WEST SUSSEX
JOINT STRATEGIC NEEDS ASSESSMENT 2014
Summary Appendix
Drafted by
Public Health Research Unit – September 2014
Contact jacqueline.clay@westsussex.gov.uk
1
Contents
Page(s)
Section 1
Population and Diversity
3 ‐ 12
Section 2
Wider Determinants of Health (Social and Place Wellbeing)
13 ‐ 26
Section 3
Lifestyles and Health Improvement
27 ‐ 36
Section 4
Health status, Life expectancy and Long Term Conditions
37 ‐ 60
Section 5
Service Utilisation
61 ‐ 66
Section 6:
Views, experiences and prioritisation
67 ‐ 72
2
Section 1: Population and Diversity
Overall Resident Population
The latest population estimate (2013) shows that there are 821,370 people resident in West Sussex, of whom
148,400 are children (aged 0-15 years), 493,700 are people of working age (16-64 years) and 179,300 people
aged 65 years or older. Over 27,700 people are aged 85 years or over. Over the last 10 years the overall
population has increased by 7%, areas in the north of the county have experienced greater population growth.
The resident population within the Clinical Commissioning Group (CCG) areas are approximately (these relate
to 2012):Coastal West Sussex
486,000
Crawley
108,500
Horsham and Mid Sussex
223,500
The registered patient population1 (people registered with West Sussex GPs) is higher:Coastal West Sussex
490,900
Crawley
127,100
Horsham and Mid Sussex
227,200
Components of Population Change
There are four components of change:-births; deaths; internal migration (from/to elsewhere in the UK) and
direct international in/out migration. Overall, in West Sussex, population growth is driven by net internal
migration, but this does differ across the county (Table 1.1).
Table 1.1 Population Components of Change 2012 to 2013
(Figures are rounded so may not sum)
Mid-2012
Population
Estimate
Natural Change
(Births - deaths
Internal
Migration Net
International
Migration Net
61,930
70
520
151,385
-470
1,500
Chichester
114,520
-280
860
Crawley
108,300
840
-600
Horsham
132,160
-50
820
Mid Sussex
141,160
210
1,390
Worthing
105,660
-170
730
West Sussex
815,120
150
5,220
*Other changes include changes to the size of armed forces stationed in the UK
Source: ONS
Adur
Arun
-10
380
140
400
-50
0
-110
750
Other*
Changes
Mid-2013
Population
Estimate
0
20
60
20
-10
10
0
100
62,510
152,820
115,300
108,970
132,880
142,770
106,120
821,370
1
This includes people who are registered with a West Sussex GP but live outside the county and excludes people who live in the county but are
registered with a GP outside of the county.
3
Births and Deaths
In 2013 there were 8,835 births in West Sussex2 and 8,672deaths3 (Figure 1.1).
After a period of growth from the early to mid-2000s, the number of births has remained fairly stable over
recent years,. The total period fertility rate4 (TPFR) is 1.90; not significantly different from the national rate.
Figure 1.1 Number of Registered Births and Deaths
West Sussex 2000 to 2013
Source: ONS
Birth data shows that the average age of the mother is 30 years. Each year there are approximately 350 to 550
births to women under the age of 20. First time teenage mothers are the target group for the Family Nurse
Partnership.
Migration (Internal and International)
The ONS estimate5 migration using a range of administrative datasets including GP registers and higher
education databases. For international migration a broad range of survey data is also used including migrant
worker and the Labour Force Surveys.

Net Internal Migration by Age
The annual net migration pattern for West Sussex (Figure 1.2a) contrasted with the annual pattern
observed in Brighton and Hove (Figure 1.2b). Brighton and Hove, with two universities, sees a large influx
of younger people, but does not see net inward migration in older groups.
In West Sussex, we see a large movement out of the county in the late teens and early 20s, reflecting the
movement of young people to higher education. While some move back in the early 20s, this does not match
2 ONS - Live births by area of usual residence of mother
3 ONS – Deaths registered during 2013.
4 The total fertility rate or total period fertility rate is the average number of children a woman would bear if she experienced current age specific
fertility rates throughout her reproductive life span. This means a figure of 1.90 means on average in West Sussex women would be expected to have
1.90 children.
5 Detailed methodology provided in ‘Population estimates for local authorities across UK constituent countries: a comparison of data sources and
methods’ (ONS 2012)
4
the earlier out-migration. In-migration also occurs in later age groups, with some in migration of families with
children and also around retirement and very old age groups; this may reflect the location of care homes.
There is a net inward migration of 1,500 people aged 60 years or over.
Figure 1.2a West Sussex (2013 data shown)
Net migration by individual age groups
Figure 1.2b Brighton and Hove (2013 data shown)
Net migration by individual age groups
Source: West Sussex Public Research Unit analysis of ONS data
National Insurance Number Registration
Information from National Insurance registration6 by international migrants is provided below, note this is not
net data, this relates to inflow only. This information provides an indication of the number, ages and origin of
new international migrants to the county.
Figure 1.3 National Insurance Registrations (Source: DWP)
In 2013/14 there were over 5,600
National Insurance Number Registrations
which listed West Sussex as their initial
registration location. Of these 3,230 were
from new EU Accession countries, 1,350
from EU Countries.
Source: DWP
6 A National Insurance Number is generally required by any overseas nationals who are looking to work or claim benefits / tax credits in the UK, this
includes the self-employed or students working part time.
5
Projected Population
The West Sussex population is forecast7 to increase from 815,000 (2012) to 881,000 (2022) and 971,000
(2037) (Figure 1.4). The age structure of the population is continuing to age, with larger increases projected in
the very old age groups (85+ and 90+ years). The number of people aged 90+ is expected to increase by 50%
by 2022 and over 300% by 2037 (from 10,000 in 2012 to over 30,000 in 2037).
Figure 1.4 Population Age Structure 2012 and 2037
The population pyramid shows the current
population ((in the bars) and the projected
population for 2037. This shows a clear bulge
of older people.
There is also a reduction in the proportion of
people in working age groups.
Specific Groups
There are a number of specific groups within the population who have “protected characteristics” or may have
different health needs. “Protected characteristics” under the Equality Act 2010 are:
- Age
- Sex
- Pregnancy and maternity
- Race
- Religion and belief
- Disability
- Marriage and civil partnership
- Sexual orientation
- Gender reassignment
Data relating to age, gender and pregnancy was outlined in the overall population section.
7 The ONS produces local authority level population forecasts on an annual basis. The figures provided in this summary relate to projections released in
May 2014.
6
Race / Ethnic Background
West Sussex is becoming more ethnically diverse. Data from the 2011 census showed that 11% of the
population was from an ethnic minority, compared with 6.5% in 2001. Of the black and ethnic minority (BME)
groups, “white other” accounted for 4% of the West Sussex population.
Table 1.2 Ethnic Background of West Sussex Population
Numbers
(Figures rounded so may not sum)
West
Sussex
2011 Census Data
White: English/Welsh/Scottish/Northern Irish/British
White: Irish
White: Gypsy or Irish Traveller
White: Other White
Mixed/multiple ethnic group: White and Black Caribbean
Mixed/multiple ethnic group: White and Black African
Mixed/multiple ethnic group: White and Asian
Mixed/multiple ethnic group: Other Mixed
Asian/Asian British: Indian
Asian/Asian British: Pakistani
Asian/Asian British: Bangladeshi
Asian/Asian British: Chinese
Asian/Asian British: Other Asian
Black/African/Caribbean/Black British: African
Black/African/Caribbean/Black British: Caribbean
Black/African/Caribbean/Black British: Other Black
Other ethnic group: Arab
Other ethnic group: Any other ethnic group
Source: ONS Census 2011
SOUTH
EAST
ENG
806,890
8,634,800
53,012,500
717,550
5,980
1,070
31,900
2,890
2,060
4,270
2,940
9,660
5,240
2,350
2,960
8,130
4,570
1,340
1,240
1,080
1,680
7,359,000
73,600
14,500
380,700
46,000
22,800
58,800
40,200
152,100
99,200
28,000
53,100
119,700
87,300
34,200
14,400
19,400
31,700
42,279,200
517,000
54,900
2,430,000
415,600
161,600
332,700
283,000
1,395,700
1,112,300
436,500
379,500
819,400
977,700
591,000
277,900
221,000
327,400
Percentage
West
Sussex
SOUTH
EAST
88.9%
0.7%
0.1%
4.0%
0.4%
0.3%
0.5%
0.4%
1.2%
0.6%
0.3%
0.4%
1.0%
0.6%
0.2%
0.2%
0.1%
0.2%
ENG
85.2%
0.9%
0.2%
4.4%
0.5%
0.3%
0.7%
0.5%
1.8%
1.1%
0.3%
0.6%
1.4%
1.0%
0.4%
0.2%
0.2%
0.4%
79.8%
1.0%
0.1%
4.6%
0.8%
0.3%
0.6%
0.5%
2.6%
2.1%
0.8%
0.7%
1.5%
1.8%
1.1%
0.5%
0.4%
0.6%
Religion
Religion remains a voluntary question on the Census, approximately 62% of residents8 stated they were
Christians on the last census.
Table 1.3 Religion (2011 Census)
Religion
Christian
Buddhist
Hindu
Jewish
Muslim
Sikh
Other religion
No religion
Religion not stated
Number of People
(figures are rounded so may not sum)
% of Total Population
West Sussex
South East
England
West Sussex
South East
England
498,350
3,050
7,350
1,450
12,650
1,150
4,100
216,850
61,900
5,160,150
43,950
92,500
17,750
201,650
54,950
39,650
2,388,300
635,850
31,479,900
238,650
806,200
261,300
2,660,100
420,200
227,850
13,114,250
3,804,100
61.8%
0.4%
0.9%
0.2%
1.6%
0.1%
0.5%
26.9%
7.7%
59.8%
0.5%
1.1%
0.2%
2.3%
0.6%
0.5%
27.7%
7.4%
59.4%
0.5%
1.5%
0.5%
5.0%
0.8%
0.4%
24.7%
7.2%
Source: ONS
8
This includes children, where the head of household provided religion. This excluded people who were residents of communal establishments.
7
Disability – Overall Figures
The Government defines disability as “a physical or mental impairment that has a ‘substantial’ and ‘long-term’
negative effect on a person’s ability to do normal daily activities” (Equality Act 2010). This definition of
disability focusses on the experience of the individual in terms of their interactions in society and in
completing everyday tasks (e.g. self-care and mobility).
The census 2011 included the following question:-
Over 17% of the population said that a health problem or disability acted to limit their daily activities, with
7.5% saying their activities were limited “a lot”. Not surprisingly older people were more likely to say activities
were limited, 49% of people aged 65 years or over saying a health problem or disability affected their daily
lives, compared with 8% of 16 to 49 year olds.
Table 1.4 Day to Day activities limited in West Sussex (2011)
Day to Day Activities
Number
Day to Day Activities
% (of the age group)
(rounded to nearest 50)
All Ages
0 to 15 years
16 to 49 years
50 to 64 years
65 years & over
Limited a lot
Limited a little
Not limited
Limited a lot
Limited a little
Not limited
60,150
1,900
10,750
11,200
36,300
78,700
3,000
15,950
16,850
42,900
668,000
140,050
312,100
128,500
87,400
7.5%
1.3%
3.2%
7.2%
21.8%
9.8%
2.1%
4.7%
10.8%
25.8%
82.8%
96.6%
92.1%
82.1%
52.5%
Figure 1.5 Age standardised long-term limiting illness (2001 and 2011)
People with a Limiting Long Term Illness or Disability per 100 of the Population.
Data have been age
standardised to take account
the different age structures of
local authority populations.
Sources: 2001 Census (S016 - Sex and age by general health and limiting long-term illness) and 2011 Census (LC3205EW - Long-term
health problems). Age standardisation used the new European Standard Population (ESP)
8
Figure 1.6 Residents with a health condition or disability limiting day-to-day activities (a little or a lot)
Standardised Rate (Per 100 Population)
This map shades Lower Super Output
Areas (LSOAs) in West Sussex. There are
over 500 LSOAs, each with approximately
1,500 households.
Areas shaded dark blue on this map have
higher rates of disability.
Data have been age standardised to take
into account the different age structure
within local areas.
This shows that areas along the coast and
west Crawley have higher rates of people
with long term limiting illness of disability.
There are also shows pockets of higher
rates across the county.
Source: Census 2011 (Broad Age Group)
Note: Excludes people living in communal establishments, broad age Groups
Marriage and civil partnership
Half of the population (aged 16 years or over) are married or in a civil partnership. Comparing 2011 with 2001
data, in 2011 there was a higher percentage of the population who are single and have never been married
(Figure 1.7).
Table 1.5 Marital Status (Census 2011)
Figures relate to Census 2011 Figures are rounded so may not sum
% - Population Aged 16+
Single (never married or never registered a same-sex civil partnership)
190,550
28.8%
Married
335,250
50.6%
1,600
0.2%
Separated (but still legally married or still legally in a same-sex civil partnership)
16,350
2.5%
Divorced or formerly in a same-sex civil partnership which is now legally dissolved
64,300
9.7%
Widowed or surviving partner from a same-sex civil partnership
53,950
8.2%
661,950
100.0%
In a registered same-sex civil partnership
Total 16+ Population (2011 Census)
Source: ONS Census 2011 Table KS103EW
Figure 1.7 Percentage Change in Marital Status (West Sussex 2001 to 2011)
*Includes people (in
2011) in a civil
partnership.
**Includes civil
partnership dissolution.
***includes surviving
partner from a civil
partnership.
9
Sexual Orientation
There is no single national survey relating to sexual orientation and a question was not included in the Census
2011. Research provides a wide range of estimates (from 0.3% to 10%).
The Integrated Household Survey (IHS) between April 2011 and March 2012 estimated that nationally: 93.9% of adults identified themselves as heterosexual/straight.
 1.1% identified themselves as Gay or Lesbian.
 0.4%identified themselves as Bisexual.
 0.3% identified themselves as ‘Other’.
 3.6% stated ‘Don’t know’ or refused to answer the question.
 0.6% stated ‘No response’ to the question.
Nationally, the Government works to an estimate9 of between 5%-7% of the population being lesbian, gay or
bisexual.
Gender reassignment
The protected characteristic relating to gender re-assignment relates to a range of people, including people
whose gender identity is different from their biological sex (at birth), a small group of people who have
undergone gender re-alignment surgery but also a broader group of people whose experience of their gender
is not aligned to “societal expectations or norms”. There is no single source of data identifying prevalence. In
2007 research10 identified the prevalence of people who had sought medical support being 20 per 100,000
(with 80% of people seeking care being male), and an incidence rate of approximately 3.0 per 100,000 people.
Additional Groups
Carers
According to the Census 2011, over 84,000 people stated that they provided unpaid care. The census
identified 1,500 child carers, although this is likely to be an under-estimate.
16,792 people provide 50 hours or more of unpaid care and a further 9,280 people provide 20-49 hours a
week. Of the 84,400 carers, the majority of carers were aged 50 years or over and the majority (58%) were
women.
Of those providing unpaid care the percentage of carers caring for 20 hours or more has increased from 26% in
2001 to 31% in 2011. People who provide 50 hours of unpaid care a week have significantly poorer health than
people who are not carers.
Data collected as part of the West Sussex Older People Survey in 2013 showed that carers providing full time
care, and living with the person they cared for were more likely to be lonely then the general over 65+ year
population.
9
Source: Estimating the size and composition of the Lesbian, Gay and Bisexual population of Britain, Equality & Human Rights Commission 2009
GIRES. The Number of Gender Variant People in the UK - Update 2011.
10
10
Table 1.6 Provision of Unpaid Care (All Hours)
Numbers are rounded to nearest 10 so may not sum
Numbers
Age Groups
16 to 24
25 to 34
290
450
Adur
All Ages
6,950
0 to 15
170
Arun
16,550
260
630
Chichester
35 to 49
1,750
50 to 64
2,520
65+
1,770
910
3,510
6,040
5,200
12,490
190
430
610
2,600
4,910
3,750
Crawley
9,900
210
630
1,150
2,790
3,370
1,740
Horsham
13,640
230
470
670
3,230
5,570
3,470
Mid Sussex
13,980
270
530
820
3,390
5,610
3,370
Worthing
10,880
170
480
810
2,700
3,920
2,810
84,400
1,490
3,470
5,440
19,970
31,920
22,100
West Sussex
Source: ONS Census 2011
Young carers
Data on young carers are collected via the Census, and 1,500 young people were identified as providing unpaid
care in West Sussex from the 2011 Census (Table 1.6). This is likely to be an under estimation. National
research has identified young carers as a group at risk of poorer health outcomes. The Longitudinal Study of
Young People in England (LSYPE) found that young carers are: 1.5 times more likely to have a disability or long-term condition themselves.
 1.5 times more likely to be from a black, Asian or minority ethnic group
 Twice as likely not to speak English as their first language
Young carers are also more likely to live in workless or lower income households as well as with an adult who
has a disability. These factors contribute towards increased stress and poorer mental wellbeing experienced by
the carer.
The Armed Forces
 Military Veterans. There is no single definition used by all organisations and services. The Ministry of
Defence (MOD) defines a veteran “as anyone who has served in HM Armed Forces at any time,
irrespective of length of service (including National Servicemen and Reservists)”. It is estimated11 that,
using this broad definition, that there are approx. 66,500 military veterans in West Sussex. Of these
veterans the vast majority are men (estimated at 87%) and 66% aged 65 years or over.
 People Currently Serving in the Armed Forces. According to the 2011 Census there are approximately
3,500 residents in West Sussex currently serving in the Armed Force, of these approximately 900 live in
Chichester, on or near to the Thorney Island military base.
Students
There are 36,000 full time students living in West Sussex. The majority are aged between 16 and 19 years and
live at home with their parents. This reflects the higher school leaving age.
11
Source of data - There is no single data source for estimating the number of military veterans. Although the decennial census
includes a question on current occupation, which includes a category for people serving in the Armed Forces, there is no question on
previous service history. This estimate is based on surveys conducted by the Royal British legion and ONS research.
11
Table 1.7 Full-time students
(Figures rounded to nearest 100 so may not sum)
Age
Number
16-19 years
20-24 years
25+ years
All ages
Source: Census 2011
25,700
5,900
4300
35,900
Gypsies and Travellers
For the first time, the 2011 Census included an ethnic background category “White: Gypsy or Irish Traveller”.
Over 1,000 people self-identified with this category in West Sussex. It is likely that this is an under-estimation
of Gypsies and Travellers in the county. Some people will have identified under other categories, including
mixed ethnic groups. A health needs assessment undertaken in West Sussex in 2010 provided an estimate of
between 3,000 and 3,500 gypsy and travellers in West Sussex. This estimate used a range of evidence include
school ethnic monitoring data, caravan and pitch counts and information from local authorities.
Families
There are approximately 234,000 families in West Sussex; of whom about 40% of families have dependent
children (Table 1.8), although this varies across West Sussex from 35% in Arun to 47% in Crawley. In relation to
families with dependent children (Table 1.8), approximately 1 in 4 families are lone parent families.
Table 1.8 Families with dependent Children
All Families with
dependent
children
Couple family
Lone parent families
Adur
6,940
5,095
3,840
1,255
1,840
200
1,645
% Lone
Parent
Families
26.5%
Arun
15,400
11,355
8,895
2,460
4,045
420
3,625
26.3%
Chichester
11,755
9,175
7,615
1,560
2,585
240
2,345
22.0%
Crawley
14,020
10,160
8,155
2,010
3,860
365
3,495
27.5%
Horsham
15,460
12,655
10,790
1,865
2,805
325
2,480
18.1%
Mid Sussex
16,990
13,965
11,850
2,115
3,025
295
2,730
17.8%
Worthing
12,095
8,855
6,980
1,875
3,240
375
2,865
26.8%
Married or civil
partnership
Cohabiting
Total
Male
parent
Female
parent
92,665
71,265
58,120
13,145
21,400
2,220
19,180
23.1%
1,041,020
6,408,565
791,970
4,571,080
643,540
3,619,145
148,430
951,935
249,050
1,837,485
28,410
201,115
220,640
1,636,370
23.9%
28.7%
West Sussex
South East
England
Total
Source: ONS Census 2011
12
SECTION 2: Wider Determinants of Health (Social and Place Wellbeing)
Education
There is a strong link between education and health, and actions taken to improve educational attainment
may also have a positive impact on health.
Adults
20% of adults in West Sussex have no qualifications, compared with 22.5% nationally. However this varies
across the county, in Adur 25.6% of adults have no qualifications compared with 14.8% in Mid Sussex. Data
from the decennial census show that the percentage of the adult population with no qualifications has
dropped 4.2% in the 10 years.
27.8% of 16-74 year olds in West Sussex achieved Level 4 qualifications or higher (degree level or above), to
the England average (27.4%), but this is lower in Adur, Arun, Crawley and Worthing.
Children and Young People
In 2012/13 52.4% of children were assessed as having a good level of development at the end of the reception
year at school, this was higher than the national percentage of 51.6%. For children eligible for a free school
meal the percentages were far lower at 33.2% (West Sussex) and 36.2% (England).
In 2012/13 59.9% of pupils12 attained 5 or more GCSE grades at A*-C grades in West Sussex. This was below
the England percentage of 60.8%. 33% of pupils eligible for a free school meal attained this benchmark
compared with 62% of children not eligible (Figures 2.1a and 2.1b); again these are below the England
percentages of 38% and 64.8% respectively.
Pupils attaining 5+ A*-C Grades at GCSE
Figure 2.1a Children Eligible for a Free School Meal
Figure 2.1b Children Not Eligible
Source: DfE
In 2013 4.9% of teenagers aged 16-18 were not in education, employment or training (NEET) within West
Sussex, this is lower than the national rate (7.6%).
12
In state maintained schools in West Sussex.
13
Employment and Economic Activity Rate
The Marmot Review13 identified that good employment acted as a protective factor for health, and that
unemployment was detrimental to health. The Review found that jobs needed to be sustainable, provide
opportunities for development and provide a minimum standard of living.
The overall economic activity rate in West Sussex is high; during the period January to December 2013 almost
84% of people aged 16 to 64 years were economically active, far higher than the national rate and the South
East (77.4% and 80% respectively).
Unemployment is low. 1.3% (May 2014) of the working age claiming Job Seekers Allowance, compared with
2.6% across the country as a whole. There are however over 22,000 people on sickness benefits in West Sussex
(Figure 2.2).
Figure 2.2 People in Receipt of Employment Support Allowance (ESA) or Incapacity Benefit
West Sussex 1999 to 2014
Source: NOMIS
The percentage of 16-64 year olds on sickness benefits has remained fairly stable (4.5% of people aged 16-64
years in February 2014 were in receipt of sickness benefits in West Sussex). Although the rate in West Sussex
remains below the national rate, nationally the percentage has fallen (Figure 2.3).
Figure 2.3 % Resident Population (aged 16-64) in receipt of Sickness Benefits 1999 to 2014
West Sussex and GB Compared
Source: NOMIS
13
'Fair Society Healthy Lives' (The Marmot Review 2010)
14
There are also large gaps between people the employment rates of all people and those in contact with
secondary mental health services (65.6% gap in 2012/13) and people with a learning disability (58.3% gap in
2012).
4,730 people in West Sussex are in receipt of Carers Allowance (as of February 2014), this represents 1% of the
working age population.
Deprivation
There are two key sources of information in relation to deprivation, the Index of Deprivation 2010 (ID2010)
and the 2011 Census.

Data from the Index of Deprivation
Using information from ID2010, West Sussex is a relatively affluent county. County level data however
masks considerable differences within areas and there are some very deprived neighbourhoods. In 2010
West Sussex ranked 130th out of 152 upper-tier authorities on the Indices of Deprivation; in 2007 West
Sussex ranked 132nd.
In relation to neighbouring authorities, West Sussex is relatively less deprived than East Sussex (ranked
90th) and Brighton and Hove (ranked 53rd); more deprived than Hampshire (ranked 141st) and Surrey
(ranked 150th). The most deprived lower-tier authority in West Sussex is Adur (ranked 145th out of 326
local authorities); the least deprived Mid Sussex (ranked 315th).
In relation to “neighbourhood level” deprivation, West Sussex has three small areas (within River and
Ham wards in Littlehampton) falling in the 10% most deprived areas in England. At ward level River and
Ham wards are within the most deprived 10% of ward in England, a further seven wards are within the
most deprived 20% in England .
Decline in coastal areas, such as Littlehampton, is in line with the wider national picture of coastal decline,
for example areas such as Eastbourne and Hastings and coastal resorts in Kent becoming relatively more
deprived.

Data from the 2011 Census
The Census provides information at output area level, an output area contains approximately 125
households and as such provides a more detailed picture than the ID2010. The census examines four
dimension of deprivation:1. Employment (deprivation identified where any member of a household not a full-time student
is either unemployed or long-term sick).
2. Education (deprivation identified where no person in the household has at least level 2
education, and no person aged 16-18 is a full-time student)
3. Health and disability (deprivation identified where any person in the household has general
health ‘bad or very bad’ or has a long term health problem).
4. Household overcrowding (deprivation identified when the household accommodation is
either overcrowded, with an occupancy rating -1 or less, or is in a shared dwelling, or has no
central heating.)
15
Information is provided where households have none of the above, and where households “score” on one,
two, three or score on all dimensions of deprivation (Table 2.1).
Table 2.1
Deprived Households
All
households
Household is
not deprived
in any
dimension
Deprived
in 1
dimension
Deprived
in 2
dimensions
Deprived
in 3
dimensions
Deprived in
4
dimensions
% of
deprived in
3 or 4
dimensions
Coastal CCG
212,040
93,290
72,650
37,530
7,720
850
4.0%
Crawley CCG
42,730
17,970
14,780
7,890
1,920
170
4.9%
Horsham & Mid
Sussex CCG
90,850
48,980
28,130
11,420
2,150
170
2.6%
345,610
160,240
115,560
56,840
11,790
1,190
3.8%
3,555,460
1,695,910
1,145,830
569,740
129,940
14,040
4.0%
22,063,370
9,385,650
7,204,180
4,223,980
1,133,620
115,940
5.7%
West Sussex
South East
England
Source: Census 2011
Figure 2.4
Households with 3 or 4 Measures of Deprivation
Source: Census 2011
16
Child Poverty
Children growing up in poverty are more likely to have lower educational, health and longer term economic
outcomes. Approximately 22,000 children in West Sussex live in low income families, half of all families in
poverty in West Sussex have a young child, aged 0-4 years. Rates of child poverty vary considerable across the
county, with almost 19% of children (under 16 years) living in poverty in Crawley to less than 9% in Mid Sussex.
Ham ward in Arun has the highest child poverty rate with 33.1%, with one neighbourhood having a child
poverty rate of 43.4%.
Table 2.2 Child Poverty Rates 2007 to 2011
ALL CHILDREN
2007
2008
2009
2010
2011
Number
%
Number
%
Number
%
Number
%
Number
%
Adur
2,100
17.3%
2,030
16.8%
2,215
18.2%
2,070
16.9%
2,045
16.5%
Arun
4,555
16.4%
4,345
15.7%
4,625
16.5%
4,445
15.8%
4,440
15.8%
Chichester
2,595
12.0%
2,625
12.1%
2,775
12.6%
2,695
12.2%
2,570
11.7%
Crawley
4,145
18.1%
4,190
17.9%
4,585
19.0%
4,695
18.9%
4,675
18.4%
Horsham
2,405
8.8%
2,345
8.6%
2,595
9.4%
2,505
9.1%
2,395
8.7%
Mid Sussex
2,390
8.3%
2,290
7.9%
2,535
8.6%
2,420
8.2%
2,425
8.1%
Worthing
3,130
15.1%
2,985
14.3%
3,315
15.7%
3,270
15.4%
3,155
14.7%
21,320
13.2%
20,815
12.8%
22,640
13.8%
22,100
13.3%
21,695
13.0%
South East
264,730
14.9%
260,920
14.5%
280,755
15.4%
275,935
15.0%
270,945
14.6%
ENGLAND
2,397,645
21.6%
2,341,975
20.9%
2,429,305
21.3%
2,367,335
20.6%
2,319,450
20.1%
West Sussex
Source: HMRC
Community Safety
Crime and disorder can have a serious impact on physical and mental wellbeing. Beyond actual crime the fear
of crime can affect the quality of life. A range of outcomes in the Public Health Outcomes Framework relate to
crime and also to older people’s perception of safety in the community.
West Sussex has a low rate of violent crime, in 2012/13 the rate was 8.9 per 1,000 population compared with a
national rate of 10.6.
Hospital admissions for violence14 are relatively low in West Sussex, in 2010/11-2012/13 there were 37
emergency admissions for violence per 100,000 of the population compared with a national rate of 57.6 per
100,000.
In 2011 re-offending rates were slightly lower than national level (24.7% of offenders re-offended in West
Sussex compared with 26.9% nationally). The rate of first time entry into the criminal justice system has
fallen15 in West Sussex from 1,104 per 100,000 10-17 year olds in 2010, to 458 in 2013.
14
The number of emergency hospital admissions for violence (external causes: ICD-10 codes X85 to Y09). Directly age standardised rate per 100,000
population.
15
Rates of young people receiving their first reprimand, warning or conviction per 100,000 10-17 year old population. Data extracted from PHOF
Outcomes Tool.
17
18
Fear of Crime
A Community Survey was undertaken in West Sussex in 2014 and included two specific questions relating to
general feelings of safety:- How safe or unsafe do you feel when outside in your local area during the day?
- How safe or unsafe do you feel when outside in your local area after dark?
This survey found that people in West Sussex, as a whole felt safe. In relation to daytime safety over 98% of
people overall, and 97% of people aged over 75 years said that they felt safe or very safe. In relation to safety
after dark, 87% of people said they felt safe or very safe after dark; this was significantly lower in people aged
75 years or over.
Figure 2.5 % Respondents who said The Felt Safe or Very Safe after Dark
Source: West Sussex Community Survey 2014 (n= 3,917). West Sussex Public Health Research Unit
Road Accidents
The rate of people killed or seriously injured on West Sussex roads remains significantly above the England
rate, in 2010-2012, the rate was 51.4 per 100,000, compared with the England rate of 40.5 per 100,000. At a
local authority level Chichester and Horsham have higher rates (Figure 2.6).
Figure 2.6 People Killed or Seriously Injured on the roads in West Sussex
Rate per 100,000 of the resident population (2010-2012 pooled data)
Source : DfT
19
Housing and Homelessness
The relationship between housing and wider health outcomes is complex. People who are most at risk of living
in poor housing will be those with existing, and sometimes multiple problems; but for some people health
problems can be triggered by housing problems. For example it is estimated that 20% of homeless young
people started drug use after they became homeless, in part due to greater exposure to drugs. For others
having a long term condition or health problem makes them more vulnerable to becoming homeless.
People who are homeless may also find it difficult to access services and sustain treatment.
Information submitted to DCLG in 2012 estimated that 85 people were sleeping rough (on the street) in West
Sussex (Table 2.3)
Table 2.3 West Sussex Estimates 2011 and 2012
Autumn 2011 Count and
Estimate Total
Autumn 2012 Count and
Estimate Total
0
10
15
11
2
5
7
50
0
26
26
17
2
6
8
85
Adur
Arun
Chichester
Crawley
Horsham
Mid Sussex
Worthing
West Sussex
Source: DCLG
Overall West Sussex has a low rate of statutory homelessness16, in 2012/13 1.54 households per 1,000
households were accepted as homeless in West Sussex; however the figure was far higher in Crawley at 6.6
per 1,000, higher than other areas in the county and the England rate (Table 2.4).
Table 2.4 Numbers Accepted as being homeless and in priority need (Rate per 1,000 Households)
2004/5
2005/6
2006/7
2007/8
2008/9
2009/10
2010/11
2011/12
2012/13
Adur
5.4
Arun
2.3
Chichester
1.3
Crawley
6.0
Horsham
2.5
Mid Sussex
1.6
Worthing
2.4
England
5.7
Source: DCLG P1E Data
5.9
1.7
1.7
3.9
1.8
1.1
2.8
4.5
3.8
1.6
1.7
2.1
1.4
1.2
2.2
3.5
2.7
0.9
1.1
2.6
1.1
0.8
1.6
3.0
2.6
1.3
1.4
1.6
1.5
0.5
0.7
2.5
2.7
0.8
0.9
2.0
1.7
0.6
0.4
1.9
3.3
1.2
1.0
3.0
2.3
0.9
0.4
2.0
2.2
1.5
1.0
3.5
4.3
0.7
0.3
2.3
2.9
0.8
0.6
6.6
1.3
0.7
0.4
2.4
16
people who are accepted by local housing authorities as being unintentional homeless and in priority need
20
Temporary accommodation - At any one time between 500 and 600 children and their families are placed in
temporary accommodation; half of these children live in Crawley. Overall temporary accommodation may not
be of poor quality but at different periods in 2013/14 a small number of families with dependent children had
been placed in temporary bed and breakfast accommodation for longer than 6 weeks in West Sussex, contrary
to national guidelines; these in the main were in the Horsham/Crawley area of the county (Figure 2.7).
Figure 2.7 Families with children in Bed and Breakfast accommodation for more than 6 weeks,
(Excluding those pending review) (Quarterly snapshots)
There are over 17,000 households on social housing lists in West Sussex. In 2013 there was a net increase in
affordable homes of just 580. Housing affordability (both in terms of buying a home or renting one) is
becoming an increasing problem.
Environment
Air Quality
Poor air quality is an environmental risk to health, increasing the risk of cardiovascular and respiratory disease.
A measure relating to air quality is included within the Public Health Outcomes Framework. This measure
estimates the percentage of deaths (of people aged 30 years or over) that can be associated with long-term
exposure to anthropogenic particulate air pollution. In 2011 an estimated 4.7% of deaths of people aged 30
years or over in West Sussex were estimated to have been associated with poor quality.
The National Air Quality Strategy (2000) introduced standards and objectives for eight pollutants, with
specified maximum concentrations acceptable to public exposure. This strategy introduced air pollution
monitoring at more local area levels through the Local Air Quality Management (LAQM) scheme. Under the
LAQM scheme, local authorities monitor air pollution levels and take action if they breach the objective
targets. If an area is likely to exceed maximum concentration levels, it is declared an Air Quality Management
Area (AQMA). In July 2014 there were nine AQMAs in West Sussex (Figure 2.5).
21
Figure 2.8 Air Quality Management Areas in West Sussex (July 2014)
In July 2014 there were no AQMAs in Arun or Crawley.
Source: DEFRA
Use of the Natural Environment
The natural environment in West Sussex is a considerable asset, with coastal, down land, countryside and
urban parks providing opportunities to enjoy the outdoors. Natural England commission an annual survey17
which measures the public use of the natural environment18.
One of the questions used on the survey has been adopted as an indicator in the Public Health Outcomes
Framework. In 2012/13 15.6% of adults (16+ years) in West Sussex said they used the outdoors for health or
exercise purposes, compared with 15.3% in England.
Noise
The Government published a “Noise Policy Statement” in March 2010, with a vision of “promoting good health
and a good quality of life through the effective management of noise within the context of Government policy
on sustainable development”. The measure adopted within the Public Health Outcomes Framework relates to
the number of complaints about noise to local authorities (as a rate per 1,000 of the population).
Overall there were approximately 3,800 complaints relating to noise to local authorities in West Sussex in
2011/12. This represents 4.7 complaints per 1,000 of the population and is significantly lower than the
national rate of 7.5. There are differences across the county. Compared with West Sussex, Arun, Crawley and
Worthing had higher rates (Figure 2.9).
17
The Monitor of Engagement with the Natural Environment (MENE) Survey
The natural environment defined as open spaces in and around towns and cities, including parks, canals and nature areas; the coast and beaches; and
the countryside including farmland, woodland, hills and rivers.
18
22
Figure 2.9 Noise complaints per thousand of the population – West Sussex Districts and Borough (2011/12)
Source: Chartered Institute of Environmental Health (CIEH).
Social Interaction, Networks and Loneliness
Social Capital
In examining factors that impact health and wellbeing many risks are identified in the JSNA, but there are also
protective factors, or assets, which act to promote and sustain health and wellbeing. The quality of the
relationships people form with others is such an asset, including relationships within families, between
neighbours and within communities. Networks, described as “social capital” are broadly grouped into:a. bonding social capital – for example within families or people of the same ethnic or religious group.
b. bridging social capital – relates to more “distant” relationships within communities or between different
groups in an area.
c. linking social capital – relates to how people in different power structures relate to one another, for
example how people are involved in formal decision making processes.
Measurement of Social Capital in West Sussex
To inform the JSNA, measures of social capital within West Sussex were included in a community survey
undertaken in 2014. This was a door-to-door household survey of approximately 4,000 people. Measures used
related the frequency of contact with friends, family and neighbours, participation in groups and clubs
(bonding capital), measuring trust within a community and how well people get on together (bridging capital)
to participation in decision making processes and how well feel able to influence local decisions (linking
capital).
a) Bonding Capital – Contact with Friends and Family
Most people meet up with friends and/or family at least once a week and one in five in daily contact (Figure
2.10).
23
Figure 2.10a
Figure 2.10b
Source: West Sussex Community Survey 2014. Analysis by West Sussex Public Health Research Unit.
The survey identified differences between areas in the county, age groups and sex. For example survey
respondents in Crawley were more likely than those in all of the other districts to contact family/friends more
than once a day with over a third (36%) giving this response compared with less than a quarter (25%) in all
other districts. Regular (more than once a day) contact was also more common amongst females than males
(23% vs. 19%).
b) Bridging Capital
A number of questions were asked to measure bridging capital.
 To the statement ‘this local area is a place where people from different backgrounds get on well
together”’ almost two thirds of people said people got on well together (agreeing or strongly agreeing
with the statement). This was fairly consistent across age groups and rural v urban areas. A lower
percentage of people agreed with the statement in the most deprived areas (LNIA areas) in West Sussex.
 62% of respondents agreed with the statement ‘people in this neighbourhood pull together to improve the
neighbourhood’. Although there were significant differences, respondents in Worthing were significantly
more likely to disagree with this statement than those in all of the other districts and respondents in rural
areas were more likely than those in urban areas to agree that people pull together (71% vs. 61%).
 People were also asked to what extent they felt that other people could be trusted (Figure 2.11). Overall
63% of respondents scored this as 7-10 on the scale indicating higher levels of trust, again there were
differences across the county, with significantly higher levels of trust in rural areas.
24
Figure 2.11 Level of Trust in Others
Source: West Sussex Community Survey 2014, West Sussex Public Health Research Unit.
c)
Linking social capital
 A question used in the Community Survey asked respondents whether they were confident that their
actions could influence decision making. 48% of respondents agreed with the statement that “When
people in this area get involved in their local community, they really can change the way that their area
runs”.

In response to this question 48% of people in West Sussex said agreed or strongly agreed with the
statement but this varied across the county, with a significantly lower percentage of people agreeing
in Arun and in LNIA areas (Figure 2.12). Respondents in Chichester and Crawley were most likely to
believe in the potential for local action to bring about change with 62% and 55% respectively agreeing
with the statement, while those in Arun were least likely to agree (41%).Respondents in non-LNIAs
were more likely than those in LNIAs to agree (50% vs.40%).
Figure 2.12 % of Respondents Agreeing to Statement “When people in this area get involved in their local
community, they really can change the way that their area runs”
25
Loneliness in Older Age
West Sussex Older People Survey
In 2013 a survey was undertaken in West Sussex of people aged 65 or over. The survey aims were to establish
a baseline from which to measure community connectedness experienced by local older people and to
investigate levels of social isolation and loneliness and their relationship with health and wellbeing. 24% of
respondents indicated that they were moderately or severely lonely. Those living in more deprived areas were
30% more likely to be lonely as those living in other parts of the county.
Loneliness was found to be highly associated with health outcomes, even after controlling for a number of
factors including age, sex, exercise and medication. Lonely people were 60% more likely to be in poor health
than non-lonely people and 78% more likely to have reported multiple emergency admissions to hospital. It is
possible that people who have poor health find it difficult to maintain their social connections and it’s also
possible that loneliness itself leads to poorer health, especially poorer mental health.
Table 2.5 Loneliness by Local Authority Area
Area
% Respondents aged 65+
Moderately or Severely Lonely
Adur
29.0%
Arun
23.8%
Chichester
22.3%
Crawley
28.3%
Horsham
19.5%
Mid Sussex
20.6%
Worthing
27.1%
West Sussex
24.4%
Source: West Sussex Public Health Research Unit
Loneliness was more common in those with poor sight, poor hearing and problems with their memory
It was also common in carers with high care burdens, but not if they lived independently. Contact with
neighbours and participation in groups were associated with a 20% reduction in the odds of a respondent
being lonely.
Volunteering in West Sussex
(Data source: West Sussex Community Survey 2014)
In West Sussex 26% of people reported that they had volunteered in the previous year. Respondents were
most likely to have supported children’s education/schools (7%), local community groups (6%), sport/exercise
(6%) and youth activities (6%).
Respondents in rural areas were more likely than those in urban areas to have provided support (36% vs. 25%).
Those in non-LNIA’s were more likely than those in LNIA’s to have provided support (28% vs. 19%).
Of those volunteering, 42% of people said they volunteered frequently (once a week).
26
Motivation for volunteering varied by age, younger respondents (18-34) were more likely than older
respondents (35-64 and 65+) to volunteer because their ‘family/friends did it’ (21% vs. 13%, 8% respectively),
older respondents (65+) were more likely to volunteer as a way to ‘meet people/make friends’.
27
SECTION 3: Lifestyles and Health Improvement
Smoking
Smoking is the single greatest cause of preventable illness and premature death in the UK and is a major cause
of health inequalities. There were 4,090 deaths attributed to smoking in West Sussex in the years 2010 to 2012
It is estimated that approximately 19% of the adult population in West Sussex smoke, but this rises to almost
27% in routine and manual workers.
(From national data) We know that some other groups have higher rates of smoking – including manual
workers, some BME groups (including Bangladeshi men and Irish men). More men than women smoke but the
gap has narrowed, and young women are now more likely to be regular smokers by the age of 15 than young
men. In 2011/12 14.3% of people with long term conditions19 were smokers, this is lower than the national
rate of 17.4%
In terms of maternal smoking, 10% of women in West Sussex smoke at the time of delivery, this is lower than
the national rate (12%). Using data collected by Health Visitors we know that approximately 20% of new born
babies live in a household where someone smokes.
Most of the national prevalence rates and surveys exclude children or young adults. The West Sussex Public
Health Research Unit has undertaken lifestyle surveys of 14/15 year olds. The 2010 survey included questions
on smoking status and whether their parents or guardians smoked. The 2010 survey found a local smoking
rate for 14/15 year olds at 9.0% (CI 8.1% - 10.0%). This was slightly lower than the previous survey in 2007.
The lifestyle surveys conducted in West Sussex have shown a strong correlation between parental smoking
and young people becoming smokers themselves. Young people with parents who smoked were over four
times as likely to smoke regularly themselves (18.9%) as those who had non-smoking parents (4.3%). Likewise,
those pupils whose parents did not smoke were 50% more likely to have never tried a cigarette. This
generational pattern acts to sustain long term health inequalities.
Alcohol
There are wide range consequences of harmful drinking on individuals, families and communities, including
health problems, crime and disorder and reduced economic productivity.
Public Health data published in September 2013 suggests that the rate of ‘increased and higher risk drinking’ in
West Sussex (23.0%) was similar to the England rate. This information relates to adults.
Local surveys20 of 14/15 year olds found that 10% of 14/15 year olds regularly drank alcohol, 55% occasionally
drank and 35% rarely or never drank alcohol.
To estimate the level of binge drinking, young people were asked: “How often do you drink with the intention
of getting drunk?” Over 10% of pupils reported regularly drinking with the intention of getting drunk, a further
19
This includes people with coronary heart disease, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder
or other psychoses.
20 Lifestyles of 14 to 15-year-olds in West Sussex 2010 (West Sussex PCT)
28
one in three reported occasional binge drinking, and around one third claimed to never or rarely binge drink.
There was little difference between the habits of boys and girls.
The number of specific admissions involving an alcohol-related primary diagnosis (or an alcohol-related
external cause) has increased in West Sussex over the last 3 years, in 2012/13 there were 518.1 admissions per
100,000 (Figure 3.1).
Figure 3.1 Admissions involving an alcohol-related primary diagnosis or an alcohol-related external cause per
100,000 of the population
Source: PHE
In 2010/11 there were over 16,500 hospital admissions attributed to alcohol. This varied across the county;
Worthing, Arun and Adur have significantly higher admission rates than the other local authority areas.
Alcohol Concern estimated wider alcohol-related health care costs in West Sussex (2010/11) to be £46.7m,
which equates to £71 per adult.
The West Sussex Public Health Research Unit has undertaken analysis of emergency admissions, looking at the
number of admissions, rate of admission per 1,000 of the population and total cost of admissions at GP
practice and CCG level. Using 2012-13 admissions data there were approximately 1,700 emergency
admissions, which cost approximately £2m.
In 2012 there were 107 deaths in West Sussex (under the age of 75) from liver disease.
Physical Activity
Figure 3.2 shows information collected via the Active People Survey; a survey commissioned by Sport England.
This is the largest national survey into physical activity levels and sports participation.
Two outcomes are published:-(i) the percentage of adults (16+) who are physically active – this means they have done at least 150
“equivalent” minutes of at least moderate intensity physical activity per week in bouts of 10 minutes
or more.
(ii) the percentage of adults (16+) who are measured as being significantly inactive – this means that they
are doing less than 30 “equivalent” minutes of at least moderate intensity physical activity per week in
bouts of 10 minutes or more.
29
In West Sussex 58.6% of adults are physically active, compared with 56.0% of adults nationally and 25.6% of
adults are physically inactive, compared with 28.5% of adults nationally. There are considerable variations
across the county, with significantly higher levels of inactivity in Adur.
Figure 3.2 (i) % of Adults Physically Active
Figure 3.2 (ii) % of Adults Physically Inactive
Source: PHE
Healthy Diet
At a local level there is relatively little data on the number of people eating a “healthy diet”. At a national level
(from the Health Survey for England) information is collected on the consumption of fruit and vegetables,
including the number of people eating the recommended five or more portions of fruit and vegetables per
day.
Nationally 26.5% of adults consume met the recommended guidelines of consuming five or more portions of
fruit and vegetables a day, this was higher in the South East (29.8%)
Again, a social gradient can be observed in relation to the consumption of fruit and vegetables. Analysis21 of
data from the 2011 Health Survey for England show that 35% of people from the highest income quintile ate
the recommended levels of fruit and vegetables compared to 20% of people in the lowest income quintile.
Obesity
Nationally, and locally, increasing numbers of people are becoming overweight and obese22; obesity can lead
to a variety of health problems including Type 2 diabetes, cardio-vascular disease and is a risk factor for some
cancers.
Childhood prevalence
Using information collected as part of the National Child Measurement Programme (NCMP), there are
significantly fewer children with excess weight and measured as obese in West Sussex when compared with
21
Roberts K, Cavill N, Hancock C, Rutter H. Social and economic inequalities in diet and physical activity. Oxford: Public Health England Obesity
Knowledge and Intelligence, 2013.
22
Definition of obesity – adults with adults, obesity is commonly defined as a body mass index (BMI) of 30 or more. For children, the British 1990 growth
reference charts are used to define weight status
30
England. In 2012/13 8.5% of reception class pupils (4/5 year olds) and 14.7% of Year 6 pupils (10/11 year olds)
were measured as obese.
The Public Health Outcomes measure relates to children measured with excess weight (including those
measured as obese); in 2012/13 20.7% of reception class and 28.4% were measured as having excess weight.
Children with disabilities are 35% more likely to be obese23. This risk increases with age and may worsen
existing conditions and/or make them at greater risk of developing obesity-related ill health problems.
Adult prevalence
In relation to adults the Public Health Outcome Framework measure relates to the prevalence of adults of
excess weight (overweight including obesity, BMI ≥25kg/m2). 64.4% of adults are estimated24 to have excess
weight or be obese in West Sussex; this is not significantly different to England.
Clustering of Unhealthy Behaviours
Analysis of the 2003 and 2008 Health Survey for England by the Kings Fund25 identified the co-occurance of
the four lifestyle risk factors (smoking, harmful drinking, poor diet and low physical activity rate. This report
identified that the percentage of adults engaged in three or all four of the behaviours had declined. However
the rate of decline was less amongst the most deprived areas and amongst people with the lower level of
education; and that this would act to increase inequalities in health outcomes. factors.
Screening Programmes
There are a number of screening programmes which aim to identify health problems and illness at an early
stage. There are three screening programmes relating to cancer; cervical, breast and bowel.
Cervical - Screening is offered to women aged 25 to 64 years. Women are invited every three years until aged
49 years and then every five years.
Breast - Screening is offered every three years to women aged 50-70 years. Women considered to be at higher
risk are offered screening at a younger age.
Bowel -Screening is offered every two years to all men and women aged 60 to 69. People over 70 are sent a
screening kit on request. From April 2010 the screening age was increased to 75 years and this is being rolled
out nationally.
Take up rates in West Sussex are generally higher than national rates, although the rate of cervical screening
has fallen in recent years (Figure 3.3). Breast screening take up rates have remained at approximately 78%.
23
Gatineau M. Obesity and disability: children and young people. Oxford: Public Health England Obesity Knowledge and Intelligence, 2014.
Data relating to adult obesity are now collected via the Active People Survey (APS) and the information shown relates to number of adults with valid
height and weight recorded APS6 quarters 2-4 and APS7 quarter 1 (mid-Jan 2012 to mid-Jan 2013). Information collected as part of the survey is
adjusted to take account of the common over-estimation of height and under-estimation of weight.
25 Buck, D. and Frosni, F.. (2012) Clustering of Unhealthy Behaviours Over Time: Implications for Policy and Practice.
24
31
Figure 3.3 Cancer screening coverage - cervical cancer (% of women eligible who screened)26
The West Sussex rate is
higher than the national
rate but nationally and
locally there have been
significant falls in
coverage rates in the
last 2 years.
West Sussex
England
Source: PHOF Outcomes (ref 2.20ii)
Figure 3.4 Screening coverage – Breast screening (% of women screened)27
West Sussex
England
Source: PHOF Outcomes (ref 2.20i)
An indicator relating to bowel screening is being developed as part of the Public Health Outcomes Framework.
Flu vaccination
Each year a flu jab is provided to people aged 65 and over and also to other risk groups, including adults and
children with weakened immune systems, some people with long term conditions and pregnant women.
Two outcomes measures are published at a county and national level, these relate to flu vaccine uptake (%) in
adults aged 65 and over and take up in at risk individuals aged over 6 months to under 65 years (excluding
pregnant women).
In 2012/13 72% of people over 65 and 47% of at risk groups (Figure 3.5) had a flu jab, both are significantly
below the national averages of 73% and 51% respectively.
26
The percentage of women in the resident population eligible for cervical screening who were screened adequately within the previous 3.5 years or 5.5
years, according to age (3.5 years for women aged 25-49 and 5.5 years for women aged 50-64) .
27 The percentage of women in the resident population eligible for breast screening who were screened adequately within the previous three years.
32
Figure 3.5 Flu vaccine uptake (%) in at risk individuals (2012/13)
All Local Authorities – With West Sussex highlighted
LAs with high take up rates
LAs with low take up
rates
Source: Public Health England
In West Sussex a local survey of older people identified reasons as to why older people had not made
appointments to have their flu jab. The most cited reasons were “haven’t got round to it”, “had one before
and it made me ill” and “don’t think it works”.
Table 3.1 Reason Given for Not Booking Flu Jab by Older People in West Sussex
Reasons why flu jab appointment not made
Tried to, but doctor has run out of vaccine
Haven't got round to it
% (of people who had not
made an appointment)
1.6%
26.6%
Can't get to the surgery
Had one before and it made me ill
1.6%
18.8%
I've been told it can give you flu
Don't think it works
8.2%
26.0%
Doctor/nurse at surgery advised me not to
3.3%
Refused to answer / no reply
20.2%
Did not know about them
0.4%
Source: Lifestyles of Older People in West Sussex – West Sussex Public Health Research Unit 2013
33
Childhood Vaccination Coverage
Routine childhood immunisation programme
(Summarised from NHS Guide to Immunisations)
Age to immunise
Diseases protected against
Vaccine given
Two months old
Diphtheria, tetanus, pertussis (whooping cough),
polio and Haemophilus influenzae type b (Hib)
Pneumococcal infection
DTaP/IPV/Hib and
Pneumococcal
conjugate vaccine
(PCV)
Three months old
Diphtheria, tetanus, pertussis, polio and
Haemophilus influenzae type b (Hib) Meningitis C
(meningococcal group C)
DTaP/IPV/Hib and
MenC
Four months old
Diphtheria, tetanus, pertussis, polio and
Haemophilus influenzae type b (Hib) Meningitis C
Pneumococcal infection
DTaP/IPV/Hib and
MenC and PCV
Around 12 months old
Haemophilus influenzae type b (Hib) Meningitis C
Hib/MenC
Around 13 months old
Measles, mumps and rubella (German measles)
Pneumococcal infection
MMR and PCV
Three years and four
months or soon after
Diphtheria, tetanus, pertussis and polio Measles,
mumps and rubella
DTaP/IPV or dTaP/IPV
and MMR
Girls aged 12 to 13 years
Cervical cancer caused by human papillomavirus
types 16 and 18
HPV
13 to 18 years old
Tetanus, diphtheria and polio
Td/IPV
Non- routine immunisations for at risk babies
Age
Diseases protected against
Vaccine given
At birth (to babies who are
more likely to come into
contact with TB than the
general population)
Tuberculosis
BCG
At birth (to babies whose
mothers have hepatitis B)
Hepatitis B
Hep B
34
Childhood immunisation – West Sussex Coverage Rates 2012/13
Immunisation
Dtap / IPV / Hib (1 year old)
Dtap / IPV / Hib (2 years old)
MenC
PCV
Hib / MenC booster (2 years old)
Hib / Men C booster (5 years)
PCV booster
3MMR for one dose (2 years old)
MMR for one dose (5 years old)
MMR for two doses (5 years old)
HPV
PPV
% Coverage
West Sussex
95.8%
96.8%
95.1%
95.1%
94.9%
81.8%
90.9%
94.5%
93.7%
88.0%
87.0%
67.9%
% Coverage
England
94.7%
96.3%
93.9%
94.4%
92.7%
91.5%
92.5%
92.3%
93.9%
87.7%
86.1%
69.1%
NHS Health Checks
The NHS Health Check is a national programme for adults in England between the ages of 40 and 74 who do
not have diabetes, stroke, and heart or kidney disease or were treated for high blood pressure or high
cholesterol levels. The scheme is to help prevent the onset of these problems.
Comparable data are available for 2011/12 and 2012/13 (Figure 3.6). In 2012/13 11% of the eligible population
was offered a health check and of those offered 51% had one.
Figure 3.6 Offer and Take Up Rates of Health Checks
% Offered - % of eligible population aged 40-74 offered an NHS Health Check in the year
% Take Up - % of those offered an NHS Health Check who received an NHS Health Check
35
Dental Health – Children
Poor oral health in children is caused by poor diet, poor oral hygiene and lack of exposure to fluoride. Children
from socially disadvantaged groups experience disproportionately high levels of oral health problems. The
most recent dental survey - with national comparators - for children aged 12 was undertaken in 2011/12. A
sample of children in each local authority England examined and number of decayed, missing or filled teeth
(DMFT) assessed. The survey provides an indication of oral health in West Sussex.
Data are provided at lower tier local authority level (Table 3.2).
Table 3.2 Dental Decay
% of children examined with
dental decay
Adur
Arun
Chichester
Crawley
Horsham
Mid Sussex
Worthing (sample size too small)
England
% D3MFT > 0
LCL
UCL
19.4%
22.8%
8.4%
17.7%
8.1%
6.9%
5.8%
9.0%
1.2%
7.6%
1.3%
0.0%
33.0%
36.6%
15.6%
27.9%
14.8%
14.4%
27.9%
27.7%
28.1%
Of those with decay average number
of teeth per child
Mean D3MFT (%
LCL
UCL
D3MFT > 0)
4.03
1.8%
6.3%
2.86
1.2%
4.6%
3.23
1.7%
4.7%
2.36
1.2%
3.5%
1.90
1.0%
2.8%
2.00
0.0%
4.0%
3.38
3.4%
3.4%
36
Health Protection
Food Hygiene Inspections
Local authorities inspect a variety of food premises including caterers, restaurants, distributors, manufacturers
and importers.
Food Hygiene Rating System – “Scores on the Door”
Premises are rated on a scale of 0 to 5, with 5 meaning that standards are very good.
5
VERY GOOD
Very high standards of food safety management - Fully compliant with
food safety legislation.
4
GOOD
Good food safety management - High standard of compliance with food
safety legislation.
3
GENERALLY SATISFACTORY
Good level of legal compliance - Some more effort might be required.
2
IMPROVEMENT NECESSARY
Broadly compliant with food safety legislation - More effort required to
meet all legal requirements.
1
MAJOR IMPROVEMENT NECESSARY
Poor level of compliance with food safety legislation – much more effort
required.
0
URGENT IMPROVEMENT NECESSARY
The food hygiene rating reflects the hygiene standards found on the date of inspection
Hygiene Ratings - West Sussex premises
5,923 premises had rating values in West Sussex (August 2014), of these over 85% rated 4 or 5. 207 premises
were rated at 0 or 1.
Figure 3.6 Food Hygiene Ratings - % at each category in West Sussex (August 2014)
by Districts and Boroughs
Source: Food Standards Agency (FSA)
37
SECTION 4: Health status, Life expectancy and Long Term Conditions
Life Expectancy
Life expectancy is an important measure of the health of a population in a given time period. It is easily
measurable and comparable between areas and time periods. Life expectancy at birth has risen consistently in
the UK over the last 50 years but significant inequalities exist between areas. West Sussex has previously been
highlighted as one of the more unequal counties in the South East in terms of small area life expectancy
distribution. Life expectancy in West Sussex is significantly higher than the national average for both men and
women (Figures 4.1a and 4.1b).
Figure 4.1a Male Life Expectancy
Figure 4.1b Female Life Expectancy
Source: NCHOD
Lower Tier Authority Data
 Male Life Expectancy - Mid Sussex and Horsham have a significantly higher life expectancy than the
county average, while values are significantly lower in Adur and Worthing.
 Female Life Expectancy - There are no significant differences in female life expectancy between West
Sussex local authorities.
Table 4.1 Life expectancy (2010-2012 Pooled Years Data)
Men (2010-12)
CI (95%)
Women (2010-12)
CI (95%)
Adur
80.4
(79.6 - 81.3)
83.4
(82.6 - 84.1)
Arun
79.7
(79.1 - 80.2)
83.5
(83.0 – 84.0)
Chichester
80.9
(80.3 - 81.6)
84.6
(84.0 - 85.2)
Crawley
79.7
(79.0 - 80.4)
83.6
(82.8 - 84.3)
Horsham
81.7
(81.1 - 82.3)
84.4
(83.8 – 85.0)
Mid Sussex
81.9
(81.3 - 82.4)
84.2
(83.7 - 84.8)
Worthing
West Sussex
78.8
80.5
(78.1 - 79.4)
(80.3 - 80.8)
83.1
83.9
(82.5 - 83.7)
(83.7 - 84.1)
Significantly lower than county LE
Source: WSCC Public Health Research Unit
Significantly higher than county LE
Small Area Life Expectancy
38
Significant inequalities exist at a local level (Table 4.2); life expectancy in Burgess Hill Dunstall (Mid Sussex) is
15 years higher than life expectancy in River ward (Arun).
Table 4.2 Wards with the Highest and Lowest Life Expectancy in West Sussex
LE
(2007-12)
89.3
(84.3 - 94.4)
Southgate
East Grinstead Imberhorne
87.5
(85.1 - 89.8)
Findon
87.4
Pound Hill South and Worth
86.6
86.6
Highest Life Expectancy
Burgess Hill Dunstall
Harting
Source: WSCC Public Health Analysis
LE
(2007-12)
78.0
(76.9 - 79.1)
Central
76.7
(75.6 - 77.9)
(85.1 - 89.7)
Heene
75.2
(73.9 - 76.5)
(84.4 - 88.9)
Marine
74.5
(73.0 - 75.9)
(84.1 - 89.1)
River
74.2
(72.8 - 75.6)
95% CI
Lowest Life Expectancy
95% CI
Inequality in Life Expectancy
Life expectancy has increased in all areas of the county, however the rate of increase has been greatest in the
most affluent areas, this means inequality has increased. Analysis shows that this is particularly true for
females.
Figure 4.2 Life expectancy at birth in each deprivation decile in West Sussex
(2001-2006 and 2007-2012 gradients compared)
Source: WSCC Public Health Analysis
Life Expectancy at 65 and Disability Free Life Expectancy
Nationally and locally, life expectancy has increased, but disability free life expectancy has not increased at the
same rate. This means people are spending more time at the end of life, living with a long term condition or
disability. In older age groups people are likely to have multiple conditions.
 Residents of West Sussex spend a higher percentage of their lives disability -free than most other local
authority areas in the country.
 On average men live 12.8 years with a disability, women 14.1 years.
39
Table 4.3 Life expectancy at age 65, DFLE at birth and at age 65 with national rankings
2008-2010 Males and Females in West Sussex
Data for West Sussex (2008-2010)
Disability free life expectancy (years)
Life expectancy age 65 (years)
Disability free life expectancy age 65 (years)
Expected years with a disability (years)
Proportion of life disability-free %
Rank life expectancy (of 150 LAs)
Rank life expectancy age 65 (of 150 LAs)
Rank DFLE (of 150 LAs)
Rank proportion of life disability free (of 150 LAs)
Source: ONS
Males
67.0
18.8
12.0
12.8
84.0
26
28
23
23
Females
68.1
21.3
14.1
15.4
81.5
34
44
22
21
Infant Mortality
Infant mortality is used as an indicator of the general health of the population, as it reflects a range of health
determinants, including socio-economic conditions and maternal health. West Sussex has a low infant
mortality rate compared with England, although not significantly lower. The rate has fallen, nationally and
locally over the last 10 years. In the period 2010-2012 there were 99 infant deaths.
Figure 4.3 Infant Mortality in West Sussex (3 Years Pooled Data 2001-3 to 2010-2012)
Source: ONS
Cause of Death – West Sussex
All Ages (2012) - There are approximately 8,500 deaths a year in West Sussex, the majority of deaths occur
after the age of 75. Over 50% of all deaths relate to circulatory diseases or cancer, followed by deaths from
respiratory diseases (Figure 4.4).
40
Figure 4.4 Cause of Death (All Ages 2012)
Source: Primary Care Mortality Database
Under 75s (Pooled Years 2010-12) - In any one year there are approximately 2,200 deaths of people aged 75
years or under in West Sussex. For deaths under the age of 75 years 3 years of data have been pooled (Figure
4.5). The main cause of premature death is cancer, although it should be noted that this includes a range of
cancers and risk factors/causes may be very different.
Figure 4.5 Cause of Death (under 75 Years only) Pooled Years Data 2010-2012
41
Potential Years of Life Lost (PYLL)
Potential years of life lost (PYLL) is a summary measure of the economic and social impact of premature
mortality on society. As the calculation includes age at death, deaths at younger ages carry more weight.
Over the period 2010-2012 (3 years pooled), there were 25,500 deaths registered to West Sussex residents,
approx. 8,500 per year. Of these, approx. 6,600 (2,200 per year, 26% of total deaths) were to those aged
under 75. PYLL has been calculated as the difference in years between age at death and 80 years, for deaths
over 28 days and under 74 years28. For the period 2020-2012 there were approximately 119,900 PYLL (40,000
per year), the breakdown by main disease classification is shown below (Table 4.4).
Of the main causes of death, congenital and chromosomal abnormalities have a high mean PYLL; people dying
from these conditions will lose an average of 35 years. External causes of morbidity and mortality, which
include accidents, suicides and poisoning, also have a very high mean PYLL; people who die from these lose an
average of 33 years. However the main causes are cardiovascular disease and cancers, these conditions have
higher numbers of people dying but at older ages.
Table 4.4 PYLL by Main Disease Classification (Data from pooled years 2010-2012)
Disease group
Count
Sum of
PYLL
Mean PYLL
(Years lost
per death)
Cancers
2,937
49,237
16
Cardiovascular disease
1,446
23,249
16
Respiratory disease
537
7,744
14
Digestive system disease
401
8,437
21
External causes of morbidity and mortality
393
13,081
33
Diseases of the nervous system
280
5940
21
Mental and behavioural disorders
107
1,898
17
Endocrine, nutritional and metabolic diseases
74
1,698
22
Diseases of the genitourinary system
67
830
12
Certain infectious and parasitic diseases
64
1,894
29
60
1,452
24
45
1,609
35
Diseases of the musculoskeletal system and connective tissue
43
863
20
Less well defined symptoms & conditions
34
1,315
38
Diseases of the skin and subcutaneous tissue
19
304
16
Certain conditions originating in the perinatal period
*
*
*
Diseases of the eye and adnexa, Diseases of the ear and mastoid
process
*
*
*
6,512
119,879
18
Diseases of the blood and blood-forming organs and certain disorders
involving the immune mechanism
Congenital malformations, deformations, and chromosomal
abnormalities
Grand total
*data supressed due to small numbers
Source: West Sussex PHRU Analysis of Mortality Data
28
The calculation of PYLL excludes deaths during the perinatal period of birth to 28 days. There were fewer than 100 such deaths over the 3 year
period.
42
Overall Population Health and Wellbeing
Data from the 2011 Census
The 2011 Census included two specific questions relating to health and long term limiting illness.
A question relating to general health:-
A question relating to limitation to day to day activities due to a health problem or disability was also used.
Data relating to this question is show on page 14.
General Health
Across West Sussex as a whole, almost 34,000 people stated that their health was “bad or very bad” this is
4.3% of the population, compared with 5.4% of the England and Wales population. Answers to this question
were strongly age related, 18.5% of the 85+ population stated poor health compared with 5.8% of the 50-64
year olds.
Figure 4.6 Self-reported Health (Good, Fair or Bad) by Age Groups (2011 Census)
Source: Census 2011 Table LC3302EW Residents in Households. This excludes people living in communal establishments
43
At a small area level age standardised rates of people stating “not good health” (Figure 4.7) shows a close
alignment between general health of the population and areas of deprivation.
Figure 4.7 Age Standardised Rate of People in Poor Health
People in Poor Health
Age Standardised Rate per 100 Population
Source: Census 2011 Table LC3302EW Residents in Households. This excludes people living in communal establishments
Population Level Emotional and Mental Wellbeing
Office for National Statistics (ONS) collects data relating to subjective well-being to complement existing socioeconomic indicators. These allow a fuller statistical picture of the nation’s wellbeing. The aim is that these
measures will provide insights into the quality of life of people in the UK.
Different aspects of wellbeing are measured, with data available to local authority level, with the four key
questions asked:
1. Overall, how satisfied are you with your life nowadays?
2. Overall, to what extent do you feel the things you do in your life are worthwhile?
3. Overall, how happy did you feel yesterday?
4. Overall, how anxious did you feel yesterday?
For the first three questions, people surveyed are asked to respond to the questions using a scale of 0 to 10,
with 10 being good. For anxiousness, the more anxious a person feels the higher the score. The ONS provide
information on average scores and also the distribution of scores in an area.
Table 4.5 Average Scores ONS Subjective Wellbeing Measures
West
Sussex
England
Life satisfaction
Worthwhile
Happiness
Anxiety
2011/12
7.7
7.9
7.5
3.0
2012/13
7.6
7.9
7.4
3.3
2011/12
7.4
7.7
7.3
3.2
2012/13
7.4
7.7
7.3
3.1
Source: ONS
44
West Sussex rated significantly higher than England on measures of life satisfaction, i.e. whether life was
worthwhile and overall happiness but there was no significant difference in terms of anxiety (Figure 4.8).
Figure 4.8 Life Satisfaction, Worthwhile and Happiness Questions
Source: ONS Wellbeing Measures 2012
Long Term Conditions
The number of people living with long term conditions is increasing; this reflects a growing and ageing
population, and also some increases in risks relating to lifestyles.
Cardio-vascular disease (CVD)
Cardiovascular disease (CVD) refers to diseases of the cardiovascular system, which includes the heart and all
blood vessels. Coronary heart disease (CHD) and cerebrovascular disease29, which are diseases of the blood
vessels supplying the brain, are the leading types of cardiovascular diseases. The main lifestyle risk factors for
CVD are smoking, physical activity, alcohol intake and diet. Approximately 30% of deaths of West Sussex
residents registered in the period 2010-2012 were due to circulatory diseases; among the under 75s the
percentage was 22%. Mortality rates from CVD have fallen consistently in West Sussex, both in relation to all
ages and under 75s, male and female. The rates are significantly below the England rate. There are clear
gender differences, locally and nationally, with the mortality rate for men remaining significantly higher than
the mortality rate for women (Figure 4.9).
29
includes stroke, transient ischaemic attack (TIA), and vascular dementia.
45
Figure 4.9(i) Mortality Rates (CVD) – Males
DSR Per 100,000 Population
Figure 4.9(ii) Mortality Rates (CVD) - Females
DSR Per 100,000 Population
Source: HSCIC
The emergency admission rate for CHD in West Sussex (2011/12) is 162.2 emergency admissions per 100,000
population; this is significantly lower than England (198.3 per 100,000).
There are over 31,000 people on GP practice CHD registers, a prevalence of 3.7%. Modelled prevalence
estimates indicate nearly 40,000 people in West Sussex have CHD, suggesting 9,000 people are undiagnosed.
The observed prevalence for hypertension in West Sussex was 44% of expected prevalence, with a total of
124,100 people on GP practice registers.
There is a social gradient in CVD morbidity and mortality. In 2011/12 the emergency admissions rate for CHD
for people living in the most deprived areas of West Sussex was 2.1 times higher than the emergency
admission rate for people living in the least deprived areas of the county.
Cancer
Although we use the single word “cancer”, there are many forms of cancer with varying risk factors, including
lifestyle and environmental factors. Smoking remains a dominant cause of cancer, with diet, harmful alcohol
use and being obese also being important risk factors. Nationally cancer survival rates have been improving
but there remains a gap between survival rates in the UK and the European average30. Childhood cancer is
rare, but nationally cancer is the single biggest cause of deaths for children and young people aged 1-14 years.
In West Sussex, there are approximately 4,300 new diagnoses of cancer each year. In total there are over
20,500 people on West Sussex GP cancer registers; this is 2.4% of the registered patient population. Nationally
the cancer incidence rate increased over the last 20 years (Figure 4.10).
The numbers in West Sussex have increased but the incidence rate (taking into account population size and
age structure) has shown a downward trend. However care should be taken in analysing a trend at a local
level, with smaller numbers there is greater year to year variance. The directly age standardised incidence rate
30
Improving Outcomes: A Strategy for Cancer’ (DoH 2011)
46
for all types of cancers in West Sussex in 2009-11 is 343.8 per 100,000 population, this is significantly lower
than the England rate of 391.0 per 100,000 (Figure 4.10).
In 2012 cancer accounted for 28% of all deaths in West Sussex. In relation to people under 75, cancer is the
biggest cause of death; 46% of all deaths of people under 75 were caused by cancer (2010-12 data).
Lung cancer is the single biggest cause of cancer deaths, for all ages and under 75 (15% and 17% of total
cancer deaths respectively)
Figure 4.10 Directly age-standardised registration rates (DSR)
All cancers, all ages (annual rate) per 100,000 European Standard population
Source: HSCIC
Diabetes
Diabetes is a condition in which the body cannot control blood sugar levels and may result in a range of
complications, including heart disease, stroke, blindness, amputations and premature death. Diabetes
accounts for 10% of all NHS funding; in most instances diabetes is preventable.
There are two main types:Type 1 – where the cells of the pancreas stop making insulin.
Type 2 (insulin resistance) – where either the pancreas cells do not make enough insulin, or the body's
cells do not react properly to it. 90% of people with diabetes have Type 2 diabetes.
The National Diabetes Audit has identified the additional risk of diabetic complications and mortality,
comparing people with diabetes to the overall population. In 2011/12 (for West Sussex as a whole) this
identified that people with diabetes were 34% more likely to have a myocardial infarction and 17% more likely
to have a stroke than the general population.
There are approximately 40,000 people on West Sussex GP diabetes registers; that represents almost 6% of
the adult registered patient population. There are an estimated 11,000 people living with diabetes but
undiagnosed.
47
There is a strong association between diabetes and deprivation.
With an increased level of adult obesity and ageing population the numbers of people with diabetes is
projected to increase above the general increase in population. Using current figures a 14% increase in GP
diagnosed diabetes is projected by 2020.
As with other long term conditions there is a growing emphasis and importance being placed on self-care,
supporting the individual patient, and where appropriate carer, to understand, monitor and manage diabetes
and to improve general physical and mental health and wellbeing.
Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) covers a number of lung diseases including chronic bronchitis,
emphysema and chronic obstructive airways disease, which act to damage the airways in the lungs. The main
cause of COPD is smoking but there are other causes including occupational exposure to some pollutants, and
exposure to asbestos.
There is a strong association between COPD and deprivation, and COPD rates are higher in men than women;
this is linked in part to higher smoking rates.
In West Sussex there are approximately 13,500 people on GP COPD registers, this represents 1.6% of the
registered population. Comparing COPD registers with modelled prevalence it is estimated that a further
10,000 may have COPD but remain undiagnosed.
Respiratory diseases are the third biggest cause of death in West Sussex. The West Sussex mortality rate is
significantly below the England rate (19.8 per 100,000 compared with 25.8 per 100,000).
Asthma
5.4 million people in the UK are currently receiving treatment for asthma: 1.1 million children (1 in 11) and 4.3
million adults (1 in 12). Given the number of people affected, asthma is the commonest of all long term
conditions. Asthma prevalence is thought to have plateaued since the late 1990s, although the UK still has
some of the highest rates in Europe and on average 3 people a day die from asthma. There were 1,167 deaths
from asthma in the UK in 2011 (18 of these were children aged 14 and under). An estimated 75% of hospital
admissions for asthma are avoidable and as many as 90% of the deaths from asthma are preventable.
In West Sussex there are over 52,000 people on GP asthma registers. Comparing registers with modelled
prevalence it is estimated this represents approximately 68% of people with asthma in the county.
48
Neurological Conditions
The term neurological condition covers a wide range of conditions relating to damage to the brain caused by
illness or injury to the brain, spinal column or nerves. The nature of conditions also vary; some conditions are
unpredictable (e.g. early stage MS and epilepsy), some are progressive (e.g. Parkinson’s, Motor Neurone
Disease ( MND), some, although lifelong, have changing needs as a person ages (e.g. cerebral palsy) and some
are sudden (e.g. an acquired brain injury following injury). A neurological condition can have a serious impact
on the individual and their family. It is estimated that one in five acute hospital admissions are accounted for
by a long term neurological condition.
Epilepsy
Epilepsy is a disease which may be defined by:- At least two unprovoked seizures occurring greater than 24 hours apart;
- One unprovoked seizure and a probability of further seizures similar to the unprovoked seizures,
occurring over the next 10 years;
- Diagnosis of a specific syndrome.
As such the term epilepsy is not confined to a single condition but encompasses a range of “epilepsies” and
tends to be higher in childhood, then decrease in adulthood and rise again in older age.


In West Sussex there are 5,000 people on GP epilepsy registers. 79% of people on GP registers on drug
treatment remained seizure free for 12 months.
In 2012/13 the emergency admissions with a primary diagnosis of epilepsy was 54.25 per 100,000
population (18+), this was lower, although not significantly, than the England rate of 56.6.
Motor Neurone Disease (MND)
MND is a progressive neurodegenerative disease that attacks the upper and lower motor neurones. The
disease leads to muscle weakness and wasting, this leads to increasing loss of mobility in the limbs, difficulties
with speech, swallowing and breathing. It is most common after the age of 50, more men than women have
the conditions (at an estimate of 3:2)
 The prevalence of MND is31 7 per 100,000 of the population. Using the 2006 MYE population of West
Sussex this suggests there are 57 people living with the condition in West Sussex.
 The incidence of MND is 2 per 100,000 of the population. Using the 2013 MYE population of West Sussex
this suggests 17 new cases of MND are diagnosed each year in West Sussex.
Parkinson’s disease
Parkinson’s disease is a progressive neurological disorder affecting learned voluntary movements such as
walking, talking, writing and swallowing - caused by a loss of a chemical messenger (dopamine) in the brain.
There are three main symptoms: tremor, rigidity and slowness of movement, not everyone will experience all
three. The disease affects slightly more men than women.
 2,250 people are estimated to be living with Parkinson’s disease in West Sussex32.
31
Source: Neuro numbers(The Neurological Alliance, 2003).
49
Acquired Brain Injury (ABI)
The term Acquired Brain Injury refers an injury caused to the brain since birth, there are many possible causes,
including a stroke, a fall, an assault, tumour or road accident.

Using national prevalence estimates, 1,900 people are estimated to be living with acquired brain injury in
West Sussex, with 80 to 125 new severe cases of ABI each year.
Between 20-25 per cent of those aged 16-45 years remain severely or profoundly disabled six months
following their injury. Men three times more likely than women to have ABI and men aged between 15-29 are
five times more likely to suffer brain injury.
Multiple Sclerosis (MS)
Multiple Sclerosis (MS) is the most common disabling neurological condition affecting young adults.
Women are almost twice as likely as men to develop MS and most people are diagnosed between the ages of
20 to 40 years. For some people, MS is characterised by periods of relapse and remission while for others it
has a progressive pattern. The Multiple Sclerosis Trust estimate a prevalence rate of between 100 to 120 per
100,000 of the population. A 1995 study in Sussex33 showed a prevalence of multiple sclerosis of 111 per
100,000 (95% confidence interval (CI) 103-120).

Crudely applied locally this equates to approximately 820 to 990 people with multiple sclerosis in West
Sussex.
Dementia
Dementia is and umbrella term used to describe a collection of symptoms including a decline in memory,
reasoning and communication skills, and a gradual loss of skills needed to carry out daily activities. These
symptoms are caused by structural and chemical changes in the brain as a result of physical diseases such as
Alzheimer’s disease.
The latest evidence of prevalence in this country is the consensus exercise carried out for the ‘Dementia UK’
report (2007). Most dementia is late onset (affecting people aged 65 and over) with about 1 in 40 cases being
early onset (up to the age of 64 years). Applying these data to the West Sussex Population (2014 projected)
gives an estimate of around 14,000 residents living with dementia. The severity of dementia is normally
classified as mild, moderate and severe. At any point in time about 55% of the population affected will have
mild dementia, 32% moderate and 13% severe.
32
33
Parkinson’s UK (2009). Parkinson’s prevalence in the United Kingdom 2009.
A prevalence survey of multiple sclerosis in Sussex M Rice-Oxley, ES Williams and JE Rees (1995)
50
Table 4.6 Total residents living with dementia by subtype and severity in West Sussex (2014)
West Sussex
2014
All dementia
13,970
Late Onset - Mild
Late Onset - Moderate
Late Onset - Severe
7,570
4,430
1,750
Alzheimer’s disease
Vascular dementia
Mixed (AD and VD)
Dementia with Lewy bodies
Frontotemporal dementia
Parkinson’s’ dementia
8,660
1,290
440
70
170
30
Other
Source: Dementia UK
10
Receiving an early diagnosis is seen as key to slowing deterioration of symptoms, increasing quality of life and
enabling patients and carers to plan for the future. In 2012/13, those on dementia registers accounted for less
than 50% of the total estimated number living with the disease. These are more likely to be those with more
severe or obvious symptoms.
There are over 5,500 people on GP dementia registers in West Sussex. Diagnosis rates vary greatly by practice,
although it is important to remember that the prevalence rates on which they are based are only an estimate
and may not truly reflect the number of people within that practice’s catchment area living with dementia
(Table 4.7).
Table 4.7 Dementia diagnosis rates by CCG with highest and lowest practice rates shown (2012/13)
March 2013
Diagnosis Rate
CCG Overall
Highest Practice
Lowest Practice
42%
50%
50%
100%
83%
91%
16%
19%
28%
Coastal CCG
HMS CCG
Crawley CCG
Source: QOF 2012/13
Kidney Disease
There are two main forms of kidney disease: Chronic Kidney Disease (CKD) and Acute Kidney Injury (AKI). CKD
is an age related condition. The main causes of CKD are high blood pressure and diabetes. CKD acts to reduce
the functioning of the kidneys and if often diagnosed in later stages, exhibiting few symptoms in early stage,
although people at all stages of CKD are at an increased risk of stroke or heart attack.
The risk for CKD increases with age, there is evidence that progression is more rapid in people from black,
Asian, and other minority ethnic groups and people in more deprived areas are at higher risk compared with
general population.
51
There are over 30,000 people on West Sussex GP CKD registers, using national prevalence models it is
estimated that there are in excess of 20,000 people in West Sussex undiagnosed. The annual cost of CKD in
West Sussex is estimated at approximately £20m.34
Musculoskeletal Conditions (MSK)
The term musculoskeletal condition (MSK) encompasses a wide range of disorders affecting joints, bones,
muscles and soft tissue; so included under this term are knee back and hip pain, arthritis and osteoarthritis,
many people affected by multiple MSK conditions.
Although the prevalence of musculoskeletal conditions increases with age, the number of working age people
affected has a major impact on the local economy and health services. Arthritis is the single most common
condition listed on claims for Disability Living Allowance in West Sussex; 3,700 people claiming DLA listed this
as their main disability35.
Table 4.8 Prevalence of MSK Conditions
Prevalence Estimate (note numbers are not mutually exclusive)
West Sussex
Rheumatoid arthritis
4,040
Childhood arthritis
50
Ankylosing spondylitis
160
Gout
2,700
SLE
140
Scleroderma
50
Polymyalgia rheumatic
1,480
Osteoarthritis
14,570
Back pain
22,830
Osteoporosis (of hip only)
36,720
Disablement (mHAQ >0.5 + pain)
53,780
SLE – systemic lupus erythematosus
Source: West Sussex Public Health Research Analysis, based on prevalence estimates from:
A heavy burden: the occurrence and impact of musculoskeletal conditions in the UK today (2011), The Arthritis Research
Epidemiology Unit, University of Manchester
Hip Fractures in West Sussex
As part of the Public Health Outcomes Framework (PH OF) there are a number of measures relating to fracture
of the neck of femur (hip). Hip fracture, in addition to being painful debilitating to the individual greatly
increases the likelihood of a person needing longer term social care; one in three people who have a hip
fracture move from living in their own home to residential care. As appropriate interventions differ according
to age, the overall indicator of emergency hospital admissions for falls injuries in people aged 65, is also split
into two sub groups for people aged 65-79 years and people aged 80+ years (Figure 4.11)
34
35
*includes primary care costs, outpatient clinics, and hospital activity.
Relates to data provided by the DWP in May 2013.
52
Figure 4.11 Hip fractures in people aged 65 and over, 65-79 and 80+ years
West Sussex Compared with England
80+ years
65-79
year olds
65+ years
Source: PHE
Comparing West Sussex with England in the period 2010/11 to 2012/13, there was no difference in fracture
rates (rate per 100,000 of the population) in the overall 65+ population or in the 65-79 age groups.
Rates between the two populations were similar in the 80+ for 2010/11 and 2011/12, but the rate increased in
the West Sussex 80+ population in 2012/13, and was significantly higher than that of the equivalent England
population in this time period. In 2010/11 there were 896 fractures in people aged 80+ years, there were 960
in 2012/13.
The PHOF indicator uses data pooled for males and females, but nationally and locally we know that females
have a higher rate of emergency hospital admission for fractured neck of femur. In 2011/12 there were 260
emergency hospital admissions with a primary diagnosis of fractured proximal femur (ICD 10 codes: S72.0,
S72.1, S72.2) for males of all ages in West Sussex; for females of all ages the figure was 797.
Liver Disease
Liver disease is the fifth largest cause of mortality in England and Wales, after heart, cancer, stroke and
respiratory disease. As people can survive with 70% liver damage, there is a substantial burden of morbidity
from liver disease, a high cost to the NHS and a huge economic and human cost from liver-related ill health.
Risk factors for liver disease include obesity, alcohol misuse, and infection with hepatitis viruses, alcohol
consumption is the main cause. There were 246 deaths in West Sussex of liver disease in the period 20102012, 152 of these were men.
It is also the only major cause of death where age-standardised mortality rates have been increasing in recent
years (Figure 4.12)36.
36
British Liver Trust.
53
Figure 4.12(i) Mortality Rates (Liver disease) – Males
DSR Per 100,000 Population
Figure 4.12(ii) Mortality Rates (Liver disease) Females, DSR Per 100,000 Population
Source: HSCIC
Sensory Impairment
Sight Loss - Over 80 per cent of sight loss occurs in people aged over 60 years, with an ageing population the
number of people with some form of sight loss will increase. Some visual impairment is associated with social,
environmental and lifestyle factors, including smoking and obesity. Adults with learning disabilities are 10
times more likely to be blind or partially sighted than the general population. Some types of visual impairment
are caused by chronic health conditions. For example, diabetic retinopathy is a symptom of diabetes. Regular
sight tests support detection.
 Population Prevalence - Adults
– 310 people aged 18-64 years in West Sussex are predicted to have a serious visual impairment.
– 15,650 people aged 18+ are predicted to have a moderate or serious visual impairment.
– 5,500 people aged 75+ are predicted to have eye conditions that could be registered.
 Population Prevalence – Children
Estimates on the prevalence of sight loss in children are largely based on data collected by a range of
services, including health, education and social care service. This assumes that severe sight loss is likely to
be detected by services at a young age. It is estimated37 that there are between 105 and 200 children (015 years) living with a severe visual impairment in West Sussex.
 Recorded Prevalence (Local Authority Registers) – Registration is voluntary, returns are provided to the
DoH every three years.
Table 4.9 Number of blind and partially-sighted people in West Sussex (March 2011).
0 to 4
5 to 17
Blind
5
50
Partially sighted
5
40
Source: NHS HSCIC & Moorfields Eye Hospital
Age Groups
18 to 49
50 to 64
225
255
235
180
65 to 74
235
195
75 or over
3,415
3,025
Some sight loss is preventable if identified and treated early enough. As part of the Public Health Outcomes
Framework three specific outcomes have been introduced relating to early identification of preventable sight
37
Based on summary provided by Child and Maternal Health Intelligence Network (CHIMAT)
54
loss, in relation to age related macular degeneration (AMD), glaucoma and diabetic eye disease. These
measures are centred on the registration for the Certificate of Visual Impairment (CVI).
An overall outcome on sight loss certification shows that in 2011/12 West Sussex had a significantly lower rate
of sight loss registration compared with neighbouring authorities and England overall.
Hearing Impairment
As with sight loss there are a range of definitions used depending on the severity of the impairment, from
moderate hearing loss, where people have difficulty following speech or quieter sounds and may or may not
use a hearing aid to severe and profound hearing loss, where someone may communicate by lip reading, or
use sign language.




20,000 people aged 18-64 years in West Sussex are predicted38 to have a moderate or severe hearing
impairment.
180 people aged 18-64 years are predicted to have a profound hearing impairment.
76,700 people aged 65 and over are predicted to have a moderate or severe hearing impairment
2,100 people aged 65 and over are predicted to have a profound hearing impairment.
Co-morbidities
There are a number of treatment/care pathways identified for specific long term conditions, but in reality
many people have more than one condition, and the likelihood of having a number of conditions increases
with age. With an ageing population there will be an increasing need for effective co-ordination of treatments
and services, across a number of conditions and illnesses. For older people multi-morbidity is the norm not the
exception.
Estimating the number of people with multiple conditions – Research in Scotland39 examined GP records to
identify patients with a diagnosis of a long term condition or disorder40. Data related to approximately a third
of the Scottish patient population. This study found that:By the age of 50 half of the population had at least one condition and from 65 years onwards most people
had multiple conditions. The prevalence of multi-morbidity increased (substantially) with age (Figure
4.13).
For people living in the most deprived areas the onset of multi-morbidity occurred 10-15 years earlier
than people living in the least deprived areas.
Mental health was not only associated with physical illness but the presence of a mental health disorder
increased as the number of physical morbidities increased, this means that people with many conditions
were more likely to also have a mental health problem or disorder.
38
Using the Institute of Public Care Predictive Care Needs models – PANSI and POPPI
Barnett K et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet
2012
40 A total of 40 conditions and disorders were included, these includes, but were not restricted to GP specific condition registers.
39
55
Figure 4.13 Percentage of People (by age group) with a recorded condition / disorder
(Study of Scottish GP Patients)
Source: Epidemiology of multi-morbidity and implications for health care, research, and medical education: A crosssectional study (Lancet 2012).
Sexual Health
Teenage Conception Rate
Note: Given low numbers, even at County level care should be taken in interpreting year on year change.
The teenage conception rate in West Sussex is significantly below the England rate. In West Sussex in 2009-11
there were 27 conceptions per 1,000 15-17 year olds. The rate has fallen over the last 5-10 years, locally and
nationally. In 2011 there were 1,120 conceptions to women aged 15-17 years in West Sussex. There is
variation across West Sussex with higher rates in Bognor, Littlehampton, and part of Crawley and Worthing.
In any one year between 50-60% of teenage conceptions end in abortion.
Chlamydia Screening
Public Health England recommends that local authorities should be working towards achieving a crude
diagnosis rate of at least 2,300 per 100,000 of the population. In West Sussex the rate was 1,808 per 100,000
people aged 15-24 years (2013). This was significantly lower than the England rate of 1.9079.
The sex specific crude rates for West Sussex (2013) were 2,361 per 1,000 15-24 females (significantly higher
than England rate) and 1,283 per 100,000 males aged 15-24 years (significantly lower than England rate).
Late Diagnoses of HIV
A late diagnosis is defined by Public Health England as adults with a CD4 cell count of less than 350 cells/mm3
within 91 days of HIV diagnosis. People who are diagnosed at a late stage have higher rates of morbidity and
mortality. In the period 2010 -12, there were 80 new HIV diagnoses in West Sussex residents with a CD4 count
less than 350 cells/mm3 at time of diagnosis. This number equates to just under half (48%) of new diagnoses,
this is the same proportion as for England as a whole.
56
Mental Health
Prevalence of Common Mental Health Problems in West Sussex - Adults
Over 100,000 people (adults) in West Sussex are estimated at any one time to have a common mental health
problem, in the main this relates to anxiety and depression.
Table 4.10 Estimated Prevalence of Common Mental Health Problem
ALL
All
(%)
Mixed anxiety and depressive disorder
59,740
9.0
Generalised anxiety disorder
29,210
4.4
Depressive episode
15,270
2.3
All phobias
9,290
1.4
Obsessive compulsive disorder
7,300
1.1
Panic disorder
7,300
1.1
107,540
16.2
Any Common Mental Health Problem
Severe Mental Health Problems

Using national prevalence assumptions41 , in West Sussex there are an estimated 2,700 people living with
a psychotic disorder, 2,000 people with a borderline personality disorder and 1,500 people with an antisocial personality disorder.
Recorded Prevalence
 GP Registers - As part of the Quality and Outcomes Framework, GPs hold three registers relating to
mental health; one for depression, one for severe mental illness (schizophrenia, bipolar disorder and
other psychoses) and a register for dementia.
 Severe Mental Illness - There are approximately 6,400 people on severe mental illness registers in West
Sussex. This represents 0.8% of registered patients, slightly lower than the national rate.
 Depression - There are approximately 42,000 patients on practice lists (aged 18+) who have a current
diagnosis of depression, a prevalence of 6.1% in this age group. This is slightly higher than the national
prevalence of 5.8%.
Relationship between physical health and mental health
Research have identified that mental health problems are strongly associated with excess mortality, not just in
relation to increased risk of suicide, but also excess mortality due to physical poor health, including
cardiovascular disease and cancer. In 2011/12 the West Sussex mortality rate of people (under 75) who had
been in contact with specialist mental health services was over three times higher than the rate for people
who had not been in contact with services.
The relationship is complex, people with mental health problems are more likely to live in deprived areas, as
are people who have long term physical health conditions; there is also reduced access to and take up of
resources which act to protect or promote health in these areas. A physical health problem may lead to a
mental health problem, and vice versa, for example depression and stress have been identified as having a
41
Derived from the Adult Psychiatric Morbidity Survey (APMS)
57
direct effect on the cardiovascular system and studies have identified that people with diabetes are two to
three times more likely to have depression.
Figure 4.14 Overlap of Mental Health Problems and Long Term Conditions
Long term conditions: 30% of
population England (approx.
15.4 million)
30% of people with a long term
condition have a mental health
problem (approx. 4.6 million)
Mental health conditions:
20% of population England
(approx. 10.2 million)
46% of people with a mental health
problem have a long term condition
(approx. 4.6 million)
(Reproduced from: Long-term conditions and Mental Health The cost of co-morbidities Kings Fund ref)
Co-morbidity also has an impact on the treatment and management costs of long term conditions. Analysis by
the Kings Fund has estimated that between 12% and 18% of expenditure on long term conditions is related to
poor mental health.
Suicide42
Suicide is defined as deaths given an underlying cause of intentional self-harm or injury/poisoning of undetermined intent
Suicide is a significant cause of early death (under 75 years). In 2011 there were 6,045 suicides in the UK in
people aged 15 years or over. This was an increase of 437 compared with 2010.
Nationally: The majority of suicides are male suicides (of the 6,045 suicides in 2011 4,552 were male, 1,493 female.
 Highest rate observed in males aged 30-44.
 Nationally the suicide rate for males aged 45 to 59 increased significantly between 2007 and 2011.
 For women, the highest rates are observed in the 45-49 years age group.
Table 4.11 Suicides West Sussex Local Authorities
Local Authority
2009
2010
2011
Adur
5
5
5
Arun
11
10
15
Chichester
6
<3
8
Crawley
<3
17
8
Horsham
4
7
19
Mid Sussex
5
5
6
Worthing
12
11
<3
Figures relate to people aged 15 and over, they exclude non-residents and relate to the date death registered
The suicide rate in West Sussex has shown a downward trend over the last ten years although the rate of
deaths has increased since 2010, this is in line with national and regional trends, although given small numbers
care should be taken when interpreting trend data at county level.
42
Suicide is defined as deaths given an underlying cause of intentional self-harm or injury/poisoning of undetermined intent (ICD codesE950-E959 and
E980-E989 excluding E988.8).
58
Figure 4.15 Mortality from suicide and injury undetermined43
1993-2012 (Annual trends) per 100,000 European Standard population
Mental Health Needs of Children and Young People
In 2004 ONS conducted a national survey44 of approx. 8,000 families in order to estimate the prevalence of
mental problems and disorders in children. This initial survey was then followed up three years later to
determine the persistence of mental disorder. This study remains the largest study undertaken in the UK and is
widely used as the source for prevalence assumptions.. The table below shows the prevalence assumptions
applied to West Sussex population of some of the most common mental health disorders as well as the
prevalence of having any mental health disorder.
Table 4.12
Estimate of the Number of Children (5-16 years) with a Mental Health Disorder
Total (West Sussex)
Population
5-16 years
Any
disorder
Conduct
disorders
Emotional
disorders
Hyperkinetic
disorders
Less
common
disorders
107,550
10,320
6,240
3,980
1,610
1,400
Conduct Behaviour Problems
It is estimated45 that 5% of children aged 5-10 display behavioural problems which are sufficiently severe,
frequent and persistent that they justify diagnosis as a mental health condition (‘conduct disorder’). A further
15-20% has problems which fall below this threshold but are still serious enough to merit concern. Depending
on age, problem behaviours may include: persistent disobedience, angry outbursts and tantrums, physical
aggression, fighting, destruction of property, stealing, lying and bullying. For about half of the children
affected, serious problems will persist into adolescence and beyond.
Prevalence Estimates by service “Tier”
Services in mental health are often described in terms of “tiers”, where services become more specialised the
further up the tier. From emotional wellbeing services at Tier 1 to highly specialist outpatient teams and
inpatient provision at Tier 4. Prevalence estimates46 for West Sussex are shown below against each of the tiers,
43
In England and Wales, it is assumed that most deaths from injury/poisoning of undetermined intent at ages 15 and over are cases where the harm
was self-inflicted but there was insufficient evidence to prove that the deceased deliberately intended to kill themselves. For this reason, suicide
statistics include deaths from intentional self-harm, and those from 'injury or poisoning of undetermined intent'.
44 Green H, McGinnity A, Meltzer H, Ford T, Goodman R. Mental Health of Children and Young people in Great Britain 2004. Office for National Statistics
on the behalf of the Department of Health and Scottish Executive. Crown Copyright 2005.
45 From Building a Better Future : The lifetime costs of childhood behavioural problems and the benefits of early intervention (Centre for Mental Health
Jan 2014)
46 Based on findings published in “Treating Children Well” (Kurtz, 1996)
59
prevalence and estimates based on population aged 17 years or under. These provide an estimate of young
people who may at any one time, need a service response or support.
Figure 4.16 Service Tiers
Prevalence
Assumption
Children in West
Sussex
0.075%
90
1.85%
2,220
7%
8,420
15%
18,040
People with a Learning Disability
In West Sussex an estimated47 15,000 adults (18+ years) have a learning disability. Of these approximately
3,100 are estimated to have a moderate or severe learning disability. Approximately 3,100 people are
recorded on West Sussex GP Learning Disability registers and at any one time approximately 2,000 people with
a learning disability are in receipt of support from social services.
Nationally and locally, there are problems in measuring specific health and wider wellbeing outcomes for
people with learning disabilities, there is inconsistent recording of learning disability status by health providers
and outcomes are difficult to track, or consistently benchmark, in relation to social care. Where learning
disability status has been recorded, available data show that a higher proportion of hospital admissions are
emergency admissions. In West Sussex (2008/9), for people whose LD status was recorded, over 64% of all
admissions were emergency admissions; this was significantly higher than the England average.
Figure 4.17 Emergency Hospital Admissions as % of total (2008/9)
All Local Authorities in Descending Order
Higher than national average
lower than national average
Source: http://www.improvinghealthandlives.org.uk/profiles/index.php
47
Adult prevalence derived from the POPPI and PANSI social care models published by the Institute of Public Care.
60
The 2008 Independent Inquiry into Access to Healthcare for People with Learning Disabilities recommended
that there should be annual health checks for adults with learning disabilities, recognising that people with a
learning disability may be less able access services, take up screening programmes and be less able to identify
specific symptoms and health problems. In West Sussex the overall the percentage of people having a health
check (of those identified as eligible) has increased (Figure 4.18), in 2012/12 69% of those eligible had a health
check, although take up is variable across practices.
Figure 4.18 Percentage of eligible people receiving a health check (% change in number)
People with Autism
Autism (sometimes referred to Autistic Spectrum Condition [ASC] or Autistic Spectrum Disorder [ASD]) can be
described as a neurodevelopmental disorder. It is a spectrum disorder meaning all people diagnosed with the
condition will share certain behaviours and traits to different extents. There are no evidenced biological
markers to identify and diagnose autism, so the following three behavioural descriptions are used:
- Social development/interaction is different or delayed
- Difficulties in communication ‐ both verbal and non‐verbal modes.
- Difficulties with thinking and behaviour (social imagination).
There are some identified risk factors for autism; there are more men diagnosed than women, although the
evidence is complex, approx. 20‐30% of people with a diagnosed learning disability are thought to have autism
and there are strong associations between the prevalence of autism and epilepsy.
Prevalence - Adults
 It is estimated that approximately 1% of the population have autism. Using this assumption it is estimated
that 7,200 people aged 18 years or over living in West Sussex with Autism, the majority of these are men.
 Recorded Prevalence - West Sussex County Council does not operate an “autism” specific service and
status is not routinely recorded on the social care system (Frameworki). An audit in 2010 by WSCC
Learning Disability Team found approx. 400 adults with autism known to the service, approx. 20 of these
had Asperger’s. However this audit was confined to people known to the Learning Disability Team.
61
Autism - Prevalence – Children
 National research48 suggests approximately 1 in 100 children have autism, in West Sussex this equates to
approximately 1,800 children and young people aged 0-18 years.
 Of Children in Need49 in West Sussex, 626 were recorded as having a disability, and 40% of these were
reported to have autism or Asperger’s.
48
Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, et al. Prevalence of disorders of the autism spectrum in a population cohort of
children in South Thames: the Special Needs and Autism Project Lancet 2006; 368: 210-5
49 49
A child in need is one who has been referred to children's social care services, and who has been assessed, usually through an initial assessment, to
be in need of social care services.
62
SECTION 5:
SERVICE UTILISATION
West Sussex Wellbeing Hubs
The West Sussex Prevention and Wellbeing Programme includes a 'hub' function. Hubs are based in each of
the West Sussex Districts and Boroughs and act to provide and coordinate services that improve the health
and wellbeing in their local area. Hubs: provide information and act as a single point of onward referral for people wishing to improve their
health;
 help to remove barriers that stop people improving their health by assisting people with access local
health and wellbeing services; and
 provide or commission additional services to support lifestyle changes that will reduce unhealthy eating,
alcohol misuse, smoking and low levels of physical activity, and help people to manage long-term
conditions.
The use of hubs has continued to increase in West Sussex. Monthly contact data (Figure 5.1) shows
that in July 2014 over 800 people contacted or were referred to the local hub.
Figure 5.1 Monthly Wellbeing Hubs Contacts
– West Sussex Total May 2013 to July 2014
Source: West Sussex County Council
Social Care - Children
Children in Need (CIN)50 – Each year the DfE collate data from social care authorities on children in need in
their area. This relates to children referred to the local authority because of their health and/or development
is at risk of being impaired without additional support.
 (as of March 31 2013) There were 3,872 children in need in West Sussex, 626 (16%) of these children had
a disability. The rate of children in need per 100,000 children was 233, lower than the England rate of 331
per 100,000.
50
A child in need is one who has been referred to children's social care services, and who has been assessed, usually through an initial assessment, to be
in need of social care services.
63
Children Subject to a Child Protection Plan (CPP)
 (As of March 31 2013) 379 children were subject to a Child Protection Plan, this is a rate CPP rate of 22.9
per 100,000 children. This rate is lower than the national rate 37.9. The rate of children subject to a child
protection plan has fallen over recent years. In 2012/13 a total of 550 children had at one time been
subject to a CPP.
Children Looked After (CLA) (numbers rounded)
 In March 2013 there were 670 children looked after (Table 5.1). 30 children were unaccompanied asylum
seeking children. The number of CLA has fallen over recent years (Table 5.1), in 2010 there were 785
children looked after.
 Of the children who had been looked after for at least 12 months, 88% had up to date immunisation
records, 85% had visited a dentist in the previous 12 months and 91% had had their annual health
assessment; all service provision higher than the England average.
Table 5.1 Children Looked After at 31 March
West Sussex
2009
2010
2011
2012
2013
745
785
745
670
670
Source: DfE
In addition to children for whom West Sussex is the responsible authority, there are children who are placed
within West Sussex but remain the responsibility of another local authority. Data for 31st March 2013 shows
that in total over 900 children looked after had their placement in West Sussex; this included 380 children
placed by external LAs.
Table 5.2 Children Looked After as of 31 March (including external LA placements)
Children who are the responsibility of West Sussex
County Council
All children
looked after at
31 March 2013
Placed
within LA
boundary
Placed
outside LA
boundary
Area of
placement
unknown*
Local authority of placement for children5
All children
placed within LA
boundary
West Sussex
670
545
90
35
925
*Placement is not known or not collected (not collected where child placed for adoption).
Children placed
internally within
LA boundary
External
children placed
within LA
boundary
545
380
Social Care - Adults
Councils typically assess a person’s need for social care support in terms of:-no need; low need; moderate
need; substantial need or critical need. Most councils in England are no longer directly funding social care for
people with low or moderate needs, although information, advice and guidance are still available.
In 2012/13, WSCC funded services for around half the number of people that it did in 2005/06 – a reduction
from 23,000 to 12,000 people (Figure 5.1). All clients groups have seen falls in the number of people supported
except for adults with a learning disability, where the number of people supported as a rate of the population
has increased.
64
Figure 5.2 Number of Services Users (All Ages) Per 100,000 of the Population
Figure 5.3 Number of Services Users (All Ages) Per 100,000 of the Population by Client Group
Residential Care – Older People
WSCC currently supports approximately 2,400 older people in long stay residential and nursing care.
Approximately 800 people supported die each year.
An analysis of new starters in 2013/14 found:- 2 out of 3 new starters were women, 1 out of 3 were aged 90 years or over.
- 24% of new customers died within the financial year.
- 41% of new starters were known to WSCC beforehand - 30% received a domiciliary care or direct
payment type service
65
-
88 customers in 2013/14 were identified as capital depleters (i.e. they entered residential care entirely
funding their own care but required assistance when their own resources were depleted).
Figure 5.4 Permanent admissions to residential and nursing care homes (of people aged 65 years or over), per
100,000 population (Outcome 2A)
Higher rates of admission
Lower rates of admission
Hospital Usage
Accident and Emergency Attendance – In 2013 there were 215,500 A&E attendances of West Sussex residents
(Figure 5.4). This was an increase of almost 5,000 on 2012. Locally, and nationally, attendances at A&E have
increased over recent years (Figure 5.5).
Figure 5.5 Attendances at Accident and Emergency
(Number of Attendances by Patients Registered with a West Sussex GP)
At a local authority level, A&E attendance rates are highest in relation to Arun, Adur and Worthing residents,
lowest in Mid Sussex and Horsham (Table 5.3).
66
Table 5.3 Emergency Admission Rates (LA) Rate per 100,000 Population
Adur
Arun
Chichester
Crawley
Horsham
Mid Sussex
Worthing
2006
914
1058
902
961
724
630
1032
2007
940
1078
917
1018
775
702
1027
2008
978
1099
935
1015
824
836
1056
2009
1037
1142
965
964
804
776
1094
2010
1060
1199
951
927
829
781
1127
2011
1068
1180
976
943
813
773
1110
2012
1055
1143
968
1005
826
775
1103
Emergency admissions
The number of emergency admissions to hospital has increased; there were 81,000 emergency admissions in
2013. The rate of admissions (rate of emergency admissions per 100,000 of the population) has remained
fairly stable over the last 3 years (Figure 5.6).
Figure 5.6a Emergency Admissions to Hospital (number)
Figure 5.6b Rate per 100,000 Population
Mental Health


Adults - In April 2014 15,405 patients of West Sussex GPs were in contact with secondary mental health
services and of these 260 were inpatients in a psychiatric hospital (1.7 per cent). 70 people were subject
to the Mental Health Act 1983. Over 4,500 people across West Sussex each quarter are referred to IAPT
services.
Children and Young People - In relation to Tier 3 provision, approximately 300-400 referrals are made
every month to CAMHS (SPFT) and, at any one time, there is a caseload of approximately 3,000 children in
West Sussex. Most referrals are made by GPs.
Maternity Services – Place of Birth
Births are fairly even distributed between four maternity units (Figure 5.7), 28% of births (2009-2013) took
place in Worthing and Southlands Hospital, 24% in St Richards, with similar proportions in East Surrey and
Princess Royal.
67
Figure 5.7 Place of birth Pooled Years Data 2009-2013
Source: West Sussex Birth Notification database
End of Life Care
As people near the end of life they may need support, and specific services, to ensure that the quality of life is
maintained, pain relief is available and sufficient, and choices are supported. Most people who state a
preference say they would prefer to die at home, but at a national level less than 50% of people do so.
In West Sussex 48% of people die in their usual place of residence (combining deaths in at home with deaths in
care homes).
Figure 5.8 Place of Death (West Sussex)
68
SECTION 6:
VIEWS, EXPERIENCES AND PRIORITISATION
Views from the West Sussex Community Survey
The West Sussex Community Survey was conducted between February and April 2014. A households “door-todoor” survey interviewed 3,917 people about their community, social networks and what at a local level
contributed to a good quality of life.
Generally in West Sussex health services were highly valued in terms of making a place a good place to live,
followed by a low crime level.
West Sussex Community Survey (2014)
The top 5 most important things for making somewhere a good place to live were:

Health services (47%)

Crime levels (44%)

Transport links (41%)

Affordable housing (38%)

Clean streets (37%)
The top 5 things people said needed improving

Facilities for young people (24%)

Transport links (19%)

Other (19%) – parking and roads frequently cited

Shopping facilities (19%)

Affordable housing (18%)
Views of People in Receipt of Social Care
People Using Services Funded by West Sussex County Council
Nationally, the Department of Health publish data relating to the outcomes and experiences of people who
use care and support, and also experience of carers. The outcomes measured are defined in the Adult Social
Care Outcomes Framework (ASCOF), with much of the data being collected via survey.
There are four domains in this framework, each has a number of measures and “overarching” measures:Domain 1: Enhancing quality of life for people with care and support needs
Overarching measure: 1A: Social care related quality of life
Domain 2: Delaying and reducing the need for care and support
Overarching measure: 2A: Permanent admissions to residential and nursing care homes, per 100,000
population (data relating to this is shown in Section 5)
Domain 3: Ensuring that people have a positive experience of care
Overarching measure(s): 3A: Overall satisfaction of people who use services with their care and support
3B: Overall satisfaction of carers with social services
Domain 4: Safeguarding adults whose circumstances make them vulnerable and protecting from
avoidable harm
Overarching measure: 4A: Proportion of people who use services who feel safe
69
Outcome 1A: Social care related quality of life (2013/14)
This is a composite measure formed from a number of questions on the Adult Users’ Survey, the maximum
score is 24.
Nationally, the social care related quality of life score was 19.0, compared to 18.8 in 2012-13 and 18.7 in both
2011-12 and 2010-11. In West Sussex the score in 2013/14 was 19.1 this was not significantly higher than
England. In 2010/11 the West Sussex value was 18.4, in 2011/12 and 2012/13 the value was 19.3. Due to
small numbers the year on year changes in West Sussex are not significantly different.
Figure 6.1
Social care-related quality of life (Score out of 24)
Higher performing local authorities
Lower performing local authorities
3A: Overall satisfaction of people who use services with their care and support
Respondents who answered 'I am extremely satisfied' or 'I am very satisfied' or 'I am very happy with the way
staff help me, it's really good' as a percentage of all respondents to the question.
In 2013/14 65% of people who were in receipt of a service said they were satisfied, this is in line with 2012/13
figure of 64.7%. The England figure in 2013/14 was 64.9%.
Figure 6.2
The Overall Satisfaction of People Using Services
Higher % of satisfaction
Lower % of satisfaction
70
3B: Overall satisfaction of carers with social services
The Respondents who answered 'I am extremely satisfied' or 'I am very satisfied' as a percentage of all
respondents to the question51 excluding those who answered 'We haven't received any support or services from
Social Services in the last 12 months'. The Carers Survey is undertaken every 2 years not annually, the data
below relates to 2012/13
In 2012/1 43% of carers (who had been in receipt of a service from WSCC) said they were satisfied, this is
similar to the England percentage of 42.7.
Figure 6.3 The Satisfaction of Carers with Social Services
Lower % of satisfaction
Higher % of satisfaction
4A: Proportion of people who use services who feel safe
Respondents who answered 'I feel as safe as I want' as a percentage of all respondents to the question.
In 2013/14 68.7% of service users in West Sussex said they felt safe, this was higher (although given small
sample size not significantly so) than the England average of 66%.
Figure 6.4 % of People Using Services “Feeling Safe”
Higher % feeling safe
51
Lower % feeling safe
excluding those who answered 'We haven't received any support or services from Social Services in the previous 12 months.
71
GP Patient Survey
- Patient Experience of GP services, GP out-of-hours Services and NHS Dental Services
The GP Patient Survey asks patients about their experience of their own GP practice and has been extended to
include information on a wider range of local services including dentistry and out of hours provision. In terms
of methodology, previously surveys were sent out every quarter; surveys are now being sent out twice a year
(January and July). Weightings are applied to take into account the age and deprivation levels of the local
community. The survey is administered by Ipsos MORI on behalf of the Department of Health (DH).
Background reports and individual practice results are published and freely available online. The survey
collects information for indicators in the NHS Outcomes Framework relating to the experience of GP services,
GP out of hours services and NHS dental services.
A summary of the 2013/14 results (of surveys undertaken between July and Sept 2013 and January to March
2014) is shown on table
72
Table 6.1 Results of GP Patient Survey 2013/14
The table shows the total number of respondents per question and the lower and upper confidence intervals.
Information relates to surveys undertaken between July to September 2013 and January to March 2014.
Overall experience of GP surgery
England
Coastal West Sussex CCG
Crawley CCG
Horsham and Mid Sussex CCG
Respondents
to question
% who said very or
fairly good
LCI
UCI
884,083
8,098
1,978
3,654
85.7%
86.1%
79.5%
88.9%
85.6%
85.3%
77.7%
87.9%
85.8%
86.8%
81.2%
89.9%
Respondents
to question
% who were very or
fairly satisfied
LCI
UCI
885,420
8,116
1,984
3,645
76.9%
75.7%
70.3%
75.6%
76.9%
74.8%
68.3%
74.1%
77.0%
76.6%
72.3%
76.9%
Respondents
to question
% who said very or
fairly good
LCI
UCI
863,894
7,858
1,938
3,513
74.6%
74.8%
67.1%
77.2%
74.5%
73.8%
65.0%
75.8%
74.7%
75.7%
69.2%
78.6%
Respondents
to question
% who said very or
fairly good
LCI
UCI
119,343
1,260
252
529
66.2%
63.8%
63.9%
65.0%
65.9%
61.1%
57.8%
60.9%
66.5%
66.4%
69.6%
69.0%
LCI
UCI
78.6%
77.6%
68.4%
82.4%
78.7%
79.4%
72.4%
84.8%
Satisfaction with opening hours
England
Coastal West Sussex CCG
Crawley CCG
Horsham and Mid Sussex CCG
Overall experience of making an appointment
England
Coastal West Sussex CCG
Crawley CCG
Horsham and Mid Sussex CCG
Overall experience of GP out-of-hours services
England
Coastal West Sussex CCG
Crawley CCG
Horsham and Mid Sussex CCG
Recommended surgery to others
Respondents
to question
England
Coastal West Sussex CCG
Crawley CCG
Horsham and Mid Sussex CCG
885,513
8,109
1,993
3,642
% who would definitely
or probably
recommend
78.7%
78.6%
70.4%
83.7%
73
The Patient Survey asked people how confident they were in managing their own health. In West Sussex a
significantly lower percentage of respondents in Crawley CCG stated they were confident in managing their
own health (compared with England overall and the other West Sussex CCGs).
Respondents with long term conditions were asked whether, in the last 6 months, they had enough support
from local services and organisations to help them manage their long term condition. 10% of respondents in
Horsham and Mid Sussex, 12% in Coastal West Sussex and 13% in Crawley said they did not have enough
support.
NHS Dental Services
The GP Patient Survey also collects information on access and experience to NHS Dentistry. Respondents who
had used an NHS dentist in the last 2 years were asked about their overall experience. Respondents who
hadn’t tried to obtain an NHS dentist in the previous two years were asked why they had not tried to. Given
the lower number of responses to these specific questions data are published at regional and area team level.
In the south of England 86% of respondents said their overall experience of NHS dental services was good
or very good.
Of those people who said they had not tried to visit an NHS dentist in the last 2 years, 25% said they
preferred to use a private dentist, 22% said they stayed with their dentist when they changed from NHS
to private, 15% said they did not need to visit a dentist and 15% said they did not think they could get an
NHS dentist in their area.
End of Life Care
Following the national End of Life Care Strategy (DoH 2008) the ONS introduced a survey52 to assess the quality
of care delivered to people in the last three months of their lives. The survey is sent to the person who had
registered the death, in the main this is a relative or friend, although they were asked to forward the survey to
another person if that was considered more appropriate.
Given small sample sizes most data are not available at CCG or local authority level. ONS have combined
information collected from the 2011 and 2012 surveys and published information to three specific aspects:(i) Overall care in the last three months of life.
(ii) Overall care from the district and community nurses, GPs, doctors and nurses following admission to
hospital.
(iii) Support for carers at the time of death and following the death.
Data relating to (i) relating to the overall quality of care is shown below (Table 6.2).
52
The survey is called the National Survey of Bereaved People (VOICES)
74
Table 6.2 End of Life Care Rated as “excellent” in the last 3 months of life.
Response to the question “Overall, and taking all services into account, how would you rate his/her care in the
last three months of life?”
CCG
Number of
responses
Outstanding/Excellent
%
LCI
Coastal West Sussex
568
45.7
41.6
Crawley
72
32.9
23.0
Horsham and Mid Sussex
207
49.6
42.8
England
40,045
43.2
42.7
The options 'Good', 'Fair' and 'Poor' were not published due to small numbers
Source: National Survey of Bereaved People (ONS)
UCI
49.9
44.6
56.5
43.7
75
GEOGRAPHIES
1) Local Authorities
2) Clinical Commissioning groups (CCGs)
76