Cardiff South, East & City Locality Needs Assessment 2015-2025

Overview of health and wellbeing needs for Cardiff South, East & City 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 ditto Incorporating feedback – info on students, added 2015 overall summary, info from GP cluster plans

Contents

Summary of health and wellbeing needs in Cardiff South, East and City ...... 2 Needs highlighted in Cardiff South, East and City GP cluster plans ...... 4 1. Population size and composition...... 5 (i) Population size, structure and projected change ...... 5 (ii) Birth and in-migration rates ...... 8 (iii) Ethnicity and languages spoken ...... 10 2. Risk factors for disease ...... 12 (i) Self-reported behaviours and USOA maps for reference ...... 12 (ii) Specific risk factors ...... 13 3. Equity, inequalities and wider determinants of health ...... 17 (i) Health equity and inequalities ...... 17 (ii) Deprivation and wider determinants of health...... 20 (iii) Community assets ...... 21 4. Ill health and service use in Cardiff ...... 22 (i) Self-reported ill health ...... 22 (ii) Burden of disease across GP clusters ...... 23 (iii) Service use ...... 23 (iv) Change in disease profile...... 26 (v) Cancer incidence ...... 30 5. Working in partnership with our local residents ...... 32

Summary of health and wellbeing needs in Cardiff South, East and City

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

Population size and composition

 The population of Cardiff is growing rapidly in size, projected to increase by 13% between 2015-25, significantly higher than the average growth across Wales and the rest of the UK. An extra 46,000 people will live in and require access to health and wellbeing services  The Cardiff population is relatively young compared with the rest of Wales, with the proportion of infants (0-4 yrs) and young working age population (20-39yrs) significantly higher than the Wales average. This reflects in part a significant number of students who study in Cardiff  There will be significant increases in particular in people aged 5-16 and the over 65s  The population of South Cardiff is ethnically very diverse, particularly compared with much of the rest of Wales, with a wide range of cultural backgrounds and languages spoken. Arabic, Polish, Chinese and Bengali are the four most common languages spoken after English and Welsh. Cardiff is an initial accommodation and dispersal centre for asylum seekers

Risk factors for disease

 Unhealthy behaviours which increase the risk of disease are endemic among adults in Cardiff o Nearly half (44%) drink above alcohol guidelines o Nearly two thirds (66%) don’t eat sufficient fruit and vegetables o Over half (55%) are overweight or obese o Around three quarters (74%) don’t get enough physical activity o Just over one in five (21%) smoke  There is considerable variation in rates of unhealthy behaviours in Cardiff o Smoking rates vary between 14% and 33% across Cardiff  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

 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  There are also significant inequalities in the ‘wider determinants’ of health, such as housing, household income and education o For example, the percentage of people living without central heating varies by area in Cardiff and Vale from one in a hundred (1%) to one in eight (13%)  There are inequalities in how and when people access healthcare o Immunisation uptake varies considerably, with uptake of infant vaccines ranging from 89% to 98% across Cardiff and Vale  In addition to health needs, each community has ‘assets’, such as social capital, community groups or community buildings

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 Cardiff South, East and City GP cluster plans

The 2015/16 GP cluster plans in Cardiff South, East and City, 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 Reduce unhealthy behaviours in population including improving levels of smoking quit rates, and improving access to obesity services o Reduce teenage pregnancy rates o Increase uptake of childhood immunisations and seasonal flu vaccine o Drug dealing and misuse is an issue in the area o Improve uptake of bowel and cervical screening  Ensure the sustainability of GP services o Improve access to GP services o Ensure sufficient access to services in light of new housing developments  Planned care o Ensure adequate provision and choice of contraceptive options o Improve communication and management for people with diabetes o Improve access to sexual health screening and contraception o Ensure adequate access to care in nursing homes o Improve understanding of dementia needs in area o Improve access to trauma, urology, neurology and gastroenterology o Improve access to diabetes, heart failure specialist advice, pulmonary rehabilitation o Improve diagnosis of hypertension and skin lesions  End of life care o Variation in approach to end of life care – need for improved consistency  Cancer o Improve early diagnosis of cancer  Locality issues o Varied access to multilingual communication available o Reduce inequalities in health, including smoking, alcohol, obesity, heart disease, diabetes and COPD

1. Population size and composition

Key points

(i) Population size, structure and projected change

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

Year Additional people Area Age group 2015 2018 2020 2025 2015-25 Cardiff 0-4 24,013 24,800 25,180 26,017 2,004 5-16 46,269 49,439 52,142 57,210 10,941 17-64 242,384 249,072 253,036 263,948 21,564 65-84 42,250 44,500 46,164 51,450 9,200 >84 7,427 7,928 8,326 9,495 2,068 All 362,343 375,739 384,848 408,120 45,777

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

Projection year

Age group 2018 2020 2025

0-4 3.3% 4.9% 8.3% 5-16 6.9% 12.7% 23.6% 17-64 2.8% 4.4% 8.9% 65-84 5.3% 9.3% 21.8% >84 6.7% 12.1% 27.8% All 3.7% 6.2% 12.6%

The Cardiff population is relatively young compared with the rest of Wales, with the proportion of infants (0-4 yrs) and young working age population (20-39yrs) significantly higher than the Wales average. A large student population of around 60,000 contributes to this. Cardiff also has a remand prison with around 800 male inmates, slightly above the average UK prison size.

The population of Cardiff is projected to increase in all age groups, with the highest increase seen in the 5- 16 (23.6% increase over 10 years) and 65-84 and over 84s (21.8% and 27.8% increase over 10 years respectively). This is in contrast to the national Wales projections which predict contraction among 0-4 year olds and 17-64 year olds, and lower growth for children aged 5-16. The overall increase in the 5

population is over three times the overall Wales increase, at 12.6% for Cardiff 2015-2025 compared with 4.1% for Wales as a whole.

The projected 10 year growth in the Cardiff population (12.6%) is higher than the England average (7.0%) and that of the nine regions within England, including London as a whole (11.9%) and the South East (7.7%). The likely reasons for this are discussed below.

On the assumption that the health needs of the additional people projected to reside in Cardiff in the future due to population growth are similar to those of the existing population, this would translate into a 1.2% year-on-year growth in service demand in Cardiff (3.7% over 3 years), considerably higher for services for some age groups (e.g. 6.9% growth for 5-16 year olds, and 6.7% for over 84 year olds, both over 3 years).

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

Wales Males Cardiff Males Wales Females Cardiff 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, Cardiff compared with Wales using ONS Midyear population estimates, 2014 (Public Health Wales, 2015)

Proportion of population by age and sex, Cardiff and Count of population by age and sex, Cardiff and Wales, Wales, 2014 2014 Cardiff Wales Cardiff Wales Age group % Males % Females % Males % Females Age group Males Females Males Females 00-04 3.4 3.1 2.9 2.8 00-04 11,947 11,077 91,079 86,596 05-09 2.9 2.9 2.9 2.8 05-09 10,435 10,383 90,296 86,028 10-14 2.6 2.4 2.7 2.6 10-14 9,100 8,601 84,933 80,158 15-19 3.3 3.4 3.1 3.0 15-19 11,587 11,958 97,095 91,352 20-24 5.7 6.0 3.6 3.4 20-24 20,116 21,213 112,027 105,551 25-29 4.4 4.1 3.2 3.1 25-29 15,547 14,484 97,544 94,557 30-34 3.9 3.7 2.9 2.9 30-34 13,821 13,258 90,870 91,202 35-39 3.2 3.1 2.7 2.7 35-39 11,268 11,108 83,293 84,454 40-44 3.1 3.0 3.1 3.2 40-44 10,951 10,585 96,215 100,341 45-49 3.0 3.2 3.4 3.6 45-49 10,652 11,164 106,600 111,213 50-54 2.9 3.1 3.4 3.6 50-54 10,390 11,015 105,862 109,796 55-59 2.6 2.6 3.0 3.2 55-59 9,207 9,292 94,304 98,390 60-64 2.3 2.3 3.0 3.1 60-64 8,080 8,266 91,683 95,850 65-69 2.0 2.1 3.1 3.2 65-69 7,110 7,463 94,316 98,517 70-74 1.4 1.6 2.3 2.4 70-74 4,923 5,762 70,022 75,593 75-79 1.1 1.5 1.7 2.0 75-79 3,947 5,292 53,177 61,432 80-84 0.8 1.2 1.1 1.5 80-84 2,845 4,312 35,321 47,503 85-89 0.4 0.8 0.6 1.0 85-89 1,594 2,874 18,707 31,334 90+ 0.2 0.5 0.3 0.7 90+ 758 1,909 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, Cardiff 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% 6.6% 5.4% 6.4% 5-16 13.2% 12.8% 13.7% 14.0% 17-64 60.8% 66.9% 58.3% 64.7% 65-84 17.5% 11.7% 19.1% 12.6% >85 2.6% 2.0% 3.5% 2.3%

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 Cardiff local authority area is almost entirely an urban one with a high population density. Based on draft local development plans (LDP), for Cardiff the predicted housing growth is 41,100 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 43,071 people identified themselves as full-time students in Cardiff, 37,043 of whom were aged 16-24. A higher proportion of 16-24 year old students (70%) considered themselves in ‘very good health’ compared with the general population of 16-24 year olds (66%).

(ii) Birth and in-migration rates

The significant increase in the size of the population in Cardiff is driven principally by a birth rate which exceeds the death rate, contributing to around 0.6% growth each year, and net in-migration, which contributes around 0.3% growth annually. In-migration rates have over recent years declined slightly in Cardiff.

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

Annual figure (rolling 3 year average) Net Net migration Natural Natural Year migration % Births change* change* % 2006 2437 0.8% 3865 1070 0.3% 2007 2375 0.7% 4074 1324 0.4% 2008 2334 0.7% 4315 1595 0.5% 2009 2877 0.9% 4473 1753 0.5% 2010 2529 0.8% 4579 1873 0.6% 2011 2224 0.7% 4677 1993 0.6% 2012 1512 0.4% 4753 2100 0.6% 2013 1399 0.4% 4742 2037 0.6% 8

2014 971 0.3% 4671 1979 0.6% * natural change = births-deaths

Cardiff is a both an initial accommodation centre and dispersal centre for UK asylum seekers. In this capacity, around 100-180 individuals seeking asylum in the UK enter Cardiff each month, and around 6 in 10 of those dispersed in the South West and Wales area live in Cardiff. The number of new asylum seekers is expected to grow between 8-15% per annum. There are thought to be around 900 asylum seekers living in Cardiff at any one time. Many asylum seekers have complex health and social care needs. Pregnant women, unaccompanied children, those with significant mental health problems, and those who have experienced traumatic events such as rape or torture, are likely to be particularly vulnerable.

Asylum seekers are located across Cardiff but historically more in the ‘southern arc’.

Figure 3. Geographical spread of asylum seeker households in Cardiff (Courtesy of CRC, 2014)

(iii) Ethnicity and languages spoken

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

Cardiff Wales

Ethnicity Persons % Persons %

All 346,090 100.0% 3,063,456 100.0% White British 277,798 80.3% 2,855,450 93.2% White Other 12,248 3.5% 55,932 1.8% Indian 7,886 2.3% 17,256 0.6% Pakistani 6,354 1.8% 12,229 0.4% Black African 5,213 1.5% 11,887 0.4% Bangladeshi 4,838 1.4% 10,687 0.3% Arab 4,707 1.4% 9,615 0.3% Asian Other 4,639 1.3% 16,318 0.5% Chinese 4,168 1.2% 13,638 0.4% Mixed White/Black 3,641 1.1% 11,099 0.4% Caribbean White Irish 2,547 0.7% 14,086 0.5% Mixed White/Asian 2,459 0.7% 9,019 0.3% Mixed Other 2,189 0.6% 6,979 0.2% Other 2,152 0.6% 5,663 0.2% Mixed White/Black African 1,742 0.5% 4,424 0.1% Black Other 1,666 0.5% 2,580 0.1% Black Caribbean 1,322 0.4% 3,809 0.1% White Gypsy or Irish Traveller 521 0.2% 2,785 0.1%

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

Main language spoken Cardiff % English/Welsh 304,729 91.7% Other European (EU) 3,973 1.2% Arabic 3,561 1.1% Polish 2,650 0.8% Bengali (with Sylheti and Chatgaya) 2,431 0.7% Chinese 2,321 0.7% African language 2,048 0.6% West/Central Asian language 1,927 0.6% Other South Asian 1,640 0.5% Other East Asian 1,365 0.4% Urdu 1,214 0.4% French 766 0.2% Portuguese 682 0.2% Panjabi 643 0.2% Other European (non EU) 638 0.2% Gujurati 610 0.2% Spanish 597 0.2% Tamil 325 0.1% Other language 153 0.0%

Table 7(b). Most common non-English, non-Welsh main languages spoken in Cardiff by age group. Source: Nomis (2015) from Census 2011

3 to 15 yrs 16-64 yrs >65 yrs Arabic Other European language Other European language Bengali (with Sylheti and Chatgaya) Arabic African language Other European language Polish Bengali (with Sylheti and Chatgaya) African language Chinese Urdu Polish Bengali (with Sylheti and Chatgaya) Gujarati

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, Cardiff

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

Area

Lifestyle characteristic Cardiff Wales Smoker 21 21 Consumption of alcohol: above guidelines 44 41 Consumption of alcohol: binge drinking 26 25 Consumption of fruit and vegetables: meets guidelines 34 33 Exercise or physical activity done: meets guidelines 26 30 Overweight or obese 55 58 Obese 21 22

Table 9. Percentage of 0-15 year olds with particular lifestyle characteristics, Cardiff. 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 Cardiff 94 17 5 48 33 34 20 Wales 94 19 6 52 36 35 19

(ii) Specific risk factors

Table 10. Self-reported smoking status in Cardiff.

Adults who reported being a current smoker (age- standardised), 2008-13

Lower Upper Confidence Confidence Smoker Interval Interval Unweighted USOA % % % Base (c) W03000085 14 - 11 18 644 W03000086 19 - 15 22 564 W03000087 13 - 10 16 717 W03000088 30 + 26 34 723 W03000089 21 17 25 539 W03000090 21 17 25 541 W03000091 23 19 28 493 W03000092 33 + 29 37 715 W03000093 17 - 14 21 689 W03000094 29 + 25 32 801

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 Cardiff

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) W03000085 24 - 21 28 644 W03000086 25 22 29 564 W03000087 23 - 20 26 717 W03000088 24 - 21 28 723 W03000089 25 21 29 539 W03000090 25 - 21 29 541 W03000091 26 22 31 493 W03000092 29 25 32 715 W03000093 20 - 17 24 689 W03000094 26 23 30 801

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 Cardiff

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) W03000085 50 - 46 54 644 W03000086 54 49 58 564 W03000087 53 - 48 57 717 W03000088 62 58 66 723 W03000089 53 48 58 539 W03000090 48 - 43 53 541 W03000091 50 - 45 55 493 W03000092 59 55 63 715 W03000093 55 51 59 689 W03000094 59 55 62 801

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 22.6% of children in reception year in Cardiff 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 Cardiff South, East and City Locality the highest percentages of children who are overweight and obese live in the Grangetown, Butetown, Splott, St Mellons and the Llanrummey/Rumney areas.

Table 13. Fruit and vegetable consumption in Cardiff.

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) W03000085 39 34 43 644 W03000086 37 33 42 564 W03000087 38 34 42 717 W03000088 29 - 25 33 723 W03000089 39 34 44 539 W03000090 38 33 43 541 W03000091 32 27 37 493 W03000092 30 - 26 33 715 W03000093 36 32 41 689 W03000094 39 + 35 43 801

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  There are also significant inequalities in the ‘wider determinants’ of health, such as housing, household income and education o For example, the percentage of people living without central heating varies by area in ComparisonCardiff andof lifeVale expectancy,from one in a hundred healthy (1%) life to one expectancy in eight (13%) and disability-free life expectancy at birth, Cardiff 2001-05 and 2005-09  ProducedThere are inequalitiesby Public Health in how Wales and when Observatory, people access using healthcare ADDE/MYE (ONS), WIMD/WHS (WG) o Immunisation uptake varies considerably, with uptake of infant vaccines ranging from 89% 2001-05 2005-09 95% confidence Inequalitygap to 98% across Cardiff and Vale interval (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 17

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 Cardiff South, East and City Locality, uptake of the 5 in 1 vaccine by age 1 is low, in particular in City & South Cardiff. A similar pattern is seen for MMR2 by age 4, where uptake is low throughout the locality, but especially in City & South. There is an association between black ethnicity and lower immunisation uptake in Cardiff.

Figure 11. Percentage of children with completed 5 in 1 primary course by age 1, Cardiff South, East & City clusters (2015)

Figure 12. Percentage of children with completed MMR course (2 doses) by age 4, Cardiff South, East & City clusters (2015)

(ii) Deprivation and wider determinants of health

Areas of deprivation in Cardiff are mainly in the southern arc, with around one in six of Cardiff’s neighbourhoods within 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 Cardiff

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 Cardiff the proportion of residents reporting bad or very bad health ranged from 1.2% in the Cathays area (Cardiff LSOA 032C) to 15% in the Rumney area (Cardiff LSOA 016A). 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 Rumney and Llanrumney areas of Cardiff.

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 Cardiff East 6.6 17.3 4.3 2.5 7.4 1.0 1.0 Cardiff South East 6.1 16.0 4.0 2.7 7.5 0.8 1.0 City & Cardiff South 6.6 17.2 4.0 2.2 9.3 0.8 1.0 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 higher than the Wales average (240 per 1,000 per year) for residents in Cardiff (270) (Public Health Wales Observatory, 2013/14). In contrast, emergency admission rates are lower for Cardiff (87 per 1,000) 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, Cardiff, deaths registered in 2013 (Source: Office for National Statistics)

Other communal Home Hospital Care home establishment Elsewhere Male 23.0 57.9 10.1 6.8 2.3 Female 14.9 55.6 20.9 7.6 1.0 Persons 18.9 56.7 15.6 7.2 1.6

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 chronic illnesses chronic 20 10

0 Percentageofpeople with 1, or 2 more 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 Cardiff 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 within areas of Cardiff with higher black and minority ethnic (BME) population. The age adjusted burden of prevalence ranges from 7.4% to 9.3% in Cardiff South, East and City locality.

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 4.9% in Cardiff.

43% of people accessing homelessness projects in England had a mental illness. The number of households in Cardiff who were deemed to be eligible, unintentionally homeless and in priority need was 690 in 2013/14.

The standardised rate for suicide among women in Cardiff (5.8 per 100,000) is above the Wales average of 5.3, with rates for men 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