Worcester Health and Wellbeing Profile

Transcription

Worcestershire
Health and Wellbeing Board
February 2015
www.worcestershire.gov.uk/jsna
1
This document is the second in a series of health and wellbeing profiles for each of the
Worcestershire Districts. It follows the Redditch Health and Wellbeing Profile that was published in
2013. The Redditch profile can be found here:
http://www.worcestershire.gov.uk/downloads/file/2914/2013_redditch_health_and_wellbeing_profile
This document draws on evidence from a variety of sources both national, for example the Office for
National Statistics, Public Health England, Association of Public Health Observatories, and local
sources such as the Worcestershire Viewpoint Survey and the 2013 Worcester Strengthening Healthy
Communities report that was commissioned by South Worcestershire CCG and Worcestershire
County Council. It focuses on local priorities and areas identified for local action. Detailed profiles of
specific subject areas such as mental health, older people and obesity as well as the latest Joint
Strategy Needs assessment (JSNA) can be found on the Council's website:
http://www.worcestershire.gov.uk/downloads/20122/joint_strategic_needs_assessment
This document was produced by Elizabeth Griffiths, Public Health Speciality Registrar, following
consultation with the Healthy Worcestershire Partnership, South Worcestershire CCG's Worcester
City Locality Group.
I would like to thank the following for their input, advice and guidance:
Emily Armitage, South Worcestershire Community Safety Partnership
Andy Boote, HIC
Francesca Davies, Worcester City Council
Peter Fryers, Worcestershire County Council
Janette Fulton, Worcestershire County Council
Jan Harvey, Worcestershire County Council
Healthy Worcestershire Partnership
Denise Horton, South Worcestershire CCG
Frances Howie, Worcestershire County Council
Helen Perry-Smith, South Worcestershire CCG
Steven Price, Worcestershire County Council
Henry Primarolo, Worcester City Council
Cameron Russell, Worcestershire County Council
Jenny Shepherd, Worcestershire County Council
Mark Sheldon, Worcestershire County Council
Rosemary Williams, South Worcestershire CCG
Worcester City Locality Group and its Chair, Dr Felix Blaine
Worcestershire JSNA Working Group
Elizabeth Griffiths
Public Health Speciality Registrar
February 2015
2
Contents
1
List of Figures.............................................................................................................................. 4
1
Executive Summary ........................................................................................................ 8
1.1
Recommendations........................................................................................................ 10
2
Introduction .................................................................................................................. 10
3
Setting the Context ....................................................................................................... 12
3.1
Worcester's population ................................................................................................ 12
3.1.1 Age ................................................................................................................................ 12
3.1.2 Ethnicity ........................................................................................................................ 14
3.1.3 Life Expectancy ............................................................................................................. 14
3.1.4 Employment ................................................................................................................. 17
3.1.5 Tenure........................................................................................................................... 17
3.1.6 Education ...................................................................................................................... 17
3.1.7 Deprivation ................................................................................................................... 17
3.1.8 Children in poverty ....................................................................................................... 19
3.1.9 Worcester Health Hot spots ......................................................................................... 21
3.1.10 Worcester's future population ..................................................................................... 22
3.1.11 Planned building developments in Worcester ............................................................. 23
3.1.12 Number of GPs per head of population ....................................................................... 24
3.2
The Health of Worcester at a Glance ........................................................................... 26
3.2.1 2014 PHOF Worcester Health Profile ........................................................................... 26
3.2.2 APHO – Changes over time .......................................................................................... 27
3.3
What Worcester residents are saying .......................................................................... 27
3.3.1 2011 Census – self-reported level of long-term health ............................................... 28
3.3.2 Health in Worcestershire – Viewpoint results, July 2014 ............................................ 29
3.3.3 Worcester Strengthening Healthy Communities, 2013 ............................................... 29
4
2014 PHOF priority areas ............................................................................................. 30
4.1
Statutory homelessness ............................................................................................... 30
4.2
Violent crime ................................................................................................................ 31
4.3
Under 18 conceptions .................................................................................................. 33
4.4
Hospital stays for self-harm.......................................................................................... 35
4.5
Drug misuse .................................................................................................................. 40
5
Worcestershire Health and Wellbeing Board priorities ............................................... 40
5.1
Older people and management of long-term conditions ............................................ 41
5.1.1 Isolation ........................................................................................................................ 41
5.1.2 Carers and carer health and wellbeing ........................................................................ 41
5.1.3 Long term conditions.................................................................................................... 44
http://www.worcestershire.gov.uk/cms/jsna.aspx ................................................................. 44
Diabetes.................................................................................................................................... 44
3
Coronary Heart Disease............................................................................................................ 46
Chronic Obstructive Pulmonary Disease (COPD) ..................................................................... 47
5.2
Mental Health and Wellbeing ...................................................................................... 49
5.3
Obesity .......................................................................................................................... 51
5.3.1 Obesity prevalence in Adults ........................................................................................ 51
5.3.2 Obesity prevalence in Children .................................................................................... 53
5.3.3 Healthy eating .............................................................................................................. 56
5.3.4 Access to green space .................................................................................................. 57
5.3.5 Physical Activity ............................................................................................................ 59
5.4
Alcohol .......................................................................................................................... 61
5.4.1 Alcohol specific hospital admissions ............................................................................ 64
5.4.2 Alcohol-related hospital admissions ............................................................................ 66
5.4.3 Alcohol use in under 18 year olds ................................................................................ 67
6
Healthy Worcester partnership priorities .................................................................... 69
6.1
Hospital admissions for self-harm amongst children and young people ..................... 69
6.2
Colorectal and prostate cancers ................................................................................... 69
6.3
Low birth weight babies ............................................................................................... 70
6.3.1 Women smoking in pregnancy ..................................................................................... 71
6.4
Young people not in employment, education or training ............................................ 73
7
Other public health priority areas ................................................................................ 74
7.1
Smoking and Tobacco ................................................................................................... 74
7.1.1 Local Tobacco Control Profile Indicators ...................................................................... 74
7.1.2 Smoking Prevalence ..................................................................................................... 75
7.2
Sexual Health ................................................................................................................ 76
7.2.1 Chlamydia ..................................................................................................................... 76
7.2.2 HIV ................................................................................................................................ 77
8
Conclusions and Recommendations ............................................................................ 80
8.1
Conclusions ................................................................................................................... 80
8.2
Recommendations........................................................................................................ 81
Appendices ............................................................................................................................... 82
9
Appendix 1 – Worcester detailed data......................................................................... 82
9.1.1 Employment ................................................................................................................. 82
9.1.2 Tenure........................................................................................................................... 84
9.1.3 Education ...................................................................................................................... 85
9.1.4 Children in need ........................................................................................................... 86
9.1.5 Takeaways and fast food outlets .................................................................................. 86
9.2
87
Bibliography.............................................................................................................................. 88
List of Figures
Figure 1 – Worcester District ward boundaries ..................................................................................................... 12
4
Figure 2 – Percentage of Population by Broad Age Groups in 2013 ...................................................................... 13
Figure 3 – Comparison of 2011 Census Population estimates for England and Worcester (outlines show 2001) 13
Figure 4 – Percentage of Population by Broad Ethnic Group in 2011 .................................................................... 14
Figure 5 – Life expectancy (LE) at birth (2008-12) for males and females by district against the national average15
Figure 6 – Worcester life expectancy at birth for males 2008-12 by Ward ........................................................... 16
Figure 7 – Worcester life expectancy at birth for females 2008-12 by Ward ........................................................ 16
Figure 8 – Percentage of Population in each National Deprivation Quintile ......................................................... 18
Figure 9 – Index of Multiple Deprivation by Worcester LSOA 2010 ...................................................................... 19
Figure 10 – Income Deprivation Affecting Children Index (IDACI), 2010 for Worcester ........................................ 20
Figure 11 – Proportion of Children Living in Worcester in income deprived households, 2010 by MSOA ............ 21
Figure 12 – Worcester health hotspots against deprivation LSOA 2010 ............................................................... 22
Figure 13 – Percentage of Projected Population in Worcester by Broad Age Groups for 2022 and 2032 ............ 23
Figure 14 – Care home development in Worcester City (approved since 2010) ................................................... 24
Figure 15 – GP Whole time equivalents (WTE) and registered patient numbers (July 2012) ................................ 24
Figure 16 – Worcester spine chart for key health indicators 2014 ........................................................................ 26
Figure 17 – Percentage of the population self-reporting long-term health problems, 2011 by district ................ 28
Figure 18 – Number of households accepted as homeless and in priority need by District against the national
average 2013-14 ................................................................................................................................. 30
Figure 19 – Rate of recorded violence against the person offences 2010/11 and 2011/12 .................................. 31
Figure 20 – Rate of violence against the person with injury per 1,000 population in Worcester 2011/12 by LSOA
and ward............................................................................................................................................. 32
Figure 21 – Violent Crimes Attributable to Alcohol for All Persons and All Ages by Worcestershire District in
2012/13 .............................................................................................................................................. 33
Figure 22 – Under 18 Conception Rates by District 2012 ...................................................................................... 34
Figure 23 – Under 18 Conception Rates significance compared to the national average Worcester Ward Area
2009-11 (3 year pooled data) ............................................................................................................. 34
Figure 24 – Under 16 Conception Rates by District 2008-10 (3 year pooled data)................................................ 35
Figure 25 – Rate of hospital admissions for intentional self-harm Worcestershire Districts all ages 2010/012011/12 .............................................................................................................................................. 36
Figure 26 – Hospital admissions due to intentional self-harm, 2010/2011 ........................................................... 36
Figure 27 – Standardised Emergency Admission ratios for Hospital stays for intentional self-harm in Worcester
all ages 2008/09 to 2012/13 by MSOA ............................................................................................... 38
Figure 28 – Rate of Emergency Hospital Admissions for self-harm aged 10-19 years old 2008/09 - 2010/11 by
Worcestershire District ...................................................................................................................... 39
Figure 29 – Mortality from suicide and injury undetermined: persons all ages, DSR per 100,000 population,
2008-2010 pooled by Worcestershire District ................................................................................... 39
Figure 30 – Number of All Drug Users in Treatment by Worcestershire District 2012/13 .................................... 40
Figure 31 – Percentage of respondents (aged over 65) who feel they belong to their immediate neighbourhood,
by district ............................................................................................................................................ 41
Figure 32 – Percentage of residents undertaking 1 or more hours unpaid care a week, 2011 ............................. 43
Figure 33 – Percentage of residents undertaking 50 or more hours unpaid care a week, 2011 ........................... 43
Figure 34 – Estimated prevalence of Dementia, UK, 2010 .................................................................................... 44
Figure 35 – Diagnosed diabetes in the 17+ year old population registered with a GP. 2011/12 .......................... 45
Figure 36 – Diagnosed diabetes in the 17+ year old population registered with a GP. 2011/12 compared to
diabetes prevalence estimates (diagnosed and undiagnosed) in the 16+ year old population for
Worcestershire and England in 2011, 2012, 2015, 2020, 2025 and 2030 .......................................... 46
Figure 37 – Type 2 Diabetes prevalence rates for Males and Females in the Worcestershire Districts 2006 ....... 46
Figure 38 – CHD prevalence rates in the Worcestershire Districts 2011 ............................................................... 47
5
Figure 39 – COPD Emergency Hospital Admissions April 2006/07-2010/11 and 2008/09-2012/13 ..................... 48
Figure 40 – Hospital Admissions for Mental Health by Worcestershire District 2008-09 to 2012-13 (5 years
pooled) ............................................................................................................................................... 49
Figure 41 – Mental Health Hospital Admission rate per 1,000 of the population by District where Primary
Diagnosis = F10-F19 - 2008/09 to 2012/13 (5 years pooled data) ..................................................... 50
Figure 42 – Mental Health Hospital admission rate/000 by District ...................................................................... 51
Figure 43 – Adjusted prevalence of underweight, healthy weight, overweight and obesity amongst adults 2012
by district compared to national average .......................................................................................... 52
Figure 44 – Estimated Percentage of Obese Adults in Worcester 2006/08 by MSOA ........................................... 53
Figure 45 – Percentage of Children Obese at Year 6 in Worcestershire Districts 2007/08 and 2012/13 against
national average ................................................................................................................................. 54
Figure 46 – Percentage of Children Obese in Reception in Worcester 2010/11 -2012/13 by MSOA .................... 55
Figure 47 – Percentage of Children Obese at Year 6 in Worcester 2010/11 -2012/13 by MSOA .......................... 55
Figure 48 – Estimated Percentage of Healthy Eating Adults in Worcestershire Districts 2006/08 ........................ 56
Figure 49 – Percentage of the population of the population aged 16+ that consume 5 or more portions of fruit
or veg a day, 2006-2008, modelled estimate (Healthy Eating Adults in Worcester) by MSOA .......... 57
Figure 50 – Worcestershire percentage of all land that is Green Space, 2005 by MSOA ...................................... 58
Figure 51 – Worcester percentage of all land that is Green Space, 2005 by MSOA .............................................. 58
Figure 52 – Percentage of Respondents who walk for short journeys in each Worcestershire District ................ 59
Figure 53 – Adult Participation in Sport and Active Recreation (formerly NI8) 2011-2013 by Age Group ............ 60
Figure 54 – Worcester Adult Participation in Sport and Active Recreation (formerly NI8) 2008-10 by MSOA ..... 61
Figure 55 – Estimated Percentage of Adults (aged 16 and over) who report engaging in Binge Drinking (20072008) .................................................................................................................................................. 62
Figure 56 – Estimated Percentage of Adults (aged 16 and over) who report engaging in Binge Drinking 20062008 by Worcester MSOA .................................................................................................................. 63
Figure 57 – Alcoholic Liver Disease emergency admissions, all ages, ICD10 K700, K701,K702,K703,K704,K709 in
Primary or first six Secondary Diagnosis Codes (2007/08-2011/12 pooled) ...................................... 64
Figure 58 – Rate of Alcohol-Specific Hospital Stays for Males in Worcestershire Districts compared to the
National average 2008/09 and 2012/13 ............................................................................................ 65
Figure 59 – Rate of Alcohol-Specific Hospital Stays for Females in Worcestershire Districts compared to the
National average 2008/09 and 2012/13 ............................................................................................ 65
Figure 60 – Rate of Alcohol-related Hospital Stays per 100,000 population for Males all ages in Worcestershire
Districts compared to the National average 2008/09 and 2012/13................................................... 66
Figure 61 – Rate of Alcohol-Related Hospital Stays for Females per 100,000 population in Worcestershire
Districts compared to the National average 2008/09 and 2012/13................................................... 67
Figure 62 – Rate of Alcohol-specific Hospital Stays (Under 18s) 5-year Trend ...................................................... 67
Figure 63 – Rate of Alcohol-specific Hospital Stays (Under 18s) per 100,000 population in Worcestershire
Districts 2006/07-2008/09 and 2010/11-2012/13 ............................................................................. 68
Figure 64 – New cases of Breast, Lung, Colorectal and Prostate Cancers, standardised incidence ratios for each
District relative to England 2007-11 ................................................................................................... 69
Figure 65 – Percentage of Births with a Low Birth weight by Worcestershire District in 2006-2010 and 2008-1270
Figure 66 – Proportion of Births with a Low Birth weight in Worcester 2008-12 by MSOA .................................. 71
Figure 67 – Women smoking in pregnancy trend over time in Worcestershire and England ............................... 72
Figure 68 – Percentage of Women Smoking at Delivery by CCG in 2012/13 ......................................................... 73
Figure 69 – Percentage of 16-18 year olds classified as 'NEET' in each Worcestershire District compared with the
National average over three years ..................................................................................................... 74
Figure 70 – Spine Chart of Local Tobacco Control Profile Indicators ..................................................................... 75
Figure 71 – Estimated Smoking prevalence among adults (18+) by Worcestershire District and National average
2011/12 .............................................................................................................................................. 75
6
Figure 72 – Chlamydia diagnosis rate per 100,000 aged 15-24, 2013 ................................................................... 76
Figure 73 – Chlamydia proportion aged 15-24 screened, 2013 ............................................................................. 77
Figure 74 – HIV testing uptake, MSM%, 2013 ........................................................................................................ 78
Figure 75 – HIV Late diagnosis (%), 2011-13 .......................................................................................................... 78
Figure 76 – HIV diagnosed prevalence rate per 1,000 aged 15-59, 2013 .............................................................. 79
Figure 77 – Percentage of 16-64 year olds in employment by Worcestershire District April 2013-March 2014 .. 82
Figure 78 – Percentage of 16-64 year olds who are unemployed and / or claiming Job Seekers' Allowance by
Worcestershire District April 2013-March 2014 ................................................................................ 83
Figure 79 – Top ten wards for unemployment proportion in Worcestershire, November 2013 .......................... 83
Figure 80 – Percentage of households in Worcestershire districts by tenure, 2011 ............................................. 84
Figure 81 – Percentage of pupils achieving 5+ A*-C grades incl. English and mathematics GCSEs 4-year Trend by
District (pupil residency) 2011/12-2012/13 ....................................................................................... 85
Figure 82 – Percentage of under 18 year olds classified as ‘in Need’ by Worcestershire District in 2010 ............ 86
Figure 83 – Number of Fast Food Outlets in Worcestershire Districts .................................................................. 87
7
1
Executive Summary
The health and wellbeing of Worcester residents is generally better than the regional and national
averages. Worcester's employment rates are significantly higher and long-term unemployment rates
are significantly lower than in the West Midlands or England as a whole (employment is a known
protective factor for health and unemployment a known risk factor for health). In addition Worcester
is amongst the best performing local authorities in England for its Tuberculosis rates; numbers of
road traffic accidents; numbers of children living in poverty and for its in incidence of acute sexually
transmitted infections.
Whilst the overall picture for Worcester is a positive one, it is important to consider the areas that
Worcester can improve upon.
This profile details a number of areas of that have been identified as priorities for improved health
and wellbeing in Worcester. Many of these are already known about and have been incorporated
into the various strategies at both district and county level by the Worcestershire Health and
Wellbeing Board and the Healthy Worcester Partnership. However there are a few issues that should
be highlighted as they are either of concern and have not yet been picked up or because the depth of
the issue needs further exploration:
Carer Health
The highest proportion of those providing 50 or more hours of unpaid care to friends and /or family
are in those wards that are amongst the most deprived in Worcester and that are experiencing some
of the worst health outcomes (Rainbow Hill, Gorse Hill and Warndon). The impact of providing such
high levels of unpaid care on the carer's health and wellbeing has not yet been explored in
Worcester.
Under 18 conception rates
Worcester has the fourth highest rates of under 18 conceptions in the West Midlands region. Rates
are highest in the wards of Warndon, Rainbow Hill, Gorse Hill, Nunnery and Cathedral which are also
the areas which have the highest rates of deprivation.
Sexual health screening
Screening for chlamydia and HIV are both very low, not only in Worcester but in Worcestershire and
the West Midlands region.
Colorectal and prostate cancer
Rates of Colorectal and prostate cancers are very high in Worcester; in particular, colorectal cancer is
almost 24% higher in Worcester than would have been expected given Worcester's age and sex
profile.
Drug and Substance misuse
The number of adults in structured treatment programmes for drug and substance misuse is far
higher in Worcester than in any of the other Worcestershire districts, however, this may be
representative of ease of access to structured drug treatment in Worcester compared to some of the
County's more rural areas.
Although this profile points to individual indicators, it also acknowledges that many health outcomes
are affected by the wider determinants of health, the quality of housing a person lives in, their
8
household income, the levels of deprivation, education and exercise to name a few. Before making
changes to services, commissioners are encouraged to undertake Health Impact Assessments to
understand the true impact their service change may have on Worcester's communities.
9
1.1
Recommendations
It is recommended that:
1.
An audit of current chlamydia screening service delivery be undertaken, with a view to
further developing screening pathways that are aligned to the existing core services of Reproductive
and Sexual Health (RSH), community pharmacy, general practice, termination of pregnancy, and any
other key identified services. In addition, work should also be undertaken to identify best practice
around increasing awareness and access to chlamydia screening by targeting the most 'at risk'
populations.
2.
An investigation be conducted into why under 18 conception rates are high in Worcester City
and in particular in the wards of Warndon, Rainbow Hill, Gorse Hill, Nunnery and Cathedral.
Furthermore, best practice for reducing the rate of under 18 conceptions should be explored and
recommendations for service delivery be made.
3.
Reasons for the high rates of prostate and colorectal cancers in Worcester and
Worcestershire are investigated and best practice for addressing these issues be explored.
4.
Working groups should be created with representatives from Public Health, South
Worcestershire CCG, NHS England and other partners as appropriate to manage delivery of
recommendations 1-3, to establish best practice and to make recommendations for future delivery.
In addition, it is recommended that the commissioners of health and care services:
5.
Promote carer support and identification in primary care given that the areas of Worcester
with the highest levels of 50 and above hours unpaid care are in the health hotspot areas of Gorse
Hill, Rainbow Hill and Warndon.
6.
Ensure demographic pressures from population projections and care home developments
are taken into account in infrastructure planning for primary care and in the wider primary care
service model.
7.
Ensure that the data in this profile is used in planning, reviewing and commissioning health
and wellbeing related services in Worcester.
2
Introduction
This document profiles the health and wellbeing of the Worcester City area. It is the second in a
series of profiles for each of the Worcestershire Districts' population, the first of which was on
Redditch1.
1
Worcestershire Public Health - Redditch Health and Wellbeing Profile, October 2013
http://www.worcestershire.gov.uk/cms/pdf/Redditch%20HWB%20Profile%20Final%2018-10-13.pdf
10
This profile looks at the health and wellbeing of the Worcester city area in relation to the other
Worcester Districts and the regional and national averages as appropriate. It looks at the
demographics of the area and the changes that are projected over the next ten to twenty years.
Whilst the overall picture of the health and wellbeing of Worcester residents is a positive one; this
profile necessarily focuses on those areas that have been highlighted as concerns from a range of
sources: the Association of Public Health Observatories (APHO) Annual Health Profiles; responses
from cross-sectional studies of Worcester residents; the Worcestershire Health and Wellbeing
Board's Priorities; the Healthy Worcester Partnership's priorities and other public health areas of
interest.
The purpose of this document is to create a picture of the health and wellbeing of Worcester
residents to be used as a tool in planning and commissioning and delivering services and assessing
the needs of the area.
A number of recommendations for further exploration have been made in-line with identified best
practice.
11
3
Setting the Context
Worcester is a University and Cathedral City in the heart of the Worcestershire County, West
Midlands. The Worcester area is served by both Worcestershire County Council and Worcester City
Council.
The following sections provide further details on the demographics, economics and geography of the
Worcester area.
Worcester City is split up into 15 wards as detailed in Figure 1 below.
Figure 1 – Worcester District ward boundaries
Source: ONS
3.1
Worcester's population
Latest estimates show that Worcester has a total population 100,405. This equates to just over 17 %
of the total population of Worcestershire (around 572,000).
3.1.1
Age
In general Worcester has a younger population than Worcestershire as a whole, but it should be
noted that Worcestershire has an older age profile than is seen across the whole of England.
60% of the Worcester population is under the age of 45, compared to 52.2% of the total population
in Worcestershire, however it is more comparable with that of the England average of 57.5%. In
contrast, the 65+ age group accounts for 15.6% of the total population in Worcester, compared to
20.5% of the population in Worcestershire, and 17.3% in England.
12
Figure 2 – Percentage of Population by Broad Age Groups in 2013
0-15
England
19.0%
West Midlands
18.4%
21.2%
Worcestershire
17.5%
Worcester
18.7%
0%
10%
16-29
30-44
20.1%
20.6%
16.7%
20.5%
20%
45-64
19.9%
18.0%
20.9%
30%
65+
25.2%
17.3%
22.8%
15.5%
27.4%
20.5%
24.3%
40%
50%
60%
70%
Percentage of Population
Source: Office for National Statistics, mid-year estimates, 2013
15.6%
80%
90%
100%
Figure 3 compares the population of Worcester against that of England in more detail. It can be seen
that the overall age and gender structure of the Worcester population is not vastly different from
that of England as a whole. However, it does appear that since 2001 the population of Worcester
has experienced a greater fall in the percentage of both men and women in the 30-40 age range
compared to England. Conversely, Worcester has experienced a greater increase in the percentage of
both males and females in the 45-50 and 60-65 age ranges during the same period when compared
to England.
Figure 3 – Comparison of 2011 Census Population estimates for England and Worcester
(outlines show 2001)
Source: 2011 Census, 2001 Mid-Year Population Estimates. Graphic by ONS Data Visualisation Centre
13
3.1.2
Ethnicity
Figure 4 below compares the population of Worcester against that of Worcestershire, the
West Midlands and England by broad ethnic group. Figures from the 2011 Census show that
93.4% of people in Worcester are from all white ethnic groups. This compares to 95.7% in
Worcestershire and 85.4% in England. Compared to the West Midlands region, the nonwhite population makes up only a small percentage of the Worcester population, the largest
broad ethnic group other than white, being Asian and Asian British at 4.4%; breaking this
down further, the largest Asian/Asian British group is Pakistani at 1.9% of the Worcester
population.
Figure 4 – Percentage of Population by Broad Ethnic Group in 2011
White
Mixed
England
West Midlands
Asian/Asian British
85.4%
82.7%
Black/Black British
2.3%
2.4%
All Other Ethnic Groups
7.8%
3.5%
10.8%
Worcestershire
3.3%
95.7%
Worcester
82%
84%
86%
0.9%
1.2% 2.4%
93.4%
80%
1.0%
1.4%
88% 90% 92% 94%
4.4%
96%
98%
100%
Source: 2011 Census
3.1.3
Life Expectancy
Women in Worcester are expected to live, on average, over four and a half years longer than males.
The average life expectancy at birth for males in Worcester is 78.3 years and for women is 82.9 years.
Figure 5 shows that Worcester has the lowest average life expectancy of all of the Worcestershire
districts for both males and second lowest for females, however, neither is significantly lower than
the England average.
14
Figure 5 – Life expectancy (LE) at birth (2008-12) for males and females by district against
the national average
86.0
Male LE 2008-12
Female LE 2008-12
Male LE England 2008-12
Female LE England 2008-12
84.0
82.0
80.0
82.9
78.0
76.0
78.3
78.6
84.4
83.4
83.0
82.8
79.9
78.8
83.1
80.0
80.6
74.0
Worcester
Redditch
Wyre Forest
Malvern Hills
Bromsgrove
Wychavon
Source: ONS
We see a greater disparity when we break life expectancy down by the areas of Worcester in which
people live. For example, males living in Warndon are expected to live 10.7 years less than those
living in St. Peter's Parish. The disparity between life expectancies in women is not as pronounced as
for males; women in Rainbow Hill are expected to live 4.4 years less than women in Warndon Parish
North. It should be noted that the data regarding life expectancy estimates for males living in
Warndon Parish North was not available for the time period.
The following maps show the life expectancy for males and females in each ward represented as
Worcestershire quintiles, not every district will have wards in each of the quintiles; for example,
none of the Worcester wards are in the top Worcestershire quintile for male life expectancy.
15
Figure 6 – Worcester life expectancy at birth for males 2008-12 by Ward
Source: ONS
Figure 7 – Worcester life expectancy at birth for females 2008-12 by Ward
Source: ONS
It can be seen that for both males and females, the wards with the lowest life expectancy (shown in
red) are concentrated in a band across the middle of the city and up into Warndon. Wards with the
highest life expectancy are in the South and Eastern areas of the city. The areas with the highest
16
differences in life expectancy across males and females appear to be in Cathedral ward which is in
the lowest quintile for males and the middle quintile for females, representing almost 6 years
difference in life expectancies between males and females in this ward.
3.1.4
Employment
Employment in Worcester is at 77.8%, above both the regional and national averages based on the
ONS 2013 mid-year estimates. Further detail on both employment and unemployment in
Worcestershire is detailed in 9.1.1.
3.1.5
Tenure
There is considerable variance between Worcestershire districts in terms of the proportion of
housing tenure, with certain areas having a much higher percentage of social rented housing.
Worcester City district dominates in terms of the proportion of housing which is privately rented, at
just over 15%. This might be expected with the greater proportion of flats in this area, closely
correlated with the age profile of the student population. Additional details on tenure in
Worcestershire are provided in 9.1.2. In addition, information relating to homelessness can be found
in section 4.1.
3.1.6
Education
The rate of pupils achieving 5 or more GCSEs in Worcester is currently below the
Worcestershire and National average, however it is not significantly different to the regional
average. For further information please refer to 9.1.3.
3.1.7
Deprivation
The Index of Multiple Deprivation 2010 (IMD) is a measure of multiple deprivation at lower layer
super output area (LSOA) which is a geographical unit that has an average population of 1,500. The
IMD is made up of 38 indicators covering seven domains and the result is a single score for a LSOA
which is then ranked (1 = most deprived area in England and 32,482 = least deprived), these can be
then grouped into deciles and quintiles. Figure 8 shows the percentage of the population in each
deprivation quintile for England, the West Midlands, Worcestershire and the six Worcestershire
districts.
17
Figure 8 – Percentage of Population in each National Deprivation Quintile
Most Deprived
England
More Deprived
20.3%
West Midlands
Average Deprived
20.2%
28.7%
10.0%
12.8%
Bromsgrove
7.1%
19.5%
Malvern Hills
8.7%
Redditch
17.1%
Wychavon
10.7%
Wyre Forest
0%
10%
30.1%
24.0%
44.2%
16.2%
14.7%
17.6%
21.1%
30.1%
19.0%
14.1%
46%
22.8%
20%
19.7%
18.3%
27.5%
17.2%
Least Deprived
19.8%
20.2%
23.1%
24.9%
Worcester
20.0%
18.8%
Worcestershire
Less Deprived
22.1%
24.0%
28.7%
18.3%
29.9%
25.3%
30%
17.3%
29%
28.7%
40%
50%
60%
70%
80%
Source: Index of Multiple Deprivation 2010, Association of Public Health Observatories,
http://www.apho.org.uk
9.7%
90%
100%
It can be seen from figure 8 that out of the six districts of Worcestershire, Worcester has the third
largest percentage of its population in the most deprived quintile at 17.1%. Behind Redditch and
Wyre Forest this is below the national and regional averages of 20.3% and 28.7% respectively,
however it is much higher than the Worcestershire average of just 10%. Almost half of Worcester's
residents are classified as being in the top two quintiles for deprivation. It should be noted that
Bromsgrove has no LSOA in the national lowest quintile for deprivation.
Figure 9 shows each LSOA in Worcester in the IMD grouped into quintiles calculated on
Worcestershire as a whole. In the whole of Worcestershire there are 72 LSOAs in the most deprived
quintile, 17 of which are in Worcester. The number of LSOAs in the most deprived quintile for
Worcestershire in the other districts are:





21 in Redditch
21 in Wyre Forest
6 in Wychavon
4 in Malvern Hills
3 in Bromsgrove
18
Figure 9 – Index of Multiple Deprivation by Worcester LSOA 2010
Source: Office of National Statistics. Quintile classification is based on quintiles calculated for the whole of
Worcestershire.
It can be seen from figure 9 that all four LSOAs in Gorse Hill lie within the most deprived quintile, the
ward areas of Warndon, Cathedral and Rainbow Hill each have three LSOA's in the most deprived
quintile, with the wards of St John, Nunnery and Arboretum having 2, 1 and 1 LSOAs in the most
deprived quintile in Worcestershire respectively.
Child poverty is closely linked to deprivation. Section 3.1.8 explores this further.
3.1.8
Children in poverty
Figure 10 shows the proportion of children aged 0-15 in living in income-deprived
households out of all children aged 0–15 in each District of Worcestershire.
19
Figure 10 – Income Deprivation Affecting Children Index (IDACI), 2010 for Worcester
2010
England
25
20
15
10
5
12.3%
18.7%
19.3%
19.5%
Worcester
Redditch
Wyre Forest
12.9%
8.6%
0
Bromsgrove Malvern Hills
Wychavon
Source:
As can be seen, each of the Worcestershire districts' proportion of children living in poverty
is significantly better than the England average of 21.8%; however, these figures hide the
levels of child poverty in some of Worcester's wards.
Figure 11 below shows the proportion of children living in income deprived households in
Worcester and is categorised according to Worcestershire quintiles. In Gorse Hill ward, over
42% of children are classified as living in poverty. Similarly, Warndon and Rainbow Hill
wards each have over a third (36.9% and 36.7% respectively) living in poverty.
20
Figure 11 – Proportion of Children Living in Worcester in income deprived households,
2010 by MSOA
Source: Association of Public Health Observatories, http://www.apho.org.uk. Quintile classification is based on
quintiles calculated for the whole of Worcestershire.
3.1.9
Worcester Health Hot spots
There are strong links between deprivation and health inequalities. The Public Health Annual Report
for Worcestershire in 2008 was focused on health inequalities and the identification of local "health
hotspots" which were areas with poor health outcomes compared to the rest of the County. These
hotspots were revisited in the 2014 report to see if there had been any changes to outcomes in these
areas. Dines Green (St John Ward); Nunnery and Ronkswood; and, Old Warndon, Gorse Hill and
Rainbow Hill have been identified as ‘health hotspots’ by Worcestershire Public Health. These are
identifiable neighbourhoods that are among the most deprived in England and which have rates of
premature mortality significantly higher than the Worcestershire average.
Figure 12 below shows a map of the Worcester hotspots overlaid on the Worcestershire deprivation
quintiles.
21
Figure 12 – Worcester health hotspots against deprivation LSOA 2010
Source: Health Hotspots from Worcestershire Public Health Annual Report 2014; IMD information from Office
of National Statistics. Quintile classification is based on quintiles calculated for the whole of Worcestershire.
All-age all-cause mortality in hotspot areas was improved from 2007-09 figures to 2011-13 figures.
Dines Green in particular has shown improvement over this time period and is no longer statistically
significantly different to the rest of Worcestershire. Nunnery and Ronkswood and Old Warndon,
Gorse Hill & Rainbow Hill are still showing higher levels of all-cause mortality than the rest of
Worcestershire.
Although showing a reduction in 2011-13 from the 2007-09 figures, under 75 mortality is significantly
higher in the hotspot areas than in the other parts of Worcestershire.
3.1.10
Worcester's future population
Figure 13 below shows ONS population projections by broad age groups for Worcester for the years
2022 and 2032, alongside the 2012 mid-year estimates. This allows us to gauge the age profile of the
Worcester population in the next 10-20 years.
It can be seen from the chart that the most notable difference from the 2012 population in
Worcester is a growth in the percentage of those that are aged 65 and above, from just 15.4% in
2012, to 17.8% in 2022 and 20.0% in 2032. The projections for those in the 0-15 and 30-44 age
brackets remain reasonably constant from 2012 -2032; the greatest reduction is projected to be in
the 16-29 age group, moving from 21.5% of the population in the 2012 mid-year estimates to 17.1%
in 2032.
22
Projections for inward and outward migration over this time period remain balanced in Worcester, as
do births and deaths, so it is projected that there would be no major changes to the population
balance other than aging2. This ageing population has implications for the health needs of the
district.
Figure 13 – Percentage of Projected Population in Worcester by Broad Age Groups for 2022
and 2032
0-15
2012
17.5%
21.5%
2022
17.4%
20.1%
2032
16.7%
0%
17.1%
20%
30-44
45-64
21.2%
20.0%
21.9%
65+
24.4%
24.4%
23.0%
15.4%
17.8%
20.0%
40%
50%
60%
70%
80%
90%
100%
Source: Office for National Statistics, figures for 2022 and 2032 are taken from the Interim 2012-based
subnational population projections. Figures for 2012 are the 2012 mid-year estimates.
3.1.11
10%
16-29
30%
Planned building developments in Worcester
The population projections above do not take account of changes in ward age profiles due to new
planning developments. For example, a large care home may increase the proportion of older
people living in an area and will have implications for the commissioners of primary care services in
the area.
Figure 14 details the care home developments have been approved by Worcester City Council since
2010. It should be noted that the South Worcestershire Development Plan (SWDP)3, covering the
Worcester, Wychavon and Malvern Hills areas, is currently being prepared with the aim of ensuring
the effective planning and management of future developments. It is therefore suggested that the
commissioners and planners of primary care consult the SWDP when planning their services.
2
3
ONS 2012-subnational population projections
http://www.swdevelopmentplan.org
23
Figure 14 – Care home development in Worcester City (approved since 2010)
Site
Ward
Number of beds
(units)
Grove Farm and University Park,
Bromyard Road
Bedwardine
160
Former Ronkswood Hospital site
Warndon Parish
South
137
Land at Newton Road and Charles
Hastings Way
Warndon Parish
South
82
Land at White Ladies Close
Arboretum
37
East Bank Drive
Claines
38
Former Faithful Overalls site, East
Bank Drive and Northwick Road
Claines
73
Source: Worcester City Council Planning Team
3.1.12
Number of GPs per head of population
The projected and known changes to Worcester's population in the next 5-10 years, as detailed
above will have considerable impact upon primary care planning4 and, in particular, the number of
GP's per head of population, the primary care skills mix and primary care links to Adult Social Care.
Worcester District is served by the South Worcestershire Clinical Commissioning Group. Current GP
whole time equivalent figures based on registered patient numbers in each of the three
Worcestershire CCG areas are shown in figure 13 below.
There were 317.8 whole time equivalent GPs (WTEs) in July 2012 in the three Worcestershire CCGs
combined, covering a registered population of 576,523 patients. This is equivalent to 1813.9 patients
per WTE GP or 55.1 GPs per 100,000 registered population.
Figure 15 – GP Whole time equivalents (WTE) and registered patient numbers (July 2012)
CCG
Redditch and Bromsgrove
South Worcestershire
Wyre Forest
Total
GP WTE
List size
Patients
per WTE
87.7
165.4
64.8
317.8
171,091
293,275
112,157
576,523
1,951.5
1,773.1
1,732.0
1,813.9
GPs per
100,000
population
51.2
56.3
57.7
55.1
Source: Exeter database and primary care contracts team, GP WTE and List sizes sourced from the South
Worcestershire CCG Needs Assessment 2013
The national average rate of GPs per 100,000 of population was 62 in 2009 but this had dropped to
59.5 in 20125. Each of the Worcestershire CCGs has a GP per 100,000 population rate that is lower
4
The Information Centre: Trends in consultation rates in General Practice 1995/6 to 2008/9
24
than the national average. It should be noted that there has been recognition nationally that there
are not enough GPs in training to replace those approaching retirement, this has triggered a GP
taskforce to be created to address this by the Department of Health and Medical Education England.
5
The Information Centre: NHS Staff 2002-2012. 2012. The Health and Social Care Information Centre
25
3.2
The Health of Worcester at a Glance
3.2.1
2014 PHOF Worcester Health Profile
The Association of Public Health Observatories (APHO) produces annual health profiles for every local
authority area. These profiles help to provide a snapshot of the overall health of the local population
and highlight potential problems through comparison with other areas and with the national
average. A 'spine chart' health summary showing the difference in health between the area and the
average for England for 32 indicators can be seen in figure 16. It shows how the health of people in
this area compares with the rest of England. This area’s result for each indicator is shown as a circle.
The average rate for England is shown by the black line, which is always at the centre of the chart.
The range of results for all local areas in England is shown as a grey bar. A red circle means that this
area is significantly worse than England for that indicator; and a green circle shows that the area is
significantly better than England, however this may still indicate an important public health problem;
yellow circles show that the area is not significantly different from the national average.
Figure 16 – Worcester spine chart for key health indicators 2014
Notes: ‡ For comparison with PHOF Indicators, please go to the following link, http://www.healthprofiles.info/PHOF.
26
Indicator Notes
1 % people in this area living in 20% most deprived areas in England, 2010 2 % children (under 16) in families receiving means-tested benefits &
low income, 2011 3 Crude rate per 1,000 households, 2012/13 4 % key stage 4, 2012/13 5 Recorded violence against the person crimes, crude
rate per 1,000 population, 2012/13 6 Crude rate per 1,000 population aged 16-64, 2013 7 % of women who smoke at time of delivery, 2012/13 8
% of all mothers who breastfeed their babies in the first 48hrs after delivery, 2012/13 9 % school children in Year 6 (age 10-11), 2012/13 10
Persons under 18 admitted to hospital due to alcohol-specific conditions, crude rate per 100,000 population, 2010/11 to 2012/13 (pooled) 11
Under-18 conception rate per 1,000 females aged 15-17 (crude rate) 2012 12 % adults aged 18 and over, 2012 13 % adults achieving at least
150 mins physical activity per week, 2012 14 % adults classified as obese, Active People Survey 2012 15 % adults classified as overweight or
obese, Active People Survey 2012 16 Directly age standardised rate per 100,000 population, aged under 75, 2009-2011 17 Directly age sex
standardised rate per 100,000 population, 2012/13 18 The number of admissions involving an alcohol-related primary diagnosis or an alcoholrelated external cause, directly age standardised rate per 100,000 population, 2012/13 19 Estimated users of opiate and/or crack cocaine aged
15-64, crude rate per 1,000 population, 2010/11 20 % people on GP registers with a recorded diagnosis of diabetes 2012/13 21 Crude rate per
100,000 population, 2010-2012 22 Crude rate per 100,000 population, 2012 (chlamydia screening coverage may influence rate) 23 Directly age
and sex standardised rate of emergency admissions, per 100,000 population aged 65 and over, 2012/13 24 Ratio of excess winter deaths
(observed winter deaths minus expected deaths based on non-winter deaths) to average non-winter deaths 1.08.09-31.07.12 25 At birth, 20102012 26 At birth, 2010-2012 27 Rate per 1,000 live births, 2010-2012 28 Directly age standardised rate per 100,000 population aged 35 and over,
2010-2012 29 Directly age standardised mortality rate from suicide and injury of undetermined intent per 100,000 population, 2010-2012 30
Directly age standardised rate per 100,000 population aged under 75, 2010-2012 31 Directly age standardised rate per 100,000 population aged
under 75, 2010-2012 32 Rate per 100,000 population, 2010-2012 ^ "Regional" refers to the former government regions.
Source: Association of Public Health Observatories Health Profiles 2014 http://www.apho.org.uk.
In 2014, the key areas of interest for Worcester were6:





3.2.2
Smoking prevalence
Teenage pregnancy
Drug misuse
Homelessness
Violent crime
APHO – Changes over time
In general the issues highlighted in the APHO for Worcester over the last 8 years have been fairly
consistent; levels of violent crime, teenage pregnancy (under 18) and homelessness have been
flagged as being significantly higher in Worcester than the England average since 2006/07.
Although significantly higher than the England average, the actual Worcester figures have shown
some improvement.
With the exception of a slight increase in figures in 2012 and 2013, recorded violence against the
person crime crude rates have steadily decreased from 2,200 incidences in 2006 to 1373 incidences
in 2014. However, it should be noted that this is an overall rate for crime against the person; it does
not provide a picture of the underlying rates in different crime indicators such as domestic violence
or sexual violence.
Under 18 conception rates have reduced year on year, save for a slight increase in 2013, from 82
pregnancies in 2007 to 70 pregnancies in 2014.
3.3
What Worcester residents are saying
The statistics provide us with a picture of Worcester's health however they do not give us any details
as to why things may be as they are. One way of gauging this is by collecting qualitative data, e.g.
surveys and interviews with residents to understand their views and attitudes towards health.
There are two main sources of recent resident level data in the Worcester area: the national 2011
Census provides us with a detailed profile of the population, including, for example their occupation
6
Association of Public Health Observatories – Worcester Health Profile
http://www.apho.org.uk/resource/item.aspx?RID=142243
27
and carer status. The Worcestershire Viewpoint Survey provides county wide data on the
Worcestershire residents and provides some qualitative insight into their views and perceptions of
living and working in the County.
In addition, in 2013 the Worcester Strengthening Healthy Communities study, was conducted in the
Warndon, Gorse Hill and Rainbow Hill areas of Worcester , this small scale study provided some
insight into the issues affecting some of the residents in these areas. .
3.3.1
2011 Census – self-reported level of long-term health
Part of the 2011 Census asked residents to self-report the level of their long-term health. Responses
were categorised into three categories: day to day activates are not limited at all; day to day
activities are limited a little; and, day to day activities are limited a lot.
The responses for the Worcestershire districts are displayed in figure 17 alongside the national
average.
It should be noted that Worcester City district has the highest proportion of the population selfreporting that their ‘day to day activities are not limited at all’ at 83.8%, above the national and
regional averages and all other districts in the county.
Section 5.1.2 looks in detail at the numbers of residents undertaking carer roles in Worcester as
reported in the 2011 Census.
Figure 17 – Percentage of the population self-reporting long-term health problems, 2011
by district
Day to day activities limited a lot
Day to day activities limited a little
Day to day activities not limited
England
8.3%
9.3%
82.4%
Bromsgrove
8.1%
9.5%
82.4%
Malvern Hills
8.7%
10.9%
Redditch
8.0%
80.5%
9.1%
82.9%
Worcester
7.2% 9.0%
83.8%
Wychavon
7.6% 10.0%
82.4%
Wyre Forest
9.2%
0%
10.7%
10%
20%
80.1%
30%
40%
50%
60%
Source: ONS - Census 2011
28
70%
80%
90%
100%
Health in Worcestershire – Viewpoint results, July 2014
In the Worcestershire Viewpoint survey of residents undertaken in May 20147, residents were asked
what they considered to be the "three most important threats to health facing people in
Worcestershire today". Results were analysed by district to see if there were any differences in
attitudes and perception of health risks in each area.





In Worcestershire as a whole, overweight and obesity was seen as by far the greatest threat
to health (mentioned by 65% of respondents and 61% of respondents who lived in
Worcester), followed by physical inactivity (a relatively lower 39% of residents, 38% in
Worcester).
Other major threats to health (in order of importance to people in Worcestershire) were
smoking, drinking too much alcohol (36% of respondents) and drug abuse and mental health
and wellbeing (24% of respondents).
Environmental quality was not considered a particular threat to health in Worcestershire;
however the highest proportion expressing concern was in the Worcester City district where
noise and pollution is higher than the more rural districts.
A higher proportion of respondents in Worcester City and Malvern Hills considered long term
conditions to be a threat to health than the other districts.
In Worcester City a third of residents considered mental health and wellbeing to be a health
issue of concern, in comparison with only a quarter in Worcestershire as a whole; there is
evidence to suggest urban living can be more stressful8.
Source: Viewpoint Residents Survey May 2014
3.3.2
Worcester Strengthening Healthy Communities, 2013
In 2011, South Worcestershire CCG and Worcestershire County Council commissioned a programme
of community engagement, service design and social action in Worcester, focussing on the areas of
Warndon, Gorse Hill and Rainbow Hill in the north east of the City. This programme recruited and
trained 20 Community Champions who then consulted over 300 people in the areas above to
understand the factors influencing their lifestyle choices, health and long term condition
management.
The study found:






Those consulted had a low expectation of what "good health" was.
Smoking levels were high amongst respondents (38.9%).
32.5% of respondents were personally affected or had a family member who had been
affected by the misuse of drugs.
Respondents cited the following lifestyle factors as important to health: influence of family
members, stress, anxiety, money worries, unemployment, bereavement, drugs and alcohol
misuse.
Amongst respondents, the most common long term condition was depression / anxiety.
Most respondents with long term conditions relied on medication rather than lifestyle
change to manage their condition.
Source: Turning Point, Worcester Strengthening Healthy Communities Research report, 2013
7
Viewpoint Residents Survey May 2014
8
Lederbogen et al. 2011. City living and urban upbringing affect neural social stress processing in humans.
Nature: Vol. 474 pp.498-501.
29
4
2014 PHOF priority areas
The Public Health Outcomes Framework (PHOF) sets out a number of Public Health related outcomes
and indicators to help understand how Public Health is being improved and protected. Every year
local authorities' performance against these indicators is reported. The areas where Worcester was
significantly worse than the England average are detailed below.
4.1
Statutory homelessness
Levels of statutory homelessness were identified within the PHOF has been significantly higher in
Worcester than the England average.
Homeless people each consume an estimated eight times more hospital inpatient services than an
average person of similar age. The Homeless charity CRISIS quotes that compared to the general
public, homeless people are 40 times more likely not to be registered with a GP and have about five
times the utilisation of A&E services9.
A ‘main homelessness duty’ is owed where the authority is satisfied that the applicant is eligible for
assistance (under the 1977 and 1996 Housing Acts, and the Homelessness Act 2001), unintentionally
homeless and falls within a specified priority need group. Such statutorily homeless households are
referred to as ‘acceptances’.
‘Homelessness prevention’ means providing people with the ways and means to address their
housing and other needs to avoid homelessness.
‘Homelessness relief’ is where an authority has been unable to prevent homelessness but helps
someone to secure accommodation, even though the authority is under no statutory obligation to do
so.
In 2013-14 the local authority took a total of 471 homeless decisions. 187 were accepted as being
homeless and in priority need which represents 4.45 per 1000 households – higher than in other
parts of the county as shown in figure 18 below. 30 were found to be eligible homeless and in
priority need but were intentionally homeless, 183 were eligible homeless but not in priority need
and 71 were eligible but not homeless10.
Figure 18 – Number of households accepted as homeless and in priority need by District
against the national average 2013-14
Number of
District
households
(000s)
Bromsgrove
39
Malvern Hills
33
Redditch
35
Worcester
42
Wychavon
50
Wyre Forest
44
England average 22,543
No. accepted as homeless
and in priority need
68
52
98
187
170
134
52,270
Rate per 1,000
population
1.74
1.58
2.80
4.45
3.40
3.05
2.32
Source: DCLG
9
CRISIS: Critical Condition, Homeless people's access to GPs
http://www.crisis.org.uk/data/files/document_library/policy_reports/gp_mediabrief.pdf
10
Department for Communities and Local Government, Table 784, Local authorities' action under homeless
provisions of the housing acts, financial year 2013/14
30
In 2013-14 Worcester took positive action to prevent 582 households becoming homeless and
provided homelessness relief to 6 households11.
4.2
Violent crime
Figure 19 below shows the rate of recorded violence against the person offences in the six
Worcestershire districts compared with the National average. It can be seen that Worcester has the
second highest rate in the county behind Redditch; both of these districts and Wyre Forest have rates
that are significantly above the National average
It should be noted, that Worcester is the only district in Worcestershire that has seen an increase in
the rate of recorded violence against the person offences between 2010/11 and 2011/12.
Figure 19 – Rate of recorded violence against the person offences 2010/11 and 2011/12
2010/11
2011/12
England 2010/11
England 2011/12
25.0
20.0
15.0
10.0
5.0
8.1
7.9
8.2
17.9 17.2
18.2 18.9
Wyre Forest
Worcester
20.7
19.4
10.7 10.2
7.5
0.0
Wychavon
Malvern Hills
Bromsgrove
Redditch
Crude rate per 1,000 population.
Source: Association of Public Health Observatories, http://www.apho.org.uk and Violence Indicator Profiles for
England Resource
Figure 20 shows a map of the rate of violence against the person per 1,000 of the population for the
financial year of 2011/12 by ward area in Worcester. It can be seen from the map that those areas
with the highest rates of violence against the person with injury are concentrated around the centre
of Worcester, particularly in Cathedral ward, with pockets of higher rates in the Warndon, Nunnery,
Gorse Hill and St. John wards. Areas with the lowest rates of violence against the person with injury
tend to be around the perimeter of Worcester with the wards of Warndon Parish North, Warndon
Parish South and St. Clement each having one LSOA that has had no reported incidents over the time
period (shown in white on the map below).
11
Department for Communities and Local Government, live tables on homelessness 2013-14
31
Figure 20 – Rate of violence against the person with injury per 1,000 population in
Worcester 2011/12 by LSOA and ward
Source: South Worcestershire Community Safety Partnership.
Alcohol-related Violent Crime
Figure 21 shows a crude rate of violent crimes attributable to alcohol per 1,000 of the population by
Worcestershire district in 2012/13. It can be seen from the chart that Worcester and Redditch have
the highest rate out of the six districts and that this is also significantly higher than the National
average. However, it should be noted that there has been a slight decrease in violent crimes
attributed to alcohol in Worcester since 2011/12.
32
Figure 21 – Violent Crimes Attributable to Alcohol for All Persons and All Ages by
Worcestershire District in 2012/13
2012/13
England
6
5
4
3
4.91
5.15
5.15
Worcester
Redditch
2
1
2.36
2.41
Malvern Hills
Wychavon
2.59
0
Bromsgrove Wyre Forest
Crude rate per 1,000 population
Source: Local Alcohol Profiles for England www.lape.org.uk
4.3
Under 18 conceptions
The health profile spine chart indicates that Worcester has a considerably higher rate of teenage
pregnancies than the National average and each of the other Worcestershire districts.
Of the 30 lower tier and unitary local authorities in the West Midlands, Worcester ranks fourth
highest in the region for under 18 conception rates behind Stoke, Walsall and Tamworth and is
ranked 10th highest in England and Wales; despite this, the actual number of teenage pregnancies in
Worcester has steadily reduced (with the exception of a very slight increase in 2013) from 82
pregnancies in 2007 to 70 in 2014
Teenage pregnancy is often associated with poor health and social outcomes for both the mother
and child. Young mothers are more likely to suffer postnatal depression and less likely to complete
their education. Children born to teenage parents are less likely to be breastfed, more likely to live in
poverty and more likely to become teenage parents themselves12.
Worcester's rate of under 18 conceptions leading to abortion is lower than the Worcestershire,
regional and national averages.
12
Botting B, Rosato M, Wood R (1998) Teenage mothers and the health of their children. ONS population
trends 93:19-28.
33
Figure 22 – Under 18 Conception Rates by District 2012
2012
England
60
50
40
30
43.1
20
10
34.5
19.0
21.6
22.1
Bromsgrove
Wychavon
Malvern Hills
25.3
0
Wyre Forest
Redditch
Worcester
Source: Association of Public Health Observatories, http://www.apho.org.uk
Figure 23 – Under 18 Conception Rates significance compared to the national average
Worcester Ward Area 2009-11 (3 year pooled data)
Source: Chimat Data Atlas
Figure 23 shows which wards in Worcester have significantly higher rates of under 18 conception
over the 2009-11 period than the England average (shown in red) or not significantly different
34
(shown in pink). Data has been supressed in areas where there were less than five under 18
conceptions over the time period.
It can be seen that under 18 conception rates are highest in the wards of Warndon, Rainbow Hill,
Gorse Hill, Nunnery and Cathedral which are also the areas which have the highest rates of
deprivation.
Figure 24 shows under 16 conception rates by Worcestershire district. It can be seen that Worcester
is no longer has the highest conception rates in the county when viewed for under 16 year olds,
instead ranking second behind Redditch. It is also no longer significantly higher than the England
average. Figure 24 below reports the rate of conceptions per 1000 women in the under 16 age
group. The actual number of conceptions is also shown for each District – both Worcester and
Redditch had 31 conceptions in the under 16 age group over the three year period but as the under
16 female population is comparatively larger in Worcester than in Redditch the rate per 1000
population is slightly lower.
Figure 24 – Under 16 Conception Rates by District 2008-10 (3 year pooled data)
2012
England
8
7
6
5
rate = 7.4
4
rate = 6.3
rate = 5.2
3
2
1
rate = 3.3
rate = 3.5
number =
15
number =
18
Malvern Hills
Bromsgrove
rate = 4.0
number =
25
number =
25
number =
31
number =
31
0
Wychavon
Wyre Forest
Worcester
Redditch
4.4
Hospital stays for self-harm
Self-harm results in more than 98,000 inpatient admissions to hospital a year in England, 99% are
emergency admissions. Self-harm is an expression of personal distress and there are varied reasons
for a person to harm themselves irrespective of the purpose of the act. People who self harm are
more likely to die from suicide, suffer from the physical after effects of attempted suicide and/or
suffer from longer-term mental health issues such as depression13.
13
Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm British Journal of Psychiatry
181, 3, 193
35
Figure 25 shows the directly age-sex standardised rate of emergency hospital admissions for
intentional self-harm in the six Worcestershire districts compared to the National average for both
2010/11 and 2011/12. The directly age-sex standardised rate shows if an area is significantly better,
worse or not significantly different than the England average, based on whether the England average
value is included within the 95% confidence interval of the local value. It can be seen that not only
was the rate for Worcester significantly worse than the England average in 2010/11, it is the only
district in Worcester to remain significantly higher than England in 2011/12 where it has the highest
rates of hospital admissions for intentional self-harm of all the Worcester Districts.
Figure 25 – Rate of hospital admissions for intentional self-harm Worcestershire Districts
all ages 2010/01-2011/12
2010/11
2011/12
England 2010/11
England 2011/12
400
350
300
250
200
150
100
299.5
282.2
197.8 202.5
209.9
273.6
316.9
310.4
234.3
231.1
187.7
225.2
50
0
Bromsgrove
Wychavon
Wyre Forest
Worcester
Redditch
Malvern Hills
The rates represented in figure 25 allow comparisons to be made across the districts and against the
England average; however it is also useful to know the actual number of events in localities.
The number of emergency hospital admissions for intentional self-harm in Worcester was 284 in
2010/11 and 271 in 2011/12.
Figure 26 – Hospital admissions due to intentional self-harm, 2010/2011
District
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
England rate
Admissions
156
178
228
284
204
240
Resident population
93,441
75,381
78,666
94,763
117,028
98,147
Source: APHO
36
Rate per 1,000 population
197.8
316.9
310.4
299.5
209.9
282.2
212.0
Data in figures 25 and 26 has been calculated using Hospital Episode Statistics (HES) via the NHS
Information Centre and using population estimates from the Office for National Statistics. Some of
the variation between trusts may be down to the way that hospital admissions have been coded. As
self-harm mainly occurs in the younger age groups, age standardised rates such as in figure 25 may
mask self-harm that is occurring in the older populations. The high rates observed in Malvern Hills in
2010/11 could be accounted for by an anomaly in the age-sex standardisation process; as Malvern
Hills has a much lower proportion of younger people in its population than the standard population
used, the standardisation calculations may become unreliable. Further analysis into the reason for
the high rates in Malvern Hills is recommended.
Figure 27 shows a more detailed analysis at MSOA level in Worcester. Middle layer super output
areas (MSOA) are a unit of geography for England and Wales which have a population of between
5,000 and 15,000 people and have between 2,000 and 6,000 households. There are 13 MSOAs in
Worcester.
It is important to note that the ‘quintile classifications’ are based on the overall quintile classification
for Worcestershire, so some districts will not have any areas that fall into certain quintiles. The
figures in the map below differ from those above in both definition and the time period covered. The
map shows the Standardised Emergency Admission Ratio (SAR) for hospital stays for intentional selfharm. An SAR is a measure of how more or less likely a person living in that area is to have an
emergency admission to hospital compared to the standard population, in this case England. The SAR
is a ratio of the actual number of emergency admissions in the area to the number expected if the
area had the same age specific admission rates as England, multiplied by 100.
An SAR of 100 indicates that the area has an average emergency admission rate, higher than 100
indicates that the area has higher than average emergency admission rate, lower than 100 indicates
lower than average emergency admission rate.
37
Figure 27 – Standardised Emergency Admission ratios for Hospital stays for intentional
self-harm in Worcester all ages 2008/09 to 2012/13 by MSOA
Source: Hospital Episode Statistics, Health and Social Care Information Centre, based on Standardised
Admission Ratios.
It can be seen from the map that Worcester has no areas that fall within the lowest quintile in
Worcestershire for self-harm admissions; once again it is the MSOA within the Wards of Warndon,
Gorse Hill, Rainbow Hill, Nunnery and Cathedral that are showing the highest rates. Parts of Rainbow
Hill, Gorse Hill and Cathedral ward have rates that are over double the expected figure.
Hospital admissions for self-harm aged 19 and under
Figure 28 below shows the rates of hospital admissions for self-harm for those aged 10-19 years old
by each Worcestershire district compared to the average rate for the County. This is calculated as
the annual average of admissions over the period 2008/09 to 2010/11 per 1,000 of the population
aged 10-19 years old. It should be noted that data for those aged 0-9 years old is not included as the
numbers are very small (less than 6 in the County as a whole). Data is for Worcestershire residents
admitted at any hospital, with self-harm defined as diagnosis code (ICD10) X60-X84 in the primary or
first six secondary diagnosis fields.
38
Figure 28 – Rate of Emergency Hospital Admissions for self-harm aged 10-19 years old
2008/09 - 2010/11 by Worcestershire District
2008/09 - 2010/11
Worcestershire
5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
2.7
Wychavon
Bromsgrove
4.6
Worcester
Redditch
3.8
3.3
2.5
4.4
0.5
0.0
Malvern Hills
Wyre Forest
Source: Worcestershire Healthcare Purchaser System
Figure 29 – Mortality from suicide and injury undetermined: persons all ages, DSR per
100,000 population, 2008-2010 pooled by Worcestershire District
2008-10
England
18
16
14
12
10
8
6
4
6.7
7.3
7.6
8.3
Bromsgrove
Wyre Forest
Worcester
Wychavon
11.6
11.6
Malvern Hills
Redditch
2
0
Source: Violence Indicator Profiles for England Resource
It can be seen from figure 28 that Redditch and Worcester have significantly higher rates of hospital
admissions for self-harm amongst 10-19 year olds. However, this could simply reflect the easier
access to the Acute Trust hospitals in those districts.
39
Figure 29 shows that Worcester has the third lowest mortality rate of the six Worcestershire districts;
rates in Worcester were not significantly different than the national average over the 2008-10
period. It should be noted that the above are based on DSR – directly standardised rates, and have
been adjusted for age, however as noted previously, this may not give a true reflection in areas with
a significantly older population than the standard population such as in Malvern Hills.
4.5
Drug misuse
Figure 30 below shows the number of all adult drug users in structured treatment for each
Worcestershire district in 2012/13 by the clients’ postcode of residence. It can quite clearly be seen
that there were more than twice as many clients that were residents of Worcester in adult drug
treatment in 2012/13 than resided in any of the other County’s districts.
However, it is important to note that this does not necessarily mean that Worcester has more
residents with drug problems than the other districts; it shows that more adults with drug problems
that resided in this district accessed structured treatment in 2012/13. It could reflect that those
adults with drug problems residing in other districts are not accessing structured treatment.
Figure 30 – Number of All Drug Users in Treatment by Worcestershire District 2012/13
Clients in
Treatment
600
2012/13
551
500
400
300
200
191
199
Wychavon
Wyre Forest
160
100
121
64
0
Bromsgrove
Malvern Hills
Redditch
Worcester
Source: National Drug Treatment Monitoring System, NDTMS, Quarterly Reports. Figure sourced from the
Worcestershire Substance Misuse Needs Assessment 2014
5
Worcestershire Health and Wellbeing Board priorities
The following have been adopted as the four key priorities of the Worcestershire Health and
Wellbeing Board within its Health and Wellbeing Strategy. As such, a number of different activities
are being undertaken across organisations to ensure that Worcestershire is able to meet the targets
set within the Strategy.
40
5.1
Older people and management of long-term conditions
Elderly patients have multiple morbidities with increasingly complex needs. This group of patients
makes increasing demands on primary care. 85-89 year olds in 2008 had a median consultation rate
of 14 per person per year, up from 6.8 per person per year for the same age band in 199614.
5.1.1
Isolation
Isolation is one of the factors that can influence both a person's mental and physical health. This
becomes particularly acute in the older population15.
One way of measuring isolation is the proxy measure of someone's social capital in the area they live.
The 2012 Worcestershire Viewpoint survey asked residents if they felt they belonged to their
immediate neighbourhood. The responses received in each of the districts, by the over 65
population, are detailed below.
As can be seen in Figure 31, the rates of social capital amongst the over 65 population is much lower
in Worcester than in the other five districts; 35% of respondents in Worcester did not feel that they
belonged to their immediate neighbourhood compared to just over 20% on average in the remaining
five districts, suggesting that there may be more older people in Worcester experiencing isolation
than in the rest of the County.
Figure 31 – Percentage of respondents (aged over 65) who feel they belong to their
immediate neighbourhood, by district
90%
80%
70%
60%
80%
76%
65%
85%
85%
Wychavon
Malvern Hills
70%
50%
40%
30%
20%
10%
0%
Worcester
Bromsgrove
Redditch
Wyre Forest
Source: Worcestershire Viewpoint Survey, 2012, NI2
5.1.2
Carers and carer health and wellbeing
Carers provide a much needed and often unpaid role in supporting other people with their health
and social care needs. In 2009/10 the Health and Social Care Information Centre (HSCIC) undertook a
Survey of Carers in Households in England16 to gauge the profile of and impact upon those
undertaking a carer role in the country. Key findings from this survey are detailed below:
14
The Information Centre: Trends in consultation rates in General Practice 1995/6 to 2008/9
SCIE Social Care Institute for Intelligence Research briefing 39 Preventing loneliness and social isolation:
interventions and outcomes 2011
16
Health and Social Care Information Centre (HSCIC ): Survey of Carers in Households – England, 2009-10
15
41





Carers were more likely to be women than men; 60 per cent of carers in England were
women.
Carers were most likely to be aged 45-64 (42 per cent); a quarter of carers (25 per cent) were
aged 65 or over.
Around half (46 per cent) of carers were in paid employment, 27 per cent were retired from
paid work and 13 per cent were looking after their home or family
92 per cent of carers were white, while 8 per cent were from black and minority ethnic (BME)
backgrounds.
Around two in five carers (37 per cent) were the only support for their main cared for person,
while the remainder reported shared caring responsibilities. This means that around 1.7
million adults in England were the sole carer for their main cared for person.
HSCIC also found that:


Around half (52 per cent) of carers said their health had been affected because of the care
they provide. A wide range of effects were mentioned; a third of carers reported feeling tired
(34 per cent), 29 per cent felt stressed, 25 per cent had disturbed sleep and 22 per cent
reported being short tempered or irritable.
Around two in five carers (42 per cent) said their personal relationships, social life or leisure
time had been affected because of the assistance they provided. Those who had been
affected in this way were asked an unprompted question to establish the effects of caring.
The most common effects were having less time for leisure activities (69 per cent), being too
tired to go out (32 per cent), being unable to go on holiday (23 per cent) and the effect upon
their own health (20 per cent).
Worcestershire County has a wide range of people undertaking unpaid care roles. The maps below
show the percentage of residents undertaking one or more hours unpaid care a week and the
percentage of residents in Worcester undertaking fifty or more hours unpaid care a week, based on
responses to the 2011 ONS census. Areas are categorised according to Worcestershire quintiles. It
should be noted that Worcester has no areas in the top two quintiles for one or more hours unpaid
care a week, meaning that there are more residents undertaking unpaid care elsewhere in the
County. Worcester is, however, represented within all quintiles when it comes to 50 or more hours
unpaid care a week, albeit that the majority of Worcester falls within the lowest quintile.
On average almost 10% of residents in Worcester are providing at least one hour of unpaid care a
week. Figure 32 shows that this is highest in Claines (11.9% or residents). The map also shows that
there is a large belt across central Worcester where less than 10% of residents are providing one or
more hours unpaid care a week – this is perhaps explained by the high youth and student population
in the central regions of Worcester who are more likely not to live near people that they might
otherwise provide care for.
42
Figure 32 – Percentage of residents undertaking 1 or more hours unpaid care a week, 2011
Source: ONS Census 2011
Figure 33 – Percentage of residents undertaking 50 or more hours unpaid care a week,
2011
Source: ONS Census 2011
43
Figure 33 above shows the percentage of residents undertaking 50 or more hours unpaid care a
week. In 2011, on average 2.1% of Worcester residents are providing 50 or more unpaid hours care a
week, equating to 2,061 people. The map shows that the areas where residents are more likely to
be providing 50 or more hours of unpaid care a week are in the Rainbow Hill, Gorse Hill and Warndon
areas, which are also the areas which have been classified as health hotspots for having the worst
health outcomes.
5.1.3
Long term conditions
Dementia
The numbers of people with dementia are expected to rise by 29% between 2012 and 2020, with the
rate of growth highest in the oldest age groups (this estimate is based on prevalence rates identified
by Dementia UK to ONS population projections).
At a national level, prevalence rises steeply by age as can be seen in Figure 34. Males in the 65-69
and 70-74 year old age group are more likely to have the condition than females; the opposite
applies for all the 75+ age groups.
Figure 34 – Estimated prevalence of Dementia, UK, 2010
Age Group
65-69
70-74
75-79
80-84
85-89
90-94
95+
Estimated prevalence of dementia
Females
Males
1.0%
1.5%
2.4%
3.1%
6.5%
5.1%
13.3%
10.2%
22.2%
16.7%
29.6%
27.5%
34.4%
30.0%
Total
1.3%
2.9%
5.9%
12.2%
20.3%
28.6%
32.5%
Source: Dementia UK 2010
Table sourced from the Worcestershire JSNA Wellbeing in Older People Profile 2013/14
http://www.worcestershire.gov.uk/cms/jsna.aspx
Diabetes
Obesity is the most potent risk factor for Type 2 diabetes. It accounts for 80–85 per cent of
the overall risk of developing Type 2 diabetes and underlies the current global spread of the
condition.
Type 2 diabetes usually appears in middle-aged or older people, although more frequently it
is being diagnosed in younger overweight people, and it is known to affect South Asian
people at a younger age. Type 2 diabetes occurs when the body is not making enough
insulin, or the insulin it is making is not being used properly. The risk of developing Type 2
diabetes can be reduced by changes in lifestyle.
Obese individuals are at a greater risk of developing Type 2 diabetes. The table below shows
estimates for the percentage of the population that has Type 2 diabetes in each of the
Worcestershire districts. These are modelled estimates that are produced by the Yorkshire
and Humber Public Health Observatory.
44
Figure 35 – Diagnosed diabetes in the 17+ year old population registered with a GP.
2011/12
Estimated Population
Worcestershire Number
Percentage
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
Worcestershire
England
5.3%
5.6%
5.8%
5.8%
6.5%
6.2%
5.9%
5.8%
3,895
3,149
4,105
5,500
5,743
5,383
27,772
2,566,288
Confidence Intervals
Lower
Upper
5.2%
5.5%
5.5%
5.8%
5.6%
6.0%
5.6%
6.0%
6.3%
6.6%
6.0%
6.4%
5.9%
6.0%
5.8%
5.8%
Source: APHO People diagnosed with Diabetes dataset http://www.apho.org.uk/
It is interesting to note that Malvern Hills has the highest prevalence rate out of the six
Worcestershire districts, but the lowest estimated rates for adult obesity. Conversely,
Redditch has the second lowest rate for type 2 diabetes but the highest rate of adult obesity.
This is likely to be due to the different population demographics of the two areas, where a
high proportion of the Malvern Hills population is aged over 60, whereas more than a third
of the population of Redditch is aged under 30. Malvern Hills and Wyre Forest both have
type 2 diabetes prevalence rates which are significantly higher than the England average.
As can be seen in figure 36, the rates of diagnosed diabetes is below the estimated
prevalence level in the population for the same time period, indicating that there may be
hidden cases that have not come to the attention of the health service. In addition, this
figure also shows that the prevalence of diabetes is projected to steadily rise in
Worcestershire and England, and that the projected rates in Worcestershire are marginally
above those projected for England as a whole.
The figure 37 shows diabetes prevalence in Worcestershire broken down for males and
females. It can be seen that the prevalence rates for females is higher than that for males
across all of the Worcestershire districts.
45
Figure 36 – Diagnosed diabetes in the 17+ year old population registered with a GP.
2011/12 compared to diabetes prevalence estimates (diagnosed and
undiagnosed) in the 16+ year old population for Worcestershire and England in
2011, 2012, 2015, 2020, 2025 and 2030
Worcestershire
16%
England
14%
12%
10%
8%
6%
4%
2%
0%
2011/12
diagnosed
diabetes
2011
estimated
prevalence
2012
estimated
prevalence
2015
estimated
prevalence
2020
estimated
prevalence
2025
estimated
prevalence
2030
estimated
prevalence
Source: APHO http://www.apho.org.uk/
Figure 37 – Type 2 Diabetes prevalence rates for Males and Females in the Worcestershire
Districts 2006
All Persons
7%
Male
Female
6%
5%
4%
3%
2%
1%
0%
Redditch
Worcester
Wychavon Wyre Forest
England
Source: Data from National Obesity Observatory website http://www.noo.org.uk/.
Original data source is the Yorkshire and Humber Public Health Observatory
http://www.yhpho.org.uk
Coronary Heart Disease
The table below shows estimates for the percentage of the population that has Coronary
Heart Disease (CHD) in each of the Worcestershire districts. These are modelled estimates
that are produced by the Yorkshire and Humber Public Health Observatory.
46
Figure 38 – CHD prevalence rates in the Worcestershire Districts 2011
Estimated Population
Worcestershire Number
Percentage
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
England
5.8%
6.5%
6.1%
4.9%
6.2%
6.4%
5.8%
4,393
4,001
3,849
3,780
5,922
5,194
2,442,901
Source: East of England Public Health Observatory http://www.apho.org.uk/
Estimated CHD prevalence is greater in males than in females for all districts. Estimated
prevalence of CHD increases with age. For example, in Worcester city the estimated CHD
prevalence using the 2011 modelled estimates were 0.38% in the 16-44 year old population,
5.18% in 45-64, 14.61% in 65-74 and 19.97% in the over 75 age group.
As with the Type 2 diabetes prevalence rates, Malvern Hills shows the highest rate for CHD
with Worcester showing the lowest in the county. Again this is more likely to be related to
the age of the local population than any direct links with obesity. Malvern, Wychavon and
Wyre Forest all have CHD prevalence rates which are significantly higher than the England
average.
Chronic Obstructive Pulmonary Disease (COPD)
In 2011 COPD was one of the most common respiratory diseases in the UK, usually affecting
people over the age of 35 (NHS Choices www.nhs.uk). The main risk factor for COPD is
smoking, with the risk increasing the longer a person has smoked. Lifestyle changes (such as
stopping smoking) can have a marked improvement on the condition and there is therefore
a need to identify areas where public health interventions may be targeted for both
prevention and management of the condition.
Worcester has the second highest rates of emergency hospital admissions for COPD in the
county, second only to Redditch. However, the rates in Worcester are significantly lower
than the national average and there appears to have been a reduction over time. Rates in
Malvern Hills, Bromsgrove, Wyre Forest and Wychavon are all significantly lower than both
Worcester and Redditch.
47
Figure 39 – COPD Emergency Hospital Admissions April 2006/07-2010/11 and 2008/092012/13
160.0%
2006/07-2010/11
2008/09-2012/13
England 2006/07-2010/11
England 2008/09-2012/13
140.0%
120.0%
100.0%
80.0%
130.6%
122.3%
60.0%
40.0%
20.0%
49.5% 52.9%
54.4% 57.7%
65.3% 64.0%
67.8% 65.4%
Malvern Hills
Bromsgrove
Wyre Forest
Wychavon
87.0% 81.5%
0.0%
48
Worcester
Redditch
5.2
Mental Health and Wellbeing
For details of the key protective factors for good mental wellbeing in Worcestershire, please refer to
the Worcestershire Health and Wellbeing Board Adult Mental Health Needs Assessment 201417.
Figure 40 below shows the average hospital admission rate per 1,000 of the population for primary
mental health diagnoses over the five year reporting period 2008-09 to 2012-13.
Figure 40 – Hospital Admissions for Mental Health by Worcestershire District 2008-09 to
2012-13 (5 years pooled)
Males
Females
30
25
20
15
10
18.4
20.5
18.3
21.3
21.5 21.6
19.9
22.3
25.0
21.3
26.9
22.2
20.2
22.8
5
0
Source: SUS Mental health hospital admissions 2008-2013 (*2012/13 data is incomplete)
It can be seen from the data that;





The average county admission rate for primary mental health diagnoses is around 20 per
1,000 males and 23 per 1000 females.
Redditch district has the highest admission rates for both males and females significantly
higher than the county average.
There is a higher rate for females than males in every district, though in Wyre Forest the
admissions for mental health for males and females are more evenly matched.
Bromsgrove has the lowest rate of all Worcestershire districts for hospital admissions for
mental health diagnoses for both males and females.
Worcester has the second highest admission rate for females and the third highest admission
rates for males in Worcestershire, both of which are over the Worcester average.
17
http://www.worcestershire.gov.uk/downloads/file/2904/2014_adult_mental_health_and_wellbeing_needs_assessment
49
Figure 41 below shows the mental health hospital admissions for anyone with a primary diagnosis of
F10-F19 over 2008/09 – 2012/13. F10-F19 medical diagnoses relate to mental and behavioural
disorders due to psychoactive substance use, for example, alcohol, opioids and cannabis.
Figure 41 – Mental Health Hospital Admission rate per 1,000 of the population by District
where Primary Diagnosis = F10-F19 - 2008/09 to 2012/13 (5 years pooled data)
Rate per 1,000
pop
Male
Female
1.4
1.2
1.15
1.10
1.0
0.95
0.8
0.81
0.74
0.6
0.61
0.4
0.88
0.43
0.59
0.49
0.43
0.39
0.44
0.48
0.2
0.0
Source: SUS Mental health hospital admissions 2008-2013 (*2012/13 data is incomplete) Figure sourced from
the Worcestershire Substance Misuse Needs Assessment 2014
It can be seen from the chart that;



Unlike general MH admissions in figure 39, the admission rate for mental and behavioural
disorders due to psychoactive substance use is much higher for males than for females in
every district, although this difference is quite small in Malvern Hills.
Worcester City has the highest admission rates for males, followed by Redditch, with
Malvern Hills experiencing the lowest rate.
Redditch has the highest admission rates for females, closely followed by Worcester City with
Malvern Hills again experiencing the lowest rate; however Wychavon is not far behind.
The admission rate per 1,000 population for mental health diagnoses for residents of each of the six
districts in Worcestershire during the five year period from 2008/09 to 2012/13 was analysed and
Figure 41 below summarises the results.




The average county admission rate for primary diagnosis mental health admissions is
approximately 2.3 persons/000.
Residents of Worcester City district have the highest admission rate of all the districts at
nearly 3 admissions per thousand population, considerably higher than the county average.
There is a higher rate for males than females in 4 out of the 6 districts – and this is true of the
county as a whole too.
Redditch residents show the second highest admission rates for mental health at 2.7
admissions per thousand population.
50



Both Worcester and Redditch have a younger and more deprived demographic than the
county average.
Amongst residents of Malvern Hills and Bromsgrove the admission rates for mental health
for males and females are more evenly matched.
Bromsgrove residents have the lowest rate of all Worcestershire districts for hospital
admissions for mental health diagnoses at 2 admissions per thousand population.
Figure 42 – Mental Health Hospital admission rate/000 by District
Worcestershire Residents
Admission Rate per Thousand Population where Primary Diagnosis
is a Mental Health Diagnosis Code (all casetypes)
2008/09 - 2012/13 (5 years pooled data)
3.5
Male
Rate per 1000 Population
3.0
Female
2.5
2.0
1.5
1.0
0.5
0.0
Bromsgrove
Malvern Hills
Redditch
Worcester City
Wychavon
Wyre Forest Worcestershire
Source: SUS Mental health hospital admissions 2008-2013 (*2012/13 data is incomplete)
5.3
Obesity
5.3.1
Obesity prevalence in Adults
Figure 43 shows the estimated percentage of the adult population that are obese (i.e. estimated
percentage of the population aged 16 and above with a body mass index of 30 or more) in each of
the Worcestershire districts. These are modelled estimates that are produced by the Association of
Public Health Observatories and are based on individual-level data from the active people survey for
2006/2008.
The active people survey is a large telephone survey commissioned by Sport England on sport and
active recreation in the over 16 adult population in England. The reliability of its findings are limited
as the number of Worcester residents taking part in the survey was small, meaning that care should
be taken when generalising the results to the whole Worcester population .
51
Figure 43 – Adjusted prevalence of underweight, healthy weight, overweight and obesity
amongst adults 2012 by district compared to national average
Underweight
England
Healthy weight
35.0%
Bromsgrove
35.0%
Malvern Hills
Overweight
Obese
40.8%
23.0%
41.5%
23.4%
37.2%
43.7%
16.6%
Redditch
33.6%
43.0%
22.9%
Worcester
33.2%
41.2%
24.2%
Wychavon
28.5%
Wyre Forest
43.3%
35.7%
0%
10%
20%
27.6%
41.5%
30%
40%
50%
60%
70%
22.0%
80%
90%
100%
Source: Active people survey
Results weighted by sex, age, ethnicity, working status, household size and socio economic classification.
Figure 43 above shows the estimated adjusted prevalence of underweight, healthy weight,
overweight and obesity in Worcestershire compared to the national average. As can be seen, the
prevalence of underweight is very low across the county, Worcester having the second largest
prevalence at 1.4% (confidence interval 0.6%, 3.1%).
Similar to the national figures, around 2/3 of the adult population is classified as overweight or obese
in each of the districts. The highest prevalence of obesity is in Wychavon, with Worcester having the
second highest prevalence at almost a ¼ of its adult population being obese.
A 1/3 of Worcester's population, 33.2% is classified as being of a healthy weight, this is however,
worse than the national average and is the second worst in the County after Wychavon.
Figure 44 -shows a more detailed analysis of the prevalence rates for Worcester at Middle Super
Output Area. It is important to note that the ‘quintile classifications’ are based on the overall quintile
classification for Worcestershire, so some districts will not have any areas that fall into certain
quintiles.
Six of Worcester's MSOA are in the lowest obesity quintile; two in the second quintile; three in the
middle quintile; one in the fourth quintile and two in the worst quintile.
In parts of the Warndon area of Worcester, over 30% of the population is estimated to be obese,
compared to just 19.3% in parts of Arboretum/Cathedral ward.
52
Figure 44 – Estimated Percentage of Obese Adults in Worcester 2006/08 by MSOA
Legend
±
Adult Obesity Estimates
Quintile classification
18.5% - 22.9%
22.9%
23.0% - 24.5%
24.6% - 26.9%
27.0% - 28.6%
30.9%
28.7% - 33.6%
22.2%
25.5%
Rainbow
28.5%
Hill
19.3%
20.7%
Warndon
Worcester Tolladine
Trotshill
20.8%
24.6%
St John's
29.8%
Ronkswood
20.5%
23.8%
24.6%
Lower
Wick
22.4%
0
0.5
1
2 Miles
5.3.2
Obesity prevalence in Children
Figure 45 shows the estimated percentage of children that are obese in year 6 as determined by the
National Childhood Measurement Programme (NCMP) in each of the Worcestershire districts for
both the period 2007/08-2012/13.
The national child measurement programme (NCMP) measures the weight and height of all school
children in reception and in year 6.
It can be seen that Worcester has the third highest prevalence of children that are obese at year 6,
only Wyre Forest shows a significantly greater prevalence for obesity than the National average.
Worcester has seen an increase in the percentage of children that are obese at year 6 between the
two time periods.
53
Figure 45 – Percentage of Children Obese at Year 6 in Worcestershire Districts 2007/08 and
2012/13 against national average
2007/08
2012/13
England 2007/08
England 2012/13
25%
20%
15%
10%
13.5%
15.5%
14.8%
17.0%
18.7%
19.3%
15.4%
15.3% 14.9%
20.9% 20.6%
17.7%
5%
0%
Malvern Hills
Worcester
Bromsgrove
Wychavon
Redditch
Wyre Forest
The maps below show a more detailed analysis of the child obesity prevalence rates for Worcester at
Middle Super Output Area. It is important to note that the ‘quintile classifications’ are based on the
overall quintile classification for Worcestershire, so some districts will not have any areas that fall
into certain quintiles.
Figure 46 shows that those areas that have the highest proportion of obese children in reception are
in the central north eastern and the western areas of the City. The highest proportion of obese
children in reception can be found in the St. Stephen's area and parts of Arboretum and Rainbow Hill,
at 14.7% of children classified as obese, the lowest being in the Warndon/Warndon Parish North area
at just 4.1%.
54
Figure 46 – Percentage of Children Obese in Reception in Worcester 2010/11 -2012/13 by
MSOA
Source: National Child Measurement Programme Quintile classification is based on quintiles calculated for the
whole of Worcestershire.
Figure 47 – Percentage of Children Obese at Year 6 in Worcester 2010/11 -2012/13 by
MSOA
Source: National Child Measurement Programme Quintile classification is based on quintiles calculated for the
whole of Worcestershire.
55
There seems to be a much less significant problem of obesity for those children in Year 6 however
the overall rates of obesity has increased, it could be that the obesity rates in the rest of the district
have also increased by Year 6. Figure 47 shows the percentage of children measured at year 6 that
were classed as obese for the period 2009/10 to 2011/12.
Interestingly, the area with the highest rate, which covers parts of Rainbow Hill and Gorse Hill wards,
was not in the highest quintile for Reception and those areas that were seem to have moved down to
the middle quintile by Year 6.
From observing figures 44, 46 and 47, that is, the estimated levels of obesity in adults, children in
reception and children in year 6, we see that there is more commonality between the areas with the
highest levels of obesity in adults and children in reception, however the areas differ adults and year
6. This would imply that there are more things impacting upon a child's obesity as they get older
than parental eating habits.
5.3.3
Healthy eating
Healthy eating is defined as those who consume 5 or more portions of fruit and vegetables per day. A
portion of fruit or vegetables was defined as an 80g serving.
The APHO has estimated the percentage of the population that eats healthily.
Worcester has the third lowest level of adults eating healthily in the County at 27%; this is lower than
the County average.
Figure 48 – Estimated Percentage of Healthy Eating Adults in Worcestershire Districts
2006/08
2006/08
England
40%
35%
30%
25%
20%
15%
24.1%
26.1%
27.0%
Wyre Forest
Worcester
30.0%
30.0%
Bromsgrove
Wychavon
33.0%
10%
5%
0%
Redditch
Malvern Hills
Figure 49 below shows a more detailed analysis of the prevalence rates at each Middle Super Output
Area (MSOA) in Worcester. It is important to note that the ‘quintile classifications’ are based on the
overall quintile classification for Worcestershire, so some districts will not have any areas that fall
into certain quintiles.
56
It can be seen from the map that Worcester is mainly in the middle quintile for the percentage of
adults estimated to be eating healthily. There are no MSOA in the highest (best) quintile and four
MSOA in the lowest.
Figure 49 – Percentage of the population of the population aged 16+ that consume 5 or
more portions of fruit or veg a day, 2006-2008, modelled estimate (Healthy
Eating Adults in Worcester) by MSOA
5.3.4
Access to green space
Worcestershire is a "green" county, having many areas classified by the ONS as having green space.
People who have access to green space are statistically more likely to exercise more and to feel
better about their surroundings than those with limited access to Green space. The map below
shows the percentage of land that is classified as Green space in 2005 in Worcestershire County.
57
Figure 50 – Worcestershire percentage of all land that is Green Space, 2005 by MSOA
Source: Data from National Obesity Observatory website http://www.noo.org.uk/ . Original data source is the
Office for National Statistics http://www.neighbourhood.statistics.gov.uk/ Map sourced from Worcestershire
Healthy weight, Healthy Lives Obesity and Physical activity 2012
http://www.worcestershire.gov.uk/cms/jsna/information-and-documents.aspx
Figure 51 – Worcester percentage of all land that is Green Space, 2005 by MSOA
Legend
±
Percentage of All Land that is Green Space 2005
Quintile classification
12.9% - 36.8%
36.9% - 49.2%
49.3% - 59.2%
59.3% - 91.0%
54.4%
91.1% - 95.2%
20.4%
44.2%
28.9%
Rainbow
25.5%
Hill
40.1%
30.4%
Warndon
Worcester Tolladine
Trotshill
55.3%
26.2%
St John's
40.9%
Ronkswood
12.9%
36.8%
51.5%
Lower
Wick
47.5%
0
0.5
1
2 Miles
Source: Data from National Obesity Observatory http://www.noo.org.uk/. Original data source is the ONS
http://www.neighbourhood.statistics.gov.uk/. Quintile classification is based on the whole of Worcestershire.
58
Map sourced from Worcestershire Healthy weight, Healthy Lives Obesity and Physical activity 2012
http://www.worcestershire.gov.uk/cms/jsna/information-and-documents.aspx
By zooming in to Worcester District we can see that none of Worcester's MSOA are classed as being
in the top two quintiles for Green Space.
5.3.5
Physical Activity
In May 2012 Worcestershire County Council conducted the Worcestershire Viewpoint Survey on
behalf of the nine partnership public organisations. The survey includes questions on how people
currently make short journeys and a total of 3,050 responses were achieved across the county. The
results of which show that:



60% of residents walk at least most of the time for journeys of one mile or less, and only 8%
never walk (made up of 5% who use another form of transport and 3% who do not make
journeys of one mile or less).
When this distance increases to one to two miles only 30% walk most of the time and 26%
never do.
In terms of cycling there is not such a difference between a journey of one mile or less and a
journey of one to two miles, with around two thirds of residents never making journeys of
two miles or less by bicycle.
This information has been broken down by each Worcestershire District and shows Worcester City
residents are the most likely to walk for journeys of one mile or less and of one to two miles. This can
be seen in figure 52 below. Redditch has the lowest proportion of respondents who walk for both
journeys of one mile or less and one to two miles.
Figure 52 – Percentage of Respondents who walk for short journeys in each
Worcestershire District
walk always/most times (ONE mile or less)
walk always/most times (ONE to TWO miles)
80%
70%
70%
60%
50%
59%
57%
58%
57%
54%
40%
43%
30%
20%
25%
26%
26%
21%
25%
10%
0%
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
Source: Worcestershire Viewpoint Survey May 2012, Analysis of Results, August 2012.
The modelled estimates of participation referred to below are based on data from Sport England’s
Active People Survey. The survey measures participation in sport and active recreation at local
authority level. Participation estimates at a Middle Super Output area (MSOA) are therefore based
59
on modelled or ‘synthetic’ estimates which combine survey data from the Active People Survey with
area level data (for example, health indicators, socioeconomic status etc.).
Figure 53 below shows the percentage of the adult population participating in 30 minutes of sport or
activity at least 3 days a week for each Worcestershire district by age group. It can be seen that
Worcester has the lowest proportion of 16 to 34 year olds and 55+ year olds participating in 30
minutes of sport or activity at least 3 days a week at 26.1% and 12.7% respectively.
Figure 53 – Adult Participation in Sport and Active Recreation (formerly NI8) 2011-2013 by
Age Group
55 +
14.1%
23.3%
29.4%
38.7%
39.7%
12.7%
25.3%
26.1%
14.7%
21.9%
14.4%
27.9%
28.1%
18.2%
15.5%
35 to 54
43.3%
29.8%
35.7%
15.8%
26.6%
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
33.6%
16 to 34
Source: Sport England. N.B. the figures for Worcestershire County are for the period April 2012-April 2013 only.
The map below shows the participation rates for adults in sport and active recreation (30 minutes of
sport and active recreation 3 times a week) for each MSOA in Worcester.
60
Figure 54 – Worcester Adult Participation in Sport and Active Recreation (formerly NI8)
2008-10 by MSOA
Legend
±
NI8 participation estimates 2008-10
Quantile classification
10.7% - 17.6% (low)
17.7% - 20.3% (low-middle)
23.3%
20.4% - 23.1% (middle-high)
23.2% - 32.9% (high)
14.1%
28%
Rainbow
21.2% Hill
Warndon
15.5%
24.6%
23.1%
Worcester Tolladine
Trotshill
28.1%
16.9%
19.3%
St John's
Ronkswood
22.3%
23.4%
21.3%
Lower
Wick
26%
0
0.5
1
2 Miles
Source: Sport England NI8 MSOA data. Quintile classification is defined by Sport England with each class
containing roughly 25% of all MSOA records. Map sourced from Worcestershire Healthy weight, Healthy Lives
Obesity and Physical activity 2012 http://www.worcestershire.gov.uk/cms/jsna/information-anddocuments.aspx
There are three areas of Worcester that fall into the ‘low’ quartile for the percentage of adults
participating in sport and active recreation. These are in the ward areas of Rainbow Hill, Gorse Hill,
Warndon and Nunnery. The areas around Warndon and Nunnery have the highest estimated rates of
adult obesity in the district, with rates also comparatively high in Rainbow Hill.
5.4
Alcohol
The prevalence of alcohol misuse in the adult population is normally presented as the proportion of
individuals reporting, or estimated to be consuming, alcohol at levels of lower, increasing or higher
risk, and those binge drinking. These are set out below:
Lower risk - A level of alcohol consumption that is within current recommended guidelines (2-3 units
daily for females and 3-4 units daily for males).
Increasing risk - A level of alcohol consumption that is above recommended levels, and that carries a
risk of physical or psychological harm. This is defined as the consumption of between 15 and 35 units
per week for females, and 22 to 50 units per week for males.
Higher risk - Consumption of alcohol at levels which are likely to cause physical or psychological
harm. This is defined as the consumption of over 35 units per week for females and over 50 units per
week for males.
Dependent drinker - A sub-set of higher risk drinking, defined as an individual that feels unable to
function without alcohol. The consumption of alcohol becomes an important, sometimes the most
61
important, factor in their life. Often experiences physical or psychological withdrawal symptoms if
their supply of alcohol is suddenly stopped.
Binge drinking - Defined as drinking more than two times the recommended daily level in one
session. For females this means drinking 6 or more units, and for men, 8 or more units.
The local alcohol profiles for England estimate that in Worcestershire, approximately 14% of the over
16 year old population abstain from drinking. Of the remaining over 16 year old drinking population,
almost 73% of the over 16 are reported as "lower risk" drinkers; just over 20% are reported as
"increasing risk" and nearly 7% as "higher risk"; the profiles estimate that of all the Worcestershire
districts, Worcester has the highest level of estimated "higher risk" drinkers within its drinking
population18.
Figure 55 below shows similar estimates for the percentage of each Worcestershire district’s
population aged 16 and over that engage in ‘binge drinking’. Binge drinking in adults is defined
separately for men and women. Men are defined as having indulged in binge drinking if they had
consumed 8 or more units of alcohol on the heaviest drinking day in the previous seven days; for
women the cut-off was 6 or more units of alcohol.
It can be seen from the chart that Worcester has the highest estimated rate of ‘binge drinking’ out of
the six Worcestershire district areas. It should be noted, however, that none of the six districts have a
significantly higher rate of binge drinking than the National average.
Figure 55 – Estimated Percentage of Adults (aged 16 and over) who report engaging in
Binge Drinking (2007-2008)
2007-08
25
England
20
15
10
18.1
18.8
19.3
19.5
20.1
22.3
5
0
Malvern Hills Bromsgrove Wychavon Wyre Forest
Redditch
Worcester
Source: Local Alcohol Profiles for England
Binge drinking estimates are also available at middle super output area level, as shown in the map for
Worcester below. These are modelled estimates from the NHS Information Centre and are displayed
by the Worcestershire quintiles, it should be noted that all areas in Worcester fall within the top
three Worcestershire quintiles for binge drinking.
18
Source Local Alcohol Profiles for England 2009 mid-year synthetic estimates
62
Figure 56 – Estimated Percentage of Adults (aged 16 and over) who report engaging in
Binge Drinking 2006-2008 by Worcester MSOA
Source: Public Health England NHS IC,
From the map it can be seen parts of the Cathedral and Arboretum ward are estimated to have 29%
of their population engaging in binge drinking (this is the highest estimated figure in Worcestershire);
compared to the lowest estimate of 19.2% in Claines.
63
Figure 57 – Alcoholic Liver Disease emergency admissions, all ages, ICD10 K700,
K701,K702,K703,K704,K709 in Primary or first six Secondary Diagnosis Codes
(2007/08-2011/12 pooled)
100
90
80
70
60
50
81.9
40
30
20
41.8
84.1
52.7
50.9
58.7
61.0
10
0
Source: NHS Worcestershire/Worcestershire County Council Public Health Calculation
Figure sourced from the Worcestershire Substance Misuse Needs Assessment 2014
It can be clearly seen from the chart that Redditch and Worcester have much higher rates of
emergency admissions for Alcoholic Liver Disease than the other districts. In contrast the rate of
admissions in Bromsgrove is almost half that of Redditch and Worcester.
5.4.1
Alcohol specific hospital admissions
Alcohol specific conditions are those conditions that are 100% caused by alcohol such as alcoholinduced behavioural disorders and alcohol-induced liver cirrhosis.
Figure 58 shows the rate of alcohol-specific hospital stays for Males across the six Worcestershire
districts in 2010/11. It can be seen that the areas of Bromsgrove, Wychavon and Malvern Hills are all
significantly lower than the England average.
All areas with the exception of Wychavon have shown an increase in the rate of alcohol-specific
hospital stays for males from 2008/09 to 2012/13. Worcester had the highest rate of all the districts
in both 2008/09 and 2012/13 at 519.51 and 530.76 per 100,000 population respectively; however
the confidence intervals for the rate are very wide, meaning that in 2012/13 the true value of
Worcestershire's rate could lie between 465 and 602. The actual count figure for Worcester was 248
in 2012/13.
64
Figure 58 – Rate of Alcohol-Specific Hospital Stays for Males in Worcestershire Districts
compared to the National average 2008/09 and 2012/13
2008/09
2012/13
England 2008/09
England 2012/13
700
600
500
530.8
519.5
491.3
434.6
439.6
411.6
350.4
374.9
330.0
100
318.8
200
294.3
300
484.8
400
0
Bromsgrove
Wychavon Malvern Hills Wyre Forest
Redditch
Worcester
Figure 59 shows the rate of alcohol-specific hospital stays for females in Worcestershire districts. It
can be seen that Bromsgrove, Worcester and Redditch have all seen a decrease in the rate of
admissions from 2008/09 to 2012/13. Only Bromsgrove has a rate significantly lower than the
England average, however when interpreting this it should be borne in mind that the confidence
intervals for these figures are very wide. The actual count for Worcester was 118 in 2012/13.
Figure 59 – Rate of Alcohol-Specific Hospital Stays for Females in Worcestershire Districts
compared to the National average 2008/09 and 2012/13
2008/09
2012/13
England 2008/09
England 2012/13
350
300
250
249.8
179.4
247.9
276.7
233.3
211.6
179.0
196.5
176.3
170.7
100
176.1
150
250.3
200
50
0
Bromsgrove Malvern Hills Wychavon
Worcester
65
Redditch
Wyre Forest
5.4.2
Alcohol-related hospital admissions
Alcohol related conditions include all alcohol specific conditions plus those where alcohol may have
been a contributory factor in events such as hypertensive diseases, various cancers and falls.
Figure 60 shows the rate of alcohol-related stays per 100,000 population for males of all ages in each
of the Worcestershire districts.
Figure 60 – Rate of Alcohol-related Hospital Stays per 100,000 population for Males all
ages in Worcestershire Districts compared to the National average 2008/09 and
2012/13
2008/09
2012/13
Eng 2008/09
Eng 2012/13
2,000
1,800
1,600
1,400
1,730
1,545
1,463
1,541
1,533
1,329
1,329
1,299
1,219
600
1,190
800
1,288
1,000
1,661
1,200
400
200
0
Malvern Hills Bromsgrove
Wychavon
Worcester
Wyre Forest
Redditch
Although rates have increased in Worcester over the time period, they have not increased as much
as in Redditch and Wyre Forest meaning that Worcester has moved from second highest to third
highest over the time period for both males and females. As previously, the confidence intervals for
these rates are wide and so the true value may not be significantly different than the other districts.
The count in Worcester in 2012/13 was 647.
Figure 61 below shows the rate of alcohol-related hospital stays for females across the six
Worcestershire districts in 2008/09 and 2012/13. Worcester is the only district to have a decrease in
rates from 2008/09 to 2012/13, however once again, the confidence intervals for these rates are
wide and so the true figure may not be significantly different. The count in Worcester was 363.
66
Figure 61 – Rate of Alcohol-Related Hospital Stays for Females per 100,000 population in
Worcestershire Districts compared to the National average 2008/09 and 2012/13
2008/09
2012/13
Eng 2008/09
Eng 2012/13
1,200
1,000
800
903
851
793
700
763
809
715
676
678
609
625
400
667
600
200
0
Wychavon
Worcester
Wyre Forest
Redditch
5.4.3
Alcohol use in under 18 year olds
Figure 62 shows the rolling figures for the rate of alcohol-specific hospital admissions for under 18
year olds over the past five years in Worcester, the West Midlands and England. Although still high,
the rate in Worcester has fallen consistently since 2007/08, narrowing the gap between the
Worcester rate and the regional and national rates.
Figure 62 – Rate of Alcohol-specific Hospital Stays (Under 18s) 5-year Trend
Worcester
West Midlands
England
100
90
80
70
60
50
40
30
20
10
0
2006/072008/09
2007/082009/10
2008/092010/11
67
2009/102011/12
2010/112012/13
Figure 63 shows the figures for the periods 2006/07-2008/09 and 2010/11-2012/13 across
the six Worcestershire districts against the national average. There has been a downward
trend in the rate of alcohol-specific hospital stays for under 18 year olds in all districts;
Worcester has moved from having the second highest rate in the County in 2006/072008/09 to the third highest behind Redditch and Wyre Forest who are the only
Worcestershire districts to be significantly worse than the England average. It should be
noted that the actual numbers of alcohol-specific hospital stays in for under 18's in
Worcester are very low – there were only 34 admissions in the 2010/11-2012/13 period.
Figure 63 – Rate of Alcohol-specific Hospital Stays (Under 18s) per 100,000 population in
Worcestershire Districts 2006/07-2008/09 and 2010/11-2012/13
2006/07 -2008/09
2010/11 -2012/13
England 2006/07 - 2008/09
England 2010/11 - 2012/13
160
140
120
100
83.85
45.93
54.55
92.56
87.88
71.80
86.41
84.90
49.10
20
42.44
40
55.93
60
121.44
80
0
Wychavon
Bromsgrove
Wyre Forest
Malvern Hills
68
Worcester
Redditch
6
Healthy Worcester partnership priorities
A number of priorities for action have been identified in the Worcester City District Health and
Wellbeing Plan (2014-16).
6.1
Hospital admissions for self-harm amongst children and young people
This has been discussed under section 3.4 of this document.
6.2
Colorectal and prostate cancers
Figure 64 below shows the standardised incidence ratios for new cases of breast cancer, lung cancer,
colorectal cancer and prostate cancers in the Worcestershire districts compared to England.
A Standardised Incidence Ratio (SIR) is used to determine if the occurrence of cancer in a relatively
small population is high or low. An SIR analysis can tell us if the number of observed cancer cases in a
particular geographic area is higher or lower than expected, given the population and age
distribution for that community.
The SIR is obtained by dividing the observed number of cases of cancer by the “expected” number of
cases. The expected number is the number of cases that would occur in a community if the disease
rate in a larger reference population (in this case England) occurred in that community. Since cancer
rates increase strongly with age, the SIR takes into account whether a community’s population is
older or younger than the reference population and also takes account of the proportion of males
and females in the population.
The England rate is 100 in each case and is represented by the blue line below.
Figure 64 – New cases of Breast, Lung, Colorectal and Prostate Cancers, standardised
incidence ratios for each District relative to England 2007-11
Lung Cancer
Colorectal Cancer
105.7
114.8
113.1
92.6
124.0
100.8
100.9
106.1
123.8
Redditch
Wyre Forest
99.4
118.7
94.3
81.5
76.8
85.5
89.1
60.3
65.6
104.8
Breast Cancer
Malvern Hills
Wychavon
99.2
99.4
107.2
91.5
113.3
Bromsgrove
Worcester
England rate, 100
Prostate Cancer
Source: ONS Cancer Incidence data, combining cancer registration data from all PHE cancer registration teams.
Indirectly age-sex standardised ratios
69
The graph shows that the number of new cases of breast cancer in Worcestershire are broadly equal
to that expected based on the England average age and sex standardised incidence rates. Rates of
lung cancer in Worcestershire are lower than would be expected, with rates in Worcester being
almost 15% lower than expected. However, the number of new cases of colorectal cancer and
prostate cancers are much higher than would be expected; the incidence of colorectal cancers in
Worcester is almost 24% (CI 11.1-37.4%) higher than would be expected and prostate cancers is 13%
(CI 1.2-26.0%) higher than would be expected.
The high levels of colorectal and prostate cancers in Worcestershire have been flagged in the annual
APHO health profiles until 2013 and as such have been highlighted as one of the priorities for the
Healthy Worcester partnership to monitor and work towards improving.
6.3
Low birth weight babies
Figure 65 shows the percentage of births classified as low weight (less than 2,500 grams) in the
Worcester districts compared to the national average. Figures are displayed as a 5 year rolling
average to improve the accuracy of the data given the small number of low birth weight births. As
can be seen, Worcester has the highest rate of children born with a low birth weight in
Worcestershire and is the only one of Worcestershire's districts where the rate of low birth weight
births is significantly higher than the national rolling average. However, it must be noted that from
2006-10 and 2008-12 the rate of low birth weight births in Worcester decreased from an average of
9.0% to 8.3% respectively.
Figure 65 – Percentage of Births with a Low Birth weight by Worcestershire District in
2006-2010 and 2008-12
2006-10
2008-12
England 2006-10
England 2008-12
12.0%
10.0%
8.0%
6.0%
4.0%
6.6% 6.5%
7.2% 6.9%
7.5% 7.4%
8.0% 8.0%
Bromsgrove
Wychavon
Malvern Hills
Wyre Forest
8.3% 8.2%
Redditch
9.0%
8.3%
2.0%
0.0%
Worcester
Source: Association of Public Health Observatories, http://www.apho.org.uk and Local Health
http://www.localhealth.org.uk
The map below shows the proportion of all live and still births which have valid birth weight
recorded with birth weight less than 2,500 grams (excluding zero weight).
70
Figure 66 – Proportion of Births with a Low Birth weight in Worcester 2008-12 by MSOA
Source: Local Health http://www.localhealth.org.uk. Quintile classification is based on quintiles calculated
for the whole of Worcestershire. Birth weight less than 2500g as a proportion of live and still births with valid
weight
It can be seen from the map that some of the areas within Cathedral ward have the highest
proportion of births in the city classified as low birth weight at 12.1% of all births compared
to just 5.7% in Claines. Five MSOA in Worcester are in the highest (worst) performing areas
based on the Worcester quintiles, whereas only two areas are in the lowest (best) quintile.
However when looking at infant deaths, none of the Worcestershire districts are
experiencing significantly different rates than the England average.
6.3.1
Women smoking in pregnancy
Women who smoke, or who are exposed to second-hand smoke, while pregnant are more
likely to have a baby with low birth weight (less than 2,500 grams) than non-smoking
mothers. Low birth weight babies are associated with higher risks of death and disease in
infancy and early childhood, and also poorer long-term health and educational outcomes.
Smoking during pregnancy increases the risk of complications during pregnancy and labour,
including miscarriage. Smoking during, and after, pregnancy also increases the risk of sudden
infant death (‘cot death’).
71
Data on smoking in pregnancy becomes unreliable to interpret below county level, however,
it is interesting to note how smoking in pregnancy behaviour in the county has changed over
time.
Figure 67 below shows the rate of pregnant women smoking at the time of delivery for the
past five years in Worcestershire and England. It can be seen that this has increased in
Worcestershire since 2008/09, becoming significantly worse than the England average in
2010/11.
Figure 67 – Women smoking in pregnancy trend over time in Worcestershire and England
Worcestershire
Worcestershire Lower CI
Worcestershire Upper CI
England
England Lower CI
England Upper CI
20
18
16
14
12
10
8
6
4
2
0
2007/08
2008/09
2009/10
2010/11
2011/12
Worcester's figures have been calculated based upon the Worcestershire average - each
district has the same rate there may therefore be some issues generalising this figure to
Worcester alone.
More recent, and more generalizable data has been collated at CCG level, and is shown in
figure 68 below. This allows us to see how smoking in pregnancy behaviours varies between
the three CCG areas. Worcester lies within the South Worcestershire CCG area, it can be
seen that smoking in pregnancy rates in the South Worcestershire CCG area are significantly
lower than the Worcestershire county figure.
72
Figure 68 – Percentage of Women Smoking at Delivery by CCG in 2012/13
2012-13
Worcestershire
16.0%
14.0%
12.0%
10.0%
8.0%
14.9%
12.9%
6.0%
10.0%
4.0%
2.0%
5.2%
0.0%
Other CCG
South Worcs
Wyre Forest
Redditch & Bromsgrove
Source: Worcestershire CCG Outcome Indicators
6.4
Young people not in employment, education or training
Figure 69 below shows the percentage of 16-18 year olds Not in Education, Employment or
Training (NEET) in each Worcestershire district over a three year period compared to the
national average rate for each year.
It can be seen that the rate of 'NEETs' in Worcester is slightly above the National average in
each of the three years. Of the other districts, Wyre Forest has experienced a significantly
higher rate of NEETs in 2009 and 2010, but not 2011. Indeed, all of the Worcestershire
district areas have a lower percentage of 16-18 year olds classified as 'NEET' in 2011
compared to 2009 with the exception of Bromsgrove which experienced a 0.6% increase.
More recent NEET data is felt to be misleading. Since Connexions services were removed,
there are a high proportion of "Unknowns" (almost 40%) so the NEET figures past 2011 are
no longer reliable.
73
Figure 69 – Percentage of 16-18 year olds classified as 'NEET' in each Worcestershire
District compared with the National average over three years
2009
2010
2011
England 2009
England 2010
England 2011
9.0%
8.0%
7.0%
6.0%
6.2%
7.2%
6.6%
6.0%
4.8%
5.7%
5.2%
4.1%
3.3%
3.5%
4.0%
4.8%
4.3%
3.7%
2.0%
5.0%
3.0%
4.9%
4.0%
7.3%
8.2%
5.0%
1.0%
0.0%
Wychavon
Malvern Hills
Bromsgrove
Redditch
Wyre Forest
Worcester
Source: Data for the Worcestershire Districts is taken from the Worcestershire County Council Instant Atlas
Toolkit. National data is taken from CHIMAT.
7
7.1
Other public health priority areas
Smoking and Tobacco
7.1.1
Local Tobacco Control Profile Indicators
Figure 70 below shows a ‘spine chart’ comparing Worcester with the National average for
various indicators that relate to the issue of smoking. It can be seen from the chart that
Worcester's performance is either similar to or better than the national average, particularly
of note is the prevalence of smoking in the routine and manual professions where Worcester
is performing better than over 75% of other areas in England.
74
Figure 70 – Spine Chart of Local Tobacco Control Profile Indicators
Source: Local Tobacco Control Profiles for England
7.1.2
Smoking Prevalence
Worcester has the second largest estimated proportion of adults that are current smokers in
Worcestershire, with estimates on smoking prevalence placing both Worcester and Redditch
above the national average. This can be seen in figure 70 below.
Figure 71 – Estimated Smoking prevalence among adults (18+) by Worcestershire District
and National average 2011/12
Current smoker
Redditch
Ex-smoker
25.2%
Worcester
33.6%
23.0%
England
16.9%
Bromsgrove
15.7%
Wyre Forest
15.5%
Malvern Hills
15.2%
0%
10%
41.1%
27.9%
20.0%
Wychavon
Never smoked
49.1%
33.2%
46.8%
36.2%
46.9%
36.4%
47.9%
34.9%
49.7%
38.3%
20%
30%
40%
46.5%
50%
60%
Source: Integrated Household Survey, ONS (experimental statistics)
75
70%
80%
90%
100%
7.2
Sexual Health
The recent Worcester Sexual and Reproductive Health Profile, published October 2014, identified a
number of areas where Worcester is performing worse than the national average: Chlamydia
diagnosis rate; Chlamydia proportion aged 15-24; HIV testing uptake; HIV late diagnosis and under
18s conception rate. The under 18s conception rate has already been discussed in section 3.3
however further details on the Chlamydia and HIV related indicators are discussed below.
7.2.1
Chlamydia
As can be seen from figure 72 below, the majority of areas in Worcestershire, with the exception of
Wyre Forest, fall below the average chlamydia diagnosis rate for 15-24 year olds. Worcester,
Bromsgrove and Malvern Hills have significantly lower rates than the national average.
Figure 72 – Chlamydia diagnosis rate per 100,000 aged 15-24, 2013
Chlamydia diagnosis rate per 100,000
England
3,000
2,500
2,000
1,500
2,154.0
1,000
1,432.0
1,560.0
1,606.0
1,736.0
1,742.0
Worcester
Redditch
Wychavon
500
0
Malvern Hills Bromsgrove
Source: PHE Sexual and reproductive health profiles 2014
76
Wyre Forest
Figure 73 – Chlamydia proportion aged 15-24 screened, 2013
Chlamydia proportion aged 15-24 screened
30
England
25
20
15
10
17.2
17.7
19.6
19.7
20.3
21.0
Redditch
Worcester
Wyre Forest
Wychavon
5
0
Perhaps one explanation for this can be found in figure 73, which shows the screening rates for
Chlamydia in 15-24 year olds. As can be seen, all districts in Worcestershire have screening rates that
are significantly lower than the national average. However, this is not unique to Worcestershire; the
majority of the West Midlands is showing screening rates significantly worse than the national
average.
7.2.2
HIV
There are three indicators relating to HIV in the Sexual and Reproductive health profile. Further
information on each of these is detailed below.
77
Figure 74 – HIV testing uptake, MSM%, 2013
HIV testing uptake, MSM (%)
England
100
95
90
85
80
90.3
90.4
Worcester
Wychavon
92.6
91.8
94.9
95.0
75
70
Bromsgrove Malvern Hills Wyre Forest
Redditch
Although most of the districts in Worcestershire are showing HIV testing uptake in men who have sex
with men (MSM) that are lower than the national average, only Worcester is showing levels that are
significantly lower than the national average, albeit by a small margin as the confidence intervals are
very wide.
Figure 75 – HIV Late diagnosis (%), 2011-13
Area
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
%
60
60
60
-
England average 45
Confidence intervals
(14.7, 94.7)
(14.7, 94.7)
(14.7, 94.7)
(44.2, 45.9)
Figure 75 shows the percentage of HIV cases that have a late diagnosis (%); Worcester, Redditch and
Wychavon are showing rates that are below the national figure, however it should be noted that the
actual numbers are so low (less than five) that drawing any conclusions from this data would be
unreliable – this is highlighted in the very wide confidence intervals above.
Figure 76 below, shows the HIV diagnosed prevalence rate per 1,000 aged 15-59 in 2013. This time,
each of the districts in Worcestershire has prevalence rates that are much lower than the national
average; this is consistent with the low screening rates.
78
Figure 76 – HIV diagnosed prevalence rate per 1,000 aged 15-59, 2013
HIV diagnosed prevalence rate per 1,000 aged 15-59
England
3
2
2
1
1
0.45
0.62
1.05
1.14
Worcester
Redditch
0.72
0.71
0
Bromsgrove
Wychavon
Wyre Forest Malvern Hills
79
8
Conclusions and Recommendations
8.1
Conclusions
This profile details a number of areas of concern regarding health and wellbeing in Worcester. Many
of these are already known about and have been incorporated into the various strategies at both
district and county level, however there are a few issues that should be highlighted as they are either
of concern and have not yet been picked up, or because the depth of the issue needs further
exploration:

Carer health; section 5.1.2 discusses the proportion of people providing unpaid care, the
areas that had the most people providing 50 or more hours care (Rainbow Hill, Gorse Hill and
Warndon) are also the areas with some of the worst health and wellbeing outcomes and the
highest levels of deprivation. Further work should be done to explore the impact providing
high levels of care has on the health and wellbeing of those in these communities.

Worcester has the fourth highest rates of under 18 conceptions in the West Midlands region.
Rates are highest in the wards of Warndon, Rainbow Hill, Gorse Hill, Nunnery and Cathedral
which are also the areas which have the highest rates of deprivation; further investigation
should be done to understand the reasons why rates are so high in these areas.

Sexual health; screening for chlamydia and HIV are both very low, not only in Worcester but
in Worcestershire and the West Midlands region.

Rates of Colorectal and prostate cancers are very high in Worcester; in particular, colorectal
cancer is almost 24% higher in Worcester than would have been expected given Worcester's
age and sex profile.

Levels of statutory homelessness in Worcester are significantly higher than the England
average. However, Worcester has the highest rates in the County for number of households
accepted as homeless and in priority need at 4.45 per 1,000 population – higher than the
England rate of 2.32 per 1,000 population.

Drug and substance misuse, the number of adults in structured treatment programmes for
drug and substance misuse is far higher in Worcester than in any of the other Worcestershire
districts, although this may mean that drug and substance misuse is hidden in the other
districts.
Although this profile points to individual indicators, it also acknowledges that so many health
outcomes are affected by the wider determinants of health, the quality of housing a person lives in,
their household income, the levels of deprivation, education and exercise to name a few.
80
8.2
Recommendations
It is recommended that:
1.
An audit of current chlamydia screening service delivery be undertaken, with a view to
further developing screening pathways that are aligned to the existing core services of Reproductive
and Sexual Health (RSH), community pharmacy, general practice, termination of pregnancy, and any
other key identified services. In addition, work should also be undertaken to identify best practice
around increasing awareness and access to chlamydia screening by targeting the most 'at risk'
populations.
2.
An investigation be conducted into why under 18 conception rates are so high in Worcester
City and in particular in the wards of Warndon, Rainbow Hill, Gorse Hill, Nunnery and Cathedral.
Furthermore, best practice for reducing the rate of under 18 conceptions should be explored and
recommendations for service delivery be made.
3.
Reasons for the high rates of prostate and colorectal cancers in Worcester and
Worcestershire be investigated and best practice for addressing these issues be explored
4.
Working groups should be created with representatives from Public Health, South
Worcestershire CCG, NHS England, Worcester City Council, Worcestershire County Council and other
partners as appropriate to manage delivery of recommendations 1-3, to establish best practice and
to make recommendations for future delivery.
In addition, it is recommended that the commissioners of health and care services:
5.
Promote carer support and identification in primary care given that the areas of Worcester
with the highest levels of 50 and above hours unpaid care are in the health hotspot areas of Gorse
Hill, Rainbow Hill and Warndon.
6.
Ensure demographic pressures from population projections care home developments are
taken into account in infrastructure planning for primary care and in the wider primary care service
model.
7.
Ensure that the data in this profile is used in planning, reviewing and commissioning health
and wellbeing related services in Worcester.
81
Appendices
9
Appendix 1 – Worcester detailed data
9.1.1
Employment
Figure 77 below shows the percentage of 16-64 year olds in employment in 2013/14 in each of the
Worcestershire districts compared to both the regional and national average.
As can be seen, employment rates exceed the regional and national averages in each of the districts.
Worcester has the third highest levels of employment in the County, it should be noted that this
figure may have been reduced by the large student population that are more likely not to be in
employment.
Figure 77 – Percentage of 16-64 year olds in employment by Worcestershire District April
2013-March 2014
Employment rate 2013/14
England
West Midlands
90.0
80.0
70.0
60.0
50.0
40.0
83.4
78.7
77.8
77.6
74.7
74.6
Malvern Hills
Worcester
Redditch
Wychavon
Wyre Forest
30.0
20.0
10.0
0.0
Bromsgrove
Source: Annual Population Survey, rates based on ONS 2013 mid-year estimates
Figure 78 looks at the percentage of 16-64 year olds who are unemployed and/or claiming
Job Seekers' Allowance (JSA) in each of the Worcestershire districts against the national
average. Unemployment figures are based on modelled estimates, whereas the JSA
claimant figures are based on a 12 month average of claims. It can be seen that levels of
unemployment and JSA are lower than the national average in each of the Worcestershire
districts. The highest levels of unemployment are in Wyre Forest, Redditch and Worcester
respectively.
Figure 79 explores this further, looking at the top ten wards for unemployment in
Worcestershire in 2013. Four of the top ten wards are in the Worcester district: Warndon,
Gorse Hill, Cathedral and Rainbow Hill – which are also some of the areas that have been
selected as health hotspot areas.
82
Figure 78 – Percentage of 16-64 year olds who are unemployed and / or claiming Job
Seekers' Allowance by Worcestershire District April 2013-March 2014
8.0%
Unemployment
JSA Claimants
England Unemployment
England JSA Claimants
7.0%
6.0%
5.0%
2.9%
Redditch
3.3%
6.2%
2.9%
5.8%
Worcester
1.7%
1.0%
1.8%
4.3%
1.8%
4.1%
2.0%
4.4%
3.0%
6.4%
4.0%
0.0%
Bromsgrove
Malvern Hills
Wychavon
Wyre Forest
Source: Office of National Statistics, unemployment rate based on model-based estimates of employment from
the Annual Population Survey calculated as a percentage of 16+ economically active population, JSA Claimant
figures based on claims of JSA averaged over a 12 month period
Figure 79 – Top ten wards for unemployment proportion in Worcestershire, November
2013
Rank (2012)
1 (1)
2 (3)
3 (2)
4
5 (6)
6
=6 (5)
7 (8)
8 (-)
9 (-)
10 (-)
Ward
Oldington & Foley Hill
Warndon
Gorse Hill
Cathedral
Broadwaters
Pickersleigh
Rainbow Hill
Charford
Areley Kings
Sidemoor
Central
District
Wyre Forest
Worcester City
Worcester City
Worcester City
Wyre Forest
Malvern Hills
Worcester City
Bromsgrove
Wyre Forest
Bromsgrove
Redditch
% Claimants 16-64
6.6%
5.4%
5.3%
4.9%
4.6%
4.4%
4.4%
4.0%
3.8%
3.7%
3.6%
Source: WCC Monthly Economic Summary November 2013 (RIU) using ONS 2013 downloaded from NOMIS
Table sourced from the Worcestershire Adult Mental Health and Wellbeing Needs Assessment 2014
Unemployment proportion for wards expresses the number of claimants resident in an area as a % of the Mid2010 population aged 16-64 in that area
These local unemployment proportions are lower than the same time last year (2012) but it is
important to remember that there is research to suggest a strong link between unemployment and
an increased risk of mental ill health.
83
The unemployment benefit claimant proportion in eight of the top ten wards is higher than the West
Midlands (3.9%) and England (3.0%) rate, and all but Wychavon district are represented. However,
there are more wards from Worcester City District represented in this top 10 list than any other area
of Worcestershire. This year, however, it is closely followed by Wyre Forest with 3 areas in the top
10. There is also some resonance as expected, with the areas of higher deprivation (and the lowest
life expectancy) in the county, including Oldington & Foley, Warndon, Gorse Hill and Rainbow Hill and
Broadwaters.
There are also three wards that have entered the top ten; these are worthy of close monitoring to
assess the potential impact, particularly considering the enduring trend of people spending more
time in unemployment. The longer people spend unemployed, the more difficult it is to get back into
the work marketplace, and the more vulnerable people are to common mental disorders such as
depression and anxiety. Figure 79 below illustrates the increasing trend of long-term unemployment
in Worcestershire, which is now running at a higher rate than shorter term unemployment and is still
increasing.
9.1.2
Tenure
Figure 80 – Percentage of households in Worcestershire districts by tenure, 2011
Owned
Shared ownership
Social rented
Private rented
10%
40%
50%
60%
70%
Living rent free
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
0%
20%
30%
80%
90%
100%
Source: Census 2011, extracted from Nomis 06/10/2014
There is considerable variance between Worcestershire districts in terms of the proportion of
housing tenure, with certain areas having a much higher percentage of social rented housing. The
highest proportion is in Redditch (over 21%) and the smallest proportion in Bromsgrove, with only
10% of housing in social rented tenure. Worcester City district dominates in terms of the proportion
of housing which is privately rented, at just over 15%. This might be expected with the greater
proportion of flats in this area, closely correlated with the age profile of the student population.
84
9.1.3
Education
GSCE Achievement
Figure 81 below shows the percentage of pupils achieving 5 or more GCSEs at grades A*-C
(including English and Maths) or equivalent at end of Key Stage 4 in each of the
Worcestershire districts from 2008/09 to 2012/13.
It can been seen from figure 81 that, with the exception of the academic year 2011/12, the
percentage of pupils achieving 5+ A*-C grades in Worcester improved from a position of
being significantly below both the regional average in 2008/09 to being in line with the
regional average in 2012/13. The Worcestershire average has shown an increase owing to
the sharp improvement in performance of pupils in Redditch), Worcester is currently below
the Worcestershire rate of 63.2% in 2012/13, however, its rate of 59.9% is the same as the
regional average.
Figure 81 – Percentage of pupils achieving 5+ A*-C grades incl. English and mathematics
GCSEs 4-year Trend by District (pupil residency) 2011/12-2012/13
Bromsgrove
Malvern Hills
Redditch
Worcester
Wychavon
Wyre Forest
68.6
66.0
55.6
58.6
61.7
55.0
69.0
61.9
63.6
56.2
59.1
57.6
71.3
60.5
68.1
59.9
60.5
59.1
2008/09
66.4
58.1
50.1
53.3
57.9
49.9
60.4
56.1
42.2
41.5
56.3
42.2
West Midlands rate
2009/10
2010/11
2011/12
2012/13
By pupil residency. State funded schools including academies and CTCs
Source:
Department for Education, Statistical First Release
85
9.1.4
Children in need
Figure 82 below shows the percentage of under 18 year olds considered to be ‘in need’ in
each district area of Worcestershire in 2010. This has been calculated from information in
the Children in Need (CIN) Census, which is an annual data collection that covers all children
who are referred to children’s social care services, even if no further action is taken. This
includes children looked after (CLA), those supported in their families or independently
(CSF/I), and children who are the subject of a child protection plan. The number of children
in need that was reported in this census in 2010 has then been expressed as a percentage of
the 2009/10 under-18 population taken from ONS mid-year estimates.
Figure 82 – Percentage of under 18 year olds classified as ‘in Need’ by Worcestershire
District in 2010
Rate of 'Children in Need' 2010
England
7.0
6.0
5.0
4.0
6.1
3.0
4.9
5.2
Worcester
Wyre Forest
2.0
1.0
2.6
2.8
3.0
Bromsgrove
Malvern Hills
Wychavon
0.0
Redditch
Source: Worcestershire Data taken from Worcestershire County Council Instant Atlas Toolkit, National data
taken from Department for Education Children in Need Census.
It can be seen that Worcester has the third highest rate of children 'in need' in
Worcestershire behind Redditch and Wyre Forest, all three districts have rates that exceed
the national average.
9.1.5
Takeaways and fast food outlets
Information from the National Obesity Observatory presented in the table below shows the
number of fast food outlets in each district of Worcestershire. In terms of crude rate per
population, Worcester and Wyre Forest clearly have the highest prevalence of fast food
outlets.
86
Figure 83 – Number of Fast Food Outlets in Worcestershire Districts
Number of
LA Name
fast food
outlets
Bromsgrove 53
Malvern Hills 29
Redditch
49
Worcester
76
Wychavon
55
Wyre Forest 76
Total
population
2010
93,441
75,381
78,666
94,763
117,028
98,147
Crude
rate per
100,000
56.7
38.5
62.3
80.2
47.0
77.4
Source: Data from National Obesity Observatory website http://www.noo.org.uk/. Original data source
for fast food outlets - Ordnance Survey InterestMap™ 2010 which provides location details of businesses,
leisure sites and geographic features in Great Britain. Three sub groups have been combined (i) Fast food
and takeaway outlets, (ii) Fast food delivery services, and (iii) Fish and chip shops.
87
Bibliography
Association of Public Health Observatories Health Profiles 2011-12, http://www.apho.org.uk.
Centre for research in Primary and Community Care, on behalf of NICE: Update on review of
reviews on teenage pregnancy and parenthood, December 2007
http://www.nice.org.uk/guidance/ph3/resources/update-on-review-of-teenage-pregnancyand-parenthood2
Submitted as an Addendum to the first evidence briefing 2003
Foresight Tackling Obesities: Future Choices – Project report, Government Office for Science,
www.foresight.gov.uk, 2nd Edition, first published in 2007.
Healthy lives, healthy people: A call to action on obesity in England, Department of Health,
October 2011.
Healthy transport = Healthy lives, British Medical Association, www.bma.org.uk, July 2012.
Local Alcohol Profiles for England, http://www.lape.org.uk/.
Local Tobacco Control Profiles for England, http://www.tobaccoprofiles.info/
National Obesity Observatory http://www.noo.org.uk/
Sport England Segmentation Tool http://www.sportengland.org/research/about-ourresearch/market-segmentation/
Statistics on obesity, physical activity and diet: England, The Health and Social Care
Information Centre, www.ic.nhs.uk, February 2012.
Teenage Pregnancy Strategy: Beyond 2010, Department of Health and Department for
Children, Schools and Families, 2010
Worcestershire County Council Instant Atlas Toolkit, http://atlas.worcestershire.gov.uk/IAS/
This document can be provided in alternative formats such as Large Print, an audio recording or
Braille; it can also be emailed as a Microsoft Word attachment. Please contact Liz Howell on telephone
number 01905 765637 or by emailing ehowell@worcestershire.gov.uk.
88

Worcester Health and Wellbeing Profile

Transcription

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