Community & Social Care Wanstead & Woodford Cluster Profile 2015

Community & Social Care Wanstead and Woodford Cluster South Woodford Health Centre 114 High Road, South Woodford, London, E18 2QS

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

1 Contents

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

1. Demography……………………………………………………… 11 Population structure and population change Age Ethnicity Household structure

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

3. A healthy environment ……………………………………… 18 Green spaces Crime Housing

4. Health Indicators ………………………………………………. 21 Self assessed health Mortality rates Life expectancy Long term illness Emergency care Children’s health

5. Well being and lifestyle …………………………………….. 33 Childhood obesity Adult obesity Smoking

6. Social care – Keeping people independent ………. 35 Need for social care Learning disability Carers Residential care

7. End of Life care …………………………………………………. 39

References 40 Appendix 1 Practice codes 41

2 Summary

Population

 The locality has an older population than the Redbridge average with 14% aged 65+ years  The population is increasing and is projected to further increase by 4% by 2025 with the biggest increases in Wanstead and Church End wards and in older age groups, with the number of people aged 65+ years projected to increase by 15%. Wanstead and Roding wards are projected to have over 20% increase in people 65+ years. However numbers of children <5years are expected to decrease.  International migration has been a key driver for population increase in Redbridge with people from the Indian subcontinent being the main migrant groups, and more recently, people from Eastern Europe, particularly Romania.  Births increased by 27% since 2002. Although the increase in the birthrate appears to have levelled off there will continue to be an increase in the 5-14 year population for the next 10 years in most of the locality wards.  The ethnic composition of the locality is less mixed than the rest of the borough with the main groups being white (70%) and Asian (13%). The proportion of older Asian people is projected to increase.

Socio-economic circumstances  Wanstead locality has a deprivation profile that is more affluent than the Redbridge or the national picture, with 50% of areas in the least deprived national quintile. However there is very considerable variation across the locality. There are pockets of deprivation in Bridge, Roding and Snaresbrook wards where 30% of areas are in the most deprived 40%. Monkhams and Church End have more than 70% in the most affluent quintile.  All wards have higher levels of employment and lower claimant rates for housing benefit and out of work benefits than the Redbridge average.  More people are home owners and fewer are in privately rented accommodation than the London or Redbridge average. However, Roding, Bridge and Wanstead wards have a higher proportion of social housing than the Redbridge average.  Most wards in the locality have a relatively small amount of green space. However, Wanstead has a large area of green space for leisure and the locality borders Epping Forest on the West side. Access to green space is known to have health and well being benefits.  Crime rates are lower in all wards than rates in Redbridge and London and have declined in all wards.  Levels of local political engagement (measured by election turnout) are similar to London levels

Health indicators  The proportion of people who said in the census that their health was bad or very bad was lower than Redbridge average. Similarly the percentage of people who said they had a long term illness that limited their activity was lower in all Wanstead wards except Snaresbrook.  Life expectancy is higher in all wards than London for both men and women, and significantly higher than Redbridge for men in Monkhams and for women in Bridge and Wanstead. The greatest increases in life expectancy were in Roding and Bridge wards.  The prevalence of diagnosed long term illness is generally similar to the Redbridge and national rates, rates of diabetes are lower than other parts of Redbridge and than England; this is likely to be due to the ethnic profile as people of Asian origin are known to be at higher risk of diabetes than white people.  The numbers of people with diabetes has increased by 28% in the period 2009/10 to 2013/14 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 or better than the Redbridge average.  Rates of diagnosed depression in adults in the locality were higher than the borough average, although rates of dementia and severe mental illness were lower.  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 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 lower than the Redbridge average rates for fast tracking suspected cancer patients and only just over half (55%) of cancer patients in the locality have 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 Wanstead locality this ratio was slightly lower than the Redbridge average.

Children’s health  The number of births in the locality increased by 27% between 2002-2013 but has levelled off and numbers are expected to decline. Rates of teenage pregnancy are low in the locality with the exception of Bridge ward. Teenage mothers are more likely to suffer post natal depression, less likely to breast feed and more likely to live in poverty.  Immunisation is an effective way of preventing disease. Redbridge has significantly lower uptake of MMR vaccine at 2 and 5 years than national rates and vaccination

4 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 one practice met the immunisation target of 90% for all vaccinations at 12 months  Childhood obesity remains a problem. Although there has been a general decrease in levels of obesity in 4-5 yr olds in the locality and for children in year 6, rates in 10-11 year olds are still double rates in 4-5 year old; this suggests that more could be done in schools serving these wards.

Adult risk factors  Adult obesity is lower in the locality than the Redbridge average but is still high with a fifth of people being obese and a further 30% being overweight. Obesity contributes to increasing prevalence of diabetes and hypertension.  Smoking rates are lower in Redbridge than the national and London rates and lowest in Wanstead locality. 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. Wanstead had the highest quit rate

Social Care indicators - Supporting Adults, maintaining independence  Over 960 adults were receiving long term care in the locality in 2015, 86% of whom were 65+ years  Wanstead has the lowest proportions and numbers of adults receiving long term care social care, but the highest proportion receiving short term care. The need for social care for older adults is likely to increase as the numbers of people aged 65+ years in the locality increases.  The prevalence of people receiving support for learning disability in the locality is almost half the Redbridge average, but a majority receiving care (59%) are living at home with family. It is unclear whether this reflects the actual numbers of people with learning disability as more affluent families may be less likely to seek support  The proportion of people receiving care who were getting direct payments (28%) is the highest in the borough. Direct payments can give people more flexibility in their choice of care and support  A majority of carers (61%) are receiving direct payments, this is the lowest in Redbridge.  The numbers of people receiving support for residential care is the lowest in the borough. However, many people may be self funding residential care. A higher proportion of people die incare homes than the Redbridge average.  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. Day centres also provide opportunities for support and to reduce loneliness. Wanstead has the highest number using the service.

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 2011/13 (18%) in Redbridge was the second lowest in the country. This has improved slightly to 20% in 2014 but it is still very low comparatively.  In the locality a slightly lower proportion of deaths (58%) were in hospital in 2014 and around 22% at home. Fewer people died in a hospice in the locality

Commissioning implications

1. Demographic change

The projected rapid increase in the older population, particularly in Wanstead and Roding wards, will have major impacts on the numbers of people in need of servi ces

1.1 Increase in child population

Although the birth rate has started to decline overall there is a continuing increase in the fertility rate in Snaresbrook and Wanstead indicating that there is likely to remain a high demand for maternity and postnatal services in the new few years.

Although the numbers of children aged 0-4 years is projected to decrease the high number of births in the period 2003-13 will increase need for children’s services for the next 15 years at least, particularly health and education services.

 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.

1.2 Increase in the older population

 The projected 14% 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.

 There is likely to be an increase in age related illnesses. Although diabetes rates are currently lower than the Redbridge average the rapid recent increase in diabetes will

6 increase the need for patient awareness and support for self management and for treatment services

 Dementia numbers are likely to increase proportionately, 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 is likely to be an increase in illnesses for which those population groups have higher risk. This includes diabetes, heart disease and TB. Early prevention, eg through lifestyle changes can reduce the development of disease; early detection and treatment, particularly for diabetes, will reduce the development of complications.

2 Socio-economic factors

 Government welfare and housing benefit changes have increased overcrowding and homelessness in the borough overall. 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. New solutions will need to be found

 Although the locality is overall more affluent and has better economic indicators than the average for the borough, there are pockets of deprivation in some wards which may get overlooked.

3. Health

Early intervention – older people

 Although the Asian population is relatively small 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 dramatically in the coming decade as this population group gets older

 The projected 14% increase in people aged 65+years 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.

 With the high proportion of older people who live alone in the locality it is likely that social isolation and loneliness will increase. Reducing social isolation can have beneficial

7 effects on reducing the need for and use of services (Seeman 2000, Steptoe 2013, PHE 2015). Support for voluntary sector agencies and for community based services which reduce social isolation will have wider benefits. Early intervention to keep older people healthy 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.

 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.

 Diabetes accounts for 10% of the NHS budget nationally (Diabetes UK). 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 diabetic patients

 Although survival from cancer is improving, incidence is increasing as the population gets older. Redbridge has worse survival rates than the national average. Only 55% of patients with cancer are fast tracked. Improving early detection of cancer will save lives through: o raising awareness of symptoms in the population o encouraging GPs to audit their referrals.

 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 currently in Roding ward, this ward also has pockets of deprivation. Needs would best be served by having integrated children services in this location.  Bridge ward has the largest numbers of teenage parents and lone parent families, who are generally in greater need of educational and social support. It is recommended that

8 a focused sexual health service to reduce teenage pregnancy, and specific support for teenage parents including health visiting services, are located in this ward  Obesity rates have continued to increase in primary school children in Wanstead wards. Levels of obesity more than double during primary school. Focused work in schools and with parents in this area is recommended  Immunisation uptake rates in practices in the locality are well below target and put children at risk. Further action should be taken to improve uptake.

9 Wanstead Locality Profile 2015

Introduction Wanstead locality is comprised of 6 wards in the west of Redbridge. It is bordered on the west by Epping Forest. There are good transport links; the A406 North Circular runs through the locality. The locality is served by the Central line Underground line.

There are 12 GP No Code Practice name surgeries in the 1 F86731 Dr Ir Sinha - Aldersbrook Medical Centre borough and 6 F86691 Dr Kashin & Partner - Clayhall Clinic 11pharmacies and. 13 F86020 Dr Howlett & Partner - Glebelands Practice Whipps Cross Hospital 26 F86675 Dr K Sundaram - Roding Lane Surgery is the nearest main 27 F86012 Dr Price & Partners - Rydal hospital with an A&E 29 F86066 Dr Hanley & Partners - Southdene Suregery department. Wanstead 32 F86013 Dr Ahmad & Partners - The Broadway Surgery and Woodford are the 36 F86064 Dr Bowley & Partners - The Elmhurst Practice main local shopping 37 F86023 Dr Hutchings & Partners - The Evergreen Surgery 44 F86641 Dr Heyes- The Shrubberies Medical Centre centres 45 F86658 Queen Mary Practice 47 F86032 Dr Sharma & Partners - Wanstead Place 1 F86731 Dr Ir Sinha - Aldersbrook Medical Centre

10 1. Demography

Population structure

Wanstead has an older age profile than Redbridge, with smaller proportions in age groups under 40 years and larger proportions in age groups over 40 years (Fig 1).

Figure 1 Population distribution males and females, 2015, Redbridge (line) and Wanstead locality

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%) over the last 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). Net internal migration was negative, indicating that more people moved out of Redbridge than moved in from other parts of the country. International migration has been a main driver (Table 1)and India, Pakistan and Bangladesh have been the most frequent sources of migration in recent years. In 2014/15 the largest group of migrants was from Romania. In 2011/12 around 1000 international migrants registering for work in Redbridge came to Wanstead locality. This has not changed over 5 years (Fig 2).

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 Fairlop International migration 3403 3000

n 2500 Natural change 3003 Seven Kings 2000 Net change 4781 1500 Wanstead Source: GLA Borough Profiles 1000 500 0 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012

Age

Wanstead locality had an estimated population of nearly 73,000 (GLA population estimates) in 2015. This is projected to increase by 4% by 2025, with the largest percentage increases in the older age groups. Numbers of children under 5 years and younger adults are projected to decline (Table 2, Fig 3).

Fig 3

Population projections by age group,

Wanstead locality. 30000 Table 2. % Change, 0-14, 65+ all ages. by ward, 2015 to 2025

0- 65+y All 14y ages 25000 Bridge 2.1 14.3 2.3 Church End 6.6 5.5 5.6 Monkhams 10.2 11.1 5.0

20000 Roding -7.4 21.5 3.1 Snaresbrook 1.9 9.9 1.3

e 0-4 l

p Wanstead 8.2 24.7 5.8

eo 5-14 p

Locality 3.1 14.3 3.8 of 15000 15-44

er Source: GLA population projections 2014

45-64 based

umb N 65-84 85+ 10000

5000

1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1

1 1 1 1 2 2 2 2 2 3 3 3 3 3 4

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

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 Source: GLA population projections 2014 based

12 However there is considerable variation by ward. Roding and Wanstead are predicted to have population increases of 22% and 25% in the 65+years respectively by 2025 (Table 3), whilst much smaller increases are expected in this age group in Church End and Snaresbrook.

Table 3 Projected population, by age, Wanstead Locality wards, 2015 and 2025

Ward Year 0-4 5-14 15-44 45-64 65-84 85+ All ages Bridge 2015 886 1479 5006 3136 1532 211 12250 Church End 2015 887 1355 5841 2699 1194 261 12237 Monkhams 2015 602 1190 3713 3026 1966 477 10974 Roding 2015 943 1708 5527 2983 1265 128 12554 Snaresbrook 2015 834 1066 5518 2846 1734 476 12474 Wanstead 2015 917 1541 4527 3299 1679 290 12253 Locality 2015 5069 8339 30132 17989 9370 1843 72742

Bridge 2025 772 1642 4717 3407 1714 279 12531 Church End 2025 769 1620 5750 3249 1250 285 12923 Monkhams 2025 546 1428 3607 3228 2123 590 11522 Roding 2025 773 1682 5274 3524 1543 150 12946 Snaresbrook 2025 687 1249 5029 3246 1925 504 12640 Wanstead 2025 752 1908 4200 3643 2088 367 12958 Locality 2025 4299 9529 28577 20297 10643 2175 75520 % change 2015-2025 -15.2 14.3 -5.2 12.8 13.6 18.0 3.8 Source: GLA population projections 2014 based

Births

Both the number of women of childbearing age and the fertility rate have been rising in Redbridge, although the increase has been less in Wanstead locality than Redbridge as a whole. All wards in Wanstead locality have had a lower fertility rate than the Redbridge average (Fig 5). The number of births in the locality increased by 27% from 761 in 2002 to 967 in 2013. It appears from the trend data that the number of births and the fertility rate have now started to level off and population projections suggest further declines.

Fig 4 Fig 5

Trends in the number of births, by locality Trends in General Fertility Rate, by ward, Wanstead locality

1,800 90.0

s r

1,600 80.0 Monkhams

44y -

5 70.0 1,400 1 Church End

1,200 60.0 aged

Snaresbrook Cranbrook & Loxford 50.0 1,000 en 40.0 Roding

Fairlop om w

800 30.0 Seven Kings Bridge

600 20.0 1,000 Wanstead

400 Wanstead er 10.0

h Redbridge

t 0.0

200 r i

0 B

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 was Asian (Indian/ Pakistani/ Bangladeshi) (37%). There is considerable variation by age with much greater diversity in the younger age groups than 65+ years (Fig 6).

The white population is expected to decrease proportionately and the Asian population to increase between 2015 and 2025 (Table 4). 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 6 Fig 7

Ethnic distribution by age, 2015 Ethnic distribution by age, projectioned 100% Redbridge 2025 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

Fig 8

Ethnic distribution by ward Census 2011)

100%

90%

80%

70% other

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

30% Chinese Asian 20% Mixed 10% White 0%

Fig 9

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

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

e 35.0 g 30.0 n

a 25.0 White 2015 23.0 33.1 46.4 68.7 ch

20.0 % 15.0 2015 White 2025 19.3 29.1 36.4 53.9 10.0 5.0 2025 0.0 Asian 2015 42.2 43.0 30.2 19.5 Asian 2025 46.8 47.6 39.7 29.3 S ource: GLA Ethnic projections

Ethnic distribution, Wanstead locality Wanstead locality has the least Black Other, ethnically diverse population in Caribbean, 2.6 Other 1.6 Black, 0.7 Black African, Redbridge with 70% white. The second 2.8 Other Asia n, 3.0 largest ethnic group is Asian (13%) (Fig Chinese, 1.7 10). Changes in the ethnic composition

of the population can affect the need for

Asian, 12.9 health care where particular ethnic

Mixed, 5.0 groups have higher risk for particular

white, 69.8 conditions, eg. Sickle cell disease is primarily found in people of West African or Caribbean origin; South Asian communities have higher risk than other

Source: 2011 Census 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

Fig 11

Around a fifth (21%) of households with % of households with dependent children headed by a lone parent dependent children in Redbridge are headed 30

25 by a lone parent. Wanstead locality as a 20 whole has a similar proportion (22%) but % 15 there is large variation. Monkams has the 10

5 lowest proportion of lone parents (11%), 0 whilst Bridge ward has the highest (27%) (Fig 11) 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 no close family support.

Overall the locality has an older population than the Redbridge average with 15% aged 65+ years. In the 2011 census, there were 10140 people aged over 65 years; of those 3593 (35%) said they were living alone; this is higher than the Redbridge average (Fig 12). All wards in the locality had higher proportions than Redbridge average.

Fig 12

Proportion of people aged 65+ years who live The older population 65+ yrs is projected to alone, Wanstead wards (Census 2011) increase by 15% by 2025 and it is likely that

s 40 r

y 35 the number of older people living alone will + 30

l 25 increase proportionately to that.

p 20 eo

p 15

o 10

% 5 0

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 quintile enables a comparison of the local with the national deprivation profile.

Fig 13 Percentage of LSOA areas by deprivation 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

Source: Index of Multiple Deprivation 2015 * 1=most deprived

16 Wanstead locality has a more affluent deprivation profile to the national or Redbridge profile. (Fig 13) with fifty percent of the areas in the most affluent national quintile. However there is considerable variation within the locality. In Monkhams nearly 90% of the area is in the least deprived quintile whilst nearly 30% of the LSOA areas in Roding and Bridge wards are in the two most deprived quintiles; Monkhams has the highest concentration of affluence in Redbridge.

Children in poverty

The proportion of children under 16 years living in poverty (children living in families where income is less than 60% of median income) has declined in parallel with the England average but less than the London average between 2006 and 2012 (Fig 14), and it remains lower than these values in all wards (Fig 15). More recent data for this indicator are not available however recent changes in the welfare system are likely to have had the consequence of increasing some child poverty as people have had housing and out of work benefits cut.

Fig 14 Fig 15

Trends in child poverty <16 yrs, Wanstead % of children <16 yrs living in poverty wards 2012, Wanstead wards 35 25 Bridge es ili 30 20 Church End

fam 25 15 Monkhams

% oor

p 20

n Roding i

15 en en Snaresbrook 5

il 10 h 0 c Wanstead

o 5

% London 0 England 2006 2007 2008 2009 2010 2011 2012 Source: GLA Ward profiles, from HMRC

Income and employment

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

Fig 16

Employment rate, Wanstead wards (census 2011) All wards in Wanstead locality had 85 employment rates above the Redbridge

75 (Fig 16), London and England averages.

population 70 Correspondingly claimant rates of

rkingage Housing Benefit (Fig 17), Job Seekers

o 60

f w f o

% Allowance (Fig 19) and Out of Work 55

50 Benefits (Fig 18) in 2014/15 were lower than Redbridge, London and England averages. Source 2011 Census

17 Fig 17 Fig 18

Rate of Housing Benefit claimed, 2015, Rate of Out of Work benefits claimed, 2014, Wanstead locality Wanstead locality 14.0

14.0

s 12.0

r 12.0

ation +

10.0 l 10.0

o 8.0

8.0 p

ation

l 6.0

6.0 age

g 4.0

n popu

4.0 f

ki 2.0

% 2.0 0.0

f o

0.0 %

Fig 19 Fig 20

Claimant rate for Job Seekers Allowance 2015, % of dependent children 18yrs living in out of Wanstead locality work households,2014, Wanstead locality

3.0 18.0

ion 16.0 t 2.5 la 14.0

2.0 12.0 popu 10.0

tive 1.5

c 8.0

a 6.0 1.0 4.0 ically 0.5 2.0 0.0 conom

e 0.0

f o

Source: GLA Ward profiles

In 2014 there were 1200 children 0-18 years living in out of work households in the locality, over half (54%) of whom were in Bridge and Roding wards (Fig 20).

Political engagement

Fig 21

People’s willingness to participate in local Turnout in Local election 2014 and London and regional elections can be seen as a Mayoral elections 2012, Wanstead locality 50 measure of political engagement and the 45

40 extent to which people feel that they have a t 35

30 nou

r 25 Local election

stake in their society. Data from the 2014 tu 20 2014 % 15 local and 2012 Mayoral elections show that 10 Mayoral 2012 5 turnout in Wanstead locality was generally 0 similar to the Redbridge average. Wanstead ward had the highest turnout in Redbridge (Fig 21). Source: GLA ward profiles

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 green spaces or

18 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. Although Wanstead locality, with the exception of Wanstead ward, does not have a large

Fig 22

% of area that is green space, Wanstead locality amount of green space (Fig 22) it is bordered 70 60 on the west side by Epping Forest which is 50 easily accessible and protected land, mainly 40 30 woodland as well as the area of Wanstead 20 10 Flats which has opportunities for leisure 0

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 borough but all wards in Wanstead locality except Wanstead ward had total crime rates that are below the Redbridge average (Fig 23). Rates of Violence against the person are much lower than the Redbridge and London averages (Fig 24).

Fig 23 Fig 24

Total crime rate, Wanstead wards, 2014/15 Violence against the person, rate, 2014/15

90 25

n o

80 i t la ation 20 l 70

pu 60 o

popu 15

000 40

, 10

1,000

20 5

e t

10 a R Rate 0 0

Source: GLA ward profiles

19 Fig 25

Trends in Total Crime Rate, Wanstead wards Trends show that total crime has 160 140

Bridge

decreased in all wards in the locality p 120 po over the last 10 years although the rate 100 Church End

1,000 Monkhams

of decrease has been less than London er p

60 Roding

e t

a 40 (Fig 25). R Snaresbrook 20 Wanstead 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.

Fig 26

There is variation across the borough Housing Tenure, Wanstead locality (fig 26). Data from the 2011 Census 100% 90% show that Monkhams ward has the 80% 70% highest proportion of owner 60% 50% Private rented occupied properties and the lowest 40% 30% Social rented proportion of social rented 20% 10% Owned properties in the borough (Fig 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 homelessness. The low stock of social housing in the borough means that there is very little capacity to house homeless people in permanent housing. Because of the high proportion of owner occupation Wanstead is likely to be fairly insulated from insecurity of tenure.

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.

20 A consequent 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 found 168 such illegal structures (ref). A minority (n=13) of these structures were in Wanstead locality and half 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 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

Wanstead 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

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

21 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. Wanstead locality had similar or lower rates of LLTI in all wards except Snaresbrook (Table 5) and a smaller proportion of people who said they were in bad or very bad health than the Redbridge average.

Table 5. Numbers (%) 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 Bridge 1710 14.7 553 4.7 Church End 1392 12.1 417 3.6 Monkhams 1548 14.9 392 3.8 Roding 1477 12.3 441 3.7 Snaresbrook 1932 16.3 575 4.8 Wanstead 1715 14.9 462 4.0 Locality 9774 14.2 2840 4.1 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 (Figs 28,29). 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 Fig 29

Projected number of people whose Projected Number of older people whose

activities are limited a little by illness, by activites are limited a lot, by age Redbridge

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 2,000 85+ 85+ 1,000

0 0 2014 2015 2020 2025 2030 2014 2015 2020 2025 2030

Source: www.poppi.org.uk version 9.0, based on 2011 Census data

22 Mortality rates

There were 1809 deaths in Redbridge in 2013, a decline from 2073 in 2002; of which 493 were in the locality

Mortality rates in Redbridge have been consistently around or below the national and London averages and have slightly declined since 2002. In Wanstead wards mortality rates were consistently below the Redbridge average and have declined in line overall in line with borough trends. However, since 2008/10 the standardised mortality ratio (which compares local rates to a national benchmark of 100) in Bridge ward has increased (Fig 30)

Fig 30

Trends in mortality, Wanstead locality (England=100) Monkhams

110 Church End

100 Ratio

Snaresbrook ty

il 90 Roding

tal 80 Bridge Mor 70

sed Wanstead i

rd 60 a Redbridge

nd 50 London Sta

Source: ONS

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 and women than the London and National averages (Figs 31,32). However the rate of increase over 10 years 1999/2003 to 2009/13 has been slightly slower.

Fig 31 Fig 32

Trends in male life expectancy Trends in Female life expectancy

85 85

83 83

81 81

s s

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 ward profiles, ONS data

23 In 2009-13 life expectancy for males was significantly higher in Monkhams ward and for females was significantly higher in Bridge and Wanstead wards than Redbridge, London and national averages (Figs 33a, 33b).

Fig 33a. Male life expectancy 2009-13, Fig 33b.Female life expectancy, 2009-2013, Wanstead locality wards Wanstead locality wards 90 90

88 88

86 86

84 84

82 82

80 80

78 78

76 76

Source: GLA

Fig 34a. Trends in Male life expectancy, Fig 34b. Trends in Female life expectancy, Wanstead wards Wanstead wards 88 88

86 86 84 Bridge 84 Bridge Church End 82 82 Church End Monkhams Monkhams 80 80 Roding Roding 78 78 Snaresbrook Snaresbrook 76 76 Wanstead Wanstead 74 London 74 London

72 Redbridge 72 Redbridge

Source: GLA ward profiles, ONS data

Over 10 years male life expectancy in increased less in London than Redbridge; Bridge and Roding wards had the largest increase at 6.1 and 5.3 years respectively (Table 6). Most wards had a greater increase in male life expectancy than Redbridge and London.

Table 6. Male and Female life expectancy at birth, 2009-13, and increase between 1999-2003 and 2009-13, Wanstead Locality

Male Female Years incr Years incr males females Bridge 81.8 86.4 6.1 4.2 Church End 80.1 85.8 3.0 2.5 Monkhams 82.1 84.0 3.9 2.1 Roding 81.5 85.0 5.3 4.1 Snaresbrook 79.8 85.0 4.7 3.2 Wanstead 80.0 86.0 2.3 4.0 Redbridge 80.2 83.9 3.4 2.7 London 79.7 83.8 3.9 3.2 Source: GLA ward profiles, ONS data

24 Redbridge has had a lower increase (1999-03 to 2009/13) in female life expectancy (2.7 years) than London (3.2 years) (Table 6). Bridge, Roding and Wanstead wards had a higher increase than the London average.

Long term illness

Information about the prevalence of major diseases comes from GP disease registers. It is likely that there will be some undetected or undiagnosed illness in communities so these data are likely to be underestimates of the true prevalence. Admissions to hospital and death rates 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 and rates from QOF database are not age standardised. Redbridge has lower rates of Cardiovascular Disease (Stroke and Coronary Heart Disease (CHD)), Chronic Obstructive Pulmonary Disease (COPD) and hypertension, but higher rates of diabetes than England. 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. People of Asian or AfroCaribbean ethnicity are at higher risk of developing diabetes.

In Wanstead locality there are lower rates of diabetes and CHD than the Redbridge average (Fig 35)

Fig 35

Table 7. Number of people with Prevalence of selected long term conditions, condition diagnosed in Locality 2014/15, Wanstead locality (QOF data) 2014/15 16.0 14.0 Condition n 12.0 Diabetes 3083

10.0 ation l CHD 1796

8.0 COPD 818

popu England

f 6.0 o Redbridge Depression 2419 % 4.0 Hypertension 9802 Wanstead 2.0 Severe mental 598 0.0 illness Dementia 360

Source: National GP practice profiles

Diabetes is a major 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.

25 The numbers of people with diabetes in the locality have increased substantially in the 5 years 2009 to 2014/15 and by 28% in the locality 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 HbA1c is a marker of control of blood <59mmol/mol, Wanstead practices, 2014/15 sugars. Only 59% of the diagnosed

Eng population in the locality had good Redbridge F86023 diabetes control as measured by F86658 F86691 (HbA1c<50mmol/mol) (Fig 36), F86066 F86012 although the variation between F86641 F86675 practices was 49% to 66%.All except F86020 F86032 one of the practices in the locality F86064 F86731 had diabetic control rates similar to F86013 the Redbridge average 0 20 40 60 80

Source: National GP Practice Profiles, QOF data

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) are significantly lower than the national rates.

Wanstead locality has higher crude prevalence of COPD than the Redbridge average (Fig 37). This is likely to be due the higher 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 rates %, 2014/15, Wanstead practices 2.0 1.8 Redbridge F86731 1.6 F86675 1.4

F86066 COPD per ion

t 1.2 F86641 1,000 la

1.0 F86658 popu

F86064 f Smoking

o 0.8 F86023 % rate % 0.6 F86012 0.4 F86020 F86032 0.2 F86013 0.0 F86691 Cranbrook Fairlop Seven Wanstead Redbridge England & Loxford Kings 0 5 10 15 20 Source: National GP Practice Profiles, QOF

26 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. It is likely that there is some under-diagnosis in practices which have high smoking prevalence and lower COPD prevalence (Fig 38).

There were 101 hospital admissions for COPD in the locality in 2012/13. This represents a higher rate than the Redbridge average.

Hypertension increased the risk of heart disease, stoke 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. 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 Wanstead locality to the Redbridge average (Fig 39). In a majority of practices over 80% of patients with diagnosed hypertension had their blood pressure well controlled (Fig 40); four practice had significantly better rates of hypertension control.

Fig 39 Fig 40

Prevalence of hypertension, by locality, 2014/15 % of patients with diagnosed hypertension 16 whose BP was <150/90mmHg, 2014/15, Wanstead practices 14 England 12 Redbridge

F86066

10 F86731 ation l F86064 pu 8

o F86032 p

f F86020 o 6

% F86658 F86691 4 F86013

F86675 2 F86641 0 F86012 F86023 Cranbrook Fairlop Seven Wanstead Redbridge England & Loxford Kings 0 20 40 60 80 100 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. Wanstead locality has the highest proportion of adults diagnosed with depression in the borough (Fig 41), but levels of dementia (Fig 43) and severe mental illness (Fig 42) are lower than the Redbridge average.

27 Fig 41 Fig 42

Prevalence of depression, people 18+ yrs, by Prevalence of severe mental illness, per locality, 2014/15 1,000, by locality 2014/15 6.0 12 5.0

a l

y 4.0 +

u 8

pop

0 on on i 3.0 6

l 100

e 4

popu

2.0 e

t %

Ra 2 1.0 0 Cranbrook & Fa irlop Seven King s Wanstead Redbridge 0.0 Loxfo rd Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford Fig 43 Prevalence of dementia, by locality, As the population ages the number of per 1,000, 2014/15 people diagnosed with dementia is likely to 7.0 increase. The number of people aged 65+

6.0

i years is projected to increase by 14% in the t

a 5.0 l u locality by 2025. A comparable increase in

pop 4.0

0 00

, the number of people suffering from 1

3.0

r e

e dementia is likely.

t 2.0 a R 1.0

0.0 Cranbrook Fa irlop Seven Wanst ead Redbridge & Loxford Kings

Source: QOF, GP Practice Profiles

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).

One year survival is determined largely by how soon the cancer is diagnosed and treated – earlier diagnosis and treatment gives a much better prognosis. England has lower survival than many other similar countries and the government has put in place actions to improve early diagnosis. Fast tracking patients with suspected cancer through the ‘Two week wait (TWW)’ route can aid earlier diagnosis. However, across the country, still the majority of people who turn out to have cancer are not fast tracked through this route.

28 The proportion of people who go through Fig 44 the TWW route was higher in Redbridge Trends in one year survival, all cancers, 15 - (58%) in 2014 than England (48%). In 99yrs. Cancer survival index*

Wanstead locality there were 260 new x

d 70

n i cancer cases diagnosed in 2014/15 of

l l 65

a v

i 60 v

which 144 (55%) (Fig 45) were referred r

u 55 S Redbridge

through TWW, however practice rates d 50

s i

d 45 London

ranged from 20% to 72% (Fig 46). r a

d 40

n a

These data should be treated with caution t 35

g 30 as there are recognised data quality A issues.

Fig 45 Fig 46

% of people diagnosed with cancer who % of people diagnosed with cancer who were were referred through TWW, by locality, referred through TWW, by practice, Wanstead 2014/15 locality, 2014/15 70 England 60 Redbridge 50 F86064 40 F86691 30 F86023 20 F86013 10 F86731 0 F86032 F86012 F86020 F86658 F86641 F86066 F86675 Source: GP Practice profiles, data from NCIN 10 20 30 40 50 60 70 80

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 Wanstead locality 40 35 overall this proportion (41%) was slightly 30 25 higher than the Redbridge average (42.8%) 20 15 in 2012/13 (Fig 47). These data are no longer 10 reported in the Practice profiles. 5 0 Cranbrook & Fairlop Seven Kings Wanstead Redbridge Loxford

29 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% ambulance attendances 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

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. Thirty four per cent of referrals to the service were from Wanstead 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 (Fig 48) (however London has the lowest uptake of vaccinations in the country). The proportion of children aged 5 who have had both MMR jabs is significantly lower 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, These levels are well below the levels

2014/15 required to create herd immunity in 95 90 the population (95%) and create a

85 significant risk of infectious disease, 80 75 Redbridge which can have long term 70 England consequences. There have been a 65 London 60 number of outbreaks of these diseases 55 50 in London in recent years. MMR1 MMR2 Source: HSCIC

No practice met the 95% threshold for all vaccinations. Only one practice met the immunisation target of 90% for at all vaccinations at 12 months. No practices met that target for the vaccination rounds at 24 months and 5 years

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

MMR MMR Dtap/IPV/Hib Men C Dtap/IPV/Hib MMR Dose 1 Dose 2 F86012 81.0% 82.4% 78.9% 73.5% 66.3% 53.0%

F86013 89.8% 90.7% 87.1% 75.9% 61.3% 54.0%

F86020 88.4% 89.5% 79.0% 71.6% 65.5% 58.6%

F86023 93.5% 93.5% 92.7% 83.3% 61.7% 57.8%

F86032 86.9% 88.2% 87.9% 81.2% 65.2% 48.0%

F86064 89.2% 91.9% 84.4% 83.3% 66.2% 53.5%

F86066 86.2% 87.2% 84.6% 70.3% 65.5% 55.8%

F86641 84.6% 85.3% 83.5% 78.9% 70.1% 53.8%

F86658 79.5% 80.8% 79.4% 66.7% 56.3% 45.0%

F86675 84.6% 87.2% 94.0% 82.0% 69.8% 64.2%

F86691 84.0% 90.7% 87.7% 84.0% 81.9% 67.0%

F86731 86.3% 88.2% 91.5% 84.7% 60.2% 48.2%

Source: COVER data

Teenage pregnancy

Fig 49

Teenage pregnancy rates (conceptions in Rates of teenage pregnancy, Wanstead wards, women <18 years) are lower in Redbridge 2011-13

than the London and national rates, s

r y

18 < however there is significant variation by

en 30

ward. om w

000 000 20

Bridge ward has significantly higher rates ,

er p than the Redbridge average (Fig 49), and 10

Wanstead ward has significantly lower rates Rate 0 than the Redbridge average. Numbers and rates in Monkhams and Church End wards were too small to report Source: ONS

Children’s use of A&E services

Rates of attendance at A&E by children under 5yrs, and rates of emergency admission for all causes in children under 18yrs were lower in Wanstead than the Redbridge average. Rates for Redbridge are not significantly different to the national average. Fig 50 Fig 51

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

F86066 600

F86675 r y

4 500

F86023 -

F86064 400

op ad F86013 p

t F86691 300

000 ans

F86020 ,

1 W

F86658 200 er

p F86032 F86641 100

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

F86009

s F86635 g

i F86642 K Y00155

ven F86028 Fig 52 e S F86087 Y00090 A&E attendance rates 0-17 years, by F86637 locality, 2011/14 F86060

F86057 400

F86707 r

y 350

F86010

18 ,

300

F86083

op p

l F86007 250

r i

a F86081

F 200 000

F86085 1,

F86612 150 er

p 100

F86624 Y02987 50 Y00918 Rate 0 F86025

F86692 Cranbrook Fairlop Seven Wanstead Redbridge

r F86082 & Loxford Kings o

x F86008

o L

F86022

k F86698

o F86042

ro b

n F86652

Cra F86657 F86703 F86702 F86655 0 100 200 300 400 500 600 700 800 Source: National GP Practice Profiles

32 There is considerable variation between practices with an almost two fold difference between the highest and the lowest rates (Fig 50)

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

Trends in childhood obesity, Wanstead wards In all Wanstead locality wards childhood obesity 25 Bridge recep rates are below the

Church End Recep Redbridge and London 20 Monkhams Recep averages. There is evidence Roding Recep that levels of obesity are Snaresbrook Recep 15 starting to decrease in

Wanstead Recep

% Bridge yr 6 reception year (Fig 53);

10 Church End yr 6 there have been significant

Monkhams yr 6 reductions % between

Roding yr 6 2008/9 and 2012/13 in 5 Snaresbrook yr 6 Bridge (25%), Snaresbrook Wanstead yr 6 (40%) and Roding (22%) London Recep 0 wards. There have also been England Recep some reductions for children London yr 6

England yr 6 in Year 6 in Monkhams and Wanstead wards. Source: NCMP

The continuing 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 prevalence of obesity of 25%. Adult obesity, particularly

33 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.

Adult Obesity rates in Wanstead are the lowest in the borough. In Wanstead locality practices the proportion of people measured as being obese or overweight was 16% and 29% respectively, although these proportions by practice ranged between 13%-20% and 26%-32%. These are the lowest levels in Redbridge. However these data should be treated with caution as around 13% (range 6% to 19% by practice) of patients had no record of weight measurement. Although these levels are relatively low they still represent increased risk.

Fig 54 Fig 55

% of adults who are overweight or obese, % of adults who are overweight/obese, by GP practice, Wanstead locality by locality, 2015 Redbridge 60% F86691 50% F86064 F86731 40% F86066 30% F86675 20% % Obese F86641 % Overweight F86020 10% % Obese % Overweight F86012 0% F86032 F86658 F86023 F86013

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 (source: ASH) have been used here.

Smoking rates in Redbridge are significantly lower than the London and National averages. Smoking rates in Wanstead locality are lower than the Redbridge average in all except Bridge wards (Fig 56). Monkhams and Snaresbrook have the lowest rates in Redbridge.

34 Fig 56

Estimated prevalence of smoking by ward, 2015

a r

ENGLAND

a rs

o LONDON t m Co REDBRIDGE Bridge Roding

e Wanstead t

n Church End a W Snaresbrook Monkhams

Goodmayes

s g

n Seven Kings

i K

Newbury en v Chadwell Se Aldborough

Hainault

p Fullwell

ir Fairlop a

F Barkingside Clayhall

Loxford

k Clementswood

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%

Fig 57

Redbridge has had a successful Quit Quit rates by ward, Wanstead locality, Smoking service for a number of years, with 2014/15 around 1000 people per year meeting a 4 80 70 week quit target; in 2014/15 50% of people 60 50 who set a quit date were still quit at 4 40 30 weeks. This is similar to the England (51%) 20 10 rate. In 2014/15 213 people in Wanstead 0 locality met the four week quit target, representing a quit rate of 53% for the locality. This was the highest rate in the Source: Smoking Cessation service borough and Quit rates were higher in Quit rate = % of people who are still quit 4 weeks after Monkhams and Roding wards than the having set a quit date Redbridge average.

35 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 there are 4706 receiving long term social care, of whom 80% (n=3759) are 65+ years (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

Around 8% of people receive care out of borough. Wanstead locality had the lowest proportion of adults (Fig 58), both 18-64 years and 65+years, receiving long term care in the borough. The numbers of older people (65+ years) receiving long term care are fairly consistent across each of the localities, although the rates are lower in Wanstead locality (Fig 59).

Fig 58 Fig 59

% of people aged 65+years receiving Adults receiving long term care, by 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 6.0

10.0 er

p 4.0

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

36 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

Twenty eight per cent of people in the locality were receiving direct payments to pay for their care; this is the highest for the borough. Wanstead also had the highest proportion of people receiving short term care.

It is likely that the higher levels of affluence in Wanstead locality mean that more people in need of long term care and support are able to pay for it themselves rather than rely on Adult Social Care Services.

Learning Disability

There were 652 people receiving support for learning disability in Redbridge in 2015. In 2013/14 there were 804 adults on GP registers with learning disability.

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

lower than the Redbridge average (Fig 62). s r 3.5 +y

18 3.0 This may reflect lower levels of need or it

op 2.5

p may be that Wanstead residents with

2.0

000 ,

1.5 learning disability needs are able to fund er

p 1.0 support privately.

0.5 Rate 0.0 Of those receiving care, 59% are living at Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford home with family. Source: Care First Redbridge

Because of recent changes in a number of eligibility criteria it is not possible to look at the trends for these data.

37 Carers

Redbridge supports 675 carers across the borough, of which 123 are in Wanstead locality. The majority (61%) of this support in the locality is through direct payments; this is the lowest 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 in residential care are in homes out of borough. Wanstead has the lowest numbers of people receiving residential care support in the borough. It is likely that this is because a higher proportion of people in need of residential care are able to fund it themselves

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.  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

38 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.

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

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 156 clients who used the service in Wanstead locality, the highest number of people using the service in the borough (Table 11).

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. Older people: two day centres, one in Hainault and one in Goodmayes cater for older people; 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

39 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 (Fig 63), 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,Wanstead locality, 2014 70.0 70

60.0 60

50.0 50

40.0 40 Wanstead

% Redbridge % 30.0 30 Redbridge England England 20.0 20

10.0 10

0.0 0 Hospital Home Care Home Hospice Hospital Home Care home Hospice 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.

There is some variation between localities. In Wanstead locality slightly more people died at home or in care homes than the Redbridge average (Fig 64). There are very low numbers of people reported to die in a hospice. Wanstead locality is adjacent to the Margaret Centre at Whipps Cross Hospital and it is likely that the numbers dying in a specialist palliative care unit are underestimated due to the coding issues mentioned above.

40 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

Local action on health inequalities Reducing social isolation across the lifecourse. Practice resource:. UCL Institute of Health Equity. Public Health England, September 2015

Seeman Teresa E. Health Promoting Effects of Friends and Family on Health Outcomes in Older Adults.American Journal of Health Promotion. 2000;14:362-70

Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. PNAS. Published online March 25 201

41 Appendix 1

GP practice codes Code Practice name F86012 Dr Price & Partners - Rydal F86013 Dr Ahmad & Partners - The Broadway Surgery F86020 Dr Howlett & Partner - Glebelands Practice F86023 Dr Hutchings & Partners - The Evergreen Surgery F86032 Dr Sharma & Partners - Wanstead Place F86064 Dr Bowley & Partners - The Elmhurst Practice F86066 Dr Hanley & Partners - Southdene Suregery F86641 Dr Heyes- The Shrubberies Medical Centre F86658 Queen Mary Practice F86675 Dr K Sundaram - Roding Lane Surgery F86680* Dr E Menon - Ferndale Surgery* F86691 Dr Kashin & Partner - Clayhall Clinic F86012 Dr Price & Partners - Rydal *Now closed