Early Years Profile – Tunbridge Wells

November 2016

Produced by

Samantha Bennett: Public Health Consultant (samantha.bennett2@.gov.uk) Del Herridge: Public Health Product & Data Manager ([email protected]) Zara Cuccu: Public Health Analyst ([email protected]) Lauren Liddell-Young: Information Officer ([email protected]) Correspondence to: Del Herridge Version: 1b Last Updated: November 2016

| Contents

1. Executive Summary ...... 2

1.1 Priorities for Tunbridge Wells ...... 2

1.2 Key Findings ...... 3

1.3 Call to Action ...... 5

2. Introduction & Objectives...... 6

3. Health Outcome Indicators ...... 9

3.1 Under 18 conceptions ...... 9

3.2 Infant mortality ...... 11

3.3 Low birth weight ...... 13

3.4 Smoking status at time of delivery ...... 15

3.5 Breastfeeding (initiation) ...... 16

3.6 Breastfeeding (prevalence at 6-8 weeks) ...... 17

3.7 Vaccination coverage ...... 18

3.8 Child development & school readiness ...... 20

3.9 Healthy weight (excess weight at 4-5 years) ...... 22

3.10 Tooth decay in children age five ...... 24

3.11 Hospital admissions due to an injury ...... 25

Appendix A: Ward key...... 27

Appendix B: Technical Information ...... 28

A.1.1 Confidence intervals ...... 28 A.1.1 Statistical significance ...... 28 A.1.1 Trend analysis ...... 28

Appendix C: Practice level immunisation data ...... 31

1 Early Years Profile – Tunbridge Wells, November 2016

| 1. Executive Summary

1.1 Priorities for Tunbridge Wells

• Decrease the percentage of 4-5yr olds with excess weight

o More 20% of reception year children are overweight • Increase the prevalence & coverage of breastfeeding at 6-8 weeks

o Coverage of breastfeeding status is less than required 95% • Increase MMR vaccination coverage

o Level of MMR dose 2 coverage is less than the recommended 90%

2 Early Years Profile – Tunbridge Wells, November 2016

1.2 Key Findings

Population Deprivation

10.4% 7.3% of children of Tunbridge Wells were living in income population deprived household are aged 0 to 5

Sherwood and Broadwater were highlighted as relatively higher.

Under 18 conceptions Infant mortality

13.6 per 1,000 2.1 per 1,000 15- 17 year olds live births between 2012 and 2014

Lower to Kent. Decreasing across Kent since 1998-2001. Decreasing since 1998-2000. Low birth weight (less than 2500g) Smoking at time of delivery

Of 1,187 maternities in 2015/16, 218 or 5.9% 115 were smoking at

of live births time of delivery between 2013 and 2014

9.7%

Similar to Kent. Stable since 1998-2000. Similar to previous years and lower than Kent.

3 Early Years Profile – Tunbridge Wells, November 2016

Breastfeeding prevalence at 6-8 weeks MMR vaccination coverage The prevalence of 86.4% breastfeeding at 6- of children at age 5 years 8 weeks check had received two doses of MMR

55.7% Similar to Kent and just short of 90% 13.8% had unknown breastfeeding status vaccination coverage targets.

Child development Excess weight 78.5% Of children aged 4-5 years, measured as part of the of pupils achieved a good level of development National Child Measurement Programme

during 2014/15 20.7% were overweight or obese Higher than Kent. Similar to previous years and Kent. Tooth decay

Of children aged five surveyed,

experienced 17.9% decayed, missing or filled teeth

Similar to Kent.

4 Early Years Profile – Tunbridge Wells, November 2016

1.3 Call to Action

Overall, Tunbridge Wells performs similar to or better than Kent for the early years profile health outcome indicators.

Effective interventions should focus on the wards identified by the Income Deprivation Affecting Children Index; Sherwood and Broadwater. From analysis these wards or practices serving these were often identified within the highest 10% of early years health outcome indicators across Tunbridge Wells.

5 Early Years Profile – Tunbridge Wells, November 2016

| 2. Introduction & Objectives

The report has been produced to mirror the NHS and Public Health England, Child & Maternal Intelligence Network early years profiles for children aged 0 to 5 years.1 The early years have been well identified as the critical point to improve health and wellbeing over the life course.2

The health outcome indicators used include;

• under 18 conceptions, • infant mortality, • low birth weight, • smoking status at time of delivery, • breastfeeding prevalence at 6-8 weeks, • vaccination coverage, • child development, • excess weight, • tooth decay.

Comparisons have been made to Kent and England. Where possible, our analysis has been completed at a lower geographical level, by ward; therefore, we have pooled several years data to improve the reliability of our findings.

1 Public Health England (2015) National child & maternal health intelligence network: early years profiles. http://atlas.chimat.org.uk/IAS/dataviews/earlyyearsprofile 2 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

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Tunbridge Wells is a district located within the west of the county. The main town is Tunbridge Wells, with transport links provided by A roads. The rest of the district is rural with a number of small villages. A ward map has been included, the key for ward names within Appendix A.

The Health & Social Care Maps detail the headline demographic information for Tunbridge Wells. For the purpose of this report, we explored ward level population estimates for children aged 0 to 5, as a percentage of the all age resident population.

For Tunbridge Wells 7.3% of its population were aged 0 to 5. The highest 20% and 10%;

Table 1: Resident population estimates, 2014: by ward.

Ward name Ages 0-5 All ages Percentage (n) (n) aged 0-5 (%) St James' 707 6795 10.4% St John's 698 7627 9.2% Southborough and High Brooms 657 7850 8.4% 430 5204 8.3% Source: ONS, produced by KPHO (ZC) October 2016.

7 Early Years Profile – Tunbridge Wells, November 2016

The Mind the Gap: Health Inequalities Action Plan for Kent sought to characterise the most deprived decile for Kent using segmentation. Within the West Kent CCG area (not coterminous with borough boundary) this did not highlighted LSOAs within this district, but relative deprivation can be identified in the second most deprived decile.

See the West Kent CCG summary for detailed locality maps. The Income Deprivation Affecting Children Index has been mapped as part of the Health & Social Care Maps. This is an indicator that describes the proportion of children living within income deprived families.3

For Tunbridge Wells 10.4% of children were living in income deprived households. The highest 20% and 10% of Tunbridge Wells wards have been highlighted;

Table 2: Income deprivation affecting children, 2015.

Ward name Percentage of children living in income deprived households (%) Sherwood 20.8% Broadwater 19.4% Southborough & High Brooms 17.2% Rusthall 14.6% Source: IMD, produced by KPHO (ZC) October 2016.

3 Families that either receive Income Support or income-based Jobseekers Allowance or Employment and Support Allowance or Pension Credit (Guarantee) or families in receipt of Working Tax Credit or Child Tax Credit with an equivalised income (excluding housing benefit) below 60 per cent of the national median before housing costs.

8 Early Years Profile – Tunbridge Wells, November 2016

| 3. Health Outcome Indicators

3.1 Under 18 conceptions The indicator definition4 is the rate of conceptions under the age of 18 per 1,000 female population aged 15-17 years. See report produced for Kent

A key measure of inequality3 from the known relationship and poorer outcomes for mum and child in terms of:

• mum’s education, qualifications, risk of postnatal depression and mental health risk, • child’s likelihood of low birth weight, being breastfed and experiencing accidents and behavioural problems.

But, a limitation of this indicator is that it does not acknowledge miscarriage or abortion.

The rate of under 18 conceptions across Tunbridge Wells in 2012-2014 was:

• 13.6 per 1,000 female population aged 15-17 years,

• this was lower in comparison to 23.7 for Kent,

• and was lower in comparison to 25.0 for England.

4 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

9 Early Years Profile – Tunbridge Wells, November 2016

The rate of under 18 conceptions across Tunbridge Wells between 1998-2000 and

2012-2014 has been:

• decreasing by 0.9 under 18 conceptions per 1,000 female population, • this was a similar pace of change in comparison to decreases of 1.0 Kent and 1.3 in England.

Ward level under 18 conceptions have been mapped for Tunbridge Wells within the Health & Social Care Maps this includes the following wards5 within the highest 20% and highlights those in the upper 10%. Whereby the rate was greater than 22.0 per 1,000 female population aged 15-17 years.

Table 3: Under 18 conceptions: by ward in 2012-2014.

Local percentile Southborough & High Brooms Within the highest 10% Sherwood St James' Within the highest 20% Broadwater Source: ONS, prepared by KPHO (ZC) October 2016.

5 Note: the remaining wards were suppressed due to conception counts less than 5.

10 Early Years Profile – Tunbridge Wells, November 2016

3.2 Infant mortality The indicator definition6 is the rate of infant deaths (persons aged less than 1 year) per 1,000 live births.

A key measure of inequality5 and an indicator of population health. There is a known relationship between infant mortality and:

• deprivation, maternal age under 20 years and non-white ethnicity of infant

This indicator is known to have a high level of validity.

The rate of infant mortality across Tunbridge Wells in 2013-20156 was:

• 2.1 per 1,000 live births, • this was in comparison to 3.0 for Kent. For Tunbridge Wells there were 8 infant deaths for the total period.

6 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf 6 Note: this is a locally produced figure, therefore, England data not available for the latest period.

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The rate of infant mortality across Tunbridge Wells has been presented between 1999-2001 and 2012-2014:

• there were 12 infant deaths during 1999-2001,

• and a peak of 17 infant deaths during 2003-2005,

• this was in comparison to 10 infant deaths during 2012-2014.

Across Kent, there has been a decrease in infant mortality over the period studied.

12 Early Years Profile – Tunbridge Wells, November 2016

3.3 Low birth weight The indicator definition7 is the percentage of live births with a low birth weight (less than 2500g).

A key public health indicator5 and a known relationship between low birth weight and:

• deprivation, lifestyle factors and access to maternity services. • And outcomes for; morbidity, mortality in infancy and childhood, as well as, long term health outcomes in adulthood

This indicator is known to have limitations as an indicator within some ethnic groups.

The percentage of low birth weight across Tunbridge Wells in 2013-20157 was:

• 5.9% of live births, • similar this was in comparison to 5.8% for Kent.

7 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf 7 Note: this is a locally produced figure, therefore, England data not available for the latest period.

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Low birth weight across Tunbridge Wells has been presented between 2006-2008

and 2013-2015:

• there were 239 low birth weight live births during 2006-2008,

• this was in comparison to 218 during 2013-2015.

Kent shows a decrease in low birth weight over the period studied.

Ward level low birth weight has been mapped for Tunbridge Wells within the Health & Social Care Maps this includes the following wards within the highest 20% and highlights those in the upper 10%;

Table 4: Low birth weight: by ward in 2013-2015. Local percentile Broadwater and Sandhurst Within the highest 10% Southborough and High Brooms and Within the highest 20% Capel Source: ONS, prepared by KPHO (ZC) October 2016.

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3.4 Smoking status at time of delivery The indicator definition8 is the percentage of maternities whereby the woman was smoking at time of delivery.

A key public health indicator5 and a known relationship with:

• growth and development of baby, • complications during pregnancy, • as well as, preventable morbidity and mortality

This indicator is produced for CCGs and has been modelled to district level based on the number of births for district residents within CCGs. We are able to present data for the latest 3 contract years. All of the Kent districts met the quality indicator for less than 5% of records with an unknown smoking status.

The percentage smoking at time of delivery across Tunbridge Wells in 2015/16:

• 9.7% of maternities, similar to previous years,

• lower than 13.0% for Kent and similar to 10.6% for England in 2015/16.

8 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

15 Early Years Profile – Tunbridge Wells, November 2016

3.5 Breastfeeding (initiation) The indicator definition9 is the percentage of all mothers who breastfeed their babies in the first 48hrs after delivery.

A key public health indicator5 with known benefits from:

• reduced illness and hospital admissions, • and lifetime risk of obesity and diabetes The prevalence of breastfeeding initiation across the county in 2014/15 was 71.3%, which compares to an England rate of 74.3%. Several areas recorded no prevalence due to data quality issues. Data for 2015/16 is yet to be published.

The percentage of mothers who initiated breastfeeding in Tunbridge Wells in 2014/15:

• 84.7%

9 Taken from Public Health Profiles http://www.phoutcomes.info/search/Initiation#page/6/gid/1/pat/6/par/E12000008/ati/101/are/E07000110

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3.6 Breastfeeding (prevalence at 6-8 weeks) The indicator definition10 is the percentage of infants who were totally or partially breastfed at the 6-8 week check.

A key public health indicator5 with known benefits from:

• reduced illness and hospital admissions, • and lifetime risk of obesity and diabetes

None of the Kent districts met the quality indicator for more than 95% of maternities to have a known breastfeeding status. Therefore, there are great limitations for interpretation of this indicator, affecting accurate interpretation and comparison.

The percentage of infants totally or partially breastfed in Tunbridge Wells in 2015/16:

• 55.7% due a 6-8 week check,

• it should be recognised that 13.8% of maternities had a unknown status

10 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

17 Early Years Profile – Tunbridge Wells, November 2016

3.7 Vaccination coverage The indicator definition11 is the percentage of children at age 5 years who have received two doses of MMR vaccine.

A key public health indicator5 for levels of other immunisation rates and the: • level of protection against vaccine preventable communicable diseases, • as well as, the overall levels of disease in the population. This indicator is produced at a general practice level and has been modelled to CCG level based on practice location. This was then apportioned to district level based on the numbers of children aged 5 years resident within the district as a proportion of the CCG total.

MMR vaccination coverage across Tunbridge Wells in 2015/167 was:

• 86.4% of children aged 5 years,

• this was similar in comparison to 85.9% for Kent.

Note 90% vaccination coverage targets are set for local authority districts.

11 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

18 Early Years Profile – Tunbridge Wells, November 2016

MMR vaccination coverage has been presented for Kent and England between

2010/11 and 2015/16. For Kent:

• coverage was higher than England during 2010/11 and 2012/13,

• lower than England during 2014/15,

• but remains similar to England in the latest year.

MMR vaccination coverage for two doses (5 year olds); highlighted the following practices within the lowest 20% and the lowest 10%. Whereby coverage was lower than 85%.

Table 5: MMR vaccination coverage for two doses (5 year olds): by practice in 2015/16. Local percentile Abbey Court Within the lowest 10% Kingswood Surgery Within the lowest 20% Source: CHIS, prepared by KPHO (ZC) October 2016.

A wider range of general practice vaccination coverage data for Tunbridge Wells has been included within Appendix B.

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3.8 Child development & school readiness The indicator definition12 is the percentage of children achieving a good level of development at the end of Early Years Foundation Stage (the end of the academic year in which the child turns 5). This is defined as achieving the expected level in areas of learning13 and in specific areas of literacy and mathematics.

A key public health indicator and priority: 10

• essential of children’s healthy development, • fundamental to later outcomes and life chances.

This is an indication for those in receipt of government funded education at the end of Early Years Foundation Stage. Therefore, does not represent those not in receipt of government funded education. Note there has been some change to this indicator over time.

Good level of development in Tunbridge Wells in 2014/15 was:

• achieved by 78.5% of pupils, • this was higher in comparison to 73.6% for Kent and similar to 66.3% for England.

12 Department for Education (2016) Early years foundation stage profile https://www.gov.uk/government/collections/statistics-early-years-foundation-stage-profile 13 personal, social and emotional development; physical development; and communication and language

20 Early Years Profile – Tunbridge Wells, November 2016

Achieving good level of development has been presented for Kent and England

between 2013/14 and 2016/17. For Kent:

• higher than England consistently across the period,

• and has increased over time.

Achieving good level of development; highlighted the following wards within the lowest 20% and the lowest 10%. Whereby achievement was lower than 75%.

Table 6: Good level of development: by ward in 2014/15. Local percentile Broadwater Within the lowest 10% Sherwood Capel Within the lowest 20% St Johns Source: MIU, prepared by KPHO (ZC) October 2016.

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3.9 Healthy weight (excess weight at 4-5 years) The indicator definition14 is the percentage of children aged 4-5 years who were classified as overweight or obese of those who had valid height and weight measurements.

A key public health indicator and priority5 and known relationship with:

• risk of obesity in adulthood, • and increased morbidity and mortality.

Low participation would affect interpretation of prevalence estimates. Kent had high participation and met the quality indicator for greater than 90% participation by pupils in reception year. See further analysis here.

The percentage of excess weight in Tunbridge Wells in 2014/15 was:

• 20.7% of those measured,

• this was similar in comparison to 22.5% for Kent and 21.9% for England.

14 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

22 Early Years Profile – Tunbridge Wells, November 2016

Overweight, obesity and excess weight across Tunbridge Wells and Kent has been presented between 2010/11 and 2014/15:

• the prevalence of overweight and excess weight has remained similar in Tunbridge Wells since 2011/12,

Ward level reception year excess weight has been mapped for Tunbridge Wells within the Health & Social Care Maps this includes the following wards within the highest prevalence of excess weight within the highest 20% and highlights those in the upper 10%;

Table 7: Excess weight in reception year: by ward in 2013/14-2014/15. Local percentile Capel Within the highest 10% Sherwood Paddock Wood West Within the highest 20% Rusthall Source: NCMP, prepared by KPHO (ZC) October 2016.

23 Early Years Profile – Tunbridge Wells, November 2016

3.10 Tooth decay in children age five The indicator definition15 is the percentage of children at age five years, within the survey sample, who had experienced decayed, missing or filled teeth.

A key public health indicator5 known to impact:

• quality of life, appearance and confidence, • as well as, missed school and education.

Each survey covers a cohort or children and there have been methodological changes between previous surveys, limiting analysis of trend. Survey non-response has been identified to be higher within more deprived areas, known to have higher tooth decay.13

Tooth decay (decayed, missing or filled) in children age five across Tunbridge Wells,

2015:7

• 17.9% of children aged five years, • similar in comparison to 16.2% for Kent and lower than 24.7% England.

Among Tunbridge Wells children, the average number of decayed teeth was 0.39 (a child this age normally has 20 primary teeth).

15 NHS England and Public Health England (2014) Guide to the early years profiles. https://www.england.nhs.uk/wp-content/uploads/2014/03/hv-ey-hlth-prof.pdf

24 Early Years Profile – Tunbridge Wells, November 2016

3.11 Hospital admissions due to an injury The indicator definition is the number of children aged 0-4 years who were admitted to hospital as a result of a deliberate or unintentional injury in per 10,000 resident 0-4 year olds.

The admission rate in Tunbridge Wells in 2015/16 was:

• 85.4 per 10,000 population

• this was significantly lower in comparison to 118.6 for Kent.

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Ward level deliberate and unintentional injury admissions have been mapped for Tunbridge Wells within the Health & Social Care Maps. This includes the following wards with admissions rates within the highest 20% across Kent.

Deliberate and unintentional injury admissions: by ward in 2015/16.

The following wards had admission rates which were in the highest Kent quintile

• Rusthall • and

Source: SUS, ONS prepared by KPHO (LLY) November 2016.

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| Appendix A: Ward key

Table 8: Tunbridge Wells: by ward

Key Name 1 Capel 2 & Lamberhurst 3 Brenchley & Horsmonden 4 Hawkhurst & Sandhurst 5 & Cranbrook 6 & 7 Speldhurst & Bidborough 8 Pantiles & St Mark's 9 10 St John's 11 Southborough & High Brooms 12 Southborough North 13 Sherwood 14 15 Paddock Wood West 16 Paddock Wood East 17 Rusthall 18 Broadwater 19 Culverden 20 St James' Source: ONS, produced by KPHO (ZC) October 2016

27 Early Years Profile – Tunbridge Wells, November 2016

| Appendix B: Technical Information

A.1.1 Confidence intervals Confidence intervals have been presented throughout this report. For percentages the Wilson & Newcombe method was used, whereas, for rates the Byar’s method was used.

A.1.1 Statistical significance Statistical significance has been referred to throughout this report. The Altman method was used to explore statistical significance for percentages, as overlapping confidence intervals do not necessarily indicate no significant difference.

A.1.1 Trend analysis Trend analysis has been referred to throughout this report. Simple linear regression was used to calculate slope, to explore rate of change of indicators over time. Visual inspection of the data determined whether the trend was stable and this method appropriate.

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Indicator Data definition

Rate of conceptions per 1,000 females aged Numerator: Total conceptions to all women aged under 18 15-17 Denominator: Total female population aged 15-17

Crude rate of infant deaths (persons aged Numerator: The number of infant deaths (aged under 1 year) in calendar year. less than 1 year) per 1,000 live births, Denominator: The number of live births in calendar years pooled data for three year periods.

Percentage of all live births at term with Numerator: Number of live births with low birth weight (<2500g) low birth weight. Denominator: Number of live births

Proportion of women smoking at time of Numerator: Number of women who smoke at time of delivery delivery Denominator: Number of maternities

Breastfeeding prevalence at 6-8 weeks Numerator: Number of infants who are totally or partially breastfed at 6-8 week check after birth Denominator: Total number of infants due a 6-8 week check

MMR vaccination coverage for two doses (5 Numerator: Number of children at age 5 years who have received two doses of MMR vaccine year olds) Denominator: Number of children at age 5 years resident within each reporting area

Children achieving good level of Numerator: Number of foundation stage pupils with a good level of development. development at the end of reception Denominator: Number of foundation stage pupils.

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Indicator Data definition

Percentage of children aged 4-5 classified Numerator: The number of primary school age children in Reception with valid height and as overweight or obese weight recorded who are classified as overweight or obese. Denominator: The total number of primary school age children in Reception with valid height and weight recorded in a particular school year.

Rate of tooth decay in children aged 5 years Numerator: Total number of decayed, missing or filled teeth in the survey sample of 5-year-old children Denominator: Number of 5-year-old children in the survey sample.

30 Early Years Profile – Tunbridge Wells, November 2016

| Appendix C: Practice level immunisation data

MMR vaccination coverage is a good indicator of vaccination coverage as a whole, due to public concerns regarding safety.

The table below shows vaccination coverage for general practices within Tunbridge Wells, district:

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Table 9: Vaccination coverage: by practice in 2015/16.

Up to 1st Birthday Up to 2nd Birthday Up to 2nd Up to 5th Birthday primaries Up to 5th birthday boosters DTaP MenC PCV DTaP MMR MenC Hib PCV DT Pol Pertussi Hib MenC MMR PCV DtaP Hib MMR PCV IPV Hib IPV Hib Infant MenC Booster s Infant Infant 1st Infant IPV MenC G Code Practice Name Booster dose

% % % % % % % % % % % % % % % % % % G82016 Kingswood Surgery 55.0 68.3 57.5 76.6 64.5 83.1 65.3 31.5 90.6 90.6 90.6 89.1 86.7 89.1 82.0 84.4 80.5 84.4 G82022 Greggs Wood Medical Centre 93.3 97.3 93.3 94.1 93.1 97.0 92.1 67.3 98.6 98.6 98.6 95.8 95.8 95.8 90.1 97.2 91.5 95.8 G82025 Clanricarde Medical Centre 93.2 93.2 92.4 84.1 95.5 92.4 94.7 80.3 94.8 94.8 94.8 92.6 94.8 93.3 95.6 94.1 94.8 86.7 G82041 Grosvenor Medical Centre 87.7 91.3 89.9 88.1 91.3 92.9 89.7 53.2 97.2 97.2 97.2 96.5 94.4 95.8 88.1 95.8 90.9 93.7 G82055 North Ridge Medical Practice 93.5 95.7 93.5 91.1 82.2 91.1 84.4 24.4 98.3 98.3 98.3 98.3 94.8 98.3 91.4 94.8 86.2 86.2 G82075 St James Medical Centre 95.8 95.8 94.4 88.1 90.5 94.0 88.1 28.6 93.2 93.2 93.2 94.3 96.6 93.2 95.5 92.0 96.6 85.2 G82103 Abbey Court Medical Practice 89.2 93.8 89.2 87.8 73.2 92.7 80.5 56.1 98.1 98.1 98.1 96.2 96.2 94.3 50.9 94.3 49.1 86.8 G82118 Woodlands Health Centre 8.9 9.7 8.9 14.5 40.3 15.3 41.9 39.5 94.9 94.9 94.9 94.9 93.6 94.3 70.7 93.0 71.3 91.1 G82137 St Andrews Medical Centre 91.7 93.8 91.7 87.0 90.2 92.4 91.3 23.9 91.3 91.3 91.3 92.4 92.4 90.2 87.0 91.3 85.9 88.0 G82152 Rusthall Medical Centre 87.5 91.1 87.5 89.5 94.2 95.3 94.2 25.6 94.9 94.9 94.9 93.7 92.4 94.9 87.3 92.4 86.1 87.3 G82155 Waterfield House Surgery 90.2 98.0 90.2 87.8 89.8 95.9 89.8 34.7 86.6 86.6 86.6 86.6 86.6 86.6 85.1 85.1 85.1 83.6 G82158 Howell Surgery 96.3 96.3 94.4 90.0 92.5 87.5 90.0 57.5 94.0 94.0 94.0 95.5 95.5 92.5 95.5 91.0 92.5 86.6 G82170 Lamberhurst Surgery 83.3 66.7 75.0 72.2 83.3 77.8 77.8 61.1 94.6 94.6 94.6 94.6 91.9 94.6 83.8 91.9 83.8 89.2 G82224 Old Parsonage Surgery 91.3 91.3 91.3 100.0 88.9 100.0 88.9 50.0 97.7 97.7 97.7 93.0 100.0 95.3 88.4 95.3 88.4 93.0 G82235 Old School Surgery 95.8 100.0 100.0 96.4 96.4 96.4 96.4 39.3 96.6 96.6 96.6 96.6 100.0 96.6 100.0 93.1 96.6 96.6 G82605 The Crane Surgery 75.0 81.3 75.0 83.3 83.3 83.3 83.3 50.0 84.6 84.6 84.6 84.6 92.3 84.6 76.9 84.6 84.6 84.6 G82715 Rowan Tree Surgery 84.6 94.2 84.6 84.8 93.5 97.8 91.3 30.4 97.9 97.9 97.9 100.0 95.7 93.6 93.6 95.7 93.6 89.4 G82732 Wish Valley Surgery 97.4 100.0 97.4 92.3 92.3 89.7 94.9 15.4 95.9 95.9 95.9 98.0 91.8 93.9 89.8 95.9 87.8 95.9 G82733 Orchard End Surgery 96.9 100.0 93.8 89.5 100.0 89.5 92.1 36.8 95.0 95.0 95.0 95.0 95.0 92.5 90.0 90.0 92.5 90.0 G82768 Lonsdale Medical Centre 89.8 93.9 90.8 78.0 89.0 81.4 87.3 20.3 94.0 94.0 94.0 88.8 94.0 91.4 87.9 88.8 87.1 86.2 Source: CHIS, prepared by KPHO (ZC) October 2016.

Key less than 80 80-90 90-95 95 or more

32 Early Years Profile – Tunbridge Wells, November 2016