Strategic Plan Needs Assessment

December 2017

Table of Contents

1.1 Area and Population ...... 6 1.1 Area ...... 6 1.2 Population Estimates ...... 6 1.3 Ethnic Minorities ...... 7 1.4 Population Density ...... 8 1.5 Overall Births and Deaths ...... 8 1.6 Migration ...... 8 1.7 Population Projections ...... 9 1.8 Centenarians in South Ayrshire ...... 11 2. Households and Dwellings ...... 15 2.1 Dwellings ...... 15 2.2 Dwelling by Type ...... 15 2.3 Household Tenure ...... 16 2.4 Households in South Ayrshire ...... 16 2.5 Household Type ...... 17 2.6 Household Projections ...... 18 2.7 Single Person Households ...... 18 2.8 Lone Parent Households ...... 19 2.9 Homelessness...... 19 2.10 Temporary Accommodation ...... 20 3. Deprivation in South Ayrshire ...... 22 3.1 Scottish Index of Multiple Deprivation (SIMD) ...... 22 3.2 Income Deprivation ...... 26 3.3 Employment Deprivation ...... 30 3.4 Geographic Access to Services ...... 34 3.5 Disabled Employment ...... 36 3.6 Lone Parent Employment ...... 36 3.7 Child Poverty ...... 36 3.8 Fuel Poverty ...... 37 4. General Population Health ...... 40 4.1 Life Expectancy and Healthy Life Expectancy ...... 40 4.2 General Health ...... 42

4.3 Long Term Conditions ...... 43 4.4 Mortality ...... 45 4.5 Smoking ...... 48 4.6 Obese Adults ...... 48 4.7 Physical Activity ...... 48 4.8 Palliative Care /End of Life ...... 49 5. Specific Health Conditions ...... 51 5.1 Learning Disabilities ...... 51 5.2 Mental Health ...... 53 5.3 Dementia ...... 56 5.4 Suicide Rates ...... 57 5.5 Risk Taking Behaviour ...... 57 5.5.1 Alcohol ...... 57 5.5.2 Drugs ...... 58 6. Unscheduled Care ...... 61 6.1 Accident and Emergency ...... 61 6.2 Inpatient Admission following Accident and Emergency Attendance ...... 63 6.3 Delayed discharges ...... 66 7. Community Services ...... 68 7.1 Carers in South Ayrshire...... 68 7.2 Care Homes ...... 69 7.2.1 Care Home Projections ...... 71 7.3 Home Care ...... 71 7.3.2 Care at Home Projections ...... 72 7.4 Adult Protection ...... 72 8. Children and Young People ...... 75 8.1 Mortality ...... 75 8.2 Maternity – Breastfeeding ...... 76 8.2 Maternal Smoking at Antenatal Booking ...... 77 8.3 Low Birth Weight ...... 77 8.4 Fertility ...... 78 8.5 Teenage Pregnancy ...... 79 8.6 Child Protection ...... 80 8.7 Looked After Children ...... 82

8.8 Child Health ...... 83 8.8.1 Developmental Milestones ...... 83 8.8.2 Dental Decay ...... 84 8.8.3 Healthy weight ...... 85 8.8.4 Children at Risk of Obesity ...... 85 9. Criminal Justice ...... 88 9.1 Crime ...... 88 9.2 Domestic Abuse ...... 89 9.3 Fires ...... 90 9.4 Violent Crime ...... 90 9.5 Road Safety ...... 91 9.6 Prison Statistics ...... 92 9.7 Community Safety ...... 92

1.1 Area and Population

1.1 Area

South Ayrshire is set in the south west of Scotland. A large rural area of 472 square miles (1,222 square km) extends from Troon and Symington in the north to Ballantrae and Loch Ryan in the south.

Approximately 70% of the population live in the towns of Troon, Prestwick and Ayr. The rest of the population live in Maybole and Girvan and rural Kyle and Carrick.

1.2 Population Estimates

In 2016, the population of South Ayrshire is estimated to be 112,470, accounting for 2.1% of Scotland's total population. The population increased by 70 between 2015 and 2016.

Figure 1: South Ayrshire Total Population

113,500 113,000 112,500 112,000 111,500 111,000 110,500 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

The population is made up of 52% female and 48% male. The percentages of the population under the age of 16 years and of working age are both below average. The percentage aged 65+ is above the Scottish average.

Figure 2: Age Structure 2016

100% 18% 24% 80% 60% 65% 40% 60%

Percentage 20% 16% 17% 0% South Ayrshire Scotland

Aged 0 - 15 Aged 16 - 64 Aged 65+

The dependency ratio (children and older people aged 65 and over expressed as a percentage of people aged 16-64) is 67% in South Ayrshire compared with 55% in Scotland. By 2039 this will increase to 87% in South Ayrshire compared to 67% across Scotland.

Figure 3 below shows the population of each of the localities within South Ayrshire. The largest locality is Ayr South & Coylton with 31,272 people, which is 28% of the South Ayrshire population. The next largest are Prestwick, with 22,010 people and Ayr North and Former Coalfield Communities, with 20,188. The two smallest are quite considerably smaller – Girvan and South Carrick Villages has 9,504 and Maybole and North Carrick Villages has 9,347 residents (8.5% and 8.3% of the South Ayrshire population respectively).

Figure 3: Population by Locality, 2015

Locality Total Population Ayr North & Former Coalfield Communities 21,170 Ayr South & Coytlon 30,454 Girvan & South Carrick Villages 9,504 Maybole & North Carrick Villages 10,697 Prestwick 22,028 Troon 18,547 Total 112,400

Figure 4 outlines the relative sizes of the population in the Ayrshire Health and Social Care Partnerships. It shows that the South Ayrshire population is relatively older than the population in North or East Ayrshire.

Figure 4: Estimated population by local authority and age group, 2016

0 0-15 16-29 30-49 50-64 65-74 75+

South Ayrshire North Ayrshire East Ayrshire

1.3 Ethnic Minorities

South Ayrshire has a relatively small ethnic minority community (1.4% of the population compared with 4.1% for Scotland).

1.4 Population Density

With a population of 112,470, South Ayrshire is in the mid-range of Scottish local authorities in terms of population and area size. However, South Ayrshire's population density of 92 persons per square kilometre is lower than neighbouring North and East Ayrshire areas reflecting the rural nature of the area.

1.5 Overall Births and Deaths

The number of births in South Ayrshire in 2016 was 976, 5.2% lower than was experienced in 2015 (1,030). The number of births in Scotland fell by 1.2% between 2015 and 2016.

Figure 5: Births in South Ayrshire and Scotland, 2015 and 2016

Births 2015 Births 2016

Male Female Male Female % change in total no. of births 2015-16 South Ayrshire 509 521 502 474 -5.2% Scotland 28,355 26,741 28,219 26,239 -1.2%

The number of deaths in South Ayrshire decreased from 1,498 in 2015 to 1,446 in 2016. Over the period 2014 to 2016 the overall death rate in South Ayrshire was slightly lower for males than for females. Compared to Scotland over the period 2014 to 2016, South Ayrshire had a higher death rate.

Figure 6: Deaths and age specific death rates by age group, the combined years 2014-2016

Age Age specific death rate per 1,000 Age specific death rate per 1,000 group people, South Ayrshire people, Scotland Male Female All Persons Male Female All Persons 0 1.9 4.1 3.0 3.5 3.2 3.4 1-14 0.1 0.1 0.1 0.1 0.1 0.1 15-29 0.7 0.5 0.6 0.6 0.3 0.5 30-44 2.7 1.6 2.1 2.0 1.1 1.5 45-64 5.9 4.3 5.0 6.6 4.3 5.4 65+ 46.3 45.4 45.8 48.4 45.3 46.7 All ages 12.7 13.1 12.9 10.5 10.4 10.5

1.6 Migration

On average over the three year period 2013-15, there was a net inflow of 273 people into South Ayrshire per year, meaning that more people entered South Ayrshire (3,635 per year) than left (3,362 per year). The 16 to 29 year olds age group accounted for the largest group of in-migrants into South Ayrshire. The largest group of out-migrants was also the 16-29 year olds.

Figure 7: Average migration in and out of South Ayrshire, 2013-15

Age Group In Out Net 0-15 610 477 133 16-29 1,028 1,287 -259 30-44 848 748 100 45-64 759 567 192 65+ 389 279 110 All ages 3,635 3,362 273

1.7 Population Projections

By 2039, the South Ayrshire population is projected to be 110,104, a decrease of 2% compared to the population in 2014. The population of Scotland as a whole is projected to increase by 7%. The projected change in South Ayrshire is not evenly spread across the different age groups. South Ayrshire’s younger population (0-15 years) is projected to decrease by 8% and its working age population by 11%. The pensionable age population is, however, projected to increase by 21% by 2039. More dramatically, the number of people aged 75 and over is projected to increase by 82% to 21,571 people, with major consequences for the demand for older people’s services (see Figure 8).

Figure 8: Population projections (2014-based) projected change (2014-2039)

100 82 85

50 21 28 7 1 1 0 -2 -7 -11 -50 All persons Children Working Age Pensionable age 75+ Population (0-15)

South Ayrshire Scotland

The Population Pyramids below highlight the changing structure within the South Ayrshire Population between 2014 and 2039. In 2014 there is a high proportion aged between 45 and 65. In 2039 the population age structure has shifted with the highest proportion being aged between 65- 75 with increased numbers aged 75+ compared to 2014.

Between 2014 and 2024, it is predicted that the 85 years+ population in South Ayrshire will increase from around 3,257 to 4,382, an increase of 34.5%. Between 2014 and 2039, this age group is projected to increase to 7,556, an increase of 132.0%. The 90+ age group is projected to increase from 1,195 in 2014 to 3,426 in 2039, an increase of 187%.

Figure 9: Estimated population of South Ayrshire 2014

90 and over 85 80 75 70 65 60 55 50 45 Male

40 35 30 Female Age 25 20 15 10 5 0 1500 1000 500 0 500 1000 1500 Persons

Figure 10: Estimated population of South Ayrshire 2039

90 and over 85 80 75 70 65 60 55 50

45 Male 40 35 Female

Age 30 25 20 15 10 5 0 2000 1000 0 1000 2000 3000 Persons

Figure 11: Estimated 65+ population of South Ayrshire 2014

90 and over 85

80 Male Age 75 Female 70 65 1500 1000 500 0 500 1000 1500 Persons

Figure 12: Estimated 65+ population of South Ayrshire 2039

90 and over 85

Age 75 Male 70 Female 65 2000 1500 1000 500 0 500 1000 1500 2000 2500 Persons

Figure 13: Trend in South Ayrshire population projections (2016-2015): 65+; 70+

35000

30000

25000

20000

15000

10000

5000

0 Estimated population projection population Estimated 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 65+ 70+

The 65+ population is projected to increase by 17.5% overall between 2016 and 2025. Figure 14 below shows the projected changes within the older age bands broken down further.

Figure 14: Trend in South Ayrshire population projections (2016-2025): 65+

9000 8000 7000 65-69 6000 70-74 5000 75-79 4000 80-84 3000 85-89 2000 1000 90+ Estimated populationprojection 0 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Amongst the older age groups there is a projected increase within all age groups between 2016 and 2025. Projections indicate that there will be a 35% increase in those aged 75-79, 25% in 80-84, 34% in 85-89 and 38% in those aged 90+.

1.8 Centenarians in South Ayrshire

Within Scotland, South Ayrshire has the highest proportion of centenarians with 3.1% of those aged 90+ being aged over 100 (38 people aged 100+). Figure 15 shows the proportion split of those aged 90 and over.

Figure 15: Population in South Ayrshire (2015) aged 90 and over.

South Ayrshire also has a higher percentage of the total population aged 80-89 (5,598 people) than the national average at 5.0% compared to national average of 3.9%

2. Households and Dwellings

2.1 Dwellings

In 2016, there were 54,942 dwellings in South Ayrshire, an increase of 307 (+0.6%) on the previous year and by 2,277 (+4.3%) over the last 10 years. Similarly across Scotland as a whole there was also an increase on the previous year of +0.7% and over the last 10 years was +6.6%1.

Figure 16: South Ayrshire dwelling estimates

56,000

55,000

54,000

53,000

52,000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

2.2 Dwelling by Type

The housing stock in South Ayrshire is fairly evenly split between detached houses (25%), semi-detached (24%), terraced (23%) and flats (27%). South Ayrshire has a larger proportion of detached, semi-detached and terraced houses than Scotland as whole1.

The proportion of dwellings in South Ayrshire with a single adult Council Tax discount applied is 36%. For Scotland, this figure is 37%2.

Figure 17: Dwellings by type – 2016

40% 38%

27% 30% 25% 23% 24% 21% 20% 21% 20%

10%

0% Flats Terraced Semi-detached Detached

South Ayrshire Scotland

1 National Records of Scotland, 2016 Estimates in Households and Dwellings 2 National Records of Scotland, 2016 Estimates in Households and Dwellings

2.3 Household Tenure

According to the 2011 Census, around 69% of South Ayrshire households own their home, which is higher than the Scottish average of 62%. Around 16% of households rent their accommodation from the Council compared to 13% nationally, 3% rent from one of the other Registered Social Landlords compared with 11% nationally, and 11% rent from private landlords which is similar to the national level at 12%. Source Census: 2011

Figure 18: Households by tenure

Households by Tenure (2011) 80% 69%

62%

60% 40% 16% 13% 11% 11% 12%

Percentage 20% 3% 1% 1% 0% Owned Rented from Other social Private rented Living rent free Council rented

South Ayrshire Scotland

2.4 Households in South Ayrshire

In 2016, there were estimated to be 51,923 households in South Ayrshire, a very small increase of 11 (+0.02%) over the previous year and 1,607 households (+3.2%) over the last 10 years. South Ayrshire’s percentage of change in number of households (+3.2%) over the last decade is the fourth smallest of all 32 Scottish council areas. Across Scotland there was an increase on the previous year of +0.7% and over the last 10 years an increase of +6.8%.

Figure 19: Household estimates for South Ayrshire

Estimated Nr of Households

2,500,000 52,500

Scotland South Ayrshire 2,450,000 52,000

2,400,000 51,500

2,350,000 51,000

2,300,000 50,500

Nr h'holdsNrScotland in Nr h'holds in South h'holdsin NrAyrshire

2,250,000 50,000

2006 2008 2009 2010 2011 2012 2013 2014 2015 2016 2007

2.5 Household Type

South Ayrshire' population is projected to decrease by -2% over the same period. Much of the projected increase in households is therefore the result of more people living alone or in small households. South Ayrshire's population is ageing, the number of people aged 65 or over is increasing much faster than the number of children and younger adults. This has an impact on household structure as children tend to live in larger households and older people in smaller ones. The average household size in South Ayrshire is projected to decrease from 2.14 people in 2016 to 1.98 people in 2039 (-8%).

The number of households containing just one adult is projected to increase by +23% from 18,204 in 2014 (35% of all households) to 22,399 in 2039 (41% of all households). The number of one adult households in Scotland as a whole is projected to increase by +31%.

Households containing just one adult with children are projected to increase by +30%, from 3,129 households in 2014 (6% of all households) to 4,060 households in 2039 (7% of all households).

The number of two adult only households is projected to rise by +7% from 17,374 in 2014 (33% of all households) to 18,555 in 2039 (34% of all households).

In contrast, the number of larger households is projected to fall. Those containing two or more adults with children are projected to decrease by -24% from 8,941 (17% of all households) in 2014 to 6,825 (13% of all households) by 2039.

Those households containing three or more adults without children are projected to decrease by -35% from 4,225 (8% of all households) in 2014 to 2,733 (5% of all households) by 2039.

Figure 20: Projected Household Split between 2014 and 2039

2.6 Household Projections

Despite the anticipated fall in population, the number of households in South Ayrshire is expected to change from 51,874 in 2014 to 54,573 in 2039, which is an increase of 5% (2,699) over the next 25 years. In Scotland, as a whole, the projected number of households is set to increase by 14% over the same 25-year period.

In Scotland, the number of lone adult households is projected to increase by 31% over the 25- year period. In South Ayrshire, the number of lone adult households is projected to increase by 23%. In contrast, the number of larger households in South Ayrshire is projected to fall, with the number of households of 2 or more adults with children decreasing by 24% over the 25- year period.

In South Ayrshire, households headed by those aged 75+ are projected to increase in number by 78% between the years 2014 and 2039. Households headed by those falling within the younger categories are all set to decrease over the same period.

Figure 21: Projected percentage change in household, by age of head of household, 2014-2039

Projected Percentage Change in Household, By Age of Head Household 2014-2039 100% 78% 79%

80%

60%

40%

20% 11% 6% 0% 1%

0% Percentage Change -1% -20% -6% -7% -18% -40% 16-29 years 30-44 years 45-59 years 60-74 years 75+ years

South Ayrshire Scotland

2.7 Single Person Households

The household composition in a geographical area can have a marked effect on the health and wellbeing of the population. Given the projected increase in the older population, alongside the reduction in the working age population, it is likely that the household composition in South Ayrshire will change considerably in the coming years.

Figure 22: Single person households.

Scotland 16-24 25-49 50-64 South Ayrshire 65+

0% 20% 40% 60% 80% 100%

Figure 22 shows that the age composition of those living in single person households is older in South Ayrshire than Scotland overall. Of those living in single person households in South Ayrshire, 47.3% are 65 or over, compared to 38.4% nationally. Due to changes in the population structure, it is likely that this will increase in the coming years.

2.8 Lone Parent Households

Another consideration of household composition is lone parents. In South Ayrshire, there are 3,129 households with a lone parent and one or more dependent children. This is 6.0% of South Ayrshire households, compared to 6.5% nationally.

2.9 Homelessness

The number of people presenting as homeless in South Ayrshire has decreased from 742 in 2015/16 to 724 in 2016/17 and is at its lowest number throughout the five year time period (see Figure 23 below).

Figure 23: People presenting as homeless in South Ayrshire

1000 946 857 743 742 800 702 724

600 Annual No. o f Homeless 400 Presentations

200

0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Source: SAC, Covalent SO5.2 04

In comparison with the other two Ayrshire Councils, South Ayrshire Council received the highest number of homeless applications for the period 2012/13 to 2016/17 (see Figure 24).

Figure 24: Homeless applications received 2012/13 to 2016/17

3,752 3,683 4,000 3,500 3,000 2,404 2,500 2,000 1,500 1,000 500 0 SouthAyrshire North Ayrshire East Ayrshire

2.10 Temporary Accommodation

The Council provides approximately 253 units of temporary accommodation. Temporary accommodation is provided by way of hostel and temporary furnished accommodation dispersed across South Ayrshire. The Council no longer uses Bed & Breakfast accommodation, except in exceptional circumstances.

The number of households in temporary accommodation accounts for 0.36% of all South Ayrshire households compared to 0.44% across Scotland.

3. Deprivation in South Ayrshire

3.1 Scottish Index of Multiple Deprivation (SIMD)

The SIMD is the Scottish government’s official too for identifying concentrations of deprivation throughout Scotland. However, this does not mean everyone living in that concentrated deprived area is deprived and not all deprived people live in deprived areas. The SIMD looks at multiple domains of deprivation. ‘Deprived’ does not just mean ‘poor’ or ‘low income’. It can also mean people have fewer resources and opportunities, for example in health and education. The SIMD ranking is a measure of relative, not absolute deprivation. An area’s deprivation is assessed in terms of 38 indicators of deprivation grouped into seven deprivation domains. They are employment, income, education, health, geographic access to facilities, crime and housing. SIMD 2016 splits Scotland into 6,976 small areas called datazones with each having a similar population based on the 2011 Census. The seven domains are combined into one SIMD, ranking each datazone in Scotland from 1 the most deprived to 6,976 the least deprived. Previous SIMD publications were split into 6,505 datazones derived from the 2001 Census. Therefore, direct comparisons between SIMD 2016 and previous SIMD publications are not advised. Also while the methodology has remained fundamentally the same, in the latest edition there were some changes to the indicators to reflect the introduction of Universal Credit, changes to the school examination system and improvement in data quality.

Figure 25 below provides a summary of the number of South Ayrshire datazones that are in the 15% most deprived in Scotland for each of the five SIMD publications since 2004 for the overall SIMD ranking and for each deprivation domain that make up the index.

Figure 25: Number and share of South Ayrshire datazones in Scotland’s 15% most overall deprived datazones in each of the five SIMD publications

Scotland’s 15% Most Deprived Datazones

2004 2006 2009 2012 20163

Domain

Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Number % National Share Local % Share Overall 13 1.3 8.8 13 1.3 8.8 18 1.8 12.2 17 1.7 11.6 19 1.8 12.4

Income 13 1.3 8.8 14 1.4 9.5 16 1.6 10.9 16 1.6 10.9 19 1.8 12.4

Employment 13 1.3 8.8 15 1.5 10.2 18 1.8 12.2 17 1.7 11.6 23 2.2 15.0

Health 19 1.9 12.9 15 1.5 10.2 22 2.2 15 21 2.2 14.3 27 2.6 17.6

Education 11 1.1 7.5 12 1.2 8.2 19 1.9 12.9 17 1.7 11.6 15 1.4 9.8

Geographic 25 2.6 17 18 1.8 12.2 18 1.8 12.2 28 2.9 19 18 1.7 11.8 Access

Crime N/A N/A N/A 16 1.6 10.9 17 1.7 11.6 17 1.7 11.6 18 1.7 11.8

Housing 0 0 0 0 0 0 0 0 0 0 0 0 6 0.6 3.9

There continues to be disparities in affluence across South Ayrshire with 19 datazones included in Scotland’s 15% most overall deprived datazones. This equates to an estimated 12,888 people or 11% of South Ayrshire residents living in the 15% most deprived datazones of Scotland. South Ayrshire now has a larger local share of the 15% most overall deprived datazones in Scotland than in the previous SIMD, 11.6% in 2012 compared with 12.4% in 2016 (a rise of 0.8 percentage points). There are a number of outlier datazones in Girvan (3), Maybole (1) and Troon (1) but most of the 15% most overall deprived datazones are in and around Ayr particularly Ayr North and Whitletts where the severest deprivation is evident. There are six datazones that suffer the severest (5% most deprived) level of overall deprivation. All are within the Ayr North area.

Based on the number of data zones in South Ayrshire and the total number of datazones across the whole of Scotland, if deprivation was uniformly distributed across Scotland, South Ayrshire’s expected national share 2.2%4. With this in mind the bulk of South Ayrshire’s national share of datazones for overall and individual deprivation domains are below the expected national share of the 15% most deprived – indicated by green shaded cells. In the last SIMD publication, South Ayrshire had a higher than expected share of datazones

3 Change in the total number of datazones in Scotland for 2016 SIMD from previous 6,505 to 6,976 and in South Ayrshire from 147 to 153. 4 This is the same for all years. 2004 – 2012 publications there were 147 South Ayrshire DZs out of total 6,505 Scottish DZs = 2.26% while 2016 publication has 153 South Ayrshire DZs out of total 6,976 Scottish DZs = 2.19%

considered to be in the 15% most health deprived in Scotland – indicated by pink shaded cells. Health or geographic access have consistently been the most deprived domains and housing the least in South Ayrshire at this level of deprivation for all SIMD publications.

Figure 26: Scotland’s 5%, 10%, 15% and 20% most overall deprived datazones in South Ayrshire (2016)

3.2 Income Deprivation

The Scottish Index of Multiple Deprivation income domain identifies areas where there are concentrations of individuals and families living on low incomes. The income domain is constructed by counting the number of people claiming relevant benefits, and dividing by the total population from the 2014 Small Areas Population Estimate rather than looking at actual income which is not available at datazone level. Thus the domain score is a simple percentage. The five income deprivation indicators are:

 Number of adults (aged 16-59) receiving Income Support (IS) or income based Employment and Support Allowance (ESA), and the number of adults (all ages) receiving Jobseeker’s Allowance (JSA)  Number of adults (aged 60 plus) receiving Guaranteed Pension Credit  Number of children (aged 0-15) dependent on a recipient of IS, JSA or ESA  Number of adults (all) not in paid employment receiving Universal Credit  Number of adults and children in Tax Credit families on low incomes

In SIMD2016 there are 19 South Ayrshire datazones that are part of Scotland’s 15% most income deprived. A direct comparison of the number of datazones income deprived between SIMD 2012 and SIMD 2016 cannot be made because of changes to the datazone boundaries and total number. However, it is an increase in terms of national and local share from 1.6% and 10.9% respectively to 1.8% and 12.4%.

There are an estimated 14,230 people or 12.6% of residents living throughout South Ayrshire who are income deprived which is a slightly higher percentage than that for Scotland as a whole at 12.3%.

Of the 12,888 people living in the 15% most overall deprived datazones in South Ayrshire, just under one third (31.5% or 4,055) of adults and children are ‘income deprived’ in the sense that they are dependent on key benefits. This means that there are more than twice as many adults and children, 8,833 (12,888 – 4,055) living in low-income households outside the so- called ‘core’ deprivation or 15% most overall deprived datazones.

There are eight income deprived datazones in the 5% most income deprived vigintile with four of these ranked equal or worse than 50th in Scotland. The most income deprived data zone in South Ayrshire is in the area of Ayr North Harbour, Wallacetown and Newton South – it’s ranked 30th.

Datazone level indicator scores and hence numbers of income deprived CANNOT be directly compared to previous SIMD publications due to the introduction of a new indicator and also the changed datazone boundaries used in SIMD 2016. However, the table below shows the population and percentage of those income deprived and that South Ayrshire’s percentage of income deprived was 0.2 percentage points lower than that across the whole of Scotland in

SIMD2012 whereas in SIMD2016 South Ayrshire’s percentage is 0.3 percentage points higher than Scotland’s.

Figure 27: Income deprivation SIMD 2012 and 2016 SIMD2012 SIMD2016 South Ayrshire Number 14,765 14,230 South Ayrshire Percentage 13.2% 12.6% Scotland Percentage 13.4% 12.3%

The table below lists the percentage of the population that is considered income deprived within each locality and neighbourhood. The 15% most income deprived datazones are clustered in Ayr, particularly the Ayr North and Whitletts area. There are also outlier datazones in Girvan (2), Maybole (1) and Troon (1).

Figure 28: Income deprivation by locality and neighbourhood

% Income Deprived % Income Deprived Locality 2012 2016

Ayr North and Former Coalfield Communities 23.6% 23.4%

Ayr South & Coylton 9.9% 8.6%

Girvan & South Carrick Villages 17.0% 17.6%

Maybole & North Carrick Villages 13.3% 12.7%

Prestwick 10.1% 9.3%

Troon 9.6% 9.3%

% Income Deprived % Income Deprived Neighbourhood 2012 2016

Alloway and Doonfoot 4.5% 3.4%

Annbank, Mossblown & Tarbolton - the Coalfields 14.8% 13.8%

Ayr North Harbour, Wallacetown and Newton 29.0% South 30.0%

Ayr South Harbour and Town Centre 15.5% 13.1%

Barassie 15.8% 15.2%

Belmont 10.0% 8.7%

Castlehill and Kincaidston 15.0% 13.9%

Coylton 7.7% 7.0%

Dalmilling and Craigie 23.2% 23.0%

Dundonald & Loans 9.6% 10.3%

Girvan 19.2% 19.2%

Heathfield 13.7% 13.0%

Holmston and Forehill 9.0% 8.3%

Lochside, Braehead and Whitletts 30.6% 30.5%

Maybole 16.5% 16.1%

Muirhead 7.0% 6.4%

Newton North 10.8% 10.6%

North Carrick Villages 10.0% 9.5%

Prestwick Airport and Monkton 10.2% 8.6%

Prestwick East 8.9% 7.3%

Prestwick West 6.2% 5.8%

South Carrick Villages 13.1% 14.2%

Symington 10.2% 10.0%

Troon 7.8% 7.1%

South Ayrshire 13.2% 12.6%

Scotland 13.4% 12.3%

Figure 29: SIMD 2016 Income Deprivation in South Ayrshire

3.3 Employment Deprivation

The Scottish Index of Multiple Deprivation employment domain is constructed by counting the number of people claiming relevant benefits and dividing by the working age population taken from the 2014 Small Area Population Estimate. The domain score is a simple percentage. The three employment deprivation indicators used are:

 Working age unemployment claimant count averaged over 12 months;  Working age Incapacity Benefit recipients or Employment and Support Allowance recipients; and  Working age Severe Disablement Allowance recipients

In SIMD2016 there are 23 South Ayrshire datazones that are part of Scotland’s 15% most employment deprived. A direct comparison of the number of datazones employment deprived between SIMD 2012 and SIMD 2016 cannot be made because of changes to the datazone boundaries and total number of datazones. However there is an increase in terms of national and local share from 1.7% and 11.6% respectively to 2.2% and 15.0%. There are an estimated 7,900 people or 11.7% of South Ayrshire’s working age population who are employment deprived which is higher than the 10.7% for the whole of Scotland. Of the 12,888 people living in the 15% most overall deprived datazones in South Ayrshire, an estimated 8,254 are of working age of which 2,295 are employment deprived. In other words, 27.8% or just over 1 in 4 working age people living in the 15% most overall deprived datazones in South Ayrshire are employment deprived. That means there are 5,605 employment deprived people (7,900 – 2,295) living outside the so-called ‘core’ deprivation or 15% most overall deprived datazones.

There are seven employment deprived datazones in the 5% most employment deprived vigintile with two of these ranked worse than 50th in Scotland. The most employment deprived data zone in South Ayrshire is in the area of Ayr North Harbour, Wallacetown and Newton South – it’s ranked 24th.

The table below shows the number and percentage of employment deprived in South Ayrshire has decreased 1.6 percentage points but still remains 1.0 percentage points above the whole of Scotland share which has also decreased 2.1 percentage points in comparison to SIMD2012.

Figure 30: Employment Deprivation SIMD 2012 and 2016

SIMD2012 SIMD2016 South Ayrshire Number 8,805 7,900 South Ayrshire Percentage 13.3% 11.7% Scotland Percentage 12.8% 10.7%

The table below lists the percentage of the working age population that is considered employment deprived within each locality and neighbourhood. The 15% most employment deprived datazones are clustered Ayr, particularly the Ayr North and Whitletts area. There are also outlier datazones in Girvan (3), Maybole (2) and Troon (2).

Figure 31: Employment deprivation by locality and neighbourhood

% of Working Age Locality Population Employment Deprived 2016

Ayr North and Former Coalfield Communities 20.6%

Ayr South & Coylton 8.8%

Girvan & South Carrick Villages 14.0%

Maybole & North Carrick Villages 1 1.5%

Prestwick 8.7%

Troon 8.7%

% of Working Age Neighbourhood Population Employment Deprived 2016

Alloway and Doonfoot 4.5%

Annbank, Mossblown & Tarbolton - the Coalfields 11.4%

Ayr North Harbour, Wallacetown and Newton South 28.4%

Ayr South Harbour and Town Centre 14.2%

Barassie 14.6%

Belmont 7.9%

Castlehill and Kincaidston 12.6%

Coylton 7.2%

Dalmilling and Craigie 19.6%

Dundonald & Loans 9.4%

Girvan 15.7%

Heathfield 11.4%

Holmston and Forehill 7.7%

Lochside, Braehead and Whitletts 25.3%

Maybole 15.0%

Muirhead 5.3%

Newton North 10.6%

North Carrick Villages 8.2%

Prestwick Airport and Monkton 7.1%

Prestwick East 7.4%

Prestwick West 5.5%

South Carrick Villages 10.4%

Symington 10.3%

Troon 7.4%

South Ayrshire 11.7%

Scotland 10.7%

Figure 32: SIMD 2016 Employment Deprivation in South Ayrshire

3.4 Geographic Access to Services

The Scottish Index of Multiple Deprivation (SIMD) measures geographic access using a number of public transport and drive times to essential services, such as a GP surgery, a post office, a primary and a secondary school, a petrol station and shopping facilities.

In South Ayrshire 18 (11.8%) of its 153 data zones are in the 15% most deprived nationally with regards to accessing services. The main clusters, in terms of the 15% most access deprived, are mainly in the more rural areas of Carrick South, Carrick North, around Coylton and Dundonald. In total this equates to around 14,674 people in South Ayrshire living in areas that are regarded as having insufficient/deprived access to services..

Figure 33: SIMD 2016 Access Deprivation in South Ayrshire

3.5 Disabled Employment

The employment rate of disabled people over the last four years has ranged from 37.5% in FY 2015/16 to a high of 46.4% in the latest FY 2016/17. Apart from the dip in 2015/16 it has remained slightly higher than the disabled employment rate across the whole of Scotland. However, the disabled employment rate remains well below the non-disabled employment rate for South Ayrshire and Scotland.

Figure 34: Employment rates 16-64 years by Disabled vs Non-Disabled

3.6 Lone Parent Employment

In 2011, 61% of male lone parents and 61% of female lone parents in South Ayrshire aged 16 to 74 were in employment compared with 55% of male lone parents and 50% of female lone parents in 20015. Of those lone parents in employment in South Ayrshire, 62% work part-time and 38% work full-time.

3.7 Child Poverty

In South Ayrshire, 16% of children6 are classified as living below the poverty line7 before housing costs (BHC), while 26% of children are classified as living in poverty after housing costs (AHC) have been deducted from their income. This level is the 8th highest level of child poverty in Scotland8.

5 2011 Census 6 Child - dependent children under the age of 20. A dependent child is defined as an individual aged under 16 or an individual aged 16 to 19 years who is: not married nor in a Civil Partnership nor living with a partner; and living with parents; and in full-time non- advanced education or in unwaged government training (http://www.hmrc.gov.uk/statistics/child-poverty/measure.pdf). 7 The proportion of children living in families in receipt of out of work (means-tested) benefits or in receipt of tax credits where their reported income is less than 60 per cent of median income (http://www.hmrc.gov.uk/statistics/child-poverty/measure.pdf). 8End Child Poverty, October – December 2015 36

The results show that there is variation across South Ayrshire’s eight multi member wards. In Ayr North ward, 38% of children are living in poverty (AHC) and 35% in Girvan & South Carrick ward compared with 18% in Prestwick and Troon wards. The table below summarises the South Ayrshire results by multi member ward.

Figure 35: Child Poverty across Multi-Member Wards

3.8 Fuel Poverty

32% of South Ayrshire residents spend more than 10% of their household income on heating costs and are said to be in fuel poverty9. This level rises to 42% of those residents that are of pensionable age10. The Scottish average for all residents is 34% and 49% for those of pensionable age.

Some of the highest percentages of fuel poverty in areas can be found in Girvan, South Carrick Villages, North Carrick Villages, Maybole and Annbank, Tarbolton and Mossblown.

9 Scottish House Condition Survey published feb 2017 10 Pensionable age defined as 60+ females, 65+ males. Since 6 April 2010 women's State Pension age has been increasing for those born on or after 6 April 1950. As at April 2015, women's State Pension age is 62.5 and it will be 63 by April 2016. State Pension age is due to be equalised at 65 for both men and women by November 2018. It is then scheduled to increase again to 66 by October 2020 and 67 by April 2028

Figure 36: Estimated Households in Fuel Poverty

4. General Population Health

4.1 Life Expectancy and Healthy Life Expectancy

Life expectancy in 2013-2015 in South Ayrshire was 77.7 years for males and 81.0 years for females. The 2013-2015 life expectancy estimate for South Ayrshire for males of 77.7 was higher than the average for Scotland as a whole. Life expectancy in Scotland was 77.1 years for males. The 2013-2015 life expectancy estimate for South Ayrshire for females of 81.0 was slightly lower than the average for Scotland as a whole. Life expectancy in Scotland was 81.1 years for females11.

The gap between male and female life expectancy at birth in South Ayrshire has decreased from 5.2 years in 2001-2003 to 3.3 years in 2013-2015. Male life expectancy has been increasing at a faster rate than for females since 2001-2003.

Extended life expectancy means that more people are living to over 75, but healthy life expectancy (i.e. the number of years of good health enjoyed by people) is not increasing as fast. As a result, those aged over the age of 60 are likely to spend more years in poor health, requiring care and support.

Figure 37: Life Expectancy between 2001 and 2015

The table below is the latest information for Intermediate zones in South Ayrshire. It’s based on a 5 year span centred on 2011 hence the slight difference in the life expectancy for South Ayrshire.

11 National Records of Scotland via ScotPHO profiles

A boy born in Prestwick Airport and Monkton area can expect to live to around 82.5 years while one born in Ayr North Harbour, Wallacetown and Newton South area might live to 72.1 years of age. A new born girl in Muirhead can expect to reach 85.7 years but her peer in Annbank, Mossblown & Tarbolton area might live to around 77.0 years of age.12

Figure 38: Life expectancy of males and females by Intermediate Zone

2010-2012 Intermediate Zone Males Females Alloway & Doonfoot 80.8 84.3 Annbank, Mossblown, Tarbolton 75.8 77.0 Ayr North Harbour, Wallacetown & Newton South 72.1 78.1 Ayr South Harbour & Town Centre 74.1 81.8 Barassie 78.0 79.0 Belmont 80.2 84.0 Carrick North 79.4 78.4 Carrick South 78.5 82.6 Castlehill & Kincaidston 75.7 84.3 Coylton 77.6 81.2 Dalmilling & Craigie 72.3 78.1 Dundonald, Loans & Symington 75.8 79.9 Girvan Ailsa 75.9 79.4 Girvan Glendoune 74.8 81.8 Heathfield 79.0 81.6 Holmston & Forehill 80.6 83.6 Lochside, Braehead & Whitletts 76.3 78.5 Muirhead 81.4 85.7 Newton North 78.4 82.4 Prestwick Airport & Monkton 82.5 82.0 Prestwick East 79.9 82.5 Prestwick West 80.6 81.9 Maybole 77.7 80.2 Troon 77.5 80.7 South Ayrshire 77.3 81.2 Scotland 76.6 80.8

12 ISD, Scotland Community Health profiles

4.2 General Health

This section examines the general health of the residents of South Ayrshire. Naturally, there are many different factors which could be considered here. One important aspect is self- perception of general health.

Figure 39 shows the self-reported general health of people living in this area compared to Scotland as a whole.

Figure 39: General health of residents 2011 census

This chart illustrates that a marginally lower proportion of South Ayrshire residents reported feeling in ‘very good health’ than in Scotland overall (50.8% of residents compared to 52.5% for Scotland). Looking at the first two categories combined, within South Ayrshire, almost 81% of residents stated their health was very good or good, compared to 82% of the Scottish population. This indicates that the perception of general health in South Ayrshire is similar to that in Scotland.

Figure 40: General health of residents by age and sex

Figure 40 above looks at the self-reported perception of general health by age and sex. It is clear from this that feelings regarding general health are very similar for males and females, but they are very different across age groups. This is not surprising given the differences in health and care need across age groups. For the 0-15 and 16-44 age groups, the percentage of residents who reported feeling in very good health is highest, at around 85% for the former and 65% for the latter. This declines throughout the age groups, with only around 15% of the 70+ population reporting that they feel in very good health.

Figure 41: Long term health problem or disability by age – extent to which day to day activities are limited

Another aspect of the health profile of South Ayrshire relates to the extent to which people feel their day-to-day activities are limited by a long-term health problem or disability. Here there is a clear association with age, with a greater number of people in each age group reporting that their day-to-day activities are limited by long-term health problems or disabilities.

4.3 Long Term Conditions

Long-term conditions are health conditions that last a year or longer, impact on a person’s life, and may require on-going care and support. The definition does not relate to any one condition, care-group or age category. Around two million people, 40% of the Scottish population, have at least one long-term condition and one in four adults over 16 reports some form of long-term illness, health problem or disability.

Long-term conditions become more prevalent with age. According to Audit Scotland, the number of people aged 75 and over will rise by 60% between 2004 and 2031. By the age of 65, nearly two-thirds of people will have developed a long-term condition.

Older people are also more likely to have more than one long-term condition: 27% of people aged 75-84 have two or more. There is a predicted rise of 38 per cent in the number of people who will be over 85 in the population by 2016, and a 144% in the over 85s by 2031.

The human costs and the economic burden for health and social care are profound. 60% of all deaths are attributable to long-term conditions and they account for 80% of all GP consultations. There are clear links between long-term conditions, deprivation, lifestyle factors and the wider determinants of health. People living with a long-term condition are likely to be more disadvantaged across a range of social indicators, including employment, educational opportunities, home ownership and income.

Someone living in a disadvantaged area is more than twice as likely to have a long-term condition as someone living in an affluent area, and is more likely to be admitted to hospital because of their condition11.

There is no straightforward way to capture the number of residents living with a long-term condition in Scotland. The best proxy for this is the Quality Outcomes Framework (QOF), which is a scheme in which GP practices are funded to keep up-to-date registers of patients living with certain conditions. Figure 42 shows the number of people on QOF registers in South Ayrshire across a range of conditions.

Figure 42: Number of South Ayrshire residents on QOF Registers

25,000 20,000 15,000 10,000 5,000 0

This shows that hypertension is the most common of long term conditions, with 19,098 residents in South Ayrshire living with this condition. This is followed by depression (8,806), asthma (7,463) and diabetes (6,427).

Figure 43: Percentage of patients in QOF practice

18 16 14 12 10 8 6 4 2

0 %of QOF patients in practice

South Ayrshire Scotland

This chart shows a comparison of the percentage of patients listed on QOF registers for South Ayrshire and Scotland. For each of these conditions (apart from Mental Health and Osteoporosis where the rates are the same), the rate is higher in South Ayrshire than Scotland. For example, in relation to hypertension the rate is 16.9% in South Ayrshire compared to 13.9% in Scotland. Given the link between age and long-term conditions, this is likely due to the older population living in South Ayrshire than in Scotland as a whole.

4.4 Mortality

In 2015, the main cause of death in South Ayrshire was circulatory disease, followed by cancer.

In 2015, the main cause of death in South Ayrshire for men was circulatory disease followed by cancer. In 2015, the main cause of death in South Ayrshire for women was circulatory disease followed by cancer.

Figure 44: Cause of death in males, South Ayrshire, 2015

Cancer

16% Circulatory 30% 6% Disease 5% Respiratory Disease 14% Digestive Disease 30% External Causes

Figure 45: Cause of death in females, South Ayrshire, 2015

Cancer 24% 26% Circulatory Disease Respiratory Disease 3% Digestive Disease 4% External Causes 15% 27% Other

In South Ayrshire, the premature mortality rate (age-standardised) for under 75’s per 100,000 population increased from 422 in 2015 to 451 in 2016. The South Ayrshire rate in 2016 is higher than the Scottish average at 440 (see Figure 46 below).

Figure 46: Premature mortality rate per 100,000 (people aged under 75)

500 440 400

300

200

100

Rate per 100,000 population 0 2010 2011 2012 2013 2014 2015 2016 South Ayrshire Scotland

In South Ayrshire, the premature mortality rate for under 75’s from cancer per 100,000 using three-year aggregates from 2013 - 2015 was 157.7 which is lower than the Scottish average of 167.1 (see Figure 47 below). Although the South Ayrshire rate was below that of Scotland for 2013 – 2015, it can be seen that the gap has shortened between them due to the increase in the South Ayrshire rate from 2012 – 2014 to 2013 – 2015.

Figure 47: Premature mortality from cancer, rate per 100,000 (people aged under 75)

190

180

170

160

150

Rate per 100,000 population 140 2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

In South Ayrshire, the premature mortality rate for under 75’s from coronary heart disease per 100,000 has gradually improved between 2006 and 2015. The rate decreased from 83.3 in 2006-2008 to 53.9 in 2013-2015. The South Ayrshire rate has been very similar to the Scottish average since 2011 and for the first time throughout the time period was slightly lower than the Scottish average in 2013-2015 (see Figure 48 below).

Figure 48: Premature mortality from coronary heart disease, rate per 100,000 (people aged under 75)

Rate per 100,000 Rateper 100,000 population 2006-2008 2007-2009 2008-2010 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

4.5 Smoking

According to the 2014 Scottish Household Survey (SHS), smoking prevalence in South Ayrshire adults dropped from 26% in 2005/06 to 22% in 2014. Meanwhile the level of smoking prevalence in adults across Scotland was at 21%. The Scottish Health Survey (SHeS) covering the period 2013-2016 has smoking prevalence for all adults at 18% in South Ayrshire and 21% across Scotland. Note SHS no longer including smoking.

Figure 49: Percentage of adults who are regular smokers.

4.6 Obese Adults

The proportion of adults in South Ayrshire considered to be obese over a rolling three-year period for men was 74% and women 66% compared to the Scottish percentage of 69% and 61% respectively.13

4.7 Physical Activity

Data from the Scottish Health Survey shows that the percentage of adults in South Ayrshire who reported meeting physical guidelines has risen since 2008. In 2013-16 69% of men and 59% of women did 150 minutes of moderately intensive physical activity per week, compared to 44% of men and 31% of women in 2008-11.

13 Scottish Health Survey

4.8 Palliative Care /End of Life

Palliative and end of life care are integral aspects of the care delivered by any health or social care professional to those living with and dying from any advanced, progressive or incurable condition. Palliative care is not just about care in the last months, days and hours of a person’s life, but about ensuring quality of life for both patients and families at every stage of the disease process from diagnosis onwards. A palliative care approach should be used as appropriate alongside active disease management from an early stage in the disease process.

Palliative care focuses on the person, not the disease, and applies a holistic approach to meeting the physical, practical, functional, social, emotional and spiritual needs of patients and carers facing progressive illness and bereavement.

There is little systematic data recorded on a person's preferred place of care at end of life. A surrogate measure for this is the: "Percentage of last six months spent in home or a community setting". Although this is not a direct measure of compliance with people's preferred place of death, it can serve to provide a broad indication of progress in implementation of the national action plan.

Figure 50: Percentage of last 6 months at home or in a community setting

Percentage (%) 84

83 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

South Ayrshire Scotland

The above figure shows that in 2013/2014, the South Ayrshire percentage fell below the national rate to 85% compared to 86% for Scotland overall. This gap has widened in 2016/17 where the South Ayrshire percentage is 2% below the Scotland figure at 85% compared to 87.

5. Specific Health Conditions

5.1 Learning Disabilities

The population of adults with learning disabilities, in 2017, is 602, based on the number of people known to South Ayrshire Council who are:

 Aged 16-17 and not in full-time education;  Aged 18 or over; or  Who have had contact with South Ayrshire Council in the past year.

From these data, the rate of people with learning disability in South Ayrshire Council is 6.4 per 1,000 adults, higher than the national average of 5.2. There has been an increase in the total number of people with learning disabilities known to Local Authorities since 2011, in line with the national trend, and a marginal (non-significant) rise from 5.4 in 2010.

The GP register for South Ayrshire indicated a total of 655 people with a learning disability registered in 2013-2014, this is a rate of 0.56 per 100 patients, which is higher than the national rate across Scotland of 0.48 per 100 patients. (NOTE THE LD indicator has not been in the 2014/15 and 2015/16 QOF’s).

The age breakdown of the adult learning disability population in South Ayrshire is shown in the table below. There are significantly more males in the younger groups and roughly the same in the older age range. There could be a number of explanations for this, including the improved recognition and recording of Autistic Spectrum Disorder (ASD) which is more common in males. In 2017, there were 93 adults diagnosed with ASD compared to 90 in 2015.

Figure 51: Adults with learning disabilities known to South Ayrshire Council in 2017

16-17 18-20 21-34 35-44 45-54 55-64 65 and Unknown Total Gender over split Males 1 27 131 48 65 53 36 0 361 60% Females 0 10 73 33 45 44 36 0 241 40% Total 1 37 204 81 110 97 72 0 602 % males 100% 73% 64% 60% 59% 55% 50%

Data Source : https://www.scld.org.uk/evidence-and-research/statistics-learning-disability-scotland/2017-report/

Figure 52: Percentage of adults with an AS diagnosis as a proportion of all adults with a Learning Disability and or an AS diagnosis known to South Ayrshire Local Authority 2009-2017

0 2009 2010 2011 2012 2013 2014 2015 2017

Monitoring of people with autism using statutory services is limited and will only record members of the population currently in contact with services. The increase demonstrated above may reflect better diagnosis and/or more effective data recording by service providers.

Of the 602 adults with learning disabilities:

 Around 80.1% have a personal life plan (well above the national average of 64.2%);  42% live with a family carer, compared to 31% nationally;  3.6% are in some sort of employment, compared to 6.2% nationally;  16.6% attend a day centre compared to 19.0% nationally;  5.8% live in care homes, compared to 7.6% nationally; and  13.1% live in supported accommodation compared to 15.9% nationally.

Evidence from a variety of sources suggests that there has been an increase of around 1% per annum in the prevalence of learning disability (LD) in adults over the past 35 years, due mainly to increases in survival17. Among young people with severe and complex learning disabilities, and the reduced mortality of older adults with learning disabilities, this increase may have fallen in recent years.

For older people (aged 60+), two-thirds with learning disabilities have additional mental disorders, such as dementia. Therefore, the most significant challenge in the future will be the ageing of the learning disability population and the additional and focussed support needs that will be required.

In particular, for adults with profound learning disabilities, it is reported that there is a higher incidence of epilepsy, sensory impairments, and gastrointestinal, respiratory and mobility problems than in the population as a whole.

About 20-25% of children diagnosed with learning disabilities have epilepsy, but this rises to 50% in children assessed as having profound learning disabilities. Among this group is a significant proportion that may need help with emotional and behavioural problems.

The key future issues for learning disability include:

 Increasing survival of pre-term infants with multiple disabilities leading to long-term increasing numbers of people with complex physical disabilities;  Increasing recognition of conditions such as Foetal Alcohol Syndrome Disorder, Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder;  Increasing numbers of older people with complex needs and end of life care needs; and  Ageing of carers.

5.2 Mental Health

Prevalence of diagnosed mental health conditions NHS Quality and Outcomes Framework (QOF) data14 for GP practices in South Ayrshire gives a profile of patients on GP registers with a diagnosed mental health condition.

 There are 20 GP practices in South Ayrshire with a total of 116,844 registered patients at April 2015.  In 2014/2015 there were 1,029 patients with a serious mental illness such as schizophrenia, bipolar affective disorder or other psychoses.  In 2014/2015 there were 8,915 people newly diagnosed with depression and whose severity of depression has been assessed.  In 2014/2015 there were 1,170 people diagnosed with dementia.

Figure 53: Prevalence of serious mental illness, diagnosed depression and dementia

Patients Prevalence Scottish Indicator Explanation on QOF (per 100 prevalence register patients) Serious Since April 2006, the definition has 1,029 0.9 0.9 mental included only patients with serious illness (MH) mental illness, defined as schizophrenia, bipolar affective disorder or other psychoses Depression The register for the depression 2 8,915 7.6 6.3 (DEP2) indicator counts patients with newly diagnosed depression and then measures the severity of the depression using a validated primary care assessment tool Dementia The definition of this indicator applies to 1,170 1.0 0.8 all people diagnosed with dementia either directly by the GP or through referral to secondary care Source: NHS QOF, 2014/15

14 NHS QOF data, 2014. http://www.isdscotland.org/Health-Topics/General-Practice/Quality-And-Outcomes- Framework/

The prevalence of serious mental illness in South Ayrshire is roughly comparable to the average prevalence for Scotland. The prevalence of diagnosed depression and dementia per 100 patients in South Ayrshire are higher than the Scottish average.

Figure 54: Prevalence of diagnosed mental illness 2009/10 – 2014/15

Prevalence of diagnosed mental illness 2009/10 - 2014/15 0.88

0.87 0.86 0.85 0.84 0.83 0.82 0.81

0.8 Prevalenceper 100 people 0.79 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

South Ayrshire Scotland

Figure 54 shows the prevalence rates for diagnosed mental illness in South Ayrshire and Scotland for 2009/10 to 2014/15. The prevalence in South Ayrshire remained consistent with the Scottish average over the period.

Figure 55: Prevalence of diagnosed depression 2009/10 to 2014/15.

Prevalence of diagnosed depression 2009/10 - 2014/15

2 Prevalenceper 100 people 0 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

South Ayrshire Scotland

Figure 55 shows that the prevalence of diagnosed depression in South Ayrshire has remained above the Scottish average for the period. The rate of decreasing prevalence is consistent with the national picture.15

Other local mental health indicators A number of other mental health indicators are collected nationally, including measures relating to prescribed drugs, psychiatric hospitalisation and deaths from suicide.

Figure 56: South Ayrshire Mental Health Indicators, 2015

Indicator South Scottish Ayrshire Average Average Patients prescribed drugs for 20% 18% anxiety/depression/psychosis – estimated number and percentage of population being prescribed drugs for anxiety, depression or psychosis Patients with a psychiatric hospitalisation – Patients 283.2 286.2 discharged from psychiatric hospitals – 3-year total number and 3 year average annual measure* Suicide rates per 100,000 population (All ages) 9.9 13.2 (2012-2016)

Source: South Ayrshire CHP Health and Wellbeing Profile 2015/16 *3-year age-sex standardised rate per 100,000 population per year

The CHP profile found that, in 2015:

 The number of patients prescribed drugs for anxiety, depression or psychosis was significantly “worse‟ in South Ayrshire than the Scottish average.  The 3-year average for patients with a psychiatric hospitalisation was higher than the Scottish average but not considered to be significantly different statistically.  The 5-year average suicide rate was lower than the Scottish average but not considered to be significantly different statistically.

15 In 2012/13, a change was introduced to the technical business rules for this indicator that excluded all patients identified prior to April 2006, which means that the latest figure is not comparable to previous years. The prevalence figure for 2012/13 has been steadily increasing, and is often not seen as reliable due partially to the cumulative nature of this register. Individuals with resolved depression will only be taken off the register if this is recorded by the practice and this is not done in all cases.

WEMWBS

Wellbeing is measured using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) questionnaire16. It has 14 items designed to assess: positive affect (optimism, cheerfulness, relaxation) and satisfying interpersonal relationships and positive functioning (energy, clear thinking, self-acceptance, personal development, mastery and autonomy. The scale uses positively worded statements with a five-item scale ranging from '1 - none of the time' to '5 - all of the time'. The lowest score possible is therefore 14 and the highest score possible is 70; the tables present mean scores.

Figure 57: WEMWBS variable mean score by sex, 2008 – 2015

South Ayrshire 2008 – 2011 Mean 2012 – 2015 Mean Difference from Score Score earlier to recent period Men 49.5 50.8 1.3 Woman 49.0 49.2 0.2

Figure 58: WEMWBS variable mean score by sex, 2008 - 2015

Scotland 2008 – 2011 Mean 2012 – 2015 Mean Difference from Score Score earlier to recent period Men 50.1 50.2 0.1 Woman 49.7 49.8 0.1

5.3 Dementia

The number of people with a diagnosis of dementia on the Quality and Outcomes Framework Register has increased from 697 in 2006/07 to 1,160 in 2015/1618. It is important to note that this relates only to people who have been diagnosed as having dementia. It is likely, therefore, to be an underestimation of the number of people actually living with dementia.

Figure 59: Number of people with a diagnosis of dementia on the QOF Register – South Ayrshire

1400 1143 1159 1195 1170 1160 1200 1107 1000 818 728 800 697 699 600 400 200 0 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

16 Note that this analysis has used the questionnaire with 14 questions with a highest score of 70. The WEMWBS short version with seven questions has not been used here.

Over the period, the prevalence rate for diagnosis in South Ayrshire has risen from 0.59 in 2006/07 to 1.03 in 2015/16. This rise is much greater compared to Scotland as a whole which has risen from 0.55 in 2006/07 to 0.80 in 2015/16. Moreover, the population structure in South Ayrshire means that the increase is likely to become greater in the coming years.

Figure 60: Raw prevalence rate (per 100 patients) for diagnosis of dementia – South Ayrshire

1.20 1.00 0.80 0.60 0.40 0.20 0.00 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

South Ayrshire Scotland

Data source: http://www.isdscotland.org/Health-topics/General-practice/Quality-and-outcomes-framework/2015-16/Register-and- prevalence-data.asp

5.4 Suicide Rates

In 2012-16, the rate in South Ayrshire was significantly low compared to Scotland overall.

Figure 61: Suicide Crude rates per 100,000 population (all ages): Persons, 5-year periods from 1997-2001 to 2012-16, by local authority area.

20 15 10 5 0 1997-2001 2002-2006 2007-2011 2012-2016

South Ayrshire Scotland

Data Source: http://www.scotpho.org.uk/health-wellbeing-and-disease/suicide/data/local-authority

5.5 Risk Taking Behaviour

5.5.1 Alcohol

Alcohol problems are a major concern for public health in Scotland. Short-term problems such as intoxication can lead to risk of injury and is associated with violence and social disorder. Over the longer term, excessive consumption can cause irreversible damage to parts of the body such as the liver and brain. Alcohol can also lead to mental health problems, for

example, alcohol dependency and increased risk of suicide. In addition, alcohol is recognised as a contributory factor in many other diseases including cancer, stroke and heart disease. Wider social problems include family disruption, absenteeism from work and financial difficulties.

Figure 62: Rate of alcohol related hospital stays

850 793.8 800 777.4 750 722.9 702.9 700 650 2012/13 2013/14 2014/15 2015/16

The rate of alcohol related hospital stays continues to show a downward trend, however it is too early to confirm if this is a long-term trend. Although there has been an improvement in South Ayrshire the rate is still higher than the national average of 664.5.

In 2015/16 the rate of stays was 702.9 (n=785). The number of patients was 526, of which 229 (44.5%) were new patients. The average number of stays per patient was 1.5.

5.5.2 Drugs

The illicit use of drugs and particularly opiates, benzodiazepines and psychostimulants, causes significant problems within Scotland as it does in other parts of the UK and Europe. Some of these problems are primarily social in nature, involving, for example, increases in acquisitive crime, prostitution, unemployment, family breakdown and homelessness. Others are more clearly associated with health problems, for example, the transmission of communicable diseases (HIV, hepatitis), injecting related injuries and increased demands upon health care services.

Figure 63: Rate of drug related hospital stays per 100,000 population

250 232.4 200 176.5 150 152.9 168.4 100 112.4 50 0 2012/13 2013/14 2014/15 2015/16 2016/17 South Ayrshire Scotland

https://www.isdscotland.org/Health-Topics/Drugs-and-Alcohol-Misuse/Publications/2017-09-26/DRHS_dashboard.swf

Data in 2015/16 had shown a positive decrease locally however an increase was seen in 2016/17. This increase is comparable to the increase in drug related deaths both locally and nationally.

It is worth noting the actual numbers (n = 217 in 2016/17) are low and variations can have a significant impact on the rate.

The majority of stays were emergency admissions (91.2% for 2016/17) and the stays were for less than one week (83.9% in 2016/17). 70.5% of admissions were for opioids (n = 153).

Drug related deaths increased significantly in 2016 to the highest level seen, both locally (n = 22) and across Scotland (n = 867, NRS 2016). The increase has been particularly among older drug users (over 35 years) who may have a range of underlying health conditions.

Reducing drug related deaths remains a priority for the ADP. The local Drug Death Prevention Group continues to meet to develop actions to improve engagement with individuals at risk, including the provision of Naloxone Kits. The DDPG established a baseline position in line with the good practice guidelines in the Staying Alive in Scotland report and are taking forward local improvement actions.

Figure 64: Drug Related Deaths

25 22 20 14 15 15 12 10

0 2013 2014 2015 2016

Data Source: National Drug Related Deaths Database 2016

6. Unscheduled Care

A key consideration in the health of a population is the extent to which they require unscheduled care. This typically relates to unplanned care and treatment which takes place in a hospital setting in an emergency. One of the key priority areas to emerge from the Public Bodies (Joint Working) (Scotland) Act, 2014 is to achieve a reduction in unscheduled care and an increase in anticipatory and planned care, working in partnership with social care and third sector services. This is required because the current pressure on the acute sector and the aging population mean that the current system is unsustainable in the future.

6.1 Accident and Emergency

Figure 65: Rate of A&E attendances (per 1,000 population)

400 300 200 100 0 2012 2013 2014 2015 2016

South Ayrshire Scotland

Figure 65 above shows that the rate (per 1,000 population) of attendances at Accident and Emergency in South Ayrshire is higher than for Scotland as a whole. This has been the case since 2012. In 2016, the rate of A&E attendances for South Ayrshire was 350.2 per 1,000 population, compared to 303.1 for Scotland as a whole.

Figure 66 shows a breakdown of A&E attendances by age. In 2016, residents in the 0-4 and 85+ age groups generated the highest number of attendances with 2,997 and 2,644 respectively. The age group with the fewest A&E attendances both years was the 5-9 age group, with 1,522 in 2015 and 1,686 in 2016.

Figure 66: Number of A&E attendees by age band 2015/2016

3500 3000 2500 2000 1500 1000 500

0 Number of A&E NumberofA&E attendances

2015 2016

Ayr South has the highest number of A and E attendances across the localities, as shown in figure 66 below. However, the actual attendance rates as shown in figure 68 are highest in Ayr North and have been so over the past 6 years.

Figure 67: Number of A & E attendances by locality 2016

Ayr North and Former Coalfield Communities 5711 Ayr South and Coylton 9076 Girvan and South Carrick Villages 7364 Maybole and North Carrick 11133 Communities 3623 Prestwick

Troon 2476

The main presenting reason for attendance in 2016 for Ayr North residents was for Trauma, Injury and Poisoning as was with the rest of South Ayrshire. There is an assumption that areas with closer proximity to hospitals will have higher attendance rates than those areas further away particularly those which are rural in nature.

Figure 68: Attendance rates per 1,000 by locality 2011 -2016

500 450 400 350 300 250 200 2011 2012 2013 2014 2015 2016

Ayr North and Former Coalfield Communities Ayr South and Coylton A&E A&E attendancesperrate1,000 Girvan and South Carrick Villages Maybole and North Carrick Communities Prestwick Troon

Figure 69: % of A & E attendances by age group and locality 2016

100.0

80.0

60.0 40.0 20.0

group(2016) 0.0 Ayr North and Ayr South and Girvan and South Maybole and Prestwick Troon

A&E A&E Attendances age by Former Coalfield Coylton Carrick Villages North Carrick Communities Communities 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+

6.2 Inpatient Admission following Accident and Emergency Attendance

An important factor in emergency care is the proportion of attendances at A&E which result in an emergency inpatient stay. Naturally this impacts upon the number of admissions and bed days in the acute setting. Figure 70 involves Ayr Hospital and shows the percentage of emergency admissions which resulted in discharge to place of residence or emergency admission into Ayr Hospital as an inpatient stay. It shows that, for Ayr Hospital, 56.0% of A&E attendances result in the patient being discharged to their place of residence. 38.3% of patients were admitted to Ayr Hospital. This conversion rate is higher than for Scotland as a whole, which is 25.2%.

Figure 70: Inpatient admission following Ayr Hospital A&E attendance (year ending March 2017)

80 70

50 40 30

attendances 20 10

Discharge destinationof as % 0 Place of Residence Admission to same hospital Other

Ayr Hospital Scotland

The conversion rate for admission following A&E attendance varied by locality during 2016. The figure below shows that the highest conversion rate was for patients who reside in Girvan and South Carrick villages followed by those residing in Troon. Ayr North and Former Coalfield communities had the lowest conversion rates.

Figure 71: Conversion rate (%) by locality 2016

50.0 45.0

40.0 35.0 30.0 25.0 20.0 15.0

Conversion rate 2016 (%) 10.0 5.0 0.0 Ayr North and Ayr South and Girvan and Maybole and Prestwick Troon Former Coalfield Coylton South Carrick North Carrick Communities Villages Communities

The rate at which those who attend A&E are admitted varies by age group with around 73% of those aged 85+ being admitted. Around 40% of those aged 0-4 are admitted. The lowest conversion rate is for those aged between 10-14.

Figure 72: Conversion rate (%) by age group 2016

80.0 72.7

70.0 60.0 50.0 39.4 40.0 30.0 20.0

10.0 Conversionrates (%) 2016 0.0

The next chart shows the rate of emergency inpatient admissions (per 100,000 population). Between 2011/12 and 2015/16, it is clear that this rate is considerably higher in South Ayrshire than in Scotland as a whole. This may be explained, at least partly, by the older age profile of South Ayrshire residents.

Figure 73: Rate of emergency inpatient admissions (per 100,000 population)

16,000

14,000 12,000 10,000 8,000 6,000 4,000

Rate per 100,000 population 2,000 0 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

Figure 74: Rate of emergency inpatient bed days (per 100,000 population)

120,000

100,000

80,000

60,000

40,000

20,000 Rate per100,000 population

0 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

Figure 74 (above) shows the rate of emergency inpatient bed days per 100,000 population. Similar to emergency admissions, the rate of bed days is higher in South Ayrshire than in Scotland as a whole. The Scotland rate has decreased slightly from 2011 to 2016 but the South Ayrshire rate has increased each year. Figure 75 (below) shows the rate of emergency inpatient bed days for the 65+ population. This suggests that the higher rate of emergency inpatient bed days seen previously is due to the older population living in South Ayrshire. However, this chart also suggests that since 2013/14, the rate for the older age group is higher in South Ayrshire than Scotland, even when taking into account the size of the older population.

Figure 75: Rate of emergency inpatient bed days for 65+ (per 100,000 population)

340,000

330,000 320,000 310,000 300,000 290,000 280,000 270,000

Rate per 100,000 population 260,000 2011/12 2012/13 2013/14 2014/15 2015/16p

South Ayrshire Scotland

6.3 Delayed discharges

A delayed discharge occurs when a patient, clinically ready for discharge, cannot leave hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available, for example to purchase a care home place.

Figure 76 below shows the rate of bed days occupied by delayed discharges for patients aged 75+. This is shown by 1,000 population.

Figure 76: Delayed discharges from inpatient care, rate of bed days occupied per 1,000 population, 2016/17

2,500

2,000

1,500

1,000 Scotland

500

Rate per 1,000 population

Fife

Angus

Falkirk

Moray

Stirling

Orkney

Shetland

Highland

Inverclyde

Midlothian

EastLothian

Dundee City Dundee

Glasgow City Glasgow

EastAyrshire

Argyll & Bute & Argyll

West Lothian West

Renfrewshire

Aberdeen City Aberdeen

South Ayrshire South

NorthAyrshire

Aberdeenshire

PerthKinross &

Scottish Borders Scottish

City of City Edinburgh

South Lanarkshire South

NorthLanarkshire

EastRenfrewshire

Clackmannanshire

EastDunbartonshire

Dumfries & Galloway & Dumfries

West Dunbartonshire West Comhairle nan Eilean Siar Comhairlenan

In 2016/17, the number of bed days occupied by patients aged 75+ experiencing delayed discharges was 1,273 per 1,000 population. This is higher than the Scotland rate for the same time period, which was 842 per 1,000 population.

7. Community Services

7.1 Carers in South Ayrshire

Carers make a valuable contribution to our society and play a key role in the delivery of health and social care services. Within South Ayrshire, there are 11,709 individuals providing care. This is 10.4% of the population, compared to 9.3% for Scotland overall. Figure 77 below shows a breakdown of the carers in South Ayrshire by the number of caring hours they provide in a week. Of the 11,709 carers identified, 6,424 provide between 1 and 19 caring hours in a week (54.9%). 3,244 (27.7%) of South Ayrshire carers provide more than 50 caring hours in a week. The pattern identified in South Ayrshire is very similar to that in Scotland as a whole.

Figure 77: Number of caring hours provided in a week

Data Source: Scottish Census 2011

While the number of caring hours provided in South Ayrshire is similar in distribution to Scotland as a whole, the age profile of those providing care is slightly different. Figure 78 shows the age profile of carers below. For the first four age categories, from children to adults aged 49, the proportion of carers is lower in South Ayrshire than in Scotland as a whole, at 38.9% and 44.9% respectively. This means that, in general, South Ayrshire carers are older than they are across the rest of the population.

This is an important consideration given the changing structure of the population over the coming years, the increase in the older population and the decrease in the working age population.

Figure 78: Age profile of carers in South Ayrshire and Scotland

Figure 79: Characteristics of unpaid carers

Unpaid Carers in South Ayrshire are less likely to be employed than in the rest of Scotland and more likely to be aged 65+. There are approximately the same percentage of female carers and young Carers in South Ayrshire as across the rest of Scotland.

7.2 Care Homes

The number of Registered Care Home Places for Older People in South Ayrshire has increased by 23% between 2006 and 2016 from 913 to 1,126 (see Figure 80 below). The total number of Residents has increased by 13% over the same time period. The number of

registered places per 1,000 population in South Ayrshire is 42 which is higher than the national rate of 38.

Figure 80: South Ayrshire registered Care Home places and total number of residents, 2006-2016

1,200

1,000

800

600

400

200

0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Total number of registered places Total number of residents

The mean age on admission to a care home in South Ayrshire was 83 in 2016 compared with 81 across Scotland. The mean age on discharge in South Ayrshire was older than the national average at 87 in South Ayrshire compared with 84 across Scotland. The average length of stay in 2016 was 2.2 in South Ayrshire compared with 2.3 across Scotland.

Between May 2016 and July 2017 there have been 798 emergency admissions to hospital for residents in Care Homes within South Ayrshire (see Figure 81 below). The average length of stay is around 6.8 days. On average there were around 53 emergency admissions per month. The most common reasons for emergency admissions were for Urinary Tract Infections and Pnuemonia.

Figure 81: Emergency Admissions to hospital from Care Homes

90 79 80 67 67 70 59 55 56 60 53 51 52 47 48 48 50 46 40 34 36 30 20

NumberofAdmissions 10 0 May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul 2016 2016 2016 2016 2016 2016 2016 2016 2017 2017 2017 2017 2017 2017 2017 Year & Month of Admission

Data Source: NHS Ayrshire and Arran , Symphony , BI Team

7.2.1 Care Home Projections

By 2026 given the projected population changes and the care home admission rate and the proportion split between Nursing and Residential remains the same rate as January 2017- in the over 65’s – there will be an estimated requirement for an additional 306 care home places (Total of 1210 Care Home Places in over 65s).

Figure 82: Population projections for those requiring a Care Home (2016- 2026)

1300 1210 1200 1183 1151

1119 1100 1083 1041 1013 1000 983 957 By 2026 it is expected that there 900 904 928 will be a requirement for an 800 additional 306 care home places. An increase of 34% compared to residentsonly 65+ 700 January 2017.

600 Projectednumber ofstay long 500 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026

7.3 Home Care

Around 1,730 people currently receive a care at home service as at 31st March 2017. The introduction of Eligibility Criteria to access services and the rollout of the Reablement service had an impact on the overall number of people in receipt of Care at Home over the past 5 years. Over the past year there has been additional demand for Care at Home which has resulted in the numbers rising in 2017. This trend has also been observed on a national level.

Figure 83: No. of people in receipt of Care at Home as at 31st March (all ages)

2500 2250

2000 1830 1730 1720 1620 1500

1000

500

0 2013 2014 2015 2016 2017

Ayr South and Coylton has the highest number of people receiving home care overall, and the highest proportion of those aged 85+ in receipt of home care.

Figure 84: Number of people receiving home care by locality and age group (as at 31st March 2017)

500 450 400 350 300 Total 85+ 250 Total 75-84 200 150 Total 65-74 100 Total Under 65 50 0 Troon Prestwick Ayr S and Girvan and Maybole and Ayr North and Coylton South Carrick North Carrick Former Coalfield

7.3.2 Care at Home Projections

It is projected that there will be a requirement of an additional 414 clients aged 65 who will require a home care service by 2027. This represents an increase of 31% compared to 2017.

Figure 85: Projected number of clients receiving care at home (2015-2027) aged over 65

2000

1671 1708 1750 1590 1631 1500 1546 1421 1457 1492 1336 1388

1000 By 2027 it is expected that there will be a requirement for an additional 414 clients age 65+ receiving care at home . An 500 increase of 31% compared to 2017.

0 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027

Actual Projected

7.4 Adult Protection

Adult Protection cases are defined as persons aged 16 years or over who are unable to safeguard their own well-being, property, rights or other interests; are at risk of harm and because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected.

Adult Protection Referrals have increased year on year with an overall increase of 234% between 2011 and 2017. Analysis of referrals indicates that this sharp increase can partly be attributed to the introduction of new adult support and protection procedures and awareness.

Figure 86: South Ayrshire annual adult protection referrals 2011-2017

1000 885 900 845 800 736 700 549 600 500 South Ayrshire 400 275 265 Annual 300 Referrals 200 100 0 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

Data Source: SWIS Referrals

8. Children and Young People

8.1 Mortality

A stillbirth is a baby born dead after 24 completed weeks of pregnancy. If the baby dies before 24 completed weeks, it is known as a miscarriage or late foetal loss. During 2012, the most recent time period for which there is data available, there were 274 stillbirths in Scotland which is 4.7 stillbirths per 1,000 births, similar to the rate seen in England for the same period. Although this rate has decreased from 5.6 stillbirths per 1,000 births in 2007, one in every 210 births in Scotland still end in stillbirth. Due to the relatively small number of pregnancies affected, it is necessary to combine the data into three-year periods to enable monitoring of the situation. Since 2003/05 there has been a variation in the number of stillbirths in South Ayrshire of between 13 to 23 stillbirths with a slight increase over the past 3 years from 13 to 17.

Figure 87: The number of stillbirths in women from South Ayrshire, summed over three-year periods.

20 23.0 17.0 17.0

10 13.0 Stillbirths Numberof 0 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 2009/11 2010/12 2011/13 Three-year period

While the majority of births in South Ayrshire had a positive outcome, a certain number of pregnancies resulted in a stillbirth of neonatal death. The crude rates for these mortality measures in South Ayrshire were higher compared to the Scottish Levels. Infant mortality is the death of a baby who dies before their first birthday. The rate of infant mortality in South Ayrshire was 3.5 per 1,000 births, which matches the rate for Scotland in the same time period. Infant mortality is closely associated with all aspects of health inequalities and deprivation. Over half of infant deaths are attributed to conditions originating in the perinatal period, with the leading cause being short gestation and low birth rate.

Figure 88: Rates of stillbirth, perinatal, neonatal and infant mortality per 1,000 births* in South Ayrshire, compared to the Scottish average. Data are four-year averages (NRS, 2017).

8.4 10 5.6 5.9 4.2 2.3 3.2 3.5 3.5 0 Stillbirth Perinatal Neonatal Infant

Estimated Four-year death Rates Rate per 1,000 total or live totallive or births Scotland SAC

Data source: (https://www.nrsscotland.gov.uk/statistics-and-data/statistics-by-theme/vital-events/general-publications/births-deaths-and- other-vital-events-preliminary-annual-figures/2015

8.2 Maternity – Breastfeeding

The most up to date validated information from ISD for 2016/17 indicates that 21.8% of women in South Ayrshire were exclusively breastfeeding at the 6-8 week review. This has shown a reduction between 2013/14 to 2015/16 with a slight rise in 2016/17. The percentage exclusively breastfed at the 6-8 week review is considerably lower than the national position of 30.3% in 2016/17. Figure 89 also shows that South Ayrshire is below the national average for all years shown. Breast feeding rates are known to be lower in younger mothers compared to older mothers and are also lower in women who smoke compared to those who do not.

Figure 89: Breastfeeding at 6-8 week review

35 30.3 28.2 30 26.1 27.1 27.2 23.8 21.8 25 22 22.5 21 South Ayrshire 20 15 10 5 Scotland 0 2012/13 2013/14 2014/15 2015/16 2016/17

Data source: https://www.isdscotland.org/Health-Topics/Child-Health/Publications/2016-10-25/2016-10-25-Breastfeeding- Report.pdf

Figure 90 below shows the differences in breastfeeding at the 6-8 week review by Locality. Rates are lowest in the Ayr North and Former Coalfield Locality at 13% compared to 29% in Prestwick.

Figure 90: Breastfeeding at 6-8 week review by Locality

40% 27% 29% 30% 25% 19% 21% 20% 13% 10% 0% ANFCC ASC GSCV MNCC Prestwick Troon Data Source: ScotPho Locality Profile ( 3 year aggregate 2014 to 2016)

Work is underway during 2017/18 to increase support from Assistant Nurse Practitioners during pregnancy and the antenatal period. The SAHSCP also increasing the uptake of premises signed up to Breastfeeding Happily Here, in conjunction with Public Health. From 2018 onwards, Health Visitors will determine feeding intention at the 32-34 week antenatal

visit. Where breast feeding is undecided, previous poor experience or first-time breast feeder then support will be offered from an assistant Nurse Practitioner.

8.2 Maternal Smoking at Antenatal Booking

Parental smoking during pregnancy is a significant factor in child healthy weight and future health. There is clear evidence that maternal smoking can directly lead to low birth weight (as much as 5% lower than non-smokers) and stillbirth. There is also some evidence that smoking during pregnancy could increase the risk of cot death and developmental delay.

The percentage of pregnant women recorded as smokers decreased from 24.1% in 2009- 2011 to 19.6% in 2013-2015. The level recorded across Scotland was 17.3% in 2013-2015.

Figure 91: Percentage of women smoking at booking

30 25 20 15 10 5 0 2009-2011 2010-2012 2011-2013 2012-2014 2013-2015

South Ayrshire Scotland

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp?id=1791#1791

8.3 Low Birth Weight

Babies are defined as having a low birth weight when they weigh less than 2,500 grams at birth. Low birth weight is linked to infant mortality and is also strongly linked to socio- economic status and to smoking in pregnancy. In older children, low birth rate has been found to be significantly associated with delay in achieving developmental milestones. The proportion of births that are deemed to be low birth rate is generally lower in South Ayrshire compared to the Scottish level.

Figure 92: Low weight live singleton birth percentage of live singleton births

3 2.5 2 1.5 1 0.5 0

South Ayrshire Scotland

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Births/

The number of births deemed to be of low weight has decreased over the past two years (see Figure 93 below).

Figure 93: Number of low birth weight live singleton births (under 2500g)

70 64 57 60 52 51 53 53 52 52 54 47 50 48 50 43 45 42 40 30 20 10 0

8.4 Fertility

Fertility in South Ayrshire increased from 55.3 births per 1,000 women aged 15 to 44 in 2014, to 56.2 in 2015. For Scotland as a whole, the general fertility rate decreased from 54.7 births per 1,000 women aged 15 to 44 in 2014, to 53.2 in 2015.

Data Source: National Records of Scotland, Vital Events Reference Tables, https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/general-publications/births-deaths-and-other- vital-events-quarterly-figures

8.5 Teenage Pregnancy

There were 981 pregnancies in South Ayrshire from April 2016 – March 2017. Of these, 44 (4.5%) involved mothers under the age of 20. This is a slightly higher proportion than across Scotland as a whole (3.9%). The overall trend in the number of pregnancies in those aged under 20 has shown a reduction in the past 6 years.

Figure 94: Pregnancies in those aged under 20 in South Ayrshire (2010-2016)

100 87 80 84 72 60 57 57

40 44 44

0 2010 2011 2012 2013 2014 2015 2016

http://www.isdscotland.org/Health-Topics/Maternity-and-Births/Publications/data-tables.asp?id=1791#1791

Breaking this down further, teenage pregnancy rates in the under 16 age group in South Ayrshire are showing a downward trend from the 2008/10 position and are below the Scottish average.

Over the aggregated 2012-2014 period, the teenage pregnancy rate per 1,000 women aged under 16 years in South Ayrshire was 3.5 which was somewhat lower than the rate for Scotland as a whole at 4.9. The South Ayrshire rate had been reducing steadily from 2006- 2008 when it was at a level of 11.0, although the 2012-2014 figure has increased from the 2011-2013 figure of 2.8.

Figure 95: Teenage rates for South Ayrshire and Scotland – Under 16 years

4 Rateper 1,000

0 2003/05 2004/06 2005/07 2006/08 2007/09 2008/10 2009/11 2010/12 2011/13 2012/14

South Ayrshire Scotland

8.6 Child Protection

Children are placed on the child protection register when there are significant concerns for their safety. Children on the register will be subject of close monitoring and support with a multi-agency plan to effect changes to reduce risk.

On 31 July 2017, in South Ayrshire, there were a total of 60 children on the child protection register:

 50% of registrations are for unborn babies or children under four years of age.

 35% of these are children under two years of age.

The South Ayrshire profile is similar to the national picture.

Figure 96: Number of children on the child protection register as at 31st July 100 91 80 70 64 61 60 60 49 49 40 20 0 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16 2016/17

The rate per 1,000 population aged 0-15 on the Child Protection Register increased steadily in South Ayrshire from 2007 to 2012 but in the last four years has seen falls and rises. In 2016 South Ayrshire had 3.9 children per 1,000 population aged 0-15 on the Register compared with 3.0 across the whole of Scotland.

Figure 97: Children on the child protection register rate per 1,000 population aged 0-15, 2007-2016

6 5 4 3 2 1 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

South Ayrshire Scotland

The number of children aged 0 to 16 years referred to the Children's Reporter on care and protection grounds decreased from 693 in 2015/16 to 454 in 2016/17.

Figure 98: Number of children referred to the Children’s Reporter on Child Protection Grounds

In 2016/17, the rate of children referred to the Children's Reporter on Child Protection Grounds within South Ayrshire was 24 per 1,000 children aged under 16 years compared to the Scottish average of 16 per 1,000 children.

Figure 99: Rate of Children referred to the Children’s Reporter on child protection grounds.

8.7 Looked After Children

The number of children looked after has reduced over the past year from 384 to 370.

Figure 100 : Overall number of children looked after as at 31st July .

400 384 380 365 370 352 360 343 340 330 320 300 2012 2013 2014 2015 2016 2017

Trends in terms of the age of children looked after show that there has a reduction in those aged between 5 to 11 and an increase in those aged 12 to 15.

Figure 101 : Age profile of children looked after as at 31st July.

200 2012 150 2013 100 2014 50 2015 0 2016 Under 1 1 to 4 5 to 11 12 to 15 16 to 17 18+

The majority of children in 2017 ( 94%) are being looked after in the community either at home with their parents, with friends/relatives or with foster carers. 6% of children looked after are in residential accommodation.

Figure 102 : Looked after Children by Status as at 31st July 2017

140 120 100 80 60 40 20 0

8.8 Child Health

8.8.1 Developmental Milestones

The overall percentage of those reaching the developmental milestones at the time of their 27-30 month review has decreased. The overall number of reviews has increased and the number of those reaching milestones has risen from 726 in 2014/15 to 738 in 2015/16. South Ayrshire performance is higher than both the national and Ayrshire and Arran level.

Figure 103 : Percentage of children reaching developmental milestones at the time of their 27-30 month review.

78 78.2 76.8 76 75.2 74 South Ayrshire 72.4 72 71.6 70.9 70 Scotland 68

66 2013/14 2014/15 2015/16

Data source: https://www.isdscotland.org/Health-Topics/Child-Health/Publications/2017-02-07/2017-02-07-Child-Health-27m- review-Report.pdf

Speech, Language and Communication is the domain where the least number of children are reaching their milestones and this area has shown a decrease over the past two years. This pattern is evident across Scotland with SLC being the lowest area where children are reaching milestones nationally.

Figure 104 : Percentage of children reaching developmental milestones at the time of their 27-30 month review by domain.

100 75 50 25 0

2013/14 2014/15 2015/16

8.8.2 Dental Decay

The percentage of Children in Primary 1 with no obvious dental decay in South Ayrshire has risen in the past two years from 66.8 to 76.7%. This is above the national average across Scotland of 69.4%.

Figure 105: Percentage of children in primary 1 with no obvious dental decay experience

80 76.7 75 70 66.8 65 64.1 60 55 2012 2014 2016 South Ayrshire Scotland

Data source: National Dental Inspection Programme (NDIP) 2017 http://www.isdscotland.org/Health-Topics/Dental- Care/Publications/data-tables.asp?id=1767#1767

The percentage of children in Primary 7 with no obvious decay in permanent teeth has also risen over the past two years from 84.2% to 85.5%, and is consistently above the national average.

Figure 106: Percentage of children in primary 7 with no obvious dental decay experience

100 82 84.2 82.5 85.5 72.4 80 65.2 59.3 60 South Ayrshire 40 Scotland 20 0 2005 2007 2009 2011 2013 2015 2017

Data source: National Dental Inspection Programme (NDIP) 2017http://www.isdscotland.org/Health-Topics/Dental-Care/Publications/data- tables2017.asp?id=2026#2026

8.8.3 Healthy weight

The percentage of children with a Healthy Weight in P1 has fluctuated above and below the national average over the past few years. Performance in South Ayrshire for 2016/17 was above the national average at 77.0 for South Ayrshire compared to 76.1 nationally.

Percentage of children in Primary 1 receiving a review, with valid height and weight data recorded, who are a healthy weight (epidemiological). These statistics have been calculated using the UK 1990 growth reference standards. These are widely accepted as the reference for growth screening in children over four years of age in the UK. These define healthy weight as children whose BMI is greater than the 2nd centile and less than the 85th centile.

Figure 107: Percentage of primary 1 children healthy weight

82.0

80.0 78.6 78.0 South 77.0 Ayrshire 76.0 Scotland 74.0

72.0

70.0 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17

Data source: ISD Scotland : Body Mass Index of Primary 1 Children in Scotland - School Year 2015/16http://www.isdscotland.org/Health-Topics/Child-Health/Publications/data-tables.asp?id=1773#1773

8.8.4 Children at Risk of Obesity

The percentage of children at risk of obesity in P1has also fluctuated above and below the national average for the past few years. Performance in South Ayrshire for 2016/17 was 10.0% compared to 10.5% nationally.

Percentage of children in Primary 1 receiving a review, with valid height and weight data recorded who are at risk of obesity (epidemiological). These statistics have been calculated using the UK 1990 growth reference standards. These are widely accepted as the reference for growth screening in children over four years of age in the UK. These define at risk of obesity as children whose BMI is greater than or equal to the 95th centile.

Figure 108: Percentage of primary 1 children at risk of obesity

14.0 13.0 12.0 South 11.0 Ayrshire 10.5 10.0 9.0 10.0 Scotland 8.0 7.0 6.0 07/08 08/09 09/10 10/11 11/12 12/13 13/14 14/15 15/16 16/17

Data source: ISD Scotland : Body Mass Index of Primary 1 Children in Scotland - School Year 2015/16http://www.isdscotland.org/Health-Topics/Child-Health/Publications/data-tables.asp?id=1773#1773

9. Criminal Justice

9.1 Crime Generally, crime levels in South Ayrshire have fallen over the period 2013/14 to 2015/16. The overall rate of reported crimes and offences per head of population in 2013-14 was 1,428 per 10,000 population compared with 1,024 per 10,000 population in 2015-16.

Figure 109: Total crimes and offences per 10,000 population

Within Ayrshire, the number of crimes recorded per 10,000 population in 2015-16 indicates that overall South Ayrshire has a lower crime rate than the national average. Crimes of dishonesty were slightly higher than Scotland.

Figure 110 : Crimes recorded by police per 10,000 population and Partnership area 2015-16

East North South Ayrshire Ayrshire Ayrshire Scotland Non sexual violence 12 12 11 13 Sexual Offences 16 15 15 19 Crimes of dishonesty 218 217 219 216 Vandalism including fire raising 112 112 93 101 Other Crimes 119 110 94 110 Total Crimes 477 467 432 458 Crime Index 104 102 94 100

9.2 Domestic Abuse

Since 2014/15, the number of domestic abuse incidents recorded by Police in South Ayrshire has reduced from 1,294 to 1,011 in 2016/1717. That’s a reduction of 22% in two years. Consequently the rate of reported domestic abuse incidents per 10,000 population in South Ayrshire has also reduced and is now well below the Scottish rate – 90 per 10,000 population vs 110.

Figure 111: Reported number of domestic abuse incidents 2010-2017

Figure 112: Reported rate of domestic abuse incidents per 10,000 population 2010-2017

Scot Government - Domestic abuse in Scotland: 2016/17 statistics

9.3 Fires

The rate of deliberately set dwelling fires per 100,000 population in South Ayrshire decreased from 199 in 2014/15 to 192 in 2015/16. The rate for Scotland was 281 in 2015/16.

Figure 113: Fires per 100,000 population

The number of accidental dwelling fires per 100,000 population in South Ayrshire increased from 68 in 2014/15 to 79 in 2015/16. The rate for Scotland was 96 in 2015/16. The Locality Profiles contain some additional information against both accidental dwelling fires and deliberate fires broken down to each locality for the period 2013-2017.

9.4 Violent Crime

The rate of violent crimes of 11 per 10,000 population in 2015/16 decreased from the previous year but has hovered between 10.8 and 13.8 for the last five years after a significant reduction from 22.9 in 2010/11.

Figure 114: Violent crimes recorded rate per 10,000 population 2010-2016

9.5 Road Safety

The overall rate of dangerous and careless driving offences recorded per 10,000 population in South Ayrshire has been increasing over recent years. The rate recorded in 2015/16 was 20 compared with 13 in 2012/13. The 2015/16 level was below the Scottish average at 22.

Figure 115 : Dangerous and careless driving offences recorded per 10,000 population

0 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16

South Ayrshire Scotland

The number of people killed and seriously injured in road traffic collisions per 10,000 population had been steadily reducing each year from 5.3 per 10,000 population in 2010 to 2.3 per 10,000 population in 2013, although 2014 has seen an increase to 3.6. This 2014 rate is in line with Scotland overall.

Figure 116 : Rate of people killed or seriously injured in road traffic collisions per 10,000 population

0 2006 2007 2008 2009 2010 2011 2012 2013 2014

South Ayrshire Scotland

9.6 Prison Statistics

The Prisoner population aged 16+ per 100,000 population in South Ayrshire was 207.7 compared to 161.9 in Scotland.

(Source: SPS via Scottish Government, Snapshot at 31 March 2014)

9.7 Community Safety

The 2016 South Ayrshire Quality of Life Survey asked respondents how safe they feel when walking alone in their neighbourhood during the day and at night. The charts below show that:

 The majority of people (98%) stated that they feel either fairly safe or very safe when walking alone outside in their neighbourhood during the day which is slightly higher than the findings from the 2014 SA1000 Quality of Life survey (97%). In 2016, two per cent stated that they felt a bit unsafe or very unsafe compared to 3% in the 2014 findings.

 In contrast to feeling safe during the day, a marked difference in responses occurs when people are asked how safe they feel when walking alone in their neighbourhood after dark. Eight out of ten of respondents (82%) said that they feel either very or fairly safe. The same result was experienced in 2014 when panel members were consulted but a lower result was found in the 2012 Quality of Life Survey (77%). The 2016 level is lower than the SHS figure for South Ayrshire (89%) and Scottish average (85%).

Figure 117: Results from SA Quality of Life Survey Question “How safe or unsafe do you feel when walking alone in your neighbourhood after dark?

100 82 82 77 80

60 2012

40 2014 23 18 18 2016 20

0 Very safe/Fairly safe A bit unsafe/ Very unsafe

Those groups more likely to feel unsafe walking alone in their neighbourhood after dark were: • Females • Those unemployed • Those living in deprived areas • Those living in privately or social rented accommodation • Those living in Ayr North, Ayr West, Kyle or Girvan and South Carrick wards • Those living in Ayr North and Former Coalfield Communities or Girvan and South Carrick Villages localities.