Section 1: The population of South

Section authors Lead author: Kieran Morgan

Version Date Changes made by number Draft v1. 7th Jan 2013 Kieran Morgan

1.1 Residents and where they live currently has a total resident population estimated at around 264,826 (ONS 2010-based mid year population projections).

Sixty per cent of South Gloucestershire's population live in the ‘fringe’ area, specifically , , Bradley Stoke, Kingswood, Downend, Staple Hill and . Approximately 20% live around , and Thornbury with the final 20% living in more rural areas.

Map 1: South Gloucestershire

1 As classified by the Department for the Environment, Food and Rural Affairs (DEFRA) – the population is located as follows: • 86.5% live in ‘urban’ areas • 4.8% in ‘town and fringe’ • 8.7% in ‘village, hamlet and isolated dwelling’.

Figure 1: Urban/rural age structure of South Gloucestershire

Source: GP registered populations (2011) and DEFRA definitions (2005) These communities are different in ways that will affect their need for services, now and in the future. For example, Figure 1 shows that non-urban populations tend to be older.

1.2 Population trends The population is projected to rise to: • 277,500 by 2015 • 287,600 by 2020 • 313,600 by 2035.

2 Figure 2: Population estimates (1994-2010) and projections (2011-2035)

Source: ONS 2010 subnational population projections and mid-year estimates This increase in the size of the population is different for men and women (Figure 2) and for different age groups (Table 1 and Figure 2). It is particularly marked for older people and least noticeable for children and those of working age.

Table 1: Projected percentage increase in the populations of South Gloucestershire and by age group South Gloucestershire predicted England predicted percentage percentage change change 2010 to 2035 2010 to 2035 Age Per Age Female Perso group Males Females son group Males s n 0-4 6 5 5 0-4 5 5 5 5-19 10 12 11 5-19 15 15 15 20-64 12 4 8 20-64 11 7 9 65+ 69 63 67 65+ 73 59 65 65-74 43 47 45 65-74 51 49 50 75-84 66 51 59 75-84 66 47 55 85+ 250 147 183 85+ 215 113 146 All ages 20 16 18 All ages 20 18 19 Source: ONS 2010 subnational population projections and mid-year estimates

3 Figure 3: Population pyramid for 2010 and 2035

Figure 4: Actual number of births in South Gloucestershire 1995-2010 and projected 2011-2035

Source: Public health data set and ONS 2010 sub-national population projections Figure 4 shows the projected number of births in South Gloucestershire up until 2035. After a recent dip, numbers are now starting to rise and are expected to continue to do so until around 2018. They are then expected to start to fall again.

4 1.3: The age of residents

Table 2: South Gloucestershire wards with the highest number and percentages of older people (65+) in 2010

Ward name % Ward name No. 25.7 Downend 2,439 Winterbourne 24.5 Hanham 2,277 Thornbury North 22.8 Rodway 2,212 Chipping Sodbury 22.2 Kings Chase 2,164 Severn 22.2 Filton 1,807 Thornbury South and 21.8 Thornbury North 1,794 Downend 21.7 Winterbourne 1,761 Hanham 21.5 Woodstock 1,675 Yate Central 20.7 Thornbury South and Alveston 1,644 20.4 Yate Central 1,601 Rodway 20.3 Chipping Sodbury 1,557 20.0 Yate North 1,499 19.7 Frampton Cotterell 1,472 Kings Chase 19.7 1,446 19.5 Longwell Green 1,443 Cotswold Edge 19.2 Boyd Valley 1,424 Boyd Valley 18.4 1,420 Staple Hill 18.4 Staple Hill 1,319 Ladden Brook 17.3 Patchway 1,251 Filton 17.2 Parkwall 1,180 Woodstock 15.8 Common 1,068 and 15.6 Westerleigh 998 Bradley Stoke Central and Stoke Parkwall 14.5 Lodge 871 Patchway 13.9 Severn 828 13.9 Dodington 799 13.0 Almondsbury 768 13.0 Bitton 684 Yate North 12.9 Ladden Brook 671 Stoke Gifford 11.5 Cotswold Edge 630 Emersons Green 11.3 and Stoke Park 626 Bradley Stoke Central and 10.7 Charfield 593 Dodington 9.7 Siston 589 Frenchay and Stoke Park 9.4 Pilning and Severn Beach 581 Bradley Stoke North 8.0 Bradley Stoke South 399 Bradley Stoke South 4.2 Bradley Stoke North 338 South Gloucestershire 16.5 South Gloucestershire 43,828 Source: ONS 2010 mid-year estimates

5 Although South Gloucestershire has a lower proportion of elderly people than the UK average, people aged 65 yea rs and over are the fastest growing age group.

Longer term ONS projections suggest that there will be around an extra 29,200 people aged over 65 years in South Gloucestershire by 2035 compared to 2010 figures; an increase of 66%. The greatest concentration of older people live on the fringes of Bristol in the Kingswood, Downend and Filton areas. Thornbury and the more rural areas of South Gloucestershire also have a significant proportion of over 65s.

The number of people aged over 85 is expected to nearly triple in the next 25 years, from around 5,378 in 2010 to 15,300 in 2035.

Dependency ratio The proportion of the population who are of working age is expected to decline as the numbers of older people increase and fertility rates fall. This is measured by the dependency ratio – the number of non-working age people (aged 0-15 years or 65 years and over) as a percentage of people of working age (16-64 years).

The dependency ratio in South Gloucestershire is currently similar to the national average at 51% in 2010 i.e. there are just short of two working age people for every non-working person. This is expected to rise to 59% in 2035.

The dependency ratio for older people (65 years and over) is 25% ie there are four working age people for every older person in 2010. This is expected to be 32% in 2035 ie a reduction to three working age people to every older person.

It is not clear if this trend, particularly when coupled with a rising divorce rate, will result in more people needing care facilities outside of the family. A number of factors may mitigate this, including the increased probability of spouses surviving into old age, migration patterns (immigrants tend to be of working age and in fairly good health) and the rise in the number of elderly with at least one child surviving.

1.4 Introduction to our diverse population

Black and minority ethnic groups South Gloucestershire had a Black and minority ethnic (BME) population of 3.6% in 20011 and an estimated 8.9% in 2009 (see Table 3).2 This compares to the national average of 17.2% in 2009.

In a number of neighbourhoods the proportion is much higher. Bradley Stoke ward had the highest ward percentage at the time of the 2001 census.

1 ONS census 2001 2 ONS estimate 2009

6 People from minority ethnic groups living in England are typically younger than the White British population, with the exception of White Irish and White Other communities.3

Table 3: Estimates of BME population in South Gloucestershire 2009 Ethnic group Number of Percentage of people total population of South Gloucestershire White British 239,000 91.2% White Irish 1,700 0.6% White other 6,600 2.5% Mixed 3,600 1.4% Asian 6,200 2.4% Black 2,500 1.0% Chinese/other ethnic group 2,700 1.0% Source: Office for National Statistics, Resident Population Estim ates by Ethnic Group, 2009

Migration Registration with general practices gives a reasonably good picture of recent immigration into South Gloucestershire and neighbouring areas, although some data are incomplete. For the single year 2010/2011,4 there were 1,387 new registrations from outside the area and Figure 5 shows the range of countries from which immigrants came. There are a small number of asylum seekers, but others are from many different countries.

In 2010/11, the highest number of new immigrant registrations came from India followed by Poland and several other eastern European countries. The pattern of country of origin varies slightly from year to year but has included these countries for some time.

3 Association of Public Health Observatories 2005 Indications of Public Health in the English Regions: 4: Ethnicity and Health: SEPHO 4 Data extracted from the Exeter system for GP registrations 2010/2011

7 Figure 5: Number of new registrations in general practices in South Gloucestershire in 2010/2011

Source: Exeter system (GP registrations, 2010/11) The broad range of countries indicates the range of translation services that may be required within health and social services and the increasing demand for English speaking for other languages (ESOL) courses which is likely to occur. Although migrants are generally assumed to be a young, healthy population in order to move to and work in another country,5 their level of health generally relates to their country of origin and may still be worse than the UK standard.

Additionally, asylum seekers and those coming from countries troubled by civil war, or violence, may have significant health needs, particularly mental health needs. Good translation services are essential for efficient treatment of immigrants’ health, especially where emergency treatment is required. Improved data recording of patients’ ethnicity and country of origin in primary and secondary care services will help to ascertain the size of the local migrant population.

1.5 Deprivation and priority neighbourhoods South Gloucestershire is, on the whole, a relatively affluent area but like most places has pockets of deprivation. A good measure of this is the Index of Multiple Deprivation (IMD) which takes data from the census and other routinely held sources to provide a score for small areas (for example, electoral wards). The IMD can be broken down into different dimensions (the tables below highlight income, income affecting children, income affecting older people, and education, skills and training) or presented as a summary of

5 SLIM 2007 Migrant Workers in the South West. South West Observatory Skills and Learning Intelligence Module, December 2007

8 all of them. The IMD is usually presented in ‘quintiles’ – equal fifths of the population, ranked according to their score.

South Gloucestershire has an average IMD score for 2010 of 10.9 (national average range 4.7 - 44.2). It is ranked 295th of 326 local authorities (1st being most deprived and 326th being least) – only ten per cent of local authority areas are estimated to be more affluent.

The IMD can also be presented for very small areas (around 4/500 households). The number of these small areas and the number of people included in South Gloucestershire that fall into each affluence/deprivation quintile in the whole of England is shown below.

Table 4: Small areas in South Gloucestershire included in English IMD quintiles Number of National IMD quintile areas in People in Percentage of - Summary SGC SCG SCG population 1 77 130,420 49.2% 2 31 47,685 18.0% 3 37 60,362 22.8% 4 16 25,141 9.5% 5 1 1,218 0.5%

Number of Number of National IMD quintile areas in people in % of SCG - Income SCG SCG population 1 63 106,478 40.2% 2 42 67,083 25.3% 3 31 50,228 19.0% 4 24 38,205 14.4% 5 2 2,832 1.1%

National IMD quintile - Number of Number of Income affecting areas in people in % of SCG children SCG SCG population 1 52 15,839 6.0% 2 53 16,381 6.2% 3 33 9,588 3.6% 4 23 7,115 2.7% 5 1 328 0.1%

9 National IMD quintile Number of Number of - Income affecting areas in people in % of SCG elderly SCG SCG population 1 59 17,000 6.4% 2 30 7,369 2.8% 3 40 10,153 3.8% 4 27 7,445 2.8% 5 6 1,861 0.7%

National IMD quintile Number of Number of - Ed, Skills & areas in people in % SCG Training SCG SCG population 1 36 65,423 25% 2 34 55,360 21% 3 36 58,591 22% 4 45 69,024 26% 5 11 16,428 6% Source: IMD (2010), ONS Relatively small numbers of people in South Gloucestershire are living in areas with the most deprivation in England (quintile 5), but noteworthy is that nearly one third of the population live in areas with the poorest scores (quintiles 4 and 5) for educational attainment, skill level and level of training.

Within South Gloucestershire, small areas can be compared with each other. The fifth of areas with the most deprivation are Staple Hill, Kings Chase, Patchway, Filton, Woodstock, Parkwall and Rodway and when low income alone is considered, Yate West and Bitton can be added. Given the impact of deprivation on health and life chances, they constitute priority neighbourhoods.

1.6 Poverty Poverty is essentially about lacking the money to acquire particular items, goods or services that are considered as essential, or necessary, to be able to take a meaningful and active part in normal everyday society. For example, being able to afford a school trip for your child, or having enough money to share a birthday celebration with friends. More fundamentally for some households though, is the desperate struggle to even afford the essentials in life – a home with sufficient space which is warm and free from damp and sufficient food to provide yourself and your family with a healthy, nutritious and balanced diet. When deprived of these essential everyday needs lives are often blighted and held back. Not only do children and adults in poverty suffer physically as a result, but often their mental health and wellbeing suffers too.

10

Measuring poverty: The most widely used measure of poverty is a relative income measure – the proportion of individuals with household incomes below 60 per cent of the contemporary median.6

Although poverty and deprivation are inextricably linked, they are nevertheless distinct concepts – the former being solely income based at individual household level, the latter often being area based on a much wider range of factors. The key point is that households living in poverty live in all areas – rich or poor – even areas characterised as not being deprived.7

Figure 6: Risk of living in poverty by household type, UK, 2000/01 to 2010/11

Source: Department of Work and Pensions (2012) http://research.gov.uk/asd/index.php Figure 6 illustrates the household composition types nationally that are most at risk of living in poverty – single parent households with children (22 per cent in 2010/11), single pensioner households (21 per cent in 2010/11) and working age single adult households without children (20 per cent in 2010/11). Working age adults in couple households without children are least likely to be living in poverty (ten per cent in 2010/11). Also illustrated by this chart is how these respective household types have fared over the years – with the risk of single parent households living in poverty fallen dramatically. This is due in large part to a greater number of single parents being in work. However, it is

6 There are several aspects to this threshold income measure. Firstly, it measures household income rather than individual income. Secondly, it uses disposable net of tax income rather than individual income. Thirdly, incomes are adjusted for household size and composition to put them on a comparable basis – a process otherwise known as equivalisation. Finally, the threshold is defined in terms of median, rather than mean income. 7 For example, it is estimated that around 70 per cent of children living in poverty in South Gloucestershire live outside of South Gloucestershire’s six Priority Neighbourhoods (using boundaries identified for analysis purposes only).

11 working age single adult households that have fared particularly badly – the only group where poverty was greater in 2010/11 compared to 2000/01.

Those working age households facing the greatest risk of living in poverty include those where no adult is in work.8 In fact, the UK has Europe’s second highest rate of children in workless households.9 However, in work poverty is a very significant factor – for example, over half of children in poverty in the UK live in households where at least one parent is in work and therefore earning a wage.10 Furthermore, the Institute for Fiscal Studies (IFS) recently reported that poverty among working-age adults without dependent children is at its highest level since 1961 (in particular single adult households without children: Figure 6).11 Dealing with the issues of low wages, and the availability of affordable, good quality childcare, are key factors in improving high rates of in-work poverty.

By contrast to the increasing number of working age adults without dependent children being in poverty, the number of pensioners living in poverty is at its lowest level since 1984 (in particular pensioner couple households – see Figure 6).12

Through the 2010 Child Poverty Act the Government has a statutory duty to meet various specified targets to reduce child poverty by 2020:

1. reduce relative low income to less than ten per cent of children (20 per cent in 2009/10) 2. reduce combined low income and material deprivation to less than five per cent of children (16 per cent in 2009/10) 3. reduce absolute low income to less than five per cent of children (to be rebased with effect from 1st April 2010) 4. a persistent low income target (which has yet to be set).13

In addition, the Coalition Government’s Child Poverty Strategy introduced a new combined severe income and material deprivation measure (again, with no target set).14 However, in an apparent departure from only concentrating on income measures of poverty, the Coalition Government in their Child

8 In 2009/10 76 per cent of workless couple households with children, and 73 per cent of workless single parent households lived in relative income poverty (After Housing Cost basis). Source: Department for Work and Pensions (2011), Households Below Average Income (HBAI), available from the following link: http://research.dwp.gov.uk/asd/index.php?page=hbai_arc. 9 In 2010 17.9 per cent of children in the UK were living in workless households, lower compared only to Ireland at 19.6 per cent. Source: Eurostat – available from the following link: http://epp.eurostat.ec.europa.eu/tgm/table.do?tab=table&init=1&plugin=1&language=en&pcode=tsisc08 0. 10 In 2009/10 57 per cent of children were in families where at least one adult was in work (After Housing Cost basis). Source: Department for Work and Pensions (2011), Households Below Average Income (HBAI), available from the following link: http://research.dwp.gov.uk/asd/index.php?page=hbai_arc. 11 Jin, W., et. al. (2011), Poverty and inequality in the UK: 2011, IFS Commentary C118, available from the following link: http://www.ifs.org.uk/publications/5584. 12Ibid. 13 Sections 3 to 6 of the 2010 Child Poverty Act, available from the following link: http://www.legislation.gov.uk/ukpga/2010/9/contents. 14 HM Government (2011), A New Approach to Child Poverty: Tackling the Causes of Disadvantage and Transforming Families’ Lives, April 2011, available from the following link: https://www.education.gov.uk/publications/standard/publicationDetail/Page1/CM%208061

12 Poverty Strategy have also included a set of indicators that measure a wider range of poverty related factors that go to the heart of some of the causes of poverty. For example, following the publication of Frank Field’s independent review into poverty and life chances in 201015 the national strategy includes a suite of indicators measuring children’s life chances (low birth weight, child development, progression to higher education, etc). Policy measures such as extending two year old entitlement to free childcare16 and the introduction of the pupil premium17 are examples of policies that support this apparent shift in focus on how to tackle child poverty.

Since the recession of 2009/10, wages have fallen18 and prices have been rising at relatively high rates.19 These economic ‘shocks’ have combined with the Coalition Government’s package of welfare reform20 and spending cuts21 to create a toxic mix which is putting immense pressure on many household budgets. Latest IFS poverty projections have indicated that rates of absolute and relative income poverty will rise.22 Furthermore, the IFS states that families with children will be particularly hard hit by the package of spending and welfare cuts – with households with children losing nearly five per cent of their net income due to tax and benefit changes by April 2014.23 Whilst UNICEF’s latest international child poverty report acknowledges the progress the UK has made in reducing relatively high rates of child poverty, they voice strong warnings about the projected future path of child poverty as a result of austerity measures and the general weak economic circumstances.24

Poverty will now be considered for the main household groups in South Gloucestershire.

15 Field, F. (2010), The Foundation Years: preventing poor children becoming poor adults, available from the following link: http://webarchive.nationalarchives.gov.uk/20110120090128/http:/povertyreview.independent.gov.uk/new s/101203-review-poverty-life-chances.aspx 16 Extension of the programme to offer 15-hours of free childcare from 20% to 40% of the most disadvantaged 2-year olds announced in the 2011 HM Treasury Autumn Statement (available from the following link: http://www.hm-treasury.gov.uk/as2011_index.htm). 17 The Pupil Premium was introduced in April 2011 and includes Free School Meal pupils, Children and Young People in Care and Service Children. Further information available from the following link: http://www.education.gov.uk/schools/pupilsupport/premium/b0076063/pp. 18 Joyce, R. (2012), The decline in household income over recession and austerity, IFS, available from the following link: http://www.ifs.org.uk/publications/6143. 19 Bank of England Inflation Reports, available from the following link: http://www.bankofengland.co.uk/publications/Pages/inflationreport/default.aspx. 20 Principally contained in the Welfare Reform Act 2012, summary available from the following link: http://www.dwp.gov.uk/policy/welfare-reform/. 21 HM Treasury (2010), Spending Review 2010, available from the following link: http://www.hm- treasury.gov.uk/spend_sr2010_documents.htm. 22 Joyce, R. (2012), op. cit. 23 Joyce, R. (2012), op. cit. 24 UNICEF (2012), Measuring Child Poverty: new league tables of child poverty in the world’s rich countries, Report Card 10, available from the following link: http://www.unicef-irc.org/publications/660.

13 Figure 7: Local rates of child poverty, 2006 to 2009

Source: HMRC Child poverty statistics

Families with children living in South Gloucestershire The only comparable local poverty figures available are for households with children. South Gloucestershire’s main ‘adjusted’ relative income measure of child poverty is the lowest of all the ex- authorities of Bath & North East Somerset, Bristol and (Figure 7). Furthermore, at around one in eight of the local population of children and young people (amounting to some 6,100 dependent children), South Gloucestershire’s child poverty rate is around half the national rate.

Statutory duties of local authorities in relation to child poverty South Gloucestershire and its partners are required to: • cooperate to reduce and mitigate the effects of child poverty • prepare and publish a local child poverty needs assessment • prepare a joint child poverty strategy • take child poverty into account when preparing or revising their Sustainable Community Strategy.

Part 2 of the Child Poverty Act 2010

Rates of child poverty in South Gloucestershire vary considerably – from around one in 30 in Severn Ward to around one in five in Kings Chase Ward. Rates of child poverty in smaller LSOA areas vary even more (Figure 8). The two LSOA areas with the highest rates of child poverty as at August 2009 include Pendennis Road area (E01014977) and New Road area (E01014926) – 35.7 per cent and 35.6 per cent respectively.

14 Figure 8: Local rates of child poverty, August 2009, by LSOA area, South Gloucestershire

Source: HMRC Child Poverty Statistics, available from http://www.hmrc.gov.uk/stats/personal- tax-credits/child_poverty.htm. Notes: Figures as at 31st August 2009. Picking up on the point made above regarding the fact that poverty and deprivation are related but distinct concepts, over two-thirds (70 per cent) of children living in poverty in South Gloucestershire live outside of South Gloucestershire’s most deprived urban communities (defined by the six Priority Neighbourhoods). This has clear implications for any poverty-related policies that focus solely on families living in South Gloucestershire’s Priority Neighbourhoods.

Older people households living in South Gloucestershire In November 2011, there were around 51,060 people of pension age in South Gloucestershire claiming the state pension.25 This amounts to almost the entire eligible population of state pensionable age – 51,900.26 Older people on low incomes are able to claim a means tested top-up element, known as the Guarantee Credit – around 2,120 individuals were claiming Pension Credit Guarantee in South Gloucestershire in November 201127 – amounting to four per cent of those claiming the State Pension. However, national take-up rates of Pension Credit Guarantee (estimated at between 73 per cent and 80 per cent) mean there will be a higher prevalence of older people on low incomes than these figures suggest.28

25 DWP Tabulation Tool: http://83.244.183.180/100pc/tabtool.html. 26 mid-2010 ONS Population Analysis Tool: 32,100 females aged 60+ and 19,800 males aged 65+ (totalling 51,900): http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77- 231847. 27 DWP Tabulation Tool: http://83.244.183.180/100pc/tabtool.html. 28 Department for Work and Pensions (2012), Income Related Benefits: Estimates of Take-up in 2009- 10, available from the following link: http://research.dwp.gov.uk/asd/index.php?page=irb_arc.

15 As with child poverty rates across South Gloucestershire, rates of older people poverty vary across the authority. The triennial Indices of Deprivation include an Income Deprivation Affecting Older People Index (IDAOPI) and are produced at LSOA level – see Figure 9.

Figure 9: Indices of Deprivation 2010, Income Deprivation Affecting Older People Index (IDAOPI), South Gloucestershire

Source: Indices of Deprivation 2010, South West Observatory South Gloucestershire has two LSOA areas which are in the bottom 20 per cent nationally for the 2010 IDAOPI: Pendennis Road area (E01014977) and the area north of the High Street around the council offices in Kings Chase Ward (E01014927). In these two areas a third of older person households are in receipt of the Pension Credit Guarantee.29

29 IDAOPI scores are 0.33 and 0.32 respectively.

16 Working age childless households living in South Gloucestershire As with older person households, there are no dedicated local poverty statistics available that will determine the extent of poverty among working age childless households living in South Gloucestershire. However, recent HMRC tax credit statistics30 do indicate that there were around 1,200 ‘in- work’ families without children in South Gloucestershire in receipt of Working Tax Credit (WTC), i.e. in work, but earning a sufficiently low income to warrant the receipt of a top-up to earnings.

Fuel poverty

Measuring fuel poverty A household is said to be fuel poor if it needs to spend more than ten per cent of its income on fuel to maintain an adequate standard of warmth. This is usually defined as 21 degrees for the main living room and 18 degrees for other occupied rooms. [This measure is likely to change in the future following Professor John Hill’s recommendations on fuel poverty.]31

The latest sub-regional fuel poverty statistics for 2010 show that there were 11,187 households living in fuel poverty in South Gloucestershire (11 per cent of all households).32 South Gloucestershire has a lower rate of households in fuel poverty compared to all the other three ex-Avon authorities.33 The national comparable figure for England is 16 per cent of households in fuel poverty.

30 HM Revenue and Customs (2012), Child and Working Tax Credits Statistics: Geographical analyses, April 2012, available from the following link: http://www.hmrc.gov.uk/stats/personal-tax-credits/cwtc- geog-stats.htm. 31Hills (2012), Getting the measure of fuel poverty, available from the following link: http://www.decc.gov.uk/en/content/cms/funding/Fuel_poverty/Hills_Review/Hills_Review.aspx. 32 Department of Energy & Climate Change (2012), Fuel poverty sub-regional statistics, available from the following location: http://www.decc.gov.uk/en/content/cms/statistics/fuelpov_stats/regional/regional.aspx 33Ibid.

17 Key Findings 1) Nationally, poverty has been falling for older person households and households with children. 2) Nationally, poverty among single adult childless adults has been rising and is at its highest level since 1961. 3) Around one in nine of South Gloucestershire’s children and young people live in poverty – amounting to around 6,100 dependent children. 4) Some 70 per cent of children living in poverty live outside of South Gloucestershire’s six Priority Neighbourhoods. 5) Nationally and locally, low in-work wages account for a significant proportion of those living in poverty. 6) Around four per cent of those claiming the State Pension are also in receipt of Pensioner Credit Guarantee. 7) Little is known about the extent of poverty among working age childless households. 8) One in nine households in South Gloucestershire live in fuel poverty.

1.7: Other communities with particular needs

Students The University of the West of England (UWE) is situated in the Severnvale locality of NHS South Gloucestershire and South Gloucestershire Council. The university has approximately 32,000 students of which around 30,000 live within South Gloucestershire. It is the largest provider of higher education in the South West. Students come from all parts of the UK and there are a growing number of international students from over 50 countries worldwide. The student population represents a significant proportion of the local population (approx 12% of South Gloucestershire or 36% of the population of Severnvale locality).34

Prison population See Section 6.2.8

Gypsy and Traveller communities Assessment of the needs of this community has been undertaken recently across the whole of the West of England.35 The main findings include the following. • A review of published literature on the health needs of Gypsies and Travellers identified considerably poorer health status compared to either other ethnic minority groups in England, or the general

34 Severnvale Locality Profile. South Gloucestershire PCT 2007 35 West of England Travellers’ Health: assessment of health needs. Ruth Kipping, North Somerset PCT 2012

18 population, including: increased prevalence of a wide range of conditions including physical and mental health, with a lower prevalence of stroke, cancer and diabetes; low rates of immunisation; problems in accessing health services; lower use of health services; and detrimental impact of wider determinants of health such as education and poor environmental conditions. Little information is available on lifestyle behaviours. • There are major differences in the provision of caravan sites in the four local authority areas and the average caravan counts reflect these differences: 38 in B&NES, 16 in Bristol, 95 in North Somerset and 249 in South Gloucestershire. These figures do not identify Gypsies and Travellers living in houses, the number of which is considerable in Bristol. Some 666 pre-school, primary and secondary school aged children were known to the Travellers Education Service during the 2010/11 academic year, with equal numbers in South Gloucestershire and Bristol. • Health visitors provide services to Gypsies and Travellers with different models of provision in the four areas. Child immunisation and breast- feeding data is available from specific audits, which in Bristol and North Somerset have identified low rates of immunisation. Local health visitors have identified the following health needs from their work: immunisations, domestic violence, access to primary care, continuity of care, access to information about services and dental health. • An accommodation needs assessment was undertaken in the West of England in 2007, which included a limited set of questions about health. This assessment identified a reasonably high rate of GP registration (86%); accommodation type is a clear marker of GP registration; nine per cent of households included someone aged 60 and above; and housing was a considerable contributing factor to health. • Qualitative studies have been undertaken in Bristol and South Gloucestershire with Gypsies and Travellers which have identified specific needs of the community, the importance of raising awareness with health professionals and opportunities to improve service provision. Further work is required in North Somerset and Bath and North East Somerset to understand the health needs of the local communities.

Refugees and asylum seekers A refugee is defined as someone who has substantiated a well-founded fear of persecution from their home country and has been granted permission to stay in the UK as a refugee or 'leave to remain' to give the technical term. An asylum seeker is someone who, having applied for refugee status, is awaiting a decision.

Refugees and asylum seekers are often from cultures very different to the indigenous population, may not understand the principles behind the UK

19 health system, may not speak English, and may have complex healthcare requirements.36

We do not have current, accurate information about the numbers of asylum seekers or refugees in South Gloucestershire. However, according to ‘Equality South West’, using Home Office figures from April 2010, only 30 asylum seekers (one per cent of the UK’s total) were claiming subsistence-only benefits in the South West region - fewer than in many parts of London, Leeds, Manchester, Luton, Slough and Brighton. At the same time, some 635 asylum seekers were asking for assistance with accommodation in the South West (Bristol 190, 95, Plymouth 225, South Gloucestershire 40, Swindon 85) – just 3.4 per cent of the UK total.

Further background is from the earlier South Gloucestershire Council Race Equality Scheme [2008 – 2011].

'As regards asylum seekers, South Gloucestershire borders two of the Home Office allocated dispersal centres in the South West – Bristol and Gloucester. Currently, approximately ten people per week are dispersed into these areas, and of these 17 single adults and 22 families with 47 children, plus one unaccompanied child, live within the South Gloucestershire unitary authority area.

These statistics reflect the adult asylum seekers who receive support from the National Asylum Seeker Service, and this level of support means that they have no problems accessing essential council services in South Gloucestershire.

No new asylum seeker families arrived during the 2006/2007 academic year, and most existing families have been granted refugee status and subsequently moved outside the unitary authority area where there is more support.

As regards people who have been granted refugee status, which means that they are entitled to the full benefits associated with UK citizenship, the border with Bristol means that South Gloucestershire now part hosts a Kurdish community of approximately 1,500 people – many of whom cannot speak English and feel marginalized in the community.

Proximity to Bristol also means that South Gloucestershire part hosts a Sudanese community of around 1,000 people. Those who initially arrived as asylum seekers tend to be employed in low skill low paid jobs despite holding professional qualifications.

This contrasts with the employment situation of those who arrived as students before the Sudanese civil war. These people tend to be well qualified and hold professional positions – and have set up their own social fund to help those Sudanese who are in need.'

36Department of Health (2012) Guidance on providing NHS treatment for asylum seekers and refugees

20 Health needs Asylum seekers and refugees are recognised to have high health needs compared with other groups, with evidence that their health deteriorates in the first two to three years following arrival in the UK.

A literature review has highlighted the following health needs of refugees and asylum seekers.

Mental health: Low level and acute mental health problems are often experienced as a result of displacement, isolation, uncertainty and poverty. Many may suffer post traumatic stress disorder from atrocities and multiple losses. Anxiety, depression and sleep problems are common.37

Maternal health: The 7th Confidential Enquiry into Maternal and Child Health38identified Black African women, including asylum seekers and newly arrived refugees, as having a mortality rate nearly six times higher than White women. Difficulties in the asylum-seeking process may delay access to antenatal care. Some women may have been victims of rape or sexual violation leading to unwanted pregnancies, or sexually transmitted infections. Female genital mutilation can lead to obstetric complications. There is low uptake of breast and cervical screening amongst asylum seeker and refugee women.

Communicable diseases: Depending upon the country of origin, circumstances of migration and underlying health, some groups of asylum seekers and refugees may have high rates of certain diseases e.g. malaria, tuberculosis (TB), HIV and hepatitis. Lack of trust and appropriate information may delay diagnosis and access to treatment and care. In 2010, 73% of TB cases reported in the UK, almost 60% of newly diagnosed cases of HIV, and 80% of hepatitis B infected UK blood donors were born abroad.39

Sexual health: Cultural or religious beliefs around sexual practices, the availability and use of contraception and experience of sexual violation may influence rates of sexually transmitted infections.

Access to GP care: Strong evidence does exist to show the difficulties asylum seekers face accessing GP treatment. The consequences of these difficulties can be increased reliance on accident and emergency services and the resulting increased costs and pressure on these. All asylum seekers and refugees are entitled to register with a GP, although GP practices retain the discretion to register refused asylum seekers to the same extent that they

37 Mind (2009) A civilised society: mental health provision for refugees and asylum seekers in England and Wales. 38Confidential enquiry into maternal and child health. Saving Mothers Lives: reviewing maternal deaths to make motherhood safer, 2003 2005. The 7th report of confidential enquires into maternal deaths in the UK; Dec 2007. 39 Health Protection Agency (2011) Migrant health: infectious diseases in the non UK born populations in the UK. An update to the base line report

21 have this discretion in relation to registering any patient, regardless of his or her residency status.40

Secondary care: Asylum seekers whose claims are still pending, refused asylum seekers being supported by UKBA, human trafficking victims and accepted refugees are entitled to: • accident and emergency services (excluding treatment provided after a patient has been admitted as an in-patient, or is given an out-patient appointment) • family planning services • treatment of certain communicable diseases such as measles, tuberculosis and pandemic flu • treatment for sexually transmitted diseases (for HIV and AIDS the exemption only applies to the initial diagnostic test and associated counselling) • treatment required under mental health legislation, or by order of a court. Other health issues: There is little evidence of the commissioning of services for disabled asylum seekers and no clear guidance exists on local authority responsibilities towards asylum seekers with care needs.

The vulnerability and ill health of asylum-seeking and refugee children is an area of particular concern, as are the health needs of older refugees. User views The joint Bristol and South Gloucestershire Local Involvement Network engagement with refugees and asylum seekers between the 28 March 2011 and 1st June 2011 was captured in a report 'Refugee Welcome Centre Issues and Concerns'. The report contains a number of recommendations for healthcare commissioners and these are: 1. That people from asylum-seeking and refugee communities are included by primary care practitioners in their grouping for ‘vulnerable people’ so that there is an enhanced awareness of the community and their differing access requirements. 2. That referral to sexual health services should be community specific and that more culturally appropriate sexual health services be available that also use appropriate information in translation. Existing outreach from sexual health services should be enhanced and actively supported by further commissioning.

40 BMA Ethics (2012) Access to health care for asylum seekers and refused asylum seekers– guidance for doctors

22 3. That existing primary care mental health services are proactive in being available to people from asylum seeking and refugee communities and that the primary care liaison service works to refer people appropriately, in particular taking into account support needs for those suffering post-traumatic stress. 4. That the roles of Healthlink workers and health trainers are enhanced, and their potential as a resource for the people from asylum-seeking and refugee communities to continue to inform health and social care commissioners and providers is deployed. 5. Information and greater cultural awareness is actively sought by healthcare providers from people from asylum seeking and refugee communities through health advocates from these communities. Effective methods of gathering and reporting community views through these workers should be created and feedback should be actively sought. 6. Interpreter support for access to exercise on prescription and gym use is provided. 7. Interpreting provision should be available to leisure centres to work with clients attending an induction session prior to use of equipment. This applies to ‘exercise on prescription’ or the ‘asylum seeker sports card scheme’ at Easton leisure centre. 8. Where interpretation is required appointment times, in both primary and secondary care, are adjusted to allow additional time for adequate and appropriate interpretation to take place. 9. That interpretation is regularly and appropriately supported with the use of visual and pictorial materials. 10. There is training for all health professionals in using interpretation in a timely and appropriate manner.

Key contacts Helen Cooke - [email protected]

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