Page |1 2014 Northamptonshire County Council: Demography Needs Assessment Northamptonshire County Council Business Intelligence and Performance Improvement Public Health October 2014 Page |2 Contents 1. Introduction ............................................................................................................................................................................................................................. 5 2. Population: the local picture................................................................................................................................................................................................... 9 2.2 About Northamptonshire: Who are we? ............................................................................................................................................................................. 11 2.3 Long term population predictions ....................................................................................................................................................................................... 12 2.4 Historical Population Growth/ Change ................................................................................................................................................................................ 14 2.5 National Comparison ........................................................................................................................................................................................................... 18 3. Births .................................................................................................................................................................................................................................. 19 4. Mortality ............................................................................................................................................................................................................................ 21 4.1 Potential years of life lost .................................................................................................................................................................................................... 30 4.2 Premature Deaths ................................................................................................................................................................................................................ 30 5. Life expectancy .................................................................................................................................................................................................................. 32 6. The difference in births and deaths .................................................................................................................................................................................. 35 7. Spatial Distribution in Northamptonshire ........................................................................................................................................................................ 36 7.1 Location and distribution of Children in Northamptonshire ........................................................................................................................................... 39 7.2 Location and distribution of Young Adults in Northamptonshire.................................................................................................................................... 41 7.3 Location and distribution of older people in Northamptonshire .................................................................................................................................... 43 8. Ethnicity and Place of Birth ............................................................................................................................................................................................... 45 9. Socio-Economic Deprivation ................................................................................................................................................................................................. 52 9.3 District level deprivation ...................................................................................................................................................................................... 56 9.4 Small area change in detail .................................................................................................................................................................................................. 58 Page |3 10. Children.............................................................................................................................................................................................................................. 69 10.2 Children in ethnic groups ................................................................................................................................................................................................... 73 10.3 Children with Special Educational Needs........................................................................................................................................................................... 74 10.4 Looked After Children ........................................................................................................................................................................................................ 76 10.5 Young People Not in Education Employment or Training ................................................................................................................................................. 78 10.6 Children with disabilities .................................................................................................................................................................................................... 79 11. Young Adults...................................................................................................................................................................................................................... 81 11.2 Socio-Economic Demographics of Young Adults ............................................................................................................................................................... 84 12. Older People ...................................................................................................................................................................................................................... 86 12.2 Critical groups for service demand amongst older people ................................................................................................................................................ 88 12.3 Dementia............................................................................................................................................................................................................................ 92 13. Minority Groups / Groups at risk of exclusion ................................................................................................................................................................. 94 13.2 Black and Minority Ethnic Communities ............................................................................................................................................................................ 96 13.3 People with disabilities .................................................................................................................................................................................................... 100 13.4 Carers in Northamptonshire ............................................................................................................................................................................................ 102 13.5 Lesbian, Gay, Bisexual and Transgender .......................................................................................................................................................................... 103 13.6 Traveller and Gypsy communities .................................................................................................................................................................................... 104 13.7 Offenders ......................................................................................................................................................................................................................... 105 13.8 Asylum Seekers and Refugees ......................................................................................................................................................................................... 108 14. Conclusions ...................................................................................................................................................................................................................... 110 Page |4 Appendices .................................................................................................................................................................................................................................. 114 Appendix 1: Population structure: County, Districts and Boroughs ........................................................................................................................................ 114 Appendix 2: Clinical Commissioning Group registered populations........................................................................................................................................ 119 Appendix 3: Job seekers allowance: Claimants by age groups under 35 and under 25 .......................................................................................................... 123 Appendix 4: Mid 2013 Population estimates for Northamptonshire and Districts in five year age bands ............................................................................. 125 Appendix 5 Data Sources ......................................................................................................................................................................................................... 142 Page |5 1. Introduction Local authorities are required by The Local Government and Public Involvement in Health Act 2007 to produce a Joint Strategic Needs Assessment (JSNA) of the health and well being of their local community. Through the JSNA local authorities are expected to consider the needs of their populations resulting in effective commissioning of services to meet these needs. Current policies aim to ensure that services are provided more flexibly, better supporting the needs of local communities, and are more effective at targeting the causes of health problems by intervening at much earlier stages. In order to support this challenging agenda it is essential to have a clear understanding of the needs of the whole population and the wider determinants of health, from the perspectives of the NHS, the local authority, and other partner organisations, such as the Police and Housing support services operating in the area. This chapter focuses on demography; analysing the size, structure and distribution of the population of Northamptonshire as well as spatial and temporal changes in response to births, deaths, migration and ageing. The critical questions asked throughout this chapter are who and where are the population of Northamptonshire and how do these specific demographics translate into existing or potential service demands. 1.1 Wellbeing and population health: why is understanding demography important to Northamptonshire? Health is determined by a complex interaction between individual characteristics, lifestyle and the physical, social and economic environment. Many experts (Dahlgren & Whitehead 1993, Bunker et al. 1995, McGiniss et al. 2002 and The Canadian Institute of Advanced research 2012 – see 1.2 and 1.3) assert that these broader determinants are more important than health care in ensuring a healthy population. The wellbeing of a population and facilitating this through encouraging and supporting healthy lifestyles and communities is therefore as critical an activity in the prevention of debilitating health conditions as the provision of effective clinical care. The range of factors contributing to both individual and collective wellbeing is significant and occurs across a number of scales, from overarching macro conditions to highly localised behaviours and individual conditions, choices and genetic predispositions. Whilst health care and the infrastructure directly associated with this make a strong contribution toward the general health of a population, social-environmental factors are considered more significant. As a result, variations in the wellbeing of communities and individuals can display significant differences at highly localised levels due to specific conditions, choices and cultural norms. Page |6 Variation in conditions may be rooted in a number of areas. Economic hardship and socio-economic deprivation are highly correlated with poor health1. The post-2007 recession and the slow recovery, initially in employment and latterly in sub-inflation earnings, may seriously threaten individual and family wellbeing; similarly it may compound institutionalised levels of deprivation emerging from an ongoing national programme of economic transition and resulting in marginalisation. It is very difficult to predict how the global, UK and Northamptonshire economies will develop and the overall effect this will have on employment and income; trends in the transition of national economy, the form of employment to which the county’s labour force has access, and the polarisation of employment demands and earnings will however affect not only demand for services but also the type of conditions requiring support. 1.2 Tackling inequalities in health2 1 2 http://www.kingsfund.org.uk/time-to-think-differently/trends/broader-determinants-health Source: Dahlgren, G. and Whitehead, M. (1993) Tackling inequalities in health: what can we learn from what has been tried? http://www.kingsfund.org.uk/time-to-thinkdifferently/trends/broader-determinants-health Page |7 1.3 Research findings about the broader determinants of health compared3 Increased levels of education are strongly related to improved health. This may be due to a greater awareness of health issues and the management of personal health, better access to or involvement in exercise or outdoor activities, or a more balanced and healthier diet. Increases in the number of people in higher education and more people from poorer backgrounds entering higher education may have long term benefits for population health. Social and community networks have a strong influence on individual and collective health. Customs, traditions and belief in the role of family and the wider community can positively affect health, reducing stress and providing a strong and consistent social support network which 3 Source: www.kingsfund.org.uk Page |8 helps to alleviate both mental and physical problems. The form of community network however can vary in its influence, and whilst support may be forthcoming through these, similarly certain negative behaviours and tendencies, such as poor diet, can be embedded. The type of housing and form of surrounding environment also affects the health of individuals and communities. Whilst certain infrastructural conditions around environment may be taken for granted within the UK, with almost universally available clean water and sanitation, high density urban development, the erosion of green space and a presumption in favour of the car over the pedestrian within towns and cities have a negative impact, encouraging inactivity and causing pollution. Within individual homes overcrowding is considered to have both immediate and long term negative health effects4, whilst quality of build and lack of maintenance can impact conditions exposing residents to problems such as damp or the cold through inadequate insulation or heating systems. The workplace environment can have as significant effect on the health of a workforce, particularly where demanding conditions are not complemented by corporate support. 4 Source: ODPM (2004) The impact of Overcrowding on Health and Education: a review of evidence and literature http://dera.ioe.ac.uk/5073/1/138631.pdf Page |9 2. Population: the local picture An Overview Northamptonshire is a centrally situated county incorporating a mix of urban and rural areas. The population density is in the lowest 25% of upper tier authority areas within England. In spite of this, the county has seen one of the most significant levels of growth during the past 30 years, well in excess of national and regional growth trends. This growth has been underpinned by significant structural shifts. Whilst the population has grown across all broad age groups, this has been particularly high in those aged 65 and above. The emergence of this top heavy profile is expected to continue in projections to 2021, with particular emphasis on the group aged 70 years and above. In spite of this growth at the top end of the age profile, the proportion of those aged 65 and above within Northamptonshire remains comparatively low against the national profile, with the child population (0-15 years) comparatively high. A key transformation within the population profile has been and will continue to be the representation of different ethnic groups in the area. Growth amongst Black, Asian, and Mixed Ethnicity groups has been high in the period 2001-2011 and this is expected to continue. The concentration of these populations is seen most prominently in Northampton and in the other key urban areas of the county. Ethnic populations are expected to grow significantly within Western European countries to 2050; whilst this may not have such a significant impact on Northamptonshire as on the UKs major cities, the proportion can be expected to grow with notable structural implications for the county’s population. The spatial distribution of population in the county shows a clear urban-rural split. This spatial division also has significant profile implications, with younger and child populations more concentrated in the urban areas and rural areas showing a more aged population. Please note: this chapter is about the resident population within Northamptonshire, which is not exactly the same as the full CCG population. Details about the CCG registered populations (Nene and Corby CCGs) can be found in the appendix. P a g e | 10 2.1 Northamptonshire’s Population: Summary P a g e | 11 2.2 About Northamptonshire: Who are we? Northamptonshire has a mixture of urban and rural areas, with most of the population concentrated in a central north to south area. This includes the county’s principal urban area, Northampton, alongside a number of its secondary urban centres. However, a third of the county’s population live in rural areas. This rural/urban split creates particular health and wider economic and demographic dichotomies. Rural areas tend to have better health related outcomes and lower service requirements, but have limited access to support services. Urban areas conversely have better access to healthcare services but tend to see concentrations of poor health. From a public health perspective these dichotomies can inform how to respond to the needs of these populations which can vary significantly. At the time of the 2011 census, Northamptonshire’s population was estimated at 691,952. This has increased in the latest population estimates for 2013 to 706,600. The gender distribution in the population shows marginally more females than males, representing 50.7% of residents. Around 63% of the population are within what was previously designated as ‘working age’ (revised after the removal of compulsory retirement age of 65 in 2011), with 20% made up of those under 16 and the remaining almost 17% the over 65’s (Fig. 1). Figure 2 illustrates the breakdown of age and gender for Northamptonshire (Northamptonshire is in orange) and England (in blue). Figure 2: Northamptonshire population age/gender distribution6 Figure 1: Northamptonshire Population 20135 Total 706,600 100% Male 348,400 49.3% Female 358,300 50.7% Aged 015 Aged 1664 Aged 65+ 141,800 20.1% 447,400 63.3% 117,400 16.6% 5 Nomis population 2013 6 ONS Population pyramids 2012-37 P a g e | 12 For absolute number of age and sex by five year age bands, broken down by district, please see appendix 4. 2.3 Long term population predictions The population of Northamptonshire is expected to continue to grow, with expectations it could reach 760,000 by 2020 and 810,000 by 2030 dependent on variances in fertility, migration, and life expectancy (Fig. 3). Considering the structural changes which have occurred in the population growth over the past 30 years, this projected change will see some further structural transition. In particular continued growth in dependent groups is expected, as some sections of working age population decline (Fig. 3). Figure 3: Projected Structural Population change to 20217 These estimates show a “squeeze” on the “working age population” (20-60), which increases at a lower rate than the 0-15 group and the “retirement” age group (65+). This is particularly relevant for commissioners, due to the rise of the oldest age group (85+). The figures in the following chart are taken from ONS subnational projections persons, the latest subnational projections available for England, published 29 th May 2014 are full 2012 based and project the population from 2014-2030. Long-term sub national population projections are an indication of the future trends in population by age and sex over the next 25 years. They are trend-based projections, which mean assumptions for future levels of births, deaths and migration are based on observed levels mainly over the previous five years. They 7 Source: Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/news/item?itemId=16 P a g e | 13 show what the population will be if recent trends continue. The projections do not take into account any policy changes that have not yet occurred, nor those that have not yet had an impact on observed trends. Five percent margin of error bars have been added to the predictions to show a potential range of scenarios and the line of best fit has been interpolated from the data. Figure 4: Population predictions 2014-20308 840,000 820,000 800,000 780,000 760,000 740,000 720,000 700,000 680,000 660,000 640,000 Northants POPPI/PANSI population prediction (with 5% margin of error bars) The Northamptonshire population is predicted to substantially rise over the next 16 years by almost 100,000 people. The ONS forecast an annual increase of around 0.8%, which is a 5,600 person increase in 2013-14 for example. If these predictions are realised it will mean a 13.57% increase of total current population. 8 POPPI/PANSI 2014 P a g e | 14 Figure 5: ONS population predictions9 Year 2014 2015 2016 2017 2018 2019 2020 2025 2030 Northamptonshire Population 712,200 718,300 724,500 730,700 736,900 743,000 749,100 777,700 802,500 It is important to emphasise that these predictions are based on current trends, primarily of the past five year’s data. There are many wider factors which influence population trends and these extraneous variables could influence population trends in either direction. 2.4 Historical Population Growth/ Change Since 1981 the population of Northamptonshire has increased by almost 33%, growing from around 530,000 residents to the current 706,600. Whilst the growth has been reflected across all segments of the population, there has also been a shift toward a more ‘top heavy’ population. In the period 1992-2013 relatively slow growth amongst those aged 0-15 years and a plateauing of 16-64 year olds after 2008 has run against an upward curve in the number of residents aged 65 years and over. Whilst population in each age group has grown in this period, the proportional increase was 16% for the 16-64 age group, 10% for the 0-15, and 28% for the 65+ group. Overall, there has been a shift in distribution within the population, with a declining proportion of children and working-age adults against a growing group of retirement age residents. The population of the county has however grown significantly against national and regional contexts. Between 1981 and 2013 Northamptonshire’s population increase was in excess of double that of England. This trend similarly outstrips the growth of the East Midlands region, although not by such a significant margin (Fig. 6). Amongst the upper tier/unitary areas for England, population growth in Northamptonshire is the 13th highest and within the top 10%. 9 ONS 2014 P a g e | 15 Figure 6: Incremental population growth 1982-201310 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 -5.0% Northamptonshire 10 England East Midlands https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 P a g e | 16 Gender division of the population has remained relatively static between 1992 and 2013, with proportion of males marginally increasing since 1981 from a 49:51 split to 49.3:50.7. The distribution of gender has however shifted in line with the ageing trend. The proportion of the female population aged over 65 rose from 16.5% to 17.7%, an increase in numbers of almost 28% against a general female population growth of just under 20%. For males aged 65+ this was more significant, going from 12.2% to 15.5%, an increase in numbers of almost 54% against general increase of under 21%. Figure 7: Population change by age group 1992-201311 500,000 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 Aged 16-64 11 Aged 0-15 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 50,000 Aged 65+ Source: ONS Mid-year Population Estimates https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 P a g e | 17 Figure 8: Population change by age group12 Year Total Population 1992 588,200 1993 590,300 1994 593,300 1995 598,100 1996 603,500 1997 609,600 1998 615,400 1999 620,600 2000 625,500 2001 631,000 2002 636,800 2003 642,600 2004 646,600 2005 654,400 2006 663,700 2007 672,100 2008 678,200 2009 683,500 2010 688,000 2011 693,900 2012 700,600 2013 706,600 12 NOMIS 2014 Population aged 16Population aged 0Population aged Aged 16-64 Aged 0-15 Aged 65+ 64 15 65+ % % % 375,600 128,000 84,600 63.9 21.8 14.4 376,200 129,100 85,000 63.7 21.9 14.4 378,200 129,600 85,500 63.7 21.8 14.4 381,500 130,300 86,300 63.8 21.8 14.4 386,500 130,300 86,700 64 21.6 14.4 391,500 130,800 87,300 64.2 21.5 14.3 396,100 131,500 87,800 64.4 21.4 14.3 399,800 132,800 88,000 64.4 21.4 14.2 403,700 133,400 88,400 64.5 21.3 14.1 408,000 133,400 89,600 64.7 21.1 14.2 412,600 133,500 90,700 64.8 21 14.2 416,800 134,100 91,700 64.9 20.9 14.3 420,200 133,800 92,600 65 20.7 14.3 427,200 133,500 93,700 65.3 20.4 14.3 435,200 133,900 94,600 65.6 20.2 14.3 441,300 134,600 96,200 65.7 20 14.3 444,400 135,300 98,500 65.5 20 14.5 445,900 136,200 101,400 65.2 19.9 14.8 446,600 137,000 104,400 64.9 19.9 15.2 448,300 138,300 107,300 64.6 19.9 15.5 447,300 140,400 112,900 63.8 20 16.1 447,400 141,800 117,400 63.3 20.1 16.6 P a g e | 18 Figure 9: Proportional population distribution by age group 1992 and 201313 2013 1992 16.6 14.4 21.8 20.1 63.3 63.9 Aged 16-64 Aged 0-15 Aged 65+ Aged 16-64 Aged 0-15 Aged 65+ 2.5 National Comparison Proportionally the distribution of population within Northamptonshire differs from that of England in some notable ways. The changing profile of the county’s population has shown a decline in working-age residents and an increase in the 65+ age group, in comparison to England, Northamptonshire has fewer 65+ population (by 0.7%). In terms of dependent groups, those aged 0-15 make up a higher proportion, with Northamptonshire’s under 16s representing 20% of residents against a national figure of 19% (Fig. 10). Figure 10: Population distribution comparison: Northamptonshire and England14 Total Male Female Aged 0-15 Aged 16-64 Aged 65+ Northamptonshire Population % 706,600 348,400 49.3% 358,300 50.7% 141,800 20.1% 447,400 63.3% 117,400 16.6% England Population 53,865,800 26,534,000 27,331,800 10,209,200 34,351,400 9,305,200 % 49.3% 50.7% 19.0% 63.8% 17.3% 13 Source: ONS Mid-year Population Estimates https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 14 Source: ONS Mid-year Population Estimates 2013 https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 P a g e | 19 3. Births Figure 11 below displays the number of live births and the general and total fertility rates between 2011 and 2013 in Northamptonshire and the districts contained within it. Figure 11: Number of live births, general fertility rate and total fertility rate15 2013 Area of usual residence Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough Live births 8,995 931 815 1,012 GFR1 2012 TFR2 66.7 71.3 62.6 64.9 2.03 2.06 2.10 2.12 Live births 9,288 959 836 930 1,179 3,232 832 65.0 70.2 55.8 2.01 2.01 1.83 994 70.3 2.18 GFR1 2011 TFR2 68.6 74.1 62.8 59.2 2.11 2.20 2.13 1.94 Live births 9,229 955 820 961 1,271 3,369 880 69.8 73.1 59.0 2.18 2.10 1.96 1,043 73.3 2.30 GFR1 67.7 75.1 59.8 59.9 2.09 2.22 2.06 1.99 1,227 3,304 901 67.1 71.5 60.0 2.09 2.06 2.01 1,061 73.5 2.31 GFR = General fertility rate: the number of live births per 1,000 women aged 15-44 TFR = Total fertility rate: the average number of children per woman Northamptonshire has had a birth rate of consistently around 9,000 live births for each year since 2011. The general fertility rate went up from 2011-12 (from 67.7 to 68.6) and then decreased from 2012-13 (from 68.6 to 66.7). The total fertility rate follows the same trend. At district level it is clear that Corby has the highest general fertility rates (the highest in 2013 of 71.3). Other urban areas like Northampton and Wellingborough also have relatively higher rates compared to the Northamptonshire average. Wellingborough also has the highest total fertility rate consistently over the period. Conversely South Northants has the lowest average general and total fertility rates (55.8 in 2013). Other less densely populated areas such as Daventry and East Northamptonshire also have relatively low general and total fertility rates. Kettering has consistently around average fertility rates over the 2011-13 period. Figure 12 beneath illustrates the levels of under 18 conceptions in Northamptonshire. 15 ONS 2014 TFR2 P a g e | 20 Figure 12: Under 18 conceptions (per 1,000) – Northants compared16 Area of usual residence England Wales EAST MIDLANDS Northamptonshire Jun13 25.2 27.0 25.5 23.1 Mar13 25.5 26.3 24.1 22.5 Dec12 26.3 28.3 26.1 31.0 Sep12 25.9 28.9 26.9 26.3 Jun12 28.4 30.9 28.4 31.1 Mar12 30.3 35.0 31.7 34.5 Dec11 29.0 34.8 30.2 32.1 Sep11 29.3 32.2 28.4 34.3 Jun11 33.2 35.3 34.6 34.6 It is clear that under 18 conceptions have been going down over the period displayed (March 2011-May 2013) for Northamptonshire as well as elsewhere in the East Midlands, England and Wales. Up until March 2013 Northants was generally above the level of under 18 conceptions compared to the East Midlands and England. But, from March 2013 onwards Northants has seen a decrease to lower than the averages of England, Wales and the East Midlands. Figure 13: Under 18 conceptions (per 1,000) – Northants compared17 40.0 35.0 30.0 25.0 England 20.0 15.0 Wales EAST MIDLANDS Northamptonshire 10.0 5.0 0.0 16 ONS 2014 17 ONS 2014 Mar11 31.4 34.4 32.4 32.4 P a g e | 21 4. Mortality Mortality can be measured in many ways and one of the most popular contemporary methods is through standardised mortality ratios. In epidemiology, standardised mortality ratio is a quantity expressed as a ratio quantifying the increase or decrease of mortality of a cohort compared to the general population. In figure 14 beneath, the number of actual deaths and the associated standardised mortality ratios from causes considered preventable are displayed for Northamptonshire, England and East Midlands. Figure 14: Mortality rate from causes considered preventable18 Area Count Northamptonshire England East midlands 3,549 264,232 23,806 Value 186.7 183.9 185.2 95% lower confidence interval 95% upper confidence interval 180.5 183.1 182.8 Northamptonshire has a slightly higher SMR for causes considered preventable than England and the East Midlands, but not by a statistically significant amount. Figure 15 on the next page illustrates several different mortality indicators for Northamptonshire and districts from 2010-2012. 18 ONS 2014 193 184.6 187.5 P a g e | 22 Figure 15: Mortality in Northamptonshire and districts 2010-12 (ONS 2014) 2012 All ages Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough 2011 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough 2010 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough Deaths (numbers) Infant Neonatal (under (under one four year) weeks) Females Perinatal (stillbirths and births under one week) Persons Males 5,839 505 728 754 841 1,799 637 575 2,832 255 353 366 403 876 300 279 3,007 250 375 388 438 923 337 296 42 5 4 4 5 20 1 3 34 3 2 3 5 19 2 79 15 6 4 11 34 3 6 Crude death rate (deaths per 1000) 8.3 8.0 9.3 8.6 8.9 8.4 7.4 7.6 5,720 514 648 765 820 1,714 640 619 2,797 260 331 381 399 813 306 307 2,923 254 317 384 421 901 334 312 46 3 1 3 6 23 2 8 33 2 1 2 6 17 1 4 82 6 8 7 10 31 9 11 5,715 521 617 761 831 1,743 640 602 2,797 241 304 347 387 902 317 299 2,918 280 313 414 444 841 323 303 31 2 4 7 3 12 1 2 23 2 3 5 2 9 1 1 70 7 10 7 9 25 5 7 Rates Age standardised mortality Infant rate mortality Persons Males Females (per 1000 live births) Neonatal mortality (per 1000 live births) 534.2 635.1 544.8 491.9 522.3 604.9 425.3 467.0 617.0 728.1 627.0 580.7 624.9 710.2 452.7 528.4 465.9 552.0 478.7 418.2 436.8 518.8 401.3 425.5 4.5 5.2 4.8 4.3 3.9 5.9 : 2.9 3.7 3.1 : 3.2 3.9 5.6 : Perinatal mortality rates (per 1000 live births and stillbirths) 8.5 15.4 7.1 4.3 8.6 10.0 3.4 5.7 8.2 8.3 8.3 8.8 8.7 8.1 7.5 8.2 540.8 665.0 494.8 517.9 539.0 593.2 440.5 516.3 631.6 767.7 602.4 623.1 647.0 679.3 492.5 611.6 460.4 573.5 402.5 418.4 450.3 516.6 386.8 439.0 5.0 3.1 : 3.1 4.9 7.0 : 7.5 3.6 : : : 4.9 5.1 : 3.8 8.8 6.3 9.7 7.2 8.1 9.3 9.9 10.3 8.3 9.3 7.8 8.9 9.2 8.2 7.2 7.9 540.4 658.5 503.5 519.1 558.2 589.0 450.9 490.8 638.5 706.7 595.0 571.9 646.9 741.1 528.8 589.5 456.7 619.0 423.4 481.8 487.4 456.1 389.4 396.2 3.3 : 5.0 6.9 2.4 3.5 : : 2.5 : 3.8 4.9 : 2.7 : : 7.5 7.6 12.4 6.8 7.1 7.4 5.8 6.8 P a g e | 23 Data from the above table concerning infant (under one year), neonatal (under four weeks) and perinatal (stillbirths and births under one week) mortality is illustrated in figure 16 beneath. (The source for this data is ONS 2014) Figure 16: Infant, neonatal and perinatal mortality in Northamptonshire and England 10 Infant mortality Northants (per 1000 live births) 9 8 Infant mortality England 7 6 Neonatal mortality Northants (per 1000 live births) 5 Neonatal mortality England (per 1000 live births) 4 3 Perinatal mortality rates Northants (per 1000 live births and stillbirths) 2 Perinatal mortality rates England (per 1000 live births and stillbirths) 1 0 2010 Year 2010 2011 Infant mortality Northants (per 1000 live births) 3.3 Infant mortality England (per 1000 deaths) 2012 4 Neonatal mortality Northants (per 1000 live births) 2.5 Neonatal mortality England (per 1000 live births) Perinatal mortality rates Northants (per 1000 live births and stillbirths) Perinatal mortality rates England (per 1000 live births and stillbirths) 2.8 7.5 6.9 2011 5 4 3.6 2.8 8.8 7.1 2012 4.5 3.9 3.7 2.7 8.5 6.6 All three of these indicators show a trend of slightly increasing over the 2010-2012 period for Northamptonshire, compared to a slight decrease in all three for England. Figure 17 below illustrates the age standardised mortality rates in Northamptonshire for all people, females and males. The age standardised rates allow for differences in the age P a g e | 24 structure of populations and allow valid comparisons to be made between geographical areas and through time19. Figure 17: Age standardised mortality in Northamptonshire 700 Age- standardised mortality rate Persons Northamptonshire 650 Age- standardised mortality rate Persons Eng and Wales 600 Age- standardised mortality rate Males Northamptonshire 550 Age- standardised mortality rate Males Eng and Wales 500 Age- standardised mortality rate Females Northamptonshire 450 Age- standardised mortality rate Females Eng and Wales 400 2010 2011 2012 Age standardised mortality rate Males Northamptonshire 540.4 Age standardised mortality rate Persons Eng and Wales 541.8 540.8 534.2 Age standardised mortality rate Persons Northamptonshire Year 2010 2011 2012 Age standardised mortality rate Females Northamptonshire Age standardised mortality rate Females Eng and Wales 638.5 Age standardised mortality rate Males Eng and Wales 640.6 456.7 458.1 526.8 631.6 623.6 460.4 445.8 528 617 619.1 465.9 451 Figure 17 shows that the age standardised mortality rate for all people is relatively static over the period, decreasing very slightly in 2012. For Females however, the age standardised mortality rate has increased over the period. Conversely the age standardised mortality for males decreased. The difference in trends for males and females explains why the rate for all people is quite static; the male and female variations nearly cancel each other out. 19 ONS 2014 P a g e | 25 Figure 18 (beneath) illustrates the age standardised mortality rates for the districts contained within Northamptonshire over the same time period (2010-12) and the significant variation that exists. Figure 18: Age standardised mortality: Northamptonshire districts (2010-12) Age standardised mortality: districts 700 Corby Age standardised mortality rate Daventry 650 East Northamptonshire 600 Kettering 550 Northampton 500 Northamptonshire 450 South Northamptonshire 400 Wellingborough 2010 2011 2012 It is clear that there exists a large difference in life expectancy depending on where you live in Northamptonshire. South Northants consistently has lower age standardised mortality than all the other districts for example, and this is gradually decreasing over the period. On the other end of the scale Corby consistently has the highest age standardised mortality, followed by Northampton (which actually worsens over the period). These varying age standardised mortality rates demonstrate the inequalities that exist within the population: where people live can have a large bearing on health outcomes in their lives. Figures 19-25 below show mortality rates which are directly standardised for Northamptonshire, East Midland authorities and England. Different causes such as: all causes, cardiovascular disease, cancer, liver disease and respiratory disease broken down by gender. P a g e | 26 Key: Mortality – Premature death: directly standardised rates with comparators20 Comparison with respect to England value: Worse Similar Better Not compared * = value estimated Period England East Midlands Derby Derbyshire Leicester Leicestershire Lincolnshire Northamptonshire Nottingham Nottinghamshire Rutland 4.03 - Mortality rate from causes considered preventable (Persons) 4.03 per 100,000 Lower 2010 - 12 187.8 188.5 207.4 184.9 233.6 166.8 181.8 188.2 247.4 187.4 145.4 4.03 - Mortality rate from causes considered preventable (Male) 4.03 per 100,000 Lower 2010 - 12 238.4 240 274.5 237 314.1 207.1 231.7 235.1 321.8 235.6 195.7 4.03 - Mortality rate from causes considered preventable (Female) 4.03 per 100,000 Lower 2010 - 12 140.6 139.9 145 135.1 158.6 128.7 135.2 143.5 177.4 142.4 98.2 Indicator Units Tolerance (Lower or Higher is better?) Figure 19: premature death: all causes Figure 20: premature death: cardiovascular disease 4.04i - Under 75 mortality rate from all cardiovascular diseases 4.04i (Persons) per 100,000 Lower 2010 - 12 81.1 82.6 91.6 82.4 108.5 71.2 82.3 80.9 111.8 77.4 85.5 4.04i - Under 75 mortality rate from all cardiovascular diseases 4.04i (Male) per 100,000 Lower 2010 - 12 114 115 125 116.3 145.8 96.9 116.4 109.7 158.6 109.7 121.3 4.04i - Under 75 mortality rate from all cardiovascular diseases 4.04i (Female) per 100,000 Lower 2010 - 12 50.1 51.4 60.1 49.3 72.6 46.2 49.7 52.9 67 46.5 50.3 4.04ii - Under 75 mortality rate from cardiovascular diseases 4.04ii considered preventable (Persons) per 100,000 Lower 2010 - 12 53.5 55.9 63 58.5 73.2 47.4 55.1 50.7 75.3 53.6 59.2 4.04ii - Under 75 mortality rate from cardiovascular diseases 4.04ii considered preventable (Male) per 100,000 Lower 2010 - 12 80.8 84.1 92.1 89.8 104.6 70.4 84 75.8 112.9 81.4 86.4 4.04ii - Under 75 mortality rate from cardiovascular diseases 4.04ii considered preventable (Female) per 100,000 Lower 2010 - 12 27.6 28.7 35.6 28.1 43.1 25.1 27.5 26.2 39.1 27 * 20 PHOF 2014 P a g e | 27 Period England East Midlands Derby Derbyshire Leicester Leicestershire Lincolnshire Northamptonshire Nottingham Nottinghamshire Rutland 4.05i - Under 75 mortality rate from cancer (Persons) 4.05i per 100,000 Lower 2010 - 12 146.5 147.2 147.6 145.3 150.6 135.8 144.7 151.8 182.7 150 116.3 4.05i - Under 75 mortality rate from cancer (Male) 4.05i per 100,000 Lower 2010 - 12 163.6 163 168.3 163.1 175.5 148.4 153.9 170.2 200 168 123.9 4.05i - Under 75 mortality rate from cancer (Female) 4.05i per 100,000 Lower 2010 - 12 130.8 132.4 128.9 128.5 128.2 124 136 134.1 166.8 133.3 108.8 4.05ii - Under 75 mortality rate from cancer considered preventable 4.05ii (Persons) per 100,000 Lower 2010 - 12 84.9 84 89.2 81.3 91.5 76.4 80.6 87.6 107.1 86.9 53.8 4.05ii - Under 75 mortality rate from cancer considered preventable 4.05ii (Male) per 100,000 Lower 2010 - 12 92.7 92 104.2 89.2 109.8 78 86.3 97.1 121.4 95.8 53.1 4.05ii - Under 75 mortality rate from cancer considered preventable 4.05ii (Female) per 100,000 Lower 2010 - 12 77.9 76.6 75.5 73.8 75.2 75 75.1 78.6 93.8 78.7 54.6 Indicator Units Tolerance (Lower or Higher is better?) Figure 21: premature death: cancer21 Figure 22: premature death: liver disease 4.06i - Under 75 mortality rate from liver disease (Persons) 4.06i per 100,000 Lower 2010 - 12 18 17.6 22.6 14.7 25.3 14.7 16.3 17.9 29.2 17.6 * 4.06i - Under 75 mortality rate from liver disease (Male) 4.06i per 100,000 Lower 2010 - 12 23.7 23.2 31.3 19.3 39 17.8 21.6 22.1 38.9 23.3 * 4.06i - Under 75 mortality rate from liver disease (Female) 4.06i per 100,000 Lower 2010 - 12 12.6 12.1 14.1 10.3 11.8 11.6 11.2 13.8 19.2 12 * 4.06ii - Under 75 mortality rate from liver disease considered 4.06ii preventable (Persons) per 100,000 Lower 2010 - 12 15.8 15.5 20.7 13.3 22.7 13.1 14.1 16.2 26.4 14.6 * 4.06ii - Under 75 mortality rate from liver disease considered 4.06ii preventable (Male) per 100,000 Lower 2010 - 12 21.1 21.1 29.2 17.7 35.5 16.5 19.2 20.5 36.5 20.2 * 4.06ii - Under 75 mortality rate from liver disease considered 4.06ii preventable (Female) per 100,000 Lower 2010 - 12 10.6 10.1 12.3 9 10.1 9.8 9.1 12 16.1 9.2 * 21 PHOF 2014 P a g e | 28 Period England East Midlands Derby Derbyshire Leicester Leicestershire Lincolnshire Northamptonshire Nottingham Nottinghamshire Rutland 4.07i - Under 75 mortality rate from respiratory disease (Persons) 4.07i per 100,000 Lower 2010 - 12 33.5 33.2 38 31.9 47.5 25.6 31.2 35.8 54.5 31.9 * 4.07i - Under 75 mortality rate from respiratory disease (Male) 4.07i per 100,000 Lower 2010 - 12 39.6 39.8 45.7 40.6 61.7 30.6 35.4 41 72.5 36.5 * 4.07i - Under 75 mortality rate from respiratory disease (Female) 4.07i per 100,000 Lower 2010 - 12 27.9 27 30.8 23.6 34.9 20.8 27.1 30.7 38.6 27.5 * 4.07ii - Under 75 mortality rate from respiratory disease considered 4.07ii preventable (Persons) per 100,000 Lower 2010 - 12 17.6 16.6 16.4 15.4 22 12.4 15.5 19.2 31.3 16.3 * 4.07ii - Under 75 mortality rate from respiratory disease considered 4.07ii preventable (Male) per 100,000 Lower 2010 - 12 20.1 18.9 19.8 18.6 30 15.4 17.5 20 36.7 16.6 * 4.07ii - Under 75 mortality rate from respiratory disease considered 4.07ii preventable (Female) per 100,000 Lower 2010 - 12 15.2 14.4 13.3 12.3 14.9 9.6 13.5 18.5 26.9 16.1 * Indicator Units Tolerance (Lower or Higher is better?) Figure 23: premature death: respiratory disease22 The only indicator where Northamptonshire is significantly worse than the national average is under 75 mortality rate from respiratory diseases considered preventable (females). For all other preventable mortality rates Northamptonshire is in line with the national averages. These indicators are updated quarterly on the Public Health Outcomes Framework23. Also in relation to deaths within the county it is interesting to consider the place of death which is broken down by CCG level and compared to England. These end of life care indicators are illustrated in figures 24 and 25 below. They show that there are a much higher proportion of 23 PHOF 2014 P a g e | 29 people in Corby CCG who die at home than the England average. This could be because of the SMR being so high in Corby, resulting in many people dying before they get to hospital, a care home or a hospice. Figure 24: Northamptonshire (Nene CCG) Mortality Indicators compared to England24 Figure 25: Northamptonshire (Corby CCG) Mortality Indicators compared to England25 24 http://www.endoflifecare-intelligence.org.uk/profiles/CCGs/Place_of_Death/atlas.html 25 http://www.endoflifecare-intelligence.org.uk/profiles/CCGs/Place_of_Death/atlas.html P a g e | 30 4.1 Potential years of life lost Potential years of life lost (PYLL) is an indicator measured by the Health and Social Care Information Centre. This measures the number of years of life lost by every 100,000 persons dying from a condition, which is usually treatable. The September 2014 release shows that Nene CCG has a directly age standardised PYLL of 1,993 per 100,000 and Corby CCG has 2,781 per 100,000. These equate to 12,867 and 1,885 years of life lost respectively. Compared to the national average of 2,027, it is clear that Corby has a high number of PYLL. It has the sixth worst standardised PYLL of any CCG in England, which is a significant concern. Nene CCG performs slightly better than the national average, however the PYLL does not vary from the national average at a significant level. Using this mortality indicator we can identify a significant concern in Corby. 4.2 Premature Deaths26 Illustrated beneath are some of the main causes of death nationally. These are expressed per 100,000 of the population, and Northamptonshire is ranked compared to other counties (where higher is always better). It is clear that Northants performs averagely on overall premature deaths: Figure 26: Causes of premature deaths 26 Longer Lives 2014 P a g e | 31 Northamptonshire performs slightly worse than the average county on cancer mortality outcomes. These are related to the above lifestyle factors. Northamptonshire performs slightly better than the average county on heart disease and stroke related outcomes. These are related to the above lifestyle factors. Northamptonshire performs very slightly below average on lung disease, which is strongly linked to smoking. Smoking appears as a cause of cancer, heart and lung disease. Northamptonshire performs well on liver disease related mortality. Liver disease mortality is caused mainly by the above lifestyle factors. P a g e | 32 5. Life expectancy27 Figure 27 beneath illustrates the life expectancy of males and females in Northamptonshire with 95% confidence intervals. Confidence intervals are observed intervals of the population parameter. It is clear that females live on average longer than males and they also have a longer life expectancy at 65. Figure 27: Life expectancy at birth and age 65 2010-2012 Life expectancy at birth and at 65 (with 95% confidence intervals) Life expectancy at birth (Male) Life expectancy at birth (Female) Life expectancy at 65 (Male) Life expectancy at 65 (Female) Score Lower CI Upper CI 79.1 82.7 18.4 20.8 78.8 82.4 18.3 20.6 79.4 82.9 18.6 21.0 Figure 28 below shows the life expectancy in Northamptonshire compared to England from 2000-2012. Evidently life expectancy has increased for both females and males in Northamptonshire, as well as nationally. In both genders, Northamptonshire began slightly above the national average in 2000-2002 and despite increasing over the period both are below the national average in 2010-12. Figure 28: life expectancy in Northamptonshire & England 2000-2012 27 ONS 2014 P a g e | 33 Figures 29-32 beneath illustrate the differences in life expectancy and healthy life expectancy between women and men in Northamptonshire compared to other authorities in the region. The red lines illustrate the England average and the green lines represent the East Midlands average. Figure 29:Healthy life expectancy28 at birth - male in years (2009-11) Figure 30: Healthy life expectancy at birth - female in years (2009-11) Figure 31: Life expectancy at birth - male in years (2010-12) Figure 32: Life expectancy at birth - female in years (2010-12) It is clear that women live longer than men by around two and a half years in Northamptonshire. Interestingly, the healthy life expectancy in Northamptonshire for men is high compared to other areas in the East Midlands as well as England. Consequently the difference in healthy life expectancy between men and women in Northamptonshire is much less marked (only 0.6 years). 28 http://fingertips.phe.org.uk/ P a g e | 34 Figure 33 beneath illustrates the various life expectancies, including life expectancy at birth, healthy life expectancy and life expectancy at age 65. These reveal key information about the Northamptonshire population and where it sits compared to the best and worst areas in England. In line with the rest of the England women tend to live longer than men (82.7 compared to 79.1). Interestingly though, there is much less difference between the healthy life expectancy of men and women in Northamptonshire (only 0.6 years). Figure 33: Life Expectancy in Northamptonshire29 29 http://www.phoutcomes.info/public-health-outcomes-framework#gid/1000049/pat/6/ati/102/page/1/par/E12000004/are/E10000021 P a g e | 35 6. The difference in births and deaths Net population increase excluding migration can be calculated by subtracting the number of deaths from the number of births. In Northamptonshire births have exceeded deaths by around 3,400 each year since 2010. Births consistently exceeding deaths in this way is one of the contributing factors to population growth. The remaining growth is explained by migration of people into the county, from abroad or elsewhere in the UK. More information on migration can be found in the section on migration (pages 47 onwards). Figure 34: Net population increase in Northants since 201030 Net population increase Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough 30 ONS 2014 2012 2011 2010 Persons Persons Persons 3,449 3,390 3,419 454 450 414 108 92 70 176 207 263 430 386 426 1,570 1,505 1,584 243 264 217 468 486 445 P a g e | 36 7. Spatial Distribution in Northamptonshire Northamptonshire is sub-divided at the lower tier level into seven different districts and boroughs. The population is not evenly dispersed across these areas, with larger concentrations occurring in the more urbanised parts (Fig. 35). This variation in population density occurs both between and within localities, with some encompassing both urban and rural areas. Within the districts and boroughs variations in population can be seen. There is greater representation of deprivation, of younger age groups (particularly 18-35 year olds), and of ethnic minority groups in the urban areas whilst more rural parts are populated by an older and less diverse demographic. The age structure across the localities of Northamptonshire shows some consistency with this. The proportion of those aged 65+ is more pronounced in the more rural parts of Daventry, East Northamptonshire, South Northamptonshire and also Wellingborough. In the more urbanised Corby and Northampton this groups represent a proportion around 4% points lower. A similar tendency occurs around the distribution of ethnic groups across localities. The proportion made up by White groups ranges from 97% in South Northamptonshire to 85% in Northampton. The concentration of Mixed, Asian, and Black groups in Northampton and Wellingborough is more than double that found elsewhere in the county. Various other distinctions between local populations can be identified. Corby and Northampton both have higher proportions of younger people amongst their population, Corby amongst under 16s and Northampton in the group of 18-30 year olds. Within other localities the population increases more significantly at later age groups from the age of 50 onward (Appendix 1). P a g e | 37 Figure 35: Northamptonshire population by lower tier Local Authority31 Population is dense in urban areas The most dense concentration of people is found in Northampton Population is most sparse in rural areas 31 Source: ONS Mid-year population estimates http://www.northamptonshireanalysis.co.uk/resource/view?resourceId=669 P a g e | 38 Figure 36: Rural Urban Classification in Northamptonshire 2011(RUC 2011) Figure 36: illustrates the distribution of towns and villages in Northamptonshire. There are clear concentrations of urban areas, rural towns and fringes surrounding them and rural villages and dispersed areas further away from the urban populations. P a g e | 39 7.1 Location and distribution of Children in Northamptonshire The population of children in Northamptonshire is comparatively high. Against a proportional figure for England of 19%, the population of those aged 0-15 in the county stands at just over 20%32. This is unevenly distributed across the districts and borough, although only Daventry has a proportion of 0-15 year olds below the national average. A tendency within the child population is for it to be concentrated within urban areas, in line with the population of younger adults and the availability of affordable housing. The distribution of those aged 0-17 years within Northamptonshire, examined at middle super output area scale, replicates this to some extent, although in a number of cases the concentration occurs within areas on the periphery of key towns. This concentration does not always translate in terms of proportion, with the higher number of children aged 0-17 as a percentage of population occurring almost exclusively in the more central urban areas of Corby, Kettering, Wellingborough, Northampton and Daventry. Within area of higher population but lower proportional representation this may present an issue around the recognition and prioritisation of specific concerns in children’s health against those of more prominent demographic groups. Distribution across age groups within Northamptonshire had changed slowly over 15 years to around 2009, but has since shown a notable increase. Of the 172,000 residents aged under 20 at the 2011 Census, age groups 5-9 years, 10-14 years, and 15-19 years all record a similar quantum of around 42,000. The population 0-4 years is almost 10% higher at 46,000. This will have implications in the transition between age groups and their health support requirements as the children born after 2009 onward grow older; it may similarly have implications around the demand for services to support children with birth rates expected to incrementally increase to 2020. 32 ONS Mid-Year Population Estimates 2013 http://www.ons.gov.uk/ons/publications/re-reference-tables.html?edition=tcm%3A77-322718 P a g e | 40 Figure 37: Population aged 0-17 years 201233 Figure 38: Population proportional (%) concentration aged 0-17 years 201234 33 Source: Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census 34 Source: Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census P a g e | 41 7.2 Location and distribution of Young Adults in Northamptonshire As at 2013 the population of young adults in Northamptonshire, defined here as 18 to 30 years old, stood at 98,800, representing 14% of all residents. This is a lower comparative proportion against the figure for England, which stood at 16%. Across the districts and boroughs there is significant variance in the distribution of this population, but the only part of the county in which this exceeds the national picture is Northampton (Fig. 39). Figure 39: Young Adult population 201335 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough England Aged 18-30 98,800 10,100 9,200 10,300 12,800 37,000 9,500 9,800 8,615,800 % Total Pop. 14.0% 15.7% 11.7% 11.7% 13.4% 17.1% 10.9% 12.9% 16.0% The tendency for young adult populations is to converge in more urbanised areas; this can particularly be seen in the proportions of people aged 18-30 years in London and the other 8 core cities of England, representing a range from 19% (London) to over 28% (Nottingham). This is replicated at the county scale with the notable concentration found in Northampton. At the lower level, using Middle Super Output Areas, in 35 ONS, Mid-Year Population Estimates https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 P a g e | 42 terms of both volume and proportion, the greater concentration in Northamptonshire is found in or on the periphery of the principle urban areas of Northampton, Kettering, Corby, Rushden, and Wellingborough (Fig. 40 and 41). Figure 40: Population aged 18-30 (2012)36 Figure 41: Population by proportion (%) 18-30 (2012)37 36 Source: Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census 37 Source: Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census P a g e | 43 7.3 Location and distribution of older people in Northamptonshire The population aged 65+ in Northamptonshire stands at around 117,000 and makes up just under 17% of the population. Whilst the growth of this demographic has been almost double that of the general population it makes up a smaller proportion of the population than for England. The convergence over the past decade has however been significant; in 2003 the variance between Northamptonshire and England was 1.6% points, but in 2013 this stands at just 0.7% points. The concentration of this group shows significant variance across the county. Within Corby and Northampton the proportion is much lower, but across the other boroughs and districts shows in some cases a quite significant increase (Fig. 42). The distribution at the middle super output area shows a trend converse to that of the population of children and young adults. The 65+ population is more dispersed across the county with particular concentrations within more rural parts and a notable absence within more urban areas, especially Wellingborough and Northampton (Fig. 43 and 44). Figure 42: Population aged 65+38 Population 65+ % 65+ 117,400 16.6 Corby 9,000 14.0 Daventry 14,700 18.7 East Northamptonshire 16,500 18.7 Kettering 16,500 17.2 Northampton 30,700 14.2 South Northamptonshire 16,400 18.8 Wellingborough 13,600 18.7 Northamptonshire 38 ONS Mid-year Population Estimates 2013 https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 P a g e | 44 Figure 43: Population aged 65+ by number39 Figure 44: Population aged 65+ by proportion (%)40 39 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census 40 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census P a g e | 45 8. Ethnicity and Place of Birth Detailed data on the ethnic structure of Northamptonshire is not as current as that on age and gender. This was however collected as part of the 2011 Census. Within the county the majority of the population falls within the White ethnic group. Just less than 10% of the population falls outside of this group. Residents of Asian origin represent the second largest ethnic group, making up just fewer than 4% of the population. Black groups make up about 2.5%, residents of Mixed Ethnic origin 2%, and those of Other Ethnic groups 0.4%. 41 Figure 45: Northamptonshire 2001 census ethnicity Figure 46: Northamptonshire 2011 census ethnicity 5% 8.5% 4% White White Mixed Mixed Asian Asian Black Black Other Other 95% 41 http://www.northamptonshireanalysis.co.uk/dataviews/view?viewId=169 91.5% P a g e | 46 Whilst the representation of non-white groups increased between the 2001 and 2011 censuses (Fig. 45 and 46), the county remains predominantly populated by resident from amongst White groups. The increase in other ethnic groups has however been significant. This has included a 100% increase amongst Black ethnicity residents, 85% in Asian residents, and an 82% increase in residents of mixed ethnicity. The population from those deemed other ethnic groups however declined; this may be explained by changes in classification, with the Chinese (or South East Asian) population being reassigned from other to Asian in the 2011 census. Parents’ country of birth reveals what types of ethnicities are living in Northamptonshire, and what the future populations’ ethnicity is going to look like. Parents’ country of birth in Northamptonshire and the districts within it for 2011-13 are displayed on the next page in figure 47. P a g e | 47 Figure 47: Parents’ country of birth: Northants and districts42 (*new EU = Joined the EU from 2004) Area of usual residence of mother 2013 2012 2011 42 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough ONS 2014 All live births 8,995 931 815 1,012 1,179 3,232 832 994 9,288 959 836 930 1,271 3,369 880 1,043 9,229 955 820 961 1,227 3,304 901 1,061 Mothers born within United Kingdom Mothers born outside United Kingdom Total births to mothers to non-UK born mothers Percentage of live births to non-UK born mothers EU New EU2 Rest of Europe (non EU) Middle East and Asia Africa Rest of World 6,811 635 704 903 994 2,116 745 714 7,170 704 725 820 1,045 2,337 773 766 7,204 705 711 849 1,014 2,293 812 820 2,184 296 111 109 185 1,116 87 280 2,117 255 111 110 225 1,032 107 277 2,025 250 109 112 213 1,011 89 241 24.3 31.8 13.6 10.8 15.7 34.5 10.5 28.2 22.8 26.6 13.3 11.8 17.7 30.6 12.2 26.6 21.9 26.2 13.3 11.7 17.4 30.6 9.9 22.7 1,187 239 71 61 95 528 34 159 1,131 201 66 54 116 487 44 163 1,008 197 58 48 96 433 38 138 1,024 217 56 39 77 469 16 150 957 186 52 28 97 430 18 146 842 177 48 26 73 385 17 116 84 8 7 6 5 43 1 14 92 16 6 2 7 48 3 10 79 10 9 3 8 42 1 6 418 13 15 14 43 260 17 56 365 9 15 11 49 208 17 56 402 14 15 15 60 237 10 51 399 31 13 14 31 259 13 38 410 25 10 17 44 260 18 36 419 23 17 23 37 267 20 32 96 5 5 14 11 26 22 13 119 4 14 26 9 29 25 12 117 6 10 23 12 32 20 14 P a g e | 48 Figures 48-51 below illustrate the trends for births of non UK mothers in Northamptonshire. Figure 48: Percentage of Births to non UK mothers Figure 49: Number of births to EU mothers (outside the UK) Percentage The percentage of births to non-UK mothers 25 24 23 22 21 20 2011 2012 2013 Figure 50: Number of births to mothers from new EU mothers Number of births The number of births to new EU* mothers 1050 1000 950 900 850 800 2011 2012 2013 Figure 51: Number of births from mothers of the rest of the world P a g e | 49 It is clear that the number of births in Northamptonshire to mothers born outside of the UK is increasing in percentage and absolute terms. The number of births to mothers born within the EU has been consistently increasing, and this is mainly due to the increasing number of new EU mothers. New EU state mothers make up a large percent of the EU births in Northamptonshire and this number is increasing (by nearly 200 additional births 2011-2013 totalling 1024 in 2013). The number of births to mothers from the rest of the world remains pretty static, with relatively more births to mothers from the Middle East and Africa (both around 400) compared to the rest of the EU and the rest of the world (both around 100). It is estimated that over the next 25 years 43% of population growth will be the result of migration43. This migration will have a structural impact on the population. Some projections suggest that within a number of Western European countries, including the UK, minority groups could constitute up to 40% of the national population by 205044. This has implications not solely in terms of ethnicity but in terms of balancing against a top-heavy population dependency; migrant populations have a role in both balancing the dependency ratio and maintaining a population under the age of 16 (Fig. 52). Figure 52: Ethnic group distribution by age in Northamptonshire 43 44 Source: ONS National Population Projections (2013) Source: Immigration, population and ethnicity: the UK in international perspective (2013), The Migration Observatory, University of Oxford http://migrationobservatory.ox.ac.uk/briefings/immigration-populationand-ethnicity-uk-international-perspective P a g e | 50 Figure 53: District and Borough population structure by age 201345 100% 95% 90% 85% 80% 75% 70% 65% 60% 55% 50% 16.6 14.0 18.7 18.7 17.2 14.2 Figure 54: District and Borough population structure by ethnicity 201146 Wellingboro 18.8 18.7 Northampton 20.1 63.3 21.2 64.8 18.7 62.5 19.4 61.8 20.1 62.6 2.9 19.2 20.4 84.5 3.2 61.8 3.6 1.2 1.30.4 6.5 93.9 5.1 1.4 3.2 1.1 East Northants 96.6 1.2 1.30.7 Daventry 96.5 1.2 1.50.6 Corby 62.0 5.9 96.9 Kettering 20.7 65.2 87.3 South Northants 95.5 82% 87% 1.4 1.3 1.6 92% 97% 102% White Mixed/multiple ethnic groups Asian/Asian British Aged 16-64 Aged 0-15 Aged 65+ Black/African/Caribbean/Black British Other ethnic group Later in this document the topic of ethnicity is discussed in fuller detail relative to specific groups. For example in the section on children (p.68) and the section on minority BME groups (p.93). Also: for age and gender population breakdown in five year bands please see appendix 4. 45 ONS Mid-year population estimates https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct& version=0&dataset=31 46 ONS Census 2011 http://www.ons.gov.uk/ons/rel/census/2011-census/keystatistics-for-local-authorities-in-england-and-wales/rpt-ethnicity.html P a g e | 51 Religion and belief47 In 2011, 64% of the county’s population was made up of residents who stated that they followed one of the main 6 religions, slightly less than the regional and national picture. The number of Christians in the county had reduced by 11.6 percentage points since the 2001 Census. There had been a corresponding increase of 11.2 percentage points in the number of the county’s residents with no religion. Between 2001 and 2011, there had also been small increases in all of the other main religions except those of Jewish faith. Figure 55: Religion distribution in Northamptonshire – pie Religion Percentage Point Change from 2001 East Midlands Percentage 2011 England Percentage 2011 Christian 59.87% 414,265 -11.64 58.81% 59.38% Hindu Buddhist 0.32% 2,194 0.08 0.28% 0.45% Hindu 1.16% 8,014 0.026 1.98% 1.52% Jewish 0.10% 679 -0.01 0.09% 0.49% Muslim 1.75% 12,104 0.85 3.10% 5.02% Sikh 0.40% 2,765 0.11 0.98% 0.79% Other Religion 0.42% 2,882 0.15 0.40% 0.43% No Religion 29.25% 202,379 11.26 27.53% 24.74% 6.74% 46,670 -1.06 6.83% 7.18% Muslim Sikh Other Religion No Religion Not Stated Not Stated 47 Count 2011 Buddhist National Citizenship Survey Schools designated with a religious character Percentage of Population 2011 Christian Jewish Recorded notifiable offences flagged ‘religion/faith’ Figure 56: Religion distribution in Northamptonshire – table http://www.ons.gov.uk/ons/guide-method/census/2011/census-data/index.html P a g e | 52 9. Socio-Economic Deprivation An Overview Socio-economic deprivation is considered to represent an important health determinant. This is supported by the notable difference which has been recorded between life expectancy in the most deprived and the most affluent areas of England. The extent of socio-economic deprivation in Northamptonshire is not as considerable as other parts of England, but specific pockets can be identified, particularly in the Corby and Northampton areas. Deprivation has a tendency to be concentrated in urban areas of the county; all of the Super Output Areas recording levels of deprivation which place them in the top 20% most deprived in England are found in urban parts of Northamptonshire. Health deprivation however has a higher occurrence at the most significant level in the county than overall deprivation. This is found within areas of Corby, Northampton, and to a lesser extent Kettering. The link between health deprivation and other forms of deprivation considered determinants is by no means explicit. Whilst 57% of those areas experiencing health deprivation amongst the top 30% in England also recorded similarly high levels of income deprivation, for environment deprivation this was 22% and for barriers to services was just 8%. This implies that health deprivation in Northamptonshire is partially linked to issues of income deprivation, but also in over 40% of cases is not linked to this nor particularly strongly to other standard determinants. In understanding the relationship between areas of socio-economic deprivation and health, and in particular unpicking the causal factors and how these manifest locally, a more detailed understanding of these areas, their embedded and recurring health issues, and the source of these problems should be considered. P a g e | 53 9.1 Socio-Economic Deprivation: Summary (IMD 2010) P a g e | 54 Socio-economic Deprivation in Northamptonshire The extent of socio-economic deprivation experienced by individuals and communities can have a significant negative impact on their health. The correlation between reduced life expectancy and increased socio-economic deprivation is significant; the range in life expectancy by local area varies by up to 9 years in England. This variance in life expectancy can be seen in something of a North-South divide which replicates the similar socioeconomic distribution in the UK48; it has also continued to widen, in particular between the most significantly deprived communities and the general population49. Fundamentally, health inequalities in populations across the globe are associated with a set of social determinants which affect the conditions and environment in which individuals and communities live50. The health implications of deprivation extend broadly. These are linked to a number of associated risks through behaviours and tendencies, including factors such as smoking, alcohol consumption and diet, alongside the environmental impact of the quality of housing, urban development, and the public realm. Such associated risks can lead directly or indirectly to health issues or medical conditions, or may be a result of an underlying condition with additional implications for the long term. Whilst it occurs within the county, socio-economic deprivation is not prevalent across the whole of Northamptonshire; in general deprivation levels around income, around child poverty, and around older people fall below the proportions for England. Instead it is unevenly dispersed across the seven lower tier authority areas. Using average deprivation scores for Local Authorities taken from the Indices of Multiple Deprivation (IMD 51), none of Northamptonshire’s localities indicate significant concentrations of deprivation that position them within the 10% most deprived local areas of England. The most deprived locality is Corby, which sits in the 2nd most deprived decile, followed by Northampton in the 4th decile and Wellingborough in the 5th. The remaining four localities all fall within the 50% least 48 Source: ONS Life expectancy at birth and at age 65 for local areas in England and Wales 2010-12 http://www.ons.gov.uk/ons/rel/subnational-health4/life-expectancy-at-birth-and-at-age-65-by-local-areas-inengland-and-wales/2010-12/index.html 49 Source: UK Parliament Public Accounts Committee (2010) Tackling inequalities in life expectancy in areas with the worst health and deprivation http://www.publications.parliament.uk/pa/cm201011/cmselect/cmpubacc/470/470.pdf 50 Source: World Health Organisation (2008) Commission on social determinants of health: Final Report http://www.who.int/social_determinants/thecommission/finalreport/en/ 51 Indices of Multiple Deprivation = a study of deprived areas. This covers seven areas of deprivation: income, employment, health & disability, education, skills & training, housing, crime and living environment. P a g e | 55 deprived areas, with South Northamptonshire recorded as the 4th least deprived locality in England. (All the deprivation data in this section of the demography chapter refers to the IMD 201052.) Over 88,000 Northamptonshire residents (13%) lived in the most deprived areas in England (based on the LSOA). This is an increase of 3% from the last publication of the index. 76% of this deprived population were income deprived. Northamptonshire’s Local Authorities rank in this order: 1. Corby (Most deprived) 2. Wellingborough 3. Northampton 4. Kettering 5. Daventry 6. East Northamptonshire 7. South Northamptonshire (Least deprived) This is the same countywide order of ranking as previously. All of Northamptonshire’s districts now rank as more deprived in national terms than previously. Of Northamptonshire’s 407 Super Output Areas (SOA), there are 17 that fall in the top 10% most deprived in England. These are located in Corby (5), Kettering (2), Northampton (7) and Wellingborough (3). This is 5 more than in 2007. There are a further 40 areas that fall within the top 20% most deprived nationally. These are located in Corby (8), Daventry (1), Kettering (4), Northampton (20) and Wellingborough (7). This is 8 more than previously. 75% of the areas that are the most deprived in 2010 were also amongst the most deprived in 2007. There are 12 more Northamptonshire areas in the top 20% of the 2010 index than in the 2007 index suggesting that the local picture may have worsened. 9.2 Countywide The proportion of the district/borough population living in the most deprived areas in Northamptonshire are as follows:        52 Corby 43% Northampton 27% Wellingborough 22% Kettering 19% East Northamptonshire 9% Daventry 4% South Northamptonshire had no areas in the county’s most deprived. IMD 2010 P a g e | 56 6 LSOAs are new to the list of the top 20% most deprived in the county (Kettering 1, East Northamptonshire 2, Corby 2, and Wellingborough 1), which means that they may be relatively more deprived in 2010 than in 2007. 6 LSOAs have dropped out of the list of the most deprived in the county (Northampton 4, Corby 1 and Wellingborough 1), which means that they may be relatively less deprived in 2010 than in 2007. Only 24% of Northamptonshire’s LSOAs have a better IMD ranking in 2010 than in 2007, which means that the majority of LSOAs now rank as more deprived than previously. Results varied by district, with a higher proportion of LSOA in South Northamptonshire and Wellingborough showing improvement in rankings and a high proportion of worsening of rankings in Corby and East Northamptonshire. 9.3 District level deprivation Corby remains Northamptonshire’s most deprived district (ranking as the 51st most deprived local authority out of 326 nationally), followed by Northampton (127th), Wellingborough (138th), Kettering (186th), East Northamptonshire (229th), Daventry (253rd) and South Northamptonshire (323rd). This order is the same as in 2007 when the previous IMD was released. Direct comparisons of local authority ranks between 2007 and 2010 are not possible as there are 28 fewer local authorities in 2010 than 2007; however using a percentage rank gives an indication (see Table beneath). Figure 57: Average IMD ranking change by district Average IMD rank % rank LA Name 2010 2007 2010 Corby 51 57 16% Daventry 253 273 78% East Northamptonshire 229 246 71% Kettering 186 206 57% Northampton 127 129 39% South Northamptonshire 323 323 99% Wellingborough 138 165 43% 2007 19% 85% 76% 64% 40% 100% 51% Change IMD rank -6 -20 -17 -20 -2 0 -27 % rank -3 -7 -5 -7 -1 -1 -8 Figure 58: Proportion of LSOAs in each district by IMD 2010 decile What do the colours mean? Figure X shows that distribution of LSOA by deciles differs greatly between districts in Northamptonshire. South Northamptonshire has no LSOA below the 5th decile indicating that it is much less deprived than the other districts. Corby doesn’t have any LSOA in the 10th decile (least deprived) and has larger proportions of LSOA in the lower deciles P a g e | 57 indicating a more deprived district. This is very similar to the pattern that was seen from the IMD 2007 Small area deprivation – Where Northamptonshire sits nationally in 2010 57 Northamptonshire LSOAs fall among the 20% most deprived nationally. Table 2 lists the numbers in each district, the proportion of the district’s LSOAs that fall in the 1st and 2nd Decile in 2010 and the change in number and proportion from 2007 for both 1st and 2nd Decile. Figure 59: Numbers of LSOA in most deprived nationally, by district Table X: IMD 2010: LSOA in 1st decile (1-10%) most deprived in England A negative number in the change column indicates that the LSOA achieved a ‘worse’ rank in ID2010 than in ID2007. Northamptonshire LSOA (94%) in the top 10% most deprived have a worse rank nationally in 2010 than in 2007. Figure 60: IMD 2010 – LSOA in the 2nd decile (11-20%) most deprived in England A negative number in the change column indicates that the LSOA achieved a ‘worse’ rank in ID2010 than in ID2007. Northamptonshire LSOA (94%) in the top 10% most deprived have a worse rank nationally in 2010 than in 2007. P a g e | 58 Figure 61: IMD 2010 – LSOA in the 2nd decile (11-20%) most deprived in England 9.4 Small area change in detail P a g e | 59 Figure 62: District ranking (less or more deprived than national comparators) Rank as less deprived Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough Rank as more deprived 14% 11% 17% 86% 89% 83% 28% 19% 40% 72% 81% 60% 45% 55% The following maps show the distribution of deprivation across Northamptonshire, relative to the national picture, by district. The basic pattern of deprivation remains similar to previous years, with South Northamptonshire having the least deprivation and Corby, the most. All the LSOA that fall in the top 20% most deprived in England are in urban areas, most in the larger towns in the county. Figure 63: Corby IMD P a g e | 60 Figure 64: Corby LSOA that fall in the county’s top 20% most deprived P a g e | 61 Figure 65: Daventry IMD Figure 66: Daventry LSOA that fall in the county’s top 20% most deprived Figure 67: East Northamptonshire IMD P a g e | 62 Figure 68: East Northants LSOA that fall in the county’s top 20% most deprived Figure 69: Kettering IMD P a g e | 63 Figure 70: Kettering LSOA that fall in the county’s top 20% most deprived Figure 71: Northampton IMD P a g e | 64 P a g e | 65 Figure 72: Northampton LSOA that fall in the county’s top 20% most deprived P a g e | 66 Figure 73: South Northamptonshire IMD There are no South Northamptonshire LSOAs that fall in the county’s top 20% most deprived. It is the only Northamptonshire district where this is the case. P a g e | 67 Figure 74: Wellingborough IMD Figure 75: Wellingborough LSOA that fall in the county’s top 20% most deprived P a g e | 68 Considered on the basis of its 407 lower level Super Output Areas (SOA)53, Northamptonshire has 17 areas which are recorded as amongst the 10% most deprived in England and a further 43 in the second most deprived 10%. Whilst a number of these are found within Corby and Northampton, they can also be found in a further four of the remaining five lower tier areas. The general distribution of these deprived areas is focused around the urban centres of Northamptonshire, in Daventry, Northampton, Rushden, Wellingborough, Corby, Kettering and Rothwell (Fig. 76). Figure 76: Deprivation in Northamptonshire by lower level Super Output Area54 The extent of deprivation within those in the highest quintile ranges significantly. The difference between the measured deprivation in the most and the least deprived of Northamptonshire’s SOAs in the top 20% , in excess of 35 points, is greater than the difference between the least deprived of this group and the most affluent SOA in Northamptonshire. Whilst the extent of deprivation increases moving from the least to the most deprived, the incline becomes noticeably sharp closer to the most deprived, with significant jumps within the 20 most deprived SOAs (Fig. 73). 54 Source: https://www.gov.uk/government/collections/english-indices-ofdeprivation P a g e | 69 10. Children An Overview The population of children, classified as those aged 0-15 years, is comparatively high in Northamptonshire, as a proportion of the population, around 20%, 1% point higher than the figure for England. Whilst this proportion varies across the seven districts and boroughs, in six of these it remains greater than the national figure. Within these lower tier areas particular concentration can be identified within a certain number of super output areas. The distribution of age groups at the sub-county level shows three tendencies. Whilst some localities show a consistency with the county profile, others divert from this on the basis of either a greater concentration of early years children or of children aged 10 and over. A number of children within the county have special support needs. These range from requirements for educational support to deal with learning difficulties to more life-limiting illnesses and disabilities. Whilst the number with identified needs appears to be growing, the extent to which this is related to a greater occurrence of conditions or a better system of understanding and diagnosis is not clear. Across key groups with special needs – Special Educational Needs, Community Health Support clients, NEETS, and those recognised as disabled or with a longterm illness – the higher level of incidence in certain parts of Northamptonshire, specifically Corby, Northampton and Wellingborough, suggests a correlation between socio-economic deprivation and additional needs. P a g e | 70 10.1 Children: Summary P a g e | 71 The health of children is a critical concern. Their general health and the associated exposures they experience during their upbringing has repercussions on their future health alongside their broader life opportunities. This is embedded across their childhood, from teenage years stretching back to their post-birth and pre-birth care. Recognition of this issue and the role it plays in building a healthier population alongside managing potential future costs to the health system is a pivotal aspect of both national and local health policy. The priority health issues for children vary significantly, emerging as they move between age groups and stages of development. Whilst the principal health issues faced by this group and risks or factors associated can be identified, significant variation is likely to occur as issues emerge in different ways throughout their upbringing. In earlier years obesity is an emerging issue which in turn has been linked back to early years and even pre-birth care. Children’s high level of dependence, and therefore high exposure to influence, is interned in relationships they have with their parents, schools, peers, and living environment. This has both demographic and spatial implications. Figure 77: Northamptonshire child population by age group 201155 Aged 0-4 Total Aged 5-9 Total 46012 Aged 10-14 Total 41194 Aged 15-19 Total 42030 Total 42500 171736 Figure 78: Northamptonshire birth rate projections56 2012 8900 2013 9000 2014 9000 2015 9000 2016 9100 2017 9200 2018 9300 55 Source: ONS Census 2011 Age Structure https://www.nomisweb.co.uk/census/2011/ks102ew 56 http://www.ons.gov.uk/ons/taxonomy/index.html?nscl=Births+and+Fertility 2019 9300 2020 9300 P a g e | 72 This age distribution also shows some concentration of certain groups within specific locations. The higher birth rate and therefore proportion of 0-4 year olds is concentrated within four lower tier areas; Wellingborough and Kettering to a marginal extent and Northampton and Corby more significantly. A converse trend is apparent in Daventry, East Northamptonshire and South Northamptonshire with larger concentrations of the groups aged 10+ (Fig. 79). The variance from the county distribution of concentration suggests the lower tier areas can potentially be divided into three profiles; relative proximity to the Northamptonshire picture (Kettering and Wellingborough), significant diversion on the basis of early years children (Corby and Northampton) and significant diversion in later year children (Daventry, East and South Northamptonshire). In terms of the management of demand and provision of support, two critical issues emerge. The first of these is around the support of child population concentrations and the testing of a presumption that key concerns within specific groups occur in these localities in line with proportional representation. Second is the mobility of this population and whether the higher numbers of older aged children in parts of Northamptonshire is linked to historic localised growth trends or broader county-based upward housing mobility. Figure 79: Distribution of child age groups by District/ Borough57 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 24.3% 26.1% 26.2% 23.9% 24.7% 24.3% 23.8% 24.7% 23.9% 26.3% 25.8% 24.2% 22.5% 26.9% 24.8% 24.5% 24.3% 23.8% 24.7% 23.3% 25.4% 24.2% 24.0% 23.4% 24.2% 27.2% 29.4% 23.3% 27.2% 26.8% 23.0% 28.8% Aged 0-4 Total Aged 5-9 Total Aged 10-14 Total Aged 15-19 Total For full detail for population by five year age groups please see appendix 4. 57 Source: ONS Census 2011 http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-localauthorities-in-england-and-wales/rpt-ethnicity.html P a g e | 73 10.2 Children in ethnic groups The growing population of children within Northamptonshire is being partly underwritten by its increasingly diverse population of ethnic groups. As at the 2011 Census White British groups represented just fewer than 86% of the county’s population, but amongst those aged 15 and under this was only 82.5%. Whilst for the most part relatively marginal numbers, the concentration of children amongst specific ethnic groups is in some cases significantly higher than their representation of the whole population. This is particularly prominent amongst White and Black Caribbean, White and Asian, Bangladeshi, and African populations. With specific social, cultural and dietary characteristics this may produce a set of additional demands in specific parts of Northamptonshire, particularly in Northampton and Wellingborough where the population of ethnic groups is more prominent. With expectations that ethnic populations are to rise heading toward 2050 this will likely provide additional pressure, not only responding to the distinct needs of these groups but also to requirements for additional support such as for pupils whose first language is not English. In 2013 the percentage of children from ethnic populations designated as ‘in need’ stood at 21% (Fig. 80) against a proportional representation in the population of 17.5%. The top five languages spoken in schools in Northamptonshire other than English (figure 81) reflect contemporary immigration trends, with a large number of Polish speaking children (2,405). The number of children who speak English as a first language is 93,230, compared to 12,046 who have a first language which is not English. Figure 80: Children in need 2013: ethnicity distribution58 58 59 Source: Extract from CHMAT 2013 http://www.chimat.org.uk/ Figure 81: Top 5 Languages spoken in schools other than English59 Main Language Number of children Polish 2,405 Bengali 831 Romanian 466 Lithuanian 436 Somalian 428 BIPI Children’s team P a g e | 74 10.3 Children with Special Educational Needs There has been a growing trend toward the recognition of a number of special support needs amongst the child population. Whilst a number of these may be highly visible in terms of physical disabilities, others around long-term special educational needs and mental health will be less easily identified. Both healthcare and other forms of support will need awareness of and planning for not only continued provision but accommodation of developments in the treatment of specific conditions alongside the ongoing introduction and segmentation of such needs. Special Educational Needs (SEN) within schools in Northamptonshire is calculated at 8,135 places. This represents around 6.5% of those within the 5-19 age bracket. The occurrence across localities shows notable variance, with higher proportions in schools in Wellingborough, Corby, and Northampton (Fig. 82); the extent to which this represents a concentration of issues within these areas or simply a more sophisticated process for identifying and supporting SEN would need further examination. Mental Health has become an increasingly important part of healthcare, recognising the impact undiagnosed conditions have on individuals as well as their social and economic impacts. Amongst children, as with the adult population, these appear to have increased over time, although the extent to which this is representative of a growing occurrence or simply better forms of diagnosis and more mainstream recognition is unclear. Similar to the adult population whilst mental health may affect anyone, there is a higher tendency within specific groups at risk of exclusion including those experiencing deprivation, people with disabilities, and those from BME or LGBT communities. Within Northamptonshire a higher than expected number of children are known to local mental health support services and looked after by the County Council; similarly the rate of hospital admission due to mental illness in Northamptonshire is almost treble of any other sub-region in the East Midlands60. The distribution of demand amongst those aged 19 years and below for community health support is highest in Northampton; the remaining districts and boroughs show a similar level of demand, although the extent to which this represents unmet or unidentified demand is not clear (Fig. 83). 60 Source: PHAST (2014) Health needs of children and young people in Northamptonshire, with emphasis on mental health http://www.google.co.uk/url?url=http://www.northamptonshireanalysis.co.uk/resource/view%3FresourceId%3D653&rct=j&frm=1&q=&esrc=s&sa=U&ei=ulYRVN7KLpHPaI SJgugO&ved=0CCUQFjAA&usg=AFQjCNGXDnWRnGBY2c7ebV6ZPtGaweFHnQ P a g e | 75 Figure 82: SEN in Northamptonshire Districts / Boroughs (2014)61 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough 61 62 Aged 5-19 125,724 11,164 14,274 16,397 16,742 37,995 15,686 13,466 SEN Support 8,135 811 767 1,011 970 2,677 763 1,136 % of 5-19 6.5% 7.3% 5.4% 6.2% 5.8% 7.0% 4.9% Figure 83: Community Health Clients aged 0-19 years by District / Borough (2014)62 Locality Corby Daventry & S. Northamptonshire E. Northamptonshire Kettering Northampton Wellingborough Clients 0-19 yrs 278 649 296 407 1256 280 % 0-19 pop. 1.8% 1.7% 1.4% 1.8% 2.3% 1.5% 8.4% Source: BIPI Children team Source: PHAST (2014) Health needs of children and young people in Northamptonshire, with emphasis on mental health http://www.google.co.uk/url?url=http://www.northamptonshireanalysis.co.uk/resource/view%3FresourceId%3D653&rct=j&frm=1&q=&esrc=s&sa=U&ei=ulYRVN7KLpHPaI SJgugO&ved=0CCUQFjAA&usg=AFQjCNGXDnWRnGBY2c7ebV6ZPtGaweFHnQ P a g e | 76 10.4 Looked After Children The number of children in care within the county has shown a significant increase during the past decade. As of 2014, cases of children in care stood at 817, over 50% higher than the number of cases in 2005 (Fig. 84). Across the districts and boroughs the number of children in care varies; there is however a more significant level of demand found in the urban areas of Northampton, Corby, Kettering and Wellingborough. Figure 84: Looked After Children 2005-201463 900 817 795 800 700 735 729 645 700 600 Figure 85: Cause of children entering care (2014)64 565 555 535 555 other, not known or not stated absent parenting family low income socially unacceptable behaviour 6.1% 3.2% 0.5% 2.0% 500 family dysfunction 400 18.1% family in acute stress 300 parent's disability or illness 200 own disability or illness 100 abuse or neglect 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 63 Source: BIPI children’s team 64 Source: BIPI children’s team 9.6% 3.3% 11.8% 45.6% P a g e | 77 The age profile for children in care shows the highest level of demand in those aged 10 to 18. This group represents 61% of cases in care within Northamptonshire. Considering the increase in child population in particular in the localities of Northampton and Corby, there may be expectations that demand for this service increases within the next 5 to 10 years as the post-2008 surge in births reaches this age bracket. The reasons for children becoming looked after are varied. For Northamptonshire most prominent amongst these cases are concerns of abuse or neglect, representing 46% of children in care, followed by family dysfunction (18%) and disability or illness (12%) (Fig. 85). Managing the occurrence of looked-after children within the county extends beyond the provision planning of services, with a number of these causes linked to wider socio-economic conditions such as long-term or institutional deprivation. P a g e | 78 10.5 Young People Not in Education Employment or Training Those aged 16-18 who are not in employment, education, or training (NEETs) have been determined a priority group for intervention and support. NEETs in Northamptonshire during the 2013-14 year varied across the period, influenced by not only changes in individual employment status but also periods of formal registration in training and education, but stood between 5.7% and 7.7% of the 16-18 population. The proportion of 16-18 year old NEETS is most pronounced in Corby, in Wellingborough and in Northampton where it is most consistently high (Fig. 86). Figure 86: 16-18 year old NEETs 2013-1465 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Apr-13 65 Connexions Northamptonshire Jul-13 Oct-13 Jan-14 P a g e | 79 10.6 Children with disabilities The number of children identified as having a disability or long-term illness is relatively low in Northamptonshire standing at 3.6% of the 0-15 population, although this is in line with the proportional distribution for England. The higher proportion of children within Northamptonshire does however suggest a greater per capita demand for support. The incidence of child disability is relatively consistent across the county, with two specific diversions from this; in Corby it is notably higher at 4.2% whilst in South Northamptonshire it is significantly lower at 2.5% (Fig. 87). The polarised extent of deprivation experienced in these two localities suggests that whilst not always the principal factor, a higher level of socio-economic deprivation may contribute to the progression of specific conditions and their effect on individuals’ lives. Figure 87: Children (0-15) with disability / long-term illness (2011) (%)66 4.5% 4.0% 3.5% 3.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0% 66 4.2% 3.6% 3.4% 3.8% 3.6% 3.9% 3.6% 3.7% 2.5% ONS Census 2011 Long-term health problem or disability https://www.nomisweb.co.uk/census/2011/qs303ew P a g e | 80 Figure 88: Children with longstanding Disabilities or illness (2011) Boys Figure 89: Children with severe disability or illness (2011) Girls 10000 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 0 to 4 5 to 9 10 to 14 15 t0 19 Longstanding Illness or disability Figures 88 and 89 illustrate the potential prevalence rates of disabilities in Northamptonshire children, based on the estimates of the Child and Maternal Health intelligence Network67. It is clear that severe disabilities are much less common, and that generally speaking there is a higher percentage of boys who are disabled than girls. 67 http://atlas.chimat.org.uk/IAS/profiles/profile?profileId=44&geoTypeId=4 P a g e | 81 11. Young Adults An Overview Comparatively the proportion of young adults (18-30), resident in Northamptonshire is low. Northampton is the only part of the county which shows a higher concentration than the England average. The distribution within the county replicates the national tendency amongst this demographic for preferring urban living; the concentrations at super output area are found in or on the edges of the urban centres of Northampton, Corby, Wellingborough, Rushden and Kettering. The proportion of Young Adults with higher qualifications at NVQ level 3 and particularly level 4 falls notably below the national average, and the occupational structure shows a high reliance amongst this group on lower level employment. Whilst JSA claimant numbers are relatively low, there are particular issues in certain parts of the county including Corby, Daventry and Wellingborough. The higher prevalence of forms of unemployment in these areas may be indicative of different issues of access to employment on the basis of socio-economic or locational marginalisation. P a g e | 82 11.1 Young Adults: Summary (2013) P a g e | 83 The young adult demographic (the age 18-30 group) may not be one traditionally associated with health risks. There are however a number of prevailing issues faced by this demographic with the potential to seriously impact life chances, impede their quality of life, and increase the chances of dependence on the health system at a later stage of their life. In terms of behaviours associated with health issues these can be most prevalent amongst young adults; people are most likely to be smokers between the ages of 20 and 3468, those aged 16 to 24 were most likely to have drunk very heavily at least once a week 69, and similarly the proportion of this group who used illegal drugs was almost double that of the figure for the broader 16-59 age group70. Exposure to these stimulants brings a set of associated risks with it. Alongside the direct short- and long-term health implication, ranging from addiction to respiratory disease, cancer and cardiovascular disease, young adults face risks to their health ranging from the mental health impacts of drug use, increasingly associated with psychotic disorders71, to STI’s and unwanted pregnancies, to involvement in violent crime in either social or domestic settings. Young adults represent a major user and client of key areas of expenditure for the NHS; mental health support is the largest single cost within the NHS72 and for A&E departments the highest demand came from 20-24 year olds, and of the 4 highest set of user, only the 1-4 age bracket diverted from concentration outside of ages 15 and 2973. Alongside the growing issues of obesity and related diagnosis of diabetes there are a broad set of issues concentrated within this demographic with potentially far reaching consequences. 68 Source: Action on Smoking and Health (2014) Smoking statistics April 2014 http://ash.org.uk/files/documents/ASH_107.pdf 69 ONS (2013) Drinking habits amongst adults 2012 http://www.ons.gov.uk/ons/rel/ghs/opinions-and-lifestylesurvey/drinking-habits-amongst-adults--2012/stb-opn-drinking-2012.html 70 Health & Social Care Information Centre (2013) Statistics on drug misuse: England 2013 http://www.hscic.gov.uk/catalogue/PUB12994/drug-misu-eng-2013-rep.pdf 71 Royal College of Psychiatrists http://www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/alcoholanddrugs/cannabisandme ntalhealth.aspx 72 Nuffield Trust http://www.nuffieldtrust.org.uk/data-and-charts/nhs-spending-top-three-diseasecategories-england 73 Source: The Health Foundation / Nuffield Trust (2014) Focus on: A&E attendances http://www.nuffieldtrust.org.uk/publications/focus-on-ae-attendances P a g e | 84 11.2 Socio-Economic Demographics of Young Adults The socio-economic profile of Young Adults in Northamptonshire indicates a higher level of concentration in lower income, earning, and skills groups when compared with national data. Across the workforce of the county the number of people with higher level qualifications is comparatively low, with a representation of people with no qualifications and NVQ level 2 qualifications (Fig. 90). Whilst for England the proportion of residents holding higher level qualifications marginally rises in the 16-34 group, for Northamptonshire this figure declines by almost 2%. This difference is more pronounced within certain localities. Strong concentrations of NVQ level 4+ qualifications in Daventry and South Northamptonshire drop significantly for the 1634 age group, and the only locality where this increases is Northampton, potentially related to its stronger attraction to this demographic as a principal urban area. Figure 90: Qualification profile 16-34 years (2011)74 Northamptonshire 22.3% 15.2% England 22.5% 13.3% 0% 20% 16.6% 15.2% 40% 11.9% 24.1% 12.4% 60% 27.4% 80% No qualifications Level 1 qualifications Level 2 qualifications Level 3 qualifications 100% The distribution of employment within the age group 16-24 indicates a greater reliance on employment within lower level occupation groups in Northamptonshire. This is particularly strong in the areas of Wellingborough, Daventry, and particularly Corby. At the other end of the Northamptonshire occupational scale is South Northamptonshire, which more closely replicates the national picture showing a more even distribution across occupational groups and a stronger concentration in the top scale (Fig. 91). 74 Source: ONS Census 2011Highest level of qualification by sex by age http://www.nomisweb.co.uk/census/2011/dc5102ew P a g e | 85 Figure 91: Employment by occupational group (2011)75 Wellingborough 16.0% 20.9% South Northamptonshire 20.2% Northampton 18.5% 20.2% Kettering 17.6% 21.1% East Northamptonshire 18.0% 22.0% Daventry 17.6% 21.7% Corby 13.5% Northamptonshire 23.0% 16.0% 17.7% England 10% Group 1 24.3% 35.5% 25.8% 33.4% 27.9% 33.4% 26.6% 29.2% 31.5% 32.3% 38.1% 33.6% 20.8% 20% 28.7% 32.5% 20.7% 21.2% 0% 34.4% 30% Group 2 28.1% 33.9% 40% 50% Group 3 60% 24.0% 70% 80% 90% 100% Group 4 This limited skills provision and higher dependence on low skilled, low paid employment amongst young adults can be linked to insecure employment and high turnover industries. An outcome of this can be a tendency for higher or more frequent levels of unemployment. Nationally the rise in unemployment amongst particularly the 16-25 age group has been of critical concern, with levels measured in 2011 in excess of 1 million, equivalent to 20% of this group unemployed. In terms of JSA claimant numbers in both the under 35 and under 25 groups, Northamptonshire is consistently below the national average. Proportions for claimants, claims under 6 months, and claims over 6 months all are lower than those found for England; this is however more marginal for the under 25 group (Appendix 2). More localised issues emerge within this data. The proportion of claimants aged under 25 is notably high in both Corby and Daventry, which alongside East Northamptonshire also display a high proportion of those claiming JSA for under 6 months. Also in Corby there are signs of long term unemployment amongst both under 25’s and under 35’s being a problem. In terms of the proportion of those under 25 claiming long term JSA, this is only in excess of the national profile in Wellingborough, a phenomenon which extends into the under 35 group. 75 Source: ONS Census 2011 occupation by economic activity by age (Group 1 highest occupational group, Group 4 the lowest) http://www.nomisweb.co.uk/census/2011/dc5102ew P a g e | 86 12. Older People An introduction Whilst the population of Northamptonshire continues to grow, this is in line with national trends witnessing an increasingly ‘top-heavy’ population. Significant improvements in the lifestyle and quality of life have contributed toward people having longer lives and staying healthy for longer, but a prominent issue exists around the extent of support demands amongst this group, particularly as they become more frail and vulnerable from the age of 85 on. This age group has a tendency to live in less densely populated areas. This presents a problem not only around access to services but also around the impact of isolation on both physical and mental health. The independence of this group, particularly those amongst the more affluent, becomes seriously compromised as they pass 85, requiring a form of support and service engagement they may be unfamiliar with. In the long term the compromising of this personal independence may be compounded by a declining level of financial independence as pension incomes and savings decline and the impact of wider pension shortfalls becomes apparent. Whilst significant attention within this group is directed at the high cost of intervention for those aged 85+, there is evidence of variation in life expectancy both by location and by social group. The lower number of those aged 85+ within certain localities of Northamptonshire may be more indicative of a significantly lower level of life expectancy linked to institutional health issues embedded in these communities. P a g e | 87 12.1 Older People: Summary (2013) P a g e | 88 The population of the UK is ageing at a significant rate. Whilst the overall population of England grew by around 15% between 1983 and 2013, the population of over 65’s grew at more than twice this rate. The growth in this population has a number of implications for the management and delivery of both direct health and broader support services. As the population of retired people makes up a growing proportion of the population, so the ratio of people with support needs increases with a smaller proportion of working age adults to provide this support; this brings with it significant issues in the management of such support services. Older people face a number of care issues rooted in the ongoing decline of their physical and mental health. Part of this is a general organic process as they reach the end of their lives, whilst others are caused by institutional personal behaviours such as smoking or drinking and socio-environmental conditions linked to issues such as mobility, isolation, domestic environment and wider social and environmental conditions. Alongside this, the demographic of the 65+ group has significantly evolved, with segmentations based around age and socio-economic status determining extent of support as well as general quality of life in old age. 12.2 Critical groups for service demand amongst older people Whilst the surge in the over 65 population is partly explained by the ‘baby boom’ after World War II, this has been supplemented by the improvement in longevity across the UK. Significant variances can be identified between areas of deprivation and affluence, but the general trend has been for an increased lifespan, with the average life expectancy at 65 increasing by between 18 and 20 years in the period from 1982 to 201276. This longevity brings with it a number of issues for both individuals and the support services on which they increasingly become dependant. As people become older they also become more frail and vulnerable, with an increasing number aged 85+ falling into this category. This also has an impact on personal income and the extent to which they can remain financially independent. Living alone also becomes an issue, resulting in amongst other things increasing social isolation with implications for individuals’ mental health and wellbeing. 76 ONS National Life Tables http://www.ons.gov.uk/ons/rel/lifetables/national-life-tables/2010---2012/index.html P a g e | 89 The population aged 85+ in Northamptonshire represent just fewer than 13% of the 65+ age group, in line with but marginally below the national profile. Populations within the lower tier areas are more significant in the areas of Northampton and Kettering (Fig. 92) Figure 92: 65+ population by age sub-group77 Wellingborough 87.6% 12.4% South Northamptonshire 87.9% 12.1% Northampton 86.3% 13.7% Kettering 86.0% 14.0% 86.8% East Northamptonshire 13.2% Daventry 88.6% 11.4% Corby 89.2% 10.8% Northamptonshire 87.2% 12.8% England 86.7% 13.3% 80% 85% Aged 65-84 For absolute numbers in five year age bands please see appendix 4. 90% 95% 100% Aged 85+ The need for and therefore cost of both social and hospital care peaks within this age group, the majority coming within the social care bracket as it escalates after the age of 7578. Part of this will be committed through residential care but a key aspect will be the provision of domiciliary care. The distribution of this group and tendency to live in rural parts of the county have implications on access to support and its effective provision; whilst some concentration of older people in urban areas can be noted, this is due mainly to location of residential and nursing care 77 ONS Mid-Year population Estimates 2013 https://www.nomisweb.co.uk/query/construct/summary.asp?mode=construct&version=0&dataset=31 78 The Nuffield Trust http://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-life P a g e | 90 units(Fig. 93 and 94). The demands presented by this distribution will extend as this population is expected to almost double during the period 2014-2030, and will represent an increasing proportion of the 65+ age group, growing from 25% to 33%79. Figure 93: Population aged 85+ by number (2011)80 Figure 94: Population 85+ by (%) concentration (2011)81 The growth within this demographic and the difference in life expectancy between men and women will also lead to a greater number of people living alone. Whilst part of this is representative of societal change ranging from emerging cultural preferences and the fragmentation 79 Projecting Older People Population Information http://www.poppi.org.uk 80 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census 81 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census P a g e | 91 of the family unit, the prolonged lifespan of individuals following bereavement will also be a factor. Whilst proportionally the percentage of older people living alone is predicted to remain relatively consistent, the number will rise by almost 30% for those aged 65-74 and by almost 80% for those aged 75+ (Fig. 95). This is particularly significant for the female population aged 65+ who are projected to consistently represent around 70% of this group. Figure 95: Population 65+ living alone projections82 Population aged 65+ Population aged 65+ living alone % living alone Population aged 6574 Population aged 6574 living alone % living alone Population aged 75+ Population aged 75+ living alone % living alone 82 2014 2015 2020 2025 2030 121,700 125,400 142,400 160,800 184,000 43,233 44,477 51,051 59,915 68,761 36% 69,600 35% 72,100 36% 78,400 37% 78,700 37% 89,500 17,480 18,120 19,740 19,770 22,530 25% 52,100 25,753 25% 53,300 26,357 25% 64,000 31,311 25% 82,100 40,145 25% 94,500 46,231 49% 49% 49% 49% 49% Projecting Older People Population Information http://www.poppi.org.uk/ P a g e | 92 12.3 Dementia Dementia is a word used to describe a group of symptoms including memory loss, confusion, mood changes and difficulty with day to day tasks. There are many causes of dementia, with Alzheimer’s the most common. Caring for people with dementia is an ever increasing burden as people live longer due to improving health in society. Figure 96 beneath illustrates the most recent predictions for dementia in older people in Northamptonshire. Figure 96: Dementia prevalence in Northamptonshire (numbers)83 Year People aged 65-69 People aged 70-74 People aged 75-79 People aged 80-84 People aged 85-89 People aged 90 and over Total population aged 65 and over 2014 2015 2020 2025 2030 515 524 484 523 618 773 821 1,080 1,002 1,093 1,243 1,273 1,568 2,098 1,956 1,827 1,858 2,163 2,717 3,673 1,972 2,011 2,284 2,756 3,539 1,674 1,764 2,177 2,763 3,647 8,005 8,250 9,755 11,858 14,526 With the population of people having dementia predicted to nearly double in the next 15 years, this is an area which is of strategic importance. Adult Social Care spends a lot of money of residential and domiciliary care for people suffering with dementia. Public Health has a large role in terms of education and advice about dementia, as this population can be better cared for when symptoms are identified more early, and diagnosis and treatment can begin. This group of older people is large and it is going to get bigger. As people get older we are more likely to 83 http://www.poppi.org.uk/index.php?pageNo=334&areaID=8386&loc=8386 P a g e | 93 develop dementia, it cannot be completely prevented but research suggests that simple things like healthy lifestyle factors significantly lower risk.84 NHS England measure and publish the numbers of people on the dementia register at CCG level85. When these numbers are compared to the estimated prevalence rates dementia diagnosis rates can be worked out. The dementia diagnosis rates illustrate the percentage of probable dementia sufferers who have been identified by the CCG and put on the dementia register. - The dementia diagnosis rate for Nene CCG is 59.37%. - The dementia diagnosis rate for Corby CCG is 86.67% This means that there are many people in Northamptonshire who have undiagnosed dementia, especially in Nene CCG (Northamptonshire excluding Corby). As prevalence rates of dementia increase over time, Public Health needs to promote initiatives aimed at diagnosing this population early. 84 http://www.alzheimersresearchuk.org//dementia-riskfactors/#acc1/ 85 https://www.primarycare.nhs.uk/ P a g e | 94 13. Minority Groups / Groups at risk of exclusion An Introduction Whilst Northamptonshire is not highly diverse in terms of population, a number of residents from quite different backgrounds with disparate needs are resident within the county. These populations experience different levels of integration with the wider community and with service providers, and similarly face differing types and extents of social support networks through which they can address the various health issues emerging within their communities; these in a number of cases emerge as institutions which serve to reinforce certain problems. An issue amongst these communities is the extent of need driven by both the prevalence of the communities within Northamptonshire and the enduring nature of the health issues. These can and have proven changeable with implications for how both populations and their needs are interpreted. The evolving profile of the non-white British community within the county has seen a transition in recurring needs requiring more detailed understanding of the sub—groups. The transformation of interpretations of disability has extended this demographic and broadened the form of intervention required. Within certain minority groups the level of localised knowledge is very limited. As a result a number of presumptions have to be made in the interpretation of both the demographic profile and the principal support or intervention requirements of each community. Similarly a number of minority communities may not be addressed within this chapter and perhaps represent a group in need of support or with a particularly embedded issue healthcare providers face problems in dealing with. To this end what is required is more detailed analysis and examination of the minority groups outlined here and the ones not included. P a g e | 95 13.1 Minority Groups / Groups at risk of exclusion: Summary (2011) P a g e | 96 Across Northamptonshire there are a number of minority communities. The location and concentration of these can vary significantly between groups, ranging from archetypal ‘ghettoisation’ of specific cultural groups within highly localised urban areas to more dispersed and even transient forms. Alongside this broad spatial patterning the key health issues of the various groups consolidated under the minority classification can be quite diverse, rooted as much in socio-cultural behaviours, traditions and institutions as in their specific socio-economic and spatial context. As a result the principal issues faced across these groups are broad, becoming more distinctive as each group is considered independently of one another. Whilst not exclusive, within the minority classification key groups of concern are considered to be the BME, Lesbian Gay Bisexual and Transgender (LGBT), people with disabilities, and Traveller communities alongside offenders and asylum seekers. 13.2 Black and Minority Ethnic Communities The Black and Minority Ethnic (BME) community within Northamptonshire has been growing at a fast rate. Whilst the population of Northamptonshire is growing at a strong rate, this is partially dependent on increasing BME groups, with the Black community growing by 100%, the Asian community by 85%, and the mixed origin community by 82% between 2001 and 2011. The age profile within this group is potentially of critical importance within a county with an increasingly ‘top-heavy’ age profile. BME is a broad classification which incorporates a number of different groups with highly distinct cultural differences. It is also a dynamic group which evolves over time. The constitution of this group changes as nationalised groups move within and between localities and regions and as new groups enter the country as a result of various geo-political influences. Amongst non-white British communities resident in Northamptonshire, using a broad classification, the largest is the Asian community, estimated at around 25,000 in the 2011 Census. This is followed by the Black community estimated at 17,000 and the Mixed ethnic groups with 14,000 (Fig. 97). Recent trends since 2004 for migration from accession state within the European Union have led to an emergence of a further group from Eastern European countries. Within Northamptonshire this group stood at around 21,500 as at 2001; this figure only includes immigrants and does not include those nationalised and second or third generation. P a g e | 97 Figure 97: BME Communities in Northamptonshire (2011)86 Asian Eastern European (EU accession states migrants) Black Mixed ethnicity Other ethnic group 25,427 21,327 16,923 14,182 2,598 The BME community does show some signs of locating within certain parts of the county. Concentrations of non-white British groups are most commonly found within urban areas, in particular Northampton, Kettering and Wellingborough. Rather than evenly distributed within these areas they show a tendency to be concentrated in specific super output areas (Fig. 98 and 99). A similar trend is identified within the Eastern European migrant community; the East Midlands and East of England areas have seen a particularly high level of in-migration. Corby had in 2013 the 11th highest proportion of residents from EU Accession States, and a localised concentration within a handful of SOAs was evident in both Corby and Northampton87. Figure 98: BME (non-white British) population by number (2011)88 86 ONS Census 2011 Ethnic Group https://www.nomisweb.co.uk/census/2011/ks201ew; 87 Northamptonshire County Council (2013): Residents born in the EU Accession States 88 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census P a g e | 98 Figure 99: BME (non-white British) population by concentration (2011)89 Across the BME communities in Northamptonshire a very different age profile exists in comparison to the White British community. This sees a significantly lower proportion of the population within the 65+ age bracket and a greater proportion of younger adults and children. The age structure of the Asian community for example has over 71% of the population aged 16-64, against an overall population profile of 63%. The proportion of children amongst the mixed ethnic origin groups is over double that amongst white groups, and amongst residents from the EU Accession States the proportion aged 16-35 is 2.5 times higher than for the general population. Within Northamptonshire schools the proportion of students from non-White British groups stands at 17%, almost double the profile of the general county population. This is particularly pronounced in primary schools where the figure again goes up to almost 19%90. Whilst the BME community is broad and covers a number of cultures and ethnic groups, there is an additional distinction within it in terms of the extent of integration with general support infrastructure. A number of factors will influence this, but one such factor is the difference between immigrant and nationalised populations, and within this their level of spoken English. The number for whom English is not their main language stands at around 89 Northamptonshire Analysis http://www.northamptonshireanalysis.co.uk/bytheme?themeId=6&themeName=Population and Census 90 Department for Education (2012) https://www.gov.uk/government/publications/schools-pupils-and-theircharacteristics-january-2012 P a g e | 99 9,250 or 6% of the County’s population, with an estimated 1.4% unable to speak English well or at all91. The number of children within schools for whom English is considered a second language is higher still, standing at 9% of all students and 10.5% of those in primary schools92. This incidence of English as a second language and poorly spoken English is most prominent within Northampton, Corby and Wellingborough (Fig. 100). Figure 100: English as a 2nd language in Northamptonshire and Districts / Boroughs (2011)93 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Main language is not English Cannot speak English or English well This demographic is predicted to continue growing in Western Europe, with some projections suggesting the proportion of population made up of BME groups could reach up to 40% by 205094. The extent to which this is derived from natural growth within existing communities, the extension of groups of mixed ethnicity through cross-cultural relationships, or ongoing immigration trends underwritten by enhanced rights of movement or geo-political instability is unclear. 91 ONS Census 2011 DC2105EW - Proficiency in English by sex by age ONS 2011 92 Department for Education (2012) https://www.gov.uk/government/publications/schools-pupils-and-theircharacteristics-january-2012 93 ONS Census 2011 DC2105EW - Proficiency in English by sex by age http://www.ons.gov.uk/ons/data/dataset-finder//q/dcDetails/Census/DC2105EW?p_p_lifecycle=1&_FOFlow1_WAR_FOFlow1portlet_dataset_navigation=datas etCollectionDetails 94 Immigration, population and ethnicity: the UK in international perspective (2013), The Migration Observatory, University of Oxford http://migrationobservatory.ox.ac.uk/briefings/immigration-populationand-ethnicity-uk-international-perspective P a g e | 100 13.3 People with disabilities Defining disability is by no means straightforward, with a number of factors contributing to where individuals stand on what is a spectrum-approach to definition. A number of allowances and support are available on the basis of long-term ill health as well as a permanent disability, whilst the extent to which support is offered for permanent physical disabilities depends on their severity, nature and potential impact on independent living. Figure 101: Population with long-term health problem or disability (2011)95 20.0% 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% As at the last Census (2011) an estimated 112,000 people, or 16% of the population had some form of disability or long-term illness which restricted their day-to-day activities. The distribution found a stronger concentration of this demographic in the more urban areas of Corby, Northampton and Wellingborough (Fig. 101). Split between two distinct groups – those with day-to-day activities limited a little and those limited a lot – for most localities this recorded stronger concentrations in those with less limiting disabilities. The exception here is Corby, where the split was almost exactly 50:50. 9.0% 7.2% 8.9% 8.9% 9.0% 9.3% 9.4% 6.6% 6.9% 7.7% Day-to-day activities limited a lot 95 8.7% 7.2% 9.9% 8.2% 5.8% 7.9% Day-to-day activities limited a little ONS Census 2011 QS303EW - Long-term health problem or disability http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-andquick-statistics-for-wards-and-output-areas-in-england-and-wales/rftqs303ew.xls&rct=j&frm=1&q=&esrc=s&sa=U&ei=tIsRVPGQEMroaM_Agtg O&ved=0CBQQFjAA&usg=AFQjCNGlPnn1yrZ_hpxlqI0-ffmwNXSpLw P a g e | 101 The occurrence of limiting long-term illness or disability dramatically escalates with age. Across an overall population proportion of 16%, for the age groups to 55 years the occurrence falls below this. After this threshold the incidence escalates with some dramatic jumps in each 5 year band from the age of 70 onwards (Fig. 102). From this perspective, long-term illness and disability are an age specific phenomenon, the incidence and demand of which can be expected to increase as the top end age groups continue to grow. Figure 102: Occurrence of long-term illness and disability by age group (2011)96 90.0% 84.5% 80.0% 69.6% 70.0% 60.0% 54.4% 50.0% 42.4% 40.0% 31.8% 25.2% 20.1% 15.5% 20.0% 15.6% 12.3% 10.0% 8.3% 4.7%5.1%5.1%5.3%6.3% 10.0% 1.9%3.9% 30.0% 96 85+ 80 to 84 75 to 79 70 to 74 65 to 69 60 to 64 55 to 59 50 to 54 45 to 49 40 to 44 35 to 39 30 to 34 25 to 29 20 to 24 15 to 19 10 to 14 5 to 9 0 to 4 All ages 0.0% ONS Census 2011 LC3101EWls - Long term health problem or disability by sex by age http://www.google.co.uk/url?url=http://www.ons.gov.uk/ons/rel/census/2011-census/keystatistics-and-quick-statistics-for-wards-and-output-areas-in-england-and-wales/rftqs303ew.xls&rct=j&frm=1&q=&esrc=s&sa=U&ei=tIsRVPGQEMroaM_AgtgO&ved=0CBQQFjAA&usg= AFQjCNGlPnn1yrZ_hpxlqI0-ffmwNXSpLw P a g e | 102 13.4 Carers in Northamptonshire The population of carers in Northamptonshire is a distinct group of around 70,000 people. These people provide care for others either formally or informally. The 2011 Census revealed significant information about the nature of their caring activities and their demographics. Key Facts from the 2011 Census97 - - - - - - 97 Population o 10% of the Northamptonshire population are informal carers Caring Commitment o 67% care for 1-19 hours per week o 21% care for 50+ hours per week o 12% care for between 20 and 49 hours per week Age o 72% are 25-64 o 21% are over 65 o 7% are under 25 Ethnicity o 94% are White o 3% are Asian/Asian British o 2% are Black/African/Caribbean/Black British o 1% are Mixed/Multiple Gender o 58% are female o 42% are male General Health o 74% report having good or very good health o 20% report having fair health o 6% report having bad or very bad health Economic Activity o 58% are in employment o 38% are economically inactive o 4% are economically active but unemployed. http://www.northamptonshireanalysis.co.uk/dataviews/view?viewId=199 P a g e | 103 13.5 Lesbian, Gay, Bisexual and Transgender Data on the location and distribution of Lesbian, Gay, Bisexual and Transgender (LGBT) groups is generally considered to be unsatisfactory. Whilst analysis has been conducted to establish a general picture of the quantum of this population this is carried out at a macro level and has been challenged in terms of sampling and therefore validity. Current Government estimations place the LGBT population somewhere between 5% and 7%. A 2012 ONS survey suggested a much lower figure of around 1.5%98, which has been subsequently challenged due to both extent and design. Despite these criticisms, this survey did suggest that there were significant generational differences in those who were willing to identify themselves as LGBT; this was much more prominent amongst those aged 16-24 (2.6%) and significantly lower amongst the 65+ (0.4%). At the regional level significant differences in the LGBT population have been reported. This is highest in London and lowest in the East of England. The population of the East Midlands region is estimated at around 1.3%, although how this translates in Northamptonshire is unknown. Detailed statistics for this demographic are in short supply, and localised knowledge is limited due to a general lack of specialist provision. Attitudes toward the community99 may have an impact on some of their key health concerns around sexual and particularly mental health; in the year 2007/08, 3% of gay men and 5% of bisexual men attempted to take their own life compared to a figure of 0.4% for the male population in general. In the same year, 1 in 5 lesbian women deliberately harmed themselves against a general rate of 0.4%. Additional issues are highly prominent within the LGBT community around their consumption of various forms of stimulant. Both gay men and lesbian women show a stronger tendency to have smoked, although for women the quantity of cigarettes smoked was lower amongst lesbians compared to heterosexuals. They are also more likely to drink more often, although how this translates to quantity and ‘binge’ drinking is not clear. Half of gay men had taken illegal drugs during the year 2007/08 in comparison to only 1 in 8 men in general, whilst lesbian and bisexual women were five times more likely to have taken drugs than heterosexual women. 98 ONS (2012) Integrated Household Survey http://www.ons.gov.uk/ons/rel/integrated-householdsurvey/integrated-household-survey/january-to-december-2012/stb-integrated-household-survey-january-todecember-2012.html 99 http://www.stonewall.org.uk/documents/prescription_for_change.pdf P a g e | 104 In comparison to the general profile, the age structure is heavily concentrated at the lower age bands, running consistently above proportional figures for the county until the age of 40, after which it drops below this significantly (Fig. 103). The population of this community is heavily concentrated in two specific localities, Northampton and Kettering, with lower concentrations in Wellingborough and Daventry. Whilst cultural factors play a considerable role in their poor health, part of this issue may also be around engagement with services and the proximity of sites to healthcare services. Figure 103: Age profile for Northamptonshire population and traveller community 2011100 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Age 0 to 4 Age 5 to 7 Age 8 to 9 Age 10 to 14 Age 15 Age 16 to 17 Age 18 to 19 Age 20 to 24 Age 25 to 29 Age 30 to 34 Age 35 to 39 Age 40 to 44 Age 45 to 49 Age 50 to 54 Age 55 to 59 Age 60 to 64 Age 65 to 69 Age 70 to 74 Age 75 to 79 Age 80 to 84 Age 85 and over 13.6 Traveller and Gypsy communities The gypsy and traveller community both nationally and in Northamptonshire is a small group. Census data for 2011 suggests the Traveller community makes up less than 0.1% of the county’s population – just over 500 residents - although this has been challenged by the Countywide Travellers Unit in Northamptonshire County Council who claims this represents only one third of the true figure. Part of their reasoning is the tendency for men to not complete Census forms; the male: female ratio on the Census is however in keeping with the near 50:50 split that would be expected. Travellers are a group considered to face some of the highest levels of health deprivation, with significantly lower life expectancy, higher infant mortality, and higher maternal mortality alongside mental health issues, substance, misuse and diabetes. These issues are representative of various lifestyle factors alongside issues of poor education, lack of integration with mainstream support services and a lack of trust in such institutions. The age profile of the community in Northamptonshire illustrates the extent of the life expectancy issue for travellers. Northamptonshire 100 Traveller Community ONS Census 2011 Ethnic Group by Sex by Age https://www.nomisweb.co.uk/census/2011/dc2101ew P a g e | 105 13.7 Offenders Offenders represent a demographic with a concentration of health issues. Poor access to healthcare prior to their sentencing alongside the impact of social, economic and cultural factors means people serving in prison are likely to have a number of pre-existing health problems101 This can be exacerbated by the prison environment itself, with health issues ranging from long-term medical conditions to mental health problems, substance misuse and sexual health concerns. These issues may be enduring and require support and treatment after offenders have been released upon completion of sentence or on probation. At all stages of this process, whilst support may be forthcoming through the prison service and the individual prisons, responsibility for the commissioning of all health services sits with NHS England. This has direct implications for the health support infrastructure in Northamptonshire. The population of those designated offenders covers two specific groups. The first is the prison population of Northamptonshire. As things stand, the county has two Category 3 prisons – Onley and Rye Hill - housing a number of what is considered lower risk offenders. This however will change as one of these is set to become a specialist institution specifically housing sex offenders. Whilst the number of prisoners within the county is not likely to significantly change, this will have some implications on the profile and needs of this group. The current population of incarcerated offenders in Northamptonshire stands at 1,303, with the potential operational capacity of 1312102 so any increase in actual numbers using the current facilities is minimal. 101 Mathis & Schonely (2008) Healthcare behind bars: what you need to know, Nurse Practitioner 33:5, pp.34-41 http://www.ncbi.nlm.nih.gov/pubmed/18578090 102 Ministry of Justice (2014) Population Bulleting (monthly) July https://www.gov.uk/government/statistics/prison-population-figures-2014 P a g e | 106 Offenders represent a distinct population with high mental and drug related issues: ï‚· More than 70% of the prison population have two or more mental disorders.103 ï‚· Male prisoners are 14 times more likely to have two or more disorders than men in general, female prisoners are 35 times more likely104. ï‚· Mental disorders are significantly over-represented in the prison population. As many as 15% of all prisoners have concurrent mental health disorders. 30% of prisoners have a history of self harm and the instances are higher in women and ethnic minority groups.105 ï‚· Up to 90% of prisoners have a diagnosable mental illness or substance abuse problem. Frequently they have both106. ï‚· 5.2% of prisoners in England and Wales have displayed symptoms of psychosis compared to 0.45% of the general population. 25% of these can be attributed to drugs and/or alcohol or withdrawal. ï‚· The suicide rate in prisons is almost 15 times higher than in the general population. In 2002 the rate was 143 per 100,000 population compared to one of 9 in 100,000 in the general population. Boys aged 15 to 17 are 18 times more likely to commit suicide in prison/ custody107. ï‚· 72% of prisoners committing suicide had a history of mental illness. 57% had symptoms present at the time they entered prison108. 103 http://www.mentalhealth.org.uk/help-information/mental-health-statistics/prisons/ 104 http://www.mentalhealth.org.uk/help-information/mental-health-statistics/prisons/ 105 http://www.mentalhealth.org.uk/content/assets/PDF/publications/fundamental_facts_2007.pdf?view=Standard 106 http://ajp.psychiatryonline.org/article.aspx?articleid=177466 107 http://www.mentalhealth.org.uk/help-information/mental-health-statistics/prisons/ P a g e | 107 The prison population have a distinct set of health needs and are expected to need more intensive support from the health service and support infrastructure. Their needs can be placed into three broad categories of physical health needs, mental health needs, and substance misuse. The prison population in Northamptonshire should be considered separately from the general population rather than as part of a comparative exercise, partly due to its transient nature and secondly due to the specific needs. This will include issues arising from institutional high-risk behaviour including unprotected sex with multiple partners and use of hard drugs. Almost two-thirds have an alcohol problem on entering prison. Co-morbidity – the occurrence of multiple serious or significant health issues – is a common problem within this demographic. Their incarceration offers a significant opportunity to address such issues with a demographic who traditionally will have had little formal contact with the NHS. There is however a potential implication over the consistency and continuity of treatment amongst those with diagnosed issues, particularly given the transient nature of this population and what can be a seemingly fragmented support network as they move between prisons and between stages of rehabilitation. Age and ethnic profile in the prisons is significantly different from the county population. Both institutions are male prisons, making a clear gender distinction, but in terms of age in HMP Onley those over 40 years represent less than 20% of the population, whilst White British account for less than 50%; HMP Rye Hill would be anticipated to have a similar profile. The transition of Rye Hill from a Category 3 prison to a specialist sex offenders unit is expected to change this profile significantly, specifically toward an older population. The second group of offenders are those no longer serving prison terms; this may include those serving suspended sentences, those on probation, and those living in secure accommodation. The current caseload for the Northamptonshire Probation Services (PBS) stands at 2,624. Almost 40% of this client group are resident in Northampton, with 184 recorded as having No Fixed Abode and 242 living at either an unknown address or one outside of the county (Fig. 104). Of this group, around 69% are White British, with the second highest group White Other (circa 7.5%). Of this group, 90% are male. 108 http://www.prisonreformtrust.org.uk/Portals/0/Documents/Prisonthefacts.pdf P a g e | 108 Figure 104: Northamptonshire Probation Service caseload109 Locality Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough No Fixed Abode Unknown / outside Northamptonshire Frequency 190 135 311 236 1039 80 207 184 242 % of total 07.24 05.14 11.85 08.99 39.6 03.05 07.89 07.01 09.22 13.8 Asylum Seekers and Refugees Asylum seekers and refugees make up a relatively small proportion of the inward migration experienced by both the UK and Northamptonshire each year. Health issues are common in asylum seekers. Whilst a number may arrive in good health, this can rapidly change as a result of difficulty accessing services and navigating a language barrier. A number however, especially those seeking political asylum, will have physical and possibly psychological issues developed prior to or during their movement from their home nation to the UK. This can vary from the impact of poor healthcare systems in their home nation, to the effects of malnutrition, to the scars of imprisonment and torture110. People seeking asylum may be offered this on political grounds but can also be successful in an application on a temporary basis for health reasons, such as if they have illness or are in the late stages of pregnancy. 109 Northamptonshire Probation Service 110 Faculty of Public Health (2008) The health needs of asylum seekers: briefing statement http://www.fph.org.uk/uploads/bs_aslym_seeker_health.pdf P a g e | 109 Nationally the UK has 149,799 refugees, and 19,602 asylum seekers as of the most recent estimates by the UN Refugee Agency111. There is very little research evidence about Northamptonshire’s total asylum seeker and refugee population, but estimates using these prevalence rates result in Northamptonshire containing 1,664 refugees and 218 asylum seekers. The demographic of people seeking asylum in the UK is evolving, although can be reduced to a smaller number of less politically stable regions, including the Middle East and Africa. The number of asylum applications and inflow has dropped quite dramatically since a significant period of growth between 1999 and 2003. Included in the asylum seekers population are a number of minors who have entered the country unaccompanied. These represent a service implication with the need to provide care and accommodation for these children. Whilst the trend over the period 2009-14 has seen a reduction in these cases at the national level, and this has been replicated at locally, the number has also remained relatively consistent (Fig. 105). Figure 105: Unaccompanied asylum seeking children looked after by Local Authorities112 England East Midlands Northamptonshire 2009 3890 250 110 2010 3480 260 120 2011 2730 200 110 2012 2200 160 85 2013 1860 120 70 2014 85 111 http://www.unhcr.org/52af08d26.html 112 Dept. for Education (2014) SSDA903 https://www.gov.uk/government/publications/children-looked-after-return-2014-to-2015-guide P a g e | 110 14. Conclusions Northamptonshire is not a homogenous place. Whilst the concentration of diversity may not be as significant as other parts of the UK, the breadth of this is notable. The demographic profile of the county shows that whilst variations against the national profile are not particularly great, they are significant enough to suggest the incorporation of local context into the development of health interventions is important. This chapter has outlined a number of critical groups considered to be in need of intervention based around policy priorities found at both national and local level. Whilst these have been divided into a number of sub-sections, neither the groups nor the health issues they face sit in isolation. The continued growth of the population and increasing concentration of more heterogeneous groups and their needs ensures that the county’s demographic will continue to evolve. A number of the groups of concern and the recurrence of their embedded issues show a strong correlation with and concentration in urban areas, particularly the parts registering lower levels of socio-economic deprivation. This concentration should not be taken as a sole statement of the greatest need. Concentration of deprivation and individual extent and marginalisation are two separate things. Whilst the data used in this chapter provides a relatively robust evidence base to guide thinking about public health, it should not be considered in isolation and we should look to enhance this with additional service-based and locally-sourced intelligence. Understanding the demography of a place is fundamental to building an understanding of not only the general and critical needs of the resident population but also the modes and practices of intervention and health management. The transformation of public health to more of an integrated discipline is highly dependent on an in depth knowledge of local demography for the effective design of intervention. It is similarly integral to the extension of public health interests into a broader set of state and quasi-state agencies and their remit which play a significant role in managing institutional health issues occurring at both broad and local scales. P a g e | 111 The population of Northamptonshire can neither be considered singular nor static. The county has grown in resident numbers and this trend is anticipated to continue. This rate reflects differently across different groups, for example the 65+ population and the BME community have seen a significant increase whilst 18-30 year olds have proportionally declined. The transformation of population structure occurs as both a cyclical and a linear phenomenon, the rise and fall of natural change through birth and death rates supplemented by migration tendencies and increased life expectancy. As a result of this structural transformation the issue of diversity around service design and provision has and will become more significant. Northamptonshire is not necessarily recognised as the most diverse part of the UK, but change in county population has been significant and this diversity has emerged both in line with national trends and in more locally distinctive ways. Alongside diversity in population, identified through standard classifications such as age, gender, ethnicity and sexuality, a more sophisticated understanding of health and health issues has emerged. This has increased the need for support services in terms of volume and in type of intervention. Issues such as binge drinking, obesity and mental health which have risen to prominence over the past decade, partly through changes in societal and cultural behaviour and partly through more sophisticated understandings of health needs, have required general service transformation alongside more focused engagement with specific demographics. As a result understanding who and where these groups are, how they are affected, and the factors which contribute toward the predominance of specific issues, has become fundamental. Using current policy frameworks at the national and local level as a guide alongside the critical issues arising from condition-specific JSNA reports published locally in 2013, five specific communities have been discussed within this chapter; communities of deprivation, older people, children, young adults, and minority groups, which itself encompasses a diversity of forms and interests. These groups vary significantly in their location and distribution within the county. Part of this is explained through socio-cultural and socio-economic conditions, specific groups converging in certain locations in line with anticipated tendencies. The urban-rural split within the county is notable with the concentration of Young Adults, BME groups and Children occurring in the more urbanised areas – Northampton, Corby, Kettering and Wellingborough - and the population of Older People tending to emerge in more rural parts of the county. Whilst this distinction is often interpreted on the basis of a P a g e | 112 division between specific lower tier local authority areas, these concentrations can be more highly localised. To this extent certain relationships between health issues, demographic group and environment can be established. This spatial phenomenon does not occur uniformly across all groups however and for certain demographics locational factors may be less significant than others. Within each of these groups there are signs of additional concentrations of sub-groups or sub-communities with more intensive support or intervention needs. The growth of the 65+ community has also seen a significant rise in those aged 85 years and over. Whilst this sub-group only accounts for around 14% of the population of older people, it also represents the group for which high-level intervention is in highest demand. Behavioural tendencies toward drinking and drug taking within both the Young Adult group and certain minority groups, such as Offenders and LGBT, manifest in differing volumes and to differing extremities; a certain number may be designated high risk but this is unlikely to be uniformly applied. There is a necessity here to gain a stronger understanding of what may be designated at-risk groups and the high risk sub-groups within these. The demographic profile also elaborates the need to both understand and anticipate projected structural changes within Northamptonshire, and how these are likely to manifest in line with national changes or are divergent from these. The population growth of the county, which has run at a significantly faster rate than that of England and the East Midlands, illustrates the issue of increasing general demand, whilst projections of continuing proportional growth amongst communities such as older people or BME groups indicate more distinct needs. Some of these may be difficult to predict; whilst both BME and migrant communities are expected to grow the categorising of these is less easy to anticipate. This form of ‘known unknown’ in the structural transformation of Northamptonshire’s demographic requires the integration of service demand analysis and the monitoring of localised and national trends as a core part of the management of public health services. There is also a need to extend the understanding gained through information conveyed in this chapter. This includes more detailed spatial analysis to further understand the location, distribution, and extent of issues identified through the application of centrally produced data sources. The demographic may be further segmented considering the different groups in need of support. A stronger body of information is required for certain groups identified in the Minority Groups section – specifically the LGBT and the Asylum Seekers communities – alongside P a g e | 113 an understanding of the profile of these different groups and how this is restructuring over time due to natural and migratory change. Additional focus could also be paid to groups either marginally acknowledge or omitted from this report. This could include children with disabilities, the segmentation of occupational grades, a more detailed study of migrants (first generation) and the construction of their community, people in permanent residential care, homeless or transient people, and those exiting the care system particularly around the transition from designated child to adult status. P a g e | 114 Appendices Appendix 1: Population structure: County, Districts and Boroughs Figure 106: Northamptonshire 2012 ONS estimate It is clear from the population pyramid that the 2012 population exhibits similar trends to what is prevailing elsewhere in the UK: an ageing population which has a slightly higher percentage of females than males. The number of people aged over 90 is high, and the number of females aged over 90 is significantly higher than the number of males. What is also noticeable about the Northamptonshire population pyramid is the significantly lower numbers of people aged between around 18-25. Why exactly this is the case can only be speculated, but it may be because of young people leaving the county to go to university elsewhere. P a g e | 115 Figure 107: Corby 2014 ONS estimate Figure 108: Daventry 2014 ONS estimate Corby has a young population compared to other areas in Northants Daventry has many 45-70 year olds There is a high proportion of 22-55 year olds There are very few 18-22 year olds Much higher percent of under 10’s P a g e | 116 Figure 109: East Northamptonshire 2014 ONS estimate Figure 110: Kettering 2014 ONS estimate The populations of East Northamptonshire and Kettering are broadly similar to that of Northamptonshire. There is a noticeable dip in 1822year olds, and a high proportion of over 90’s reflecting the ageing population. P a g e | 117 Figure 111: Northampton 2014 ONS estimate Figure 112: South Northamptonshire 2014 ONS estimate S. Northants has many over 90’s There are also many people aged 60-70 Northampton has the highest proportion of 18-30 year olds very low numbers of 18-22 year olds P a g e | 118 Figure 113: Wellingborough 2014 ONS estimate P a g e | 119 Appendix 2: Clinical Commissioning Group registered populations113 Intro: ONS 2011 census based CCG level populations (mid 2011). There are two CCGs who commission health care on behalf of the Northamptonshire population, Nene CCG and the smaller Corby CCG. The population’s size and age distributions are illustrated in figures 114 and 115 beneath. Figure 114: Nene CCG mid 2011 population 12,000 10,000 Population 8,000 6,000 4,000 2,000 0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 Age 113 http://www.ons.gov.uk/ons/rel/sape/clinical-commissioning-group-population-estimates/mid-2011--census-based-/stb---clinical-commissioning-groups---mid2011.html P a g e | 120 Figure 115: Corby CCG mid 2011 population 1,200 1,000 600 400 200 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 90+ Population 800 Age P a g e | 121 Figure 116: Nene and Corby CCG populations – age distribution in percentage terms P a g e | 122 Populations of each GP practice by age group and gender, and trends114 There are 49 GP practices in Northamptonshire, each with varying quantities and types of population. Because there are so many, each will not be discussed in turn, but there is a hyperlink in the reference if they need to be viewed. Estimated unregistered population within the local authority Based on the size of the ONS mid year population estimates for Nene and Corby CCGs compared to the ONS estimate for the same year115 in the whole of Northamptonshire there exists a significant population who are not registered with the NHS. As of 2011, Nene CCG has a registered population of 616,744, Corby CCG has 61,608. Collectively this adds up to 678,351 registered population. The ONS estimate for Northamptonshire in 2011 is 691,952, leaving an unregistered population of 13,601. The Nuffield Trust point to the health needs of unregistered populations being “significant” and claim that unregistered populations account for nearly 100,000 patient episodes in one year nationally116. 114 http://fingertips.phe.org.uk/profile/general-practice/data 115 http://www.ons.gov.uk/ons/interactive/vp2-2011-census-comparator/index.html 116 http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/130425_reclaiming-a-population-health-perspective.pdf P a g e | 123 Appendix 3: Job seekers allowance: Claimants by age groups under 35 and under 25 Figure 117: Claimants under 35 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough England JSA Total 11,490 1,460 840 1,010 1,630 4,500 JSA Total under 35 5,710 840 400 490 790 2,200 JSA Claimants <35 49.7% 57.5% 47.6% 48.5% 48.5% 48.9% JSA 6 Months 7,000 1,030 600 610 970 2,620 JSA 6 Months under 35 3,890 630 320 330 540 1,460 490 220 44.9% 320 1,560 968,850 770 495,290 49.4% 51.1% 840 536,120 JSA 6 Months <35 Claimants 6 mths + 55.6% 61.2% 53.3% 54.1% 55.7% 55.7% 4,490 430 240 400 660 1,880 150 46.9% 170 460 309,990 54.8% 57.8% 720 432,730 <35 Claimants 6mths+ 1,820 210 80 160 250 740 % Claimants 6mths+ <35 40.5% 48.8% 33.3% 40.0% 37.9% 39.4% % <35 claimants 6mths+ 31.9% 25.0% 20.0% 32.7% 31.6% 33.6% 70 310 185,300 41.2% 43.1% 42.8% 31.8% 40.3% 37.4% P a g e | 124 Figure 118: Claimants under 25 Northamptonshire Corby Daventry East Northamptonshire Kettering Northampton South Northamptonshire Wellingborough England JSA Total 11,490 1,460 840 1,010 1,630 4,500 490 1,560 968,850 JSA Total under 25 2,840 450 230 260 410 1,030 110 350 241,940 JSA Claimants <25 24.7% 30.8% 27.4% 25.7% 25.2% 22.9% JSA 6 Months 7,000 1,030 600 610 970 2,620 22.4% 320 22.4% 25.0% 840 536,120 JSA 6 Months under 25 2,060 350 190 190 300 730 80 230 164,290 JSA 6 Months <25 Claimants 6 mths + 29.4% 34.0% 31.7% 31.1% 30.9% 27.9% 4,490 430 240 400 660 1,880 25.0% 170 27.4% 30.6% 720 432,730 <25 Claimants 6mths+ 780 100 40 70 110 300 % Claimants 6mths+ <25 17.4% 23.3% 16.7% 17.5% 16.7% 16.0% % <25 claimants 6mths+ 27.5% 22.2% 17.4% 26.9% 26.8% 29.1% 30 120 77,650 17.6% 16.7% 17.9% 27.3% 34.3% 32.1% P a g e | 125 Appendix 4: Mid 2013 Population estimates for Northamptonshire and Districts in five year age bands Figure 119 Northamptonshrie population by five year age groups: ONS 2013 mid year estimates Northamptonshire Corby Daventry East Northants Kettering Northampton South Northamptonshire Wellingborough Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total Total aged Total aged aged aged aged aged 26- aged aged aged aged aged aged aged aged aged aged aged aged 86 All Ages 0-5 6-10 11-15 16-20 21-25 30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81-85 and over 706,647 56,681 43,326 41,762 40,951 40,735 43,708 45,672 46,703 53,492 54,582 47,516 41,115 42,048 37,510 24,957 19,274 13,930 12,685 64,212 5,857 4,030 3,751 3,713 4,048 4,940 4,702 4,096 4,618 4,934 4,403 3,663 3,128 2,781 2,078 1,624 1,051 795 78,556 5,232 4,686 4,788 4,294 4,051 3,620 3,936 4,777 6,203 6,726 6,072 5,185 5,463 4,873 3,183 2,430 1,623 1414 87,969 6,151 5,339 5,601 5,161 4,293 4,215 4,831 5,561 6,959 7,045 6,231 5,376 6,019 5,304 3,492 2,658 1,903 1830 95,748 7,718 5,964 5,574 5,262 5,337 5,780 6,202 6,475 7,503 7,324 6,100 5,436 5,833 5,275 3,441 2,631 1,933 1960 216,739 19,401 13,380 12,014 13,737 14,997 16,915 16,859 15,195 15,221 15,322 13,118 11,152 11,101 9,370 6,431 5,123 3,848 3555 87,465 6,033 5,257 5,534 4,612 4,047 3,763 4,499 5,701 7,255 7,494 6,653 5,695 5,778 5,457 3,439 2,601 1,954 1693 75,958 6,289 4,670 4,500 4,172 3,962 4,475 4,643 4,898 5,733 5,737 4,939 4,608 4,726 4,450 2,893 2,207 1,618 1438 P a g e | 126 Figure 120: 2012-based sub national population projections Figures are in thousands (to one decimal place) Northamptonshire - males CODE E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 AREA Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 24 24 24 24 24 24 24 24 24 24 24 24 24 24 23 23 23 23 23 23 23 23 24 24 24 24 5-9 22 23 23 24 25 25 25 25 25 25 25 25 25 25 25 25 25 25 24 24 24 24 24 24 24 24 10-14 21 21 21 21 22 22 23 24 25 25 26 26 26 26 26 25 25 25 25 25 25 25 25 25 25 25 15-19 22 22 21 21 21 21 21 21 21 21 22 23 23 24 24 25 25 25 25 25 25 25 25 25 25 25 20-24 20 20 20 20 20 19 19 19 19 19 18 18 18 18 19 19 20 20 21 21 22 22 22 22 22 22 25-29 21 21 22 22 22 23 23 23 23 22 22 22 22 22 21 21 21 21 21 21 22 22 23 24 24 24 30-34 22 23 23 23 23 22 23 23 23 24 24 24 24 24 24 24 23 23 23 23 22 22 22 22 23 23 35-39 23 22 22 23 23 24 24 24 24 24 24 24 24 24 25 25 25 25 25 25 25 25 24 24 24 23 40-44 26 26 26 25 24 23 23 23 23 24 24 25 24 24 24 24 25 25 25 26 26 26 26 26 26 26 45-49 27 27 27 27 27 26 26 26 25 24 24 23 23 23 24 24 25 25 25 25 25 25 25 26 26 26 50-54 24 24 25 26 27 27 27 27 27 27 26 26 26 25 24 24 23 23 24 24 24 25 25 25 25 25 55-59 21 21 21 22 23 23 24 25 26 26 27 27 27 26 26 26 26 25 25 24 23 23 23 23 24 24 60-64 20 20 20 20 20 20 20 21 21 22 23 23 24 25 26 26 26 26 26 26 25 25 25 24 24 23 65-69 19 20 20 20 20 20 19 19 19 19 19 20 20 21 21 22 23 23 24 25 25 25 25 25 25 25 70-74 13 13 14 15 16 17 18 19 19 19 18 18 18 18 18 18 18 19 19 20 21 21 22 23 23 24 75-79 9 10 10 10 10 11 11 12 13 14 15 16 17 17 17 16 16 16 16 16 16 17 17 17 18 19 80-84 6 7 7 7 7 8 8 8 8 9 9 9 10 11 11 13 14 14 14 14 14 13 13 13 14 14 85-89 4 4 4 4 4 4 4 5 5 5 5 6 6 6 6 7 7 7 8 9 10 10 11 11 11 10 90+ 2 2 2 2 2 2 2 2 2 3 3 3 3 3 4 4 4 4 5 5 5 6 6 6 7 8 All ages 346 349 352 355 358 361 364 367 370 373 376 379 382 385 388 390 393 395 398 400 402 404 407 409 411 413 P a g e | 127 Northamptonshire – females CODE E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 E10000021 AREA Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire Northamptonshire AGE 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 23 23 23 23 23 23 23 23 23 23 23 23 22 22 22 22 22 22 22 22 22 22 22 23 23 23 21 22 23 23 24 24 24 24 24 24 24 24 24 24 24 24 24 23 23 23 23 23 23 23 23 23 20 20 20 21 21 22 23 23 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 24 20 20 20 20 20 20 19 20 20 20 21 22 23 23 23 23 24 24 24 24 24 24 24 24 23 23 20 20 19 19 19 19 18 18 18 18 18 18 18 18 18 19 19 20 20 21 21 21 21 21 21 21 22 22 22 22 22 22 22 22 22 21 21 21 21 20 20 20 20 20 20 20 21 22 22 22 23 23 23 23 24 24 24 23 23 23 23 23 24 23 23 23 23 22 22 22 22 22 21 21 21 21 22 22 23 23 23 23 23 24 25 25 25 25 25 25 25 25 25 25 25 25 24 24 24 24 23 23 23 23 27 27 26 26 25 24 23 23 24 24 25 25 26 25 25 25 25 25 25 25 26 25 25 25 25 25 27 28 28 27 27 27 27 26 26 25 24 24 23 24 24 25 26 26 26 26 26 26 26 26 26 26 24 25 26 26 27 27 28 28 27 27 27 27 26 26 25 24 24 23 24 24 25 26 26 26 26 26 21 21 22 22 23 24 25 25 26 27 27 27 27 27 27 27 27 26 26 25 24 23 23 24 24 25 22 21 21 20 20 21 21 21 22 23 24 24 25 26 27 27 27 27 27 27 27 26 26 26 25 24 19 21 21 22 22 21 21 20 20 20 20 20 21 22 22 23 24 25 26 26 26 27 27 26 26 26 13 14 14 15 16 18 19 20 21 21 20 20 19 19 19 19 20 20 21 21 22 23 24 24 25 25 11 11 11 12 12 12 12 13 14 15 17 18 19 19 19 19 18 18 18 18 18 18 19 19 20 21 9 9 9 9 9 9 9 10 10 10 10 11 12 12 13 15 16 16 17 17 16 16 16 16 16 16 6 6 6 6 6 6 6 7 7 7 7 7 8 8 8 8 9 9 10 11 12 13 13 14 14 14 4 4 4 4 4 5 5 5 5 5 5 6 6 6 6 7 7 7 8 8 8 9 10 10 11 12 355 358 361 364 367 370 373 376 379 382 385 387 390 393 395 398 400 403 405 407 410 412 414 416 418 420 P a g e | 128 Corby - males CODE E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 AREA Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 5-9 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 10-14 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 20-24 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 25-29 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 30-34 2 2 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 35-39 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 40-44 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45-49 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 50-54 2 2 2 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 55-59 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 3 3 60-64 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 65-69 1 1 1 1 2 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 70-74 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 75-79 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 80-84 1 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 85-89 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 90+ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 All ages 31 31 32 32 33 33 34 34 35 35 36 36 37 37 37 38 38 39 39 39 40 40 40 41 41 41 P a g e | 129 Corby – females CODE E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 E07000150 AREA Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby Corby AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 3 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 2 2 2 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 32 33 33 34 34 35 35 36 36 37 37 38 38 38 39 39 40 40 40 41 41 41 42 42 42 43 P a g e | 130 Daventry - males CODE E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 AREA Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 5-9 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 10-14 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 20-24 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 25-29 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 30-34 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 35-39 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 40-44 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 45-49 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 50-54 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 55-59 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 60-64 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 65-69 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 70-74 2 2 2 2 2 2 3 3 3 3 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 75-79 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 80-84 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 85-89 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 1 90+ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 All ages 39 39 40 40 40 40 40 41 1 41 41 42 42 42 42 43 43 43 43 43 44 44 44 44 44 44 P a g e | 131 Daventry – females CODE E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 E07000151 AREA Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry Daventry AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 2 2 2 2 2 2 2 2 3 3 3 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 39 39 40 40 40 40 40 41 41 41 41 42 42 42 42 42 43 43 43 43 43 44 44 44 44 44 P a g e | 132 East Northamptonshire - males CODE E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 AREA East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 5-9 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 10-14 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 20-24 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 25-29 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 30-34 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 35-39 3 3 2 3 3 3 3 3 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 2 2 40-44 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45-49 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 50-54 3 3 3 3 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 55-59 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 60-64 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 3 3 3 3 3 3 65-69 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 3 70-74 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 75-79 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 2 2 2 2 2 2 2 2 3 3 3 80-84 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 85-89 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 90+ 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 All ages 43 43 44 44 44 44 45 45 45 45 46 46 46 46 47 47 47 47 47 48 48 48 48 48 49 49 P a g e | 133 East Northamptonshire – females CODE E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 E07000152 AREA East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire East Northamptonshire AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 44 44 45 45 45 45 46 46 46 46 47 47 47 48 48 48 48 48 49 49 49 49 50 50 50 50 P a g e | 134 Kettering - males CODE E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 AREA Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 5-9 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 10-14 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 20-24 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 25-29 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 30-34 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 35-39 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 3 3 3 3 3 3 40-44 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 45-49 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 50-54 3 3 3 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 55-59 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 60-64 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 3 3 3 3 65-69 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 3 70-74 2 2 2 2 2 2 3 3 3 3 3 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 75-79 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 80-84 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 85-89 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 90+ 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 All ages 47 47 48 48 48 49 49 50 50 51 51 52 52 52 53 53 53 54 54 54 55 55 55 56 56 56 P a g e | 135 Kettering – females CODE E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 E07000153 AREA Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering Kettering AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 3 3 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 4 4 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 2 2 2 3 3 3 3 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 3 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 48 49 49 50 50 51 51 51 52 52 53 53 54 54 54 55 55 55 56 56 56 57 57 57 58 58 P a g e | 136 Northampton - males CODE E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 AREA Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 9 5-9 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 10-14 6 6 6 6 6 6 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 15-19 7 7 7 7 7 6 6 6 6 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 20-24 7 8 8 8 8 8 8 8 8 8 7 7 7 7 8 8 8 8 9 9 9 9 9 9 9 9 25-29 8 8 8 8 8 8 9 9 9 9 9 9 9 8 8 8 8 8 8 8 9 9 9 9 9 10 30-34 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 8 9 9 9 35-39 8 8 8 8 8 8 9 9 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 9 9 8 40-44 8 8 8 8 8 8 7 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 45-49 8 8 8 7 7 8 8 8 8 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 50-54 7 7 7 7 8 8 7 7 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 55-59 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 60-64 5 5 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 65-69 5 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 7 7 70-74 3 3 3 4 4 4 5 5 5 5 5 5 5 4 4 5 5 5 5 5 5 6 6 6 6 6 75-79 2 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 80-84 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 4 4 3 3 3 3 3 3 85-89 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 3 3 3 3 3 90+ 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 All ages 106 107 108 110 111 112 113 114 116 117 118 119 120 121 122 123 124 125 126 126 127 128 129 130 131 131 P a g e | 137 Northampton – females CODE E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 E07000154 AREA Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton Northampton AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 6 6 6 6 6 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7 7 7 7 7 6 6 6 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 9 9 9 9 9 9 9 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 9 9 9 9 8 9 9 9 9 9 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7 7 7 8 8 8 9 9 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 8 8 8 8 8 7 7 7 7 8 8 8 7 7 7 7 7 7 7 7 7 7 7 7 7 8 8 8 8 8 8 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 6 6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 5 5 5 6 6 6 5 5 5 5 5 5 6 6 6 6 6 7 7 7 7 7 7 7 7 7 3 4 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 6 6 6 6 6 6 7 7 3 3 3 3 3 3 3 3 4 4 4 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 4 3 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 109 110 111 112 114 115 116 117 118 119 120 121 122 122 123 124 125 126 127 128 128 129 130 131 131 132 P a g e | 138 South Northamptonshire – males CODE E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 AREA South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 5-9 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 10-14 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 20-24 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 25-29 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 30-34 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 35-39 3 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 2 40-44 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45-49 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 50-54 3 3 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 55-59 3 3 3 3 3 3 3 3 3 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 60-64 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 3 3 3 3 3 3 3 3 3 65-69 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 70-74 2 2 2 2 2 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 75-79 1 1 1 2 2 2 2 2 2 2 2 2 3 3 2 2 2 2 2 2 2 2 2 3 3 3 80-84 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 85-89 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 90+ 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 All ages 43 43 43 43 44 44 44 44 45 45 45 45 46 46 46 46 47 47 47 47 48 48 48 48 48 48 P a g e | 139 South Northamptonshire – females CODE E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 E07000155 AREA South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire South Northamptonshire AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 4 4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 4 4 4 4 4 4 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 4 4 4 1 1 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 44 44 44 44 45 45 45 46 46 46 46 47 47 47 48 48 48 48 49 49 49 49 49 50 50 50 P a g e | 140 Wellingborough - males CODE E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 AREA Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough AGE GROUP 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 0-4 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 5-9 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 10-14 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 15-19 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 20-24 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 25-29 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 30-34 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 35-39 2 2 2 2 2 2 3 3 2 2 2 2 2 3 3 3 3 3 3 3 3 3 2 2 2 2 40-44 3 3 3 3 3 3 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 45-49 3 3 3 3 3 3 3 3 3 3 3 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 50-54 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 3 3 3 3 3 3 3 55-59 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 3 3 3 60-64 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 65-69 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 70-74 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 75-79 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 80-84 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 85-89 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 90+ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 All ages 37 38 38 38 38 39 39 39 39 40 40 40 40 41 41 41 41 41 42 42 42 42 42 43 43 43 P a g e | 141 Wellingborough – females CODE E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 E07000156 AREA Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough Wellingborough AGE GROUP 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ All ages 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 2 3 3 3 3 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3 3 3 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 39 39 39 39 39 40 40 40 40 41 41 41 41 41 42 42 42 42 42 42 43 43 43 43 43 43 P a g e | 142 Appendix 5 Data Sources End of Life Care (2014) http://www.endoflifecare-intelligence.org.uk/profiles/CCGs/Place_of_Death/atlas.html - Includes: place of death, CCG level data. Fingertips (2014) http://fingertips.phe.org.uk/ - Includes: general practice profiles. HSCIC (2014) http://www.hscic.gov.uk/home - Includes: large range of social care data and health data. Indices of Multiple Deprivation (2010) https://www.gov.uk/government/statistics/english-indices-of-deprivation-2010 - Includes: socioeconomic deprivation. Longer Lives (2014) http://healthierlives.phe.org.uk/topic/mortality#are/E10000021/par/E92000001/ati/102/pat/ - Includes: years of life lost to specific diseases. P a g e | 143 MentalHealth.org (2014) http://www.mentalhealth.org.uk/help-information/mental-health-statistics/prisons/ - Includes: prisoners mental health statistics. Neighbourhood Statistics (2014) www.neighbourhood.statistics.gov.uk - Includes: population pyramids (current and predictions), neighbourhood summaries. NOMIS (2014) http://www.nomisweb.co.uk/ - Includes: population growth and predictions, labour market statistics. Northamptonshire Analysis www.northamptonshireanalysis.co.uk - Includes: adult social care, children and young people, community involvement and social capital, community safety, economy, education and skills, environment and living, health and wellbeing, performance measures, population and census. ONS (2014) http://www.ons.gov.uk/ons/datasets-and-tables/index.html - Includes: mid year population estimates, birth rates, fertility, under 18 conceptions, mortality (age standardised mortality, infant mortality, neonatal mortality, perinatal mortality), life expectancy. P a g e | 144 ODPM (2004) http://dera.ioe.ac.uk/5073/1/138631.pdf - Includes: overcrowding impact on health and education. Prison Reform Trust (2014) http://www.prisonreformtrust.org.uk/Portals/0/Documents/Prisonthefacts.pdf - Includes: prisoner data. Public Health Outcomes Framework (2014) http://www.phoutcomes.info/ - Includes: sections on wider determinants of health, health protection, health improvement, healthcare public health and preventing premature mortality. POPPI and PANSI: www.poppi.org.uk and www.pansi.org.uk - Includes population predictions, by age gender and relative to specific conditions. Rural Urban Classification (2011) https://www.gov.uk/government/collections/rural-urban-definition - Includes: rural/urban classifications Stonewall (2011) http://www.stonewall.org.uk/documents/prescription_for_change.pdf P a g e | 145 - Includes LGBT prevalence data. The Kings Fund http://www.kingsfund.org.uk - Includes: research on wider determinants of health UN (2014) http://www.unhcr.org/52af08d26.html - Includes: refugees and asylum seekers.