 0.16 E01024567 Grove 24.24 0.31 0.14 E01024583 Milton Regis 23.36 0.36 0.22 E01024620 Sheppey Central 22.14 0.12 0.16 E01024587 Minster Cliffs 22.02 0.23 0.17 E01024560 Chalkwell 21.86 0.27 0.21 E01024551 Abbey 21.49 0.23 0.21 E01024586 Minster Cliffs 20.72 0.14 0.21 E01024562 Chalkwell 20.33 0.15 0.11 E01024556 Boughton and Courtenay 19.89 0.14 0.14 E01024561 Chalkwell 19.77 0.21 0.13 E01024566 East Downs 19.43 0.16 0.11 E01024623 Teynham and Lynsted 19.34 0.20 0.20 E01024606 St Michaels 19.33 0.10 0.12 E01024598 Queenborough and Halfway 18.43 0.16 0.16 E01024593 Murston 18.29 0.20 0.10 E01024595 Queenborough and Halfway 18.15 0.15 0.15 E01024570 Hartlip, Newington and Upchurch 17.73 0.22 0.13 E01024565 East Downs 17.48 0.10 0.08 E01024557 Boughton and Courtenay 17.20 0.24 0.19 E01024601 Roman 16.68 0.17 0.18 E01024577 Kemsley 16.34 0.19 0.13 E01024594 Queenborough and Halfway 16.08 0.11 0.12 E01024588 Minster Cliffs 15.42 0.07 0.11 E01024619 Sheppey Central 15.34 0.18 0.16 E01024617 Sheppey Central 15.15 0.16 0.12 E01024568 Grove 14.52 0.07 0.13 E01024589 Minster Cliffs 14.39 0.13 0.14 E01024602 St Ann's 14.31 0.11 0.15 E01024555 Boughton and Courtenay 14.11 0.06 0.10 E01024630 Woodstock 13.85 0.18 0.14 E01024553 Abbey 13.65 0.07 0.19 E01024554 Borden 13.59 0.16 0.11 E01024558 Boughton and Courtenay 13.53 0.10 0.10 E01024628 West Downs 13.27 0.11 0.12 E01024571 Hartlip, Newington and Upchurch 12.81 0.15 0.11 E01024592 Murston 11.32 0.12 0.11 E01024569 Grove 11.29 0.11 0.13 E01024564 Davington Priory 11.11 0.09 0.09 E01024573 Hartlip, Newington and Upchurch 11.10 0.15 0.12 E01024625 Watling 11.02 0.10 0.09 E01024576 Kemsley 10.79 0.10 0.18 E01024605 St Ann's 10.73 0.11 0.09 E01024574 Iwade and Lower Halstow 10.39 0.10 0.16 E01024575 Iwade and Lower Halstow 10.10 0.13 0.11 E01024578 Kemsley 10.10 0.16 0.12 E01024603 St Ann's 9.86 0.06 0.10 E01024626 Watling 8.02 0.05 0.11 E01024572 Hartlip, Newington and Upchurch 7.71 0.04 0.11 E01024629 West Downs 7.25 0.07 0.07 E01024607 St Michaels 6.82 0.10 0.09 E01024631 Woodstock 4.73 0.06 0.06 E01024632 Woodstock 4.36 0.00 0.04

Source: DCLG, Index of Multiple Deprivation 2007

Health and Social Care Map – Swale Overview 26

Income Deprivation Domain

This domain measures the proportion of the population in an area experiencing deprivation related to low income. A combined count of income deprived individuals per LSOA is calculated by summing the following five indicators:

 Adults and children in Income Support families  Adults and children in Income-Based Jobseeker’s Allowance families  Adults and children in Pension Credit (Guarantee) families  Adults and children in Child Tax Credit families (who are not in receipt of Income Support, Income-Based Jobseeker’s Allowance or Pension Credit) whose equivalised income (excluding housing benefits) is below 60 per cent of the median before housing costs  Asylum seekers in England in receipt of subsistence support, accommodation support, or both

As one would expect, there are strong similarities between overall deprivation and the individual domains, although there are slight differences for some of the Lower Super Output Areas (LSOAs) depending on the domain. Deprivation for income is a strong reflection of the overall deprivation score. Income deprivation affecting children is a sub domain of the income domain exhibits similar patterns to the overall index, although the levels of child poverty are a little more wide spread in Sittingbourne and Faversham. Income deprivation affecting older people slide shows similar patterns to the overall index although there are a few more areas in Faversham that fall into the worst 20%.

The scores for the individual domains can be useful because it can give a reason as to why particular communities may have relatively higher levels of deprivation. For example, some areas are not in the most deprived quintile overall, but may be for a particular domain. Therefore it highlights that specific action may be required around the improving particular domains deprivation score for communities.

Health and Social Care Map – Swale Overview 27

Income deprivation takes account of income support, job seekers allowance, family tax credit, disability tax credits, asylum-seeker subsistence and accommodation support. The income deprivation profile reflects the overall deprivation profile for Swale.

Employment Deprivation Domain

This domain measures employment deprivation in an area conceptualised as involuntary exclusion of the working age population from the labour market. A combined count of employment deprived individuals per LSOA is calculated by summing the following seven indicators:

 Claimants of Jobseeker’s Allowance (both Contributory and Income-Based) women aged 18-59 and men aged 18-64, averaged over 4 quarters  Claimants of Incapacity Benefit women aged 18-59 and men aged 18-64, averaged over 4 quarters  Claimants of Severe Disablement Allowance women aged 18-59 and men aged 18-64, averaged over 4 quarters  Claimants of Employment Support Allowance women aged 18-59 and men aged 18-64  Participants in New Deal for the 18-24s who are not in receipt of Jobseeker’s Allowance, averaged over 4 quarters  Participants in New Deal for 25+ who are not in receipt of Jobseeker’s Allowance, averaged over 4 quarters  Participants in New Deal for Lone Parents (after initial interview) aged over 18, averaged over 4 quarters

Employment deprivation includes unemployment claimant count, severe disablement allowance, incapacity benefit claimants. The employment deprivation profile reflects the overall deprivation profile for Swale.

Health and Social Care Map – Swale Overview 28

Education, Skills and Training Deprivation Domain

This domain measures the extent of deprivation in terms of education, skills and training in an area. The indicators are structured into two sub-domains: one relating to children and young people and one relating to adult skills. These two sub-domains are designed to reflect the ‘flow’ and ‘stock’ of educational disadvantage within an area respectively. Seven indicators are used to calculate this domain:

Sub-domain: Children/young people  Average points score of pupils taking English, Maths and Science Key Stage 2 exams  Average points score of pupils taking English, Maths and Science Key Stage 3 exams  Average capped points score of pupils taking Key Stage 4 (GCSE or equivalent) exams  Proportion of young people not staying on in school or non-advanced education above age 16  Secondary school absence rate – the proportion of authorised and unauthorised absences from secondary school  Proportion of those aged under 21 not entering Higher Education

Sub-domain: Skills  Proportion of adults aged 25-54 with no or low qualifications

Education deprivation takes account of the average points score by pupils at key stages two, three and four, the proportion of young people not staying on in school or non-advanced further education above 16, the secondary school absence rate, the proportion of those aged under 21 not entering higher education and the proportion of working age adults (aged 25 to 54) in the area with no or low qualifications. The education deprivation profile is similar to the overall deprivation profile for Swale.

Health and Social Care Map – Swale Overview 29

Health Deprivation and Disability Domain

This domain measures premature death and the impairment of quality of life by poor health. It considers both physical and mental health. The domain measures morbidity, disability and premature mortality but not aspects of behaviour or environment that may be predictive of future health deprivation. Four indicators are used to calculate this domain:

 Years of Potential Life Lost – an age and sex standardised measure of premature death  Comparative Illness and Disability Ratio – an age and sex standardised measure of morbidity and disability  Measures of acute morbidity – an age and sex standardised rate of emergency admissions to hospital  Proportion of adults under 60 suffering from mood or anxiety disorders – a modelled indicator for the proportion of adults suffering from mood and anxiety disorders

Deprivation due to health and disability includes mortality rates, comparative illness and disability ratio, emergency admissions to hospital (derived from hospital episode statistics) and adults under 60 suffering from mood or anxiety disorders (based on prescriptions, hospital episode statistics, suicides and health benefits data. Health deprivation for Swale is a close reflection to the overall deprivation profile for Swale.

Health and Social Care Map – Swale Overview 30

Crime Domain

This domain measures the rate of recorded crime in an area for four major crime types representing the risk of personal and material victimisation at a small area level.

 Violence – number of reported violent crimes (19 reported crime types) per 1000 at risk population  Burglary – number of reported burglaries (4 reported crime types) per 1000 at risk population  Theft – number of reported thefts (5 reported crime types) per 1000 at risk population  Criminal damage – number of reported crimes (11 reported crime types) per 1000 at risk population

The crime deprivation domain covers burglary, theft, criminal damage and violence. The highest crime deprivation is in Sheerness, Leysdown, Kemsley, Milton Regis, Murston, the rural area around Teynham, part of the St Ann’s ward and part of the Abbey ward in Faversham.

Health and Social Care Map – Swale Overview 31

Barriers to Housing and Services Domain

This domain measures the physical and financial accessibility of housing and key local services. The indicators fall into two sub-domains: ‘geographical barriers’, which relate to the physical proximity of local services, and ‘wider barriers’ which includes issues relating to access to housing such as affordability. Seven indicators are combined to calculate this domain:

Sub-domain: Wider barriers  Household overcrowding – the proportion of households within an LSOA which are judged to have insufficient space to meet the household’s needs  Homelessness – the rate of acceptances for housing assistance under the homelessness provisions of the 1996 Housing Act (at local authority district level)  Difficulty of access to owner-occupation (local authority district level) – proportion of households aged under 35 whose income means they are unable to afford to enter owner occupation

Sub-domain: Geographical barriers  Road distance to a GP surgery  Road distance to a supermarket or convenience store  Road distance to a primary school  Road distance to a post office

The domain relating to deprivation regarding barriers to housing fall into two sub-domains: geographical barriers and wider barriers. Geographical barriers take into account road distance to doctor surgery premises, supermarket, primary school and post office and the wider barriers include household overcrowding and difficulty of access to owner-occupation. The association with overall deprivation is less clear due to housing affordability having an impact on the domain score. Most of the rural area of Swale and the eastern part of the Isle of Sheppey are the most deprived

Health and Social Care Map – Swale Overview 32 for this domain. A principal reason for this may be due to the isolation and difficulties in accessing services.

Living Environment Deprivation Domain

This domain measures the quality of individuals’ immediate surroundings both within and outside the home. The indicators fall into two sub-domains: the ‘indoors’ living environment, which measures the quality of housing, and the ‘outdoors’ living environment which contains two measures relating to air quality and road traffic accidents. Four indicators are combined to calculate this domain:

Sub-domain: The indoors living environment  Social and private housing in poor condition  Houses without central heating

Sub-domain: The outdoors living environment  Air quality  Road traffic accidents

Living environment deprivation includes social and private housing in poor condition, housing without central heating, air quality and road traffic accidents involving injury to pedestrians and cyclists. The highest levels of deprivation for this domain are in Sheerness East and part of Sheerness West, Leysdown, the area to the north of Sittingbourne centre, and parts of the rural wards of East Downs, Teynham and Lynsted and Boughton and Courtney. There is not a clear relationship with overall deprivation for this domain. This could be due to a number of reasons including air pollution and road traffic accidents due to proximity of major roads such as the A2 and A299 and older housing that may be in poor condition.

Health and Social Care Map – Swale Overview 33

Swale had the third highest unemployment rate from the local authorities in the eastern and coastal Kent area in 2009.

Swale had the fifth highest rate of unemployed people by local authority in Kent. All data relating to unemployment that is not fully up to date should be treated with some caution because it can change rapidly.

Health and Social Care Map – Swale Overview 34

Sheerness east and west both have high levels of unemployment, are deprived and exhibit some of the worst health outcomes in the area.

Swale has the second lowest proportion of economically active people in the eastern and coastal Kent area.

The number of benefit claimants by type of claim are shown for all local authorities in the eastern and coastal Kent area. There are similarities when comparing the percentage of benefits claims among all of six the local authorities in the eastern and coastal Kent area. The main differences are in the number of people claiming benefits. Only Thanet has more people than Swale.

Health and Social Care Map – Swale Overview 35

Gross median weekly wage for full time workers in east Kent districts, 2011 Source: NOMISweb

800

700

600

500

400

300

Gross average weekly wage weekly average Gross 200

100

0

Kent Dover Swale Thanet Ashford England Shepway South East Canterbury Resident area

The average gross weekly wage earnings of people living in Swale is £587 a week. This compares to £660 for Kent and £616 for England.

Health and Social Care Map – Swale Overview 36

Main causes of death in Swale

2010 Swale

Swale Cancer of digestive Other organs cancer 26% 39%

Breast Cancer of Other respiratory cancerProstate organs cancer9% 19% 17% 10%

Cancer Respirato 47% Swale ry 11% Circulato ry Stroke 23% 18%

Coron ary Other heart circula diseas tory e diseas 52% e 30%

The main causes of death are from circulatory diseases (23%) and cancer (47%). Within circulatory disease, just over half are due to coronary heart disease and just under a quarter are due to strokes. For cancer deaths, the majority are for cancers of the digestive system and respiratory system.

Health and Social Care Map – Swale Overview 37

Mortality from all causes, all ages, Males

Source: NCHOD 1200

1000

800

600

400

200

Directly age-standardised mortality per 100,000 age-standardised Directly 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

England 933.2 907.8 891.8 875.1 841.8 817.3 807.9 796.7 754.4 733.4 708.2 688.6 679.6 652.3 636.1 NHS Eastern and Coastal Kent 942.9 933.1 884.2 839.5 819.8 786.6 795.5 804.9 758.9 735.8 687.7 692.3 661.9 697.8 630.1 NHS West Kent 872.3 831.7 814.9 805.1 781.8 739.7 726.2 746.0 689.6 670.2 620.0 627.6 596.7 600.4 590.0 Medway 984.1 992.2 966.6 970.6 978.3 891.2 870.7 862.6 784.6 792.0 807.1 752.5 759.3 715.5 711.9

Trends in all age all-cause mortality (AAACM) have been steadily falling over the past 10 years or so. The rates in males remain higher than the female rate. The rates for the eastern and coastal Kent area are broadly comparable to the rates for England, slightly higher than the west Kent area but slightly lower than Medway.

Mortality from all causes, all ages, Females Source: NCHOD 800

600

400

200

0 Directly age-standardised mortality per 100,000 age-standardised Directly 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

England 606.7 599.3 589.6 586.3 564.5 553.0 550.4 555.4 524.6 515.6 496.3 488.6 486.6 459.7 454.8 NHS Eastern and Coastal Kent 591.4 590.7 568.2 578.4 574.7 553.7 542.0 556.4 511.2 535.2 520.9 489.4 475.1 469.6 462.7 NHS West Kent 585.9 569.3 547.2 565.0 553.2 506.2 523.7 514.3 497.6 480.8 456.1 463.3 459.8 442.1 445.6 Medway 663.9 698.4 597.8 629.7 621.1 592.8 587.0 603.8 559.3 555.8 556.0 524.4 518.1 493.7 513.1

Health and Social Care Map – Swale Overview 38

Mortality from all causes, all ages, both sexes Source: NCHOD 1000

800

600

400

200

0

Directly age-standardised mortality per 100,000 age-standardised Directly 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

England 744.8 730.6 719.1 710.8 684.3 667.9 663.2 661.9 626.6 613.2 591.6 579.3 574.6 547.3 540 NHS Eastern and Coastal Kent 739.1 734.5 702.2 693.4 677.3 654.4 651.3 666.0 621.5 624.6 595.3 581.0 558.8 573.5 539 NHS West Kent 705.2 679.8 659.7 665.9 650.9 606.9 615.2 615.5 581.7 566.0 529.8 538.4 522.1 513.2 512 Medway 795.4 821.8 750.9 772.7 765.3 723.2 707.7 710.7 659.4 659.9 673.4 622.6 623.7 590.1 601

Trends in all age all-cause mortality (AAACM) rates in Swale are consistently higher than that of the. In 2005, the gap narrowed to the extent that the Swale rate was below the eastern and coastal Kent rate, but since then the rate for Swale has been slightly higher.

Mortality from all cancers aged under 75, both sexes Source: NCHOD 160

120

80

40 Directly age-standardised mortality per 100,000 age-standardised Directly 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NHS Eastern and Coastal Kent 148.6 139.8 136.6 127.1 134.7 130.4 128.0 125.4 122.3 116.6 118.5 115.2 113.3 107.2 106.7 Swale CD 151.2 139.9 120.7 135.2 136.8 133.9 137.6 115.8 119.0 112.4 105.9 127.2 113.8 113.5 129.9

Cancer mortality rates in the under 75s in Swale have been steadily falling and are generally comparable than the eastern and coastal Kent rate.

Health and Social Care Map – Swale Overview 39

Mortality from all circulatory disease aged under 75, both sexes Source: NCHOD 160

120

80

40 Directly age-standardised mortality per 100,000 age-standardised Directly 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NHS Eastern and Coastal Kent 127.2 126.6 119.3 116.8 110.8 97.2 92.1 89.2 82.1 84.1 74.6 72.8 65.0 72.8 64.0 Swale CD 130.0 142.1 129.1 145.7 124.0 108.3 101.3 96.0 99.2 80.7 85.1 85.1 74.9 80.4 68.0

Circulatory mortality rates in the under 75s in Swale have been steadily falling and are consistently higher than the eastern and coastal Kent rate.

Mortality from bronchitis, emphysema and other COPD, all ages, both sexes Source: NCHOD 60

40

20 Directly age-standardised mortality per 100,000 age-standardised Directly 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NHS Eastern and Coastal Kent 30.5 32.1 33.8 30.9 26.6 28.6 30.0 28.3 28.5 32.3 30.3 26.9 28.7 28.8 26.5 Swale CD 36.5 39.8 41.7 39.5 36.3 32.9 37.6 34.0 35.6 35.5 40.1 28.1 44.9 30.9 34.0

Respiratory mortality rates in the under 75s in Swale have been relatively stable and are higher than the eastern and coastal Kent rate. There was a decrease in the rate in 2007 and 2009 to the extent that the rates were almost the same.

Health and Social Care Map – Swale Overview 40

Infant mortality rates, 1997 - 2010 Source: NCHOD 10

9

8

7

6

5

4

Rate per 1,000 liveper 1,000 births Rate 3

2

1

0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

England 5.9 5.6 5.7 5.6 5.4 5.3 5.3 5.1 5.0 5.0 4.8 4.7 4.6 4.3 Swale 5.1 5.4 4.8 2.8 2.8 3.4 5.6 4.0 5.3 6.3 9.2 6.4 4.7 3.3 NHS Eastern and Coastal Kent 5.7 4.1 5.1 3.5 4.2 5.9 5.6 4.2 5.5 4.8 6.0 4.7 4.6 3.8

Trends in infant mortality are harder to analyse when there are only a small number of infant deaths in an area. The national infant mortality rate has been steadily falling since 1998 whereas the trend in the eastern and coastal Kent area and Swale has been rising, however the very small numbers involved (average of 39 infant deaths per year in the eastern and coastal Kent area and just an average of just 8 in Swale) mean that the year on year rate can varying erratically.

Admission rates are shown by quarter and form part of the NHS submission to local Crime and Disorder Partnerships.

Health and Social Care Map – Swale Overview 41

Admission rates in Swale for admission due to an assault are broadly comparable with those for the eastern and coastal Kent area. Admission rates for alcohol and drug related conditions have fallen below the eastern and coastal Kent rates in recent years.

Burglary, criminal damage and theft are the offences that resulted in the highest crime rates in Swale in 2011/12.

Health and Social Care Map – Swale Overview 42

Local Authority Housing Stock - Occupancy & Tenure - 2011

Unoccupied Unoccupied Household Occupied Unoccupied Household Spaces: Second Local Authority Household Household Spaces: Vacant residence / Spaces Spaces household holiday space accommodation Medway 99566 3326 467 2859 Ashford 41450 1519 235 1284 Canterbury 55584 2484 522 1962 Dartford 35240 788 36 752 Dover 44314 2144 546 1598 Gravesham 38266 871 56 815 56454 1868 198 1670 Sevenoaks 44364 1284 151 1133 Shepway 41155 3337 733 2604 Swale 49257 2059 382 1677 Thanet 55228 4072 912 3160 Tonbridge and Malling 42735 1164 144 1020 Tunbridge Wells 42695 1299 192 1107

Owner Registered Other Public LA Dwelling Occupied and Local Authority Social Landlord Sector Dwelling Stock Private Rented Dwelling Stock Stock Dwelling Stock Medway 3046 4251 304 101680 Ashford 4990 2032 0 42160 Canterbury 5197 2237 30 57060 Dartford 4337 1619 130 34820 Dover 4579 2239 231 42000 Gravesham 5876 1346 25 34460 Maidstone 0 8063 680 56200 Sevenoaks 2 6638 41 41360 Shepway 3441 1783 310 43790 Swale 0 8127 0 49340 Thanet 3118 4570 79 56050 Tonbridge and Malling 0 7869 365 41990 Tunbridge Wells 21 7199 20 39910

Health and Social Care Map – Swale Overview 43

Obesity can contribute to a range of health conditions, such as heart disease, high blood pressure, diabetes, indigestion and some cancers. Adult and child obesity levels are becoming an increasing issue for the health service, as greater numbers of people put on extra weight, through poor diet or insufficient exercise.

The synthetic estimate of the prevalence of adult obesity has been mapped across electoral wards in Swale (slide 48). It was generated from the height and weight of adult respondents (aged 16 years or more), as measured by the Health Survey for England. Obesity is measured using the Body Mass Index (BMI) formula, which is based on an individual’s height and weight. A BMI of 25 to 29.9 is considered overweight; a score of 30 or above is considered obese.

Sheerness west has the highest estimated adult obesity prevalence. More than 30% of the population are estimated to be obese. The next highest wards, with obesity prevalence estimated to be between 26% and 30% are the remaining wards in the Isle of Sheppey with the exception of Sheerness East, Murston and Davington Priory.

Health and Social Care Map – Swale Overview 44

Binge drinking can be defined as drinking more than the recommended daily intake and is classified as more than eight units in a day for men and more than six units for women. Binge drinking can relate to alcohol-related accidents and poisoning, which can result in attendance at Accident and Emergency departments. It can also impact on alcohol-related crime and many social problems. Binge drinking over a prolonged period of time can lead to chronic ill health and premature death through cirrhosis of the liver

This estimate was generated from the data collected in the Health Survey for England about the quantities of all the different types of alcoholic drinks (beer, wine, spirits, sherry and alcopops) consumed on a respondent’s heaviest drinking night in the previous week.

The prevalence of binge drinking in Swale is relatively low in comparison to other areas of the eastern and coastal Kent area. The wards around the centre of the three major urban areas have the highest prevalence.

Health and Social Care Map – Swale Overview 45

Smoking is a major cause of lung cancer, cardiovascular disease and chronic obstructive pulmonary disease (COPD), although it can, in addition, be a cause of, or contribute to, many other cancers and conditions, such as asthma or high blood pressure.

The synthetic estimate for current smoking was generated from the Health Survey for England. Adult respondents (aged 16 years or more) were defined to be smokers if they reported that they were a current cigarette smoker in the survey.

The prevalence of smoking in Swale is relatively high in comparison with the rest of the eastern and coastal Kent area. All wards on the Isle of Sheppey have high levels of smoking prevalence as do Milton Regis, Davington Priory and Murston wards. In all of these areas, the estimated prevalence is above 30%.

Health and Social Care Map – Swale Overview 46

The healthy lifestyle measure for fruit and vegetable consumption for adults (aged 16 years or more) was generated from the data collected in the 2001 and 2002 Health Surveys for England. It was estimated by modelling data found about the quantities of different types of fruit and vegetables consumed on the previous day.

The consumption of fruit and vegetables across Swale is poor. There are no areas on the Isle of Sheppey where it is estimated that less than one in four people of the population consume their recommended daily intake of fruit and vegetables. There are also low estimated levels of fruit and vegetable consumption in central areas of Sittingbourne and Faversham.

Health and Social Care Map – Swale Overview 47