Community & Social Care Cranbrook & Loxford
Cluster Profile
2015
Community & Social Care Cranbrook & Loxford Cluster 69, Albert Road, Ilford, Essex, IG1 1HP.
Developing a sustainable preventative quality health and adult social care service delivered locally for the residents of Redbridge
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Contents
Summary ………………………………………………………………… 3 6 Commissioning implications……………………………………. Introduction……………………………………………………………. 10
1. Demography……………………………………………………… 10 Population structure and population change Age Ethnicity Household structure
2. Social Indicators…………………………………………………. 16 Deprivation Income and employment Political engagement
3. A healthy environment ……………………………………… 19 Green spaces Crime Housing
4. Health Indicators ………………………………………………. 22 Self assessed health Mortality rates Life expectancy Long term illness Emergency care Children’s health
5. Well being and lifestyle …………………………………….. 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 P r a c t i c e codes 41 2
Cranbrook and Loxford Locality
Summary
Population
The locality has the youngest population in Redbridge with only 10% aged 65+ years The population is increasing and is projected to further increase by 19% by 2025 with the biggest increases in Clementswood and Loxford wards and in older age groups, with the number of people aged 65+ years projected to increase by 25%. International migration is a key driver for population increase in Redbridge with people from the Indian subcontinent being the main migrant groups Births have increased by 50% since 2002. Although the increase in the birthrate appears to have levelled off there will continue to be an increase in the 0-14 year population for at least 10-15 years The ethnic composition of the locality is majority (52%) Asian. The proportion of older Asian people is projected to increase.
Socio-economic circumstances Cranbrook and Loxford locality is the most deprived in the borough, Loxford and Clementswood wards in particular have levels of deprivation in the worst 30% in the country. There are lower levels of employment and a higher proportion of people claiming out of work and housing benefits than Redbridge average. One third of children in Loxford ward are living in poverty and one third of families are headed by lone parents. Fewer people are home owners and more are in privately rented accommodation than the London or Redbridge average. Less than 50% of households are owner occupiers in Loxford, Clementswood and Valentine wards. The locality also has the highest numbers of people applying for housing for reasons of overcrowding or homelessness The locality is the most urbanised in the borough and, with the exception of Cranbrook ward, has the lowest amount of green space Crime rates are the highest in Redbridge Levels of local political engagement are low, suggesting that people feel less of a stake in their local communities.
Health indicators The proportion of people who said that their health was bad or very bad was higher than Redbridge average
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Life expectancy in Loxford ward is significantly lower than London and Redbridge averages for both men and women, and death rates higher than the London average The prevalence of diagnosed long term illness is generally lower than the Redbridge and national average and this is likely to be due to the younger age profile, but rates of diabetes are much higher than Redbridge and national rates. The numbers of people with diabetes has increased by 64% in the period 2009/10 to 2014/15 and is projected to continue to increase. In a majority of locality practices control of diabetes (as measured by levels of HbA1c) is similar to Redbridge average, but this is only 57% with good control. Three practices have significantly lower rates. This is likely to lead to more complications in the long term. Rates of diagnosed severe mental illness in adults in the locality were the highest in the borough, although rates of depression were no different. Dementia is high and 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 worse than average rates for fast tracking suspected cancer patients and only around half (53%) 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 Cranbrook and Loxford locality this ratio was slightly higher than the Redbridge average.
Children’s health Births: Cranbrook and Loxford locality had the highest number of births (n=1536) in Redbridge, and a third of births were in this locality. 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 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 all vaccinations. Only four practices met the immunisation target of 90% for at all vaccinations at 12 months Loxford ward has significantly higher rates of teenage pregnancy than the national average. Teenage mothers are more likely to suffer post natal depression, less likely to breast feed and more likely to live in poverty. Rates of attendance at and admission to A&E by children <18yrs are slightly lower in the locality than the Redbridge average.
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Childhood obesity remains a problem. Although there has been a general decrease in levels of obesity in 4-5 yr olds in the locality, in 10-11yr olds obesity has increased in Loxford and Valentine wards, and rates of obesity double between reception and year 6, suggesting more could be done in schools serving these wards.
Adult risk factors Adult obesity is high in the locality with a fifth of people being obese and a further 30% being overweight. Obesity contributes to increasing prevalence of diabetes and hypertension. Smoking rates are lower in Redbridge than the national and London rates. There were 254 deaths attributable to smoking in 2013. Redbridge has a successful smoking cessation programme with 50% of service users meeting the 4 week quit target. Rates of smoking in Cranbrook and Loxford wards are higher than the Redbridge average and quit rates are lower.
Social Care indicators - Supporting Adults, maintaining independence The need for social care for older adults is likely to increase as the numbers of people aged 65+ years increases Over 1100 adults were receiving long term care in the locality in 2015, 77% of whom were 65+ years. 157 people were receiving care for learning disability over half of whom received care in the family home. A higher proportion of people receiving long term care in Cranbrook and Loxford locality are 18-64 years and this reflects the greater needs of this population. Fewer people receiving care were getting direct payments (12%) than in other localities. Direct payments can increase flexibility in care provision A majority of carers (69%) are receiving direct payments, this is similar to the average The locality has a number of large residential care homes and this is reflected in the higher numbers of people in residential care. The community meals service provides meals every day of the year to people assessed to be in need and enables people to stay in their own home as they get frailer. Fifty seven per cent of users are aged 85+years. Day centres also provide opportunities for support and to reduce loneliness.
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%) was the second lowest in the country. This has improved slightly to 20% in 2014 but it is still very low comparatively.
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The pattern in the locality reflects the broader Redbridge picture with nearly 60% of people dying in hospital and around 20% at home.
Commissioning implications
1. Demographic change
The rapid increase in the population 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 there is likely to remain a high demand for maternity and postnatal services.
The high number of births in the period 2003-13 will increase need for children’s services for the next 10-15 years at least, particularly health and education services. The projected 23% increase in children 014 years will result in:
Increased need for school places Increased need for health visitors and school nurses Increased need for paediatric health services, including CAMHS The increased fertility rate suggests larger family sizes. This will impact on need for larger housing units to accommodate larger families.
Children 0-4years are high users of health services, particularly A&E services, but also GP services. Consideration should be given to developing specific urgent care services or centres for children in areas with integrates services where there is high need. Clementswood ward in particular is projected to have a 46% increase in the child population.
1.2 Increase in the older population
The projected 25% increase in people aged 65+years in the locality, and particularly those aged 85+years, will increase the number of frail elderly who will be in need of social care support, either to maintain independent living or for residential care.
There is likely to be an increase in age related illnesses. The rapid increase in diabetes will increase the need for patient awareness and support for self management and for treatment services to prevent diabetic complications which are damaging to health and expensive to treat.
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Dementia numbers are likely to increase, with consequent need for support for this vulnerable group. A review of the likely availability of dementia services is recommended
1.3 Changes in ethnic composition
With continuing migration from SE Asia, and the aging of the resident Asian population there will be an increase in illnesses for which those population groups have higher risk. This includes, diabetes, heart disease and TB
2 Socio-economic factors
Government welfare and housing benefit changes have increased overcrowding and homelessness in the borough, and particularly in the locality which has a high percentage of people living in privately rented accommodation vulnerable to insecurity of tenure.
The housing situation throughout the borough gives little flexibility to deal with increasing pressures in the market due to the low proportion of social housing. New solutions will need to be found
The locality has a poor physical environment with lack of green space, significant levels of poverty and unemployment and economic vulnerability. These situations are particularly focussed in Loxford, Clementswood and Valentine wards
Poor physical, social and economic environments increase the likelihood of mental and physical ill health
It is recommended that: Improved physical environment in Ilford. More green spaces be provided for leisure activity and opportunities for physical activity Support for people to find work/improve skills Attention is paid to improving road safety to reduce accidents
3. Health
Early intervention – older people
Cranbrook & Loxford locality has a majority Asian population and the proportion of older people who are Asian will increase as the population ages. Asian people have a much higher risk of CHD and diabetes. Need for both preventative and treatment services for
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these conditions is likely to increase dramatically in the coming decade as this population group gets older
The projected 25% increase (n=255) in people aged 85+ is likely to result in a corresponding increase in people who have conditions that limit their daily activities, and who are likely to need support to live independently, or in more severe cases, residential care.
Increased work on falls prevention will be needed to reduce the numbers of elderly people who fall and need hospital care. This should include vitamin D supplementation where individuals are vitamin deficient and at risk of osteoporosis. In particular in the older Asian population will be more at risk because of darker skin and less sun exposure.
Early intervention to keep older people healthy and independent will help reduce and/or delay the need for health and social care services. Such interventions may be better provided by a vibrant voluntary sector who are often closer to communities. Developing and maintaining the voluntary sector will need robust funding mechanisms.
The burden of diabetes is rapidly increasing. This will affect the health and lives of thousands of local residents and will also present an increasing need for both primary and secondary health care. It is estimated that diabetes accounts for 10% of the NHS budget (Diabetes UK), it is likely that proportion in much greater in Redbridge and in Cranbrook and Loxford locality. Preventing diabetes and reducing its effects should be a key priority for the locality through: o Improving access to leisure services and facilities to reduce obesity o Increasing opportunities and programmes for physical activity o Improved diabetic control through Expert patient programmes and improved primary care services for diabetic patients
Levels of severe mental illness are a significant problem in the locality. Mental illness can result in loss of employment, family problems and further ill health. Provision of effective mental health services that can provide timely treatment should be a priority
Although survival from cancer is improving, incidence is increasing as the population gets older. Redbridge has worse survival rates than the national average. Improving early detection of cancer through raising awareness of symptoms in the population and encouraging GPs to audit their referrals will save lives.
Too many people die in hospital and too few die at home in the locality and Redbridge as a whole. The Gold Standards Framework in Primary care can facilitate and enable people to die at home and this should be rolled out in the practices in the locality.
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Maternity and Children’s services
Continuing high rates of migration of younger adults is likely to continue to increase the need for maternity services despite the apparent current trends in fertility.
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 in Clementswood and Loxford wards. These are also the poorest wards with the highest needs. Ensuring the provision of integrated services in these wards is vital.
The locality, and Loxford ward in particular, 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 children’s services, including health visiting services, are concentrated in children’s centres to facilitate client access and joint working, and that the numbers of health and social care professionals reflect that need.
Obesity rates have continued to increase in primary school children in Loxford and Valentines wards. Levels of obesity double during the primary school period. 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.
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Cranbrook & Loxford Locality Profile 2015
Introduction Cranbrook & Loxford locality is comprised of 5 wards in the south of Redbridge. It is bordered to the south by London Borough of Newham and to the east by Barking and Dagenham. There are good transport links; the North Circular Road runs on the western edge and the locality is served by overground lines from Liverpool St to Shenfield.
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No Code Practice name The locality contains Ilford 2 F86042 Dr S Sinha - Balfour Road Surgery which has a thriving local 7 F86698 Dr P Mahendra-Yogam - Cranbrook Surgery shopping centre. There 12 F86008 Gants Hill Medical Centre 16 Y00918 Dr H Singh - Granville Medical Centre are 13 GP surgeries in the 20 F86082 Dr Sahu - Ilford Lane Surgery borough, 12 pharmacies 21 F86022 Dr Greenaway & Partners - Ilford Medical Centre and a polyclinic. King 22 F86692 Dr S Mathukia - Mathukia'S Surgery George Hospital is the 24 F86025 Dr Kanagasudrem & Partners - Oak Tree Med Prac nearest main hospital with 31 F86702 Dr W Solomon - St Clements Surgery an A&E department. 33 F86655 Dr S Babbar - The Courtland Surgery 35 F86652 Dr Sehra - The Drive Surgery 42 Y02987 The Practice Loxford 43 F86703 Dr K Subberwal - The Redbridge Surgery
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1. Demography
Population structure
Cranbrook and Loxford locality has a younger population than the Redbridge average with more children 0-9 years, more adults 25-39 years but fewer people in the 50+ age group(Fig 1).
Fig 1 Population pyramid 2015 (line = Redbridge, blocks = locality population)
90+ Males Females 85-89
80-84
75-79
70-74
65-69
60-64
55-59
50-54 band
45-49 ge
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%) in 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). Fig 2. Table 1. Types of population NI registrations to international migrants change 2014, Redbridge Type of change Change 5000
n 4500
Internal -1622 4000 Cranbrook &
Loxford migration 3500
3000 Fairlop
International 3403
n 2500 migration Seven Kings 2000 Natural change 3003 1500 Source: GLA Borough Profiles Wanstead 1000
500
0 2007/2008 2008/2009 2009/2010 2010/2011 2011/2012 Source: GLA ward profiles. NI = registrations for eligibility to work in UK
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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. India, Pakistan and Bangladesh have been the most frequent sources of international migration. In 2014/15 the largest group of migrants was from Romania. In 2011/12 nearly half of international migrants registering for work in Redbridge came to Cranbrook and Loxford locality (Fig 2).
Age
Cranbrook and Loxford locality had an estimated population of nearly 80,000 (GLA population estimates) in 2015. This is projected to increase by 19% by 2025, with the largest percentage increases in children and in people aged over 65years (Table 3).
However there is considerable variation by ward. Clementswood and Loxford are predicted to have population increases of 36% and 25% respectively by 2025 (Table 2).
Fig 4 Fig 3 Population projections by age, Cranbrook & Projected % increase in population 2015 to 2020 Loxford locality and 2020 to 2025, by age, Cranbrook and Loxford 50000 locality 20.0
45000 15.0
10.0 2015-20 40000 2020-25 5.0 35000 0.0 0-4 5-14 15-44 45-64 65-84 85+ All ages 30000 0-4 5-14
25000 15-44 Table 2. % change, 0-14, 65+, all ages. by 45-64 ward, 2015 to 2025
20000 65-84 0-14y 65+y All 85+ ages 15000 Clementswood 46.0 32.8 38.2 Cranbrook 15.3 25.4 8.7 10000 Loxford 22.3 35.7 26.6 Mayfield 9.4 0.8 4.4 5000 Valentines 14.0 34.8 11.1
0 Locality 23.0 25.0 18.8 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 Source: GLA population projections 2014 based
Table 3. Projected population, by age, Locality wards, 2015 and 2025
Ward Year 0-4 5-14 15-44 45-64 65-84 85+ All ages Clementswood 2015 1794 2524 8797 2637 1023 140 16915 Cranbrook 2015 1076 1593 6236 2889 1462 284 13540 Loxford 2015 1678 3070 8618 2947 1102 205 17620 Mayfield 2015 1272 2224 6508 3027 1331 230 14592 Valentines 2015 1640 2090 7272 2945 1177 175 15299 Locality 2015 7460 11501 37431 14445 6095 1034 79981
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Ward Year 0-4 5-14 15-44 45-64 65-84 85+ All ages Clementswood 2025 2522 3783 12110 3413 1322 223 23373 Cranbrook 2025 1134 1944 6327 3125 1850 339 14719 Loxford 2025 2040 3768 10686 4035 1521 253 22303 Mayfield 2025 1260 2565 6486 3353 1354 220 15238 Valentines 2025 1646 2608 7616 3298 1569 254 16991 Locality 2025 8602 14668 43225 17224 7616 1289 92624 % change 2015- 2025 15.3 27.5 15.5 19.2 25.0 24.7 15.8 Source: GLA population projections 2014 based
Births
Both the number of women of childbearing age and the fertility rate have been rising in the laste decade. All wards in Cranbrook and Loxford locality have a higher fertility rate than the Redbridge average Fig 5). The number of births in the locality increased by 50% from 980 in 2002 to 1536 in 2013 (Fig 4). This was a third of the births in the borough in 2013. It appears from the trend data that the number of births and the fertility rate have now started to decrease and population projections suggest further declines.
Fig 4 Fig 5
Trends in the number of births, by locality Trends General Fertility Rate, Cranbrook &
1,800 Loxford locality wards 1,600 120.0
1,400 100.0 1,200 Cranbrook Cranbrook & Loxford 80.0 1,000 Mayfield Fairlop 60.0 800 Clementswood 600 Seven Kings 40.0 Loxford 400 Wanstead 20.0 Valentines 200 0.0 Redbridge
0
03 04 05 06 07 08 09 10 11 12 13
02
0 0 0 0 0 0 0 0 0 0 0 0
2 2 2 2 2 2 2 2 2 2 2 2
Ethnicity
Redbridge is a very ethnically diverse borough, Ethnic projections for the borough show that in 2015 38% were identified as white, and the next largest group Asian (Indian/Pakistani/Bangladeshi) (37%). There is considerable variation by age with much greater diversity in the younger age groups than 65+ years (Fig 6).
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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 Source: GLA Ethnic projections
The white population is expected to decrease proportionately and the Asian population to increase between 2015 and 2025 (Fig 8). This is most noticeable in the older population 65+yrs in which 29% projected to be Asian by 2025 compared to 19% in 2015 (Table 4).
Fig 8
Table 4. Change percentage distribution of Projected changes in ethnic composition, Redbridge, 2015 to 2025 ethnic populations, 2015 to 2025, by age
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
Fig 9
There is also considerable variation across Ethnic distribution, Cranbrook & Loxford the borough, with BME communities locality Black concentrated in wards in Cranbrook and Other Black Other Caribbean Loxford locality (Fig 9, Fig 10). Black Changes in the ethnic composition of the African white population can affect the need for health Other Asian Mixed care where particular ethnic groups have Chinese higher risk for particular conditions, eg.
Sickle cell disease is primarily found in people of West African or Caribbean Asian origin; South Asian communities have higher risk than other communities of Source: 2011 Census
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Fig 10
Ethnic distribution by ward Census 2011)
100%
90%
80%
70% other
60% Other Black
Black Caribbean 50% Black African 40% Other Asian 30% Chinese
20% Asian Mixed 10% White 0%
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 dependent children in Redbridge are headed headed by lone parent, locality wards 35.0 by a lone parent. Loxford ward had the 30.0 second highest percentage with 33% lone 25.0 20.0 parents (Fig 11). Overall in the locality 23% 15.0 10.0 of families were headed by a lone parent. 5.0 0.0
Source: 2011 Census
Older people living alone
Older people have greater need for health and social care which increases as they get older. Older people living alone are more vulnerable and likely to be in need of support from statutory or voluntary services if they have not got close family support.
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Overall the locality has a younger population with less than 10% aged 65+ years. In the 2011 census, there were 6,800 people aged over 65 years (9.5%). Of those 1,784 (26%) said they were living alone. This locality had the lowest number of people aged 65+ years in Redbridge, and also the lowest proportion of people 65+years living alone (Fig12).
Fig 12
% of people 65+yrs and % of those living alone However, the older population 65+ Census 2011 yrs is projected to increase by 25% 40.0 by 2025 and it is likely that the 35.0 30.0 number of elderly living alone will 25.0 increase proportionately to that. 20.0 % living alone 15.0 % 65+ 10.0 5.0 0.0 Cranbrook Seven Fairlop Wanstead Redbridge & Loxford Kings
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 into national quintiles enables a comparison of the local with the national deprivation profile.
Cranbrook & Loxford is the most deprived locality in Redbridge. Data from the 2015 Index of Deprivation show that 67% of areas in the locality are in the most deprived 40%. Loxford and Clementswood are the most deprived wards with all the areas in the most deprived 40% (Fig 13).
Fig 13. Percentage of areas by deprivation quintile*. Index of Deprivation 2015
100% 100%
90% 90% 80% 80% 70% 70% 60% 5 5 60% 50% 4 40% 4 50% 3 30% 3 40% 20% 2 2 30% 10% 1 0% 1 20%
10%
0% Locality Redbridge
*Shows the proportion of areas in each ward that fall into national quintiles for deprivation. 1=most deprived quintile
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However, the proportion of children under 16 years living in poverty (children living in families where income is less than 60% of median income) declined by much more than the national and London averages between 2006 and 2012 (Fig 14), although it remains higher in Clementswood and Loxford wards than London and national rates (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 child poverty as people have had housing and out of work benefits cut.
Fig 14 Fig 15
% of children <16yrs living in poverty % of children <16yrs living in poverty, 2012 60 40 35 50 Cranbrook 30 25 40 Valentines 20 Mayfield 15 30 Clementswood 10 20 Loxford 5 0 London 10 England 0 2006 2007 2008 2009 2010 2011 2012 Source: GLA Ward profiles
Income and employment
Employment rates in Redbridge in 2011 (67%) were slightly below the London (69%) and national (71%) rates (Fig 16).
Fig 16
All wards in Cranbrook and Loxford Employment rates 2011 Census locality had below the Redbridge 80.0 60.0 average, Loxford and Clementswood had 40.0 the lowest rates in the borough. 20.0 0.0
Source 201 Census
Correspondingly, these wards also had the highest rates of benefit claims for Housing Benefit (Fig 17), Job Seekers Allowance (Fig 19) and Out of Work Benefits in 2014/15 (Fig 18). Over 20% of dependent children in Loxford were in out of work households (Fig 20).
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Fig 17 Fig 18
Rate of housing benefit claims 2015 Rate of Out of work benefits 18.0 claims 2014 16.0 16.0 14.0 14.0 12.0 12.0 10.0 10.0 8.0 8.0 6.0 6.0 4.0 4.0 2.0 2.0 0.0 0.0
Fig 19 Fig 20
Claimant rate for Job Seekers % of dependant children in out of Allowance, 2015 work households 2014 5.0 25.0 4.0 20.0 3.0 15.0 2.0 10.0 1.0 5.0 0.0 0.0
Source: GLA Ward profiles
In 2014 there were 3225 children 0-18 years living in out of work households in the locality, the majority (58%) of whom were in Clementswood and Loxford wards.
Political engagement
People’s willingness to participate in local and regional elections can be seen as a measure of political engagement and the extent to which people feel that they have a stake in their society.
Fig 21
Data from the 2012 London % Turnout in local and London Mayoral Mayoral elections show that elections
turnout in Cranbrook and Loxford 45.0 40.0 locality was lower in all wards 35.0 30.0 than both the Redbridge and to 25.0 Local election 20.0 2014 London averages, with 15.0 10.0 Mayoral 2012 Clementswood ward having the 5.0 0.0 second lowest turnout in Redbridge (Fig 21). Turnout in local elections showed a similar Source: GLA ward profiles picture.
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2. 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 green environments they are happier and healthier (Mitchell 2008). Good planning in urban areas to maximise availability of green space for residents should therefore be a priority.
Fig 22
Cranbrook and Loxford locality, containing % of area that is open space, 2014 45.0 Ilford town is the most densely populated 40.0 35.0 and urbanised area in Redbridge, and apart 30.0 25.0 from Cranbrook ward, which contains 20.0 15.0 Valentines Park, has low access to green 10.0 5.0 spaces (Fig 22). Creation of more green 0.0 spaces for leisure and pleasure in Ilford is likely to have broad health benefits.
Source: GLA ward profiles
Crime
Levels of actual and perceived crime and violence can impact directly on health and indirectly on people’s sense of safety and security. Fear of crime can increase social isolation by preventing people from going out. Although Redbridge has higher crime rates than the national average it has lower rates than the London average.
Fig 23
There is wide variation in rates across the Crime rate, 2014/15 borough but three of the four wards with 160.0 140.0 the highest rates are in Cranbrook and 120.0 100.0 Loxford locality, with Clementswood having 80.0 60.0 the highest which is twice as high as the 40.0 20.0 Redbridge average. Loxwood, Clementswood 0.0 and Valentines all have rates higher than London average (Fig 23). This pattern is also eflected in the rate of Violence against the person (Fig 24). Fig 24 Fig 25
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Violence against the person, rate, Trends in Total crime rate, by ward
2014/15 300.0
50.0 250.0
40.0 Clementswood 200.0 30.0 Cranbrook 150.0 20.0 Loxford 10.0 100.0 Mayfield
0.0 50.0 Valentines
0.0 London
Source: GLA ward profiles
Trends show that total crime has decreased in all wards over the last 10 years (Fig 25).
Housing
Redbridge has the highest proportion of privately owned properties in London and the 2nd lowest proportion of social rented housing in London with only 11% of properties in this sector compared to 24% in London. Owner occupation decreased by 11% in Redbridge between 2001 and 2011 with a corresponding rise in private renting. In 2015 there were 4,500 houses in the social rented sector in the borough.
There is variation across the borough. Data from the 2011 Census show that Cranbrook and Loxford has the lowest proportion of owner occupied properties and correspondingly the highest proportion of rented properties, the majority of which are privately rented (Fig 26, although Loxford has the second highest proportion of social rented housing in Redbridge.
Fig 26
Housing tenure In particular there are very high
100% rates of privately rented 90% 80% accommodation in Loxford, 70% 60% % Households Private Valentines and Clementswood 50% Rented - 2011 40% wards. 30% % Households Social 20% Rented - 2011 10% 0% % Households Owned - 2011
Source: 2011 census
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
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homelessness. The low stock of social housing in the borough means that there is very little capacity to house homeless people in permanent housing.
In 2015 the number of people on the housing list was 7812 of which 29% were due to homelessness and nearly half due to overcrowding.
A consequence of the severe pressure in the housing market has been the illegal renting of outbuildings as residential accommodation (‘beds in shed’). A recent review in Redbridge (Beds in Sheds, 2013)found 168 such illegal structures. Nearly half (n=77) of these structures were in Cranbrook and Loxford locality, (with 23 in Loxford ward alone) and 46 of these were occupied. Across Redbridge 65% of the occupants were found to be Asian, 18% were Eastern European. Many of these structures provided poor and inadequate housing with health and safety risks.
The number of people who were in temporary accommodation due to homelessness has increased and in June 2015 was 2174 households, 366 of which were in B&B (299) or hostels (67). Redbridge has the 9th highest number of people 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 Cranbrook & Loxford has consistently the highest number of road accidents in the borough, perhaps unsurprisingly as it has the highest density of people and roads (Fig 27). Road accidents have increased in 2014.
Fig 27
Total road casualties, trend by locality 350
300
250 Cranbrook & Loxford 200 Fairlop 150 Seven Kings
100 Wanstead
50
0 2010 2011 2012 2013 2014
Source: GLA ward profiles
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4. Health indicators
Self assessed health
Two questions in the census can give a general snapshot of health of the population; one question is about general state of health, the other is whether the respondent has a long standing illness that limits their activity. In 2011, 5% of the Redbridge population said they were in bad or very bad health and over 41,000 people (15%) said that they had a limiting long term illness (LLTI), of which nearly half (47%) said that it limited their activities a lot. This was a 6% increase on 2001, although this was a lower increase than the population increase reflecting the fact that the population increased faster in the younger age groups who are less likely to have a long term illness. Cranbrook & Loxford had lower rates of LLTI than the Redbridge average, but a slightly larger proportion of people who said they were in bad or very bad health (Table 5).
Table 5. Numbers and % of people who said they had any limiting long term illness (LLTI), and who described their health as bad ort very bad
No with LLTI % with LLTI No with % with bad/v bad bad/v bad health health Clementswood 1947 13.3 756 5.2 Cranbrook 1982 15.5 687 4.9 Loxford 2408 14.6 930 5.6 Mayfield 2024 14.8 681 5.0 Valentines 1951 13.8 647 5.1 Locality 10,312 14.4 3701 5.2 Redbridge 41,372 14.8 13,675 4.9 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 and 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 402 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.
Fig 30
In Cranbrook and Loxford Trends in mortality, Cranbrook & Loxford wards mortality rates for most (E&W =100)
wards are above the
150 Redbridge average but have
Ratio Cranbrook
ty 130
i Mayfield declined in line overall in tal 110 Clementswood line with borough trends.
Mor
90 Loxford
sed Mortality rates in Loxford i
rd Valentines a 70 ward are 30% higher than
nd Redbridge 50 Sta Redbridge average and are London the highest in the borough (Fig 30). 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 (Fig 31) and women (Fig 32) than the London and National averages. However the rate of increase over 10 years 1999/2003 to 2009/13 has been slightly slower.
Fig 31 Fig 32
Trends in male life expectancy Trends in Female life expectancy
85 85
83 83
81 81
s
s r
r
79 Redbridge 79 Redbridge
Yea Yea 77 London 77 London 75 England 75 England
73
73
2004 2005
2003 2006 2007 2008 2009 2010 2011 2012 2013
2003 2005 2006 2007 2008 2009 2010 2011 2012 2013
2004
------
-
------
-
99 00 01 02 03 04 05 06 07 08 09
99 00 01 02 03 04 05 06 07 08 09
9 0 0 0 0 0 0 0 0 0 0
9 0 0 0 0 0 0 0 0 0 0
1 2 2 2 2 2 2 2 2 2 2
2 2 2 2 2 2 2 2 2 2 1 Source: GLA borough profiles
In 2009-13 life expectancy for males and females was significantly lower in Loxford ward than Redbridge averages (Figs 33a and 34b) , by 4 yrs and 3 years respectively (Table 6).
23
Over 10 years male life expectancy in Loxford increased less than in London and Redbridge. Mayfield ward had the largest increase at 4.4 years .
Table 6. Male and Female life expectancy at birth, 2009-13, and increase between 1999-2003 and 2009-13, Cranbrook & Loxford locality
Male Female Increase Increase yrs yrs males females Mayfield 81.2 83.4 4.4 2.2 Cranbrook 79.9 82.5 2.2 0.8 Loxford 76.4 81.3 2.6 2.8 Valentines 78.6 83.6 4.2 3.9 Clementswood 79.0 83.6 2.7 5.0 Redbridge 80.7 84.2 3.4 2.7 London 79.7 84.1 3.9 3.2
Redbridge has had a lower increase in female life expectancy (2.7 years) than London (3.2 years) (Table 6). Clementswood ward experienced one of the largest increases in life expectancy for women (5.0 years).
Fig 33a. Male life expectancy 2009-13, Fig 33b. Female life expectancy, 2009-2013, Cranbrook and Loxford locality wards Cranbrook and Loxford locality wards 88.0 88 86.0 86 84.0 84 82.0 82 80.0 80 78.0 78 76.0 76 74.0 74 72.0 72 70.0 70 68.0 68
Source: GLA ward profiles, data from ONS
Fig 34a. Trends in male life expectancy Fig 34b. Trends in female life expectancy Cranbrook and Loxford locality wards Cranbrook and Loxford locality wards 88 84 86 82 84
80 Clementswood Clementswood
82
fe Cranbrook
li Cranbrook
f 78 o 80
s Loxford Loxford r
Yea Mayfield 76 78 Mayfield Valentines Valentines 74 76 England England Redbridge 72 74 Redbridge
70 72
24
Long term illness
Information about the prevalence of major diseases comes from GP disease registers (QOF). It is likely that there will be some undetected or undiagnosed illness in communities so these data are likely to be underestimates pf the true prevalence. Admissions to hospital and mortality 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 CVD (Stroke and CHD), 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 Cranbrook and Loxford locality there are higher 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. Cranbrook & Loxford locality (QOF data) 2014/15 16.0 Condition n 14.0
Diabetes 6706
12.0
on i t England CHD 2402
a 10.0 l 8.0 COPD 665
popu Redbridge
6.0 of
Depression 2847
% 4.0 Cr'k & Hypertension 11657 2.0 Loxford 0.0 Severe mental 917 illness
Dementia 598
Source: National practice profiles
Diabetes is a major disease. Obesity is the main risk factor for Type 2. 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.
The number of people with diabetes in the locality has increased by 65% between 2009 and 2014 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. HbA1c is a marker of control of blood sugars. Only 57% of the diagnosed population in the locality had good diabetes control (HbA1c<59mmol/mol). This
25
is the same as the Redbridge average, but still represents high risk of major complications. The variation across practices was 45% to 75%.
Fig 36
% of diabetic patients with A majority of practices in the locality had HbA1c<59mmol/mol, 2014/15, by diabetic control rates similar to the practice Redbridge average. Three practices had Eng significantly worse rates Redbridge F86042 F86657 F86022 There were 67 hospital admissions for F86703 F86698 diabetes in 2012/13. Later data are not F86008 F86082 reported F86652 F86025 Y02987 Y00918 F86702 F86655 F86692
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 and 2014.
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.
Cranbrook and Loxford has lower crude prevalence of COPD than the Redbridge average Fig 37). This is likely to be due the lower age profile of the population. COPD is mainly a disease of people 75+ years. Fig 37 Fig 38
% smoking prevalence and COPD prevalence per 1,000, 2014/15, by practice
Redbridge Y02987 F86655 F86022 F86082 COPD/1,000 F86025
F86657 Smoking % F86042 F86702 F86008 F86698 F86652 F86692 F86703 Y00918 0 5 10 15 20 Source: National GP Practice Profiles, QOF Source: National GP profiles, QOF data
26
COPD is often under-diagnosed, particularly in the early stages. In the locality practices in general the highest prevalence rates are found in populations with the highest smoking rates. Half of all cases were diagnosed in 2 large practices. It is likely that there is some under-diagnosis in practices which have high smoking prevalence and low COPD prevalence.
There were 77 hospital admissions for COPD in 2012/13. This represents a lower rate than the Redbridge average.
Hypertension increases 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 other disease.
Prevalence of diagnosed hypertension was similar in Cranbrook and Loxford locality to the Redbridge average. In half of practices over 80% of patients with diagnosed hypertension had their blood pressure well controlled. Two practices had significantly worse blood pressure control than the Redbridge average.
Fig 39 Fig 40
Prevalence of hypertension, by locality, 2014/15 % of hypertensive patients whose BP is <150/90mmHg, 2014/15, by practice 16.00 England 14.00 Redbridge F86703 12.00 F86652
F86702
on 10.00 i
t F86042 a l 8.00 F86022
popu F86008
of 6.00 F86025 % F86657 4.00 Y02987 Y00918 2.00 F86698 F86082 0.00 F86692 Cranbrook Fairlop Seven Wanstead Redbridge England F86655 & 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. Cranbrook and Loxford locality has a similar proportion of adults diagnosed with depression than the borough average (Fig 41), but a slightly higher rate of severe mental illness and dementia (Figs 42 and 43).
27
Fig 41 Fig 42
Prevalence of depression, people 18+ yrs, Prevalence of severe mental illness, by locality, 2014/15 per 1,000, by locality 2014/15 6.0
12
5.0
10 s
on
i
r
t y
4.0 a + l 8 18
popu
on
i 0 t 3.0 6
a
l 100
r e
popu 4
2.0 p
% e
t a R 2 1.0
0 0.0 Cranbrook Fa irlop Seven Wanstead Redbridge Cranbrook Fairlop Seven Wanstead Redbridge & Loxford Kings & Loxford Kings
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
6.0 increase. The number of people aged 65+
on i
t 5.0
a years is projected to increase by 25% in the l u
pop 4.0
0 locality by 2025. A comparable increase in
00 ,
1 3.0
r
e the number of people suffering from
p
e
t 2.0
Ra dementia is likely. 1.0
0.0 Cranbrook Fa irlop Seven Wanstead 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 (all cancers) have not improved as much as London survival rates (Fig 44).
Fig 44
One year survival is determined largely by Trends in one year survival, all cancers, 15 - how soon the cancer is diagnosed and 99yrs. Cancer survival index*
75 x
treated – earlier diagnosis and treatment e
d 70
n
i
l l 65
gives a much better prognosis. England a v
i 60
v r
u 55 has lower survival than many other S Redbridge
d d 50
e
s i
similar countries and the government has d 45 London
r a
d 40 n put in place actions to improve early a
t 35
s
e g 30 diagnosis. Fast tracking patients with A suspected cancer through the ‘Two week wait (TWW)’ route can aid earlier Source: NCIN Cancer Commissioning Toolkit * Index calculated as Observed/expected diagnosis.
28
However, across the country, still the majority of people who turn out to have cancer are not fast tracked through this route. The proportion of people who go through the TWW route was higher in Redbridge (58%) in 2014/15 than England (48.8%) (Fig 45). In Cranbrook & Loxford locality there were 161 new cancer cases diagnosed in 2014 of which 53% were referred through TWW, however practice rates ranged from 30 to 73% (Fig 46). These data should be treated with caution as there are some data quality issues.
Fig 45 Fig 46
% of people diagnosed with cancer who were % of cancer cases referred through TWW, by practice, Cranbrook & Loxford, 2014/15 referred through TWW, by locality, 2014/15 England 70.0 Redbridge 60.0 F86703 F86042 50.0 F86025 40.0 Y00918 30.0 F86652 F86692 20.0 F86702 10.0 F86082 F86022 0.0 F86008 F86657 F86655 Y02987 F86698 10 20 30 40 50 60 70 80 Source: GP practice cancer profiles, data from NCIN
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 Fig 48
% of hospital admissions that were % of hospital admissions that were emergencies, by locality, 2012/13 emegency, by practice, 2012/13 Redbridge 50 F86082 45 F86657 40 Y02987 35 F86692 F86655 30 F86022 25 F86698 20 F86652 15 F86042 F86025 10 F86702 5 F86703 0 Y00918 Cranbrook Fa irlop Seven King s Wanstead Redbridge 0.0 20.0 40.0 60.0 & Loxford Source: National Practice profiles
The proportion of hospital admissions that are emergencies can give an indication of need and of the way that people and GPs use local services. In Cranbrook and Loxford locality overall this proportion (44.7%) was slightly higher than the Redbridge average (42.8%) (Fig
29
47), but there were considerable differences between practices, with a range 36% to 52% (Fig 48). These data are no longer reported in profiles.
An A&E audit in 2013 of people aged 75+years attending Queen’s Hospital A&E department was conducted. 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% attendances by ambulance 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. Twenty one per cent of referrals to the service were from Cranbrook and Loxford locality. Nearly half of initial referrals came from GPs, the remainder from voluntary or statutory organisations.
Children’s Health
Prevention – childhood immunisations
Immunisation against Measles, Mumps and Rubells (MMR) in children aged 2 years is lower than the national average but similar to the London average (however London has the lowest uptake of vaccinations in the country). The proportion of children aged 5 who have
30
had both MMR jabs is significantly lower in Redbridge than both the London and national averages (Fig 49) and is the 7th lowest in London.
Fig 49
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 (Table 8). Only four practices 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, 12 months 24 months 5 years Dtap/ Dtap/ MMR MMR IPV/Hib Men C IPV/Hib MMR Dose 1 Dose 2 F86008 90.5% 90.5% 86.0% 78.3% 83.6% 73.0% F86022 86.9% 85.9% 80.3% 76.3% 83.9% 72.2% F86025 80.4% 85.6% 86.1% 76.1% 81.5% 60.0% F86042 94.8% 92.8% 86.9% 89.3% 87.8% 72.5% F86082 89.0% 89.0% 86.3% 82.1% 86.5% 67.6% F86652 91.0% 91.9% 88.6% 84.6% 87.1% 75.0% F86655 81.3% 87.5% 84.8% 83.5% 87.0% 69.6% F86657 95.2% 91.6% 93.8% 88.2% 86.1% 67.6% F86692 88.7% 90.1% 87.3% 85.3% 86.0% 62.5% F86698 79.2% 83.3% 86.0% 82.0% 84.4% 81.3% F86702 85.4% 87.8% 93.1% 84.7% 89.5% 72.4% F86703 92.3% 97.4% 92.5% 88.1% 72.3% 59.6% Y00918 92.4% 90.2% 85.3% 84.0% 87.8% 78.9% Source: COVER data
Children’s use of A&E services
Rates of attendance at A&E by children under 5yrs (Fig 51), and rates of emergency admission for all causes in children under 18yrs (Fig 52) were similar in Cranbrook and Loxford locality to the Redbridge average. Redbridge rates were not significantly different from national rates. However there is considerable variation in attendance rates for children 0-4 years between practices with a 50% difference between the highest and the lowest rates (Fig 50).
31
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 600
s
F86066 r
500 4y
F86675 - 0
F86023 400
pop pop
F86064
300 ad
F86013 000
e ,
t
s F86691
n 200 er 1 er
p
F86020 Wa F86658 100 F86032 Rate 0 F86641 Cranbrook Fairlop Seven Wanstead Redbridge F86731 & Loxford Kings F86012 F86704 F86034 F86009
F86635 Fig 52
gs n
i F86642
K
A&E attendance rates 0-17 years, by Y00155
ven F86028 locality, 2011/14 e
S
F86087 400
Y00090 s r
y 350
F86637
18 , F86060 300
F86057 pop 250
F86707 200
000
F86010 1,
150 er
F86083 p
100 p
o F86007
l r
i 50 Rate a F86081 F F86085 0 F86612 Cranbrook Fairlop Seven Wanstead Redbridge F86624 & Loxford Kings Y02987 Y00918 F86025
F86692
d
r F86082
o f
x F86008
o L
F86022 &
k F86698
o F86042
ro b n F86652
F86657 Cra F86703 F86702 F86655 0 100 200 300 400 500 600 700 800 Source: National GP Practice Profiles These data are no longer reported in the national profiles
Teenage pregnancy
Fig 53
Teenage pregnancy rates (conceptions in Rates of teenage pregnancy, Cranbrook and women <18 years) are lower in Redbridge Loxford locality wards, 2011/13 50 than the London and national rates, however 45 40
there is significant variation by ward. Loxford 35 1,000
30 ward has significantly higher rates and r 25 pe 20
e e t
a 15
Cranbrook ward has significantly lower rates R 10 5 than the Redbridge average (Fig 53). 0
Source: ONS
32
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 annually in reception and year 6. Of major concern is the fact that obesity rates double between the ages of 4-5 and 10-11years.
In Cranbrook and Loxford locality wards there is some evidence that levels of obesity are starting to decrease both in reception year and in year 6 (Fig 54). In reception children rates have decreased in both Loxford and Clementswood (by 25%) wards, although rates have increased in Mayfield. For year 6 children rates have decreased in some wards (Mayfield, Cranbrook) but have continued to increase in other wards.
Fig
Trends in childhood obesity , by ward
30 Clementswood recep
Cranbrook recep 25 Loxford recep
Mayfield recep 20 Valentines recep en
dr il Clementswood Y6
h 15 c
f o Cranbrook Y6
% 10 Loxford Y6
Mayfield Y6
5 Valentines Y6
Redbridge Recep 0 Redbridge yr 6
London Recep
London Yr 6
Source: NCMP
The continuing wide gap between rates of reception and year 6 children, which has in some areas increased, suggests that more could be done in primary schools to address this issue.
33
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 when coupled with lack of physical activity, is associated with an increased risk of diabetes, heart disease, cancer and other illnesses.
Fig 55
% of adults who are overweight/obese, by GP In Cranbrook & Loxford locality practice, Cranbrook & Loxford locality practices the proportion of people
Redbridge measured as being obese or F86652 overweight was 19% and 32% F86082 Y00918 respectively, although these Y02987 F86042 proportions by practice ranged F86698 F86702 % Overweight between 16%-22% and 26%-36% (Fig F86692 % Obese 55). This shows slightly lower F86655 F86008 prevalence than the national average. F86022 However these data should be treated F86703 F86657 with caution as around 10% (range 2% F86025 to 23% by practice) of patients had no 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% record of weight measurement. Source: Health Analytics 2015
Smoking
Smoking is a major cause of death and disease. In 2013 there were 254 deaths in Redbridge that were attributable to smoking, around 14% of all deaths. The main sources of data about smoking behaviour are from patient information from GPs (QOF) and estimates derived from national surveys. These give slightly different prevalence figures. For consistency estimates have been used here. Smoking rates in Redbridge are significantly lower than the London and National averages.
Smoking rates in Cranbrook and Loxford locality wards are higher than the Redbridge average in all wards except Cranbrook (Fig 56).
Redbridge has had a successful Quit Smoking service for a number of years with around 1200 people per year meeting a 4 week quit target. In 2014/15 the rate was 50% this is lower than London (54%) but similar to England (51%) rates (Table 9).
34
Fig 56
Source: ASH
Table 9. Accessing to the Smoking cessation service, and quit rates, by locality, 2014/15 Fig 57
No Quit rates by ward accessing 4 week % quit Locality service quitters rate 80 60
Cranbrook
% 40 & Loxford 587 260 44.3 20 Fairlop 461 239 51.8 0 Seven Kings 568 286 50.4 Wanstead 402 213 53.0
Redbridge 2018 998 49.5 Source: Smoking Cessation service
In 2014/15 nearly 600 people living in Cranbrook & Loxford locality accessed the smoking cessation service. Four week quit rates were lower for the locality (44%) than the Redbridge average. Nearly half of service users were from Loxford ward and quit rates there were 60%.
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
35
admission or the need for residential care. In Redbridge in 2015 there are 4706 receiving long term social care, of whom 80% (n=3759) are 65+ years (Table 10).
The numbers of older people receiving long term care are fairly consistent across each of the localities, although the rates are higher in Cranbrook and Loxford locality (Fig 58), thus despite fewer older people there is a higher proportion of people in need. Around 8% of people receive care out of borough.
Table 10. 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
For adults aged 18-64years Cranbrook and Loxford locality had the highest proportion receiving long term care (Fig 60). However, a smaller proportion of adults in the locality were receiving short term care than the Redbridge average (Fig 61).
Only 11% of people in the locality were receiving direct payments to pay for their care; this is the lowest in the borough and less than half the rate in Wanstead locality. Direct payments can give clients greater flexibility in how care is provided to meet their needs.
Fig 58 Fig 59
Adults receiving long term care, by % of people aged 65+years receiving locality, 2015 long term care, 2015, by locality 25.0 14.0
12.0
op 20.0 p
10.0 18+ 15.0 8.0
% 000 , 1 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
1
18
5.0
ed 4.0
p
g 1
po 4.0
op p
3.0 000 ,
2.0 1
000
, 2.0
1
er p
er 1.0 1.0
p
0.0 0.0 Rate Rate Cranbrook Fairlop Seven Wanstead Redbridge Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford Kings & Loxford Source: Care First database
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.
The proportion of people receiving care for learning disability in the locality is above the Redbridge average (Fig 62). This may be because of higher prevalence or it may be due to higher rates of seeking support. Over half (54%) of people receiving support for learning disability in the locality are living at home with family.
Fig 62
Prevalence of people with learning Because of recent changes in a number of diability receiving care, 2015, by locality eligibility criteria it is not possible to look at 4.0
the trends for these data. s r 3.5 +y
18 3.0
op 2.5
p
2.0
000 ,
1
1.5 er
p
1.0
0.5 Rate 0.0 Cranbrook Fairlop Seven Kings Wanstead Redbridge & Loxford Source: Care First Redbridge
Carers
Redbridge supports 675 carers across the borough, of which 157 are in Cranbrook and Loxford locality. The majority (69%) of this support in the locality is through direct payments; this is comparable to the Redbridge average.
37
Residential care
There were 769 people supported by Adult Social Care in residential or nursing homes across the borough in 2015. 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 being supported in residential care are in homes out of borough.
The locality has the second highest number of people in residential care. The locality has a number of large residential care homes and this is reflected in the higher numbers of people in residential care.
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 nutritionally balanced two course meal and is available 365 days of the year. Clients are assessed for need. Clients pay a flat rate for the meal. This service is not means tested.
The great majority (83%) of clients are aged over 75 years with 57% aged 85+ years (Table 11). Most clients use the service nearly every day. In 2014/15 there were 101 clients who
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used the service in Cranbrook and Loxford, spread evenly across the locality. This was a lower number than other localities (Table 12) but may reflect the younger age profile of the locality.
Table 11. Current users of community meals Table 12. Community meals service users , service, as at Nov 2015, by age and gender 2014/5 by locality Age group n % Locality n 18 - 64y 14 5.1% Cranbrook & Loxford 101 65 - 74y 33 12.1% Fairlop 154 75 - 84y 71 26.1% Seven Kings 110 85+ 154 56.6% Wanstead 156 All ages 272 Total 521 Gender
Male 37% Female 63% Source: Community Meals service
Day centres
There are a number of day centres across the borough which cater for older adults with specific needs. These can be accessed by people across the borough. They provide a means tested service and include lunch, day activities and often transport. Provision of day centre opportunities can reduce the need for health and social care by reducing social isolation and loneliness. Older people: two day centres, one in Hainault and one in Goodmayes cater for older people; People with disabilities: three centres, in Hainault, Aldborough and Snaresbrook, cater for people with disabilities, Dementia sufferers: two centres provide day services for people with dementia, in Monkhams and Chadwell
7. End of life care
In surveys a majority of people say that they would prefer to die at home (Gomes 2011). In recent years there has been a national focus on and investment in palliative care to enable people to die at home, or in their usual place of residence, eg a residential home.
In Redbridge there are a large number (n=75) of residential care homes. There is also a hospice in Havering, and hospice care is commissioned from St Joseph’s Hospice in Hackney. The Margaret Centre at Whipps Cross Hospital is a specialist palliative care unit within the hospital site. Unfortunately data relating to the Margaret Centre is coded as Whipps Cross
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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, Cranbrook & Loxford 70.0 locality, 2014
70 60.0 60 50.0 Cranbrook 50 & Loxford
40.0
40 Redbridge
% Redbridge % 30.0 30 England 20 England 20.0 10 10.0 0 0.0 Hospital Home Care home Hospice Hospital Home Care Home Hospice Source: End of Life Care profiles; endoflifecare-intelligence.org.uk Source: Public Health mortality files
The proportion of people dying in hospital 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 Cranbrook and Loxford locality fewer people died in hospital and more in care homes than the Redbridge average Fig 64). The locality has two large care homes and a number of smaller ones.
References
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
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
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Appendix 1
Code Practice name F86008 GANTS HILL MEDICAL CENTRE F86022 ILFORD MEDICAL CENTRE F86025 OAK TREE MEDICAL CENTRE F86042 BALFOUR ROAD SURGERY F86082 ILFORD LANE SURGERY F86652 THE DRIVE SURGERY F86655 THE COURTLAND SURGERY F86657 YORK ROAD SURGERY F86692 MATHUKIA'S SURGERY F86698 CRANBROOK SURGERY F86702 ST CLEMENT'S SURGERY F86703 THE REDBRIDGE SURGERY Y00918 GRANVILLE MEDICAL CENTRE Y02987 The Practice Loxford
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