Overview of Health and Wellbeing Needs for Vale of Glamorgan Locality

Overview of health and wellbeing needs for Vale of Glamorgan Locality,

2015-2025

Version number Date Author/s Comments 1.0 draft 18 August 2015 Dr Tom Porter & Dee Hickey First draft for circulation among locality leads for feedback, suggested additional useful info etc. Any comments please to tom.porter@wales.nhs.uk 1.1 10 December Updates by TP Incorporating feedback – summary info on 2015 students, added overall summary, info from GP cluster plans, info on non-co-terminosity of USOAs and cluster areas

Contents

Summary of health and wellbeing needs in the Vale of Glamorgan ...... 2 Needs highlighted in Vale GP cluster plans ...... 3 1. Population size and composition...... 5 (i) Population size, structure and projected change ...... 5 (ii) Birth and in-migration rates ...... 7 (iii) Ethnicity and languages spoken ...... 8 2. Risk factors for disease ...... 10 (i) Self-reported behaviours and USOA maps for reference ...... 10 (ii) Specific risk factors ...... 11 3. Equity, inequalities and wider determinants of health ...... 15 (i) Health equity and inequalities ...... 15 (ii) Deprivation and wider determinants of health...... 17 (iii) Community assets ...... 19 4. Ill health and service use in the Vale ...... 20 (i) Self-reported ill health ...... 20 (ii) Burden of disease across GP clusters ...... 21 (iii) Service use ...... 21 (iv) Change in disease profile...... 24 (v) Cancer incidence ...... 27 5. Working in partnership with our local residents ...... 29

Summary of health and wellbeing needs in the Vale of Glamorgan

The following information is a summary of a detailed assessment presented in chapters 1 to 5.

Population size and composition

 The population age structure of the Vale of Glamorgan is very similar to the Wales average, with the exception of a slightly lower number of young adults (20-24yrs)  The population of the Vale will increase modestly over the next 10 years, by around 3% or 4,000 people. However, this masks significant growth in the over 65s and over 85s categories

Risk factors for disease

 Unhealthy behaviours which increase the risk of disease are endemic among adults in the Vale o Nearly half (43%) drink above alcohol guidelines o Two thirds (67%) don’t eat sufficient fruit and vegetables o Over half (54%) are overweight or obese o Around three quarters (73%) don’t get enough physical activity o Just under one in five (18%) smoke  There is considerable variation in rates of unhealthy behaviours in the Vale o Smoking rates vary between 17% and 29% across the Vale  Many children in Cardiff and Vale are also developing unhealthy behaviours o Two thirds (67%) of under 16s don’t get enough physical activity o Over a third (34%) of under 16s are overweight or obese

Equity, inequalities and wider determinants of health

Ill health and service use

 The disease profile in Cardiff and Vale is changing o The number of people with two or more chronic illnesses in Cardiff and Vale has increased by around 5,000 in the last decade, and this trend is set to continue o Around 1 in 7 (15%) people consider their day-to-day activities are limited by a long-term health problem or disability o Many people with chronic conditions are not diagnosed and do not appear on official registers o Due to changes in the age profile of the population and risk factors for disease, new diagnoses for conditions such as diabetes and dementia are increasing significantly  Around 1 in 5 adults have visited their GP within a 2 week period; and nearly three quarters visit a pharmacy over a year period  The highest rates of attendance at the Emergency Department are from people living in more deprived areas of Cardiff and Vale  Rates of delayed transfer of care for social care reasons are nearly twice as high in Cardiff and Vale than the Wales average  Heart disease, lung cancer and cerebrovascular disease are the leading causes of death in men and women  Preventable illness and deaths o Many (but not all) of the most common chronic conditions and causes of death may be avoided by making changes in health-related behaviours

Working in partnership with our local residents

 There are a number of consistent themes from local residents and health professionals about how they would like services to look in future  These include: o Helping people stay healthy and independent for as long as possible o Early diagnosis of disease and receiving the best treatment available, wherever an individual lives o Co-ordinated and convenient care, as close to home or work as possible

Needs highlighted in Vale GP cluster plans

The 2015/16 GP cluster plans in the Vale include the following needs and demands, set out in the context of the UHB’s strategic priorities.

 Understand the needs of the population (in addition to information provided in this document) o Cater for an increasing population size o Improved communication for patients with English as a second language o Improve uptake of vaccines for Western Vale o Increase flu immunisation ‘at risk’ uptake o Improve alcohol awareness o Increase engagement with smoking cessation pathway o Improve access to primary care mental health services, CAMHS, optometry o Improve healthcare provision to housebound elderly o Patients with early mental health issues not meeting criteria for mental health services  Ensure the sustainability of GP services o Reduce number of ‘did not attends’ o Reduce number of inappropriate frequent attendees at out-of-hours and emergency services o Improve access to primary care  Urgent care o High emergency admissions Central Vale  Planned care o Reduce unnecessary hospital admissions o Improve access and equity of access to planned care including cardiology, dermatology, family planning, minor surgery, dermatology, ENT, paediatric services o Improve care of patients with chronic health problems o Improve management of patients with AF  End of life care o Improve patient choice over place of death and to ensure as comfortable as possible o Ensure needs of patients in nursing homes are met o Identify needs of patients on dementia register  Cancer o Improve rates of early detection and treatment o Increase awareness of national screening programmes  Locality issues o Reduce incidence of flu cases

1. Population size and composition

Key points

(i) Population size, structure and projected change

Table 1. Population projections for Vale by broad age group, 2015-2025. Source: StatsWales (2014)

Year Additional people Area Age group 2015 2018 2020 2025 2015-25 Vale 0-4 7,146 7,148 7,073 6,816 -330 5-16 17,874 17,889 18,199 18,184 310 17-64 77,347 76,876 76,291 75,063 -2,284 65-84 22,548 23,979 24,890 27,116 4,568 >84 3,583 3,909 4,150 5,085 1,502 All 128,498 129,801 130,603 132,264 3,766

Table 2. Projected percentage increase in population of Vale by broad age group, over 3, 5 and 10 years from 2015. Source: StatsWales (2014)

Projection year

Age group 2018 2020 2025

0-4 0.0% -1.0% -4.6% 5-16 0.1% 1.8% 1.7% 17-64 -0.6% -1.4% -3.0% 65-84 6.3% 10.4% 20.3% >84 9.1% 15.8% 41.9% All 1.0% 1.6% 2.9%

While the population of the Vale is projected to increase only marginally overall, at 2.9% compared with an all-Wales projection of 4.1%, this masks significant changes in the age make-up of the population. The 65- 84 and over 84s age groups will see marked increases (20.3% and 41.9% over 10 years respectively). These increases are in excess of the Wales averages for these age groups of 13.9% and 39.4% respectively. In contrast, there is a projected contraction of 4.6% among infants aged 0-4 years.

On the assumption that the health needs of the additional people projected to reside in the Vale in the future due to population growth are similar to those of the existing population, this would translate into a 2.1% year-on-year growth in service demand for 65-84 year olds in the Vale (6.3% over 3 years), and 2.9% annual growth in demand for the over 84 age group (9.1% over 3 years).

Figure 1. Proportion of population by age and sex, Vale compared with Wales using ONS Midyear population estimates, 2014 (Public Health Wales, 2015)

Wales Males Vale of Glamorgan Males Wales Females Vale of Glamorgan Females

90+ 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 05-09 00-04 8 6 4 2 0 2 4 6 8

Table 3. Proportion of population by age and sex, Vale compared with Wales using ONS Midyear population estimates, 2014 (Public Health Wales, 2015)

Proportion of population by age and sex, Vale of Count of population by age and sex, Vale of Glamorgan Glamorgan and Wales, 2014 and Wales, 2014 Vale of Glamorgan Wales Vale of Glamorgan Wales Age group % Males % Females % Males % Females Age group Males Females Males Females 00-04 2.9 2.8 2.9 2.8 00-04 3,681 3,539 91,079 86,596 05-09 3.0 2.9 2.9 2.8 05-09 3,889 3,738 90,296 86,028 10-14 2.9 2.8 2.7 2.6 10-14 3,709 3,525 84,933 80,158 15-19 3.1 3.0 3.1 3.0 15-19 4,000 3,819 97,095 91,352 20-24 2.8 2.6 3.6 3.4 20-24 3,627 3,298 112,027 105,551 25-29 2.9 2.6 3.2 3.1 25-29 3,678 3,364 97,544 94,557 30-34 2.9 2.8 2.9 2.9 30-34 3,665 3,593 90,870 91,202 35-39 2.9 2.9 2.7 2.7 35-39 3,704 3,763 83,293 84,454 40-44 3.2 3.5 3.1 3.2 40-44 4,076 4,518 96,215 100,341 45-49 3.4 3.8 3.4 3.6 45-49 4,335 4,811 106,600 111,213 50-54 3.6 3.8 3.4 3.6 50-54 4,583 4,876 105,862 109,796 55-59 3.1 3.5 3.0 3.2 55-59 4,009 4,454 94,304 98,390 60-64 3.0 3.2 3.0 3.1 60-64 3,807 4,078 91,683 95,850 65-69 3.0 3.3 3.1 3.2 65-69 3,784 4,252 94,316 98,517 70-74 2.2 2.5 2.3 2.4 70-74 2,848 3,182 70,022 75,593 75-79 1.7 2.0 1.7 2.0 75-79 2,123 2,577 53,177 61,432 80-84 1.2 1.5 1.1 1.5 80-84 1,489 1,948 35,321 47,503 85-89 0.6 1.1 0.6 1.0 85-89 761 1,341 18,707 31,334 90+ 0.2 0.7 0.3 0.7 90+ 302 939 7,971 20,854

Produced by Public Health Wales Observatory, using 2014 Mid Year Produced by Public Health Wales Observatory, using 2014 Mid Year Population Estimates (ONS) Population Estimates (ONS)

Table 4. Current and projected population age structure, Vale and Wales, 2015-2025. Source: StatsWales (2014)

Proportion of population

2015 2025 (projected)

Age (yrs) All Wales Cardiff All Wales Cardiff 0-4 5.9% 5.6% 5.4% 5.2% 5-16 13.2% 13.9% 13.7% 13.7% 17-64 60.8% 60.2% 58.3% 56.8% 6

65-84 17.5% 17.5% 19.1% 20.5% >85 2.6% 2.8% 3.5% 3.8%

The increase in the older population is significant from a healthcare resource perspective, because hospital use and costs rapidly increase with age in this group (Figure 2).

Figure 2. Annual hospital cost in Wales by age and sex, excluding maternity. (Graph courtesy of Nuffield Trust, taken from Roberts, A and Charlesworth, A. 2014. A decade of austerity in Wales).

Across Wales, the increase in population alone is projected to contribute to an increase in spend on acute care by 1.2% each year in the period 2010-2025 (Nuffield Trust).

The Vale of Glamorgan is predominantly rural, with five small urban centres and a large number of villages and hamlets. In the Vale, the predicted housing growth is 9,960 new homes between 2006 and 2026.

The LDP takes into account projected population growth so should not be a driver itself of additional growth.

In the 2011 Census 6,369 people identified themselves as full-time students in the Vale, 5,575 of whom were aged 16-24. A higher proportion of 16-24 year old students (74%) considered themselves in ‘very good health’ compared with the general population of 16-24 year olds (68%).

(ii) Birth and in-migration rates

The Vale has a relatively stable population size which reflects a low net migration rate, and roughly equal birth and death rates.

Table 5. Historic migration, births and natural change in the Vale, 2006-2014 Source: StatsWales (2015)

Annual figure (rolling 3 year average) Net Net migration Natural Natural Year migration % Births change* change* % 2006 849 0.7% 1302 38 0.0% 2007 779 0.6% 1327 98 0.1% 2008 798 0.6% 1388 147 0.1% 2009 623 0.5% 1437 217 0.2%

2010 294 0.2% 1485 274 0.2% 2011 40 0.0% 1452 282 0.2% 2012 -69 -0.1% 1450 292 0.2% 2013 29 0.0% 1390 213 0.2% 2014 181 0.1% 1357 154 0.1% * natural change = births-deaths

(iii) Ethnicity and languages spoken

Table 6. Ethnicity, Vale of Glamorgan and Wales. Source: Nomis (2015) from Census 2011

Vale Wales

Ethnicity Persons % Persons %

All 126,336 100.0% 3,063,456 100.0% White British 119,212 94.4% 2,855,450 93.2% White Irish 1,966 1.6% 55,932 1.8% White Gypsy or Irish Traveller 639 0.5% 14,086 0.5% White Other 629 0.5% 11,099 0.4% Mixed White/Black 610 0.5% 16,318 0.5% Caribbean Mixed White/Black African 566 0.4% 17,256 0.6% Mixed White/Asian 454 0.4% 13,638 0.4% Mixed Other 431 0.3% 9,019 0.3% Indian 388 0.3% 6,979 0.2% Pakistani 252 0.2% 3,809 0.1% Bangladeshi 247 0.2% 4,424 0.1% Chinese 216 0.2% 12,229 0.4% Asian Other 174 0.1% 9,615 0.3% Black African 173 0.1% 5,663 0.2% Black Caribbean 165 0.1% 11,887 0.4% Black Other 121 0.1% 10,687 0.3% Arab 72 0.1% 2,580 0.1% Other 21 0.0% 2,785 0.1%

Table 7. Most common main language spoken in Vale, over 3s. Source: Nomis (2015) from Census 2011

Main language spoken Vale % English/Welsh 120,026 98.4% Other European (EU) 482 0.4% Other East Asian 264 0.2% Chinese 213 0.2% Polish 199 0.2% Other European (non EU) 140 0.1% French 93 0.1% Other South Asian 93 0.1% Arabic 83 0.1% Spanish 82 0.1% West/Central Asian language 55 0.0% African language 47 0.0% Bengali (with Sylheti and Chatgaya) 46 0.0% Gujurati 39 0.0% Other language 38 0.0% Panjabi 37 0.0% Portuguese 32 0.0% Urdu 29 0.0% Tamil 20 0.0%

Around 1 in 10 (8%) of people in Cardiff and Vale can read, write and speak Welsh, significantly below the rate in the rest of Wales (15%) (Census 2011).

2. Risk factors for disease

Key points

(i) Self-reported behaviours and USOA maps for reference

Note that information from the Welsh Health Survey is currently reported by Upper Super Output Area (USOA) which is not directly co-terminous with cluster boundaries. Therefore information is presented here by USOA rather than cluster.

Figure 4. Upper Super Output Area (USOA) boundaries, Vale of Glamorgan

Table 8. Age-standardised percentage of adults with particular lifestyle characteristics, Vale, 2013-14. Source: Welsh Health Survey (2015).27

Area

Lifestyle characteristic Vale Wales Smoker 18 21 Consumption of alcohol: above guidelines 43 41 Consumption of alcohol: binge drinking 24 25 Consumption of fruit and vegetables: meets guidelines 33 33 Exercise or physical activity done: meets guidelines 27 30 Overweight or obese 54 58 Obese 18 22

Table 9. Percentage of 0-15 year olds with particular lifestyle characteristics, Vale. Source: Welsh Health Survey (2013).

Self-rated health status Lifestyle characteristic

Good / Limiting Physically Very good Long- long- active on 5 Physically general standing standing or more active on 7 Overweight Area health illness illness days days or obese Obese The Vale of Glamorgan 95 21 5 54 36 26 14 Wales 94 19 6 52 36 35 19

(ii) Specific risk factors

Table 10. Self-reported smoking status in the Vale.

Adults who reported being a current smoker (age-standardised), 2008-2013 Lower Upper Confidence Confidence Smoker Interval Interval Unweighted USOA % % % Base (c)

The Vale of Glamorgan W03000055 17 - 15 20 1,022 W03000056 18 - 15 21 867 W03000057 29 + 26 32 1,037 W03000058 17 - 14 20 804

Wales 23 22 23 92,081 Source: Welsh Health Survey: 2008-2013

(a) Values significantly higher than Wales denoted by '+', values significantly lower than Wales denoted by '-'. (c) Bases vary, those shown are for the whole sample.

Table 11. Self-reported physical activity in the Vale

Adults who reported being physically active on 5 or more days in the past week (age-standardised), 2008-2013

Physically active on 5 or more days in Lower Upper the previous Confidence Confidence week Interval Interval Unweighted USOA % % % Base (c)

The Vale of Glamorgan W03000055 31 27 34 1,022 W03000056 28 25 32 867 W03000057 29 26 32 1,037 W03000058 26 23 30 804

Wales 29 29 30 92,081 Source: Welsh Health Survey: 2008-2013

(a) Values significantly higher than Wales denoted by '+', values significantly lower than Wales denoted by '-'. (c) Bases vary, those shown are for the whole sample.

Table 12. Obesity and overweight in the Vale

Adults who were overweight or obese (age-standardised), 2008- 2013

Body Mass Index: Lower Upper Overweight Confidence Confidence or obese Interval Interval Unweighted USOA % % % Base (c)

The Vale of Glamorgan W03000055 53 - 50 57 1,022 W03000056 56 53 60 867 W03000057 61 57 64 1,037 W03000058 51 - 47 55 804

Wales 58 58 58 92,081 Source: Welsh Health Survey: 2008-2013

(a) Values significantly higher than Wales denoted by '+', values significantly lower than Wales denoted by '-'. (c) Bases vary, those shown are for the whole sample.

There are an estimated 8,000 people aged 16 and over in Cardiff and Vale with a BMI over 40 (1.9%), including 800 with a BMI over 50 (0.2%).

Among children and young people, overweight and obesity is also a problem (Table 9). The child measurement programme has found that over a fifth (21%) of children in reception year in the Vale of Glamorgan are overweight or obese (Child Measurement Programme for Wales, 2013/14).

Figure 5. Proportion of children who are overweight or obese, 4 to 5 years

Proportion of children aged 4 to 5 years who are overweight or obese, Wales and local authorities Produced by Public Health Wales Observatory, using CMP data (NWIS)

Figure 6. Proportion of children who are overweight or obese, 3 years combined data, 2011/12-2013/14, Children aged 4 to 5 years, Cardiff and Vale UHB

In the Vale, the highest percentages of children who are overweight and obese live in the Gibbonsdown and Barry areas of the Vale.

Table 13. Fruit and vegetable consumption in the Vale.

Adults who reported eating five or more portions of fruit and vegetables the previous day (age-standardised), 2008-2013

Consumption of fruit and vegetables: Lower Upper Meets Confidence Confidence guidelines Interval Interval Unweighted USOA % % % Base (c)

The Vale of Glamorgan W03000055 36 33 40 1,022 W03000056 34 30 38 867 W03000057 28 - 24 31 1,037 W03000058 37 33 40 804

Wales 34 34 35 92,081 Source: Welsh Health Survey: 2008-2013

(a) Values significantly higher than Wales denoted by '+', values significantly lower than Wales denoted by '-'. (c) Bases vary, those shown are for the whole sample.

3. Equity, inequalities and wider determinants of health

Key points

 There are stark inequalities in health outcomes in Cardiff and Vale o Life expectancy for men is nearly 12 years lower in the most-deprived areas compared with those in the least-deprived areas o The number of years of healthy life varies even more, with a gap of 22 years between the most- and least-deprived areas o Premature death rates are nearly three times higher among the most-deprived areas compared with the least deprived  ComparisonThere are also significant of life expectancy, inequalities in the healthy ‘wider determinants’ life expectancy of health, and such disability as housing,-free lifehousehold expectancy income and at educationbirth, Cardiff 2001-05 and 2005-09 Producedo For by example, Public Health the percentage Wales Observatory, of people living using without ADDE/MYE central (ONS),heating WIMD/WHSvaries by area (WG) in Cardiff and Vale from one in a hundred (1%) to one in eight (13%) 2001-05 2005-09 95% confidence Inequalitygap  There are inequalities in how and when people accessinterval healthcare (SII in years)  In addition to health needs, each community has ‘assets’, such as social capital, community groups Malesor community buildings Life 75.9 12.9 expectancy 76.9 12.8 Comparison of life expectancy, healthy(i) Health life equity expectancy and inequalities and disability -free life expectancy at birth, Wrexham 2001-05 and 2005-09Healthylife 63.0 22.5 63.7 22.7 Produced by Public Health Wales Observatory,Life expectancy usingexpectancy ADDE/MYE for men (ONS), is nearly WIMDWIMD/WHS(WG) 12 2008 years (WAG) lower in the most-deprived areas compared with those in the least-deprived areas. The number of years of healthy life varies even more, with a gap of 22 years Disability-free life 59.2 17.2 59.8 between theexpectancy most- and least-deprived2001 areas.-05 2005-09 17.1 Males Females 1 FigureComparison 7. Life expectancy of life expectancy, in years, in healthyCardiff and life Vale. expectancy Source: Public and disability Health Wales-free Observatory life (2011). 75.9 Life expectancy expectancyLife at birth, Cardiff and80.6 Vale UHB 2001-05 and 2005-09 8.8 77.3 Producedexpectancy by Public Health Wales Observatory,81.7 using ADDE/MYE (ONS), WIMD/WHS (WG) 10.0 63.9 Healthy life expectancy Life expectancy with 95% Inequality gap 64.7 2001-05 200565.4-09 21.0 Healthylife confidence interval (SII in years) 60.8Males expectancy 65.9 22.0 Disability-free life expectancy 61.5 76.1 11.6 Life expectancy 62.1 Disability-free life 77.3 12.3 11.8 Females expectancy 62.5 12.9

79.9 Healthy life 63.4 22.5 Life expectancy 81.0 expectancy 64.2 22.7

65.5 Healthy life expectancy 66.1 Disability-free life 59.6 16.7 expectancy 62.0 60.1 16.7 Disability-free life expectancy 62.5 Females 0 10 20 30 40 50 60 70 80 90 Life expectancy 80.7 8.5 81.8 9.9

Healthy life 65.7 20.2 expectancy 66.3 21.3

Disability-free life 62.1 12.3 expectancy 62.5 12.9

Key: SII, Slope Index of Inequality. The Slope Index of Inequality (SII) measures the absolute gap in years of life expectancy between the most and least deprived, taking into account the pattern across all fifths of deprivation within the Local Authority

FigureAll-cause 8. Premature mortality, mortality under 75, in malesmales, in European Cardiff and age Vale-standardised by deprivation rate fifths. (EASR) European per 100,000, age-standardised Cardiff and Vale UHB and Wales, 2001-09 rates (EASR) per 100,000 population (Source: Public Health Wales Observatory 2013) Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WG)

Most deprived within Cardiff and Vale (95% CI) Wales EASR Least deprived within Cardiff and Vale Cardiff and Vale overall 900 800 700 600 500 400 300 200 Rate Ratio - most deprived divided by least deprived 100 2.6 2.5 2.4 2.5 2.8 2.9 2.8 0 2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Risk factors and mortality for many common conditions is also adversely affected by deprivation, with a significant inequality ‘gap’ between those in the most- and least-deprived communities.

Figure 9. Obesity in Cardiff and Vale by deprivation fifth (Public Health Wales, 2014)

Percentage of adults reporting to be obese, by deprivation fifth, all persons, Cardiff and Vale UHB Produced by Public Health Wales Observatory, using Welsh Health Survey (WG) 2004/05 - 2008 95% confidence interval 2009 - 2012

24 Most deprived 28

21 Next most deprived 24

15 Middle 20

14 Next least deprived 17

13 Least deprived 15

Figure 10. Uptake of the 5 in 1 primary in Health Board resident children reaching one year of age during 01/07/2013 to 30/06/2014, by MSOA of residence

Source: Public Health Wales Vaccine Preventable Disease Programme (2015)

Uptake of childhood vaccinations varies considerably across Cardiff and Vale.

In the Vale, uptake of vaccines is generally good, with uptake across the locality for the 5 in 1 at age 1 above 95%. However, uptake of MMR2 by age 4 is lower than the 95% target, particularly in Central Vale.

Figure 11. Percentage of children with completed 5 in 1 primary course by age 1, Vale clusters (2015)

Figure 12. Percentage of children with completed MMR course (2 doses) by age 4, Vale clusters (2015)

(ii) Deprivation and wider determinants of health

Most deprivation in the Vale is around Barry, and around 1 in 15 neighbourhoods in the Vale are in the 10% most deprived in Wales.

The ‘wider determinants’ of health including income, quality and availability of housing, employment, education and community safety show large variation across Cardiff and Vale and, in particular, within Cardiff. Two examples are given below.

Figure 13. Areas of deprivation in Cardiff and Vale, based on the Welsh Index of Multiple Deprivation (WIMD) 2014. Source: Public Health Wales Observatory (2014) (nb. This map will be updated in autumn 2015 as a result of correcting errors identified in the WIMD income score)

Figure 14. Percentage of people living in households with no central heating. Source: Public Health Wales Observatory (2012) from Census 2001 data.

Further data is available in a Public Health Wales Observatory report (2012) on wider determinants.

(iii) Community assets

A comprehensive mapping exercise to establish community assets is recommended for each locality. An overview of some assets in each USOA is available using the Public Health Wales Observatory health assets reporting tool, available at http://howis.wales.nhs.uk/sitesplus/922/page/63326.

4. Ill health and service use in the Vale

Key points

(i) Self-reported ill health

Over 30,000 people in Cardiff and Vale classified themselves in 'bad' or 'very bad' health, a rate of 6.4%.

At the LSOA level within the Vale of Glamorgan the proportion of residents reporting bad or very bad health ranged from 1.2% to 15%. However these are crude percentages only and do not take into account the age structure of the population. The areas with the highest percentages are found in the Cadoc and Buttrills areas in the Vale of Glamorgan.

Figure 15 . Self-reported general health status, Cardiff and Vale, 2011

This compares with the Wales average of 7.6%. Across Cardiff and Vale, the broad ethnic group with the most people rating themselves in ‘bad’ or ‘very bad’ health is white, at 6.7%; all other ethnic groups are below the average of 6.4%, with Asian/British Asian ranking the lowest, with 3.7% rating their health as bad.

The proportion of people who self report ‘bad’ or ‘very bad’ health is lower in Cardiff and Vale among people who can read, write and speak Welsh (1.9%) compared with people without Welsh language skills (7.4%) (Census 2011).

Around 1 in 7 (15%) of the adult population in Cardiff and Vale considered their day-to-day activities were limited a lot by a long-term health problem or disability. A third (32%) had a limitation of any sort. These rates are slightly lower than the Wales average of 16% and 34% respectively.

(ii) Burden of disease across GP clusters

Table 14. Age-standardised percentage of patients on selected chronic condition registers, Cardiff & Vale UHB, 2014, to indicate the relative burden of recorded disease across GP clusters having taken age into account. Source: Public Health Wales Observatory, using Audit+ (NWIS) (2015)

Chronic condition

Area Asthma Hypertension CHD COPD Diabetes Epilepsy Heart Failure Central Vale 7.2 17.0 4.0 2.2 6.9 1.0 0.8 Eastern Vale 6.7 14.1 3.4 1.4 5.6 0.8 0.7 Western Vale 6.5 13.4 3.4 1.3 5.0 0.8 1.2 Cardiff and Vale UHB 6.7 15.6 3.8 1.9 6.5 0.8 0.9 Wales 6.8 15.7 4.0 2.2 6.7 0.9 1.0

Key: COPD, chronic obstructive pulmonary disease; CHD, coronary heart disease

(iii) Service use

Nearly 1 in 5 adults (18%) in Cardiff and Vale visit their GP each fortnight, and over the period of a year around one third of adults (34%) visit an outpatient department. Self-reported attendance at a community pharmacy within the last year is higher in Cardiff and Vale (74%) than Wales as a whole (70%).

Table 15. Age-standardised percentage of adults using NHS services in Cardiff and Vale and Wales in the prior 2 weeks to 1 year (Welsh Health Survey 2012-13)

NHS service C&V Wales Family doctor (GP) (past 2 weeks) 18 17 Attended casualty (past 12 months) 16 17 Outpatients (past 12 months) 34 32 In hospital as an inpatient (past 12 months) 9 9 Pharmacist (past 12 months) 74 70 Dentist (past 12 months) 69 70 Optician (past 12 months) 52 50

Attendance at major Emergency Departments is below the Wales average (240 per 1,000 per year) for residents in the Vale (188) (Public Health Wales Observatory, 2013/14). Similarly, emergency admission rates are lower for the Vale (103) than the Wales average (112).

During 2013, there were 101,270 new attendances across all ages at University Hospital Wales (UHW), putting substantial pressure on secondary care systems. There are many factors that can affect service utilisation including underlying population need, provision of services (including elective, emergency, community and primary care services), as well as patient and parental behaviour in seeking health care.

The figure below shows the crude rate per 1,000 population of emergency unit attendances at UHW in 2013 for Cardiff and Vale residents at MSOA level and it is evident from the map that the highest rates of EU attendances are from residents who live in the most deprived areas of Cardiff. For example the association with deprivation is clear when looking at Butetown. Figure 16 shows that higher rates are seen in the dark area to left of Lloyd George Avenue compared to the lighter area to the right (Atlantic Wharf).

Figure 16. Emergency Unit attendances, UHW, C&V residents (2013)

Llanedeyrn / Rumney / Llanishen estate Pentwyn Trowbridge Mynachdy / Llandaff North

Splott / Tremorfa

Butetown

Grangetown / Riverside

Figure 17. Emergency Unit attendances at UHW by deprivation fifth for Cardiff and Vale residents combined using WIMD 2011 (2015)

Emergency Unit attendances, University Hospital of Wales, crude and European age-standardised rate per 1,000, Cardiff and Vale residents by deprivation fifth, 2013 Produced by Public Health Wales Observatory, using WIMD (WG), MYE (ONS) and UHW EU dataset (Cardiff & Vale UHB Information Dept.) Crude rate Age-standardised rate 300

250

200

150

100

0 Least deprived Next least Middle Next most Most deprived deprived deprived

Rates of delayed transfer of care for social care reasons are nearly twice as high in Cardiff and Vale than the Wales average (Cardiff 8.6 per 1,000; Vale 8.2 per 1,000; Wales 4.7 per 1,000).

The impact of significant reductions in local authority funding are yet to be seen but these could adversely affect general and tailored support for vulnerable individuals in the community. This may result in an increase in hospital admissions where families or individuals are unable to cope, and place further pressure on resources in the community to support patients being discharged from hospital.

Around one in five people locally die in their home, and around six in ten in hospital.

Table 16. Percentage of deaths by place of occurrence, Vale of Glamorgan, deaths registered in 2013 (Source: Office for National Statistics)

Other communal Home Hospital Care home establishment Elsewhere Male 22.9 57.5 8.9 8.6 2.2 Female 13.6 55.8 19.6 9.5 1.5 Persons 18.0 56.6 14.6 9.1 1.8

Note. Deaths at home are those at the usual residence of the deceased (according to the informant)‚ where this is not a communal establishment. Care homes includes homes for the chronic sick; nursing homes; homes for people with mental health problems and non-NHS multi function sites. Other Communal Establishments include hospices; schools for people with learning disabilities; holiday homes and hotels; common lodging houses; aged persons’ accommodation; assessment centres; schools; convents and monasteries; nurses’ homes; university and college halls of residence; young offender institutions; secure training centres; detention centres; prisons and remand homes. Elsewhere includes all places not covered above such as deaths on a motorway; at the beach; climbing a mountain; walking down the street; at the cinema; at a football match; while out shopping; or in someone else's home. This category also includes people who are pronounced dead on arrival at hospital.

(iv) Change in disease profile

The proportion of people with chronic illness rises with age (Figure 18). While this pattern has not altered significantly over the past 10 years, because the population is getting older on average this manifests as a trend of an increasing average number of illnesses per individual in the population (Figure 19). Over the past 10 years there have been around 13,000 additional individuals in Cardiff and Vale with one chronic illness and 5,000 with two or more chronic illnesses. This trend is set to continue.

Figure 18. Percentage of individuals in Wales with 1, 2 or more illnesses by age group (Welsh Health Survey, 2013)

100 90 80

70 60 50 2 or more 40 1

30 chronicillnesses 20 10

0 Percentageof peoplewith 1, 2 ormore 16-24 25-34 35-44 45-54 55-64 65-74 75+ Age (yrs)

Figure 19. Percentage of individuals in Wales with 1, 2 or more illnesses by year (Welsh Health Survey, 2003-2013)

100 90 80

70 60 50 2 or more 40 1 chronic illnesses chronic 30 20 10 % People%aged 16+ with 2 more1, or 0 2003 2008 2013 Year

The profile of disease in the Vale is changing. Examples are given for two common diseases – diabetes and dementia – which affect many people, including their families, friends and carers. In both cases many (but not all) instances of the disease could be prevented by modifying behaviours such as diet and physical activity.

Diabetes

It is thought that the number of people who have been diagnosed with diabetes and appear on the GP registers, 22,181, is lower than the number who actually have the disease, in particular for type 2 diabetes. It has been estimated that there are actually 29,000 adults in Cardiff and Vale with diabetes, around 8% of the population. This suggests there is a shortfall in diagnosis of around 7,000 adults, or over a quarter of predicted cases.

The percentage of people reporting being treated for diabetes has been rising steadily over the last ten years across Wales. Current projections are for the adult population with diabetes in Cardiff and Vale to increase from around 29,000 to around 40,000 by 2025, an increase of nearly 40%. Recorded prevalence of diabetes varies significantly. The age adjusted burden of prevalence ranges from 5% to 6.9% in the Vale.

Figure 20. Prevalence of diabetes, persons aged 17 and over, Cardiff and Vale UHB residents, 2013/14

Dementia

The number of people living with dementia is also projected to rise significantly. The driver for this is mostly the increase in the over 85 population (see above). There is evidence that the risk of developing dementia at any given age is actually starting to fall, but this decline does not sufficiently offset the rise in the population size. Similarly to diabetes, there are thought to be many people currently living with dementia whose condition has not yet been diagnosed.

Table 17. Estimated number of people with dementia in Cardiff and Vale, 2015 to 2025 (Source: Daffodil Cymru)

Year

Age group 2015 2020 2025 30-64 yrs (early onset dementia) 109 116 121 65-69 yrs 282 269 291 70-74 yrs 465 576 554 75-79 yrs 813 894 1,110 80-84 yrs 1,262 1,375 1,540 85 yrs and over 2,565 2,875 3,355 65 yrs and over (total) 5,387 5,988 6,849

Figure 21. People with dementia on GP registers in Cardiff and Vale; and estimated total number of people with dementia, including those currently undiagnosed. Source: Public Health Wales Observatory (2013)

Mental health

4,111 people are on the primary care register for serious mental illness (including schizophrenia, bipolar disorder and other psychoses), around 0.8% of the GP list size in Cardiff and Vale.

In general, people with a psychotic illness have fewer qualifications and are more likely to have left school before the age of 16 with no qualifications, compared with other groups. The percentage of Year 11 school leavers who were known to be not in education, employment or training (NEET) in 2013 in Wales was 3.7%, with a local rate of 3.8% in the Vale.

43% of people accessing homelessness projects in England had a mental illness. The number of households in the Vale who were deemed to be eligible, unintentionally homeless and in priority need was 195 in 2013/14.

The standardised rates for suicide among men and women in the Vale are below the Wales average.

(v) Cancer incidence

Table 18. Incidence of top 3 newly diagnosed cancers in males in South Wales, 2007-2011. European age- standardised rate per 100,000 population. Source: Welsh Cancer Intelligence and Surveillance Unit (WCISU).

Year

Cancer site 2007 2008 2009 2010 2011 Prostate 125.5 118.7 106.9 110.1 104.8 Trachea, bronchus and lung 64.6 65.8 58.9 59.6 62.7 Colorectal 61.5 61.6 66.2 67.8 57.7 All excluding NMSC 471.5 465.2 440.2 448.2 444.9

Key: NMSC, non-melanoma skin cancer

Table 19. Incidence of top 3 newly diagnosed cancers in females in South Wales, 2007-2011. European age- standardised rate per 100,000 population. Source: Welsh Cancer Intelligence and Surveillance Unit (WCISU).

Year

Cancer site 2007 2008 2009 2010 2011 Breast 122.2 126.1 128.7 131.4 116.9 Trachea, bronchus and lung 40.5 43.9 38.1 40.6 41.1 Colorectal 39.4 37.5 39.3 34.9 39.8 All excluding NMSC 379 384 390 390.8 382.1

Key: NMSC, non-melanoma skin cancer

(vi) Causes of death

Table 20. Top 5 causes of death in men, England and Wales 2012

Cause of death EASR per million Ischaemic heart disease 954 Trachea, bronchus and lung cancer 442 Cerebrovascular disease 341 Bronchitis, COPD 327 Pneumonia 260

Key: EASR, European age-standardised rate

Table 21. Top 5 causes of death in women, England and Wales 2012

Cause of death EASR per million Ischaemic heart disease 426 Cerebrovascular disease 327 Trachea, bronchus and lung cancer 298 Breast cancer 239 Bronchitis, COPD 224

Key: EASR, European age-standardised rate

In Cardiff and Vale, although death rates from cancer, respiratory disease and heart disease overall are gradually decreasing, for some other conditions such as liver disease, mortality is increasing.

Figure 22. Changes in mortality rates for liver disease, cancer, respiratory disease and circulatory disease (Source: Public Health Wales Observatory, 2011)

Under 65 European age standardised mortality rates for various diseases, Wales, percentage change from 1996 baseline Produced by Public Health Wales Observatory, using ADDE/MYE (ONS)

220% 200% 180% 160% liver 140% malignant cancers 120% respiratory 100% circulatory 80% 60% 40%

% change in EASR sincechange EASR 1996% in 20%

1996 1997 1998 1999 2004 2005 2006 2007 2008 2009 2000 2001 2002 2003

5. Working in partnership with our local residents

Key points

As part of the development of ‘Shaping our Future Wellbeing’, residents and service users from Cardiff and the Vale were asked their views on what they wanted to see from their local NHS over the next 10 years. The following statements summarise these views, in particular those relating to the local community:

I want or need...

 To have the tools and support that enable me to live a healthy life, minimising my risk of disease

 Rapid access to services which can diagnose my disease at an early stage

 Easy access to high quality advice. This could be via helplines or websites but, when I have a complex problem, I want to be able to talk to people who know me and understand my disease and its treatment

 To have ownership of how and where my care is delivered at the end of my life

 To stay close to my community and family

 Rapid access to knowledgeable healthcare professionals who can advice me when my health deteriorates, allowing treatment alterations that allow me to stay at home as much as possible

 Care which is delivered close to where I live and work, so that I can continue to lead as normal a life as possible, whilst still working closely with clinical teams to ensure the best outcomes for me

 To maintain independence and have the best quality of life possible during my care

 To die with dignity in a place of my choosing

 A co-ordinated service, including out of hours, so I don’t repeat the same story

 To always be offered the best, most effective treatments, regardless of where I live and which health professional I see

 Decisions regarding my care to be made by experienced clinicians who have an understanding of my condition, whatever time of day or night

 To receive holistic care from a range of health professionals, who communicate effectively with each other and work as a team