THE HEALTH OF THE PEOPLE OF AND LOMOND

Needs assessment report

June 2007

0 Acknowledgements

This report was written by Elaine Garman. Its preparation was invaluably supported by the following for:

Data sourcing and creation of tables and graphs

Ann Boyle Chris Carr Ian Douglas David Greenwell Colin Steel Susan Vaughan Stephen Whiston

Supporting the community roadshow events

Caroline Champion Mavis Gilfillan Anne Helstrip Carol Millar David Ritchie

Providing comments and thoughts on the communities’ health needs

All members of communities who devoted their own time to coming to the community roadshow events

Attendance at the health needs assessment working group

David Bruce Chris Carr Caroline Champion Anne Helstrip Sylvia Moran Jim Proctor Stephen Whiston

1 Contents Page No.

1. Introduction to the area 3

2. Demography and socio-economic determinants of health 4

3. Life-style, behaviour and child health 8

4. Morbidity, mortality and life-expectancy 12

5. Activity in secondary care 14

6. Transport and access 15

7. Perceived needs of the population 16

8. Conclusions 17

Appendices

1. 18

2. 19

3. 39

4. 43

5. 51

6. 61

7. 63

2 1. INTRODUCTION TO THE AREA

Helensburgh and Lomond is one area of four localities in and Bute. The locality stretches from in the north, encompasses Ardgarten and Arrochar at the top of Long, goes south and west to peninsula and takes in , Helensburgh and . The eastern boundary is created by (see Figure 1.1).

Both Council and the Community Health Partnership use the four administrative areas. The other three are Bute and ; , and ; and , Lorn and the Isles. The total population of Argyll and Bute is 90,870 (based on 2005 for (GROS) Mid Year Estimate (MYE)). The Helensburgh and Lomond population is estimated at 26,438. Argyll and Bute itself is one of the largest and most sparsely populated local authority areas in Scotland. Its population is scattered across an area of just under 2,700 square miles, more than a third live in settlements with a population of less than 1,000 compared to a Scottish average of 8% of the population living in such small communities.

The population density of Argyll and Bute as a whole is approximately 0.13 persons per hectare. For Helensburgh and Lomond it is around 0.75, which reflects the main population centre of Helensburgh. The population sparseness in the rest of the locality and indeed in the local authority area as a whole makes transport and communications difficult.

3 2. DEMOGRAPHY AND SOCIO-ECONOMIC DETERMINANTS OF HEALTH

Demography

The GROS MYE for 2005 indicates a population total of 26,438 for Helensburgh and Lomond with a broadly similar age structure as Argyll and Bute and (see Figure 2.1) but a fall of almost 1,500 since 2002. Figure 2.2 shows the change in the age groups in this time. The small differences in the percentages in the age groups are around slightly fewer in the older age groups and more in some of the younger age groups (see Figure 2.3). The presence of large numbers of military personnel in the 15-29 years and 30-44 years make both these larger cohorts than the comparators.

Whilst the population in Helensburgh and Lomond and Argyll and Bute as a whole has been declining recent GROS projections indicate population growth. This is due to the assumption of positive migration into Argyll and Bute with concomitant large increases in projected numbers of elderly people by 2014 (47% rise in numbers of 75+ years from 1984 figures – see Table 2.1 and Figures 2.4 and 2.5). The GROS 2004 based projection relied on quite large inward migration. This offsets the negative natural change and therefore generates population growth over the course of the projection. However it may be that these assumptions are too high given lower level migration assumptions that underlie subsequent mid-year estimates for the area in 2005 and 2006 (see Figure 2.6).

Argyll and Bute Council has undertaken their own analysis using the 2001 Census as the base year for the model and subsequent years using Small Area Population Estimates (SAPEs) where they were available (2002 to 2005). Whilst they project an overall decrease of the Helensburgh and Lomond population by 15.3% by 2024 they also project an increase of 32%, 30% and 39% for 65+ years, 75+ years and 85+ years respectively by 2020 for Helensburgh and Lomond (see Table 2.2 and Figure 2.7).

Using the same year’s GROS projections the increase in Argyll and Bute’s population to 2024 is around 4% (compared with the local authority’s projection of a decrease of - 4.3%). Whichever projection is considered both indicate a likely increase in the older population. Based on the GROS projection in comparison to other local authority areas, Argyll and Bute is likely to have a higher dependency ratio than many other areas (see Figure 2.8). The increased numbers of elderly people not only gives rise to the increasing need for services but also raises the issue of how that care is provided with a smaller, younger population.

Feeding into this dependency ratio is the number of live births in the area. Since the 1980s the birth rate has been declining and projections indicate (again based on 2004 GROS projections) a levelling off and indeed a small increase for Argyll and Bute (see Figure 2.9). The number of births in Helensburgh and Lomond in 2002 was 260.

Alongside a current projection in population numbers there is also a projected increase in the numbers of households with greater numbers of people living by themselves. The increase in the population between 2004 and 2024 is predicted to be 3,486 whilst the number of households is predicted to increase by 5,320 (see Figure 2.10). This increase is fuelled by a changing pattern of household occupancy with greater numbers living by themselves. Between 2004 and 2024 there is expected to be a 6% increase in the number of 75+ year olds living by themselves with a smaller increase (2%) of lone parent households (see Figures

4 2.11 and 2.12). The affect this has on average household size is around the Scottish average (see Figure 2.13).

Socio-economic determinants of health

Argyll and Bute is not highly deprived compared to other local authority areas, but there are still significant numbers of people in deprivation. For much of the area the population is heterogeneous in its nature and therefore does not have many areas of concentrated multiple deprivation. Houses with the same postcode can be at opposite ends of the socio-economic spectrum. In many rural areas deprived individuals and households are fairly evenly distributed throughout the patch, with circumstances of deprivation having more to do with an individual’s characteristics than the area in which they live. In Argyll and Bute it is often individuals and households rather than communities who face deprivation and social exclusion.

That said some areas within Argyll and Bute are classed through the Scottish Index of Multiple Deprivation (SIMD) as within the 15% most deprived in Scotland and two are within the 5% most deprived. Ten datazones (each datazone made up of 500 – 1,000 people) in the most deprived 15% are found within the local authority boundary, two of which are in Helensburgh and Lomond (see Figures 2.14 and 2.15). One of these is within the most deprived 5%. Given the population numbers, around 4% of the Helensburgh and Lomond population lies in a datazone that is within the 15% most deprived and in Argyll and Bute as a whole the number equates to around 8%.

Overall in Helensburgh and Lomond employment deprivation extends to 5% of the population and with regard to income deprivation – 8%. The latter is measured by the number of people in households receiving income based benefits such as Income Support.

For the main population base in the locality the local economy relies a lot on the activity produced by the naval base at and its associated services. However many of the Helensburgh population travel to for work. In the more rural parts of the locality labour markets are localised due to high cost of travel and the distances and time of travel required to access other labour markets. There are high levels of low skill and low aspiration.

SIMD indicates that one of the datazones in Helensburgh and Lomond ranked the worst in Argyll and Bute for education, skills and training. This measurement combines information on pupil performance, pupils aged 16+ who enter fulltime education, adults with no qualifications and school absences. This highlights the inequalities that exist as students in Argyll and Bute have traditionally performed above the national averages on standardised testing in all but the Primary 4 level. students performed even better when compared to the national scores, with an average of 10% more students achieving or exceeding the standardised score.

Population sparseness in the rural areas (see Figure 2.16) gives rise to much of the Helensburgh and Lomond locality being classified as accessible rural or remote rural (see Figure 2.17). As a result geographic access to services is problematic and SIMD places Argyll and Bute in the most deprived 10% for this domain (see Figure 2.18).

With the health domain the worst areas swing back to the urban centres rather than the rural areas. One of the Helensburgh datazones ranks 3rd worst for health in Argyll and Bute (see

5 Figure 2.19). This measurement comprises data such as comparative mortality, hospital episodes for alcohol abuse, ‘sickness benefit’ claimants, emergency admissions to hospital, drug prescribing for depression and low birth weight babies.

The housing deprivation category consists of the percentage of people living in households without central heating and those who live in overcrowded households. Parts of the local authority area are without access to mains gas and as a result more houses are without central heating than the average. In Argyll and Bute 60% of the datazones are ranked within the top 50% most housing deprived areas in Scotland. Deprivation in this category is evenly split between urban and rural areas.

Results of the 2002 Scottish House Conditions Survey reinforce the housing deprivation position. This survey showed that 83% of the housing stock in Argyll and Bute was in need of some repair, of which 46% was urgent. These are both above the national average. In addition, an estimated 21% of households in Argyll and Bute were suffering fuel poverty compared to a national average of 13% (see Tables 2.3 and 2.3a). The definition used for fuel poverty is when a household is required to spend more than 10% of its income (including Housing Benefit or Income Support for Mortgage Interest) on all household fuel use.

According to an Argyll and Bute report1 most households deemed below tolerable standard are located in rural areas. Estimates on unfit housing can be unreliable but the most recent figures suggest that 2.4% of all houses or just over 1,000 homes in Argyll and Bute are below tolerable standard. This is more than double the estimate for all Scotland.

With regard to antisocial behaviour, domestic abuse and crime Argyll and Bute fares better than Scotland as a whole. Tables 2.4, 2.5 and 2.6 show comparisons within the former NHS Council areas.

Summary

The population information for Argyll and Bute is currently showing greater deaths than births but with recent years showing a net migration gain. Helensburgh and Lomond, like Argyll and Bute as a whole is likely to experience greater future ageing in the older age ranges than Scotland. However population projections may have over estimated inward migration and as a result this may not feed through to as large cohorts in the older age groups as currently being estimated. Nonetheless, an ageing population is a reality, the degree of which is still being debated.

Deprivation in Argyll and Bute is less amenable to measurement due to its scattered distribution throughout the area. Where there are areas of concentrated multiple deprivation in Helensburgh and Lomond this accounts for 4% of the local population living in the worst 15% most deprived areas in Scotland. While many in Helensburgh are able to access higher paid employment in Glasgow much of rural Argyll have access only to low pay jobs. In 2003 the average worker in Argyll and Bute earned £381 per week2. These earnings were 13% lower than those in Scotland. In 2001 the average wage was £390 per week which was only 3% lower than the Scottish average at the time. Overall there are a number of characteristic that can be used to describe the area:

1 Argyll and Bute Council Area Data, October 2006, unpublished 2 ibid

6

ƒ Helensburgh and Lomond experiences 5% employment deprivation ƒ Helensburgh and Lomond experiences 8% income deprivation ƒ One of the two datazones in the locality which lies in the 15% most deprived in Scotland is ranked worst in Argyll and Bute for education, skills and training ƒ The local authority area is within the 10% most deprived for geographic access ƒ The quality of the housing stock is worse than the Scottish average ƒ 21% of households in Argyll and Bute were suffering fuel poverty compared to a national average of 13% ƒ Antisocial behaviour, domestic abuse and crime statistics in Argyll and Bute are better than Scotland as a whole.

7 3. LIFE-STYLE, BEHAVIOUR AND CHILD HEALTH

Much of the information on lifestyles and behaviour comes from survey work carried out at national level or previously at NHS Board level by the former NHS Argyll and Clyde (NHSAC). When broken down to Community Health Partnership level and potentially to a locality the reliability of the data is very suspect. There is little to support the data results as being anything other than chance. Where the information is taken from a total population, for example all new mothers, then a measure such as the breast feeding rate should be accurate. Any issues of the robustness of the data will be flagged up throughout this section where appropriate.

Smoking

The numbers of adults (16+ years) smoking in the period 1999-2005 has shown no discernible trend due at least in part to the size of the numbers in the sample from Argyll and Bute in the Scottish Household Survey (see Table 3.1). The rate has varied between 24.9% and 29.8% according to the sample. A national target of a smoking rate of 22% for adults been set for 2010. Currently 14 people are accessing the smoking service in Helensburgh and Lomond. The quit rate for this service is 71%; 73% at one month and 67% at 6 months.

The prevalence of smoking nationally in the most deprived areas has fallen from 42.2% in 1999 to 34.3% in 2005. A national target has been set for those who live in the most deprived areas to reduce the percentage smoking to 33.2% by 2008.

There is a further national target to reduce smoking during pregnancy, which seeks a reduction from 29% to 20% by 2010. The proportion of women smoking during pregnancy in 2005 was 22.7%. In 2004 the rate in Argyll and Bute was 24.4%.

Smoking prevalence data amongst young people (13 and 15 year olds) in Scotland is collected biennially as part of the Scottish Schools Adolescent Lifestyle and Substance Use Survey (SALSUS). 14% of 15 year old boys and 24% of 15 year old girls in Scotland smoke regularly. 5% of 13 year old boys and 7% of 13 year old girls in Scotland smoke regularly.

A pilot conducted in and 2004-06 gives an indication of rates in S2 in Argyll and Bute – 17.5% in Campbeltown, 19.5% in Lochgilphead in 2004. There is no local survey data for Helensburgh and Lomond.

Alcohol

The Alcohol Profile for Argyll and Clyde (ISD Scotland, 2006a3) indicates that there were 850 alcohol related acute hospital discharges in Argyll and Bute in 2004-2005 compared with 542 in West (North) (see Table 3.2). In 2004-2005 there were 57 discharges from hospital with a diagnosis of alcoholic liver disease in Argyll and Bute while there were 47 discharges with the same diagnosis in (North). In the Argyll and Clyde area as a whole there were 4,319 alcohol related discharges from general hospitals in 2004-2005. Comparing alcohol-related hospital discharge rates standardised for age differences, the rate for the Argyll and Clyde Area was 96 compared with 75 for Scotland as

3 ISD Scotland (2006a) Alcohol Profile Argyll and Clyde, : ISD Scotland

8 a whole. According to figures released by National Statistics4, Argyll and Bute has an alcohol-related death rate (both male and female) at least 50% higher than the UK average. These figures are mirrored across Scotland where the alcohol-related death rates have been growing at a disproportionate rate to the rest of the UK. In Scotland the male rates have risen from an average of 16 per 100,000 population in 1991/93 to almost 40 per 100,000 in 2002/04. This compares with a rise from 8 to 15 per 100,000 over the same period in . The female alcohol-related deaths show a similar disparity where the English figures have increased from 5 to 7 while the Scottish figures have risen from 8 to 16 per 100,000 during this period. This indicates that Argyll and Bute and West Dunbartonshire experience a substantial degree of alcohol related harm.

When we look at the different local authority areas in former NHS Argyll and Clyde we see that 30 per 10,000 population committed a drunk driving offence in Argyll and Bute while only 21 per 10,000 offences were committed in West Dunbartonshire5. This may be in part due to higher car ownership and poor public transport but across Scotland this rate was only 22 per 10,000. If we look at the drunkenness offences, almost 28 per 10,000 were committed in Argyll in Bute in 2004, 34 per 10,000 in West Dunbartonshire but only 14 per 10,000 across Scotland. Whilst the trends show gradual decline in these figures between 1996 and 2004 the comparison to the rest of Scotland indicates a concern.

Drugs

Both Argyll and Bute and West Dunbartonshire have significant problems of drug misuse although the prevalence of problem drug use in West Dunbartonshire is considerably higher than that in Argyll and Bute. A study of problem drug use in the 15 to 55 age group in Scotland6 estimated that there were 609 problem opioid and benzodiazepine users in Argyll and Bute with a prevalence of 1.35%. In all of West Dunbartonshire there were an estimated 1,185 problem opioid and benzodiazepine users with a prevalence of 2.22% (see Table 3.2). The Drug Misuse Statistics Scotland7 indicate that in 2006, 168 new patients attended drug services in Argyll and Bute and 404 new patients attended drug services in West Dunbartonshire. A survey carried out by the Specialist Pharmacist for Substance Misuse for NHSAC indicated that 137 people were receiving methadone maintenance treatment for a drug misuse problem in Argyll and Bute while 270 people were receiving methadone maintenance treatment for a drug misuse problem in West Dunbartonshire.

Obesity

Within the former NHS Argyll and Clyde 66% of the sample in the 2003 Scottish Household Survey were overweight and obese (see Table 3.3). However the sample size gives rise to the figures being interpreted with caution. The local NHS Argyll and Clyde Your Health and Wellbeing Survey 2001 provided a bigger sample size (1,087 for Argyll and Bute). This gives a rate of 50% of people being overweight or obese. Again the results are not statistically significant.

4 National Statistics (Spring 2007) Health Statistics Quarterly, National Statistics 5 ISD Scotland (2006a) Alcohol Profile Argyll and Clyde. Edinburgh: ISD Scotland 6 Hay G, Gannon, McKeganey N, Hutchinson S and Goldberg D. (2005) Estimating the National and Local Prevalence of Problem Drug Misuse in Scotland, Edinburgh: ISD Scotland 7 ISD Scotland (2006b) Drug Misuse Statistics Scotland 2006,Edinburgh: ISD Scotland

9 From available information (ISD Child Health Surveillance Programme – Pre-school) there is an indication that nationally there have been significant increases in prevalence of overweight and obesity between 24 and 49 months. From the weight and height of children at 39 months (using pre-school child health surveillance programme data) the children can be put into categories including overweight, obese or severely obese. For children born in 2001 the proportion of 39 month-old children in Argyll and Clyde who were overweight (20%) was a little lower than for Scotland as a whole (21%) but higher than the UK reference standard for 1990 (15%). Of these overweight children in Argyll and Clyde, over one-third was classified as obese. Half of these obese children were severely obese.

By the time children have reached Primary 7 the problem of overweight and obesity has increased. Two areas in NHS Argyll and Clyde participated as pilot areas for the School Health Surveillance System – and town. From this small sample our children did not compare well with their counterparts in the other five Boards which also participated. 39% of the sample was overweight whilst the other Scottish children were 34% overweight. Of the Argyll and Clyde children who were overweight over a half were obese and over half again were severely obese. These proportions were also reflected in the Scottish figures.

The recommended health guidelines for physical activity are to take at least 30 minutes of moderate physical activity on five or more days per week or, for even greater health benefits, to take at least three 20 minute sessions of vigorous exercise per week. 51% of the sample in NHS Argyll and Clyde’s Your Health and Wellbeing Survey indicated that they meet the lower level guideline. Again caution should be taken in interpreting the figures with the sample size.

Oral Health

Closely related to issues of diet is oral health. For children the drive has been to ensure that they are registered with a general dental practitioner and for as many as possible to have no decayed, missing or filled teeth. The Scottish target is for 60% of five year olds to meet this requirement by 2010. The National Dental Inspection Programme8 indicates that for P1 children examined in the school year 2005/06 51.7% of children in NHS Argyll and Clyde had no decayed, missing or filled teeth. The Argyll and Bute results can be separated out in this survey (statistically sound) and made available to CHPs. The results show that 63% of these children in the sample had no decayed, missing or filled teeth. The Scottish average was 54%. Nationally the trend shows a decline in prevalence of decay and clear association with social deprivation and tooth decay.

8 Accessed at http://www.scottishdental.org/dentalinspection.htm

10 Breastfeeding

Research suggests that babies who are breastfed as well as receiving other benefits are less predisposed to overweight and obesity in adult life. The Scottish target is that at least 50% of mothers should still be breastfeeding at six weeks (after birth) by the year 2005. By 2005, 45.6% of babies were being breastfed at 6-8 weeks in Argyll and Bute. However we had very disappointing figures in 2006 with around 50% of mothers breastfeeding at time of first health visitor visit and only 39.2% of mothers still breast feeding at 6-8 weeks (Scottish average 36.2%) (see Figures 3.1 and 3.2). The lowest rates of breastfeeding are found in the most disadvantaged communities. Over the period 2000-2004, the breastfeeding percentage at 6-8 weeks, was four times higher in Argyll and Clyde in deprivation category 1 (the most affluent areas) than in deprivation category 7 (the most deprived). The figures were 52% and 12% respectively. So while improvements had been made in Argyll and Bute recent indications show this may not have been sustained and it is likely that health inequalities will exist within these figures.

Low Birth Weight

Like breast feeding, low birth weight rates are higher with greater social disadvantage. In Argyll and Bute the percentage of singleton births weighing less than 2500gms (approximately 5lbs 8oz) has been between 4.7% and 6.8% in the period 1998-2005/06. The provisional 2005/06 figures from ISD (Information Services Division [part of NHS Scotland]) show 6.8%. The Scottish average for the same year was 5.7%.

Immunisation

The immunisation rates for childhood vaccines in Argyll and Bute in 2006 were around the national average of 96% of children having completed the primary course at 12 months. The target for all childhood immunisation is to reach 95% of children having completed the primary courses of immunisation. For measles, mumps and rubella (MMR) the primary course is not due for completion until 24 months of age and the average in 2006 in Argyll and Bute was 90.4% whilst the Scottish average was 92.1%. The trend for Argyll and Bute similar to the rest of Scotland is for a low and steady increase in immunisation rates for MMR following adverse media coverage.

Summary

Many of the lifestyle behaviours cannot be reported with confidence because of small samples. It is difficult to suggest that Argyll and Bute and Helensburgh and Lomond in particular are better or worse than the Scottish average. Many of these behaviours are associated with greater social disadvantage and as a whole Argyll and Bute is not as disadvantaged as many areas in Scotland. However the area does have worrying rates of alcohol problems. On the positive side oral health and immunisation show improving public health trends.

11 4. MORBIDITY, MORTALITY AND LIFE-EXPECTANCY

Life Expectancy

In Argyll and Bute life expectancy is slightly higher than for Scotland as a whole. For a baby born boy today he would be expected to live until he were 75.1 years (Scotland 74.2) and a girl could expect to reach almost 81 (80.7 years) and in Scotland generally 79.2 years (see Figures 4.1 and 4.2). Within this life span individuals may experience limiting long-term illness or disability. Table 4.1 shows self-reported health and long-term illness. Those in Argyll and Bute report slightly less ill-health than the rest of Scotland.

Morbidity and Mortality

A similar pattern of cause of death occurs in Helensburgh and Lomond as across Scotland (see Figure 4.3). The 2005 figures show that Argyll and Bute has fewer deaths from stroke and cancer than Highland Council area but more people dying from coronary heart disease (see Figure 4.4). Like the rest of Scotland the rate of death for these conditions is declining over time (see Figures 4.5 – 4.8) with the exception in Argyll and Bute of male rates of cancer (for the period examined).

Figure 4.4 also demonstrates that both Highland and Argyll and Bute show excess deaths of ‘External Causes’ over those expected. Examination of the Argyll and Bute figures show that the standardised mortality ratios (SMR) for accidents (SMR 114.8) and particularly motor vehicle accidents (SMR 116.7)9 account for this rate over the norm (SMR for Scotland = 100). This is also borne out in the road accidents data10 which give Argyll and Bute a rate of 32 accidents per 10,000, 50 casualties per 10,000 and accidents involving a fatality of 0.9 per 10,000 in 2002 compared to a Scottish rate of 28, 38 and 0.5 respectively. These figures will include visitors to the area.

Prevalence of diabetes (Types 1 and 2) is similar in Argyll and Bute compared to West Dunbartonshire11. Argyll and Bute Type 1 prevalence is currently 0.5% compared to 0.6% in West Dunbartonshire (former NHS Argyll and Clyde part) and the figures are 3.1% and 3.2% for the same areas for Type 2. These are important figures as diabetes places an individual at higher risk from coronary heart disease (CHD). As already mentioned Argyll and Bute shows higher levels of CHD than the rest of NHS Highland.

Mental health measures are not particularly sophisticated but as well as considering the alcohol-related hospital discharges prescribing rates of antidepressant drugs may be used as a proxy measure. However it should be noted that prescribing rates can vary for different reasons. For example different populations may use primary care services differently – men may be more reluctant to present to a general practitioner than a woman or those in more deprived circumstances may not prioritise tackling a health issue over all the other the daily problems that there are. NHS Argyll and Clyde12 reported a percentage of estimated patients on antidepressants (based on a crude rate) of 6% for Argyll and Bute compared to 8% for the

9 Source: GROS death registrations, 2003-2005 and GROS MYE 2004 10 Scottish Executive (2003) Road Accidents Scotland 2003, Scottish Executive 11 Source: SCI-DC & CHI (February 2007) 12 NHS Argyll and Clyde (2004) Argyll and Clyde Health Annual Report of the Director of Public Health 2004, NHS Argyll and Clyde

12 NHSAC part of West Dunbartonshire and overall for the NHS Board area 7% and for Scotland as a whole 6%.

Physical and mental health ‘long term conditions’ represent 80% of the health burden and are increasing due to demographic change. Although elderly people are, in general, healthier than their counterparts in previous generations, increasing age inevitably increases the likelihood of ill-health, in particular due to long term conditions. The exact impact of a combination of increasing healthy life expectancy and increasing morbidity as a result of an ageing population is difficult to predict but has been summarised as severe morbidity declining whilst moderate ill-health increases.

With an ageing population and the corresponding increasing co-morbidity (see Figure 4.9) there is an important challenge to delivering care in the most appropriate and effective way. The demand for healthcare (see Table 4.2) has been assessed13 to increase in relation to the number of conditions. Similarly emergency admissions have increased and an illustration of the impact of these trends on emergency medical bed use in Scotland over the past two decades can be seen in Figure 4.10.

Summary

The selected ‘All Cause’ SMR data (seen in Figure 4.4) shows that Argyll and Bute like Highland Council area enjoys a healthier profile than the rest of Scotland. This is further reflected in the improved life expectancy compared to the Scottish average. However there are areas that improvements could be made to that health profile – in the prevention of coronary heart disease and in the reduction and prevention of accidents especially road traffic accidents. Both have been a feature of the Joint Health Improvement Plan14.

13 Rundall TG, Shortell SM, Wang MC, Casalino L, Bodenheimer T, Gillies RR, Schmittdiel JA, Oswald N and Robinson JC (2002) As good as it gets? Chronic care management in nine leading US physician organisations BMJ; 325:958-61 14 Argyll and Bute Community Planning Partnership Joint Health Improvement Plan 2006/2009, Argyll and Bute Community Planning Partnership

13 5. ACTIVITY IN SECONDARY CARE

The total secondary care activity shows that Helensburgh and Lomond and Bute and Cowal localities generate the most activity in the CHP – with the former using slightly more outpatient care than the other locality and vice versa for inpatient care (see figures 5.1 and 5.2)15. As expected Helensburgh and Lomond makes most use of NHS Glasgow and Clyde services (see Figures 5.3 and 5.4). Appendix 13 of the West Dunbartonshire Needs Assessment Report gives current bed numbers at the Hospital which provides access to medical, surgical, stroke rehabilitation, medicine for the elderly (assessment, rehabilitation and geriatric orthopaedic), community maternity, psychiatry and dementia beds. In addition, the hospital also provides day facilities for renal haemodialysis, day surgery, medical day unit, haematology day unit and day hospital for elderly patients.

Figures 5.5 – 5.20 indicate the level of activity in selected specialties across for Helensburgh and Lomond patients in NHS Greater Glasgow and Clyde hospitals. An increase in activity of varying degrees was shown in the three years data in:

ƒ trauma and orthopaedics ƒ ear, nose and throat ƒ general surgery elective admissions ƒ accident and emergency inpatient and daycases ƒ general medicine elective inpatient, day cases and emergencies ƒ geriatric medicine emergency inpatients

Other areas showed a decrease in activity. These included:

ƒ general surgery emergency admissions ƒ geriatric medicine elective inpatient admissions ƒ cardiology inpatient and daycases ƒ general psychiatry inpatient and daycases

The biggest change in terms of which hospital treated patients was seen in general surgery emergency inpatient activity reflecting the change made to services at the previously.

Summary

On the whole the picture is one of increasing demand on secondary care although there may be some caution needed in interpreting the rise as data gathering may have improved over the three years that were examined. As mentioned in the previous section with an ageing population and increasing co-morbidity other ways of meeting care needs require to be developed to meet demand.

15 Source of data - Tribal Consulting

14 6. TRANSPORT AND ACCESS

Of prime importance with a locality that has both remote and rural areas is the ability to access services. As discussed in Section 2 one of the problems in Argyll and Bute is such a difficulty. Travel times are important especially with an increasingly elderly population. Travel times to general medical practitioner surgeries do not appear to exceed much above 30 minutes using public transport for Helensburgh and Lomond16. Travel times using AA Route Planner were collated for the main Glasgow hospitals (see Table 6.1 and Figure 6.1). These indicate that for many of the villages outside Helensburgh the travel time to a hospital other than the Vale of the Leven exceeds 60 minutes. From the feedback on these travel times they are felt to be very optimistic i.e. with good weather, no holiday or rush hour traffic and a confident driver.

Public transport was discussed in detail in the community events (see Section 7) and it was evident that bus or train routes did not currently cater for direct access to the Royal Alexandra Hospital in Paisley for most of the Helensburgh and Lomond population. Easier transport links to Gartnavel General Hospital were noted.

Summary

Geographic access to services is encompassed in the calculation for multiple deprivation. For Argyll and Bute and Helensburgh and Lomond specifically many of the datazones are in the 10% most deprived across Scotland for this domain. Whilst car ownership is higher than the Scottish average public transport is often infrequent and does not provide straightforward journeys to hospital services. For an increasingly elderly population transport to access services in an equitable manner remains an important issue.

16 Source: SIMD Data Scottish Executive

15 7. PERCEIVED NEEDS OF THE POPULATION

As part of the health needs assessment process, community engagement events were held in different venues throughout Helensburgh and Lomond. These ‘roadshows’ provided an opportunity to present a summary of the health needs assessment thus far and importantly gather information from communities as to their perceived health needs.

Throughout one week in May, afternoon and evening sessions were conducted in /Cove, Garelochhead, Helensburgh and Arrochar. The Arrochar event also attracted residents from who are part of Bute and Cowal locality but who also access services based at the Vale of Leven Hospital.

The format of the sessions was to provide information on an informal basis. Data was displayed on boards and a PowerPoint presentation was running on a continuous basis to provide explanation. However most of the explanation was provided by staff on a one-to-one basis using the data displayed. This allowed for in-depth discussion of issues and generated comments and thoughts from residents of the area. People were encouraged to record these on a ‘talking wall’. All data from this was collected and collated into themes. These comments (in themes) are reproduced in full in Appendix 7. No changes have been made to spelling, grammar or emphasis. As well as staff from NHS Highland being present a member of staff from Partnership for Transport was also available to speak to members of the public for most of the sessions.

The themes which produced most opinion were transport and access. As well as issues recorded about patients finding difficulty in accessing services at the Royal Alexandra Hospital (RAH) in Paisley there was also concern over ability of elderly relatives able to find transport home in the middle of the night when they had accompanied an elderly relative to the RAH.

Mental health services and services for elderly patients also featured in comments with an emphasis on the need for skilled services in the community and access to local inpatient care.

Summary

The communities’ concerns were heavily dominated by transport and access. Discussion on a one-to-one basis dealt with health issues such as alcohol and indeed potential improvements to individual’s own lifestyle behaviours across a range of topics were discussed. However the views recorded on the ‘talking wall’ were understandably around their worries of present and future issues for an increasingly elderly population.

16 8. CONCLUSIONS

Argyll and Bute is an area that has similar causes of death in terms of disease processes compared to the rest of Scotland and as a whole is healthier and has longer life expectancy for both sexes. The accident rate and specifically the road traffic accident rate is worse than the Scottish average and alcohol consumption appears to be problematic. Helensburgh and Lomond, where it can be determined, has similar patterns.

Deprivation is scattered throughout the area, with only ten areas of concentrated multiple deprivation lying in the 15% most deprived in Scotland, two of which are in Helensburgh. One of the SIMD domains used to calculate the multiple deprivation index is geographic access and this kind of deprivation is widespread in the locality.

Many of the poorer aspects of health (e.g. low rates of breast feeding, higher levels of alcohol consumption, higher rates of coronary heart disease) increase with greater social disadvantage. We can assume that such health inequalities exist in Helensburgh and Lomond as in the rest of Scotland.

Despite differences in assumptions from different sources regarding varying degrees of inward migration, we know that the Helensburgh and Lomond population is likely to become increasingly elderly. This not only increases demand on services but with a smaller younger population fewer people are available to generate tax revenue for growth of services and labour to provide the required health and social care services.

The secondary care demand has shown increased activity over the past three years. The NHS is currently “managing chronic disease with an acute care mentality” (Scottish Executive 200517 ). This (Kerr) report goes on to state “the next twenty years will see an ageing population, a continuing shift in the pattern of disease towards long term conditions and a growing number of older people with multiple conditions and complex needs. These changes in themselves will make the current model of health care delivery unsustainable.”

There is a need to ensure that as our population becomes older and relatively healthier the increasing numbers of long term conditions will need to be managed more effectively and efficiently through planned anticipatory care and better planning around emergency care. This will require promoting preventative care particularly in disadvantaged areas, the active promotion of self care, the development of expert patients, with less dependence on clinicians for those low/medium risk patients as well as the identification and proactive management of high risk individuals.

Team working will need to be enhanced, across disciplines in primary care, and between primary and secondary care, and between health and social care providers, recognising that optimal care may require proportionally more investment in social care as opposed to health care. Part of this picture of care will be ease of access for patients to different parts of this care pathway.

17 Scottish Executive (2005) Building a Health Service Fit for the Future, Edinburgh, Scottish Executive

17

Appendix 1

Figure 1.1: Boundary Map of Helensburgh and Lomond Locality

18 APPENDIX 2

Figure 2.1: Percentage of Population by Age Group

Estimated Population for Helensburgh and Lomond 2002-2005

2500

2000

2002 1500 2003 2004 1000

Population 2005 500

0 0-4 5 - 9 10 - 16 - 20 - 25 - 30 - 35 - 40 - 45 - 50 - 55 - 60 - 65 - 70 - 75 - 80 - 85 - 90 & 15 19 24 29 34 39 44 49 54 59 64 69 74 79 84 89 0ver Age Range

Figure 2.2: Estimated Population for Helensburgh and Lomond 2002-2005

19 25

20

15 Helensburgh & Lomond Argyll & Bute NHS Highland 10 Percentage of population 5

0 00-14 15-29 30-44 45-59 60-74 75+ Age Group

Figure 2.3: Percentage of Population by Broad Age Group

Changing age structure of the Argyll & Bute population 1984-2024

1984 1994 2004 2014 2024 00-14 18610 16990 15203 12424 13342 15-29 20983 17510 13431 16894 13517 30-44 17667 18685 18761 15539 18999 45-59 14861 17475 20018 20134 16986 60-74 13608 13846 15824 18274 18818 75+ 6641 7402 7953 9769 13014 Total 92370 91908 91190 93034 94676

1984- 1984- 1984 1994 2004 2014 2024 2024 2014 00-14 -8.7 -10.5 -18.3 7.4 -28.3 -33.2 15-29 -16.6 -23.3 25.8 -20.0 -35.6 -19.5 30-44 5.8 0.4 -17.2 22.3 7.5 -12.0 45-59 17.6 14.6 0.6 -15.6 14.3 35.5 60-74 1.7 14.3 15.5 3.0 38.3 34.3 75+ 11.5 7.4 22.8 33.2 96.0 47.1 Total -0.5 -0.8 2.0 1.8 2.5 0.7

Table 2.1: Change in Population Numbers and in Changing Age Structure in Argyll and Bute 1984-2024

20 25000

20000

15000

10000

Number of persons 5000

0 00-14 15-29 30-44 45-59 60-74 75+ Age group

1984 1994 2004 2014 2024

Figure 2.4: Change in Population Numbers and in Changing Age Structure in Argyll and Bute 1984-2024

70

60 50

40 30

20

10 0

-10 -20

-30 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024

00-14 15-29 30-44 45-59 60-74 75+

Figure 2.5: Percentage Change in Age Groups 2004-2024

21 100,000 90,000 80,000 70,000 60,000 50,000 40,000 30,000 Population Number 20,000 10,000 0 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022 2024 Year

GRO(S) MYE GRO(S) 2004 based projection A&B Council 2004 based projection GRO(S) 2002 based projections

Figure 2.6: Population Estimates and Projections for Argyll and Bute 1982-2024

22 Helensburgh and Lomond Projected Projected Projected Projected % increase by % increase by % increase by numbers numbers numbers numbers 2010 2015 2020 2005 2010 2015 2020 65+ years 4274 4616 5283 5655 8% 23% 32% 75+ years 1931 2050 2227 2506 6% 15% 30% 85+ years 465 510 569 645 10% 22% 39%

Table 2.2: Projected Numbers and Percentage Change for Helensburgh and Lomond for Older People (Argyll and Bute Council Assumptions Based on 2001 Census and SAPEs 2002-05 Data)

23 Projected percentage changes in older age groups for Helensburgh and Lomond

55% 50% 45% 40% 35% 65 & over 30% 75 & over 25% 20% 85 & over 15% 10%

% change from2005 5% 0% 2010 2015 2020 Year

Figure 2.7: Projected Percentage Changes in Older Age Groups for Helensburgh and Lomond (Argyll and Bute Council assumptions based on 2001 Census and SAPEs 2002-2005 data)

Glasgow City Edinburgh, City of West Lo thian West Dunbartonshire East City City Argyll & Bute Highland P erth & Kinross Islands Angus Islands Eilean Siar Dumfries & Galloway Scotland

0.0% 20.0% 40.0% 60.0% 80.0% 100.0% Percentage of Total Population % Population under 65 % Population over 65

Figure 2.8: Projected Population Age Structure for Scottish Local Authorities 2024

24

1,400

1,200

1,000

800

600

Number of births of Number 400

200

0 1981-1982 1983-1984 1985-1986 1987-1988 1989-1990 1991-1992 1993-1994 1995-1996 1997-1998 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011-2012 2013-2014 2015-2016 2017-2018 2019-2020 2021-2022 2023-2024

Live Births GRO(S) Projection 2004 GRO(S) Projection 2002 A&B Council Projection Assumption

Figure 2.9: Live Births and Projected Live Births in Argyll and Bute 1981-2024

100,000

90,000 Change in numbers 80,000 2004-2024 (N= 3486)

70,000

60,000

50,000

Number 40,000 Change in numbers 30,000 2004-2024 (N= 5320)

20,000

10,000

0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

GRO(S) 2004 based population projection GRO(S) 2004 based all household projection

Figure 2.10: Predicted Rise in Population and Households 2004-2024

25 35%

30%

25%

20%

15%

10%

5%

0% 16-29 30-44 45-59 60-74 75+

2004 2024

Figure 2.11: Percentage of Households Headed by Someone in Each Age Group in Argyll and Bute 2004 and 2024

45.0%

40.0%

35.0%

30.0%

25.0%

20.0%

15.0%

10.0%

5.0%

0.0% 1 adult 1 adult, 2+ adults 2+ adults, 1+ children 1+ children

2004 2024

Figure 2.12: Household Projections by Household Type in Argyll and Bute 2004 and 2024

26 2.3

2.2

2.1

2.0

1.9

1.8

1.7 Projected household size household Projected

1.6

1.5 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024

Scotland Argyll & Bute Highland

Figure 2.13: Projected Household Size 2004-2024

27

Figure 2.14: SIMD 2006: Overall Rank Argyll and Bute Datazones by Decile

28

Figure 2.15: SIMD 2006: Overall Deprivation (Helensburgh, Rhu and Shandon area)

29

Figure 2.16: Population Sparsity by Census Area (Census 2001)

30

Figure 2.17: Scottish Executive Urban Rural Classification 2005-2006

31

Figure 2.18: SIMD 2006: Geographic Access Domain: Argyll and Bute Datazones by Decile

32

Figure 2.19: SIMD 2006: Health Domain (Helensburgh, Rhu and Shandon area)

33 Households experiencing fuel poverty Scotland by Council areas, 2002

Difficulty heating Achieved home Heating system sample size per local No Yes Full CH Partial CH Heaters/fires/other Area authority No. % No. % No. % No. % No. % Scotland 15,168 1,522,000 69% 670,000 31% 1,901,000 87% 169,000 8% 117,000 5%

Argyll and Clyde ------Argyll and Bute 400 26,000 65% 14,000 35% 33,000 83% 5000 12% <20 5% West Dunbartonshire (A&C part) ------West Dunbartonshire (whole council) 416 32,000 76% 10,000 24% 37,000 88% 4000 10% <20 3% Source: Communities Scotland Scottish House Condition Survey 2002 - Fuel Poverty In Scotland

Table 2.3: Fuel Poverty

34

Households experiencing fuel poverty Scotland by Council areas, 2002

Achieved Fuel poverty - 2002 definition sample size per Not fuel poor Fuel poor Unobtainable local Area authority No. % No. % No. % Scotland 15,168 1,851,000 84% 286,000 13% 56,000 3%

Argyll and Clyde ------Argyll and Bute 400 31,000 77% 8000 21% <20 2% West Dunbartonshire (A&C part) ------West Dunbartonshire (whole council) 416 38,000 90% 3000 8% <20 2% Source: Communities Scotland Scottish House Condition Survey 2002 - Fuel Poverty In Scotland

Table 2.3a: Fuel Poverty

35 Neighbourhood and social characteristics Scotland and five council areas, 2-year period 2001-2002

Rating of neighbourhood Whether given up as a place to Noisy neighbours/ Vandalism/graffiti/ time for charity/local live loud parties damage to property groups (very (very (very Base good/fairly common/fairly common/fairly in past 12 months Area sample good) common) common) (yes)

Scotland 28,685 92% 8% 19% 26%

Argyll and Clyde - - - - -

Argyll and Bute 548 94% 5% 13% 28% East Renfrewshire (A&C part) - - - - -

Renfrewshire 899 90% 8% 19% 17% West Dunbartonshire (A&C part) - - - - -

Inverclyde 499 89% 8% 20% 21%

East Renfrewshire (whole council) 506 97% 6% 12% 27%

West Dunbartonshire (whole council) 499 88% 10% 28% 24%

Source: Scottish Executive website Scotland's People Volume 7: Results from the 2001-2002 Scottish Household Survey.

Table 2.4: Neighbourhood and Social Characteristics

36 Rates per 100,000 population of domestic abuse incidents recorded by the police, by selected Council area and financial year, 1999-00 to 2005-06

1999-00 2000-01 2001-02 2002-03 2003-04 2004-05 2005-06

Argyll & Bute 520 354 367 571 469 479 514

East Dunbartonshire 255 349 343 234 391 364 450

East Renfrewshire 197 190 219 283 345 369 450

Glasgow City 1,024 1,033 1,106 1,097 1,284 1,316 1,446

Highland 243 799 754 673 702 639 632

Inverclyde 663 626 543 666 926 924 1,001

Renfrewshire 516 571 641 647 930 896 881

West Dunbartonshire 790 838 852 883 1,305 1,382 1,292

SCOTLAND 648 687 696 710 815 859 899

Source: Scottish Executive web site. Accessed at http://www.scotland.gov.uk/Publications/2007/01/19160856/29

Table 2.5: Rates of Domestic Abuse

37 Crime recorded by the police, by type of crime committed in Scotland by Council areas, 2002

Argyll West Scotland and Dunbartonshire Bute (whole council)

Crime

Index Rate Index Rate Rate Index (Scot. No. per (Scotland No. per No. per (Scot. = = 10,000 = 100) 10,000 10,000 100) 100) 2002 Non-sexual crimes of violence 16,461 33 100 202 22 67 473 51 155 Crimes of indecency 6,552 13 100 113 12 92 64 7 54 Crimes of dishonesty 235,668 465 100 1,967 215 46 4,605 493 106 Fire-raising, vandalism, etc. 95,470 189 100 908 99 52 2,324 249 132 Other crimes 72,883 144 100 996 109 76 1,583 170 118 Total crimes 427,034 843 100 4,186 458 54 9,049 970 115 Selected crime: Serious assault 6,685 13 100 93 10 77 228 24 185 Offensive weapons 9,691 19 100 94 10 54 248 27 139 Domestic housebreaking 29,534 58 100 275 30 52 767 82 141 Vandalism 89,808 177 100 868 95 54 2,142 230 129

Table 2.6: Recorded Crime by Type of Crime 2002

38

Appendix 3

Number of adult (aged 16y+) smokers in the sample

1999 2000 2001 2002 2003 2004 2005 N N N N N N N Clyde (Argyll & Clyde minus Argyll & Bute) 280 284 286 271 252 256 232 Argyll & Bute 56 74 58 73 70 65 68

NHS Argyll & Clyde (former) 337 357 344 345 322 322 300

Highland (former) 156 130 157 139 145 159 117

Highland 212 203 215 212 215 224 185

Percentage of adult (aged 16y+) smokers

1999 2000 2001 2002 2003 2004 2005 % % % % % % % Clyde (Argyll & Clyde minus Argyll & Bute) 31.0 29.2 28.9 29.5 28.4 26.3 25.4 Argyll & Bute 23.4 28.7 22.5 29.8 28.1 24.9 27.4

NHS Argyll & Clyde (former) 29.4 29.1 27.6 29.5 28.3 26.0 25.8

Highland (former) 27.9 22.0 26.6 24.4 25.5 26.4 20.4

Highland 26.5 24.1 25.3 26.0 26.3 25.9 22.5

Planned levels for smoking 2005-2010

2005 2006 2007 2008 2009 2010 % % % % % % Clyde (Argyll & Clyde minus Argyll & Bute) 25.5 24.7 23.9 23.2 22.5 21.8 Argyll & Bute 24.1 23.4 22.7 22.0 21.3 20.6

NHS Argyll & Clyde (former) 25.2 24.4 23.7 22.9 22.2 21.5

Highland (former) 25.6 24.8 24.0 23.3 22.6 21.9

Highland 25.1 24.3 23.6 22.9 22.2 21.5 Source: Scottish Household Survey; ASD Health

Table 3.1: Percentage of Current and Planned Smoking in Adults Aged 16+ Years 1999-2005

39 Opiod and Prevalence of Drug service Methadone Alcohol related Drunk driving benzodiazepine opiod and new patients in maintenance discharges in offences in users benzodiazepine 2006 patients 2004-05 2004 per use 10,000 population Argyll and Bute 609 1.35% 168 137 850 30 West 1185 2.2% 404 270 542 21 Dunbartonshire (North) Scotland 22

Table 3.2: Alcohol and Drug Statistics

40 Body Mass Index >25 (overweight, including obese)

2003 1998 1995 2003 Bases % % % N Argyll & Clyde (former) 66.0 62.3 53.9 379

Highland (former) 67.0 61.1 * 610

Clyde 67.5 61.0 * 308

Highland 66.2 62.1 * 681

Scotland 65.4 61.0 55.6 6,700

Body Mass Index >30 (obese)

2003 1998.0 1995 2003 Bases % % % N Argyll & Clyde (former) 26.6 24.3 18.0 379

Highland (former) 26.6 21.3 * 610

Clyde 26.3 23.1 * 308

Highland 26.7 22.4 * 681

Scotland 22.4 18.8 15.9 6,700

Source: Scottish Health Survey Note: * indicates that these data are not available.

Table 3.3: Overweight and Obesity 1995 – 2003

41 80

70

60

50

40

30 % breastfed

20

10

0

e ife re e gh r ay uth lin g ire r ire ian ian rgh ian hire hire sh yde s s alkirk tir shire Bute oth bur yr yrshi est F anshi F S asgow Angus inross Borders allow rton ew ewshi l dinbu Dundee K G W st Loth h A Invercl gyll & Midl est Loth ast A & & th Glasgowenfr Ea th Edin th & E orth Ayrout s Levenmokmann or R Ar rth E W N S ie ne c East Glasgow N West G o ou er a N S P mli ldy & l North Lanarksh s & Northa East FifeC East Renfr South Lanarkshire Dumfr kc East Dunba South EastSouth Glasgow WestWest Glasgow Dunbartonshire othe Dunfer Kir lenr G Source: ISD Scotland Community Health Partnership CHSP-PS February 2007

Figure 3.1: % Breastfed at 10 Days by Community Health Partnership in 2006

70

60

50

40

30 % breastfed% 20

10

0

e y fe if h e e a ir k g e w te ire an e ire r F n de ir u h i h t Fi t out hire ly shire h s ders ow sgow s sh B k r rshi r as nm Falkir a & r ot y y all E nansh Stirli lasgo l a Angus A A Bo Wes verc Dunde an Midlothian th st Gl In nfrew Lanarks r s & G e & nbartonshirea enfrew East L East Ayrshireo km u R Re Argyl N South ie lin c E North Glasgow We st G r y & Leve orth North EdinburghSouth Edinburgh Perth & Kinross rm s & North ld st D N mf e a Cla a East South Lan Du nfe E South EastSouth Glasgow WestWest Glasgow Dunbartonshire irkc Du K lenroth G Source: ISD Scotland Community Health Partnership CHSP-PS February 2007

Figure 3.2: % Breastfed at 6-8 Eeeks by Community Health Partnership

42 Appendix 4

Life Expectancy at Birth Males

76

74

72 Scotland 70 Argyll & Bute Highland 2 68

Life Expectancy in Years 66

64

5 9 3 5 3 -83 -8 -8 -9 9 -97 0 1 3 7 1 5 8 8 8 9 93- 9 -2001 01- 9 9 9 9 9 0 19 1 1985-87 1 1989-91 1 1 19 1997-99 2 2003-05 199 Years

Figure 4.1: Life Expectancy at Birth – Males (Highland 2 = Highland Council)

Life Expectancy at Birth Females

82

80

78 Scotland Argyll & Bute 76 Highland 2

Life Expectancy in Years 74

72

3 5 7 1 -8 -9 1-8 3 5-8 7-89 9 1-93 3-95 7-99 001 8 8 8 8 9 9 9 2 98 19 1 19 19 19 19 19 1995-97 19 2001-03 2003-05 1999- Years

Figure 4.2: Life Expectancy at Birth – Females (Highland 2 = Highland Council)

43 Source: Your Self-reported health and limiting long-term illness/health problem/disability Health and Wellbeing survey Scotland, Argyll and Clyde and its five Council areas, by age band, 2001 2001 (16+ years)

Source: 2001 Census - all people in households Good or fairly good health AND no Not good health limiting long-term AND limiting long- Limiting long-term illness term illness illness Not good health Poor health

Area Age band Population Number % Number % Number % Number % No. % Scotland All ages 4,976,005 3,938,723 79% 433,377 9% 978,376 20% 492,283 10% - - 0 - 15 968,539 919,818 95% 8,494 1% 44,998 5% 12,217 1% - - 16 - 64 3,242,288 2,667,206 82% 262,634 8% 528,179 16% 309,537 10% - - 65 - 84 696,205 334,405 48% 141,834 20% 354,205 51% 149,429 21% - - 85+ 68,973 17,294 25% 20,415 30% 50,994 74% 21,100 31% - - Argyll and Bute All ages 87,403 69,433 79% 6,680 8% 17,081 20% 7,569 9% 148 13% 0 - 15 16,957 16,229 96% 127 1% 683 4% 172 1% - - 16 - 64 54,519 45,257 83% 3,858 7% 8,571 16% 4,549 8% 65 - 84 14,294 7,517 53% 2,278 16% 6,631 46% 2,424 17% 85+ 1,633 430 26% 417 26% 1,196 73% 424 26% West Dunbartonshire (A&C part) All ages 47,088 36,536 78% 4,742 10% 9,868 21% 5,426 12% 85 17% 0 - 15 9,450 8,911 94% 91 1% 486 5% 144 2% - - 16 - 64 30,992 24,750 80% 3,070 10% 5,697 18% 3,615 12% 65 - 84 6,117 2,763 45% 1,419 23% 3,271 53% 1,502 25% 85+ 529 112 21% 162 31% 414 78% 165 31% All ages 92,625 70,799 76% 9,917 11% 20,522 22% 11,221 12% - - 0 - 15 18,598 17,484 94% 230 1% 1,008 5% 336 2% - - West Dunbartonshire (whole council) 16 - 64 59,911 47,416 79% 6,210 10% 11,472 19% 7,233 12% - - 65 - 84 12,974 5,640 43% 3,124 24% 7,169 55% 3,289 25% - - 85+ 1,142 259 23% 353 31% 873 76% 363 32% - - Table 4.1: Self-reported Health and Limiting Long-term Illness

44

Other Causes 15% Diseases of the Digestive System 5% Cancer 24% External Causes 5%

Other Circulatory Diseases* 6% Stroke Coronary Heart 12% Disease 20% Diseases of the Respiratory System 13%

Figure 4.3: Primary Cause of Death in Helensburgh and Lomond

45

SMR (Scotland =100) 0 20 40 60 80 100 120 140 160 180

Diseases of the 245 Respiratory System 124

141 External Causes 50

Diseases of the 111 Digestive System 57

269 CV D/Stroke 127

Coronary Heart 419 Disease 237

632 Cancer 284

Acute Myocardial 214 Inf arc tion 151

2336 AllCauses 1120

Argyll & Bute Highland Scotland = 100

Average annual number of deaths by cause are shown in bar series base

Figure 4.4: Standardised Mortality Ratios for Selected Cause of Death 2002-2005 (age and sex standardised to Scotland population GROS MYE 2003-2005 for administrative areas)

46 1,2 Stroke (both se x e s)

35

30

25

20 Argyll & Bute Highland 3 15 Scotland population 10

5 Standardised rate per 100,000 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year

Figure 4.5: Stroke Trends in Mortality 1996-2005 (age standardised mortality rates by year of death registration aged < 75 years) (Highland 3 = Highland Council)

2,4 CHD (both sexes)

140

120

100

80 Argyll & Bute Highland 3 60 Scotland population 40

20 Standardised rate per 100,000 0 1996 1998 2000 2002 2004 Year

Figure 4.6: Coronary Heart Disease (CHD) Trends in Mortality 1996-2005 (age standardised mortality rates by year of death registration aged < 75 years) (Highland 3 = Highland Council)

47 Cancer - Male 5,6

250

200

150 Argyll & Bute Highland 3 100 Scotland population

50 Standardised rate per 100,000 0 1996 1998 2000 2002 2004 Year

Figure 4.7: Cancer (Males) Trends in Mortality 1996-2005 (age standardised mortality rates by year of death registration aged < 75 years) (Highland 3 = Highland Council)

Cancer - Female 5,6

160 140 120

100 Argyll & Bute 80 Highland 3 Scotland

population 60 40 20 Standardised rate per 100,000 0 1996 1998 2000 2002 2004 Year

Figure 4.8: Cancer (Females) Trends in Mortality 1996-2005 (age standardised mortality rates by year of death registration aged < 75 years) (Highland 3 = Highland Council)

48

Figure 4.9: Longstanding Illnesses by Age (both sexes, Scottish Health Survey 1998)

Chronic conditions %hospitalised pa Average doctor Average drugs per person visits pa prescribed pa

0 3.4% 1.7 2.2

1 7.6% 4.6 11.0

3+ 17.3% 9.4 28.3

Multiplier x5 x5 x3

Table 4.2: Effect of Multiple Co-morbidity on Health Care Use

49

Source: ISD Scotland

Figure 4.10: Bed Days by Emergency Inpatients by Broad Age Group 1981 to 2002

50 Appendix 5

T o ta l A d m itte d P a tie n t C a re A c tiv ity b y L o c a lity & Y e a r

8,000

6,000 2003-04 4,000 2004-05 2005-06 2,000

- Oban Lorn & the Helensburgh & M id Argyll, Islay & Cowal & Bute Is le s Lom ond Kintyre 2003-04 5,535 6,959 6,814 6,083 2004-05 6,047 6,896 6,870 5,971 2005-06 5,942 7,051 7,019 6,071

Figure 5.1: Total Inpatient Care by Locality and Year

Total New Outpatient Attendance by Locality

10,000 9,000 8,000 7,000 6,000 2003-04 5,000 2004-05 4,000 2005-06 3,000 2,000 1,000 0 Oban Lorn & the Cowal & Bute Helensburgh & Mid Argyll, Islay & Isles Lomond Kintyre

Figure 5.2: Total New Outpatient Attendance by Locality and Year

NHS GG&C Admitted Patient Care Activity by Locality & Year

8,000

6,000 2003-04 4,000 2004-05 2005-06 2,000

- Oban Lorn & the Helensburgh & M id Argyll, Islay Cowal & Bute Is le s Lom ond & Kintyre 2003-04 1,963 4,503 6,577 3,005 2004-05 1,945 4,558 6,646 2,938 2005-06 1,949 4,969 6,846 2,893

Figure 5.3: Total Inpatient Care Admitted NHS Greater Glasgow and Clyde Hospitals by Locality and Year

51 NHS GG&C New Outpatient Attendances by Locality

5000 4500 4000 3500 3000 2003-04 2500 2004-05 2000 2005-06 1500 1000 500 0 Oban Lorn & the Cowal & Bute Helensburgh & M id Argyll, Islay & Is le s Lom ond Kintyre

Figure 5.4: Total New Outpatient Attendances Seen by NHS Greater Glasgow and Clyde by Locality and Year

Helensburgh / Lomond Locality Inpatient and daycase episodes by year of discharge for the specialty of Trauma & Orthopaedics

600

500

400

300

200

Number of episodes 100

0 Glasgow Royal Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total Infirmary National Hospital Hospital General Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.5: Trauma and Orthopaedic Inpatient and Daycase Episodes by Year and Hospital

52 Helensburgh / Lomond Locality Daycase episodes by year of discharge for the specialty of Ear, Nose & Throat (ENT)

40 35 30 25 20 15 10

Number of episodes of Number 5 0 Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total National Hospital Hospital General Hospital Infirmary/Gartnavel Ge ne r a l Hospital 2003-04 2004-05 2005-06

Figure 5.6: ENT Daycase Episodes by Year and Hospital

Helensburgh / Lomond Locality Elective inpatient episodes by year of discharge for the specialty of Ear, Nose & Throat (ENT)

120

100

80

60

40

Number of episodes of Number 20

0 Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total National Hospital Hospital General Hospital Infirmary/Gartnavel Ge ne r a l Hospital 2003-04 2004-05 2005-06

Figure 5.7: ENT Elective Inpatient Episodes by Year and Hospital

53 Helensburgh / Lomond Locality Emergency inpatient episodes by year of discharge for the specialty of Ear, Nose & Throat (ENT)

45 40 35 30 25 20 15 10 Number of episodes 5 0 Royal Alexandra Hospital Western Infirmary/Gartnavel Other Grand Total Ge ne r a l Hospital 2003-04 2004-05 2005-06

Figure 5.8: ENT Emergency Episodes by Year and Hospital

Helensburgh / Lomond Locality Daycase episodes by year of discharge for the specialty of General Surgery

600

500

400

300

200

Number of episodes of Number 100

0 Glasgow Royal Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total Infirmary National Hospital Hospital General Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.9: General Surgery Daycase Episodes by Year and Hospital

54 Helensburgh / Lomond Locality Elective inpatient episodes by year of discharge for the specialty of General Surgery

400 350 300 250 200 150 100 Number of episodes 50 0 Glasgow Royal Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total Infirmary National Hospital Hospital General Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.10: General Surgery Elective Inpatient Episodes by Year and Hospital

Helensburgh / Lomond Locality Emergency inpatient episodes by year of discharge for the specialty of General Surgery

400 350 300 250 200 150 100 Number of episodes of Number 50 0 Glasgow Royal Royal Alexandra Vale of Leven General Western Other Grand Total Infirmary Hospital Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.11: General Surgery Emergency Inpatient Episodes by Year and Hospital

55 Helensburgh / Lomond Locality Inpatient and daycase episodes by year of discharge for the specialty of Accident & Emergency 45 40 35 30 25 20 15

Number of episodes 10 5 0 Glasgow Royal Infirmary Royal Alexandra Hospital Other Grand Total Hospital 2003-04 2004-05 2005-06

Figure 5.12: Accident and Emergency Inpatient and Daycase Episodes by Year and Hospital

Helensburgh / Lomond Locality Daycase episodes by year of discharge for the specialty of General Medicine

250

200

150

100

Number of episodes of Number 50

0 Glasgow Royal Golden Jubilee Royal Alexandra Vale of Leven Western Other Grand Total Infirmary National Hospital Hospital General Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.13: General Medicine Daycase Episodes by Year and Hospital

56 Helensburgh / Lomond Locality Elective inpatient episodes by year of discharge for the specialty of General Medicine

200 180 160 140 120 100 80 60

Number of episodes 40 20 0 Glasgow Royal Royal Alexandra Vale of Leven General Western Other Grand Total Infirmary Hospital Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.14: General Medicine Elective Inpatient Episodes by Year and Hospital

Helensburgh / Lomond Locality Emergency inpatient episodes by year of discharge for the specialty of General Medicine

1200

1000

800

600

400

Number of episodes of Number 200

0 Glasgow Royal Royal Alexandra Vale of Leven General Western Other Grand Total Infirmary Hospital Hospital Infirmary/Gartnavel General Hospital 2003-04 2004-05 2005-06

Figure 5.15: General Medicine Emergency Inpatient Episodes by Year and Hospital

57 Helensburgh / Lomond Locality Elective inpatient episodes by year of discharge for the specialty of Geriatric Medicine

250

200

150

100

Number of episodes of Number 50

0 Royal Alexandra Hospital Vale of Leven General Western Infirmary/Gartnavel Other Grand Total Hospital General Hospital 2003-04 2004-05 2005-06

Figure 5.16: Geriatric Medicine Elective Inpatient Episodes by Year and Hospital

Helensburgh / Lomond Locality Emergency inpatient episodes by year of discharge for the specialty of Geriatric Medicine

35

30

25

20

15

10 Number of episodes of Number 5

0 Royal Alexandra Hospital Vale of Leven General Western Infirmary/Gartnavel Other Grand Total Hospital General Hospital 2003-04 2004-05 2005-06

Figure 5.17: Geriatric Medicine Emergency Inpatient Episodes by Year and Hospital

58

Helensburgh / Lomond Locality New & return outpatient attendances by year of clinic for the specialty of Dermatology

900 800 700 600 500 400 300 200

No. ofNo. patients attending 100 0 Glasgow Royal Royal Alexandra Vale of Leven Western Other Grand Total Infirmary Hospital General Hospital Infirmary/Gartnavel Ge ne r a l Clinic 2005-06

Figure 5.18: Dermatology Outpatient Attendances by Hospital 2005-2006

Helensburgh / Lomond Locality Inpatient and daycase episodes by year of discharge for the specialty of Cardiology

120

100

80

60

40

Number of episodes of Number 20

0 Glasgow Royal Golden Jubilee Western Other Grand Total Infirmary National Hospital Infirmary/Gartnavel General

Hospital 2003-04 2004-05 2005-06

Figure 5.19: Cardiology Inpatient and Daycase Episodes by Year and Hospital

59 Helensburgh / Lomond Locality Inpatient and daycase episodes by year of discharge for the specialty of General Psychiatry (Mental Illness)

120

100

80

60

40

Number of episodes 20

0 Royal Alexandra Hospital Vale of Leven General Other Grand Total Hospital Hospital 2003-04 2004-05 2005-06

Figure 5.20: General Psychiatry Inpatient and Daycase Episodes by Year and Hospital

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Appendix 6

Glasgow Royal Royal Alexandra, Southern Infirmary Paisley General The Vale of Leven Gartnavel G4 0SF PA2 9PN G51 4TF G83 0UA G12 0XH Time Distance Time Distance Time Distance Time Distance Time Distance (minutes) (miles) (minutes) (miles) (minutes) (miles) (minutes) (miles) (minutes) (miles) Helensburgh 43 29.6 36 21.8 39 24.9 19 8.4 39 20.4 Inverarnan 66 51.8 60 44 62 47.1 39 27.9 62 42.6 Kilcreggan 81 45.5 75 37.7 77 40.8 59 24.8 77 36.3 Arrochar 56 43.1 49 35.2 51 38.4 28 19.2 51 33.9 91 64.5 84 56.7 86 59.8 64 40.6 87 55.3 Source AA Route Planner

Table 6.1: Time and Distance to Travel to NHS Greater Glasgow and Clyde Hospitals from Different Points in Helensburgh and Lomond

61

100 90 80 Helensburgh 70 60 Inverarnan 50 Kilcreggan 40 30 Arrochar 20 Inveraray 10 0

Time Time Time Time Time (miles) (miles) (miles) (miles) (miles) Distance Distance Distance Distance Distance (minutes) (minutes) (minutes) (minutes) (minutes) G4 0SF PA2 9PN G51 4TF G83 0UA G12 0XH Glasgow Royal Royal Alexandra, Southern General The Vale of Gartnavel Infirmary Paisley Leven

Source: AA Route Planner

Figure 6.1: Time and Distance to Travel to NHS Greater Glasgow and Clyde Hospitals from Different Points in Helensburgh and Lomond

62 Appendix 7

Output from Health Needs Assessment Roadshows – Comments from Members of the Public

1. Transport

Public transport to healthcare Is there any? Public transport in this village (Arrochar/Tarbet) is extremely difficult as the villages are all spread out

Only drivers can access Paisley easily, public transport takes up a whole day

Difficult to get to OPD at Vale of Leven if you don’t have a car.

Road signs needed to get home from the RAH. If you don’t know the way – you can’t remember the road back .

Emergency transport to RAH – very little/non – existent.

No evening services from Kilcreggan/Cove to Helensburgh.

Would be good if there was a cycle path between Cardross and Helensburgh

Transport to RAH unsuitable for Helensburgh and peninsula

Time to get there especially at busy times.

Transport – public not joined up

Evening ferry service to IRH.

Previously experienced problem of going in ambulance with relative to the RAH in the middle of the night + left with no means transport to get back to Garelochhead. Elderly friends didn’t feel they would be up to driving at that time.

Transport to OP particularly where people lack stamina – frail people.

New ferry from Kilcreggan – – Helensburgh is not properly accessible for anyone with mobility issues. No handrail, not allowed to sit on upper deck, etc.

People abusing surgery transport to access RAH.

63 2. Access

Local out-patients clinics Local palliative care with respite for patients and carers

Services at Vict Hospital – increase Local primary Health Services E.G. minor surgery

Provision of efficient Accident and Emergency Services – locally

Re transport provision – wrong question is being asked. NOT how to get patients/visitors to distant hospitals, BUT why not provide health services nearer to the patients?

Surely there should be A+E facilities nearer to Helensburgh.

Concerned about the fact there is no Accident +Emergency at Vale of Leven. Royal Alex. at Paisley is too far even for visiting with your own car. Where does it leave people who cannot drive? Constant hold-ups on A82 add to the concern. RAH very good orthopaedics!! Pleased with services offered at V.O.L. ie geriatric and ear nose and throat. Keep it open and improve A+E PLEASE.

Please do not close the Vale of Leven Hospital – Very essential for all ages in this area. Please spare a thought for those who cannot get a doctor on call in the Garelochhead and peninsula area.

Current hospital services and accessibility are barely adequate. We need improvement and expansion not reduction in local services.

The RAH is too far away for patients of any description and is too difficult to access for emergency services and elderly patients. A joint option required

Accident and emergency facilities needed locally. Time much too long transferring to Paisley and getting admitted.

Will I still be able to go to the Vale of Leven Hospital for assessment + tests/treatment

Issues driving to work at VOLH because of peace campers blockades

Glasgow is much easier to get to than Paisley

Local A+E services at all times. Keep clinical services in local area.

Inconvenience of travelling to RAH without car

Fast access to Accident + Emergency Services is very necessary especially for older people who can have transport problems. The Vo L Hospital is also absolutely essential not for just existing but for upgrading.

No dermatology now at OPD Victoria Why?

64

No drop off point at Paisley Hospital for picking up patients

Please keep V of Leven Hosp. open. Gartnaval and Jubilee are next for Argyll and Bute. Consider travel to RAH

Sick and elderly people do not travel well. Local treatment is essential.

3. Mental Health/Elderly

Re Mental Health Please let us have skilled support services for community care for patients with mental health issues

Mental Health Care. Totally inadequate! 2 patients in Leverndale at present awaiting places in Vale psychiatric ward. Care of the elderly how can we change that? I could go on and on.

Counselling services instead of anti depressants.

In view of the projected increase in the number of elderly people in the community why has the Jeannie Deans unit been closed

Issues for elderly population

4. Quality of Care/Facilities

Where to start? Vale of Leven looks desparately unloved and uncared for from the exterior to interior decoration to broken fitments etc. Take the main lobby display about investment and improvements – last updated APRIL 2004. What message does that give.

RAH very good orthopaedics!! Pleased with services offered at V.O.L. ie geriatric and ear nose and throat. Keep it open and improve A+E PLEASE.

Ambulance service is wonderful

The communications by the hospitals between each other when complicated medical procedures are required are excellent - only parking and travel to RAH are difficult.

Ambulance services!

RAH – dirty wards.

Immediate care of relatives and discharged patients in the middle of the night.

65 5. Choice

The Vale of Leven must be retained at all costs as it has been underinvested for several years. Paisley does not offer a viable alternative to a local facility

Please keep the Vale of Leven Hospital. Talk of choice? This is mine!

6. Miscellaneous

Thank you for this information – well presented and cohesive.

Funding from Scottish Executive should better plan for quality workforce to support voluntary sector projects tackling health needs in the area.

Essential to bring areas of deprivation up, not just pour services in.

7. Carers Issues

Please more support for carers of patients with mental health illness.

66