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- 1 - Compendium of Information report for Bexley’s Joint Strategic Needs Assessment 2012

Compendium of information report for Bexley’s Joint Strategic Needs

Assessment 2012

Supporting data for Bexley’s Joint Strategic Needs Assessment 2010-12

Compiled using Department of Health, JSNA guidance on core dataset 2007

Published September 2012


Foreword


Lead author

Khushbu Lalwani

Acknowledgments

Sarah Seager for advice and support. Meic Goodyear and Brian Coutinho at Lewisham PCT for sharing their

innovative and local Public Health Information Portal with Bexley. Debalina Lahiri, Joseph Barker, Lorraine

Harker, Fiona Casey, Angela Grover, Jamie Dickie and Steven Burgess for support in putting together the

compendium of information.

List of contributors

Rosemary England, Kelly Gaddes, Dr. Gunen Ucyigit, Dr. Neil Santamaria, Steven Burgess, Jamie Dickie, Dr.

Ricky Gondhia, Teresa Salami Aldeti, Fola Ikpehai, John Grumitt, Dr. Dharini Shanmugabavan, Kate Dawes,

David Parkins, Elaine Robertson, Julie Bristow, Vida Cunningham, Charlene Williams, Sarah Nichols, Rebecca

Spencer, Jo Woodvine, Jon Winter, Philippa James, Diane H, Annie Gardner, Elaine Green, Duncan Bridgewater,

Edna Menta, Christina Hayward, Brendan Ring, Mo Tomori, Maria Hawes Gatt, Alison Rogers, Beverly Mac, Jill

May, Mina Epelle, Jackie Larkin, Annie Gardner, Amanda Smith, Jesca Gudza, Janine Wooster, Maureen

Holkham, Alison McLaughlin, Nicola Couchman, Nola Saunders, Kevin Taylor, Alison Balantyne, Tricia Oates,

Charlotte Shrimpton, Clive Cain, Jill Moore, Jeremy Clark, Mark Bunting, Cyril O'Brien, Peter Buck, Tony

Plowright, Sheila Gogah, David Bryce-Smith, Nick Hollier, Nick Marsden, Sab Kaur, Nigel Gausden, Sue

Robinson, Clare Fernee, Yvonne Jenkins, Rosemary England, Alun Bayliss, Margaret Anderson, Martin Murphy,

Mark Bradley, Graham Lettington, Shirley Johnstone, Julie Tilbrook, Edwin Mensah, Juned Mohammed, Kath

Hollands, Neal Moran, Dr. Winnie Kwan, Imogen Moore, Lorraine Harker, Angela Grover.


London Borough of Bexley www.bexley.gov.uk

Bexley Care Trust www.bexley.nhs.uk

http://www.bexley.gov.uk/

http://www.bexley.nhs.uk/


Table of Contents

Foreword ................................................................................................................................................. - 2 -

Glossary of terms .................................................................................................................................... - 6 -

Sources and acronyms .......................................................................................................................... - 10 -

List of figures and tables ....................................................................................................................... - 11 -

Chapter 1 Introduction .......................................................................................................................... - 16 -

1.1 Demography .............................................................................................................................................. - 17 -

1.2 Socioeconomic status ................................................................................................................................ - 26 -

1.3 Life expectancy ......................................................................................................................................... - 38 -

1.4 Mortality .................................................................................................................................................... - 46 -

1.5 Infant Mortality ......................................................................................................................................... - 51 -

Chapter 2 Providing a healthy start to life and transition into adulthood ............................................ - 53 -

Chapter 3 Providing healthy environments & sustainable development ............................................. - 77 -

Chapter 4 Enabling positive citizen behaviour change & promoting health. ...................................... - 84 -

Chapter 5 Providing services for residents including those with long term conditions to maximise

choice, control and wellbeing ............................................................................................................. - 108 -

Appendix 1: Health profile for Bexley 2011 ...................................................................................... - 149 -

Appendix II: Child Health Profile for Bexley 2011 ........................................................................... - 153 -

Feedback form .................................................................................................................................... - 156 -

References ........................................................................................................................................... - 158 -


Glossary of terms

Terms in italics across the document can be referred to in the glossary of terms.

Asset Score

The asset score is part of the Scaled Approach which presents a model for interventions delivered by

Youth Offending Teams (YOTs) working with children and young people who have offended, and as a

result appear before the courts for sentence. It reflects the statutory aim of the youth justice system - to

prevent offending by children and young people - and is designed to help YOTs become more effective

in delivering this principal aim in their local communities.

The Asset - Core Profile should be used to assess the likelihood of reoffending and, if applicable, the

Asset - Risk of Serious Harm form should also be used to asses the risk of serious harm to others. If

available, a Common Assessment Framework (CAF) should be used to inform the Asset assessment

(also applicable to Wales if/when available). This work should all be supported by practitioners' own

professional judgement. Following the assessment, practitioners should use the framework below to

determine the most suitable level of intervention for managing the child or young person.

Child/young person profile Intervention level

Low likelihood of reoffending (as indicated by Asset score [dynamic

and static factors] between 0 and 14 inclusive) AND

Low risk of serious harm (as indicated by No Risk of Serious Harm

assessment being required, or low risk of serious harm following

assessment)

Standard

Medium likelihood of reoffending (as indicated by Asset score [dynamic

and static factors] between 15 and 32 inclusive) OR

Medium Risk of Serious Harm (as indicated by rRsk of Serious Harm

assessment)

Enhanced

High likelihood of reoffending (as indicated by Asset score [dynamic

and static factors] between 33 and 64 inclusive) OR

High risk of serious harm or very high risk of serious harm (as indicated

by risk of serious harm assessment)

Intensive

Scoring 2 or more on health or substance misuse triggers a further questionnaire which is health or

substance misuse specific and is likely to lead to a referral for substance misuse services or to our health

worker.

Decile1

Each of ten equal groups into which a population can be divided according to the distribution of values

of a particular variable: the lowest income decile of the population.

Directly standardised mortality rate (DSR)

The Age standardised rate (ASR) for an area is the number of deaths, usually expressed per 100,000, that

would occur in that area if it had the same age structure as the standard population and the local age-

specific rates of the area applied.


Directly standardised mortality rate is calculated by dividing the number of deaths by the actual local

population in a particular age group multiplied by the standard population for that particular age group

and summing across the relevant age groups. The rate is usually expressed per 100,000.

Confidence interval

95% confidence intervals are usually calculated for both SMRs and ASRs to give an indication of the

level of uncertainty of the calculation. Statistical uncertainties usually arise because these rates or ratios

are based on a random sample of finite size from a population of interest. Confidence intervals are then

used to assess what would happen if we were to repeat the same study, over and over, using different

samples each time. The precise statistical definition of the 95% confidence interval states that on

repeated sampling, 95 times out of 100 the true population value would be within the calculated

confidence interval range and 5 times the true value would be either higher or lower than the range.

However, when calculating SMRs or ASRs for different PCTs or electoral wards, the information is not

based on a sample and is therefore not subject to sampling error. It is, however, subject to random

fluctuations over time or between local PCTs\electoral wards. In this case the 95% confidence interval is

a way of conveying the stability of the rates. The smaller the confidence interval, the more stable the

rate. More events lead to a smaller interval, so mortality rates from rare causes of death have quite wide

the intervals and the rates fairly unstable.

Excess winter deaths

England, in common with other European countries, experiences higher levels of mortality in the winter

than in the summer. There is some evidence to suggest that excess winter mortality (EWM) is

preventable. Mortality in winter increases more in England compared to other European countries with

colder climates, suggesting that it is more than just lower temperatures responsible for the excess

mortality in winter. The Excess Winter Mortality Index (EWM Index) is the excess winter deaths

expressed as a ratio of the expected deaths based on the non-winter death rate.

Median

Denoting the middle term of a series arranged in order of magnitude.

Mean

The quotient of the sum of several quantities and their number; an average.

Output Area

The smallest units for which data are available on Neighbourhood Statistics2. Output Areas are

subdivisions of 2003 wards and each contains approximately 125 households (300 residents).

Quintile

Each of five equal groups into which a population can be divided according to the distribution of values

of a particular variable: the lowest income quintile of the population.

Rate3


Rates and ratios are key cornerstones in understanding the health, morbidity, and mortality of

populations. Plain numbers of events, such as deaths, or births, or hospital admissions have very little

meaning in themselves, lacking a context in which they can be interpreted. Calculating rates supplies

such a context, by transforming the data in terms of the population at risk and the time period relevant.

A rate is a quantity in one dimension divided by a quantity in (usually) another dimension, with an

indication of time.

Slope index of inequality

Slope index of inequality can be used to reflect the socioeconomic dimensions to inequalities. The

approach involves calculating the mean (health) status of each socioeconomic group and then ranking

classes by their socioeconomic status. The slope index of inequality is the linear line that shows the

relation between the level of health or the frequency of a health problem in each socioeconomic category

and the hierarchical ranking of each socioeconomic category on the social scale.

Standardised mortality ratio (SMR)4

An SMR is essentially a comparison of the number of the observed deaths in a population with the

number of expected deaths if the age-specific death rates were the same as a standard population. It is

expressed as a ratio of observed to expected deaths, multiplied by 100.

SMRs equal to 100 imply that the mortality rate is the same as the standard mortality rate. A number

higher than 100 implies an excess mortality rate whereas a number below 100 implies below average

mortality.

Standard Occupational Classification (SOC) (NOMIS)

The Standard Occupational Classification was first published in 1990 to replace both the Classification

of Occupations 1980 (CO80) and the Classification of Occupations and Dictionary of Occupational

Titles (CODOT). SOC 90 has been revised and updated to produce SOC 2000.

The two main concepts of the classification remain unchanged:

kind of work performed - job, and

the competent performance of the tasks and duties - skill

Super Output Area

Super Output Areas (SOAs) are aggregations of Output Areas and form part of the NeSS geography

hierarchy. They have the advantages that they are not generally subject to boundary change, and that

within each layer of the hierarchy, the SOAs are reasonably consistent in terms of size of population.

There are two layers of SOA: Lower and Middle. Lower Layer SOAs are subdivisions of Middle

Layer SOAs, which in turn are subdivisions of local authorities.

Lower Layer

Minimum population: 1000

Average (mean): 1,500

Total areas in England and Wales: 34,378


Middle Layer

Minimum population: 5000

Average (mean): 7,200

Total areas in England and Wales: 7,193

Ward

Electoral wards (electoral divisions in Wales and the Isle of Wight) are the base unit of UK

administrative geography, being the areas from which local authority councilors are elected.

Commonly referred to just as 'wards'.


Sources and acronyms

ONS Office For National Statistics

LHO London Health Observatory

NCHOD National Centre For Health Outcomes Development

VS Office For National Statistics, Vital Statistics

GLA Greater London Authority

POPPI Projecting Older People Population Information System

PANSI Projecting Adult Needs And Service Information System

SEAPS Sport England Active People Survey

NOMIS National Online Manpower Information System

NWPHO North West Public Health Observatory

SOPHID Survey Of Prevalent HIV Infections Diagnosed

LAPE Local Alcohol Profiles England

IC NHS Information Centre

ERPHO Eastern Region Public Health Observatory

GUMCAD Genitourinary Medicine Clinic Activity Dataset

WHO World Health Organisation

MEDE Mede Provides Instant Access To Information On Clinical, Operational And Financial Data At

Bexley Care Trust

CAMHS Children And Adolescent Mental Health Services

NVQ National Vocational Qualification

QOF NHS Quality Outcomes Framework

SOC Standard Occupational Classification


List of figures and tables

Figure 1 Bexley's electoral ward map ................................................................................................................................ - 17 - Figure 2 Population estimates 2010-2016 by Bexley Ward, Greater London Authority 2008 PLP Low ..................... - 18 - Figure 3 Population levels from 31

st March 2005 – 31

st March 2026. Strategic Planning and Development, London

Borough of Bexley. ..................................................................................................................................................... - 19 - Figure 4 Population estimated change in Bexley 2006-2010, GLA 2009 ........................................................................ - 20 - Figure 5 Projection of all white and black and minority ethnic groups in Bexley 2001-2020. GLA 2011 ................... - 21 - Figure 6 Projections of Black and Asian Minority Ethnic Groups in males and females in Bexley 2001-2010. GLA 2011

..................................................................................................................................................................................... - 22 - Figure 7 Live births count: persons, 3 year average time periods by South East London Borough of residence, 1990-

2007, LHO/ONS 2008 ................................................................................................................................................ - 23 - Figure 8 Annual rate of live births per 1000 female population in 2008 (with 95% confidence intervals) for maternal

ages of childbearing age between 15-44, by South East London PCT of residence, (NCHOD 2009) ................. - 25 - Figure 9 Birth projection by ethnicity of all mothers. Greater London Authority 2008 .............................................. - 25 - Figure 10 Deprivation: a national and local view. Health Profile for Bexley (APHO 2010 – See appendix 1 for full

profile) ........................................................................................................................................................................ - 26 - Figure 11 ACORN Profile map and key, Central Office for Information 2011 ............................................................ - 28 - Figure 12 Bexley ACORN Profile, Central Office for Information 2011 ....................................................................... - 30 - Figure 13 Overall proportion of all persons in employment April 2004 – September 2009 ONS 2010 ....................... - 33 - Figure 14 Percentage of unemployment in Bexley October 2006 - September 2009, ONS 2010 .................................. - 33 - Figure 15 Percentage employment by occupation by ward in Bexley, ONS 2001 .......................................................... - 34 - Figure 16 Jobseekers Allowance claimants, ONS June 2010 ........................................................................................... - 35 - Figure 17 Percentage of people claiming jobseekers allowance January 2006 - May 2010, ONS 2010 ....................... - 35 - Figure 18 Proportion of all people claiming jobseekers allowance, NOMIS/ONS July 2010 ....................................... - 36 - Figure 20 Proportion of males claiming ............................................................................................................................ - 36 - Figure 19 Proportion of females claiming jobseekers allowance, NOMIS/ONS July 2010 .......................................... - 36 - Figure 21 Life expectancy at birth: females, all ages, 3 year average time periods by South East London Borough of

residence ONS Vital Statistics 1991-2008 ................................................................................................................ - 38 - Figure 22 Life expectancy at birth: males, all ages, 3 year average time periods by South East London Borough of

residence ONS Vital Statistics 1991-2008 ................................................................................................................ - 39 - Figure 23 Male life expectancy at birth 2003-07 by ward, LHO/ONS 2009 ................................................................... - 39 - Figure 24 Female life expectancy at birth 2003-07 by ward, LHO/ONS 2009................................................................ - 40 - Figure 25 Life expectancy at age 65: females, 3 year average time periods by South East London Borough of

residence/ ONS Vital Statistics 2009 ........................................................................................................................ - 40 - Figure 26 Life expectancy at age 65: males, 3 year average time periods by South East London Borough of residence/

ONS Vital Statistics 2009 .......................................................................................................................................... - 41 - Figure 27 Life Expectancy by Deprivation Deciles, showing the Slope index of inequality Bexley, Males, 2004-08 - Slope

index of inequality = 7.8 years, LHO 2009 ............................................................................................................... - 41 - Figure 28 Male life expectancy by deprivation decile 2001-2008, APHO ....................................................................... - 42 - Figure 29 Life Expectancy by Deprivation Deciles, showing the Slope index of inequality Bexley, Females, 2004-08 -

Slope index of inequality = 4.7 years, LHO 2009 ..................................................................................................... - 43 - Figure 30 Female life expectancy by deprivation decile 2001-2008, APHO ................................................................... - 44 - Figure 31 Male slope index of inequalities in life expectancy by deprivation deciles: gap years in life expectancy

between PCTs. WCC, National Centre for Health Outcomes and Development ................................................. - 45 - Figure 32 Female slope index of inequalities in life expectancy by deprivation deciles: gap years in life expectancy

between PCTs. WCC, National Centre for Health Outcomes and Development ................................................. - 45 - Figure 33 Mortality from all causes: females, all ages, directly age-standardised rates (DSR) per 100, 000 population

by south east London borough of residence, annual time trends, 1993-2010 (NCHOD/ONS 2012) .................. - 46 - Figure 34 Mortality from all causes: males, all ages, directly age-standardised rates (DSR) per 100, 000 population by

south east London borough of residence, annual time trends, 1993-2010 (NCHOD/ONS 2012) ........................ - 47 - Figure 35 Mortality from all causes for persons of all ages by ward. 5 year average standardised mortality ratios (SMR

where 100 = England) with 95% confidence intervals 2003-07 (LHO/ONS 2009) ................................................ - 48 - Figure 36 Major causes of death, Vital Statistics ONS 2008 ........................................................................................... - 49 - Figure 37 Cancer mortality rate by deprivation quintile 2004-08, LHO ........................................................................ - 49 - Figure 38 Lung cancer mortality by deprivation quintile, 2004-08 LHO ....................................................................... - 50 - Figure 39 Infant Mortality in Rate in Bexley, London and England & Wales 2001-2007. ONS Vital Statistics 2009 - 51 - Figure 40 Neonatal Mortality Rate in Bexley, London and England 2001-2007. ONS Vital Statistics 2009 ............... - 52 - Figure 41 Post neonatal mortality rate in Bexley, London and England and Wales 2001-2007. ONS Vital Statistics

2009 ............................................................................................................................................................................. - 52 -


Figure 42 Total number of live births and low birth weight. ONS 2007-09. LHO analysis 2010 ................................. - 54 - Figure 43 Percentage of live births less than 2500 grams. ONS 2007-09. LHO analysis 2010...................................... - 54 - Figure 44 Initiation of breast feeding within 48 hours of delivery in Bexley, South East London, London and England

2009-10. NCHOD 2012 .............................................................................................................................................. - 55 - Figure 45 Prevalence of breast feeding at 6-8 weeks from birth in Bexley, 2010/11 Q1 – 2011/12 Q4. NCHOD 2012 . - 56

- Figure 46 Smoking at time of delivery in Bexley, South East London, London and England 2011/12 Q4. NCHOD 2012-

56 - Figure 47 Percentage of screens completed in South East London 2009-10. National Hearing Screening Programme

(NHSP) ........................................................................................................................................................................ - 57 - Figure 48 Percentage of babies lost in the hearing screening process in South East London 2009-10. National Hearing

Screening Programme. .............................................................................................................................................. - 57 - Figure 49 Proportion of children in poverty. London Borough of Bexley 2007 ............................................................ - 59 - Figure 50 Participation rates in the National Child Measurement Programme 2007-2010 for Bexley ....................... - 60 - Figure 51 Prevalence of reception children who are obese, overweight, healthy and underweight between 2007 and

2010 in Bexley, National Child Measurement Programme 2009/10 ...................................................................... - 61 - Figure 52 Prevalence of children in Year 6 who are obese, overweight, healthy, underweight between 2007 and 2010 in

Bexley, National Child Measurement Programme 2009/10 ................................................................................... - 62 - Figure 53 Proportion of children who are obese, overweight, healthy weight and underweight in Reception in south

east London, National Child Measurement Programme 2009-10 ......................................................................... - 63 - Figure 54 Proportion of children who are obese, overweight, healthy weight and underweight in Year 6 in south east

London, National Child Measurement Programme 2009-10 ................................................................................. - 64 - Figure 55 Prevalence of children who are obese, overweight, underweight and healthy weight in Bexley, National

Child Measurement Programme 2009-10 ................................................................................................................ - 65 - Figure 56 Coverage for routine childhood immunisations 2008-2012, HPA COVER .................................................. - 66 - Figure 57 Proportion of children attaining 5 or more A*-C grades in Bexley (End of Key Stage 4). London Borough of

Bexley 2011 ................................................................................................................................................................. - 66 - Figure 58 Number of children looked after (LAC) in Bexley 2008-2011. London Borough of Bexley 2011 ............... - 68 - Figure 59 Children subject to a child protection plan in Bexley 2008-2011. London Borough of Bexley 2011 .......... - 69 - Figure 60 Proportion of looked after children placed in Bexley and out of borough. London Borough of Bexley 2011 .. -

70 - Figure 61 Conceptions in under 18s in Bexley 1998-2010 DCSF/ONS ........................................................................... - 70 - Figure 62 Under 16 conception rates per 1000 females aged 13-15 in south east London 2005-07 DCSF/ONS.......... - 71 - Figure 63 Rate of legal terminations per 1000 females for women over 35 in south east London, 2010 NCHOD ...... - 72 - Figure 64 Mental Health asset score 2 or above by age in Bexley. London Borough of Bexley 2010/11 ..................... - 73 - Figure 65 Mental Health asset score 2 or above by ethnicity in Bexley. London Borough of Bexley 2010/11 ............ - 73 - Figure 66 Mental Health asset score 2 or above by gender in Bexley. London Borough of Bexley 2010/11 ............... - 74 - Figure 67 Mental Health asset scores for children and young people in Bexley. London Borough of Bexley 2010/11 - 74

- Figure 68 Substance misuse asset score 2 or above by age. London Borough of Bexley 2010/11 ................................. - 75 - Figure 69 Substance misuse asset score 2 or above by ethnicity. London Borough of Bexley 2010/11 ........................ - 75 - Figure 70 Substance misuse asset score 2 or above by gender. London Borough of Bexley 2010/11 ........................... - 76 - Figure 71 Substance misuse by asset score of children and young people. London Borough of Bexley 2010/11 ........ - 76 - Figure 72 Likelihood of considering types of accommodation as they become older for respondents aged over 60 .. - 78 - Figure 73 Drug prevalence estimates in Bexely 2004-09. Bexley Annual Drug Treatment Needs Assessment 2010/11- 78

- Figure 74 Alcohol related admission rate per 100 000 in south east London 2002-2011 NCHOD ............................... - 79 - Figure 75 Admissions: three year average rate per 100,000 poplation for persons under 18 with alcohol specific

conditions by SE London 2007-09 - 2009-10 ............................................................................................................ - 79 - Figure 76 .............................................................................................................................................................................. - 79 - Figure 77 Alcohol attributable hospital admissions in males and females 2004-2009 (NWPHO 2010) ....................... - 80 - Figure 78 Mortality from alcohol specific conditions in males and females in south east London 2005-07 NCHOD - 80 - Figure 79 Alcohol attributable mortality rates for males and females (NWPHO 2010) ............................................... - 80 - Figure 80 The chart shows Bexley's measure for each indicator in the Local Alcohol Profiles for England (LAPE), as

well as the regional and England averages and range of all local authority values for comparison purposes.

(NWPHO 2010) .......................................................................................................................................................... - 81 - Figure 81 Alcohol related crime 2004-2009 (NWPHO 2010) ........................................................................................... - 81 - Figure 82 All libraries active users in Bexley 2009-10. London Borough of Bexley ..................................................... - 82 - Figure 83 All libraries active users in Bexley 2009-10. London Borough of Bexley ...................................................... - 82 - Figure 84 Active library users in Bexley by age profile 2009-10. London Borough of Bexley ..................................... - 83 - Figure 85 Genre of books issues in libraries in Bexley 2009-10. London Borough of Bexley ....................................... - 83 -


Figure 86 Coverage of breast screening programme in women aged 53-64 in Bexley. 2003-09 IC/KC52 .................. - 84 - Figure 87 Bowel Screening quarterly uptake rate by PCT in south east London 2009-2011. Bromley Public Health

Intelligence Department 2011 ................................................................................................................................... - 85 - Figure 88 Bowel Screening Positivity quarterly rate by PCT in south east London 2009-2011. Bromley Public Health

Intelligence Department 2011 ................................................................................................................................... - 86 - Figure 89 Cervical Screening Coverage (age 25-64) – Rolling averages per quarter – 07/08, 09/09, 09/10, 10/11 for

Bexley Bromley and Greenwich. Bromley Public Health Intelligence Department 2011.................................... - 87 - Figure 90 Cervical screening coverage in women aged 25-64 in Bexley 2001-2011 IC/KC50 ..................................... - 88 - Figure 91 Proportion of female patients aged 25-64 with recorded cervical cancer screening in south east London

2010-11 NCHOD ........................................................................................................................................................ - 89 - Figure 92 Sexually transmitted diagnoses in Bexley residents between 2008-09 by gender, GUMCAD 2008-09 ....... - 91 - Figure 93 HIV: Numbers of diagnosed infected patients by index of multiple deprivation, annual trends 2004-2008,

(SOPHID 2010) .......................................................................................................................................................... - 91 - Figure 94 Number of patients infected with HIV by probable route of infections, 2004-2008 (SOPHID 2009) ......... - 93 - Figure 95 Percentage of HIV patients by ethnic group 2004-08 (SOPHID 2009) .......................................................... - 94 - Figure 96 Proportion of adults participating in recommended levels of physical activity by south east London Borough

NHS ICIP/ONS 2007-09 ............................................................................................................................................ - 95 - Figure 97 Proportion of adult population regularly undertaking 30 minutes of moderate intensity sport October 2008-

09 by local authority, Sport England Survey .......................................................................................................... - 95 - Figure 98 Map showing obesity prevalence in different wards of Bexley. Obesity Needs Assessment 2010 ............... - 96 - Figure 99 number of takeaway outlets per 1000 people by ward. Obesity Needs Assessment 2010 ............................ - 97 - Figure 100 Modelled estimate for fruit and veg consumption by local authority, NHS IC 2003-05 ............................ - 99 - Figure 101 Model based estimate of fruit and veg consumption by local authority, NHS information centre 2005-05- 99

- Figure 102 Smoking among patients with selected conditions by south east London PCT of residence NCHOD 2007-08

................................................................................................................................................................................... - 100 - Figure 103 Deaths attributed to smoking 2006-08 APHO ............................................................................................. - 100 - Figure 104 Excess Winter Mortality Index (EMW Index) (ratio of excess winter deaths: expected non-winter deaths) in

Bexley, London and England 2005-2008, HNA Toolkit Commissioning Support for London ......................... - 103 - Figure 105 Excess Winter Mortality Index (EMW Index) (ratio of excess winter deaths: expected non-winter deaths) in

south east London, 2006-08. HNA Toolkit Commissioning Support for London .............................................. - 104 - Figure 106 Location of dental practices in Bexley and level of deprivation, 2009 ....................................................... - 106 - Figure 107 Percentage of dental health patients seen in previous 24 months March 2006 – March 2010, NCHOD - 106 - Figure 108 Map showing the provision of social care services weighted against the older population (+65) within the

ward. London Borough of Bexley. .......................................................................................................................... - 110 - Figure 109 Mortality from diabetes in Bexley (ICD9 250 adjusted, ICD10 E10-E14), NCHOD 1993-2010 ............. - 113 - Figure 110 Mortality from diabetes in Bexley (ICD9 250 adjusted, ICD10 E10-E14) in all persons, NCHOD 1993-2008-

113 - Figure 111 Age specific rates of glaucoma in England and Wales. GP Annual prevalence survey 2007 .................. - 114 - Figure 112 Age-specific rates of cataracts in England and Wales. GP Annual Prevalence Survey 2007 .................. - 115 - Figure 113 Prevalence of stroke by south east London Borough of residence, NCHOD 2010/11 .............................. - 116 - Figure 114 Mortality from stroke: persons under 75 years by south east London Borough of residence, NCHOD

2008/10 ...................................................................................................................................................................... - 117 - Figure 115 Mortality from stroke in persons of all ages by south east London Borough of residence, NCHOD 1993-

2010 ........................................................................................................................................................................... - 118 - Figure 116 Mortality from stroke in females under 75 by south east London Borough of Residence, NCHOD 1993-

2010 ........................................................................................................................................................................... - 119 - Figure 117 Mortality from stroke in males under 75 by south east London Borough of Residence, NCHOD 1993-2010 -

120 - Figure 118 Emergency hospital admissions, stroke, persons of all ages, NCHOD 2007-08 ........................................ - 121 - Figure 119 Emergency readmission to hospital within 28 days of discharge, stroke, NCHOD 2007-08 ................... - 122 - Figure 120 Mortality from asthma by south east London Borough of residence, NCHOD 2008-10 ......................... - 123 - Figure 121 Mortality from bronchitis and emphysema by south east London Borough of residence, NCHOD 1993-

2008 ........................................................................................................................................................................... - 123 - Figure 122 Modelled estimates of COPD by south east London PCT, ERPHO 2005-2020 ........................................ - 124 - Figure 123 Modelled estimates of COPD prevalence 2010 by gender group, ERPHO ............................................... - 125 - Figure 124 Proportion of persons of all ages with asthma, who have been prescribed asthma related drugs in the last

12 months by south east London PCT, NCHOD 2007-08 .................................................................................... - 125 - Figure 125 Mortality from bronchitis and emphysema, NCHOD 2008-10 .................................................................. - 126 - Figure 126 Mortality from asthma by south east London Borough of Residence, all persons, NCHOD 2006-08 .... - 126 - Figure 127 Mortality from CHD in persons of all ages in south east London, NCHOD 1993-2010 .......................... - 127 -


Figure 128 Mortality from all cancers for all ages, NCHOD 1993-2010 ...................................................................... - 128 - Figure 129 Mortality from all cancers for persons <75 years of age, NCHOD 1993-2008 ......................................... - 129 - Figure 130 Years of life lost due to mortality from all cancers in persons under 75, 3 year average NCHOD 2008-10 ... -

130 - Figure 131 Years of life lost due to all cancers in persons of all ages, NCHOD 2006-08 ............................................ - 131 - Figure 132 Incidence of tuberculosis in south east London 2010 NCHOD .................................................................. - 131 - Figure 133 Mortality from tuberculosis in south east London 1993-2008 NCHOD .................................................... - 132 - Figure 134 Age standardised mortality rate from suicide and injury undetermined for persons of all ages in south east

London, 1995-2010 NCHOD ................................................................................................................................... - 133 - Figure 135 Comprehensive care plan for patients on mental health register in south east London, 2007-08 NCHOD .... -

134 - Figure 136 Depression severity assessment at outset of treatment in south east London 2007-08 NCHOD ............. - 135 - Figure 137 Prevalence of depression among diabetic patients and or coronary heart disease in south east London

2007-08 NCHOD ...................................................................................................................................................... - 136 - Figure 138 Prevalence of psychosis in south east London 2007-08 ............................................................................... - 137 - Figure 139 Prevalence of dementia in south east London 2010/11 NCHOD ................................................................ - 137 - Figure 140 Care Review among patients with dementia in south east London 2007-08 NCHOD ............................. - 139 - Figure 141 Prevalence of learning disabilities, annual percentages with 95% confidence intervals, persons, 18+ years,

by South East London PCT of residence, 2010/11 NCHOD ................................................................................ - 143 - Figure 142 Health Profile for Bexley 2010, APHO 2011 ............................................................................................... - 149 - Figure 143 Child Health Profile for Bexley 2011 ............................................................................................................ - 153 - Table 1 Practice registered population on 1st January 2011, Bexley Care Trust .......................................................... - 17 - Table 2 Population estimates 2010-2016 by Bexley Ward, Greater London Authority 2008 PLP Low ....................... - 18 - Table 3 Population projection pyramid: annual percentage of males and females, all ages, by 5 year age bands in

Bexley, 2010. GLA 2008 PLP Low ........................................................................................................................... - 20 - Table 4 All Ethnicities population projections in Bexley 2001-2020. GLA 2011 ........................................................... - 21 - Table 5 Employment by occupation. January 2009 - December 2009. ONS annual population survey...................... - 34 - Table 6 Number of babies screened for hearing by PCT in South East London 2009/10. National Hearing Screening

Programme ................................................................................................................................................................. - 58 - Table 7 Educational Achievement of Looked After Children 2008-2010. London Borough of Bexley 2011 .............. - 68 - Table 8 Placement type of looked after children 2009-2011. London Borough of Bexley 2011.................................... - 69 - Table 9 People aged 65 and over living alone by age and gender. POPPI 2012............................................................. - 77 - Table 10 Mortality from cervical cancer for females of all ages 1993-2010 ................................................................... - 86 - Table 11 Modelled estimates of prevalence of obesity in Bexley adults. Obesity Needs Assessment 2010 .................. - 89 - Table 12 Analysis from school lunch box survey. Bexley care Trust 2008-2009............................................................ - 90 - Table 13 People aged 65 and over predicted to have a fall by age. London Borough of Bexley 2010 ........................ - 101 - Table 14 Number of people predicted to be admitted into hospital as a result of falls. POPPI 2012......................... - 101 - Table 15 Total population, population aged 65 and over and population aged 85 and over as a number and as a

percentage of the total population, projected to 2030 in Bexley, POPPI 2012 .................................................... - 108 - Table 16 Population aged 65 and over, projected to 2030, POPPI 2012 .............................................................. - 108 - Table 17 Number of people aged 65 (percentage of total) and over by age and ethnic group, year 2009. POPPI 2012 .... -

108 - Table 18 People aged 65 and over with a limiting long-term illness, by age, projected to 2016 in Bexley. POPPI 2012 .. -

110 - Table 19 People aged 65 and over who are obese or morbidly obese, by age and gender, projected to 2016 in Bexley.

POPPI 2012 .............................................................................................................................................................. - 111 - Table 20 Prevalence of glaucoma ..................................................................................................................................... - 114 - Table 21 Number of people projected to have dementia in Bexley, POPPI 2012 ........................................................ - 138 - Table 22 Number of clients receiving community-based services in 2009-10. London Borough of Bexley ............... - 139 - Table 23 Type of community-based services received by eligible clients in 2009-10. London Borough of Bexley ... - 140 - Table 24 Working-age client group - key benefit claimants. August 2010 London Borough of Bexley .................... - 140 - Table 25 People predicted to have a moderate or severe learning disability in Bexley and hence likely to be in receipt

of services by age. POPPI 12 ................................................................................................................................... - 144 - Table 26 People predicted to have a severe learning disability in Bexley and hence likely to be in receipt of services by

age. POPPI 2012 ...................................................................................................................................................... - 145 - Table 27 The percentage distribution of households receiving intensive Home Care split by age and primary service

user type, 18+ years, 2008 IC/CASSR .................................................................................................................... - 145 - Table 28 People aged 65 and over providing unpaid care to a partner, family member or other person, by age and by

hours of care provided, projected to 2016 in Bexley. POPPI 2012 ....................................................................... - 146 -


Table 29 Current population estimates for vulnerable groups with housing-related support needs. London Borough of

Bexley ........................................................................................................................................................................ - 147 - Table 30 Housing related needs for specific populations between 2006-2009. London Borough of Bexley. ............. - 148 -

- 16 - 1. Introduction

Chapter 1 Introduction

Information in the following pages along with the information provided by customers, patients and residents as

referred to in section 1.5 in the joint strategic needs assessment document (JSNA) 2010-12, provides the

supporting evidence for the conclusions made in JSNA. The following pages give a broad outline of the

general status of the borough with regard to demographics, socioeconomic status, life expectancy, mortality

and infant mortality. This broad outline supports various conclusions throughout the JSNA.

The rest of the document is broken down into the life course perspective as is the JSNA 2010-12 document:

Providing a healthy start to life and transition into adulthood

Providing healthy environments and sustainable development

Enabling positive citizen behaviour change and promoting health

Providing services for residents including those with long term conditions to maximise choice,

control and wellbeing

A note to the reader…

The Compendium of information report for Bexley 2011 is the evidence report that accompanies

the Joint Strategic Needs Assessment 2010-12; these documents can be accessed on the Bexley

Care Trust website at www.bexley.nhs.uk and the London Borough of Bexley website at

www.bexley.gov.uk; a summary document is also available. To request a copy of either documents

please email [email protected].

If you would like to skim read the document you can do this by reading the key words

highlighted in green.

Terms in italics can be referred to in the glossary of terms on page 5.

Further information on acronyms can be found in the sources and acronyms section on page 7.

http://www.bexley.nhs.uk/

http://www.bexley.gov.uk/

mailto:[email protected]

- 17 - 1.1 Introduction: DEMOGRAPHY

1.1 Demography

Bexley is an outer London borough with a northern boundary on the river Thames and is situated between

Bromley, Greenwich and Dartford. It is generally considered an affluent suburban borough. Bexley has 21

electoral wards.

Figure 1 Bexley's electoral ward map

The Greater London Authority (GLA) 2011 population estimates for 2011 show the Bexley resident

population as 220 223. This population is predicted to increase to 224 038 by 2020.

Table 1 Practice registered population on 1st January 2011, Bexley Care Trust

Females Males Persons External Grand Total

0-4 5 - 64 65 -

74

75

Plus Total 0-4 5 - 64

65 -

74

75

Plus Total Total Total Total

Clocktower 2148 31153 3688 3937 40926 2205 31195 3238 2726 39364 80290 95 80385

Frognal 1367 19858 2566 3288 27079 1386 19597 2223 2060 25266 52345 1713 54058

North

Bexley 3523 37606 3432 3458 48019 3628 37040 3011 2315 45994 94013 910 94923

TOTAL 7038 88617 9686 10683 116024 7219 87832 8472 7101 110624 226648 2718 229366

Population make up by ward


The breakdown of population by ward can be seen in Figure 2. The current largest ward populations are

Thamesmead East, Erith and Christchurch. The greatest population increases between 2010 and 2016 are

expected in the Christchurch, Erith and Barnehurst wards. The current population registered with general

practices in Bexley is 229 366.

Figure 2 Population estimates 2010-2016 by Bexley Ward, Greater London Authority 2008 PLP Low

Table 2 Population estimates 2010-2016 by Bexley Ward, Greater London Authority 2008 PLP Low

Ward Number

2010 2016

Barnehurst 9989 10243

Belvedere 10751 10727

Blackfen and Lamorbey 10174 10091

Blendon and Penhill 10141 10084

Brampton 10071 9934

Christchurch 10315 10882

Colyers 10329 10245

Crayford 10235 10479

Cray Meadows 10213 10292

Danson Park 10214 10402

East Wickham 10118 10247

Erith 10612 11155

Falconwood and Welling 10324 10258

Lesnes Abbey 10728 10635

Longlands 9588 9736

North End 10325 10282

Northumberland Heath 10354 10557

St. Mary's 9851 9976

St. Michael's 10378 10239

Sidcup 10184 10106

Thamesmead East 11099 11341

Population projections by Ward: persons, all ages, comparison of 2010 with 2016

8500

9000

9500

10000

10500

11000

11500

Barn

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t

Belv

eder

e

Bla

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and P

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Cra

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Cra

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ark

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St. M

ary'

s

St. M

ichae

l's

Sid

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Tha

mesm

ead E

ast

Nu

mb

er

2010 2016


Local projections carried out by the London Borough of Bexley (LBB) combine GLA 2007 population figures,

the 2004 London Housing Capacity Study, 2001 Census data and a study commissioned by LBB in 2007. The

GLA suggests that household size will reduce from 2.34 people per household to 2.19 by 2031. However, in

Bexley, our evidence points to an increase in household size. Thus, even using the same Strategic Housing

Land Availability Assessment (SHLAA) data (number of new homes) this is one of the reasons why the

population growth is shown to be different.

Since this work was completed, additional potential housing sites have been identified in the Barnehurst

ward in the Strategic Housing Land Availability Assessment 2009 which could potentially increase the

population in this are further than stated, although not to the same amounts as Erith, Thamesmead East,

Crayford and Christchurch Wards.

Figure 3 Population levels from 31

st March 2005 – 31

st March 2026. Strategic Planning and Development, London

Borough of Bexley.

Population Levels: Scenario 1 2005

Population 2017

Population % Change 2005-2017

2026 Population

Change from 2017

% Change 2017-2026

Total Pop Change

2005 - 2026

% Change 2005-2026

All 218849 230168 5.17 238647 8480 3.68 19798 9.05

00ADGA Barnehurst 10202 10700 4.88 11073 373 3.49 871 8.54

00ADGB Belvedere 10794 10898 0.96 10976 78 0.72 182 1.69

00ADGC Blackfen and Lamorbey 10279 10304 0.24 10322 19 0.18 43 0.42

00ADGD Blendon and Penhill 10122 10199 0.75 10256 57 0.56 133 1.31

00ADGE Brampton 10263 10263 0 10263 0 0 0 0

00ADGF Christchurch 10327 11211 8.56 11873 662 5.91 1546 14.97

00ADGG Colyers 10398 10471 0.71 10527 55 0.53 129 1.24

00ADGJ Cray Meadows 10141 10646 4.97 11023 378 3.55 882 8.7

00ADGH Crayford 10238 11629 13.58 12671 1042 8.96 2433 23.76

00ADGK Danson Park 10178 10620 4.34 10951 331 3.12 772 7.59

00ADGL East Wickham 10239 10483 2.38 10665 182 1.74 426 4.16

00ADGM Erith 10611 13044 22.93 14867 1823 13.97 4256 40.11

00ADGN Falconwood and Welling

11375 11843 4.11 12193 350 2.96 817 7.19

00ADGP Lesnes Abbey 10805 10907 0.95 10984 77 0.7 179 1.66

00ADGQ Longlands 9247 9568 3.48 9809 241 2.52 562 6.08

00ADGR North End 10268 10874 5.9 11328 454 4.17 1060 10.32

00ADGS Northumberland Heath 10445 10983 5.15 11386 403 3.67 941 9.01

00ADGW Sidcup 10145 10285 1.37 10389 104 1.01 243 2.4

00ADGT St Mary's 10054 10336 2.8 10546 211 2.04 492 4.89

00ADGU St Michael's 10536 10547 0.11 10556 9 0.08 20 0.19

00ADGX Thamesmead East 12178 14356 17.88 15987 1631 11.36 3809 31.28

Population make up by age

Bexley has an ageing population compared to London. The largest proportion of females is in the 45-49 age band

and in men it is the 30-34 age band.


As seen in Figure 4 the proportion of residents over 65 has been projected to increase from 2006 to 2016,

whereas a decrease has been projected for residents between ages 15-64. There will therefore be a higher need for

services for services associated with older age.

Figure 4 Population estimated change in Bexley 2006-2010, GLA 2009

Table 3 Population projection pyramid: annual percentage of males and females, all ages, by 5 year age bands in

Bexley, 2010. GLA 2008 PLP Low

Age range Number of

Females % Females Number of Males % Males

0 to 4 7084 3.3 7273 3.4

5 to 9 6385 3.0 6397 3.0

10 to 14 6381 3.0 6456 3.0

15 to 19 6720 3.1 7003 3.2

20 to 24 6217 2.9 6274 2.9

25 to 29 7748 3.6 7433 3.4

30 to 34 8537 4.0 8338 3.9

35 to 39 7843 3.6 7885 3.7

40 to 44 8169 3.8 7888 3.7

45 to 49 8336 3.9 7486 3.5

50 to 54 7122 3.3 6689 3.1

55 to 59 5999 2.8 5537 2.6

60 to 64 6109 2.8 5679 2.6

65 to 69 4650 2.2 4104 1.9

70 to 74 4255 2.0 3554 1.6

75 to 79 3734 1.7 2923 1.4

80 to 84 2991 1.4 2040 0.9

85 to 89 2036 0.9 1106 0.5

Population projections 2006 and 2016 for Bexley, GLA 2009

5 4 3 2 1 0 1 2 3 4 5

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 +

Ag

e G

ro

up

% Population% Male 2006 % Female 2006

% Male 2016 % Female 2016


90+ 1136 0.5 469 0.2

Population make up by ethnicity

Population projections published by the GLA in 2011 illustrate a projected decrease in all White ethnic

groups and an increase in all Black and Asian Minority Ethnic (BAME) groups in Bexley. As illustrated

in Figure 6, this projection is highest in Black African groups.

Table 4 All Ethnicities population projections in Bexley 2001-2020. GLA 2011

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

All Ethnicities 219,054 219,328 218,449 218,189 218,752 218,939 219,087 220,111 220,520 220,336

White 200,124 199,114 197,071 195,638 194,977 194,072 193,118 192,938 192,314 191,211

Black Caribbean 1,776 1,899 2,011 2,122 2,233 2,329 2,426 2,527 2,611 2,688

Black African 4,105 4,843 5,549 6,238 6,913 7,523 8,141 8,766 9,301 9,806

Black Other 1,673 1,854 2,026 2,203 2,388 2,562 2,742 2,937 3,114 3,280

Indian 5,574 5,527 5,452 5,397 5,372 5,342 5,308 5,305 5,294 5,263

Pakistani 363 375 384 393 403 409 416 425 432 435

Bangladeshi 389 405 419 433 451 467 483 504 523 538

Chinese 1,554 1,510 1,459 1,415 1,382 1,351 1,320 1,299 1,279 1,254

Other Asian 2,055 2,159 2,247 2,334 2,429 2,510 2,593 2,689 2,769 2,837

Other 1,440 1,643 1,832 2,015 2,203 2,372 2,540 2,721 2,883 3,026

BAME 18,930 20,214 21,378 22,550 23,775 24,867 25,969 27,174 28,206 29,125

2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

All Ethnicities 220,223 220,579 220,933 221,283 221,631 221,975 222,497 223,015 223,528 224,038

White 190,213 189,647 189,123 188,640 188,204 187,809 187,602 187,432 187,298 187,198

Black Caribbean 2,761 2,838 2,910 2,977 3,041 3,101 3,161 3,218 3,271 3,322

Black African 10,287 10,772 11,230 11,660 12,064 12,444 12,815 13,163 13,490 13,798

Black Other 3,442 3,606 3,765 3,920 4,067 4,208 4,345 4,478 4,605 4,727

Indian 5,236 5,222 5,210 5,200 5,190 5,181 5,177 5,173 5,169 5,165

Pakistani 438 443 447 450 453 456 459 461 463 465

Bangladeshi 552 567 581 594 606 617 628 638 647 656

Chinese 1,232 1,215 1,199 1,186 1,174 1,163 1,155 1,147 1,141 1,135

Other Asian 2,901 2,970 3,035 3,097 3,155 3,209 3,262 3,312 3,359 3,403

Other 3,162 3,301 3,433 3,559 3,676 3,787 3,893 3,992 4,085 4,171

BAME 30,011 30,933 31,810 32,643 33,427 34,166 34,895 35,583 36,230 36,840

Figure 5 Projection of all white and black and minority ethnic groups in Bexley 2001-2020. GLA 2011


Figure 6 Projections of Black and Asian Minority Ethnic Groups in males and females in Bexley 2001-2010. GLA 2011

Births

Figure 7, live birth counts between 1990-2007 illustrate an overall decrease in births in Bexley since 1990, lower

than neighbouring boroughs in south east London. The rate of live births per 1000 births for women in Bexley

of childbearing age is close to the England average and is generally lower than neighbouring boroughs in

south east London. Birth projections in black and minority ethnic groups illustrate a projected increase of births in

Black Caribbean and Black African groups.

Projections of all White ethnic and Black Asian and Minority Ethnic groups in

Bexley 2001-2020. GLA 2011

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

Year

%

All white

All BAME

Black and Minority Ethnic male population projection in Bexley. GLA 2011

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Year

%

Black Caribean

Black African

Black Other

Indian

Pakistani

Bangladeshi

Chinese

Other Asian

Other

Black and Minority Ethnic female population projection in Bexley. GLA 2011

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020

Year

%

Black Caribean

Black African

Black other

Indian

Pakistani

Bangladeshi

Chinese

Other Asian

Other


Figure 7 Live births count: persons, 3 year average time periods by South East London Borough of residence, 1990-

2007, LHO/ONS 2008

Area 2002 2003 2004 2005 2006 2007 2008 2009 2010

Lewisham 3845 3932 4068 4284 4568 4671 4872 4888 4982

Southwark 4138 4342 4452 4714 4753 4966 5008 4873 5131

Lambeth 4374 4787 4753 4739 4908 4822 4837 4863 4929

Bexley 2517 2640 2699 2686 2788 2947 2975 3029 2993

Bromley 3401 3651 3589 3663 3740 3956 3983 4104 4070

Greenwich 3345 3446 3721 3963 4236 4471 4361 4480 4674

Live births count: persons, 3 year average time periods by South East London

Borough of residence, 1990-2007

2580

2803

3026

3249

3472

3695

3918

4141

4364

4587

4810

1990-

92

1991-

93

1992-

94

1993-

95

1994-

96

1995-

97

1996-

98

1997-

99

1998-

00

1999-

01

2000-

02

2001-

03

2002-

04

2003-

05

2004-

06

3 y

r a

verage n

um

ber

Lewisham Lambeth Southwark Greenwich Bromley Bexley

Released: 09/06/2008

Source: LHO / ONS


2500

3000

3500

4000

4500

5000

5500

2002 2003 2004 2005 2006 2007 2008 2009 2010

N

u

m

b

e

r

Number of live births for women aged 15-44 years by S.E. London Borough of Residence. Annual trends, 2002-2010

Lewisham Southwark Lambeth


Figure 8 Annual rate of live births per 1000 female population in 2008 (with 95% confidence intervals) for maternal

ages of childbearing age between 15-44, by South East London PCT of residence, (NCHOD 2009)

Figure 9 Birth projection by ethnicity of all mothers. Greater London Authority 2008

The proportion of black and ethnic minority young people in Bexley schools is 25%. This is higher than the

level of the general population at 13% and the number of children resident in the borough from black and ethnic

minorities (0-16 years old) at 19%.

Fertility: annual rate of live births per 1000 female population (with 95%

confidence intervals) for maternal ages 11-49 years, of childbearing age

between 15-44, by South East London PCT of residence, 2008

50

55

60

65

70

75

80

85

90

England London Lewisham Lambeth Southwark Greenwich Bromley Bexley

Ra

te/

10

00

fe

ma

le p

op

ula

tio

n a

ge

d 1

5-4

4

0

500

1,000

1,500

2,000

2,500

3,000

2001-0

2

2002-0

3

2003-0

4

2004-0

5

2005-0

6

2006-0

7

2007-0

8

2008-0

9

2009-1

0

2010-1

1

2011-1

2

2012-1

3

2013-1

4

2014-1

5

2015-1

6

2016-1

7

2017-1

8

2018-1

9

2019-2

0

2020-2

1

2021-2

2

2022-2

3

2023-2

4

2024-2

5

2025-2

6

< Historic | Projected > .

MID-YEAR to MID-YEAR

BIR

TH

S

White

Black Caribbean

Black African

Black Other

Indian

Pakistani

Bangladeshi

Chinese

Other Asian

Other

- 26 - 1.2 Introduction: SOCIOECONOMIC STATUS

1.2 Socioeconomic status

Bexley sits in the 111th position of deprivation out of the 152 local authorities in England – 1 takes the position of

most deprived and 152 takes the position of least deprived. The Index of Multiple Deprivation 2007 (IMD 2007)

which forms part of the Index of Multiple Deprivation (IMD) 2007 is based on the small area geography known

as Lower Super Output areas (LSOAs). The spread of deprivation in Bexley is illustrated in figure 10.

Comparisons of deprivation at a national level illustrate the areas in Bexley which are most deprived in

relation to the national picture. The number of areas increases when deprivation is observed within Bexley

only. In either illustration, the Thames corridor between the wards of Thamesmead East and North End are

the most deprived areas.

The IMD brings together 37 different indicators which cover specific aspects or dimensions of deprivation:

Income (22.5%), Employment (22.5%), Health and Disability (13.5%), Education, Skills and Training (13.5%),

Barriers to Housing and Services (9.3%), Living Environment (9.3%) and Crime (9.3%). These are weighted and

combined to create the overall IMD 2007.

Figure 10 Deprivation: a national and local view. Health Profile for Bexley (APHO 2010 – See appendix 1 for full

profile)


ACORN is a geodemographic segmentation tool which segments small neighbourhoods, postcodes, or consumer

households into categories, groups and types. The ACORN profile for Bexley in Figure 11 and 12 contains the

geodemographic information of Bexley. The colours in figure 11 represent the various segments

represented in the key on the right. These are broadly grouped into people who have existing problems,

people who will have problems in the future, people with possible future concerns and healthy people.

Light purple, number 15 dominates the map of Bexley which is the colour category for ‘healthy pensioners

dining out’. This is followed by a selection of blues under 23, 24 and 25: ‘Towns and villages with average

health and diet’, ‘Mixed communities with better than average health’ and ‘Affluent towns and villages

with excellent health and diet’

There are pockets of people in the red 14 category ‘Less affluent neighbourhoods, high fast good, sedentary

lifestyles’ which correlates with the map of deprivation. There are also pockets of groups in the bright

green 6 category ‘Elderly with associated health issues which reflects the picture of the borough that we

know.

The northern Thames corridor of Bexley has a concentration of category 13 orange ‘Disadvantaged multi-

ethnic younger adults, high levels of smoking’ which represents a section of the future problems for the

borough.

Figure 11 ACORN Profile map and key, Central Office for Information 2011


The ACORN profile in figure 12 describes the relationship between the area of Bexley and the base area,

London by comparing the proportion of each data element. Each element is reviewed by looking at three areas:

- Percentage of Area

Counts of the number of people within each data element in Bexley and is shown as raw counts

and as percentages of the total area. These percentages are used to calculate an index.

- Percentage of Base

Counts of the number of people within each data element in London and are shown as percentages of the

total base. These percentages are used to calculate an index.

- Index

The index shows how the percentage of an element within Bexley compares with the percentage of

that element in the London base. Differences between these two percentages are measured by the index in

the following way.

- An index of 100 indicates that the representation of that element is the same within the study

area as in the base area.

- An index of over 100 shows above-average representation (e.g. 140 shows that this element is

40% over-represented in the area compared with the base).

- An index of under 100 shows below-average representation.

- Charts

The radar chart (aka Spider's Web) is useful way to display 2-dimensional data. Each observation is represented as

a star-shaped figure with one ray for each variable/category. For a given observation, the length of each ray is

made proportional to the size of that variable.

8 Disadvantaged neighbourhoods with poor diet & severe health issues

7 Home owning pensioners, traditional diets

6 Elderly with associated health issues

5 Deprived neighbourhoods with poor diet, smokers

4 Post industrial pensioners with long term illness

3 Vulnerable disadvantaged, smokers with high levels of obesity

2 Disadvantaged elderly, poor diet, chronic health

1 Older couples, traditional diets, cardiac issues

Existing problems

13 Disadvantaged multi-ethnic younger adults, high levels of smoking

12 Deprived multi-ethnic estates, smokers and overweight

11 Urban estates with sedentary lifestyle & low fruit & veg consumption

10 Multi-ethnic, high smoking, high fast food consumption

9 Poor single parent families with lifestyle related illnesses

Future problems

19 Affluent families with some dietary concerns

18 Low income families with some smokers

17 Affluent professionals, high alcohol consumption, dining out

16 Home owning older couples, high levels of fat & confectionery

15 Affluent healthy pensioners dining out

14 Less affluent neighbourhoods, high fast food, sedentary lifestyles

Possible future concerns

25 Affluent towns and villages with excellent health and diet

24 Mixed communities with better than average health

23 Towns and villages with average health and diet

22 Students and young professionals, living well

21 Younger affluent, healthy professionals

20 Young mobile population with good health and diet

Healthy


Figure 12 Bexley ACORN Profile, Central Office for Information 2011


Office for National Statistics figures for financial year end (FYE) March 2010 indicate that 76.6% of Bexley’s

economically active residents are in employment. However, between 2009 and 2010, the number of


economically inactive residents increased by 17% to 34,300. It should be noted that over the same period the

number of people claiming out of work benefits has risen by 2%. The economic downturn has had a significant

impact in Bexley with unemployment rising from a fairly steady 2,300 in 2006 to more than 5,000 in February

2010 – recent research commissioned by LBB indicated that Slade Green was one of the wards most affected

by increased claimant counts during the recession.5

Bexley has a lower take up of Job Seekers Allowance (JSA) at 3.3%, than its London neighbours at 4.2% and

national average of 3.8% (June 2010). It also has a higher take up of working tax credit than most of its statistical

neighbours, currently 22%. Bexley has 11 lower level super output areas (out of 146 in total), which are among

the 10% most deprived areas in the country. It has a further 40 areas which are among the 40% most

disadvantaged areas based on the IMD.

Figures 16-19 show areas of Bexley where there are higher levels of JSA claimants, these correlate both with

increased social housing and black and minority ethnic groups.

Local intelligence6 shows that the majority of households in Bexley (40%) are comprised of older families, of

which over half are middle aged, middle income owner occupiers living on very large developments of 1930s

suburban semi-detached housing.

National Online Manpower Information System (NOMIS) official labour market statistics show that nearly 36%

of jobs in Bexley are part-time which should be considered alongside apparent high levels of employment. Bexley

has the highest rate of part-time employment in London. Male employment rates in Bexley have shown a

big fall compared to rates in London.

Bexley’s occupational structure mirrors Britain as a whole rather than London. Bexley’s office workforce has a

relatively low representation of higher level managerial and professional jobs. Skilled trades are over-represented.

In 2008, the median gross weekly pay for Bexley’s full-time workers was £591, in 2009 this had dropped to

£529.9; 84% of the London median wage. Full-time female workers in Bexley are paid 80% of the London

median wage for female employees, for part-time female workers that drops to 76%. In terms of total

workplace earnings Bexley ranked 26th out of the 33 London boroughs in 2009 – up from 28th in 2007. The

Borough’s total residents’ earnings ranking slipped from 19th to 23rd.

NOMIS also shows that 46.6% of Bexley’s working age population are qualified to NVQ3 and above,

compared to 53.2% in London (ONS 2009). However, it should be noted that educational attainment rates for

NVQ3 and above in Bexley increased by 3.2% between 2008 and 2009, compared with a 1.6% increase in

London.

The job impacts of the recession may have been more severe in Bexley than the rest of London. Bexley is

rated “very high” in terms of the projected increase in unemployment and “high” in terms of the number of jobs in

sectors that are vulnerable to the recession (NOMIS).

Bexley is part of the least competitive sub-region of London, although London far out-performs other regions of

the UK. Bexley’s sub-region witnessed economic growth comparable to the North and Midlands. Entrepreneurial

activity is low in Bexley, even compared against the rest of East London. This contrasts sharply with growth in

the rest of London and the country.


Figure 13 Overall proportion of all persons in employment April 2004 – September 2009 ONS 2010

Figure 14 Percentage of unemployment in Bexley October 2006 - September 2009, ONS 2010

Percentage Employment of population, All persons, April 04 - September 09

62

64

66

68

70

72

74

76

78

80

82

Apr

04-

Mar

05

Oct

04-

Sep

05

Jan

05-

Dec

05

Apr

05-

Mar

06

Jul 05-

Jun 06

Oct

05-

Sep

06

Jan

06-

Dec

06

Apr

06-

Mar

07

Jul 06-

Jun 07

Oct

06-

Sep

07

Jan

07-

Dec

07

Apr

07-

Mar

08

Jul 07-

Jun 08

Oct

07-

Sep

08

Jan

08-

Dec

08

Apr

08-

Mar

09

Jul 08-

Jun 09

Oct

08-

Sep

09

Perc

en

tag

e E

mp

lom

en

t o

f P

op

ula

tio

n

Bexley (%)

London (%)

Great Britain(%)

05/2010

Source: ONS

Percentage of Unemployed Bexley Population, Comparision with London and Britain

Unemployment percentage rates, all persons, Oct 04 - Sep 09

3

4

5

6

7

8

9

Oct

04-

Sep

05

Jan

05-D

ec 0

5

Apr

05-

Mar

06

Jul 0

5-Ju

n 06

Oct

05-

Sep

06

Jan

06-D

ec 0

6

Apr

06-

Mar

07

Jul 0

6-Ju

n 07

Oct

06-

Sep

07

Jan

07-D

ec 0

7

Apr

07-

Mar

08

Jul 0

7-Ju

n 08

Oct

07-

Sep

08

Jan

08-D

ec 0

8

Apr

08-

Mar

09

Jul 0

8-Ju

n 09

Oct

08-

Sep

09

Pe

rce

nta

ge

Un

em

plo

ym

en

t

Bexley %

London %

Great Britain %

05/2010

Source: ONS


Figure 15 Percentage employment by occupation by ward in Bexley, ONS 2001

Table 5 Employment by occupation. January 2009 - December 2009. ONS annual population survey

Bexley

(numbers)

Bexley

(%)

London

(%)

Great Britain

(%)

SOC 2000 major group 1-3 46,600 45.4 54.7 44.1

1 Managers and senior officials 18,500 17.9 17.7 15.7

2 Professional occupations 10,300 10.0 17.9 13.6

3 Associate professional & technical 17,800 17.2 18.8 14.7

SOC 2000 major group 4-5 26,800 26.1 18.6 21.7

4 Administrative & secretarial 16,400 15.8 11.0 11.2

5 Skilled trades occupations 10,400 10.0 7.6 10.4

SOC 2000 major group 6-7 15,200 14.8 13.1 16.1

6 Personal service occupations 8,700 8.4 7.0 8.6

7 Sales and customer service occs 6,400 6.2 6.0 7.4

SOC 2000 major group 8-9 14,200 13.8 13.6 18.1

8 Process plant & machine operatives 4,800 4.7 4.5 6.7

9 Elementary occupations 9,300 9.0 8.9 11.3

* Standard Occupational Classification

Notes: Numbers and % are for those of 16+

% is a proportion of all persons in employment

Percentage employment by occupation by ward, Bexley, ONS 2001

0

5

10

15

20

25

Barn

ehurs

t

Belv

edere

Bla

ckfe

n a

nd L

am

orb

ey

Ble

ndon a

nd P

enhill

Bra

mpto

n

Christc

hurc

h

Coly

ers

Cra

yfo

rd

Cra

y M

eadow

s

Danson P

ark

East

Wic

kham

Erith

Falc

onw

ood a

nd W

elli

ng

Lesnes A

bbey

Longla

nds

Nort

h E

nd

Nort

hum

berland H

eath

St

Mary

's

St

Mic

hael's

Sid

cup

Tham

esm

ead E

ast

Ward

%

1.Manager and Senior Officials

2.Professional

3.Associate Professional and Technical

4.Administrative and Secretarial

5.Skilled Trades

6.Personal Services

7.Sales and Customer Services

8.Process Plant and Machine operatives

9.Elememtary Occupations


Figure 16 Jobseekers Allowance claimants, ONS June 2010

Figure 17 Percentage of people claiming jobseekers allowance January 2006 - May 2010, ONS 2010

JSA Claimaints, all persons, percentage of Bexley population for June 2010

0

1

2

3

4

5

6

All people Males Females

Perc

en

tag

e o

f P

op

ula

tio

n

Bexley %

London %

05/2010

Source: ONS

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Jan-

06

Mar-

06

May-

06

Jul-06

Sep

-06

Nov-

06

Jan-

07

Mar-

07

May-

07

Jul-07

Sep

-07

Nov-

07

Jan-

08

Mar-

08

May-

08

Jul-08

Sep

-08

Nov-

08

Jan-

09

Mar-

09

May-

09

Jul-09

Sep

-09

Nov-

09

Jan-

10

Mar-

10

May-

10

Perc

en

tag

e o

f P

op

ula

tio

n

Bexley %

London %

Britain %

05/2010

Source: ONS

Percentage of population claiming JSA in Bexley, Annual Time Trends, comparison with

London and Britain, Jan 06 - May 10


Figure 18 Proportion of all people claiming jobseekers allowance, NOMIS/ONS July 2010

Figure 20 Proportion of males claiming

jobseekers allowance, NOMIS/ONS July 2010

Table 1 Percentage Jobseekers Allowance claimants by age and duration. ONS claimant count August 2010

Bexley

(numbers)

Bexley

(%)

London

(%)

Great Britain

(%)

Figure 19 Proportion of females claiming

jobseekers allowance, NOMIS/ONS July 2010


By age of claimant

Aged 18-24 1,225 27.8 23.9 28.9

Aged 25-49 2,445 55.5 60.5 55.6

Aged 50 and over 715 16.2 15.5 15.2

By duration of claim

Up to 6 months 2,955 67.1 62.9 63.2

Over 6 up to 12 months 780 17.7 19.9 19.0

Over 12 months 670 15.2 17.1 17.8

Note: % is a proportion of all JSA claimants

- 38 - 1.3 Introduction: LIFE EXPECTANCY

1.3 Life expectancy

Life expectancy in Bexley is higher than the national and regional average. It is particularly higher in the wards

Blackfen and Lamorbey for males and Danson Park for females.

The lowest life expectancy for men is in the Thamesmead East ward which is significantly lower than

Blackfen and Lamorbey with the highest life expectancy for men. Figure 27 illustrates this difference as a

slope index of inequality: the difference in life expectancy of men in the most deprived and least deprived

decile in 2004-08 was 7.8 years. Over the years, figure 28 demonstrates that life expectancy in men in all

deprivation deciles has improved. However in some areas of higher deprivation life expectancy in men has not

had the same effect, particularly in decile 4 where life expectancy has actually decreased.

The lowest life expectancy for females is in the Colyers ward which is significantly different to the life

expectancy in the Danson Park ward. The slope index of inequality in figure 29 illustrates a difference in life

expectancy of women in the most deprived and least deprived decile in 2004-08 of 4.7 years. Similar to the

above, figure 30 illustrates life expectancy in females over the years, which has in general improved, however this

is not the case for deprivation decile 5 and 8. Decile 8 is a less deprived decile and further analysis into this is

probably needed.

The difference in life expectancies between the most deprived and least deprived areas is compared to other areas

in London in figures 31 and 32, illustrating that there is a higher inequality of life expectancy in males than in

females in Bexley. The difference in life expectancies in males is higher than the difference in females and sits

between Bromley and Enfield.

Figure 21 Life expectancy at birth: females, all ages, 3 year average time periods by South East London Borough of

residence ONS Vital Statistics 1991-2008

Life expectancy at birth: females, all ages, 3 year average time periods by South East

London Borough of residence, 1991-1993 to 2006-2008

76

77

78

79

80

81

82

83

84

85

1991-1

993

1992-1

994

1993-1

995

1994-1

996

1995-1

997

1996-1

998

1997-1

999

1998-2

000

1999-2

001

2000-2

002

2001-2

003

2002-2

004

2003-2

005

2004-2

006

2005-2

007

2006-2

008

Ye

ars

England London Lewisham Lambeth Southwark Bexley Bromley Greenwich


Figure 22 Life expectancy at birth: males, all ages, 3 year average time periods by South East London Borough of

residence ONS Vital Statistics 1991-2008

Figure 23 Male life expectancy at birth 2003-07 by ward, LHO/ONS 2009

Life expectancy at birth: males, all ages, 3 year average time periods by South East London

Borough of residence, 1991-1993 to 2006-2008

69

70

71

72

73

74

75

76

77

78

79

80

81

1991-1

993

1992-1

994

1993-1

995

1994-1

996

1995-1

997

1996-1

998

1997-1

999

1998-2

000

1999-2

001

2000-2

002

2001-2

003

2002-2

004

2003-2

005

2004-2

006

2005-2

007

2006-2

008

Ye

ars


Life expectancy at birth (with 95% confidence intervals) by ward, 5 year average,

males , 2003-07

Average

70

72

74

76

78

80

82

84

86

Barn

ehurs

t

Belvedere

Bla

ckfe

n a

nd L

am

orb

ey

Ble

ndon a

nd P

enhill

Bra

mpto

n

Christ

churc

h

Coly

ers

Cra

yfor

d

Cra

y M

eadow

s

Danso

n P

ark

East

Wickham

Erith

Falconw

ood a

nd W

elling

Lesn

es Abbey

Longla

nds

North E

nd

Northum

ber

land H

eath

St Mary

's

St Michael's

Sid

cup

Tham

esm

ead E

ast

Ye

ars


Figure 24 Female life expectancy at birth 2003-07 by ward, LHO/ONS 2009

Figure 25 Life expectancy at age 65: females, 3 year average time periods by South East London Borough of

residence/ ONS Vital Statistics 2009

Life expectancy at birth (with 95% confidence intervals) by ward, 5 year average,

females , 2003-07

Average

70

72

74

76

78

80

82

84

86

88

Barn

ehurs

t

Belvedere

Bla

ckfe

n a

nd L

am

orb

ey

Ble

ndon a

nd P

enhill

Bra

mpto

n

Christ

churc

h

Coly

ers

Cra

yfor

d

Cra

y M

eadow

s

Danso

n P

ark

East

Wickham

Erith

Falconw

ood a

nd W

elling

Lesn

es Abbey

Longla

nds

North E

nd

Northum

ber

land H

eath

St Mary

's

St Michael's

Sid

cup

Tham

esm

ead E

ast

Ye

ars

Life expectancy at age 65: females, 3 year average time periods by South East London


16

17

18

19

20

21

22

2000-2

002

2001-2

003

2002-2

004

2003-2

005

2004-2

006

2005-2

007

2006-2

008

Ye

ars



Figure 26 Life expectancy at age 65: males, 3 year average time periods by South East London Borough of residence/

ONS Vital Statistics 2009

Figure 27 Life Expectancy by Deprivation Deciles, showing the Slope index of inequality Bexley, Males, 2004-08 - Slope

index of inequality = 7.8 years, LHO 2009

Life expectancy at age 65: males, 3 year average time periods by South East London


13

14

15

16

17

18

19

2000-2

002

2001-2

003

2002-2

004

2003-2

005

2004-2

006

2005-2

007

2006-2

008

Ye

ars



Figure 28 Male life expectancy by deprivation decile 2001-2008, APHO

Note. Sources: ONS death registration data and mid-year population estimates & Department of Communities and Local

Government, Indices of Deprivation 2007. Analysis carried out by LHO and EMPHO on behalf of APHO. For details of

data sources and calculations go to: http://www.apho.org.uk/resource/view.aspx?RID=75050

0

2

4

6

8

10

12

14

16

Southwark Greenwich Bexley Bromley Lewisham Lambeth

Y

e

a

r

s

Slope Index of Inequality for Life Expectancy of males by Deprivation Deciles. 5 year averages (with 95% confidence

intervals) by South East London borough of residence, 2006-10


Figure 29 Life Expectancy by Deprivation Deciles, showing the Slope index of inequality Bexley, Females, 2004-08 -

Slope index of inequality = 4.7 years, LHO 2009

0

2

4

6

8

10

12

Southwark Greenwich Bromley Lewisham Lambeth Bexley

Y

e

a

r

s

Slope Index of Inequality for Life Expectancy of females by Deprivation Deciles. 5 year averages (with 95% confidence

intervals) by South East London borough of residence, 2006-10


Figure 30 Female life expectancy by deprivation decile 2001-2008, APHO

Note. Sources: ONS death registration data and mid-year population estimates & Department of Communities and Local

Government, Indices of Deprivation 2007. Analysis carried out by LHO and EMPHO on behalf of APHO. For details of

data sources and calculations go to: http://www.apho.org.uk/resource/view.aspx?RID=75050

Female life expectancy by deprivation decile, 2001-2008

74.0

76.0

78.0

80.0

82.0

84.0

86.0

88.0

1 2 3 4 5 6 7 8 9 10

Deprivation decile

Lif

e e

xp

ecta

ncy

2004-08

2003-07

2002-06

2001-05


Figure 31 Male slope index of inequalities in life expectancy by deprivation deciles: gap years in life expectancy

between PCTs. WCC, National Centre for Health Outcomes and Development

Figure 32 Female slope index of inequalities in life expectancy by deprivation deciles: gap years in life expectancy

between PCTs. WCC, National Centre for Health Outcomes and Development

- 46 - 1.4 Introduction: MORTALITY

1.4 Mortality

Mortality from all causes in both females and males has decreased over the years and is one of the lowest in south

east London. Mortality from all causes for people in Bexley is highest in the North End ward which is

significantly higher than the mortality rate in the St. Mary’s ward where mortality rate is the lowest. The top

five causes of death are cancers, ischemic heart diseases, respiratory diseases, other circulatory diseases and

digestive diseases.

Mortality for both cancer and chronic obstructive pulmonary disease (COPD) are higher in people living in more

deprived areas: there is a correlation between cancer and COPD mortality and deprivation.

Figure 33 Mortality from all causes: females, all ages, directly age-standardised rates (DSR) per 100, 000 population

by south east London borough of residence, annual time trends, 1993-2010 (NCHOD/ONS 2012)

0

100

200

300

400

500

600

700

800

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

Mortality from all causes in females of all ages. Directly age-standardised rates (DSR) per 100,000 population by S.E. London

Borough, London and England. Annual trends, 1993-2010

England London Lewisham Southwark


Figure 34 Mortality from all causes: males, all ages, directly age-standardised rates (DSR) per 100, 000 population by

south east London borough of residence, annual time trends, 1993-2010 (NCHOD/ONS 2012)

0

200

400

600

800

1000

1200

1400

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

Mortality from all causes in males of all ages. Directly age-standardised rates (DSR) per 100,000 population by S.E. London

Borough, London and England. Annual trends, 1993-2010



Figure 35 Mortality from all causes for persons of all ages by ward. 5 year average standardised mortality ratios (SMR

where 100 = England) with 95% confidence intervals 2003-07 (LHO/ONS 2009)

The five most common causes of death in Bexley match the picture across the country:

• Cancers 28.8%

• Ischemic heart diseases 15.3%

• Respiratory diseases 13.1%

• Other circulatory diseases 10.9%

• Digestive diseases 4.3%

Mortality from all causes for persons of all ages by Ward. 5 year average

Standardised Mortality Ratios (where 100 = England) with 95% confidence

intervals, 2003-07

England

70

90

110

130

150

Barn

ehurs

t

Belvedere

Bla

ckfe

n a

nd L

am

orb

ey

Ble

ndon a

nd P

enhill

Bra

mpto

n

Christ

churc

h

Coly

ers

Cra

yfor

d

Cra

y M

eadow

s

Danso

n P

ark

East

Wickham

Erith

Falconw

ood a

nd W

elling

Lesn

es Abbey

Longla

nds

North E

nd

Northum

ber

land H

eath

St Mary

's

St Michael's

Sid

cup

Tham

esm

ead E

ast

SM

R (

10

0 =

En

gla

nd

)


Figure 36 Major causes of death, Vital Statistics ONS 2008

Figure 37 Cancer mortality rate by deprivation quintile 2004-08, LHO

Mortality: Main underlying causes of death in Bexley. Annual percentages, 2008

Neoplasms (cancers)

28.8%

All other causes

16.4%

Ischaemic heart diseases

15.3%

Respiratory diseases

13.1%

Other circulatory diseases

10.9%

Digestive diseases

4.3%

Genitourinary diseases

3.6%

Mental and behavioural

disorders

3.2%

Nervous system diseases

2.3%

External causes of morbidity

and mortality

2.0%

Directly age-standardised mortality rate (DSR) from all cancers per 100 000

population by local authority and local deprivation quintile (95% confidence

intervals) in persons <75. 2004-08, LHO

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

1 2 3 4 5

Deprivation quintile

DS

R p

er

100 0

00

Upper CI

Value

Lower CI


Note: Cancer = ICD-10 C00-C97; Local deprivation quintiles defined at LSOA level. LSOAs within each LA ranked

according to IMD score and grouped into quintiles with approximately equal count of LSOAs. 1 is the most deprived quintile

in LA; LA based on boundaries as of April 2009.

Figure 38 Lung cancer mortality by deprivation quintile, 2004-08 LHO

Note. Sources: Lung cancer = ICD-10 C33-C34; Local deprivation quintiles defined at LSOA level. LSOAs within each

LA ranked according to IMD score and grouped into quintiles with approximately equal count of LSOAs. 1 is the most

deprived quintile in LA; LA based on boundaries as of April 2009.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

1 2 3 4 5

DS

R p

er

100 0

00

Deprivation quintile

Directly age-standardised mortality rate (DSR) from lung cancer per 100 000 population by local authority and local deprivation quintile, persons under 75 years 2004-08, LHO

Upper CI

Value

Lower CI

- 51 - 1.5 Introduction: INFANT MORTALITY

1.5 Infant Mortality

Infant mortality is a crude indicator because deaths occurring during different periods of the first year

reflect different groups of casual factors. Infant mortality rate in the borough has decreased since 2001. It has

decreased steeply in comparison to the rates of London and England and Wales. This is a reflection of the general

health status of the borough.

Neonatal mortality occurs in the first 27 completed days of life. The factors affecting neonatal deaths are very

similar to those that influence perinatal mortality. Neonatal mortality rate has decreased significantly since

2004 to 2007 in comparison to the rates of London and England.

Post neonatal mortality on the other hand has increased since 2004 raising concerns in Bexley. Post neonatal

deaths are strongly associated with social and economic factors as reflected by place of residence, father’s

occupation and social class. The leading causes of death for this period are sudden infant death syndrome (SIDS),

diseases of the respiratory system, and other infections and congenital malformations.7

Figure 39 Infant Mortality in Rate in Bexley, London and England & Wales 2001-2007. ONS Vital Statistics 2009

Infant Mortality (age under 1 year) in Bexley, London and England and Wales

2001-2007

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

2001-03 2002-04 2003-05 2004-06 2005-07

Rat

e per

1000 liv

e bir

ths

BexleyLondonEngland & Wales

Source: ONS Vital Statistics 2009

- 52 - 1.5 Introduction: INFANT MORTALITY

Figure 40 Neonatal Mortality Rate in Bexley, London and England 2001-2007. ONS Vital Statistics 2009

Figure 41 Post neonatal mortality rate in Bexley, London and England and Wales 2001-2007. ONS Vital Statistics

2009

Neonatal Mortality in Bexley, London and England and Wales 2001-2007

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

2001-03 2002-04 2003-05 2004-06 2005-07

Rat

e p

er 1

000

liv

e b

irth

s

BexleyLondonEngland & wales


Post neonatal Mortality in Bexley, London and England and Wales 2001-2007

0.0

0.5

1.0

1.5

2.0

2.5

3.0

2001-03 2002-04 2003-05 2004-06 2005-07

Rat

e p

er 1

000

liv

e b

irth

s

Bexley

LondonEngland & Wales


- 53 - 2. PROVIDING A HEALTHY START TO LIFE AND TRANSITION INTO ADULTHOOD

Chapter 2 Providing a healthy start to life and transition into adulthood

The health profile for Bexley 2010 (Appendix 1) shows that life expectancy at birth for those living in the most

deprived super output areas in Bexley is below that of those living in more affluent areas in Bexley.

However, life expectancy for all groups is above the England average.

Low birth weight is an important determinant of mortality, morbidity and disability in infancy and

childhood. It also has a long-term impact on health outcomes in adult life. Low birth weight is usually the

consequence of poor nutritional status and inadequate nutritional intake of pregnant women. The highest

percentage of low birth weight births in 2007-09 were in the wards of Blackfen and Lamorbey, Crayford

and North End.

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Southwark Lambeth London Lewisham England Greenwich Bexley Bromley

P

e

r

c

e

n

t

a

g

e

Low birthweight (<2500 g) birth annual percentages with 95% confidence intervals by South East London PCT of

residence, London and England, 2010


Figure 42 Total number of live births and low birth weight. ONS 2007-09. LHO analysis 2010

Figure 43 Percentage of live births less than 2500 grams. ONS 2007-09. LHO analysis 2010

Breastfeeding is an important factor in ensuring the best start to life for a baby. Breast milk is the only

natural food designed for a baby and it protects the baby from infections and diseases. It is linked to strong

physical and emotional development. Evidence in the literature and specifically from the Marmot Review

suggests that when a baby is breastfed he/she is less likely of becoming obese and therefore developing type II

diabetes and other illnesses later in life.

Total number of live births and low birth weight. ONS 2007-09

0

100

200

300

400

500

600

700

800

900

Black

fen

and

Lam

orbe

y

Cra

yfor

d

Nor

th E

nd

Long

land

s

Colye

rs

St M

icha

el's

Tham

esm

ead

Eas

tErit

h

Eas

t Wickh

am

Chr

istchu

rch

Falcon

woo

d an

d W

ellin

g

Belve

dere

Bar

nehu

rst

Dan

son

Par

k

Bra

mpt

on

Nor

thum

berla

nd H

eath

Lesn

es A

bbey

Sidcu

p

Cra

y M

eado

ws

St M

ary's

Blend

on a

nd P

enhi

ll

Liv

e b

irth

s

0

10

20

30

40

50

60

Bir

th w

eig

ht

< 2

500g

Total number of live births Live births with weight <2500g

Percentage of live births <2500g. ONS 2007-09

0.0

5.0

10.0

15.0

20.0

25.0

Black

fen

and

Lam

orbey

Cra

yfor

d

North

End

Long

land

s

Coly

ers

St M

icha

el's

Tham

esmea

d Eas

t

Erit

h

Eas

t Wickh

am

Chris

tchur

ch

Falco

nwood

and

Wellin

g

Belve

dere

Bar

nehur

st

Dans

on Par

k

Bra

mpt

on

North

umbe

rland

Heat

h

Lesn

es Abbe

y

Sidcu

p

Cra

y M

eadow

s

St M

ary's

Blend

on and

Pen

hill

%


Breast feeding initiation is currently significantly better than the national average. Although the rate of

breastfeeding initiation is good there is not a commensurate rate of the maintenance of breastfeeding with only

51% of babies still either partially or fully breastfed at the 6-8 week check. Smoking at the time of delivery is

significantly higher than south east London, London and England and requires immediate attention.

Figure 44 Initiation of breast feeding within 48 hours of delivery in Bexley, South East London, London and England

2009-10. NCHOD 2012

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Lambeth Southwark Lewisham London Bromley Greenwich England Bexley

P

e

r

c

e

n

t

a

g

e

Breastfeeding initiation by S.E. London Borough, London and England. Annual percentages with 95% confidence intervals,

2009/10


Figure 45 Prevalence of breast feeding at 6-8 weeks from birth in Bexley, 2010/11 Q1 – 2011/12 Q4. NCHOD 2012

Figure 46 Smoking at time of delivery in Bexley, South East London, London and England 2011/12 Q4. NCHOD 2012

The aim of the National Hearing Screening Programme is to identify as early as possible if the baby has any

hearing difficulties. One to two babies in every 1000 are born with a hearing loss in one or both ears. It is not easy

to identify that a young baby has a hearing loss. The hearing screening test will allow those babies who do

England

London

Bexley

0%

10%

20%

30%

40%

50%

60%

70%

80%

2010/11 Q12010/11 Q22010/11 Q32010/11 Q42011/12 Q12011/12 Q22011/12 Q32011/12 Q4

P

e

r

c

e

n

t

a

g

e

Prevalence of infants being breastfed at 6-8 weeks from birth. Bexley compared with London and England, 2010/11 Q1 -

2011/12 Q4

0%

2%

4%

6%

8%

10%

12%

14%

England Bexley Lewisham Greenwich Bromley London Lambeth Southwark

P

e

r

c

e

n

t

a

g

e

Percentage (with 95% confidence intervals) of women who smoked at time of delivery. Bexley benchmarked against its SEL

PCTs, London and England, 2011/12 Q4


have a hearing loss to be identified early. This ensures that the child has a better chance of developing speech

and language skills and of making the most of social and emotional interaction from and early age.

Figure 47 and 48 illustrate that Bexley has one of the highest proportion of babies being screened for hearing

and one of the lowest proportion of babies lost between inviting a mum to have her baby screened and the

actual screen taking place as a result of the administration.

Figure 47 Percentage of screens completed in South East London 2009-10. National Hearing Screening Programme

(NHSP)

Figure 48 Percentage of babies lost in the hearing screening process in South East London 2009-10. National Hearing

Screening Programme.

88

90

92

94

96

98

100

% o

f sc

ree

ns

com

ple

ted

South East London PCT

Percentage of screens completed in South East London 2009-10. National Hearing Screening Programme


Table 6 Number of babies screened for hearing by PCT in South East London 2009/10. National Hearing Screening

Programme

PCT by Sector

PCT area

GLA Births NHSP Births

1

Screens Offered Declined Started

South East

Lambeth 4769 5283 5145 35 4954

Lewisham 4665 4841 4670 38 4503

Southwark 5008 4985 4862 16 4699

Greenwich 4667 4509 4429 14 4388

Bexley 3054 2906 2880 4 2878

Bromley 4025 4067 4048 9 4034

Total 26188 26591 26034 116 25456

London Total 126,378 131032 129136 285 126541

1. Actuals listed by NHSP, 2. Babies lost between offer and start of screening. Discounts declines, 3. Screens completed at 3

months, 4. All babies lost during screening process. Discounts declines.

Latest figures show that 8801 children (19.5%) in Bexley live in an ‘out of works benefit’ household. 2584

children are eligible for free school meals, illustrating the level of child poverty in the borough.

0%1%2%3%4%5%6%7%8%9%

10%

% o

f b

ab

ies

South East London PCT

% of babies lost in the Hearing Screening Programme in South East London 2009-10. National Hearing Screening Programme.

PCT by Sector

PCT area Babies Lost

2

Completed

% Complete3

Total Lost

4 % Lost

4

South East 0 0

Lambeth 156 4903 92.9 345 6.5%

Lewisham 129 4444 91.9 359 7.4%

Southwark 147 4656 93.4 313 6.3%

Greenwich 27 4278 94.9 217 4.8%

Bexley -2 2846 98 56 1.9%

Bromley 5 4011 98.6 47 1.2%

Total 462 25138 94.9 1337 5.0%

London Total 2310 125193 95.5 5509 4%


Figure 49 Proportion of children in poverty. London Borough of Bexley 2007

The nationally published data for the ‘Be Healthy ‘indicators relating to the health of children in the early years,

show that Bexley is not significantly different to the England average on obesity in children aged 4-5. Child

obesity levels in the borough reflect a similar picture: 9.6% of reception year children are obese, rising to 20%

in year 6. Although both of these figures are slightly lower than the average for London, they are higher

than England overall (9.6% and 18.3% respectively) and show a concerning pace of increase between the

ages of 5 and 11 years old.

NI116 - Proportion of children in poverty. London Borough of Bexley 2007

0.00

5.00

10.00

15.00

20.00

25.00

Wes

t Sus

sex

Sto

ckpor

t

Swin

don

Esse

x

Sut

ton

Ken

t

Hav

erin

g

Bex

ley

Thur

rock

Med

way

Sou

then

d-on

-Sea

Ave

rage

Sta

tist

ical

Nei

ghb

ours

Engl

and

% o

f ch

ild

ren


Figure 50 Participation rates in the National Child Measurement Programme 2007-2010 for Bexley

Participation rates in the National Child Measurement Programme 2007-2010

50

60

70

80

90

100

2007/08 2008/09 2009/10

Participation Rates

Year

Pe

rce

nta

ge

Reception

Year 6


Figure 51 Prevalence of reception children who are obese, overweight, healthy and underweight between 2007 and

2010 in Bexley, National Child Measurement Programme 2009/10

Prevalence of reception children who are obese, overweight, healthy and

underweight between 2007 and 2010, National Child Measurement Programme

2009/10

0

10

20

30

40

50

60

70

80

90

2007/08 2008/09 2009/10

Year

Pre

vale

nce Obese

Overweight

Healthy

Underweight


Figure 52 Prevalence of children in Year 6 who are obese, overweight, healthy, underweight between 2007 and 2010 in

Bexley, National Child Measurement Programme 2009/10

Prevalence of children in Year 6 who are obese, overweight, healthy and underweight

between 2007 and 2010, National Child Measurement Programme 2009/10

0

10

20

30

40

50

60

70

2007/08 2008/09 2009/10

Year

Pre

vale

nce Obese

Overweight

Healthy

Underweight


Figure 53 Proportion of children who are obese, overweight, healthy weight and underweight in Reception in south

east London, National Child Measurement Programme 2009-10

Proportion of children who are obese, over weight, healthy weight and underweight in Reception,

National Child Measurement Programme 2009-10

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TAK 5A7 5A8 5LD 5LF 5LE

Bexley Care Trust Bromley PCT Greenw ich Teaching

PCT

Lambeth PCT Lew isham PCT Southw ark PCT

PCT

Pre

cale

nce Obese

Over w eight

Healthy w eight

Underw eight


Figure 54 Proportion of children who are obese, overweight, healthy weight and underweight in Year 6 in south east

London, National Child Measurement Programme 2009-10

Proportion of children who are obese, over weight, healthy weight and under weight in Year 6,

National Child Measurement Programme 2009-10

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TAK 5A7 5A8 5LD 5LF 5LE

Bexley Care Trust Bromley PCT Greenw ich Teaching

PCT

Lambeth PCT Lew isham PCT Southw ark PCT

PCT

Pre

cale

nce

Obese

Over w eight

Healthy w eight

Underw eight


Figure 55 Prevalence of children who are obese, overweight, underweight and healthy weight in Bexley, National

Child Measurement Programme 2009-10

Childhood immunisations are measured by measuring the proportion of the population that has been

vaccinated against the vaccine preventable diseases. Outbreaks of diseases such as the measles outbreak in the

summer of 2010 are examples where children who have not been vaccinated may become infected, and rapidly

infect those around them. This reiterates the importance of monitoring coverage and ensuring that the WHO

recommended 95% coverage is achieved to attain maximum immunity.

Coverage for immunisations measures the proportion of children aged 1, 3 and 5 who have completed courses of

immunisations as recommended by the NHS Immunisations Schedule8. There has been a stark improvement in

coverage in Bexley since 2009 which has been mostly due to improvements in data collection systems.

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

Bexley Care Trust Bromley PCT GreenwichTeaching PCT

Lambeth PCT Lewisham PCT Southwark PCT

Pre

vale

nce

PCT

Prevalence of children who are underweight, National Child Measurement Programme 2009-10

Reception

Series1

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%



Pre

vale

nce

PCT

Prevalence of children who have a healthy weight, National Child Measurement Programme 2009-10

Reception

Year 6

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%



Pre

vale

nce

PCT

Prevalence of children who are overweight, National Child Measurement Programme 2009-10

Reception

Year 6

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%



Pre

vale

nce

PCT

Prevalence of children who are obese, National Child Measurement Programme 2009-10

Reception

Year 6


Figure 56 Coverage for routine childhood immunisations 2008-2012, HPA COVER

Figure 57 Proportion of children attaining 5 or more A*-C grades in Bexley (End of Key Stage 4). London Borough of

Bexley 2011

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Pe

rce

nta

ge

co

ve

rag

e

Yearly Quarter

Coverage of Vaccinations Evaluated Rapidly (COVER) Children aged 1, 2 and 5 for Bexley 2008-12

Age 1 DTaP/IPV/Hib Age 2 PCV boosterAge 2 Hib/Men C Age 2 MMRAge 5 DTaP/IPV Pre-school booster Age 5 MMR booster

5 or more A*-C grades at GCSE including English and Maths (End of Key Stage 4)

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

2005 2006 2007 2008 2009 2010

% a

ch

ievin

g e

xp

ecte

d le

ve

l

Bexley London Statistical Neighbours England


There is a lack of an agreed definition that supports the accurate identification of the number of disabled children

and young people (CYP) locally and nationally. Estimations vary significantly depending on the severity of

disability that is being included in the estimation.

There are a number of common definitions used for planning purposes and generally, a figure of 7% of the

population is cited, deriving from analysis of the 2004/05 Family Resources Survey (FRS) undertaken by the

Department for Work and Pensions (DWP)9. Based on the latest projections

10 for children and young people it

can be estimated that there are 3766 children and young people with disabilities in Bexley.

Existing data11

indicates that there are at least 447 moderately, severely or profoundly disabled with at least 70

profoundly disabled and at least 214 severely disabled CYP; There are approximately 600 CYP with Special

Education Needs (SEN); 1250 CYP under the age of 16 receive Disability Living Allowance (DLA).

The areas with the highest proportions of disabled CYP are Erith, Welling and Barnehurst. Approximately 20% of

disabled CYP are from black and minority ethnic backgrounds and 10% from Black and African groups. There

are twice as many boys as girls identified with disabilities. The number of CYP identified with disabilities tends to

increase with age, with less than 10% aged under 5, 44% aged 5-11 and almost half aged 12-18. There are twice

as many boys as girls identified with disabilities, which is line with national figures. 7% of children

identified with disabilities are young children, 44% are primary school aged and 49% secondary school.12

Differing definitions and categories make direct comparison much of the data difficult. Around 40% of the total

number of disabled CYP have Autism Spectrum Disorders (ASD), with around half of all those identified

currently on the Disabled Children’s Register. Need for 12-18 year olds may increase over the next 5-10 years in

relation to ASD and Global Development Delay, but may decrease in relation to Cerebral Palsy, Congenital

Abnormalities, Epilepsy and Learning Difficulties

Prevalence data indicates that one in ten children and young people aged five to fifteen experience some

form of diagnosable mental disorder - that is, around three in every class. However, evidence relating to

adolescents indicates that the prevalence of mental health problems during teenage years is as high as one in four

or one in five13

. The current population of children and young people in Bexley is 51,520. On the basis of the

above prevalence data, it is therefore likely that 4,322 young people aged 0-15 years and between 1,659 and 2,073

adolescents aged 16-17 in Bexley suffer with a diagnosable mental disorder and would require interventions from

tier 2, 3 or 4 services.

Using the most recent ONS population projection data, the following rates can be inferred for specific disorders

for young people aged 5-15 years in Bexley. Conduct disorders (5.3%) 1,585; emotional disorders (4.3%)

1,286; being hyperactive (1.4%) 419; less common disorders (1.3%) 389. In Bexley the trend in referrals to

specialist CAMHS shows an increase in the severity and complexity of routine presentations, with a greater

proportion presenting with tier 3 level mental health need.

Among children with a learning disability, a 40% prevalence rate of associated mental health problems has been

identified14

. On this basis, the number of children in Bexley with mental health problems associated with

learning disability might be expected to be 51, aged 5-9, 130 aged 10-14 and 163 aged 15-19, comprising a

total of 344. The range of mental health need for this group will be provided across all four tiers. One study found

a prevalence rate for autistic spectrum disorder (ASD) of 1% of the child population.15

When applied to Bexley,

this would mean that approximately 432 children aged 5-15 would have a diagnosis of ASD. Whilst ASD is

recognised as a neuro-developmental disorder, it is also associated with a range of emotional, behavioural and

mental health difficulties, requiring the intervention of services across the four tiers. Findings from a service

audit carried out in March 2010 indicated that children and young people with neuro-developmental disorders

made up 32% of the total clinical caseload of specialist CAMHS.

Research has found that between 1 in 12 and 1 in 15 young people self harm in the UK16

. On this basis, among

the population aged 15 - 17 in Bexley, we could expect that between 553 and 691 would self harm at some

time. The trend within Bexley shows an increase in the number of emergency presentations of deliberate self

harm / suicidal to specialist CAMHS. Between September 2009 and August 2010, 85 young people in Bexley who


had deliberately self harmed with varying degrees of suicide risk, were referred to specialist CAMHS having

presented to A&E.

Estimates of the number of children who may experience mental health problems appropriate to a response from

CAMHS at tiers 1, 2, 3 and 417

can be applied to the population of Bexley as follows:

% of children/young people Number of children / young people

Tier 1 15% 7,728

Tier 2 7.5% 3,864

Tier 3 1.85% 972

Tier 4 0.47% 247

The upward trend in significant and chronic mental health presentations in Bexley has resulted in a higher

proportion (67%) of young people requiring specialist CAMHS, now receiving tier 3 interventions. This has

inverted the above % of children expecting to receive tier 2/3 interventions.

Looked After Children represent one of the most vulnerable cohorts of children and young people in terms of

mental health, with 45% of looked after children likely to have a mental health disorder18

.Currently in

Bexley, there are 224 LAC and 100 (45%) of these are currently receiving a service from specialist CAMHS (70

receiving clinical interventions and 30 subject to consultation).

Figure 58 Number of children looked after (LAC) in Bexley 2008-2011. London Borough of Bexley 2011

Table 7 Educational Achievement of Looked After Children 2008-2010. London Borough of Bexley 2011

Percentages

2008 2009 2010

LAC achieving 5 A*-C or equivalent grades (incl. E&M) at end of KS4 4.5 11.8 15.8

LAC achieving 5 A*-C or equivalent grades in any subjects at end of KS4 9.1 23.5 26.3

LAC achieving 5 A*-G or equivalent at end of KS4 59.1 47.1 52.6

LAC achieving 1 A*-G or equivalent at end of KS4 68.2 70.6 73.7

LAC achieving Level 4+ in English at end of KS2 75 42.9 33.3

LAC achieving Level 4+ in Maths at end of KS2 62.5 42.9 22.2

LAC achieving Level 4+ in English and Maths at end of KS2 NA NA 11.1

LAC achieving Level 2+ in Reading at end of KS1 85.7 25 0

LAC achieving Level 2+ in Writing at end of KS1 85.7 25 0

LAC achieving Level 2+ in Maths at end of KS1 100 50 0

No. Looked After Children

215

220

212

208

210

212

214

216

218

220

222

2008/09 2009/10 Apr 10-Feb 11


Research demonstrates that looked after children share many of the same health risks and problems of their peers,

but often to a greater degree19

. They can have greater challenges such as emotional turmoil within their own

families, frequent changes of home or school, and lack of access to the support and advice of trusted adults.

Children often enter the care system with a worse level of health than their peers, in part due to the impact of

poverty, poor parenting, chaotic lifestyles and abuse or neglect. Longer-term outcomes for looked after children

remain worse than their peers.20

The ONS survey found that two thirds of all looked after children have at least one physical health

complaint. They are more likely than their peers to experience speech and language problems, bedwetting, co-

ordination difficulties and eye or sight problems21

. Young men and women in care and care leavers are more

likely than their peers to be teenage parents.22

In March 2010 220 children and young people were looked

after by Bexley. This is an increase of 2% on the previous year.23

Since December 2008 there has been a steady increase in the number of children subject to a Child Protection

Plan in Bexley24

. This followed a period of heightened awareness of safeguarding and child protection issues

following the Baby Peter case and has been reflected nationally. It appears that this has now leveled off.

Figure 59 Children subject to a child protection plan in Bexley 2008-2011. London Borough of Bexley 2011

In March 2010, 84 children were subject to a child protection plan in Bexley. The categories of abuse have

remained relatively stable with neglect issues continuing to be the major reason for a child protection plan.

Very young children are most at risk from abuse25

.

Table 8 Placement type of looked after children 2009-2011. London Borough of Bexley 2011

% 2009-

10

% Apr

10-Feb

11

Placement with other foster carer 78.2 74.1

Independent living 2.8 9.9

Foster placement w relative/friend 8.3 5.2

Residential placement 5.6 8.0

Placed for adoption 5.1 2.8

Placed with Parent 0 0

Missing from placement 0 0

Other placement 0 0

Children Subject to a Child Protection Plan

8586

76

60

65

70

75

80

85

90

2008/09 2009/10 Apr 10-Feb 11

No

. ch

ild

ren


Figure 60 Proportion of looked after children placed in Bexley and out of borough. London Borough of Bexley 2011

Current data shows that Bexley will not achieve its target to reduce the under 18 conception rate by 50% in

2010. In order to achieve this goal Bexley needed to have reduced the rate from 37.5 per 1000 girls aged 15-19

(which was the rate in the baseline year 1998) to 18.8 in 2010. Currently the rate is 43.6 per 1000 (as at Quarter 1

2009) and whilst there were some in-year improvements the full year performance for 2008 was below the target.

In terms of actual numbers there were 49 conceptions to girls aged 15-17 between January and March 2009.

Figure 61 Conceptions in under 18s in Bexley 1998-2010 DCSF/ONS

Placement of LAC

(Feb 2011)

55%

45%

Placed in Bexley Placed out of borough

0

20

40

60

80

100

120

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

R

a

t

e

Teenage conceptions for women under 18 years by S.E. London Borough, London and England. Rates per 1,000 females aged 15-

17 years. Annual trends, 1998-2010

ENGLAND LONDON Lewisham Southwark


Figure 62 Under 16 conception rates per 1000 females aged 13-15 in south east London 2005-07 DCSF/ONS

Note. For conceptions leading to abortions, rates based on fewer than 10 events have been suppressed. Occasionally it

has been necessary to apply a secondary suppression to avoid the possibility of disclosure by differencing. All data is

final.

Under 16 conception rates per 1000 females age 13-15 by local authority of

residence 2005-07 DCSF/ONS

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Lambeth LB Lewisham

LB

Southwark

LB

Bexley LB Bromley LB Greenwich

LB

LONDON England

Local Authority

Rate

per

1000 f

em

ale

s a

ged

13-1

5

Under 16 conception rate

Percentage leading to abortion


Figure 63 Rate of legal terminations per 1000 females for women over 35 in south east London, 2010 NCHOD

In 2007/08, there were 87 young people in treatment for substance misuse in Bexley26

– they were

using mainly alcohol and cannabis. This report provided an estimate of the number of vulnerable young

people who may be using substances – the estimate was 749 young people from a range of vulnerable

groups*. In 2009

27, a large scale piece of qualitative work was carried out – 75 young people were

interviewed and asked a range of questions about substance use. They reported widespread use of

alcohol and cannabis and also emerging trends in the use of cocaine, ketamine and MDMA powder.

Bexley has a higher proportion of children and young people aged 16 and under claiming Disability Living

Allowance (DLA) than in London and England (15% in Bexley compared to 12% in London and 11% in

England).

The Youth Offending Team (YOT) dealt with 200 orders equating to 150 young people during the last

financial year. From these 45 young people had an asset score of 2 or above for mental health issues

and 58 young people had an asset score of 2 or above for substance misuse issues. It is important to

note that a proportion of the numbers in both mental health and substance misuse will include young

people that scored 2 or above for both.

Below are pie charts that reflect different areas of statistical information.

* The vulnerable groups: excludes, frequent truants, YP who have been arrested, homeless young people, LAC

0

2

4

6

8

10

12

14

16

18

20

Southwark Lambeth Greenwich Lewisham London Bexley Bromley England

R

a

t

e

Annual rate of legal NHS and private abortions per 1,000 females (with 95% confidence intervals) for women of maternal ages 35+

by S.E. London PCT, London and England, 2010


Figure 64 Mental Health asset score 2 or above by age in Bexley. London Borough of Bexley 2010/11

Figure 65 Mental Health asset score 2 or above by ethnicity in Bexley. London Borough of Bexley 2010/11

Mental Health Asset Score 2 or Above

01.04.10 - 31.03.11

By Age

9%

31%

60%

12 - 13 yr olds (4)

14 - 15 yr olds (14)

16 - 18 yr olds (27)


01.04.10 - 31.03.11

By Ethnicity

92%

4%4%

White British (41)

Black/Black Other (2)

Other (2)


Figure 66 Mental Health asset score 2 or above by gender in Bexley. London Borough of Bexley 2010/11

Figure 67 Mental Health asset scores for children and young people in Bexley. London Borough of Bexley 2010/11


01.04.10 - 31.03.11

By Gender

80%

20%

Male (36)

Female (9)


01.04.10 - 31.03.11

By Asset Score

53%38%

9%

Asset Score 2 (24)

Asset Score 3 (17)

Asset Score 4 (4)


Figure 68 Substance misuse asset score 2 or above by age. London Borough of Bexley 2010/11

Figure 69 Substance misuse asset score 2 or above by ethnicity. London Borough of Bexley 2010/11

Substance Misuse Asset Score 2 or Above

01.04.10 - 31.03.11

By Age

3%

24%

73%

Age 12 - 13 yr olds (2)

Age 14 - 15 yr olds (14)

Age 16 - 18 yr olds (42)


01.04.10 - 31.03.11

By Ethnicity

78%

17%

5%

White British (45)

Black/ Black Other (10)

Other (3)


Figure 70 Substance misuse asset score 2 or above by gender. London Borough of Bexley 2010/11

Figure 71 Substance misuse by asset score of children and young people. London Borough of Bexley 2010/11


01.04.10 - 31.03.11

By Gender

83%

17%

Male (48)

Female (10)


01.04.10 - 31.03.11

By Asset Score

62%

33%

5%

Asset Score 2 (36)

Asset Score 3 (19)

Asset Score 4 (3)

- 77 - 3. PROVIDING HEALTHY ENVIRONMENTS AND SUSTAINABLE DEVELOPMENT

Chapter 3 Providing healthy environments & sustainable development

People living alone are more likely to require social services with the rate for elderly males requiring support

increasing. We are expecting increases of:

o 9.4% for those males aged 65-74

o 6.9% for those males aged 75 and over

o 7.1% for those females aged 65-74

o 2.8% for those females aged 75 and over

o 7.9% for all aged 65-74

o 3.9% for all aged 75 and over

Table 9 People aged 65 and over living alone by age and gender. POPPI 2012

2012 2013 2014 2015 2016

Males aged 65-74 predicted to live alone 1,780 1,840 1,840 1,860 1,920

Males aged 75 and over predicted to live alone 2,584 2,618 2,686 2,686 2,720

Females aged 65-74 predicted to live alone 3,150 3,240 3,300 3,330 3,420

Females aged 75 and over predicted to live alone 6,832 6,832 6,893 6,893 7,015

Total population aged 65-74 predicted to live alone 4,930 5,080 5,140 5,190 5,340

Total population aged 75 and over predicted to live alone 9,416 9,450 9,579 9,579 9,735

Figures may not sum due to rounding. Crown copyright 2010

The majority of older people have indicated that they would like to continue living in their own property, or

where necessary move to single level accommodation such as a bungalow or flat. There was very little

aspiration to use Council or Housing Association accommodation, with a strong preference for the private

sector28

.

Home ownership amongst older people in Bexley remains quite high with:

o 85% of 65-74 year olds owning their own homes

o 77% of 75-84 year olds owning their own homes

o 70% of 85 plus year olds owning their own homes

Approximately half of older people live in a semi detached property, 27% a terraced house, 22% a flat and 6% a

detached house. Despite the high rates of ownership, the majority of owner occupiers 63.8% (2008) were only

receiving a state pension and no other state benefits. This reflects an ‘asset rich and income poor’ population.

Some of the difficulties these people will experience include an inability to fund repairs to their property which

could lead to a dilapidated and unsafe environment, trouble with meeting living expenses particularly heating

costs as they try to heat bigger spaces with older inefficient heating systems, isolation and a lack of state support

mechanisms.


Figure 72 Likelihood of considering types of accommodation as they become older for respondents aged over 60

Using the Department of Health Ready Reckoner tool29

it is estimated that Bexley has 31,098 hazardous or

increasing risk drinkers, 7,738 harmful or higher risk drinkers, 4,256 dependent drinkers and 18,634 binge

drinkers.

Figure 73 Drug prevalence estimates in Bexely 2004-09. Bexley Annual Drug Treatment Needs Assessment 2010/11

Research by the North West Public Health Observatory shows that Bexley has below the national average in most

indicators and has one of the lowest alcohol related hospital admission rates in London. However the following

rates in Bexley are higher than the regional averages:

alcohol-attributable recorded crimes

alcohol-attributable violent crimes

0

100

200

300

400

500

600

700

800

2004/ 05 2006/ 07 2007/ 08 2008/09

Nu

mb

er

of

pe

op

le

Year

Drug prevalence estimates in Bexley 2004-2009. Bexley Annual

Drug Treatment Needs Assessment 2010/11

Problem drug (opiate/or crack cocaine) users

Problem opiate users

Problem crack cocaineusers


Figure 74 Alcohol related admission rate per 100 000 in south east London 2002-2011 NCHOD

Figure 75 Admissions: three year average rate per 100,000 poplation for persons under 18 with alcohol specific

conditions by SE London 2007-09 - 2009-10

Figure 76

0

500

1000

1500

2000

2500

2002/03 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11

R

a

t

e

/

1

0

0

,

0

0

0

Rate of Hospital Admissions per 100,000 for Alcohol Related Harm (age-standardised) by S.E. London PCT of residence, 2002/03 -

2010/11

Lewisham Southwark Lambeth

0

10

20

30

40

50

60

70

England Bexley London Bromley LewishamGreenwichLambethSouthwark

R

a

t

e

Admissions: three year average rate per 100,000 population (with 95% confidence intervals) for persons under 18 years with alcohol specific conditions, by S.E. London PCT, London and England, 2007/08-2009/10


Figure 77 Alcohol attributable hospital admissions in males and females 2004-2009 (NWPHO 2010)

Figure 78 Mortality from alcohol specific conditions in males and females in south east London 2005-07 NCHOD

Figure 79 Alcohol attributable mortality rates for males and females (NWPHO 2010)

Mortality from alcohol specific conditions: directly age standardised rates per 100,000

population (with 95% confidence intervals) for males and females of all ages, by South

East London PCT of residence, 2005-2007

0

5

10

15

20

25

F M F M F M F M F M F M F M F M

England London Lewisham Southwark Lambeth Bexley Bromley Greenwich

DS

R/1

00

,00

0 p

opu

lati

on

22/10/2009

Source: NWPHO/ONS


Figure 80 The chart shows Bexley's measure for each indicator in the Local Alcohol Profiles for England (LAPE), as

well as the regional and England averages and range of all local authority values for comparison purposes. (NWPHO

2010)

The London Borough Offender Profile report 200930

shows that 48% of prisoners from Bexley in 2008/09

stated that they use drugs. Between October 2008 and September 2009, 176 of the 551 offenders assessed had a

drug problem (32%). 52% of those with a drug misuse problem also had an alcohol misuse problem.

During 2008/09, convictions for drug offences, burglary and robbery are significantly higher for drug misusing

offenders that in the total offender population. 41.6% of offenders aged 18-24 had a drug misuse problem,

compared to 33% of 25-30 year olds and 35% of 31-40 year olds31

.

Figure 81 Alcohol related crime 2004-2009 (NWPHO 2010)


In July 2010 the Research and Analysis Team of Transport for London made available the final collision and

casualty data for the calendar year of 2009. It showed that by the end of 2009 Bexley had reduced the number

of people killed and seriously injured by 44% and the number of children killed or seriously injured by

43% compared to the baseline.

Figure 82 All libraries active users in Bexley 2009-10. London Borough of Bexley

Figure 83 All libraries active users in Bexley 2009-10. London Borough of Bexley

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Num

ber

of

peop

le

All Libraries Active Users 2009-2010 in Bexley. London Borough of Bexley

Adults Children

All Bexley Libraries Active Users by Gender in Bexley 2009-10. London Borough of Bexley

�Female

�Male

�Unknown


Figure 84 Active library users in Bexley by age profile 2009-10. London Borough of Bexley

Figure 85 Genre of books issues in libraries in Bexley 2009-10. London Borough of Bexley

Active library users in Bexley by age profile 2009-10. London Borough of Bexley

Age 0-13

Age 14-17

Age 18-59

Age 60+

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

1 2 3 4

Genre of books issued in libraries in Bexley 2009-10. London Borough of Bexley

Adult fiction

Adult non-fiction

Children's fiction

Children's non-fiction

Audio-visual

- 84 - 3. ENABLING POSITIVE CITIZEN BEHAVIOUR CHANGE AND PROMOTING HEALTH

Chapter 4 Enabling positive citizen behaviour change & promoting health.

A slight decrease in coverage has been seen in coverage of the breast screening programme in women aged 53-64

which has in general remained fairly stable between 2003 and 2009. Cervical screening coverage in south east

London was highest in Bexley and has remained above the national target.

Figure 86 Coverage of breast screening programme in women aged 53-64 in Bexley. 2003-09 IC/KC52

Breast screening programme in Bexley: coverage (%) of the resident women aged 53-64 who have had

a test with a recorded result at least once in the previous three years, annual time trends, 2003 to 2009

65

67

69

71

73

75

77

79

81

2003 2004 2005 2006 2007 2008 2009

Pe

rce

nta

ge

National Target Bexley

20/01/2010

Source: IC/KC62

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

England Bexley Bromley London GreenwichLewishamSouthwarkLambeth

P

e

r

c

e

n

t

a

g

e

Breast Screening Programme. Annual percentages (with 95% confidence intervals) of females aged 53-70

screened at least once in previous 3 years, by South East London PCT of residence, London and England,

31/03/2011


Figure 87 Bowel Screening quarterly uptake rate by PCT in south east London 2009-2011. Bromley Public Health

Intelligence Department 2011

Bowel Screening Uptake by PCT

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

April 2009 to June

2009

July 2009 to

September 2009

October 2009 to

December 2009

January 2010 to

March 2010

April 2010 to June

2010

July 2010 to

September 2010

Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 2009/10 Q1 2010/11 Q2 2010/11

Up

take

(%

)

Bexley

Bromley

Greenwich

Lambeth

Southwark

Lewisham

34.0% 34.1%

38.4% 39.9%

53.5% 55.9%

SE London

0%

10%

20%

30%

40%

50%

60%

Lambeth Southwark Lewisham Greenwich Bexley Bromley

P

e

r

c

e

n

t

a

g

e

Bowel screening in persons aged 60-75. Percentage uptake by South East London PCT of residence, 2011

Q1-3


Figure 88 Bowel Screening Positivity quarterly rate by PCT in south east London 2009-2011. Bromley Public Health

Intelligence Department 2011

Table 10 Mortality from cervical cancer for females of all ages 1993-2010

Bowel Screening Positivity by PCT

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

April 2009 to June

2009

July 2009 to

September 2009

October 2009 to

December 2009

January 2010 to

March 2010

April 2010 to June

2010

July 2010 to

September 2010

Q1 2009/10 Q2 2009/10 Q3 2009/10 Q4 2009/10 Q1 2010/11 Q2 2010/11

Po

siti

vity

(%

)

Bexley

Bromley

Greenwich

Lambeth

Southwark

Lewisham

0

2

4

6

8

10

12

D

S

R

/

1

0

0

,

0

0

0

Mortality from cervical cancer for females of all ages. Directly age-

standardised rates (DSR) per 100,000 population by South East London

PCT of residence, London and England. Annual trends, 1993-2010

England

London

Lewisham

Southwark


Figure 89 Cervical Screening Coverage (age 25-64) – Rolling averages per quarter – 07/08, 09/09, 09/10, 10/11 for

Bexley Bromley and Greenwich. Bromley Public Health Intelligence Department 2011

Cervical Coverage (age 25-64) - Rolling Averages per Quarter - 2007/08, 2008/09, 2009/10, 2010/11 -

Bromley, Bexley & Greenwich

66

68

70

72

74

76

78

80

82

84

01

/04

/07

to

30

/06

/07

01

/07

/07

to

30

/09

/07

01

/10

/07

to

31

/12

/07

01

/01

/08

to

31

/03

/08

01

/04

/08

to

30

/06

/08

01

/07

/08

to

30

/09

/08

01

/10

/08

to

31

/12

/08

01

/01

/09

to

31

/03

/09

01

/04

/09

to

30

/06

/09

01

/07

/09

to

30

/09

/09

01

/10

/09

to

31

/12

/09

01

/01

/10

to

31

/03

/10

01

/04

/10

to

31

/06

/10

01

/07

/10

to

30

/09

/10

01

/10

/10

to

31

/12

/10

Pe

rce

nta

ge

Bromley

Bexley

Greenwich

Bexley

England

London

60%

65%

70%

75%

80%

85%

90%

95%

100%

2001-022002-032003-042004-052005-062006-072007-082008-092009-102010-11

P

e

r

c

e

n

t

a

g

e

Cervical screening coverage (%) of women aged 25-64 years

who were screened in the last 5 years. Bexley compared with England and London. Annual trends, 2001-02-2010-11


Figure 90 Cervical screening coverage in women aged 25-64 in Bexley 2001-2011 IC/KC50

Bexley

England

London

60%

65%

70%

75%

80%

85%

90%

95%

100%

2001-022002-032003-042004-052005-062006-072007-082008-092009-102010-11

P

e

r

c

e

n

t

a

g

e

Cervical screening coverage (%) of women aged 25-64 years who were screened in the last 5 years. Bexley compared with England

and London. Annual trends, 2001-02-2010-11


Figure 91 Proportion of female patients aged 25-64 with recorded cervical cancer screening in south east London

2010-11 NCHOD

Model-based estimates using HSE

Modelled (synthetic) estimates of the prevalence of obesity among adults are based on a combination of HSE,

Census and other data. These should be interpreted with caution as the estimates are modelled.

Model based synthetic estimates show that 21.5% (95% CI: 19.3 - 23.9)† of Bexley’s adult population can be

expected to be obese. Although this is slightly below the national average of 25%, it means that there are over

41,000 adults in Bexley who are obese.

Table 11 Modelled estimates of prevalence of obesity in Bexley adults. Obesity Needs Assessment 2010

PCT population Estimate of number of

people who are obese Estimate of number of people

who have a raised waist

circumference

Actual numbers BMI greater than 30kg/m2 Male

>102cm Female >88cm

† A confidence interval gives an estimated range of values which is likely to include the ‘true’ value. Confidence intervals are

usually calculated so that the percentage of all data which falls within this range is 95%. The width of the confidence interval gives us an indication of how uncertain we are about the value in question. A very wide interval indicates that the data is not as reliable and that more data is required for definite conclusions to be made.

75%

76%

77%

78%

79%

80%

81%

82%

83%

84%

85%

86%

Bromley Bexley England Greenwich London Southwark Lewisham Lambeth

P

e

r

c

e

n

t

a

g

e

Cervical screening coverage of females aged 25-64 years. Percentages

(with 95% confidence intervals) by South East London PCT of residence,

London and England, 2010/11


M F M F M F

16-24 11944 11661 1075 1399 1194 1982

25-34 15771 16286 3312 2931 3312 4886

35-44 15772 16012 3943 3843 4732 5764

45-54 14176 15458 3969 4174 5387 6956

55-64 11216 12107 3701 3632 5159 6054

65-74 7657 8906 2374 3117 3905 5344

75+ 6539 9900 1177 2673 2681 5643

Sub

Total 83074 90329 19551 21770 26370 36629

TOTAL 173403 41321 62999

In the school lunch box survey 2008-09 information was collected on the carbohydrate, total fat, saturated fat,

protein, salt and energy content of the children’s lunchboxes. The results of this survey show that across Bexley

there is a high percentage of children in schools eating high fat, sugar and salt products at lunchtime (on average

90% of children in schools across the three time points in table 3). In addition, the last time the survey was

carried out only 8% of children were eating both fruits and vegetables in their packed lunch. If just looking at

fruit alone the percentage is higher – 55% on last measurement – but that is still only just over half of the children

surveyed. This figure is much less for vegetables alone – only 15% in the last survey.

Table 12 Analysis from school lunch box survey. Bexley care Trust 2008-2009

Nu

mber

o

f ch

ild

ren

surv

eyed

Nu

mber

o

f ch

ild

ren

who

hav

e a

hea

lthy

bal

ance

d

pac

ked

lu

nch

, as

p

er

reco

mm

endat

ion

s

% e

atin

g/d

rinkin

g h

igh

fat

,

salt

an

d s

ugar

pro

duct

s %

eati

ng

at

leas

t 1

pie

ce o

f

fru

it

% e

atin

g s

alad

or

veg

etab

les

%

eati

ng

b

oth

fr

uit

an

d

veg

etab

les

%

eati

ng

a

mil

k

or

dai

ry

pro

duct

% e

atin

g c

arb

oh

yd

rate

% e

atin

g n

on

-dai

ry p

rote

in

%

dri

nk

ing

w

ater

, m

ilk

o

r

pu

re u

nsw

eete

ned

fru

it j

uic

e

Sept 2008

283 2 91 42 13 7 58 93 60 25

June 2009

510 2 87 57 19 11 56 93 59 37

Nov 2009

427 3 93 55 15 8 55 93 58 36

Across the UK the increase in sexual promiscuity has resulted in an epidemic rise in sexual transmitted

infections (STI). In Bexley genital warts and Chlamydia accounted for the highest number of STI diagnosed in

2008-09. More females than males were diagnosed with these STIs except gonorrhoea where more males than

females were diagnosed, figure 81. Deprivation is closely linked to HIV diagnosis and the rate of diagnosis

between the most deprived and least deprived is in fact increasing (Figure 82).

The two ethnic groups most affected by STIs in Bexley are White and Black/Black British ethnic groups. At

least two thirds of all positive diagnoses of Gonorrhoea, Herpes, Warts and Chlamydia were in white men and

women. Black / British men and women suffered from a disproportionately high positivity rate for Syphilis

(29% of all Syphilis diagnoses despite being only approximately 6% of the total Bexley population).


Figure 92 Sexually transmitted diagnoses in Bexley residents between 2008-09 by gender, GUMCAD 2008-09

Figure 93 HIV: Numbers of diagnosed infected patients by index of multiple deprivation, annual trends 2004-2008,

(SOPHID 2010)


Figure 94 Number of patients infected with HIV by probable route of infections, 2004-2008 (SOPHID 2009)

HIV: numbers of diagnosed infected patients by probable route of HIV

infection, annual trends, 2005 - 2009

0

20

40

60

80

100

120

140

160

2005 2006 2007 2008 2009

Nu

mb

er

Sex between men

Sex between men and women - males

Sex between men and women - females

Injecting drug use/blood-blood products recipient/mother-to-child transmission/Other or not known


Figure 95 Percentage of HIV patients by ethnic group 2004-08 (SOPHID 2009)

Although adult obesity prevalence in Bexley is lower than the London and national averages, it still remains a

concern. According to synthetic estimates based on the Health Survey for England, 21.5% of adults in the

Borough are obese, compared to 25% in England as a whole

Overweight and obesity are more common in lower socioeconomic and socially disadvantaged groups,

particularly among women. In women, the mean BMI is markedly higher in Black Caribbeans and Black

Africans than in the general population, and markedly lower in Chinese. In men, the mean BMI of Chinese

and Bangladeshis is significantly lower than that of the general population. (Obesity Health Needs

Assessment, 2010)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

2005 2006 2007 2008 2009

Pe

rce

nta

ge

White males White females Black African males Black African females Other


Figure 96 Proportion of adults participating in recommended levels of physical activity by south east London Borough

NHS ICIP/ONS 2007-09

Figure 97 Proportion of adult population regularly undertaking 30 minutes of moderate intensity sport October 2008-

09 by local authority, Sport England Survey

0%

2%

4%

6%

8%

10%

12%

14%

London England Lambeth Bromley Southwark Greenwich Lewisham Bexley

P

e

r

c

e

n

t

a

g

e

Proportion of adults aged 16 and over participating in recommended

levels of physical activity. Three year average percentages (with 95%

confidence intervals) by South East London PCT, London and England, 2007 - 2009

Percentage of Adult Population regularly undertaking 30 minutes of moderate intensity

sport, Oct 2008 - Oct 2009, by Local Authority

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Bexley Bromley Greenwich Lambeth Lewisham Southwark

Percen

tage o

f P

opu

lati

on


Source: Active People

Survey / Sport England


–

Figure 98 Map showing obesity prevalence in different wards of Bexley. Obesity Needs Assessment 2010

Source: QOF data from GP practices, 2009-10


Figure 99 number of takeaway outlets per 1000 people by ward. Obesity Needs Assessment 2010

Perhaps a more robust measure of access to health food options can be obtained by using data from the 2008 Place

Survey‡. At the time of the survey, more than three quarters (79%) of Bexley residents felt it was easy or very

easy for them to get to a shop which sells fruit and vegetables. However, ease of access appears to vary

considerably by ward – residents of Thamesmead, Lesnes Abbey, St. Michael’s, East Wickham, Falconwood and

Welling, North End, and Colyers are less likely to find it easy to access this kind of facility. There appears to be a

relationship between those wards which have higher levels of adult obesity and areas whose residents report that it

is less easy to access healthy foods such as fruit and vegetables.

Figure 10 – ease of access to shops selling fruit and vegetables. (Place Survey 2008-09) Obesity Needs Assessment 2010

‡ The Place Survey is the new biennial statutory survey which all local authorities in England are required to carry out. Together with the

tenant satisfaction (STATUS) survey, it replaces the series suite of Best Value Performance Indicator (BVPI) user satisfaction surveys,

which have been carried out since 2000.


The introduction of the School Food Trust Food & Nutrient Based Standards has meant that food

provision and consumption have improved and meal numbers have risen. Rates have risen from 23%

uptake in 2007/2008 to 29% in 2009/2010. Packed lunch surveys conducted locally have shown that 0.6% of

packed lunches are balanced, which compared to 1.1% nationally is poor.32


Figure 100 Modelled estimate for fruit and veg consumption by local authority, NHS IC 2003-05

Figure 101 Model based estimate of fruit and veg consumption by local authority, NHS information centre 2005-05

The prevalence of smoking in Bexley has reduced from 27% between 2003-0533

to between 21% and 23%

in 2009.34

Smoking rates are considerably higher among routine and manual workers as well as disadvantaged

and vulnerable communities. Although smoking prevalence rates are reducing, the decline is slower among

lower-income groups. As seen in Figure 89 Smoking is highest in south east London among patients with selected

conditions.

Model based estimate for fuit and veg consumption, percentage of persons by local authority,

2003-05

0

5

10

15

20

25

30

35

Bexley Southwark Lewisham Greenwich Bromley Lambeth

Perc

en

tag

e o

f p

op

ula

tio

n

Released: 17/12/07

Source: NHS Information Centre

Model based estimate of fruit and veg consumption, percentage of persons by local

authority, 2003-05, With 95% Conifidence Intervals

15

20

25

30

35

40

Bexley Southwark Lewisham Greenwich Bromley Lambeth

Percen

tage o

f popu

lati

on

Upper CI Width

Lower CI Width

Model Based Estimate for F & VConsumption 95% CI (Lower)

Model Based Estimate for F & VConsumption

Released: 17/12/07

NHS Information Centre


Figure 102 Smoking among patients with selected conditions by south east London PCT of residence NCHOD 2007-08

Figure 103 Deaths attributed to smoking 2006-08 APHO

There are around 3000 accidental falls in Bexley per year with 2254 attending A&E and 797 resulting in

admissions. This is significantly lower than the average for England. Women show a higher rate of hospital

admissions from falls than men.

94%

94%

95%

95%

96%

96%

Bexley England London Bromley Greenwich Southwark Lambeth Lewisham

P

e

r

c

e

n

t

a

g

e

Smoking among patients aged 16+ years with selected conditions: annual percentages (with 95% confidence intervals) by South East

London PCT of residence, London and England, 2010/11

Deaths Attributed to Smoking 2006 - 2008, percentage deaths per population, all people over 35,

upper 95%CI,

195

200

205

210

215

220

England London Bexley

No.

Released: 2010

Source: AHPO


Table 13 People aged 65 and over predicted to have a fall by age. London Borough of Bexley 2010

People aged 65 and over predicted have a fall, by age

2010 2011 2012 2013 2020

65-74 4,075 4,133 4,272 4,374 4,698

75-84 3,580 3,611 3,630 3,688 4,040

85 and over 2,107 2,150 2,193 2,279 2,838

Total population 65 and over 9,762 9,894 10,095 10,341 11,576

Table produced on 31/08/12 19:34 from www.poppi.org.uk version 7.0 People aged 65 and over predicted have a fall, by age and gender, projected to 2016

2012 2013 2014 2015 2016

People aged 65-69 predicted to have a fall 2,275 2,357 2,398 2,398 2,398 People aged 70-74 predicted to have a fall 2,002 2,049 2,056 2,103 2,244

People aged 75-79 predcted to have a fall 1,788 1,788 1,807 1,807 1,788 People aged 80-84 predicted to have a fall 1,900 1,931 1,931 1,931 1,965 People aged 85 and over predicted to have a fall 2,322 2,322 2,408 2,408 2,537 Total population aged 65 and over predicted to have a fall 10,287 10,447 10,600 10,647 10,932 Figures may not sum due to rounding. Crown copyright 2010

Rates for people who report at least one fall during the last 12 months are as follows:

Table 14 Number of people predicted to be admitted into hospital as a result of falls. POPPI 2012

Table produced on 31/08/12 19:36 from www.poppi.org.uk version 7.0

People aged 65 and over predicted to be admitted to hospital as a result of falls, by age, projected to 2016

2012 2013 2014 2015 2016

People aged 65-69 predicted to be admitted to hospital as a result of falls

57 59 61 60 60

People aged 70-74 predicted to be admitted to hospital as a result of falls

78 79 79 81 86

People aged 75 and over admitted to hospital as a result of falls 688 696 707 714 718

Total population aged 65 and over predicted to be admitted to hospital as a result of falls

824 834 847 855 863


Rates for admissions to hospital as a result of unintentional falls are as follows:

The recent trends over the last four years have seen a national increase in the number of households in fuel

poverty. It is estimated that 20% of households nationally are now in fuel poverty. The increase in the last few

years is partly as a result of increasing fuel bills. In Bexley the most recent indication of fuel poverty is the

National Indicator 187. The survey carried out in 2008 revealed that 18% of households could be considered

to be in fuel poverty.

The effect of cold on mortality rates is demonstrated by the increase in the winter months. Excess winter deaths

are calculated by comparing the number of deaths between December and March against the average for the

proceeding four months. In 2007/08 there were some 23,800 excess winter deaths nationally. For every winter

death there are an estimated 8 emergency admissions. The Excess Winter Mortality Index (EWM Index)

indicates that for the period 2006-08 the index in Bexley was highest in south east London and higher than

London and England. This will require further investigation by local health services in Bexley.


Figure 104 Excess Winter Mortality Index (EMW Index) (ratio of excess winter deaths: expected non-winter deaths) in

Bexley, London and England 2005-2008, HNA Toolkit Commissioning Support for London

0%

5%

10%

15%

20%

25%

30%

35%

40%

Lambeth London Bexley England LewishamGreenwichBromleySouthwark

E

W

M

I

n

d

e

x

(

%)

Excess Winter Mortality Index for persons aged 85 years and over. Percentages (with 95% confidence

intervals) by S.E. London Borough, London and England, 2002-2009


Figure 105 Excess Winter Mortality Index (EMW Index) (ratio of excess winter deaths: expected non-winter deaths) in

south east London, 2006-08. HNA Toolkit Commissioning Support for London

0%

5%

10%

15%

20%

25%

30%

35%

Bromley Bexley London England LambethLewishamGreenwichSouthwark

P

e

r

c

e

n

t

a

g

e

Excess Winter Mortality Index for persons of all ages. Four year average percentages (with 95% confidence

intervals) by S.E. London Borough, London and England, 2007-2010

0%

5%

10%

15%

20%

25%

Lambeth Bexley Bromley England London LewishamSouthwarkGreenwich

E

W

M

I

n

d

e

x

(

%)

Excess Winter Mortality Index for persons under 65. Percentages (with 95% confidence intervals) by S.E.

London Borough, London and England, 2002-2009


The most recent dental data for five year olds in Bexley dates from 2001/02. At that time 36% of 5-year-olds in

Bexley had experienced tooth decay and children had on average 1.2 affected teeth. However, inequalities in

oral health existed across the borough and a third of five-year-old children were experiencing dental decay in the

more deprived wards, where each child had an average of three affected teeth. Thus significant groups of children

were continuing to experience dental decay and require access to oral healthcare.

There are no recent five or twelve year old data sets available for Bexley. However, deprivation may be used as a

proxy indicator for oral health.35


Figure 106 Location of dental practices in Bexley and level of deprivation, 2009

Figure 107 Percentage of dental health patients seen in previous 24 months March 2006 – March 2010, NCHOD

Total percentage of dental health patients seen in previous 24 months, as a percentage of

population, time trend data, march 06- march 10

30.0

35.0

40.0

45.0

50.0

55.0

60.0

Mar

-06

May

-06

Jul-06

Sep

-06

Nov

-06

Jan-

07

Mar

-07

May

-07

Jul-07

Sep

-07

Nov

-07

Jan-

08

Mar

-08

May

-08

Jul-08

Sep

-08

Nov

-08

Jan-

09

Mar

-09

May

-09

Jul-09

Sep

-09

Nov

-09

Jan-

10

Mar

-10

Percen

tage o

f popu

lati

on

accessin

g N

HS

den

tistr

y

England

London

Bexley

- 108 - 5. PROVIDING SERVICES FOR RESIDENTS INCLUDING THOSE WITH LONG TERM CONDITIONS TO

MAXIMISE CHOICE, CONTROL AND WELLBEING

Chapter 5 Providing services for residents including those with long term conditions to maximise

choice, control and wellbeing

As described in the demographic section above, Bexley has a particularly ageing population. The age breakdown

and population estimates for the various years up to 2020 can be seen below. The largest increase can be seen in

people aged 65-69 between 2010 and 2030.

Table 15 Total population, population aged 65 and over and population aged 85 and over as a number and as a percentage of the total population, projected to 2030 in Bexley, POPPI 2012

2012 2015 2020 2025 2030

Total population 233,800 240,600 252,500 264,100 274,800

Population aged 65 and over 38,200 39,800 42,200 46,100 51,700

Population aged 85 and over 5,300 5,700 6,500 7,500 8,500

Population aged 65 and over as a proportion of the total population 16.34% 16.54% 16.71% 17.46% 18.81%

Population aged 85 and over as a proportion of the total population 2.27% 2.37% 2.57% 2.84% 3.09%


Table 16 Population aged 65 and over, projected to 2030, POPPI 2012

2012 2015 2020 2025 2030

People aged 65-69 11,000 11,600 10,700 12,400 14,600

People aged 70-74 8,500 8,800 10,700 9,900 11,500

People aged 75-79 7,600 7,700 7,900 9,600 8,900

People aged 80-84 5,800 6,000 6,400 6,700 8,200

People aged 85-89 3,500 3,800 4,200 4,600 5,000

People aged 90 and over 1,800 1,900 2,300 2,900 3,500

Total population 65 and over 38,200 39,800 42,200 46,100 51,700

Figures are taken from Office for National Statistics (ONS) subnational population projections by sex and quinary age. The latest subnational population projections available for England, published 21 March 2012, are based on the 2010 mid year population estimates and project forward the population from 2010 to 2035. Long term population projections are an indication of the future trends in population by age and gender over a period of 25 years. They are trend based projections, which means assumptions for future levels of births, deaths and migration are based on observed levels mainly over the previous five years. They show what the population will be if recent trends in these continue. The projections do not take into account any future policy changes.

Table 17 Number of people aged 65 (percentage of total) and over by age and ethnic group, year 2009. POPPI 2012

People aged 65-74

People aged 75-84

People aged 85+

White (this includes British, Irish and Other White) 17,042 (93.42%)

12,424 (95.80%)

4,824 (97.65%)



Mixed Ethnicity (this includes White and Black Caribbean; White and Black African; White and Asian; and Other Mixed)

95 (0.52%)

56 (0.43%)

13 (0.26%)

Asian or Asian British (this includes Indian; Pakistani; Bangladeshi; and Other Asian or Asian British)

582 (3.19%)

265 (2.04%)

54 (1.09%)

Black or Black British (this includes Black Caribbean; Black African; and Other Black or Black British)

379 (2.08%)

160 (1.23%)

24 (0.49%)

Chinese or Other Ethnic Group 150 (0.82%)

61 16

All people 18,248 12,966 4,931


In 2009/10 a total of 4922 older people received social care services. Of these:

o 4129 had a Physical Disability and/ or temporary illness/ frailty as their primary client type

o 113 had a Hearing Impairment as their primary client type

o 145 had a Visual Impairment as their primary client type

o 24 had Dual Sensory Loss as their primary client type

o 471 had Mental Health (total) as their primary client type, of which 471 had dementia.

o 1 had Vulnerable people as their primary client type

o 38 had a Learning Disability as their primary client type

o 1 had Substance Misuse as their primary client type

In 2009/10 a total of 4259 older people received care community based services such as home care or day care.

1522 were supported at any one time (as at 31 March 2010). A further 930 older people were supported in

residential or nursing home care (some also a community based service). 617 older people were supported at any

one time (as at 31 March 2010).



Figure 108 Map showing the provision of social care services weighted against the older population (+65) within the

ward. London Borough of Bexley.

Table 2 Projections for various conditions in people over 65 in Bexley. POPPI 2010

2008 2010 2015 2020 2025 Absolute

increase

%

Increase

Males aged 65+ predicted to

have dementia

888 921 1,043 1,171 1,312 424 47.7%

Females aged 65+ predicted

to have dementia

1,656 1,674 1,744 1,871 2,059 403 24.3%

Males and females aged 75+

registered blind or partially

sighted

3,520 3,580 3,800 4,060 4,640 1,120 34.5%

Population aged 65+ with

BMI above 30

8,731 8,922 9,709 1,0226 11,117 2,386 27.3%

Table 18 People aged 65 and over with a limiting long-term illness, by age, projected to 2016 in Bexley. POPPI 2012

2012 2013 2014 2015 2016

People aged 65-74 with a limiting long-term illness 7,287 7,474 7,586 7,623 7,773

People aged 75-84 with a limiting long-term illness 7,111 7,164 7,271 7,271 7,217

People aged 85 and over with a limiting long-term illness

3,263 3,325 3,387 3,510 3,633

Total population aged 65 and over with a limiting long- 17,662 17,963 18,243 18,404 18,623



term illness


Figures are taken from Office for National Statistics (ONS) 2001 Census, Standard Tables, Table S016 Sex and age by general health and limiting long-term illness. The most recent census information is for year 2001 (data from the 2011 census is due to be published 2012-2014).

Numbers have been calculated by applying percentages of people with a limiting long-term illness in 2001 to projected population figures.

Table 19 People aged 65 and over who are obese or morbidly obese, by age and gender, projected to 2016 in Bexley.

POPPI 2012

2012 2013 2014 2015 2016

People aged 65-69 with a BMI of 30 or more

3,477 3,603 3,666 3,666 3,666


2,406 2,463 2,466 2,523 2,694


1,940 1,940 1,961 1,961 1,940


1,224 1,241 1,241 1,241 1,265

People aged 85 and over with a BMI of 30 or more

855 855 884 884 923

Total population aged 65 and over with a BMI of 30 or more

9,902 10,102 10,218 10,275 10,488


Rates for obesity are as follows:

Age range % males obese

% males morbidly obese

% females obese

% females morbidly obese

65-69 29 1 30 3

70-74 27 0 29 1

75-79 21 0 28 1

80-84 16 1 23 1

85+ 10 0 19 0

Figures are taken from Health Survey for England (2005), volume 2, table 4.2: Body mass index (BMI), by age and sex. An individual with a BMI of 30 or greater is classed as obese. A BMI of 40 or greater is classed as morbidly obese.

The prevalence rates have been applied to ONS population projections of the 65 and over population to give estimated numbers predicted to be obese and morbidly obese, to 2030.

Long term conditions (also called chronic conditions) are health problems that require management over long

period of time in years or decades. Long term conditions (LTCs) include a wide range of health conditions

including non-communicable diseases, communicable diseases, certain mental health disorders and ongoing

impairments in structure such as blindness or joint disorders.



Guidance published in 200536

suggests that in order to provide the most appropriate treatment for each individual,

the patients identified should be stratified into one of three levels according to their needs:

Level 1: Supported self care. This level would apply to 70-80% of the Long Term Condition population and

involves helping individuals and their carers to care for their conditions effectively.

Level 2: Disease specific care management. This would apply to people who have a complex single need or

multiple conditions.

Level 3: Case management. This level would apply to 3-4% of the Long Term Condition population, and

requires the identification of the very high intensity users of unplanned secondary care.

Since 1996, the number of people in the UK with diabetes has increased from 1.4m to 2.6m and is forecast to

increase to over 4m by 2025 largely as a result of the aging population and rapidly increasing numbers of

overweight or obese people.37

5% of all pregnancies, (approximately 140 in Bexley), are affected by gestational

diabetes.

Recent figures by the APHO estimate that there are 12,666 people with diabetes in Bexley compared to 10,047

registered in QOF.38

This puts the number at risk with pre-diabetes, i.e. raised blood sugars, at 37,998.39

Mortality from diabetes in Bexley peaked in 2007 after relative stability since 1998. Mortality in men is higher

than mortality in women however remains unstable. (Figure 96)

The cardiovascular risk of a person with diabetes is the same as a person who has already had a heart attack.

Diabetes is the most common cause of end stage renal disease. 1 in 3 people with Type 2 develop kidney disease.

Diabetes is the leading cause of blindness in the UK. It is also the most common cause of lower limb amputations.

70% of people die within 5 years of an amputation. 16% of beds at Queen Mary’s Sidcup are taken by people

with diabetes. The cost of inpatient care for someone with diabetes can be up to 5 times that of a person without

the disease.40

Complications of diabetes make up 1 in 5 of all CHD, foot and renal admissions.41



Figure 109 Mortality from diabetes in Bexley (ICD9 250 adjusted, ICD10 E10-E14), NCHOD 1993-2010

Figure 110 Mortality from diabetes in Bexley (ICD9 250 adjusted, ICD10 E10-E14) in all persons, NCHOD 1993-2008

0

2

4

6

8

10

12

14

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

D

S

R

Mortality from diabetes (ICD9 250 adjusted, ICD10 E10-E14): females of all

ages. Directly age-standardised rates (DSR) per 100,000 population by South

East London Borough of residence, London and England. Annual trends, 1993-2010

Persons Males Females

0

2

4

6

8

10

12

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

D

S

R

Mortality from diabetes (ICD9 250 adjusted, ICD10 E10-E14): persons of all ages. Directly age-standardised rates (DSR) per 100,000

population by South East London Borough of residence, London and England. Annual trends, 1993-2010

England London Bexley



The National Eye Health Epidemiological Model (NEHEM) developed by the Eye Health Alliance has been used

to provide local prevalence estimates for cataracts, age related macular degeneration, glaucoma and low vision.

This model was developed for use by clinicians and commissioners to help identify areas of local need for eye

health services.

Additionally this profile has drawn upon prevalence estimates from The Royal National Institute for the Blind

(RNIB) and also the GP Annual Prevalence Study – the latter, however, should be interpreted with caution as

these prevalence estimates are based on diagnosed cases, thus excluded the potentially large numbers of people

who have undiagnosed eye diseases.

Diabetic retinopathy is most common in people who have had diabetes for a long time and, therefore, the

likelihood of diabetic retinopathy increases with age. It is estimated that 2.3% of people aged 75 and over are

affected by diabetic retinopathy to the extent where vision is significantly compromised; applied to the

Bexley population this is equivalent to 285 persons aged 75 and over.

The NEHEM suggests that the overall prevalence of glaucoma in Bexley is 1.43%; this is lower than in

London and England (1.52% and 1.47% respectively). Based on NEHEM estimates, 1983 persons in Bexley

are thought to be affected by glaucoma.

Table 20 Prevalence of glaucoma

Mean estimated

glaucoma cases

Low estimated

glaucoma cases

High estimated

glaucoma cases

n % n % n %

Bexley 1,983 1.43 1244 0.91 2,795 2.04

London 63,328 1.52 42,349 1.02 88,792 2.13

England 449,847 1.47 280,407 0.92 634,946 2.07

Figure 111 Age specific rates of glaucoma in England and Wales. GP Annual prevalence survey 2007



The NEHEM suggests that the overall prevalence of cataracts in Bexley is between 1.72% and 6.36%; this

is lower than in London and England (1.75%-6.37% and 1.88%-6.77% respectively). Based on NEHEM

estimates between 1,233 and 4,543 people in Bexley are thought to be affected by cataracts that cause

significant sight loss.

Figure 112 Age-specific rates of cataracts in England and Wales. GP Annual Prevalence Survey 2007

Given the prevalence models available to estimate the likely prevalence of cataracts in Bexley, there are likely to

be between 913 and 4,543 persons in Bexley affected by cataracts that affect vision.

The RNIB suggests that 36.2% of people aged 75 and over are affected by age related macular degeneration

(AMD) to the point where there is significant sight loss. Applying these figures to the Bexley population

suggests that 4,489 people in Bexley are affected by AMD.

0

50

100

150

200

250

300

1-4 5-14 15-24 25-44 45-64 65-74 75+

Age Group

Ag

e-s

pecif

ic r

ate

per

10,0

00

po

pu

lati

on

Men

Women

0

50

100

150

200

250

300

350

400

1-4 5-14 15-24 25-44 45-64 65-74 75+

Age Group

Ag

e-s

pecif

ic r

ate

per

10,0

00 p

op

ula

tio

n

Men

Women



The NEHEM suggests that the overall prevalence of AMD in Bexley is 2.27%; this is lower than in London

and England (2.41% and 2.45% respectively). Based on NEHEM estimates 1,125 people in Bexley are thought

to be affected by AMD. Given the prevalence models available to estimate the likely prevalence of AMD in

Bexley, there are likely to be between 1,125 and 4,489 persons in Bexley affected by AMD.

Prevalence of stroke and transient ischemic attacks in Bexley is highest in south east London after

Bromley; prevalence in Bexley is significantly higher than prevalence of stroke and transient ischemic attacks in

London.

Just over 80 per cent of all strokes occur in people aged 64 and over. Men are more at risk of stroke than women.

About 25 per cent of all men and 20 per cent of all women will experience a stroke if they reach the age of 85.

Nearly one person in every three who has a stroke will die within the first year following the stroke; usually in the

first ten days. Of those surviving, around 65 per cent will make a reasonable recovery, but 35 per cent will still

need a great deal of help to manage with day-to-day tasks, often from both family and professionals.

Figure 113 Prevalence of stroke by south east London Borough of residence, NCHOD 2010/11

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

1.6%

1.8%

England Bromley Bexley Lewisham London Greenwich Lambeth Southwark

P

e

r

c

e

n

t

a

g

e

Patients of all ages registered with GP practices with a coded diagnosis of

stroke or TIA. Annual percentages (with 95% confidence intervals) by South

East London PCT of residence, London and England, 2010/11



Figure 114 Mortality from stroke: persons under 75 years by south east London Borough of residence, NCHOD

2008/10

0

5

10

15

20

25

Greenwich Lewisham Lambeth Southwark London England Bexley Bromley

D

S

R

Mortality from stroke in persons aged under 75. Directly age-standardised rates per 100,000 (with 95% confidence intervals) by

South East London PCT of residence, London and England. 3 year averages, 2008-10



Figure 115 Mortality from stroke in persons of all ages by south east London Borough of residence, NCHOD 1993-

2010

30

40

50

60

70

80

90

100

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

D

S

R

Mortality from stroke (ICD9 430-438 adjusted, ICD10 I60-I69): persons of all ages. Directly age-standardised rates (DSR) per

100,000 population by South East London Borough of residence, London and England. Annual trends, 1993-2010

England London Lewisham Lambeth



Figure 116 Mortality from stroke in females under 75 by south east London Borough of Residence, NCHOD 1993-

2010

0

5

10

15

20

25

30

35

40

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

D

S

R

Mortality from stroke for females under 75. Directly age-standardised rates (DSR)

per 100,000 population by South East London PCT of residence, London and

England. Annual trends, 1993-2010


Lambeth Bexley Bromley Greenwich



Figure 117 Mortality from stroke in males under 75 by south east London Borough of Residence, NCHOD 1993-2010

0

10

20

30

40

50

60

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

Mortality from stroke for males under 75. Directly age-standardised

rates (DSR) per 100,000 population by South East London PCT of

residence, London and England. Annual trends, 1993-2010

England

London

Lewisham

Southwark



Figure 118 Emergency hospital admissions, stroke, persons of all ages, NCHOD 2007-08

Emergency hospital admissions: stroke, persons of all ages, annual indirectly age and sex

standardised rates (ISR) per 100,000 population with 95% confidence intervals, 2007/08

100

105

110

115

120

125

130

135

140

145

150

England Bexley

In

dir

ectl

y a

ge

-sta

nd

ard

ise

d r

ate

s/

10

0,0

00

po

pu

lati

on Released: 07/2009

Source: NCHOD/ONS

0

20

40

60

80

100

120

140

England Bexley

I

S

R

/

1

0

0

,

0

0

0

Emergency hospital admissions for persons of all ages with stroke. Indirectly

age-standardised rates/100,000 population (with 95% confidence intervals)

for Bexley and England, 2009/10



Figure 119 Emergency readmission to hospital within 28 days of discharge, stroke, NCHOD 2007-08

Emergency readmissions to hospital within 28 days of discharge: Stroke (ICD 10 codes: I61 to

I64), persons, all ages, annual indirectly age and sex standardised percent with 95% confidence

intervals, 2007/08

0

2

4

6

8

10

12

14

16

18

20

England Bexley

In

dir

ectl

y a

ge

an

d s

ex

sta

nd

ard

ise

d p

erc

en

t


Source: NCHOD/ONS

0%

2%

4%

6%

8%

10%

12%

14%

16%

England Bexley

P

e

r

c

e

n

t

a

g

e

Emergency readmissions to hospital within 28 days of discharge for persons

of all ages with stroke. Indirectly age-standardised percentages, with 95%

confidence intervals, for Bexley and England, 2009/10



Figure 120 Mortality from asthma by south east London Borough of residence, NCHOD 2008-10

Figure 121 Mortality from bronchitis and emphysema by south east London Borough of residence, NCHOD 1993-

2008

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Lambeth Southwark Greenwich England London Bromley Lewisham Bexley

D

S

R

Mortality from asthma in persons of all ages. Directly age-standardised rates per 100,000 (with 95% confidence intervals) by

South East London PCT of residence, London and England. 3 year averages, 2008-10

Mortality from bronchitis and emphysema: persons, all ages, directly age-standardised rates (DSR)

per 100,000 population by South East London PCT of residence. Annual time trends, 1993-2008

0

2

4

6

8

10

12

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

DS

R/

10

00

00

England Lo ndo n Lewisham So uthwark Lambeth B exley B ro mley Greenwich


Source: NCHOD/ONS



Coronary Obstructive Pulmonary Disease (COPD) accounts for more time off work than any other illness. An

exacerbation of COPD is one of the most common reasons for admission to hospital with 1 in 8 admissions due to

COPD.

Within Bexley there are 3, 312 patients registered on the COPD QOF register with the current recorded

prevalence rate being 1.48%. The expected prevalence rate for Bexley, based on the health profile for Bexley

2010 (Appendix 1) is 3.5% (7,832). The graph below details that the expected prevalence in Bexley over the next

15 years - set to increase over the next 10 years.

Figure 122 Modelled estimates of COPD by south east London PCT, ERPHO 2005-2020

Modelled Estimates of Percentage COPD Prevelance, 2005 - 2020, Time trend

2.5%

3.0%

3.5%

4.0%

4.5%

5.0%

2005 2006 2007 2008 2009 2010 2015 2020

Bexley

Bromley

Greenwich

Lewisham

Lambeth

Southwark



Figure 123 Modelled estimates of COPD prevalence 2010 by gender group, ERPHO

Figure 124 Proportion of persons of all ages with asthma, who have been prescribed asthma related drugs in the last

12 months by south east London PCT, NCHOD 2007-08

Modelled Estimates of COPD Prevelance, 2010, by Gender group

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Prevalence of COPD (males 16+) Prevalence of COPD (females 16+) Prevalence of COPD (persons 16+)

Percen

tage P

revale

nce (

Modelled E

sti

mate

)

Bexley

England

Proportion of persons of all ages with asthma, who have been prescribed asthma related drugs in the

last 12 months by South East London PCT of residence, 2007/08

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0


Pe

rce

nta

ge


Source: NCHOD/ONS



Figure 125 Mortality from bronchitis and emphysema, NCHOD 2008-10

Figure 126 Mortality from asthma by south east London Borough of Residence, all persons, NCHOD 2006-08

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

Bromley Southwark Bexley England Greenwich London Lambeth Lewisham

D

S

R

Mortality from bronchitis and emphysema for persons of all ages.

Directly age-standardised rates (with 95% confidence

intervals)/100,000 population by S.E. London Borough, London and England. 3 year averages, 2008-10

Mortality from asthma (ICD10 J45-J46): persons of all ages, directly age-standardised rates (DSR)

per 100,000 population with 95% confidence intervals, by South East London PCT of residence. 3

year average, 2006-08

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5


DS

R/

10

00

00

po

pu

lati

on


Source: NCHOD/ONS



Figure 127 Mortality from CHD in persons of all ages in south east London, NCHOD 1993-2010

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Lambeth Southwark Greenwich England London Bromley Lewisham Bexley

D

S

R

Mortality from asthma in persons of all ages. Directly age-standardised rates

per 100,000 (with 95% confidence intervals) by South East London PCT of

residence, London and England. 3 year averages, 2008-10



Bexley has shown a significant number of incidence rates in all cancers compared to London and England on the

whole. Incidence rates in females in Bexley are significantly higher than the average female incidence rate in

London in persons of all ages inflicted by all types of cancers. The proportion of deaths occurring at home in

Bexley from cancer, in both genders, is significantly greater than London.

There is a lack of national data available for population in end of life care. Local data shows that practices had

identified 1411 patients as Gold Patients in Bexley in 2009-2010. Gold Patients represented anything from

0.2% to 1.6% of total number of patients in each practice. The average cost of a gold patient dying in hospital in

2009-2010 was £3342.00 (Mede extract December 2010).

Figure 128 Mortality from all cancers for all ages, NCHOD 1993-2010

45

65

85

105

125

145

165

185

205

225

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

D

S

R

Mortality from coronary heart disease (ICD9 410-414 adjusted, ICD10 I20-I25): persons of all ages, directly age-standardised rates (DSR)/100,000 population by South East London PCT of residence,

London and England. Annual trends, 1993-2010




Figure 129 Mortality from all cancers for persons <75 years of age, NCHOD 1993-2008

140

160

180

200

220

240

260

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

Mortality from all cancers for persons of all ages. Directly age-standardised rates (DSR) per 100,000 population by South East

London Borough of residence, London and England. Annual trends, 1993-2010


80

100

120

140

160

180

200

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

Mortality from all cancers for persons under 75. Directly age-standardised rates (DSR) per 100,000 population by South East

London Borough of residence, London and England. Annual trends, 1993-2010




Figure 130 Years of life lost due to mortality from all cancers in persons under 75, 3 year average NCHOD 2008-10

0

20

40

60

80

100

120

140

160

180

200

Lambeth Lewisham Southwark Greenwich England London Bexley Bromley

D

S

R

Years of life lost due to mortality from all cancers in persons under 75.

Directly age-standardised rates per 100,000 (with 95% confidence intervals)

by South East London PCT of residence, London and England, 2008-10



Figure 131 Years of life lost due to all cancers in persons of all ages, NCHOD 2006-08

Figure 132 Incidence of tuberculosis in south east London 2010 NCHOD

YEARS OF LIFE LOST DUE TO ALL CANCERS IN PERSONS OF ALL AGES

USING DSR PER 10,000

125.00

130.00

135.00

140.00

145.00

150.00

155.00

160.00

ENGLAND LONDON Bexley LB

DS

R/1

0,0

00

MALES FEMALES ALL



Figure 133 Mortality from tuberculosis in south east London 1993-2008 NCHOD

0

10

20

30

40

50

60

70

Greenwich Lambeth London Southwark Lewisham England Bromley Bexley

D

S

R

Annual incidence of tuberculosis in persons of all ages. Directly age-standardised rates per 100,000 (with 95% confidence intervals) by

South East London PCT of residence, London and England, 2010

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

199319941995199619971998199920002001200220032004200520062007200820092010

D

S

R

/

1

0

0

,

0

0

0

Mortality from tuberculosis for persons of all ages. Directly age-

standardised rates (DSR) per 100,000 population by South East London

PCT of residence, London and England. Annual trends, 1993-2010

England

London

Lewisham

Southwark



1 in 6 people in the working adult population (18-64) will suffer from mental health problems, including

depression, phobia, obsessive compulsive disorder, panic disorder, generalised anxiety disorder, and mixed

anxiety & depressive disorder42

. In Bexley, this would equate to 21,333 people, of which 2,666 will be known

to secondary mental health services due to the severity of their mental health needs43

. This level of incidence

will also vary according to deprivation, gender, ethnicity and health.

Suicide is an important health issue and often an indicator of the mental well being of a population. Although the

overall rate of suicide has fallen since 1982 by more than 12 per cent, there are still around 5000 deaths from

suicide in England each year — this includes both suicide verdicts and undetermined deaths. 'Undetermined

deaths' are deaths were there is inconclusive evidence about the intention to die, these are now widely accepted as

being suicides. In the last 20 years or so, suicide rates have fallen in older men and women, but risen in young

men. The number of suicides in Bexley is lower than the national average and there have been no ‘suicide

hot spots’ in the borough over the last number of years44

. Figure 134 Age standardised mortality rate from suicide and injury undetermined for persons of all ages in south east

London, 1995-2010 NCHOD

0

2

4

6

8

10

12

D

S

R

/

1

0

0

,

0

0

0

Mortality from suicide for persons of all ages. Directly age-standardised rates

(DSR) per 100,000 population by South East London PCT of residence, London

and England. Annual trends, 1993-2010


Lambeth Bexley Bromley Greenwich



Figure 135 Comprehensive care plan for patients on mental health register in south east London, 2007-08 NCHOD

Comprehensive care plan for patients on mental health register. Annual percentages (with 95%

confidence intervals) for persons of all ages by South East London PCT of residence, 2007/08

70.0

72.0

74.0

76.0

78.0

80.0

82.0

84.0

86.0

88.0

90.0


Pe

rce

nta

ge

84%

86%

88%

90%

92%

94%

96%

P

e

r

c

e

n

t

a

g

e

Comprehensive care plan among persons of all ages on the mental health

register: annual percentages (with 95% confidence intervals) by South East

London PCT, London and England, 2010/11



Figure 136 Depression severity assessment at outset of treatment in south east London 2007-08 NCHOD

Depression severity assessment at outset of treatment:, annual percentages with 95%

confidence intervals, persons, 18+ years, by South East London PCT of residence, 2007/08

70.00

75.00

80.00

85.00

90.00

95.00

100.00


Pe

rce

nta

ge

80%

82%

84%

86%

88%

90%

92%

94%

England Lambeth London Southwark Bromley Lewisham Bexley

P

e

r

c

e

n

t

a

g

e

Depression severity assessment at outset of treatment: annual percentages (with 95% confidence intervals) for persons 18+, by

South East London PCT of residence, 2010/11



Figure 137 Prevalence of depression among diabetic patients and or coronary heart disease in south east London

2007-08 NCHOD

The Care Trust have supported the Bexley Early Intervention in Psychosis (EIP) Team which was created because

we recognise that early treatment is crucial because the first few years of psychosis carry the highest risk of

serious physical, social and legal harm. One in ten people with psychosis commits suicide - two thirds of these

Prevalence: depression in patients with diabetes and/or coronary heart disease, annual

percentages with 95% confidence intervals for persons of all ages by South East London PCT of

residence, 2007/08

70

75

80

85

90

95


Percen

tage


Source: NCHOD/QOF

82%

83%

84%

85%

86%

87%

88%

89%

90%

Greenwich England Lambeth Bexley Southwark Bromley Lewisham

P

e

r

c

e

n

t

a

g

e

Screening for depression in patients with diabetes and/or coronary heart disease: annual percentages (with 95% confidence intervals)

for persons of all ages, by South East London PCT of residence, 2010/11



deaths occur within the first five years of illness45

. Intervening early in the course of the disease can prevent

initial problems and improve long term outcomes. If treatment is given early in the course of the illness and

services are in place to ensure long-term concordance (co-operation with treatment), the prospect for recovery is

improved.

The EIP team is one of several platforms the Care Trust is supporting to promote wellbeing and recovery from

mental health problems early intervention and support will prevent younger people being ‘stuck’ within adult

mental health services for the whole of their lives and investment in Wellbeing schemes such as The Being Well

in Bexley Scheme at MIND in Bexley supports the need to provide interventions to support people in work to

remain in work at a time when their mental health is deteriorating and provides guidance and assistance to people

who have been marginalised socially due to their mental illness.

Figure 138 Prevalence of psychosis in south east London 2007-08

Of all London PCT’s, Bexley has the third highest proportion of the population aged 65+, and the second

highest estimated prevalence of late onset dementia (73 – 76.5 / 1000). Dementia is predominantly a disorder

of later life and in Bexley the projected percentage increase in the number of people with dementia in the borough

from 2005 – 2021 is 28%. (The average London increase is projected to be 14%)46

.

Figure 139 Prevalence of dementia in south east London 2010/11 NCHOD

0.0%

0.2%

0.4%

0.6%

0.8%

1.0%

1.2%

1.4%

Lewisham SouthwarkGreenwich London England Bromley Bexley

P

e

r

c

e

n

t

a

g

e

Psychoses prevalence: annual percentages (with 95% confidence intervals) for persons of all ages, by South East London PCT of

residence, 2010/11



Table 21 Number of people projected to have dementia in Bexley, POPPI 2012

2012 2013 2014 2015 2016

People aged 65-69 predicted to have dementia 136 141 143 143 143





People aged 90 and over predicted to have dementia 536 536 567 567 594

Total population aged 65 and over predicted to have dementia 2,772 2,793 2,847 2,853 2,944


Rates for men and women with dementia are as follows:

Age range % males % females

65-69 1.5 1 70-74 3.1 2.4 75-79 5.1 6.5 80-85 10.2 13.3 85-89 16.7 22.2

0.0%

0.1%

0.2%

0.3%

0.4%

0.5%

0.6%

England Bromley Bexley Greenwich London Lewisham Lambeth Southwark

P

e

r

c

e

n

t

a

g

e

Dementia prevalence: annual percentages (with 95% confidence intervals)

for persons of all ages, by South East London PCT, London and England, 2010/11



90+ 27.9 30.7

The most recent relevant source of UK data is Dementia UK: A report into the prevalence and cost of dementia prepared by the Personal Social Services Research Unit (PSSRU) at the London School of Economics and the Institute of Psychiatry at King's College London, for the Alzheimer's Society, 2007.

Figure 140 Care Review among patients with dementia in south east London 2007-08 NCHOD

In Adult Social Care, services are primarily provided to clients who are assessed as being eligible for services

under the Fair Access to Care Services (FACS) Department of Health guidance.

A key aim of Adult Social Care services is to support people to remain independent and in their own homes. Table

15 shows the number of clients receiving community-based services in 2009/10:

Table 22 Number of clients receiving community-based services in 2009-10. London Borough of Bexley

Client 2009/10 Total

Aged 18-64 Aged 65+

People with physical impairment 940 3996 4936

People with learning disability 259 22 281

People with mental health problems 1222 240 1462

People with substance misuse

problems

58 0 58

Other vulnerable adults 15 1 16

Total 2494 4259 6753

64%

66%

68%

70%

72%

74%

76%

78%

80%

82%

84%

86%

Greenwich Southwark London England Lambeth Lewisham Bromley Bexley

P

e

r

c

e

n

t

a

g

e

Care review for patients of all ages with dementia. Annual percentages (with 95% confidence intervals) by South East

London PCT of residence, London and England, 2010/11



Figures taken from tables in the final submission of RAP (available on the NHS Information Centre website:

http://www.ic.nhs.uk/) show that:

63% of these service users were aged 65 and over;

People with physical impairments including those who were also older people represented 73% of

service users;

21% of service users had mental health problems, predominantly in the 18-64 age group;

People with learning disabilities represented 4% of service users.

Access to a range of community-based services is important in prolonging independence. The provision of Home

Care services helps to prolong independence and prevent people from going into residential care. Day Care

services help people to avoid social isolation by engaging in a range of different activities within a social setting.

Equipment and adaptations enable people to remain independent in the home for longer. Table 16 shows the type

of community-based services that eligible clients received in 2009-10.

Table 23 Type of community-based services received by eligible clients in 2009-10. London Borough of Bexley

Client Total

of

clients

Home

Care

Day

Care

Meals Existing /

new Direct

payments

and Personal

Budgets

Professional

support

Equipment

&

adaptations

Physically disabled

people 4936 1721 410 184 1228 1566 3153

Learning disabled

people 281 29 223 1 58 38 31

People with mental

health problems 1462 97 92 16 133 1216 85

People with substance

misuse problems 58 0 2 0 0 55 1

Other vulnerable

adults 16 2 0 0 4 8 6

Total 6753 1849 727 201 1423 2883 3276

Figures taken from tables in the final submission of RAP (available on the NHS Information Centre website:

http://www.ic.nhs.uk/) show that those receiving services benefitted from a range of different services, depending

on their assessed needs, including:

27% of clients received home care services, 10% received day care services, 3% meals, 21% direct

payments and individual budgets, 43% professional support and 48% equipment and adaptations;

64% of those clients with a physical disability benefitted from equipment and adaptations;

79% of learning disability clients benefitted from Day Care provision;

83% of people with mental health problems and 94% of people with substance misuse problems

received professional support.

Key Benefit Claimants:

Table 24 Working-age client group - key benefit claimants. August 2010 London Borough of Bexley

Bexley

(numbers)

Bexley

(%)

London

(%)

Great Britain

(%)

http://www.ic.nhs.uk/

http://www.ic.nhs.uk/



Total claimants 18,210 12.6 14.5 14.7

By statistical group

Job seekers 4,300 3.0 3.9 3.5

ESA and incapacity benefits 6,930 4.8 5.9 6.7

Lone parents 3,070 2.1 2.4 1.7

Carers 1,440 1.0 0.9 1.1

Others on income related benefits 600 0.4 0.6 0.5

Disabled 1,540 1.1 0.8 1.0

Bereaved 330 0.2 0.2 0.2

Key out-of-work benefits† 14,900 10.3 12.7 12.3

Source: DWP benefit claimants - working age client group

† Key out-of-work benefits includes the groups: job seekers, ESA and incapacity benefits, lone

parents and others on income related benefits.

Note: % is a proportion of resident population of area aged 16-64

The number of people aged 18-64 with a physical disability, helped to live at home, and those supported by

social care in care homes, is predicted to remain fairly stable in the longer term.

There are around 7 500 people currently on the Physical Disability Register. 33 390 adults were accessing

services for people with physical disability and sensory impairment (PDSI) at 31 March 2010, the vast

majority most of whom have identified physical disability as their primary client type:

o 359 have a Physical Disability as their primary client type

o 15 have a Hearing Impairment as their primary client type

o 11 have a Visual Impairment as their primary client type

o 5 have Dual Sensory Loss as their primary client type

81% of customers with PDSI are from the White British ethnic group. People from black and minority ethnic

groups account for the remaining 19% of customers, with the largest minority from the Black or Black British

community, representing 6% of customers with PDSI. 56.3% of customers with PDSI are female.

Customers reside all across the borough, but there are concentrations of customers with PDSI in Cray

Meadows, Crayford and North End. These wards collectively house nearly a quarter of customers and are

located within the south and east of the borough.

The main services used by this client group are equipment and rehabilitation which is generally provided by

Inspire Community Trust at the Whitehall centre. This centre is located on the extreme eastern edge of the

borough (North End Ward), which means that a large resource is currently being put into providing

transport for those furthest from this centre.

There are 195 people registered blind, 246 registered partially sighted, 162 registered dual sensory loss, 220

people deaf without speech, who sign, around 60 people deaf with speech, who can speak and around 1,500

people who are hard of hearing.

The number of admissions of people with physical disability and sensory impairment into care homes has

declined over the past three years. This is largely due to the shift from the traditional path of entering care

homes when needs dictate, to a situation where they can be managed with an intensive home care support

package and respite care.



There are 11,700 people who hold a blue badge. About a third of these (3,700 people) would be on a higher

rate mobility allowance. This gives an indication of the number of people who have a severe disability.

There are around 25 people who attend the day support service who are known to have long term deteriorating

condition(s) such as multiple sclerosis, Parkinson’s disease, arthritis etc. They attend the Inspire Independent

Living Centre for socialisation and to help them cope with their conditions through peer support.

Figure 6: Map showing the geographic distribution of PDSI clients in the Borough. London Borough of

Bexley

There are various types of learning disabilities which and can be broadly divided into three categories:

1. Academic skills disorders such as problems with reading and writing. Example: dyslexia, dyspriaxia

2. Speech and language disorders which includes difficulties with pronunciation

3. Problems with motor skills and memory. Example: Learning disability associated with brain injury

Estimates suggest Bexley has a population of 4,07447

with learning disabilities - within which, 774 are young

people (under 20yrs), 525 are older people (65+ years). The remaining 2,775 are adults of working age. These

groups will have a mixture of severe/profound, moderate or mild learning disabilities. In the case of people with

mild/moderate learning disabilities, lower estimates suggest a prevalence rate of around 25 per 1000

population. Mild to moderate learning disability has a link to poverty and rates are higher in deprived and

urban areas. §

‘The proportion of people with learning disabilities who are known to services is estimated to be around one

quarter of actual prevalence’**

– In Bexley, there are 723 adults with learning disabilities known to social services.

QOF registers (Nov 2009) report 495 adults with learning disabilities (12% of the estimated population).

§ DH (2001) Valuing People: A New Strategy for Learning Disability for 21

st Century.

** Disability Rights Commission (2006) Equal Treatment: Closing the Gap. DRC



Nationally, the recording of learning disability in primary care is poor. ††

In Bexley, 48% of adults known to

specialist services have been identified in primary care.

Figure 141 Prevalence of learning disabilities, annual percentages with 95% confidence intervals, persons, 18+ years,

by South East London PCT of residence, 2010/11 NCHOD

Figure 5 Map showing the geographic distribution of LD clients in the Borough

††

Disability Rights Commission (2006) Equal Treatment: Closing the Gap. DRC

0.00%

0.05%

0.10%

0.15%

0.20%

0.25%

0.30%

0.35%

0.40%

0.45%

0.50%

England Greenwich Lewisham London Lambeth Bexley Bromley Southwark

P

e

r

c

e

n

t

a

g

e

Persons aged 18 and over with learning disabilities. Annual prevalences with 95% confidence intervals by South East London

PCT, London and England, 2010/11



Table 25 People predicted to have a moderate or severe learning disability in Bexley and hence likely to be in receipt

of services by age. POPPI 12

2012 2013 2014 2015 2016

People aged 65-74 predicted to have a moderate or severe learning disability 69 70 71 72 73

People aged 75-84 predicted to have a moderate or severe learning disability 28 28 29 29 28

People aged 85 and over predicted to have a moderate or severe learning disability 10 10 10 10 11

Total population aged 65 and over predicted to have a moderate or severe learning disability 106 108 110 110 112


These predictions are based on prevalence rates in a report by Eric Emerson and Chris Hatton of the Institute for Health Research, Lancaster University, entitled Estimating Future Need/Demand for Supports for Adults with Learning Disabilities in England, June 2004. The authors take the prevalence base rates and adjust these rates to take account of ethnicity (i.e. the increased prevalence of learning disabilities in South Asian communities) and of mortality (i.e. both increased survival rates of young people with severe and complex disabilities and reduced mortality among older adults with learning disabilities). Therefore, figures are based on an estimate of prevalence across the national population; locally this will produce an over-estimate in communities with a low South Asian



community, and an under-estimate in communities with a high South Asian community.

Prediction rates have been applied to ONS population projections of the 65 and over population in the years 2011 and 2021 and linear trends projected to give estimated numbers predicted to have a moderate or severe learning disability, and hence likely to be in receipt of services, to 2030.

Predictions of the number of people with a moderate or severe learning disability for 2011 and 2021 are as follows:

Age range % in 2011 % in 2021

65-69 0.36 0.36

70-74 0.34 0.34

75-79 0.23 0.23

80+ 0.18 0.18

Table 26 People predicted to have a severe learning disability in Bexley and hence likely to be in receipt of services by

age. POPPI 2012

People aged 18-64 predicted to have a severe learning disability, and hence likely to be in receipt of services

2012 2013 2014 2015 2016

18-64 247 249 251 253 255

Table 27 The percentage distribution of households receiving intensive Home Care split by age and primary service

user type, 18+ years, 2008 IC/CASSR

Council with

Social Services

Responsibility

Aged 18 - 64

Aged 65

and over Total

Total Physical

Disabilities

Learning

Disabilities

Mental

Health

Problems

Other

England 27.2% 11.5% 13.0% 2.1% 0.5% 72.8% 100.0%

Lewisham 33.8% 8.9% 19.4% 0.3% 5.2% 66.2% 100.0%

Southwark 20.2% 16.2% 3.4% 0.5% 0.2% 79.8% 100.0%

Lambeth 26.0% 21.0% 5.0% 0.0% 0.0% 74.0% 100.0%

Bexley 15.6% 12.3% 2.2% 0.3% 0.8% 84.4% 100.0%

Bromley 15.6% 10.9% 4.3% 0.4% 0.0% 84.4% 100.0%

Greenwich 14.0% 11.7% 2.0% 0.2% 0.1% 86.0% 100.0%

It is evident from the last census that there are still many regular and substantial carers that choose not to make

themselves known to social care and those who do not readily identify with the term ‘carer’. Last year 1776

carers in Bexley received either a carers assessment or review of their own situation and of these 756

accessed either a break of support service. Work is continuing to identify more ‘hidden carers’ and to ensure

that those providing considerable support to enable another to remain at home are aware of the local supports

available. From data it is evident that less than 50% of those providing over 50 hours of care and above are in

contact with carers services within statutory and voluntary sectors in Bexley.

The numbers of people providing unpaid care to a partner, family member or other person is increasing:



o 8.0% of those aged 65-74 providing 20-49 hours of unpaid care per week

o 8.2% of those aged 65-74 providing 50 or more hours of unpaid care per week

o 2.9% of those aged 75-84 providing 20-49 hours of unpaid care per week

o 3.1% of those aged 75-84 providing 50 or more hours of unpaid care per week

o 8.3% of those aged 85+ providing 20-49 hours of unpaid care per week

o 8.1% of those aged 85+ providing 50 or more hours of unpaid care per week

o 6.7% of those aged 65+ providing 20-49 hours of unpaid care per week

o 6.3% of those aged 65+ providing 50 or more hours of unpaid care per week

Table 28 People aged 65 and over providing unpaid care to a partner, family member or other person, by age and by hours of care provided, projected to 2016 in Bexley. POPPI 2012

2012 2013 2014 2015 2016

People aged 65-74 - Not providing any care 16,590 17,015 17,271 17,356 17,696

People aged 65-74 - Provide care for between 1 and 19 hours per week 1,704 1,747 1,773 1,782 1,817

People aged 65-74 - Provide care for between 20 to 49 hours per week 277 284 289 290 296

People aged 65-74 - Provide care for 50 or more hours per week 840 861 874 878 896

People aged 75-84 - Not providing any care 11,774 11,862 12,038 12,038 11,950

People aged 75-84 - Provide care for between 1 and 19 hours per week 622 627 636 636 632

People aged 75-84 - Provide care for between 20 to 49 hours per week 107 108 109 109 108

People aged 75-84 - Provide care for 50 or more hours per week 540 544 552 552 548

People aged 85 and over - Not providing any care 4,380 4,462 4,545 4,710 4,875

People aged 85 and over - Provide care for between 1 and 19 hours per week 82 84 85 88 91

People aged 85 and over - Provide care for between 20 to 49 hours per week 26 27 27 28 29

People aged 85 and over - Provide care for 50 or more hours per week 120 122 124 129 134


Figures are taken from Office for National Statistics (ONS) 2001 Census, Standard Tables, Table S025 Sex and age by general health and provision of unpaid care. The most recent census information is for year 2001 (data from the 2011 census is due to be published 2012-2014).

The term unpaid care" covers any unpaid help

looking after or supporting family members

friends

neighbours or others because of long-term physical or mental ill-health or disability or problems related to old age."

Numbers have been calculated by applying percentages of people who do or do not provide unpaid care by their age and the number of hours provided, to projected population figures.

Vulnerable groups in Bexley include but are not limited to the following groups:



- homeless families and single people with support needs

- vulnerable households with support needs

- older people/ sheltered housing and learning disability

- young adults at risk, including young pople leaving care, and young parents

- people who misuse alcohol or illegal substances

- people with long term health needs

- mentally disordered offenders

- victims of domestic violence or hate crime

There is evidence to suggest that two in five customers with substance misuse issues are in need of housing-

related support. Current population estimates for vulnerable groups with housing related support needs are set

out below.

Table 29 Current population estimates for vulnerable groups with housing-related support needs. London Borough of

Bexley

The following table illustrates how housing-related needs for specific population groups have changed over

time; this may give some indication of future needs.

Other vulnerable group No. with housing related

support needs

% with housing related

support needs

Single homeless 595 43.2%

Victims of domestic violence 141 10.2%

Drug misusers 107 7.8%

People who misuse alcohol 92 6.7%

Homeless families in need of support 90 6.5%

Young adults leaving care 70 5.1%

Offenders 49 3.6%

Mentally disordered offenders 43 3.1%

Young adults at risk 38 2.8%

Refugees / asylum seekers 37 2.7%

Young parents 34 2.5%

Ex-Prolific Offenders or Ex-Offenders 30 2.2%

People with HIV/AIDS 25 1.8%

Unaccompanied minors 16 1.2%

Travellers 5 0.4%

MAPPA clients 4 0.3%

Total 1,376 100%



Table 30 Housing related needs for specific populations between 2006-2009. London Borough of Bexley.

SU Group Pop’n in

need 2006/07

Pop’n in Need

2007/08

Pop’n in Need

2008/09

Ave. annual increase (+) / decrease (-)

Homeless 600 600 625 +2.1%

Rough sleepers 2 1 0 -100.0%*

Learning disabilities 136 144 149 +4.7%

Physical disabilities 960 944 965 +0.3%

HIV /AIDS 25 25 26 +2.0%

Substance mis-use 100 100 106 +3.0%

Travellers 4 6 5 +11.8%

Domestic violence 60 80 155 +60.7%**

Offenders 40 40 50 +11.8%

Mental health 75 74 76 +0.7%

Mentally disordered offenders 35 44 44 +12.1%

Older people with support needs 1,591 1,602 1,613 +0.7%

Older people: dementia / MH 440 440 470 +3.4%

Frail elderly 13,200 13,230 13,750 +2.1%

Young Parents 48 45 45 -3.2%

Young people at risk 16 -25yrs (incl c/leavers)

98 110 110 +5.9%

Refugees /asylum seekers 44 41 38 -7.1%

Minority communities n/a n/a 500*** n/a

Notes: * Caution should be taken when interpreting this increase as numbers are small. ** This large increase could be partly attributed to customers feeling safer accessing DV services As we have improved DV services points of access, people feel safer accessing this. ***Estimated value

- 149 - Appendix I: Health Profile for Bexley 2010

Appendix I: Health profile for Bexley 2011

A summary of the health of Bexley is provided in the health profile for Bexley created by the Association of

Public Health Observatories (APHO).

Figure 142 Health Profile for Bexley 2010, APHO 2011

- 153 - Appendix II: Child Health Profile for Bexley 2011

Appendix II: Child Health Profile for Bexley 2011

Figure 143 Child Health Profile for Bexley 2011

- 156 - Appendix III: Feedback form

Feedback form

Bexley’s JSNA is a process that allows the users and providers of Bexley’s health and social services to

jointly identify the ‘bigger picture’ in terms of the needs of residents. This will ensure that everyone has

a fair opportunity to have the best possible health and wellbeing.

Bexley would like your feedback about the JSNA, please answer the following questions:

1. Does this document depict the health and social care needs of Bexley residents?

Yes / No

If you answered ‘no’, what do you think is missing from the JSNA?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

2. Did any of the results surprise you? If so, what were they?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

3. Is there any information currently not included in the JSNA that would be useful to you or

your organisation? Please describe and explain why the information would be useful:

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

4. Have we addressed the need for equality in local services?

Yes / No

5. Was the JSNA easy to read?

Yes / No

6. What didn’t you like about the report?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

7. Do you have any other comments you'd like to make about the JSNA? ………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………

8. Would you like to join Bexley Care Trust’s membership scheme Your Health Matters to

keep in touch with information from your local NHS?

- 157 - Appendix III: Feedback form

Yes / No

If you answered ‘yes’, please visit: www.bexley.nhs.uk/yourhealthmatters to register.

9. Would you like to join TalkBack – the London Borough of Bexley resident panel to have

your say on a range of issues and services?

Yes / No

If you answered ‘yes’, please visit: www.bexley.gov.uk/talkback

10. Name: ……………………………………………………………………………..

Organisation: …………………………………………………………………….

E-mail address: …………………………………………………………………..

Telephone number: ……………………………………………………………...

Please return the form to:

Communications Team

Bexley Business Support Unit

221 Erith Road

Bexleyheath

Kent DA7 6HZ

Or

[email protected]

If you would like more information about Bexley’s JSNA please contact Bexley Business Support Unit

Communications Team at [email protected].

http://www.bexley.nhs.uk/yourhealthmatters

http://www.bexley.gov.uk/talkback

- 158 - References

References

1 Oxford Dictionaries. www.oxforddictionaries.com accessed on 20

th January 2011

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Every effort has been made to ensure that the information contained within the Joint Strategic Needs

Assessment documents for Bexley is accurate, up-to-date and complete. However, it is possible that it

may not be representative of the whole body of evidence available and resources may contain errors or

out-of-date information. If you have and queries or require any further assistance in obtaining the latest

evidence, please contact Bexley Business Support Unit Communications Team at

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