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HULL JSNA TOOLKIT RELEASE 7:

Housing, Environment and

Social Care

Mandy Porter, Robert Sheikh Iddenden, and Des Cooper

December 2017

Further information is available at www.hullcc.gov.uk/pls/hullpublichealth/

2 Hull JSNA Toolkit: Housing, Environment and Social Care, December 2017

This document is one of a suite of reports that form the basis of Hull’s Joint Strategic Needs Assessment (JSNA). Each of these JSNA documents and summaries are available for perusal or downloading at www.hullcc.gov.uk/pls/hullpublichealth/. Further reports are also available. Whilst this document contains a substantial quantity of information, it may not include everything you need. If you require any further information not included within this document, or require further explanation, please contact us and we’ll try to help. Epidemiologists/Statisticians, Public Health Sciences, Hull Public Health, Hull City Council, Warehouse 8, Guildhall Road, Hull. HU1 1HL [email protected] (01482 616304) [email protected] (01482 616304) [email protected] (01482 616241)

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HULL JSNA TOOLKIT: Housing, Environment and

Social Care

Contents

1 SUMMARY ........................................................................................... 7

2 ACKNOWLEDGEMENTS ................................................................... 13

3 INTRODUCTION ................................................................................ 13

3.1 Other Reports ................................................................................................ 13 3.2 Terminology, Abbreviations, Statistical Methods and Terms ................... 14

3.3 Data Sources ................................................................................................. 15 3.4 Deprivation .................................................................................................... 15

3.5 Comparator Areas ......................................................................................... 16 3.6 Public Health Outcomes Framework Indicators ......................................... 17

4 HOUSING ........................................................................................... 18

4.1 Introduction ................................................................................................... 18

4.2 Housing and Neighbourhood Renewal Strategy 2011-2016 ...................... 18 4.2.1 Theme 1: Increasing Housing Options and Meeting Housing Needs ......... 19 4.2.2 Theme 2: Improving Access to Housing For All ......................................... 19

4.2.3 Theme 3: Improving the Quality of Housing and Investing in the Existing Housing Stock ............................................................................................ 19

4.2.4 Theme 4: Improving Neighbourhood Quality ............................................. 20 4.2.5 Theme 5: Neighbourhood Renewal and Growth ........................................ 20

4.3 Decent Homes Standard ............................................................................... 21

4.3.1 Central Heating .......................................................................................... 21

4.3.2 Fuel Poverty ............................................................................................... 23 4.4 Household Composition ............................................................................... 28 4.5 Types of Housing .......................................................................................... 31 4.6 Household Tenure ......................................................................................... 33 4.7 Housing Stock and Additional Housing Provided ...................................... 35

4.8 Housing Prices and Affordability ................................................................. 38 4.8.1 Affordable Housing Need ........................................................................... 40

4.9 Rents, Lettings and Tenancies..................................................................... 40 4.10 Numbers on Local Authority Housing Waiting Lists .................................. 42 4.11 Social Housing Sales .................................................................................... 44

4.12 Local Authority Housing Expenditure and Income .................................... 45 4.13 Household Projections ................................................................................. 46

4.14 Hull City Council Customer Profiles (Housing Types) ............................... 48

5 HOMELESSNESS .............................................................................. 49




5.1 Introduction ................................................................................................... 49

5.2 Statutory Homelessness .............................................................................. 49 5.2.1 Public Health Outcomes Framework Indicators ......................................... 51 5.2.2 Reasons for Statutory Homelessness ........................................................ 53

5.3 Homelessness Prevented or Relieved ......................................................... 55 5.4 Information from Hull City Council Choice Based Lettings Register ....... 57

5.5 Households in Temporary Accommodation ............................................... 59 5.5.1 Public Health Outcomes Framework Indicators ......................................... 59

5.6 Homeless People NOT Accepted as Statutorily Homeless ....................... 61 5.6.1 Annual Estimate of Rough Sleepers .......................................................... 61 5.6.2 Health and Other Services for Homeless People ....................................... 63

5.6.3 Use of Accident and Emergency Services ................................................. 63 5.6.4 Housing Services for Homeless People ..................................................... 65 5.6.5 Cost of Homelessness to Public Services .................................................. 66

6 ENVIRONMENT ................................................................................. 67

6.1 Land Use ........................................................................................................ 67 6.1.1 Utilisation of Outdoor Space for Exercise or Health Reasons .................... 68

6.2 Climate Change ............................................................................................. 70 6.3 Air Pollution ................................................................................................... 71

6.3.1 Modelled Estimates of Levels of Air Pollution ............................................ 71

6.3.2 Mortality From Air Pollution ........................................................................ 76

6.4 Noise Pollution .............................................................................................. 79

6.4.1 Public Health Outcomes Framework Indicators ......................................... 79 6.4.2 1.14i – Number of Complaints.................................................................... 80

6.4.3 1.14ii and 1.14iii – Exposure To Transport Noise of 65db(A) or More During Daytime; 55db(A) or More During The Night-time ...................................... 82

6.5 Sustainable Development Management Plans ........................................... 85

6.5.1 Public Health Outcomes Framework Indicators ......................................... 85

7 SOCIAL CARE ................................................................................... 87

7.1 Registered Deaf or Hard of Hearing ............................................................. 87 7.2 Registered Blind or Partially Sighted .......................................................... 88

7.3 In Receipt of Social Care .............................................................................. 89

7.4 Social Care Clients Receiving Self Directed Support ................................ 89

7.5 Carers Receiving Needs Assessment or Review and a Specific Carer’s Service or Advice and Information .............................................................. 90

7.6 New Social Care Clients ............................................................................... 91 7.7 Admissions to Residential Care Homes ...................................................... 91 7.8 Safeguarding Adults ..................................................................................... 92

7.9 Satisfaction with Services and Sufficient Support ..................................... 92 7.9.1 Parental Experience of Services for Disabled Children .............................. 92 7.9.2 Quality of Life Improvement following Equipment and Minor Adaptations . 93 7.9.3 Sufficient Support from Local Services to Manage Long-Term Conditions 94 7.9.4 Sufficient Support to Live Independently at Home ..................................... 95

7.10 Adult Social Care Outcomes Framework 2016/17 ...................................... 96 7.10.1 ASCOF Domain 1: Enhancing Quality of Life For People With Care and

Support Needs ........................................................................................... 98




7.10.2 ASCOF Domain 2: Delaying and Reducing the Need For Care and Support ................................................................................................................. 108

7.10.3 ASCOF Domain 3: Ensuring That People Have a Positive Experience of Care and Support ..................................................................................... 113

7.10.4 ASCOF Domain 4: Safeguarding Adults Whose Circumstances Make Them Vulnerable and Protecting From Avoidable Harm .................................... 117

7.11 Projected Future Need Among Those Aged 18-64 Years ........................ 118 7.11.1 Substance Abuse ..................................................................................... 118 7.11.2 Mental Health ........................................................................................... 119 7.11.3 Learning Disabilities ................................................................................. 121 7.11.4 Physical Disabilities ................................................................................. 122

7.12 Looked After Children ................................................................................. 125 7.13 Social Isolation Among Social Care Users and Their Carers .................. 126

7.13.1 Social Care Users .................................................................................... 126

7.13.2 Adult Carers ............................................................................................. 129

8 PUBLIC HEALTH OUTCOMES FRAMEWORK ............................... 131

8.1 1.06 – Adults With a Learning Disability and Adults in Contact with Secondary Mental Health Service in Appropriate Accommodation ........ 131

8.2 1.10 - Killed or Seriously Injured on Roads ............................................. 131 8.3 1.14 – Exposure to Noise ............................................................................ 131

8.4 1.15 – Statutory Homelessness.................................................................. 131

8.5 1.16 – Utilisation of Outdoor Space for Exercise or Health Reasons ..... 132

8.6 1.17 – Fuel Poverty ...................................................................................... 132 8.7 1.18 – Social Isolation Among Social Care Users and Their Carers ....... 132

8.8 1.19 – Older People’s Perception of Community Safety .......................... 132 8.9 3.01 – Mortality Attributable to Air Pollution ............................................. 133 8.10 3.06 – Public Sector Organisations With Sustainable Development Plans

...................................................................................................................... 133 8.11 3.07 – Comprehensive, Agreed Inter-Agency Public Health Incident Plans

...................................................................................................................... 133

9 REFERENCES ................................................................................. 134

10 APPENDIX ....................................................................................... 137

10.1 Data Sources ............................................................................................... 137 10.2 Synthetic or Modelled Estimates ............................................................... 140 10.3 Local Surveys .............................................................................................. 140

10.4 Hospital Episode Statistics ........................................................................ 142 10.5 Quality and Outcomes Framework ............................................................ 142 10.6 General Practice Groupings ....................................................................... 143

10.6.1 Background .............................................................................................. 143 10.6.2 Historical Groupings ................................................................................. 143

10.6.3 Current Groupings ................................................................................... 144 10.7 Outcome Measures, Performance Targets and Progress Towards Targets

...................................................................................................................... 154 10.7.1 Historical Indicators, Outcome Measures and Targets ............................ 154 10.7.2 Problems Associated With Some Outcome Measures ............................. 154 10.7.3 Public Health Outcomes Framework ........................................................ 154




10.8 Statistical and Epidemiological Methods and Terms ............................... 162

10.8.1 Confounding, Effect Modification and Interaction ..................................... 162 10.8.2 Confidence Intervals ................................................................................ 163 10.8.3 Small Number of Events .......................................................................... 163 10.8.4 Percentiles, Quartiles, Quintiles and Medians ......................................... 164 10.8.5 Standardisation ........................................................................................ 164

10.8.6 Moving Average ....................................................................................... 165 10.8.7 Significance Testing ................................................................................. 165

10.9 Underlying Data for Figures ....................................................................... 166 10.10 Time Period for Information, Date Last Updated and Source for Each

Table and Figure .......................................................................................... 178

10.10.1 Tables ...................................................................................................... 179 10.10.2 Figures ..................................................................................................... 180

11 INDEX ............................................................................................... 182




JSNA TOOLKIT: Housing, Environment and Social Care

1 SUMMARY This release incorporates data provided by NHS Hull, Hull City Council and other partners and forms a foundation for the Joint Strategic Needs Assessment (JSNA) which can be found at www.hullcc.gov.uk/pls/hullpublichealth/. It is important to examine levels of health and ill-health as well as levels of risk factors and attitudes towards health in different populations for monitoring purposes including the monitoring of health-related targets, examining trends over time, comparison with other geographical areas, examining patterns of health and risk factors within the population of Hull (e.g. comparison of different groups such as those defined by deprivation), assessment and evaluation of programmes designed to improve health, assessing the existing and future need for health-related services following changes in health, ill-health or risk factors so that the Commissioning function can be adequately fulfilled. Further documents such as the health equity audits, reports from the adult and young people health and lifestyle surveys, social capital surveys, child obesity reports and Index of Multiple Deprivation report are available at www.hullcc.gov.uk/pls/hullpublichealth/. A local analysis of each of the indicators within the Public Health Outcomes Framework is also available at www.hullcc.gov.uk/pls/hullpublichealth/. Public Health Outcomes Framework: Adults with a learning disability (PHOF 1.06i) and adults in contact with secondary mental health services (PHOF 1.06ii), who live in stable and appropriate accommodation; the number of people killed or injured on the roads per 100,000 population (PHOF 1.10); the number of complaints about noise per 1,000 population (PHOF 1.14i); the percentage of the population that is affected by excessive transport noise during the daytime (PHOF 1.14ii) and at night-time (PHOF 1.14iii); the number of households accepted as statutorily homeless per 1,000 households (PHOF 1.15i); the number of households living in temporary accommodation per 1,000 households (PHOF 1.15ii); the use of outdoor spaces for exercise or health reasons (PHOF 1.16); the percentage of households in fuel poverty (PHOF 1.17); social isolation among social care users (PHOF 1.18i) and their carers (PHOF 1.18ii); mortality attributable to air pollution (PHOF 3.01); NHS organisations with a board approved sustainable development policy (PHOF 3.06) are all indicators within the Public Health Outcomes Framework. Housing: There were 112,596 households in Hull recorded at the 2011 census. Most households in Hull live in terraced houses or bungalows (51%), with a further 7% in detached, and 28% in semi-detached, houses or bungalows. Half of households lived in owner-occupied accommodation, ranging from 82% in Kings Park to 17% in Myton. 21% of households lived in council housing, ranging from <1% in


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Beverley to 55% in Orchard Park and Greenwood. A further 7% lived in other social rented accommodation, ranging from <1% in Holderness to 18% in Bransholme East. 20% of households rent privately, ranging from 7% in Orchard Park and Greenwood, Bransholme West, Longhill and Ings to 57% in Newland. More than one third of households in Hull (35%) were single-person households, ranging from 23% in Kings Park to 58% in Myton. Around one third of single-person households were aged 65+ years, fewer than one fifth in Avenue and Myton, more than one half in Bricknell and Ings. More than one quarter of households (28%) contained dependent children, ranging from 17% in Myton to 43% in Bransholme East. More than one in six households only contained people aged 65+ years (18%), ranging from 9% in Kings Park to 30% in Ings. Fuel Poverty: Overall, for 2014, it is estimated that 15,026 (13.2%) of households (out of total 113,998) spend 10% of more of their income on fuel (or would do so in order to achieve satisfactory heating requirements) (PHOF 1.17). There were substantial differences by ward, with percentages ranging from ranged from 4.2% in Kings Park, and less than 10% in Sutton, Ings and Beverley wards to 23.4% in Newland and 19.4% in Avenue. Affordable housing need: It is estimated that there is a net need for 338 affordable homes per year from 2013-2030 above the current supply of affordable homes. Homelessness: During the 2015/16 financial year 399 households in Hull were accepted as statutorily homeless, that is being homeless and in priority need. This equates to 3.48 per 1,000 households (PHOF 1.15i), having decreased substantially since 2004/05 when it stood at 9.31 per 1,000 households, but remaining more than double the average for Yorkshire and Humber, and higher than most comparator areas. In 2015/16 there were 0.3 per 1,000 households in Hull living in temporary accommodation (PHOF 1.15ii). The peak for Hull occurred in 2007-08 at 0.66 per 1,000 households. The rate in 2015/16 was the same as the Yorkshire and Humber average, lower than the comparator average and 90% lower than the English average. There are many more homeless people than those who are deemed statutorily homeless. In 2016 there were an estimated 15 rough sleepers, compared with 23 in 2015. However this figure does not include ‘hidden homeless’ people, such as those squatting or staying in places that are inaccessible to outreach workers, nor those people in hostels or shelters. It is estimated there are around 40-60 people in Hull with severe and multiple disadvantage who are at risk of being homeless but who are frequently assessed as being ‘intentionally homeless’ and therefore ineligible for re-housing. Hull had 9.53 bed-spaces for single homeless people or homeless couples per 10,000 population, 75% higher than the Yorkshire and Humber regional average. The rate of homelessness prevented or relieved in Hull 2015/16 was 46.9 per 1,000 households, five times higher than England and four times higher than the Yorkshire and Humber region.




Environment: One third of the land in Hull is defined as green space (34%) with one filth being domestic gardens (21%). Domestic buildings cover 9% of land, with non-domestic buildings covering 9%. Roads cover 13% of the city. From Natural England’s Monitor of Engagement with the Natural Environment survey 2015/16 18% of Hull residents had used outdoor spaces for health or exercise reasons over the previous seven days (PHOF 1.16), similar to England and 18% and the Yorkshire and Humber region. 44 per 100,000 residents in Hull were killed or seriously injured on the roads during 2013-15, one sixth higher than for England but similar to the Yorkshire and Humber regional average (PHOF 1.10). Further details are given in Hull JSNA Toolkit: Accidents. Air Pollution: DEFRA has produced modelled estimates of air pollution for 2015. These show the highest levels in Hull occurring along the southern edge of the city (A63 corridor), near the train/bus station, and around the industrial areas along the River Hull and around the docks. Estimated mortality attributable to pollution have been produced based on the modelled estimates of pollution and the relative risk of 6% increase per 10μg/m3 PM2.5 estimated by the Committee on the Medical Effects of Air Pollutants. It is estimated that 4.8% of deaths in Hull among those aged 30+ years may be attributable to air pollution in 2015 (PHOF 3.01). Noise Pollution: There were 13.4 complaints about noise per 1,000 residents in Hull during 2014/15 (PHOF 1.14i), compared with 7.1 per 1,000 for England and 6.5 per 1,000 for the Yorkshire and Humber region. 2.4% and 2.8% of Hull residents were estimated to be exposed to excessive daytime (PHOF 1.14ii) or night-time (PHOF 1.14iii) transport noise respectively in 2011, compared with the England averages of 5.2% and 8.0% respectively and the Yorkshire and Humber regional averages of 4.0% and 6.2% respectively. Climate Change: There have been major floods in Hull previously, and there is the risk that serious flooding can re-occur. Furthermore, due to deprivation levels, resilience and ability to cope with flooding and other climate changes could be more difficult in Hull compared to other less deprived geographical areas. There are not just negative impacts resulting from climate change but also opportunities arising from the switch to a low carbon economy, which the city of Hull is in a unique position to take advantage of this. Renewable energy has been identified as a key growth cluster for the city, within Hull’s City Plan, demonstrating the opportunities within the green economy that will replace the current carbon economy.




25% of NHS organisations in Hull reported having a board approved sustainable development plan, lower than England, the Yorkshire and Humber region and each of the comparator local authorities (PHOF 3.06). Social Care: 9,795 adults received social care during 2013/14, of whom 8,225 received it in the community. Around 70% of social care clients were aged 65+ years. 37% of clients in Hull receiving social care in the community received self-directed support in 2010/11, compared to 29% in England. 3,780 new clients were assessed for social care in Hull during 2013/14 of whom 80% went on to receive a service. There were 685 adult safeguarding alerts reported during 2012/13, of which 385 became safeguarding referrals, of which around half were for those aged 65+ years. From the 2014 GP Patient Survey, 67% of patients in Hull with long-term conditions reported they had sufficient support from social services to manage their conditions. Adult Social Care Outcomes Framework 2016/17 Domain 1: From the Adult Social Care Survey, the quality of life score of service users (ASCOF 1A) in Hull was higher than for England and the Yorkshire and Humber region. Eight out of ten service users in Hull reported that they had control over their daily life (ASCOF 1B), similar to England and the region. Almost all service users in Hull (99%) received self-directed support (ASCOF 1C(1A)), higher than for England and the Yorkshire and Humber region, and half the comparator local authorities, while all carers in Hull received self-directed support (ASCOF 1C(1B)), higher than England, the region and five of the ten comparator local authorities. One third of service users in Hull (33%) received direct payments (ASCOF 1C(2A)) higher than for England (28%) and the region (26%) as well as six of the ten comparator local authorities, while 100% of carers in Hull received direct payments (ASCOF 1C(2B)), higher than England, the region and six of the ten comparator local authorities. From the 2016/17 Carers Survey the carer-reported quality of life score (ASCOF 1D) for Hull (7.5) was a little lower higher than for England, significantly lower than for the Yorkshire and Humber region, and in the middle of the range of comparator local authorities. Fewer than 1% adults with a learning disability were in paid employment (ASCOF 1E) in Hull, much lower than for England and the Yorkshire and Humber region, as well as lower than all but one comparator local authorities. Fewer than 5% of adults in Hull in contact with secondary mental health services in 2015/16 (ASCOF 1F) were in paid employment, lower than England, the Yorkshire and Humber region and six of the ten comparator local authorities. Three-quarters of adults in Hull (75%) with a learning disability lived in their own home or with their family (ASCOF 1G), similar to England but a little lower than the region and six of the ten comparator local authorities. Almost three-quarters of adults in Hull (73%) in contact with secondary mental health services in 2015/16 lived independently with or




without support (ASCOF 1H) higher than for England (59%) and the region (65%), but similar to many of the comparator local authorities. 53% of services users in Hull reported that they had as much social contact as they would like (ASCOF 1I(1)), higher than for England (45%), the region (46%) and each of the comparator local authorities. From the 2016/17 Carers Survey 32% of carers in Hull reported that they had as much social contact as they would like (ASCOF 1I(2)) lower than England (36%) and the region (39%), but in the middle of the range of the ten comparator local authorities (25% to 46%). Adult Social Care Outcomes Framework 2016/17 Domain 2: The rate of permanent admissions into residential or nursing care homes of both younger adults (aged 18 to 64) (ASCOF 2A(1)) and older people (aged 65+) (ASCOF 2A(2)) per 100,000 population, at 17 and 919 per 100,000 respectively, were higher in Hull than England and the region, in the middle of the range of comparator local authorities for younger adults but at the top of the range for older people. Among Hull residents aged 65+ years discharged from hospital, 2.4% were offered reablement or rehabilitation services (ASCOF 2B(2)), a little lower than for England and the region, as well as lower than six of the ten comparator local authorities. 90% of the older people discharged into these services in Hull were still living at home 91 days after discharge from hospital (ASCOF 2B(1)), higher than England, the region and eight of the ten comparator local authorities. Discharge form hospital for adults in Hull was delayed (ASCOF 2C(1)) for 13.4 per 100,000 population, a little lower than England and a little higher than the region, but lower than four of the ten comparator local authorities. 46% of these delays among Hull adults were attributable to social care (ASCOF 2C(2)) (3.6 per 100,000), compared with 42% for England (6.3 per 100,000) and 39% for the region (4.8 per 100,000). 47% of new service users in Hull that received a short term service during the year received either no ongoing support or support of a lower level (ASCOF 2D), lower than for England (78%), the region (70%) and all but one of the ten comparator local authorities Adult Social Care Outcomes Framework 2016/17 Domain 3: At 66%, the proportion of service users satisfied with the care and support they receive (ASCOF 3A) was similar to England (65%) and the region (65%), as well as in th emiddle range of the ten comparator local authorities (62% to 73%). From the 2016/17 Carers Survey just one third of carers in Hull (37%) were satisfied with the support or services they and the person they care for had received from Social Services in the last 12 months (ASCOF 3B), a little lower than for England (39%) and the Yorkshire and Humber region (41%), but was in the middle of the range of the ten comparator local authorities (28% to 55%).




Also from the 2016/17 Carers Survey 68% of carers in Hull felt they had been included or consulted in discussions about the person they care for (ASCOF 3C), lower than England (71%) and the Yorkshire and Humber region (74%), but similar to many of the ten comparator local authorities (range 63% to 81%). At 76%, the proportion of service users who find it easy to find information about services (ASCOF 3D(1)) was similar to England, the region and many of the ten comparator local authorities. From the 2016/17 Carers Survey, more than two thirds of carers in Hull (68%) during found it easy to find information about services (ASCOF 3D(2)), only slightly higher than for England (64%) and the Yorkshire and Humber region (66%), and higher than eight of the ten comparator local authorities. Adult Social Care Outcomes Framework 2016/17 Domain 4: From the Adult Social Care Survey, more than two thirds of service users in Hull (70%) felt as safe as they wanted to be (ASCOF 4A), similar to England, the region and many of the comparator local authorities. From the Adult Social Care Survey, 75% of respondents in Hull reported that care and support services helped them in feeling safe (ASCOF 4B), higher than England (70%), the region (69%) and eight of the ten comparator local authorities.




2 ACKNOWLEDGEMENTS

This report uses data from a variety of sources. Special thanks are due to Lesley Alderson-Speight and Karen Lees, both from Hull City Council’s Housing Strategy and Renewal team, who provided invaluable information for the housing and homelessness sections, including providing a thorough and very extensive redraft of the homelessness section.

3 INTRODUCTION

3.1 Other Reports This revision of the JSNA Toolkit for Hull is a series of stand alone reports on specific diseases or conditions, people groups, risk factors for disease and other health and wellbeing related issues. Each of these individual reports sum to form the JSNA Toolkit, which informs the production of the JSNA. Each of the JSNA Toolkit documents may be accessed on, and downloaded from, www.hullcc.gov.uk/pls/hullpublichealth/. The full list of reports is as follows: Executive Summary Abbreviations Glossary Geographical Area Demography and Demographics Housing, Environment and Social Care Deprivation and Associated Measures General Health, Disabilities, Caring and Use of Services Dental Health Inpatient Hospital Admissions Life Expectancy Mortality Overweight and Obesity Physical Activity Diet Alcohol Consumption Drug and Substance Abuse Smoking Vaccinations and Immunisations Screening All Circulatory Disease Coronary Heart Disease Stroke Other Circulatory Diseases All Cancers





Lung Cancer Colorectal Cancer Prostate Cancer Breast Cancer Diabetes Chronic Kidney Disease All Respiratory Disease Asthma Chronic Obstructive Pulmonary Disease Epilepsy Hypothyroidism Palliative Care Mental Health and Learning Disabilities (includes Social Capital) Infectious Diseases Digestive Diseases Sexual Health Accidents Children and Young People Older People In order to avoid duplication between the individual reports, references will be made to other reports which may contain further information or explanation. It is the intention to release the JSNA Toolkit documents on an on-going basis, with new information added to the documents and existing data updated as new information becomes available over time. The two tables in the APPENDIX starting on page 178 give the time period to which the data refers, when the information was last updated and the source for each table and figure within this document.

3.2 Terminology, Abbreviations, Statistical Methods and Terms Further more technical information is available in the Glossary document on www.hullcc.gov.uk/pls/hullpublichealth/ which includes specific information on particular datasets (e.g. delays between death occurrence and registration in Public Health Mortality File, explanation of clinical episodes within Hospital Episode Statistics, further information on the Quality Outcomes Framework data, etc), abbreviations used within these JSNA Toolkit documents and other local reports, and an explanation of some statistical methods and statistical terms used within the JSNA Toolkit documents and other local documents, such as problems associated with synthetic or modelled estimates, problems associated with small numbers, explanations of confidence intervals, significance testing, standardisation, life expectancy, total period fertility rate, confounding and effect modification, etc. Some of this information is also included within the APPENDIX.





3.3 Data Sources Where possible, we have used sources of data that are routinely available nationally, either as published material (e.g. the NHS Information Centre Indicator Portal (previously known as the Compendium of Clinical and Health Indicators or Compendium), the Census, labour market website (nomis), Quality and Outcomes Framework (QOF) data, Public Health Outcomes Framework indicators, etc), from Government websites (e.g. Department of Health) or other websites (e.g. those quoted as data sources for Public Health Outcomes Framework). Elsewhere we have used raw data at patient or episode level (e.g. Public Health Mortality Files) to construct local indicators of health. Local information has been provided by colleagues within the NHS Hull Clinical Commissioning Group, the North Yorkshire and Humber Commissioning Support Unit, Hull City Council and other organisations. The prevalence of lifestyle behavioural risk factors comes from local surveys such as the local Health and Lifestyle and Social Capital Surveys, and comparison information from the annual Health Survey for England (Health Survey for England 2008) and the General Household Survey (Economic and Social Data Service 2008). Full information about each of the local surveys conducted is available at www.hullcc.gov.uk/pls/hullpublichealth/. Furthermore, the source of each table and figure is given in section 10.10 on page 179 (tables) and in section 10.10.2 on page 180 (figures). Also see section 10.1 on page 10.1. We have provided the most up-to-date data available. Not all the data relate to the same time period. Different sets of data are published at different times of the year and the most recent data may not yet be published, or if the numbers of events are very low for rare diseases, the data for several years are combined to obtain a more reliable picture.

3.4 Deprivation Unemployment, poor housing, lack of qualifications, crime and many other social and environmental factors all indirectly affect the health of the population. Different scales and scores have been produced which attempt to measure deprivation. In general, in relation to national averages, Hull has a higher unemployment rate, more poor housing, residents qualified to a lower level and higher levels of crime. Increased deprivation means that there is poorer health, but this is compounded as poor health also affects other measures such as employment and motivation to improve employment, education and the person’s environment such as housing. In addition, those who live in the most deprived area are more likely to have risk factors for ill health such as smoking, poor diet, lack of physical activity, etc. It is also generally more difficult to change lifestyle behaviour if the environment is more stressful resulting from poorer employment prospects and housing, increased debt, relationship problems, etc. The Index of Multiple Deprivation (IMD) 2015 (Communities and Local Government 2015) score has been produced nationally and is a measure of deprivation derived for each lower layer super output area (LLSOA). There are 166 LLSOAs geographical





areas defined within Hull following the 2011 Census. These geographical areas have a minimum population size of 1,000 and a mean population size of 1,500. The IMD 2015 index is based on seven domains which are weighted according to their relative importance in relation to the overall score (weights in brackets): (i) income deprivation (22.5%); (ii) employment deprivation (22.5%); (iii) health deprivation and disability (13.5%); (iv) education, skills and training deprivation (13.5%); (v) barriers to housing and services (9.3%); (vi) living environment deprivation (9.3%); and (vii) crime (9.3%). The IMD 2015 score measures deprivation, but is not such a good measure of affluence. As it is applied to a geographical area, it relates to average levels of deprivation within an area. Therefore, there may be some residents of the area who are very much more deprived than the average and some very much better-off relative to the average. Using the IMD 2015 score, Hull is ranked as the 3rd most deprived local authority out of 326 (bottom 1%). The IMD 2015 scores for all of England’s LLSOAs have been divided into five approximately equal-sized groups ranging from the 20% most deprived areas to the 20% least deprived areas. These five groups are referred to as national quintiles. However, as more than half (52%) of Hull’s LLSOAs are within the bottom 20%, local analyses have used Hull’s local quintiles. Further detailed analysis of the IMD and changes over time is available in a separate IMD report available at www.hullcc.gov.uk/pls/hullpublichealth/. The Hull JSNA Toolkit: Deprivation and Associated Measures also includes additional information on deprivation as well as information on unemployment, benefit claimants, crime, etc.

3.5 Comparator Areas Local analyses of comparator areas have been undertaken. The first analysis in 2007, which was updated in 2009, identified 10 comparator areas which were similar to Hull with regard some key measures such as deprivation, population, ethnicity, housing, etc. None of the comparators areas were very similar to Hull with regard to all the measures examined, which means that differences were evident for some comparator areas. The Office for National Statistics (ONS) grouped local authorities into groups, and Hull was in their Industrial Hinterlands group, but Hull was the least similar to the group average. Furthermore, ONS deemed that North East Lincolnshire was Hull’s nearest comparator, but this was in a different classification group. Local analyses have used the 10 comparators identified plus North East Lincolnshire as comparator areas. A further analysis of comparator areas was undertaken during 2013 following transfer of Public Health Science to Hull City Council. Hull City Council generally uses 15 comparator areas for their analyses. All their areas together with the 11 areas used previously were examined (some were included in both groups). It was felt that there were too many to use all 15 of Hull City Council comparators and a number of the indicators used to determine similarity were not important from the health or public health point of view1.

1 Such as taxbase per head of population, percentage of daytime net flow, housing benefit caseload,

percentage of households with less than four rooms, percentage of households in purpose-built flats rented from local authority, authorities with coast protection expenditure, etc.





Whilst some of the 11 locally used comparators boundaries of local authority and NHS (i.e. Clinical Commissioning Group) no longer matched, it was decided to continue to use the 11 comparator areas previously used for consistency and comparability. The comparators are as follows:

1. Middlesbrough** 2. Stoke-on-Trent 3. Sandwell* 4. Salford 5. Wolverhampton 6. Sunderland 7. Plymouth* 8. Derby* 9. Leicester 10. Coventry* 11. North East Lincolnshire

*The boundary of the local authority does not match that of the CCG, so data relating to the Quality Outcomes Framework (see section 10.5 on page 142) is unavailable. **Middlesbrough local authority and Redcar and Cleveland local authority form NHS South Tees CCG. All comparator QOF data trends use South Tees as a comparator area (historical data for the Middlesbrough Primary Care Trust (PCT) and Redcar and Cleveland PCT have been combined for comparability). Redcar and Cleveland local authority is one of the comparator areas used by Hull City Council so is quite similar to Hull in terms of certain characteristics.

3.6 Public Health Outcomes Framework Indicators A local analysis of the outcome measures published as part of the Public Health Outcomes Framework (PHOF) is available at www.hullcc.gov.uk/pls/hullpublichealth/. The JSNA Toolkit reports also include information on the relevant PHOF indicators for the specific topic. Further details of the indicators is available in Table 62, which details which JSNA Toolkit report includes further analysis for each indicator. Further information about the indicators that relate to housing, the environment or social care is given in section 8 on page 131.





4 HOUSING

4.1 Introduction Much of the data presented in this section is extracted from the ‘live tables’ available at the Communities and Local Government website. These ‘live tables’ contain housing statistics by local authority on a number of different measures relating to housing stock, availability, affordability and homelessness (Communities and Local Government 2011). Information is provided at local authority level for the following measures:

housing stock and additional households provided by the local authority;

house prices and affordability of housing;

rents, lettings and tenancies;

numbers on local authority housing waiting lists;

social housing sales;

local authority housing expenditure and income;

household projections; and

homelessness. Much of the rest of the data comes from Hull City Council, from it’s Housing and Neighbourhood Renewal Strategy 2011-2016, and from various documents produced by the Housing team. Some information is also taken from the Public Health Outcomes Framework, first published in January 2012 (Department of Health 2012; Department of Health 2012), within which statutory homelessness and fuel poverty are two of the indicators (see section 0 on page 48).

4.2 Housing and Neighbourhood Renewal Strategy 2011-2016

Hull City Council’s Housing and Neighbourhood Renewal Strategy 2011-2016 outlines the long-term vision for housing in Hull as follows:

“The city’s housing stock meets not only individual needs but also the aspirations of Hull’s current citizens and people moving to the city. Demand for a greater range of housing choice has increased as a result of the increase in jobs available. All of our neighbourhoods are safe with an appropriate mix of good quality housing within a high quality, well managed environment. We have achieved this by focusing on those parts of the city most in need of change to achieve neighbourhood renewal.




As a result, Hull is able to capitalise on natural assets, existing expertise and potential for development as a national and international centre for renewable energy. It is maximising the opportunities provided as a port city and so increasing the economic prosperity and wellbeing of Hull’s residents.”

(Hull City Council 2011)

The Housing and Neighbourhood Renewal Strategy 2011-2016 has five key themes: 4.2.1 Theme 1: Increasing Housing Options and Meeting Housing Needs

“In addressing this theme, our activities will support economic growth by linking housing to employment and training programmes and responding to the national welfare reform agenda to assist people into work. We will also support delivery of other programmes such as social care and health, including provision of adapted housing to meet the needs of particular groups as well as the growing numbers of older people. Levels of homeless presentations and people seeking advice on their housing options show that there is a need to support individuals. Low household income in Hull means that many households cannot obtain mortgages or access market housing for sale or rent and require more affordable housing. Many people also need housing support to enable them to live independently.”


4.2.2 Theme 2: Improving Access to Housing For All

“In this section, we say what can be done to increase the number of homes available in all tenures. This includes building new homes but also bringing empty homes back to use. Studies such as our housing market assessment show that there is an overall shortfall of housing in the city, as well as a need for more affordable housing and a need for larger properties because of recent population and household growth and to meet aspirations.”


4.2.3 Theme 3: Improving the Quality of Housing and Investing in the Existing

Housing Stock

“This theme addresses the need to improve the quality of council, housing association and private sector homes. It is based on stock condition and fuel poverty evidence. This theme covers both new housing and existing housing




and most importantly, looks at how we can make homes energy efficient and reduce the amounts of money households have to spend on fuel costs.”


4.2.4 Theme 4: Improving Neighbourhood Quality

“Individual and household pleasure in where they live takes into account not only satisfaction with their home but also the neighbourhood in which it is placed. The quality of neighbourhoods as a place to live was a key issue raised in the consultation exercise on the strategy. Improving the quality of the place people live in can only be address though a partnership approach between the Council, residents and partners. Resource availability means that in the medium term this will need to focus in most neighbourhoods on improving neighbourhood management using activities that address this theme while working with a range of partners. Support will be provided to communities who request help in identifying housing priorities. We will measure and report neighbourhood change, building on our existing neighbourhood modelling profile.”


4.2.5 Theme 5: Neighbourhood Renewal and Growth

“This section sets out our plans for addressing neighbourhood renewal in our priority areas. The public resources available to invest in social and affordable housing nationally and locally have reduced since the last Strategy. We have had to re-timetable the plans set out in the Housing and Neighbourhood Renewal Strategy published in 2008 covering u to 2011. We will concentrate on neighbourhood renewal in six priority areas. These areas were chosen based on evidence of need and in discussion with people who live and work in Hull. It continues work started earlier, especially through the Gateway programme. The priority areas are at Newington, St Andrew’s, Preston Road, Ings, New Bridge Road, North Bransholme and Orchard Park. The timescales for activity in these areas will vary, as well as how we deal with them. Activity will also depend on what funding is available and what is needed in the areas. We will encourage private developers to build in these areas and it e growth areas identified in the core strategy centred on Kingswood and in the city centre.”





4.3 Decent Homes Standard To meet the Decent Homes Standard, a home should: (i) meet the current legal standard for housing; (ii) be in a reasonable state of repair; (iii) have reasonably modern facilities and services; and (iv) provide a reasonable degree of warmth. More specific information is provided at www.hullcc.gov.uk. From the Housing and Neighbourhood Renewal Strategy 2011-2016 (Hull City Council 2011) around 29% of homes in the city are social rented, with the remaining 71% privately owned, with 18% of these privately owned houses privately rented. As of April 2014 98% of council housing and all but 4 housing association homes met the Decent Homes Standard. The Housing Revenue Account (HRA) asset management strategy will set out plans for how this standard may be maintained. The Private Housing Stock Condition survey from 2009 estimated that around one third of private housing did not meet the Decent Homes Standard. 4.3.1 Central Heating From the 2011 census the percentages of households with central heating, by type of central heating, is known. This information is presented in Table 1 for Hull wards, Area Committee Areas and localities. Only one in twenty five homes in Hull had no central heating, with the highest percentages in Southcoates West (7.5%), Avenue (6.7%), Newington (6.2%), Drypool (5.8%), Newland (5.7%) and Beverley (5%) wards. The overwhelming majority of Hull households had gas central heating (83.8%), including more than 90% of households in Holderness and Kings Park wards. Only two wards had fewer than 80% of households with gas central heating, Myton (62.2%) and Newland (79.8%). More than one in four (26.6%) of households in Myton had electric central heating (including storage heaters), the only ward where more than 9% had this form of central heating.


http://www.hullcc.gov.uk/



Table 1: Types of central heating (% of all households) from the 2011 census for wards, Area Committee Areas and localities in Hull

Ward / Area Committee Area / Locality

Number of households

Type of central heating (% of households)

None Gas Electric1 Other2

Bransholme East 3,983 1.4 81.0 8.7 8.9

Bransholme West 3,424 1.2 85.3 6.9 6.6

Kings Park 3,949 1.7 91.2 3.4 3.6

Area: North Carr 11,356 1.4 85.9 6.3 6.4

Beverley 3,707 5.0 87.2 5.0 2.8

Orchard Park & Gwood 5,754 3.9 82.0 5.6 8.5

University 4,167 3.4 81.4 8.7 6.6

Area: Northern 13,628 4.0 83.2 6.4 6.4

North Hull 24,984 2.9 84.4 6.3 6.4

Ings 5,367 2.9 85.2 7.7 4.3

Longhill 5,166 3.4 88.0 3.3 5.3

Sutton 5,312 1.4 88.8 5.5 4.2

Area: East 15,845 2.6 87.3 5.5 4.6

Holderness 5,411 3.6 91.6 1.7 3.1

Marfleet 5,610 3.1 89.1 1.8 6.0

Southcoates East 3,383 2.8 88.1 2.4 6.7

Southcoates West 3,481 7.5 86.0 2.6 4.0

Area: Park 17,885 4.1 89.0 2.0 4.9

Drypool 6,298 5.8 82.3 7.2 4.7

East Hull 40,028 3.7 87.3 4.2 4.7

Myton 8,687 4.2 62.2 26.3 7.3

Newington 4,742 6.2 84.4 4.4 5.0

St Andrew's 3,797 4.6 81.4 7.2 6.8

Area: Riverside 23,524 5.1 75.1 13.7 6.1

Boothferry 5,304 4.0 85.4 6.2 4.3

Derringham 5,392 4.1 87.2 5.1 3.6

Pickering 5,207 3.2 88.1 3.7 5.1

Area: West 15,903 3.8 86.9 5.0 4.3

Avenue 6,117 6.7 82.6 5.7 5.0

Bricknell 3,443 2.9 89.9 3.6 3.6

Newland 4,895 5.7 79.8 8.8 5.7

Area: Wyke 14,455 5.4 83.4 6.2 4.9

West Hull 47,584 4.7 80.6 9.4 5.3

Hull 112,596 3.9 83.8 6.9 5.3 1 Including storage heaters 2 Oil, solid fuel, other or two or more types




4.3.2 Fuel Poverty One of the indicators within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to fuel poverty. The percentage of households in an area that experience fuel poverty based on the "low income, high cost" methodology. Under the "low income, high cost" measure, households are considered to be fuel poor where: they have required fuel costs that are above average (the national median level) were they to spend that amount, they would be left with a residual income below the official fuel poverty line. The key elements in determining whether a household is fuel poor or not are: income; fuel prices; and fuel consumption (which is dependent on the dwelling characteristics and the lifestyle of the household). A household is said to be in fuel poverty if it needs to spend more than 10% of its income on fuel to maintain an adequate standard of warmth. This is usually 21 degrees for the main living area and 18 degrees for other occupied rooms. The focus was on heating the home, but additional fuel costs component also includes modelled spending on energy for water heating, lights and appliances and cooking.

𝐹𝑢𝑒𝑙 𝑝𝑜𝑣𝑒𝑟𝑡𝑦 𝑟𝑎𝑡𝑖𝑜 = 𝑓𝑢𝑒𝑙 𝑐𝑜𝑠𝑡𝑠 (𝑚𝑜𝑑𝑒𝑙𝑙𝑒𝑑 𝑢𝑠𝑎𝑔𝑒 × 𝑝𝑟𝑖𝑐𝑒)

𝑖𝑛𝑐𝑜𝑚𝑒

The modelled usage was determined by modelled information relating to the energy efficiency of the property, cost of energy, and household income. Information came from the Census and other sources of data such as the English Housing Survey from the Capacity Development for Local Government, Domestic Fuels Inquiry from the Department of Energy and Climate Change, and prices sourced for consumer price indices from the Office for National Statistics. Two separate models were created – one for the private sector and one for the social housing sector. Some factors were included in both models. The private sector model included factors such as economic status of the households, dwelling age, economically active, region, rural or urban, highest educational attainment, households with central heating and sole use of bath/shower and toilet, and children in household. The public sector model includes factors such as dwelling age, region, rural or urban, highest educational attainment, households with central heating and sole use of bath/shower and toilet, economically inactive due to permanently sick or disabled, tenure, converted flat, and people aged 60+ in household. Table 2 gives the estimated percentage of households in fuel poverty for Hull and comparator areas from PHOF, and Figure 1 gives the screenshot of the indicator from the local PHOF analysis (Porter 2015). Overall, for 2014, it is estimated that 15,026 of households (out of total 113,998) spend 10% of more of their income on fuel (or would do so in order to achieve satisfactory heating requirements). The fuel poverty estimates are subject to wide variation from year to year, with the modelled percentage of households in fuel poverty in Hull in 2013 lower than all but one of the 10 comparator




local authorities, while in 2014 the modelled percentage for Hull was higher than all but one of the ten comparator local authorities. Further information is also available from the original data sources from the Department of Energy and Climate Change (Department of Energy and Climate Change 2014) where information is available at lower layer super output area level (LLSOAs). Table 2: Fuel poverty for Hull and comparators, 2011 to 2014

Area Households in fuel poverty (%)

2011 2012 2013 2014

England 10.9 (10.9, 10.9) 10.4 (10.4, 10.4) 10.4 (10.4, 10.4) 10.6 (10.5, 10.6)

Hull 10.6 (10.4, 10.7) 11.1 (10.9, 11.3) 11.7 (11.5, 11.9) 13.2 (13.0, 13.4)

Yrks. & Humber 11.0 (11.0, 11.1) 10.8 (10.7, 10.8) 10.6 (10.5, 10.6) 11.8 (11.8, 11.8)

Wolverhampton 14.8 (14.6, 15.0) 18.3 (18.1, 18.6) 16.3 (16.1, 16.5) 13.1 (12.9, 13.3)

Salford 11.1 (10.9, 11.3) 10.7 (10.6, 10.9) 9.9 ( 9.7, 10.1) 10.8 (10.6, 10.9)

Derby 14.6 (14.4, 14.8) 16.0 (15.7, 16.2) 12.8 (12.6, 13.1) 10.7 (10.5, 10.9)

Stoke-on-Trent 15.4 (15.2, 15.6) 16.1 (15.9, 16.3) 14.7 (14.5, 14.9) 12.5 (12.4, 12.7)

Coventry 15.7 (15.5, 15.9) 16.3 (16.1, 16.5) 15.9 (15.7, 16.1) 13.0 (12.8, 13.1)

Plymouth 10.2 (10.0, 10.4) 10.3 (10.1, 10.5) 13.4 (13.2, 13.6) 12.8 (12.6, 13.0)

Sandwell 14.0 (13.8, 14.2) 18.0 (17.7, 18.2) 16.4 (16.2, 16.6) 12.8 (12.7, 13.0)

Middlesbrough 15.5 (15.2, 15.8) 15.1 (14.8, 15.4) 15.4 (15.1, 15.7) 14.3 (14.1, 14.6)

Sunderland 11.9 (11.7, 12.1) 11.7 (11.6, 11.9) 12.4 (12.2, 12.6) 12.7 (12.5, 12.9)

Leicester 16.3 (16.1, 16.5) 21.3 (21.1, 21.5) 16.6 (16.4, 16.8) 13.5 (13.3, 13.7)

Avg. above 10 13.9 (13.7, 14.1) 15.5 (15.3, 15.7) 14.4 (14.2, 14.6) 12.6 (12.4, 12.8)

NE Lincolnshire 12.1 (11.9, 12.3) 10.1 (9.8, 10.3) 10.8 (10.6, 11.0) 12.3 (12.0, 12.5)




Figure 1: Indicator 1.17 Fuel poverty




Figure 2 shows a map of the percentage of households within each LSOA that is in fuel poverty (spending 10% or more on income) for 2014. In 43 LSOAs (26% of the total) fewer than 10% of households are in fuel poverty, but within 70 LSOAs (42% of the total) it is estimated that between 10% and 14.9% of households are in fuel poverty, while within 34 LSOAs (20% of the total) it is estimated that between 15% and 19.9% of households in fuel poverty. In 12 LSOAs (7% of the total) it is estimated that between 20% and 24.9% of households are in fuel poverty, while in seven LSOAs (4% of the total) it is estimated that 25% to 29.9% of households are in fuel poverty and spend 10% or more of their income on fuel (or would do so in order to achieve satisfactory heating requirements). Figure 2: Percentage of households in fuel poverty 2014

Table 3shows the percentage of households in fuel poverty by ward, area committee area and locality in Hull in 2014. The percentages ranged from 4.2% in Kings Park, and




less than 10% in Sutton, Ings and Beverley wards to 23.4% in Newland and 19.4% in Avenue. Table 3: Percentage of households in fuel poverty in Hull 2014

Hull ward, area and locality Number and percentage of households in fuel poverty

Households Percent (95% CI)

Bransholme East 578 14.3 (13.3, 15.4)

Bransholme West 480 13.8 (12.7, 15.0)

Kings Park 169 4.2 ( 3.6, 4.9)

North Carr 1,227 10.7 (10.1, 11.2)

Beverley 348 9.3 ( 8.4, 10.2)

Orchard Park and Greenwood 955 16.4 (15.5, 17.4)

University 660 15.7 (14.6, 16.8)

Northern 1,963 14.2 (13.7, 14.8)

North Hull 3,190 12.6 (12.2, 13.0)

Ings 489 9.0 ( 8.3, 9.8)

Longhill 643 12.3 (11.4, 13.2)

Sutton 457 8.5 ( 7.8, 9.3)

East 1,589 9.9 ( 9.5, 10.4)

Holderness 572 10.4 ( 9.7, 11.3)

Marfleet 778 13.7 (12.8, 14.6)

Southcoates East 469 13.7 (12.5, 14.8)

Southcoates West 502 14.2 (13.1, 15.4)

Park 2,321 12.8 (12.3, 13.3)

Drypool 800 12.5 (11.8, 13.4)

East Hull 4,710 11.6 (11.3, 11.9)

Myton 1,116 12.7 (12.0, 13.4)

Newington 849 17.7 (16.7, 18.8)

St Andrews 671 17.4 (16.3, 18.7)

Riverside 3,436 14.4 (14.0, 14.9)

Boothferry 620 11.5 (10.7, 12.4)

Derringham 557 10.2 ( 9.4, 11.0)

Pickering 574 10.9 (10.1, 11.8)

West 1,751 10.9 (10.4, 11.4)

Avenue 1,201 19.4 (18.4, 20.4)

Bricknell 358 10.3 ( 9.3, 11.3)

Newland 1,180 23.8 (22.7, 25.0)

Wyke 2,739 18.7 (18.1, 19.4)

West Hull 7,126 14.8 (14.5, 15.1)

Hull 15,026 13.2 (13.0, 13.4)




4.4 Household Composition From the 2011 census we know the number of people in households by type of household. Table 4 shows the household composition for wards, area committee areas and localities in Hull from the 2011 census. More than one third of households in Hull were single person households (35.3%), with the lowest percentage in Kings Park (22.5%) and the highest percentage in Myton (58%). Around one third of single person households were aged 65+, fewer than one fifth in Myton and Avenue, more than half in Ings and Bricknell. Almost one in six households in Hull (17.7%) contained only people aged 65+ years, ranging from 8.6% of households in Kings Park to 29.8% of households in Ings. More than one quarter of households in Hull (28.4%) contained dependent children, with the highest percentage found in Bransholme East (43.3%) and the lowest in Myton (16.7%). Five other wards had more than one third of their households with dependent children: Bransholme West, Kings Park, Orchard Park and Greenwood, Marfleet and Southcoates East. Few wards had more than a handful of households composed entirely of students, with exceptions being Newland (14.9%), University (7.4%), Beverley (2.8%) and Avenue (2.0%).




Table 4: Household composition by ward, Area Committee Area and locality in Hull, 2011 census


All h

ou

seh

old

s

Household composition (% of all households)

Single person households

Families Other household types

All aged 65+

Couples Lone parents

Dep

en

den

t

ch

ild

ren

All f

ull-t

ime

stu

den

ts

All aged 65+

Other

No

ch

ild

ren

Dep

en

den

t

ch

ild

ren

No

n-

dep

en

den

t

ch

ild

ren

Dep

en

den

t

ch

ild

ren

No

n-

dep

en

den

t

ch

ild

ren

<65 65+

Bransholme East 3,983 19.4 7.9 3.5 13.3 21.8 5.7 17.1 4.5 4.3 - - - - 2.3

Bransholme West 3,424 18.2 11.7 7.5 12.7 16.6 7.1 15.2 5.4 2.7 - - 0.2 2.5

Kings Park 3,949 18.0 4.5 4.0 26.1 26.7 7.7 5.6 2.5 2.1 - - - - 2.6

Area: North Carr 11,356 18.6 7.8 4.9 17.6 21.9 6.8 12.6 4.1 3.1 0.1 0.1 2.4

Beverley 3,707 18.8 11.1 11.4 21.3 16.0 7.3 4.0 3.3 1.3 2.8 0.2 2.6

Orchard Pk & Gwd 5,754 20.2 11.1 5.0 10.2 17.8 5.8 18.5 5.8 2.9 0.2 0.3 2.2

University 4,167 21.1 12.0 5.6 13.0 16.2 4.2 9.6 3.5 2.6 7.4 0.3 4.6

Area: Northern 13,628 20.1 11.4 6.9 14.1 16.8 5.7 11.8 4.4 2.4 3.1 0.3 3.1

North Hull 24,984 19.4 9.8 6.0 15.7 19.1 6.2 12.2 4.3 2.7 1.7 0.2 2.8

Ings 5,367 16.0 20.1 9.4 15.7 16.8 7.3 6.6 4.0 1.8 0.1 0.4 2.0

Longhill 5,166 18.0 15.8 7.2 15.0 16.7 6.0 11.3 5.7 2.5 - - 0.1 1.7

Sutton 5,312 17.8 9.9 7.4 20.0 18.6 8.8 9.8 3.4 2.2 - - 0.1 1.8

Area: East 15,845 17.3 15.3 8.0 16.9 17.4 7.4 9.2 4.3 2.2 0.1 0.2 1.8

Holderness 5,411 15.7 9.4 7.8 19.6 23.6 10.0 6.7 3.3 1.8 - - 0.1 2.1

Marfleet 5,610 22.0 12.5 5.5 12.4 17.4 5.4 14.4 5.0 2.6 - - 0.2 2.5

Southcoates East 3,383 17.2 14.3 5.9 12.9 19.2 6.9 12.6 4.7 3.4 - - 0.3 2.6

Southcoates West 3,481 23.8 9.2 5.5 19.2 18.6 6.5 7.9 3.6 2.1 - - 0.3 3.1

Area: Park 17,885 19.5 11.3 6.3 16.0 19.8 7.3 10.4 4.2 2.4 0.0 0.2 2.5

Drypool 6,298 32.4 10.7 4.4 17.6 15.7 4.6 6.6 2.6 1.4 0.1 0.3 3.5

East Hull 40,028 20.7 12.8 6.7 16.6 18.2 6.9 9.3 4.0 2.2 0.1 0.2 2.4

Myton 8,687 47.3 10.8 2.5 12.2 8.9 2.0 6.0 2.7 1.9 0.5 0.1 5.3

Newington 4,742 25.1 9.0 4.1 14.9 18.0 6.2 10.5 4.2 3.4 - 0.4 4.1





All h

ou

seh

old

s

Household composition (% of all households)

Single person households

Families Other household types

All aged 65+

Couples Lone parents

Dep

en

den

t

ch

ild

ren

All f

ull-t

ime

stu

den

ts

All aged 65+

Other

No

ch

ild

ren

Dep

en

den

t

ch

ild

ren

No

n-

dep

en

den

t

ch

ild

ren

Dep

en

den

t

ch

ild

ren

No

n-

dep

en

den

t

ch

ild

ren

<65 65+

St Andrew's 3,797 34.9 10.0 3.0 13.0 13.3 4.4 9.5 3.8 3.3 - - 0.2 4.5

Area: Riverside 23,524 36.8 10.3 3.4 14.3 13.3 3.9 7.6 3.1 2.3 0.2 0.2 4.4

Boothferry 5,304 16.5 14.6 7.8 18.5 21.0 7.3 6.7 3.6 1.3 - - 0.4 2.3

Derringham 5,392 20.4 15.3 8.3 19.2 17.2 5.0 7.8 3.3 1.2 - - 0.3 1.9

Pickering 5,207 21.2 15.8 8.0 15.5 14.9 6.5 9.3 4.4 1.9 - - 0.3 2.4

Area: West 15,903 19.4 15.2 8.0 17.8 17.7 6.3 7.9 3.7 1.5 0.0 0.3 2.2

Avenue 6,117 33.8 7.9 3.4 17.2 14.1 3.6 6.0 2.6 2.3 2.0 0.3 6.9

Bricknell 3,443 13.4 14.1 9.6 19.1 21.8 7.4 5.9 3.7 1.9 0.5 0.3 2.4

Newland 4,895 27.8 8.1 1.8 12.8 10.6 2.6 6.3 2.4 2.9 14.8 0.2 9.6

Area: Wyke 14,455 26.9 9.4 4.3 16.2 14.8 4.2 6.1 2.8 2.4 5.9 0.3 6.8

West Hull 47,584 28.6 11.6 5.1 15.6 14.9 4.7 7.4 3.3 2.2 1.9 0.3 4.5

Hull 112,596 23.7 11.6 5.9 16.0 17.0 5.8 9.1 3.8 2.3 1.2 0.2 3.4

- - Wards with fewer than 5 households




4.5 Types of Housing Table 5 provides information on housing types from the 2011 Census. Hull had substantially fewer detached houses or bungalows (7%) compared to the region (21%) or the national average (22%), fewer semi-detached properties (27% versus 37% for the region and 31% for England), and a higher percentage of terraced housing (49% versus 28% for the region and 25% for England). There was a slightly lower percentage of household spaces with no residents (3.5% versus 4.3% for the region and nationally). An estimate of the number of local authority dwellings, housing association dwellings and private dwellings is given in section 4.7 below. Table 5: Types of housing within Hull and numbers with no residents, from the 2011 census Housing type Hull Y&H England

N % % %

All Household Spaces 116,651 100 100 100

Household spaces with at least one resident 112,596 96.5 95.7 4.3

Household Spaces with no residents 4,055 3.5 95.7 4.3

Household spaces with at least one resident: 112,596 100 100 100

In an Unshared Dwelling: 112,398 99.8 99.8 99.6

House or Bungalow: 94,208 83.7 85.4 78.1

Detached 8,043 7.1 20.8 22.4

Semi-detached 30,853 27.4 37.2 31.2

Terraced (incl end-terrace) 55,312 49.1 27.5 24.5

Flat, Maisonette or Apartment: 18,114 16.1 14.2 21.2

In a Purpose-Built Block of Flats 13,882 12.3 11.6 16.4

Part of a Converted or Shared House 3,073 2.7 1.8 3.8

In a Commercial Building 1,159 1.0 0.8 1.0

Caravan / Other Mobile / Temporary Structure 76 0.1 0.2 0.4

In a Shared Dwelling 198 0.2 0.2 0.4

This information is also available at ward level, and is presented as such, as well as by Area Committee area and Locality in Table 6. Orchard Park and Greenwood had the highest percentage of household spaces with no usual residents (6.5%), followed by Avenue (6.2%), St Andrews (6.0%) and by Newland (5.8%). Kings Park had the highest percentage of detached houses or bungalows (32%), followed by Sutton (14.9%). Beverley was the only ward where a majority of occupied swelling were semi-detached houses or bungalows (50.1%). Terraced housing was the most common type in Hull (50.9%), forming a majority of occupied dwellings in 19 out of the 23 wards in Hull. This included more than three-quarters of all occupied dwellings in Southcoates West (79.5%) and more than two thirds in Myton (70.3%), Bransholme West (69.0%) and Newland (66.8%). Derringham was the only ward where a majority of occupied dwellings were flats, maisonettes or apartments (65.4%).




Table 6: Types of housing in Hull by ward, Area Committee Area and Locality from the 2011 census

area A: Total household spaces

No usual residents (% of A)

B: Total households 1+ usual resident

Percentage of households with at least one usual resident

House or bungalow Flat, maisonette or apartment

Other3 Detached Semi-detached Terraced1

Purpose-built

Conversion2

Bransholme East 4,076 2.3 3,983 10.3 17.1 65.1 9.5 0.3 0.1

Bransholme West 3,512 2.5 3,424 4.5 19.8 69.0 8.8 0.4 0.1

Kings Park 4,087 3.4 3,949 32.1 45.0 21.9 3.9 0.2 0.4

Area: North Carr 11,675 2.7 11,356 16.1 27.6 51.2 7.3 0.3 0.2

Beverley 3,816 2.9 3,707 7.9 50.1 36.3 6.1 1.8 0.7

Orchard Pk & Gd 6,152 6.5 5,754 5.2 26.7 61.0 13.4 0.2 0.4

University 4,344 4.1 4,167 7.1 34.6 46.0 13.0 1.8 1.8

Area: Northern 14,312 4.8 13,628 6.5 35.5 49.7 11.3 1.1 0.9

North Hull 25,987 3.9 24,984 10.9 31.9 50.4 9.5 0.7 0.6

Ings 5,528 2.9 5,367 12.8 32.1 45.1 12.2 0.3 0.6

Longhill 5,296 2.5 5,166 5.2 41.5 45.3 9.7 0.2 0.5

Sutton 5,428 2.1 5,312 14.9 37.0 42.9 6.2 0.7 0.5

Area: East 16,252 2.5 15,845 11.0 36.8 44.4 9.4 0.4 0.5

Holderness 5,566 2.8 5,411 6.6 44.8 47.1 2.0 1.1 1.2

Marfleet 5,751 2.5 5,610 4.9 32.3 55.5 8.8 0.4 0.6

Southcoates East 3,443 1.7 3,383 8.2 49.6 38.4 4.5 0.4 0.7

Southcoates West 3,614 3.7 3,481 2.7 15.3 79.5 3.9 0.7 1.8

Area: Park 18,374 2.7 17,885 5.6 36.0 54.4 5.0 0.7 1.0

Drypool 6,542 3.7 6,298 8.3 27.2 45.4 18.4 2.0 2.6

East Hull 41,168 2.8 40,028 8.2 35.0 49.0 8.8 0.8 1.1

Myton 9,078 4.3 8,687 2.6 8.3 24.8 55.5 9.9 3.5

Newington 4,925 3.7 4,742 5.0 21.4 61.6 7.3 6.9 1.7

St Andrew's 4,040 6.0 3,797 4.3 19.6 47.9 22.0 10.6 2.1

Area: Riverside 24,585 4.3 23,524 4.9 17.8 41.5 30.4 7.3 2.7

Boothferry 5,393 1.7 5,304 5.3 26.1 60.1 7.8 0.9 1.4

Derringham 5,573 3.2 5,392 3.4 22.9 70.3 6.1 0.2 0.6

Pickering 5,231 0.5 5,207 7.6 36.4 45.4 9.9 0.4 0.7




area A: Total household spaces

No usual residents (% of A)

B: Total households 1+ usual resident

Percentage of households with at least one usual resident

House or bungalow Flat, maisonette or apartment

Other3 Detached Semi-detached Terraced1

Purpose-built

Conversion2

Area: West 16,197 1.8 15,903 5.4 28.4 58.7 7.9 0.5 0.9

Avenue 6,520 6.2 6,117 3.3 8.8 64.7 11.4 16.0 2.4

Bricknell 3,537 2.7 3,443 8.5 37.4 48.0 7.6 0.4 0.8

Newland 5,199 5.8 4,895 5.0 12.1 66.8 11.9 7.5 2.9

Area: Wyke 15,256 5.3 14,455 5.1 16.7 61.5 10.6 9.4 2.2

West Hull 49,496 3.9 47,584 4.7 19.8 52.8 18.5 6.4 1.9

Hull 116,651 3.5 112,596 7.3 27.9 50.9 13.1 3.1 1.3 1 Includes end-terrace 2 Part of converted or shared house (includes bedsits) 3 Flat, maisonette or apartment in a commercial building; caravan

4.6 Household Tenure From the 2011 census the tenure of households in Hull are available. These are shown in Table 7 by ward, Area Committee Area and locality in Hull. Home ownership exceeded 80% in three wards: Kings Park (82%), Holderness (81.3%) and Beverley (80.7%), and exceeded 50% in four area Committee Areas: West (61.2%), East (58.2%), Park (54.4%) and North Carr (52.3%). Council houses were most common in Orchard Park and Greenwood (54.6%) and Bransholme West (51.4%). Private rentals were most common in Newland (57.2%), Avenue (42.4%) and St Andrews (38.2%).




Table 7: Tenure of households in Hull by ward, Area Committee Area and Locality from the 2011 census


Total households

Tenure of household (% from 2011 census)

Owned Shared

Ownership

Rented from

Council

Other Social Rented

Private rented

Living rent free

Bransholme East 3,983 35.7 0.2 33.6 17.9 11.2 1.5

Bransholme West 3,424 37.1 0.3 51.4 2.5 7.2 1.6

Kings Park 3,949 82.4 0.2 1.5 3.3 12.1 0.5

Area: North Carr 11,356 52.3 0.2 27.8 8.2 10.3 1.2

Beverley 3,707 80.7 0.2 0.4 2.1 16.2 0.4

Orchard Pk & Gwd 5,754 24.2 0.2 54.6 11.4 6.9 2.7

University 4,167 41.2 0.1 23.2 10.1 24.2 1.2

Area: Northern 13,628 44.7 0.2 30.3 8.5 14.7 1.6

North Hull 24,984 48.2 0.2 29.2 8.3 12.7 1.4

Ings 5,367 58.5 0.7 24.5 6.7 7.4 2.2

Longhill 5,166 48.1 0.1 40.6 1.8 7.2 2.2

Sutton 5,312 67.6 0.2 18.8 2.1 9.7 1.6

Area: East 15,845 58.2 0.4 27.9 3.6 8.1 2.0

Holderness 5,411 81.3 0.3 2.6 0.8 14.5 0.6

Marfleet 5,610 33.8 0.9 39.5 13.2 11.0 1.6

Southcoates East 3,383 35.2 0.9 39.0 14.7 8.3 2.0

Southcoates West 3,481 64.5 0.2 3.9 3.6 27.0 0.8

Area: Park 17,885 54.4 0.6 21.3 7.8 14.6 1.2

Drypool 6,298 51.3 0.2 9.6 6.5 31.0 1.3

East Hull 40,028 55.4 0.4 22.0 5.9 14.6 1.5

Myton 8,687 17.1 0.6 32.7 14.7 32.5 2.5

Newington 4,742 47.6 0.4 13.9 5.1 31.6 1.4

St Andrew's 3,797 29.2 0.6 22.1 8.0 38.2 1.8

Area: Riverside 17,226 28.1 0.5 25.2 10.6 33.5 2.0

Boothferry 5,304 69.5 0.2 13.1 2.9 13.3 1.0

Derringham 5,392 62.4 0.3 12.8 4.6 18.7 1.1

Pickering 5,207 51.5 1.7 24.8 6.8 13.6 1.7

Area: West 15,903 61.2 0.7 16.8 4.8 15.2 1.3

Avenue 6,117 49.0 0.5 3.1 4.1 42.4 0.9

Bricknell 3,443 72.9 0.6 9.5 4.9 10.5 1.7

Newland 4,895 30.2 0.5 4.2 7.0 57.2 1.0

Area: Wyke 14,455 48.3 0.5 5.0 5.2 39.8 1.1

West Hull 47,584 45.3 0.6 16.2 7.0 29.3 1.5

Hull 112,596 49.5 0.4 21.2 6.9 20.4 1.5




4.7 Housing Stock and Additional Housing Provided The total number of dwellings within the Hull boundary was estimated in 2013 to be 118,700 to the nearest ten dwellings. There were 24,510 local authority dwellings, 8,880 private registered provider (housing association) dwellings and 240 other public sector dwellings. It is estimated that the number of private dwellings is 85,070 giving a total of 118,700. Total housing stock figures use the Census 2011 dwelling count as a baseline, with information on subsequent changes to the dwelling stock collected annually as at 31st March through the Housing Flows Reconciliation form, and the private stock is calculated by calculating the difference. Table 8 gives the estimated number of local authority dwellings within the Hull local authority boundary between 1994 and 2016. The figures provided by the Department of Communities and Local Government are from returns submitted by local authorities, although data before 2003/04 are more prone to errors as they were validated less rigorously. It can be seen that the number of dwellings has decreased substantially between 1994 and 2016 by 35%. The estimated number of dwellings in England decreased even more than Hull – by 56% - over the same period (from 3,666,190 in 1994 to 1,612,000 in 2016). It is perhaps not surprising that local authority housing has reduced by a lesser amount in Hull. Owing to Hull’s high levels of deprivation, there will be a greater need for local authority housing. It is possible that people in Hull are less willing (or able) to buy their council house owing to lower incomes and expectations compared to England as a whole. Table 8: Number of local authority dwellings within the Hull boundary

Year Estimated number of local authority dwellings within Hull boundary as at 1st April

1994 37,465

1995 37,176

1996 37,175

1997 36,901

1998 36,358

1999 36,822

2000 36,259

2001 35,153

2002 34,244

2003 32,410

2004 30,998

2005 29,888

2006 28,854

2007 28,288

2008 27,737

2009 27,480

2010 27,126




Year Estimated number of local authority dwellings within Hull boundary as at 1st April

2011 25,799

2012 25,690

2013 25,490

2014 25,350

2015 24,970

2016 24,510

Table 9 includes additional social rent dwellings2, additional units of intermediate affordable housing3 and total additional affordable dwellings4 provided by the local authority. All the dwellings were also funded by the local authority, unless otherwise stated. The figures included new build and acquisitions. The figures shown represent the best estimate and may be subject to revisions. The figures have been rounded to the nearest 10 and therefore totals may not sum due to rounding. Of the 204 properties in 2013-14 (200 in Table 9 due to rounding), 192 were for affordable rent, of which 100 were new build, 36 were acquisitions and 56 were developed using the Empty Homes Community Fund. There were a further 12 Affordable Home Ownership properties, of which 11 were new builds and 1 was an acquisition. The data are taken from the Department of Communities and Local Government’s (DCLG) official published statistics on gross affordable housing supply. The figures are compiled annually from a range of administrative data and local authority returns. The total additional supply in each area is used to calculate the enhancement to the New Homes Bonus and this spreadsheet is provided to assist local authorities with the data checking for the grant allocation process. Affordable housing is defined in line with PPS3. Further information can be found in the DCLG Statistical Release at www.communities.gov.uk/housing/housingresearch/housingstatistics/housingstatisticsby/affordablehousingsupply/affordablehousingreleases/

2 Social Rent housing with rent levels set in line with the Government's rent influencing regime.

3 Intermediate affordable housing is the sum of intermediate rent and low cost home ownership.

4 Affordable housing is the sum of social rent, intermediate rent and low cost home ownership.


http://www.communities.gov.uk/housing/housingresearch/housingstatistics/housingstatisticsby/affordablehousingsupply/affordablehousingreleases/

http://www.communities.gov.uk/housing/housingresearch/housingstatistics/housingstatisticsby/affordablehousingsupply/affordablehousingreleases/



Table 9: Number of additional social rent dwellings, units of intermediate affordable housing and affordable dwellings provided by Hull’s local authority Year Provided by local authority in Hull

Additional social rent dwellings

Additional units of intermediate

affordable housing

Total additional affordable dwellings

1991-92 400 0 400

1992-93 400 10 410

1993-94 310 80 380

1994-95 400 60 460

1995-96 590 140 720

1996-97 120 80 190

1997-98 120 60 180

1998-99 100 0 100

1999-00 190 0 200

2000-01 120 0 120

2001-02 80 10 80

2002-03 60 0 60

2003-04 40 0 40

2004-05 10 0 20

2005-06 10 0 20

2006-07 50 10 60

2007-08 90 30 130

2008-09 70 20 80

2009-10 30 50 80

2010-11 180 70 250

2011-12 300 80 380

2012-13 40 70 180

2013-14 - 10 200

2014-15 10 - 290

2015-16 - - 130

- nil or less than 5. *

Table 10 gives the number of new dwelling started and completed in Hull for 2015/16. The data comes from the local authority and the National House Building Council (NHBC) building controls returns submitted to Communities and Local Government. Table 10: Number of new build dwellings started and completed in Hull 2015/16

Property type Number of new build dwellings

Started Completed

Private enterprises 870 480

Housing Association 0 0

Local authority 0 0

Total 870 480




4.8 Housing Prices and Affordability Table 11 gives the mean and median house prices in Hull. Data are taken from the House Price Statistics for Small Areas (HPSSAs) collection of statistics produced by the Office for National Statistics. Table 11: Mean and median house prices in Hull for quarter 3 2013 to quarter 3 2016

Year and quarter

Mean house prices

Median house prices

2013 Q3 £100,696 £92,000

2013 Q4 £101,591 £92,000

2014 Q1 £102,931 £93,250

2014 Q2 £104,721 £95,000

2014 Q3 £106,654 £97,000

2014 Q4 £107,963 £99,000

2015 Q1 £108,073 £98,000

2015 Q2 £109,314 £98,975

2015 Q3 £110,027 £100,000

2015 Q4 £111,215 £100,000

2016 Q1 £110,797 £100,000

2016 Q2 £110,993 £102,000

2016 Q3 £111,876 £103,500

Table 12 gives the ratio of lower quartile house price to lower quartile earnings in Hull over the period 1997 to 2016. The information is from the Department of Communities and Local Government. The Annual Survey of Hours and Earnings (ASHE) is based on a 1% sample of employee jobs. Information on earnings and hours is obtained in confidence from employers. It does not cover the self-employed nor does it cover employees not paid during the reference period. Information is as at April each year. The statistics used are workplace based full-time individual earnings. The lower quartile is the estimate of the house price or earnings where 25% of house prices or earnings fall below that figure when all figures are ranked. The median is the figure for which half of all house prices or earnings fall below. In 2013, the methodology changed, leading to a small discontinuity in affordability ratios. From 2013 onwards affordability ratios are created using a different source of House Price data - the ONS House Price Statistics for Small Areas datasets, which is based on a different version of the Land Registry data to previous data releases. Differences are small, however, at least for Hull, as can be seen from Table 12. Whilst the affordability of properties in Hull has reduced considerably over the period 1997 to 2015, properties are much more affordable in Hull relative to incomes compared to England as a whole. The ratio of the lower quartile of house price to lower quartile of




earnings for England increased from 3.57 in 1997 to 7.02 in 2015 (the ratio of the medians increased from 3.54 to 7.63). Table 12: Ratio of lower quartile house price to lower quartile earnings in Hull, 1997-2015

Year Ratio of lower quartile house price to lower quartile earnings

Ratio of median house price to median earnings

1997 2.21 2.18

1998 2.18 2.13

1999 2.31 2.36

2000 2.11 2.23

2001 1.99 2.21

2002 1.88 2.14

2003 2.24 2.58

2004 2.45 2.89

2005 3.09 3.40

2006 3.66 3.79

2007 4.31 4.18

2008 4.11 4.21

2009 3.53 3.43

2010 4.32 4.03

2011 3.93 3.79

2012 3.82 3.87

2013a 3.82 3.92

2013b 3.80 3.83

2014 4.14 4.07

2015 4.28 4.10 a 2013 based on discontinued methodology b 2013 based on house price data from the ONS House Price Statistics for Small Areas




4.8.1 Affordable Housing Need Affordable housing is defined as social rented, affordable rented and intermediate housing provided to eligible households whose needs are not met by the market, where eligibility is determined with regard to local incomes and local house prices (Communities and Local Government 2012). The Hull Strategic Housing Market Assessment (Hull City Council 2013) estimated that 40,730 households in Hull (36% of all households) were unable to afford market housing without subsidy. In assessing housing need, three elements need to be considered. Firstly, the current affordable housing need, which is defined in the report as households on the council’s Housing Register in housing need (bands A to C) who are not currently occupying affordable housing (i.e. excluding those in affordable housing awaiting a transfer), and who are not able to afford market housing; secondly, newly forming households; and thirdly existing households falling into housing need. The supply of affordable housing is the anticipated social rented re-lets (based on the past 5-years of social rented housing supply) as well as intermediate housing ‘re-lets’ (e.g. re-sales of shared ownership). Table 13 shows the annualised figures for the 18-year period from 2013-2018 for each of these, as well as the net annual need (defined as total need for affordable housing minus the supply of affordable housing. The total need is 2,895 affordable homes per year, with 2,557 affordable homes supplied per year, leaving net need of 338 affordable homes per year. Table 13: Need for affordable housing, 2013-2030 annualised

Area Backlog

need

Newly forming

households

Existing households

falling into need

Total need

Supply Net

need

Hull 243 1,112 1,540 2,895 2,557 338

4.9 Rents, Lettings and Tenancies Table 14 gives the local authority average weekly rents over the financial years 1998/99 to 2015/16 in Hull. Average weekly rents have more than doubled in Hull, increasing by 117%, between 1998/99 and 2015/16. Housing stock figures are used to estimate the average and are taken as at 1st April of the following financial year. Average rents data for between 2003/04 and 2007/09 inclusively are estimated using total housing stock figures from the Housing Revenue




Account (HRA) audited base claim form. Before 2003/04, the average rents data are estimated using total housing stock figures from the HRA second subsidy claim form. Average rents data for 2003/04 and onwards are based on a standardised 52 week collection calculated by Communities and Local Government from figures provided by local authorities. Data prior to 2003/04 may have been reported on various different collection scales. Table 14: Local authority average weekly rents

Financial year Average weekly rents

1998/99 £34.24

1999/00 £35.20

2000/01 £37.06

2001/02 £42.10

2002/03 £45.24

2003/04 £46.12

2004/05 £47.61

2005/06 £49.21

2006/07 £51.55

2007/08 £55.21

2008/09 £56.87

2009/10 £58.43

2010/11 £59.18

2011/12 £62.87

2012/13 £66.28

2013/14 £69.84

2014/15 £72.60

2015/16 £74.23

Table 15 gives the average weekly rents charged by registered social landlords over the financial years 1998/99 to 2015/16 in Hull. Average weekly rents have increased in Hull by 81% between 1998/99 and 2015/16. Data is collected by the Tenant Services Authority via the annual Regulatory and Statistical Return (RSR) based on general needs stock only. Figures are based on only the larger Registered Social Landlords (RSLs) completing the long form. Up until 2006 the threshold for completing the long form was that the RSL owned/ managed at least 250 units/bed spaces. From 2007 this increased to 1,000 units/bed spaces. Note that the average RSL rents within a local authority area can move down from one year to the next. This is especially true if, during the latest year, most of the local authority stock has been transferred through a large-scale voluntary transfer to the RSL sector. Averages are calculated for self-contained units only.




Table 15: Registered social landlords’ average weekly rents

Financial year: Average weekly rents

1998/99 £45.08

1999/00 £46.82

2000/01 £48.00

2001/02 £49.72

2002/03 £50.90

2003/04 £51.95

2004/05 £54.80

2005/06 £55.92

2006/07 £58.52

2007/08 £60.98

2008/09 £63.63

2009/10 £66.95

2010/11 £66.89

2011/12 £70.65

2012/13 £73.59

2013/14 £76.92

2014/15 £79.85

2015/16 £81.81

4.10 Numbers on Local Authority Housing Waiting Lists Table 16 gives the number of households on the local authority housing waiting lists (excluding households looking for transfers) on the 1st April from 1997 to 2016. The number of households in Hull reported from the 2011 census was 112,596, which gives an estimated 7.3% of all households on the local authority housing waiting lists for 2016. Local authorities sometimes maintain a common waiting list with the Housing Association/s in their district. However, no information is available where a Housing Association maintains a separate waiting list to the local authority. Hull does not maintain a common register. Direct comparisons between authorities' housing waiting lists can be misleading in particular because authorities have different arrangements for checking that applicants continue to require housing and their policies and practices can change over time. The introduction of choice-based approaches to the letting of social housing (whereby applicants have more of a say and choice over where they live) has had an impact on the size of the waiting list. Choice-based lettings (CBL) has led to increases in the number of households on the waiting lists, including those groups which are traditionally under-represented in social housing, e.g. people in employment. The accuracy of the list also depends on the extent to which housing authorities keep the register up-to-date, e.g. some people might already have found housing, yet remain on




the list. The introduction of CBL and the removal of the statutory duty to maintain a register have taken away much of the rationale for regularly reviewing the waiting list. Even where local authorities have not adopted CBL, not everyone on the waiting list will necessarily be in urgent housing need. It will also include those who consider social housing as their preferred or one of a number of housing options, and those who decide to get onto the waiting list ladder before they need or want to move house - particularly where the priority system is heavily based on waiting time. The Homelessness Act 2002 removed the statutory duty to maintain a housing register as of 31 January 2003. However, it was anticipated that housing authorities would continue to maintain a waiting list of housing applicants in order to perform their allocation function properly. Local authorities, from time to time, conduct a review of their lists to remove the names of those who no longer want housing. This can lead to a large year-on-year reduction in the size of their list. However, the frequency with which local authorities carry out these reviews varies considerably. Consequently the total number of households on waiting lists can rise year-on-year if only a few local authorities have updated their list but can decline if a lot of local authorities have updated their lists. Therefore the total number of households on waiting lists can overstate the numbers of households who still require housing assistance. Table 16: Number of households on local authority housing waiting lists

1st April, of year: Number of households on waiting lists

1997 8,403

1998 8,582

1999 8,586

2000 7,694

2001 8,267

2002 8,563

2003 9,924

2004 11,133

2005 9,612

2006 6,890

2007 10,364

2008 12,416

2009 10,291

2010 10,296

2011 12,026

2012 9,647

2013 8,645

2014 7,451

2015 6,783

2016 8,274




4.11 Social Housing Sales Table 17 gives the total number of social housing sales between 1997/98 and 2016/17 in Hull, and include local authority stock sold through Right to Buy and other council house sales. Information is collected quarterly from each local authority. Figures for local authorities are shown 'as reported'. The numbers in brackets which appear after some of the sales figures show the number of quarters for which information has been provided. For the period 1979/80 to 1997/98 there were 76 quarters. Where there is no indication information can be assumed complete. 'All sales' includes the number of dwellings sold through Large Scale Voluntary Transfers (LSVTs). Capital receipts include only the money received from Right to Buy sales and are therefore net of discounts. Empty cells are left empty if no information were available to populate them at the time of publication. Table 17: Number of social housing sales Year Right to buy sales Capital receipts

£(000's) Total sales (inc.

LSVTs)

1979/80–97/98 6,247 . 10,394

1998/99 247 3,530 261

1999/00 339 4,415 353

2000/01 287 3,457 287

2001/02 590 6,804 590

2002/03 880 11,207 880

2003/04 1,175 19,451 1,175

2004/05 893 20,501 893

2005/06 521 16,638 521

2006/07 499 17,142 499

2007/08 341 13,217 341

2008/09 89 3,421 89

2009/10 79 2,956 79

2010/11 60 1,974 1,250

2011/12 70 70

2012/13 115 3,235 117

2013/14 187 5,711 187

2014/15 160 4,647 160

2015/16 209 6,179 209

2016/17 210* 6,380*

*Based on first three quarters only




4.12 Local Authority Housing Expenditure and Income Table 18 gives the local authority housing expenditure and income for Hull in 2010/11. Council house financing is currently run on a national basis based on assessments of authorities need to spend and expected income. Where authorities' income exceeds their need to spend the excess is paid to central government (negative subsidy) to fund subsidy for those places where need to spend is greater than income. Not all local authorities with housing responsibilities (Unitary Authorities and District Councils) still have council housing - around half have transferred ownership to a housing association. Housing Revenue Accounts are generally closed some time after transfer and a small number of these authorities had residual activity in these accounts in this year - expenditure of £4.7m and income of £2.6m across England. Capital charges include debt, depreciation and impairment (stock valuation) charges. The amount per dwelling is based on dwelling numbers on 1 April 2010 from the Housing Subsidy Claim form or the Housing Strategy Statistical Appendix. These statistical tables have been discontinued, with 2010/11 being the last year for which this data is available. Table 18: Local authority housing expenditure and income

Expenditure or income

Details Amount 2010/11 (£)

Expenditure

Supervision and management

General 17,693

Special 6,078

Repairs 20,808

Spend for capital purposes -

Capital charges 23,001

Negative subsidy -

Other 836

Total Total expenditure 68,417

Total amount per dwelling 2.5

Income

Rents Dwellings 79,981

Rents Other 1,573

Heating and other services 2,408

Investment income 646

Subsidy Government -

Subsidy Local authority 1,254

Other 50

Total Total income 85,911




4.13 Household Projections Table 19 gives the projected number of households (in thousands) in Hull for 2014-2039, from the Department of Communities and Local Government live tables (https://www.gov.uk/government/statistical-data-sets/live-tables-on-household-projections). All projections are 2014-based and project forward 25 years from 2011 (base year) to 2039. The 2014-based interim household projections are linked to the Office for National Statistics 2014-based interim sub-national population projections. They are not an assessment of housing need and do not take account of future policies; they are an indication of the likely increase in households given the continuation of recent demographic trends. Local authority household projections are less robust than those at the regional level, particularly for those areas with relatively small numbers of households. This should be taken into account in using the figures. All figures from 2014 are based on the methodology used for the interim 2014-based projections and may differ to those published under previous projections. Table 19: Projected number of households in Hull, 2014-2039

Year Number of households in Hull (000s)

2014 114

2015 114

2016 115

2017 115

2018 116

2019 116

2020 117

2021 117

2022 117

2023 118

2024 118

2025 118

2026 119

2027 119

2028 120

2029 120

2030 121

2031 121

2032 121

2033 122

2034 122

2035 122

2036 123

2037 123

2038 123

2039 124


https://www.gov.uk/government/statistical-data-sets/live-tables-on-household-projections

https://www.gov.uk/government/statistical-data-sets/live-tables-on-household-projections



Table 20 gives the equivalent information by age of household, for 2014 and 2039, where age of household is based on the household representative (usually taken as the oldest male within the household). Again, note that the figures are linked to population projections, and are not an assessment of housing need or do not take account of future policies. They are an indication of the likely increase in households given the continuation of recent demographic trends. Table 20: Projected number of households in Hull by age, 2014 and 2039

Age group Number of households in Hull (in thousands)

2014 2039

<25 7 7

25-34 21 19

35-44 20 21

45-54 22 23

55-64 17 17

65-74 14 16

75-84 9 13

85+ 4 7

Table 21 gives the equivalent information by household type. Again, note that the figures are linked to population projections, and are not an assessment of housing need or do not take account of future policies. They are an indication of the likely increase in households given the continuation of recent demographic trends. Table 21: Projected number of households in Hull by household type, 2014 and 2039

Household type Number of households in Hull (000s)

2014 2039

One person 40 45

Couple and no other adult 25 25

Couple and one or more other adult 8 7

Lone parent (with or without other adult) 33 37

Other* 9 10 *The Other category above includes lone parent households with all children non-dependent, other households with 2 or more adults, & other households.

Table 22 gives the equivalent information by the number of dependent children. Again, note that the figures are linked to population projections, and are not an assessment of housing need or do not take account of future policies. They are an indication of the likely increase in households given the continuation of recent demographic trends.




Table 22: Projected number of households in Hull by number of dependent children, 2014 and 2039

Number of dependent children Number of households in Hull (000s)

2014 2039

With no dependent children 81 87

With one dependent child 17 23

With two dependent children 11 10

With three or more dependent children 5 4

4.14 Hull City Council Customer Profiles (Housing Types) The Hull City Council Customer Profiles were produced using the methodology from a Leeds University PhD project, which involved cluster analysis of a number of Census variables at output area level after the 2001 census (resulting in 10 classifications), but has revised using data from the 2011 census, resulting in 13 classifications, which are mapped in Figure 3. For a description of these classifications see Hull JSNA Toolkit: Deprivation and Associated Measures. Also see the Life Expectancy and Mortality JSNA Toolkits for analyses using these classifications . Figure 3: Hull City Council’s Customer Profiles (Housing Types), 2011




5 HOMELESSNESS

5.1 Introduction Homelessness affects many people, and impacts not only on individuals and families, but also on public funding. In Hull, although performance against the two homeless indicators in the Public Health Framework is showing a year by year improvement (see sections 5.2.1 and 5.5.1), the considerable cost to the public purse, as well serious health and social care needs, are from homeless people who are not usually included in calculating these indicators. In Hull it is estimated there are around 40-60 people with severe and multiple disadvantage who are homeless or at risk of being homeless but who are reluctant to engage with services and so are not included in the numbers of people recorded in the Public Health Framework indicators. A recent national study estimates that the cost to public funds for these people is around £19,000 per person annually (see section 5.6.5). Regular updates on homelessness are provided to the Homelessness Strategy Focus Group, who can be contacted at [email protected].

5.2 Statutory Homelessness Housing authorities have a duty to secure accommodation for some homeless people in accordance with part 7 of the Housing Act 1996. The duty arises if a household is considered to be vulnerable because of a specified priority need and is not assessed as being intentionally homeless. In considering whether the duty arises the local authority considers if the household is vulnerable due to a priority need on an individual basis e.g. families with children are a priority need but some families will not need assistance. Some people may be homeless but have no recourse to public funds because they do not have a legal right to reside in the UK or are recent job seekers from the European Economic Area (EEA) who do not have a job and are not able to claim housing benefit. Assistance in such cases may be limited to reconnection to the country of origin. Not all homeless people seek help from the local authority. Many people at risk of rough sleeping do not approach the local authority directly for assistance and in many cases they are not “statutorily homeless” because following investigation a decision is made that their actions have led to loss of their last settled home. Hull City Council fully recognises the importance of providing assistance to such people but that it needs to be in a way that they will use. Hull City Council does this by procuring direct access hostels through the housing related support commissioning process and working closely with





people provide outreach services. A multi agency “hard to house” group meets to explore ways to meet individual needs. Within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012), statutory homelessness is one of the indicators (see section 3.6 on page 17 for more information on the public health outcomes framework ). There are two sub indicators: (i) homelessness acceptances per thousand households; and (ii) households in temporary accommodation per thousand households. The definition for the numerator of the first indicator is the “number of households who are eligible, unintentionally homeless and in priority need, for which the local authority accepts responsibility for securing accommodation under part VII of the Housing Act 1996 or part III of the Housing Act 1985” (Department of Health 2012; Department of Health 2012). The definition for the second indicator is the “number of households in ‘temporary accommodation’ as arranged by local housing authorities” (Department of Health 2012; Department of Health 2012). Table 23 gives the numbers of homeless in Hull for 2015/16. Households in the "Duty was owed but no accommodation has been secured" category are those accepted as owed a main duty, or awaiting a decision on their application, but able to remain in their existing accommodation for the immediate future. The numbers in temporary accommodation as at 31st March 2016 are also given in this table. Data are extracted from the Department of Communities and Local Government ‘live tables’. Table 23: Homelessness, 2015/16 Decisions and households accommodated

Homeless level Group Number of households

Decisions made during the year April 2015 - March 2016

Numbers accepted as being homeless and in priority need

399

Eligible homeless and in priority need but intentionally <5

Eligible homeless but not in priority need 164

Eligible but not homeless <5

Total decisions 600

Households accommodated by the authority as at 31st March 2016

Bed and breakfast (including shared annexe) 6

Hostels (including women's refuges) <5

Local authority/Registered social landlord stock 25

Private sector leased by LA <5

Other (including private landlord) <5

Total 31

Duty owed but no accommodation has been secured at end March 2014 71

In order for the information in Table 23 to relate to the public health indicators, the number of households in Hull is required so that the rate of homelessness per thousand households can be calculated.




Table 24 shows the rate of homelessness acceptances per 1,000 households for Hull and comparators, for 2004/05 to 2015/16. The rate in Hull in 2015/16 accepted as being homeless and in priority need per 1,000 households was 3.48, higher than for England, the Yorkshire and Humber region, the average of the 10 comparator areas and North East Lincolnshire, with only Wolverhampton, Derby, Coventry and Sandwell of the 10 comparator areas having a higher rate of homelessness acceptances in 2015/16. Using the same denominator of 114,672 households as used in the ‘Live Tables’ the rate of households living in temporary accommodation as at 31st March 2016 was 0.27 per 1,000 households. Table 24: Trends in homelessness acceptances per 1,000 households 2004/05 to 2015/16, Hull and comparators

Area Financial year

2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

England 5.73 4.50 3.48 3.00 2.48 1.86 2.03 2.31 2.41 2.32 2.40 2.52

Hull 9.31 5.98 5.78 8.66 6.23 4.04 4.37 4.57 5.02 3.07 3.60 3.48

Yks. & Humber 6.35 4.50 3.87 3.45 2.87 1.78 2.01 2.22 2.19 1.57 1.42 1.49

Wolverhampton 4.73 4.66 5.75 4.24 4.34 3.42 3.27 3.67 3.61 3.26 3.21 3.60

Salford 12.89 14.80 11.08 6.42 4.85 2.47 2.50 2.87 2.66 2.25 2.91 3.47

Derby 10.98 8.59 7.81 4.80 2.97 3.21 2.65 1.63 1.63 3.05 2.66 3.57

Stoke-on-Trent 8.64 5.54 4.51 3.06 2.35 2.15 2.44 2.50 2.21 2.21 2.06 1.64

Coventry 3.55 .. 2.69 .. 4.33 4.24 5.54 4.54 4.12 4.15 4.72 4.11

Plymouth 6.32 5.68 3.30 3.67 3.42 2.24 2.55 2.01 2.39 2.52 2.41 2.18

Sandwell 5.82 7.93 7.38 3.91 4.49 3.82 2.95 4.36 4.13 4.47 4.52 4.32

Middlesbrough 7.83 4.78 2.35 1.66 0.52 0.14 1.36 1.50 1.09 1.34 1.28 0.72

Sunderland 4.98 4.94 4.83 3.50 1.79 1.37 1.39 0.68 1.03 1.38 0.67 0.64

Leicester 7.00 2.82 3.04 1.80 0.89 0.62 0.46 0.88 0.75 0.73 0.86 1.01

Avg. of above 10 7.03 6.58* 5.28 3.72* 3.09 2.48 2.58 251.04 2.44 2.61 2.62 2.62

NE Lincolnshire 5.92 5.65 4.33 3.58 2.19 2.31 2.79 2.28 2.49 1.67 1.48 1.25

*Average of 9 (excludes Coventry)

5.2.1 Public Health Outcomes Framework Indicators One of the indicators (1.15i) within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to statutory homelessness. Screenshot for this indicator taken from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015) are shown in Figure 4. This report is updated regularly as and when new data are released. The full report may be downloaded from www.hullcc.gov.uk/pls/hullpublichealth/.





Figure 4: Public Health Outcomes Framework Indicator 1.15i Statutory homelessness – eligible homeless people not in priority need




5.2.2 Reasons for Statutory Homelessness People become homeless for a wide range of reasons and the following tables provide information about the reasons why people are classified as being in priority need and the reasons they became homeless. The majority of people are accepted as being in priority need because they have children or are pregnant (Table 25). People may however may have more than one priority need but the information is collected and reported on the basis of the hierarchy of priority need set out by the Department of Communities and Local Government. Many people who are homeless and at risk of rough sleeping do have issues that affect their health as a result of drinking and drug use, or have mental and physical health issues, but who are not accepted as being statutorily homeless because they do not meet the criteria of being unintentionally homeless. It should be noted that young people are generally referred to the Targeting Young People service, with this team supporting young people who are at risk of becoming homeless. Table 25: Reasons for acceptance as being homeless due to being in priority need Main priority need category 2010 2011 2012 2013 2014 2015 2016

Homeless because of emergency (fire, flood, storms, disaster, etc) * * * * * * 4

Applicant whose household includes dependent children 357 384 415 308 292 287 371

Applicant is, or household includes, a pregnant women and no other dependents

78 81 104 54 43 34 38

Applicant aged 16 or 16 years old 4 8 * 4 * * *

Applicant formerly “in care”, and aged 18 to 20 years old * * * * * * *

Old age * * 3 4 4 * 4

Physical disability 3 6 13 13 9 11 13

Mental illness or disability 3 * 4 7 10 4 8

Drug dependency * * * * * * *

Alcohol dependency * * * * * * *

Former asylum seeker * * * * * * *

Having been “in care” * * * * * * *

Having served in HM Forces * * * * * * *

Having been in custody / on remand * * * * * * *

Having fled their home because of violence / threat of violence 4 3 * 7 3 5 5

Having fled their home because of violence / threat of violence due to domestic violence

12 17 19 21 26 15 12

Total 461 499 558 418 387 356 455

*Suppressed as fewer than three cases, with totals adjusted accordingly




The most common reasons among accepted homelessness cases for the loss of their last settled address are parents no longer willing to accommodate them, the breakdown of relationships with partners and, increasingly, the termination of assured short hold tenancy (Table 26). Table 26: Accepted homeless cases – reason for loss of last settled address Main priority need category 2010 2011 2012 2013 2014 2015 2016

Parents no longer willing or able to accommodate 162 209 159 100 88 82 82

Other relatives or friends no longer willing or able to accommodate 29 32 50 24 23 22 24

Non-violent breakdown of relationship with partner 43 42 65 43 35 26 49

Violent breakdown of relationship, involving partner 62 60 72 76 93 69 96

Violent breakdown of relationship, involving associated persons * * 3 * * * 8

Racially motivated violence * * * * * * *

Other forms of violence * 6 3 5 10 7 7

Racially motivated harassment * * * * * * *

Other forms of harassment 6 * 7 9 * 5 7

Mortgage arrears (repossession or other loss of home) 6 20 13 8 * 4 *

Rent arrears on local authority or other public sector dwellings * * 9 * * 6 *

Rent arrears on registered social landlord or other housing association dwellings

11 * 3 7 4 * 6

Rent arrears of private sector dwellings * * 5 * * * *

Termination of assured short hold tenancy 75 93 127 112 108 112 128

Reasons other than termination of assured short hold tenancy 21 17 24 10 4 11 21

Required to leave accommodation provided by Home Office as asylum support

41 13 14 6 6 10 12

Left prison / on remand * * * * * * *

Left hospital * * * * 3 * 5

Left other institution or local authority care * * * * * * *

Left HM Forces * * 4 10 3 3 3

Other reason (e.g. emergency, sleeping rough or in hostel, returned from abroad)

* 4 * 7 * * 5

Total 456 496 558 417 374 357 448





5.3 Homelessness Prevented or Relieved Considerable activity is undertaken locally on preventing or relieving homelessness, which reduces the levels of acceptances. The results of this activity are shown in Table 27, although it should be noted that the homelessness prevented includes non statutory homelessness cases as well as statutory homelessness cases. Table 27: Local activities preventing or relieving homelessness (statutory and non-statutory) Action 2010 2011 2012 2013 2014 2015 2016

Mediation with family / friends / Home visits 45 65 62 76 47 34 5

Financial payments from Prevention fund 23 28 26 63 25 32 18

Resolving housing benefit problems 9 15 13 29 19 16 10

Resolving rent arrears with private / social landlord 20 37 10 13 17 6 6

Sanctuary scheme measures for domestic violence 333 364 801 778 863 792 628

Crisis intervention 55 19 9 19 11 5 5

Negotiation (i.e. with landlord) 54 21 44 51 35 29 40

Mortgage arrears 30 20 6 13 7 * *

Other assistance including major adaptations, resolving anti-social behaviour, tackling disrepair

3,833 3,937 4,294 4,053 3,960 3,812 3,945

Hostel accommodation 202 206 228 326 280 268 261

Private sector with bond payment from Prevention fund 100 30 46 21 21 20 29

Private sector – no bond 107 119 128 196 150 99 115

Accommodation arranged with family / friends 251 128 80 64 76 100 19

Supported accommodation 84 38 116 86 36 13 21

Management move 4 * 23 34 32 22 26

Housing register / successful Housing Association nomination 308 323 224 332 257 238 136

Other – Minerva project / reconnection to A8 country 29 * 72 94 20 * *

Total cases 5,487 5,350 6,182 6,248 5,856 5,486 5,264





Table 28 shows the rate of homelessness prevented or relieved per 1,000 households for Hull and comparator areas. As well as having a higher rate of homelessness acceptances than comparators, Hull also has a far higher rate of cases of homelessness prevented or relieved per 1,000 households than comparator areas, with a rate four and a half times higher than the comparator average. Table 28: Trends in rate of homelessness prevented or relieved for Hull and comparators

Area

Rate of homelessness prevented or relieved per 1,000 households, by financial year

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

England 7.7 8.7 9.2 9.1 10.2 9.7 9.3

Hull 38.0 50.1 48.3 55.1 52.8 51.6 46.9

Yks. & Humber 9.0 10.8 11.5 11.1 11.2 12.0 12.8

Wolverhampton 2.3 22.3 47.6 24.8 26.5 19.4 17.7

Salford 7.4 6.9 4.8 3.7 3.5 2.8 3.7

Derby 12.1 15.7 15.4 15.0 16.0 11.3 10.2

Stoke-on-Trent 9.4 11.3 12.6 9.1 8.4 12.0 10.6

Coventry 1.9 7.3 11.7 8.3 10.8 11.6 10.3

Plymouth 4.5 4.6 4.4 5.1 8.1 9.8 9.2

Sandwell 3.1 12.5 15.2 12.8 16.4 13.9 9.2

Middlesbrough 6.0 9.1 6.9 8.8 10.2 8.4 7.1

Sunderland 6.7 6.1 6.6 6.3 4.5 24.5 33.5

Leicester 16.0 14.0 14.9 18.2 13.5 14.6 20.4

Avg. above 10 6.9 10.9 14.0 11.3 11.8 13.2 13.7

NE Lincolnshire 3.3 5.4 9.6 11.4 8.9 9.0 9.2

Quarterly trends in the numbers of homelessness acceptances for Hull are shown in Figure 5 for January-March 2011 to January-March 2017 inclusive. There appear to be fewer homelessness acceptances from 2014 as well as fewer cases of no priority need. The underlying data are given in the APPENDIX on page 166.




Figure 5: Trends in quarterly homelessness acceptances for Hull 2011 to 2017

5.4 Information from Hull City Council Choice Based Lettings Register

Information from the Hull City Council Homesearch Choice Based Lettings Register5 at March 2015 shows that 60 households have a priority for re-housing due to being homeless and in priority need. Of these, one third of applicants were aged 18-25 years, half were aged 26-45 years. Seven of these households were single person households, 24 were two-person households and 14 were three-person households. An additional 96 households are awarded additional points because they are homeless but were not found to be in priority need following investigation, nearly 80% of whom were single people. At March 2015, 27 households (21 of whom were one person households) have a priority for move on from hostels and supported accommodation with an additional 267 households having points because they live in a hostel (over 80% being single people). Homesearch also gives information about where people registered currently live and 1,617 households out of the 9,013 registered appear to be living in accommodation which is not permanent, of whom 35 reported that they had a disability. Around 4.8% of these 1,617 households live outside Hull.

5 Homesearch does not form a common waiting list with private registered providers ( housing

associations ) operating in Hull

0

20

40

60

80

100

120

140

160

180

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Accepted Intentionally homeless No priority need Not homeless Ineligible




Table 29: March 2015 snapshot of current occupancy of people registered on Hull City Council Homesearch Choice Based Lettings Register, where living in temporary accommodation

Current occupancy Local connection to Hull

No Yes Total

Bed & Breakfast

9 9

Direct Access Hostel 11 321 332

HM Forces 3 8 11

Hotel

4 4

In Hospital

9 9

Mobile Home/Caravan 2 11 13

No Fixed Abode 26 1,050 1,076

Prison 13 34 47

Probation Hostel 4 9 13

Rough Sleeping

57 57

Supported Housing

24 24

Women's Refuge

3 3

Any Other Temporary Accommodation

19 19

Grand total 59 1,558 1,617




5.5 Households in Temporary Accommodation Trends in the number of households living in temporary accommodation, expressed as a rate per 1,000 households, are shown in Table 30 for Hull and comparator areas, for the financial years 2004/05 to 2015/16. The peak for Hull occurred in 2007-08 at 0.7 per 1,000 households. The rate in 2015/16 was the same as the Yorkshire and Humber average, half the comparator average and 90% lower than the English average. Table 30: Trends in households living in temporary accommodation per 1,000 households 2004/05 to 2013/14, Hull and comparators

Area

Households living in temporary accommodation per 1,000 households by financial year*

2004

/05

2005

/06

2006

/07

2007

/08

2008

/09

2009

/10

2010

/11

2011

/12

2012

/13

2013

/14

2014

/15

2015

/16

England 4.8 4.6 4.1 3.7 3.0 2.4 2.2 2.3 2.5 2.6 2.9 3.1

Hull 0.1 0.3 0.3 0.7 0.3 0.3 0.3 0.4 0.4 0.3 0.3 0.3

Yks. & Humber 1.0 1.1 1.0 0.8 0.7 0.4 0.4 0.4 0.4 0.3 0.3x 0.3

x

Wolverhampton 0.4 0.6 0.5 0.5 0.4 0.6 0.5 0.6 0.5 0.6 0.6 0.5

Salford 0.7 0.9 0.8 0.5 0.4 0.2 0.3 0.6 0.5 0.6 0.6 0.6

Derby 0.5 0.9 0.8 0.5 0.5 0.3 0.3 0.3 0.3 0.3 0.3 0.3

Stoke-on-Trent 0.2 0.2 0.1 0.1 0.0 0.0 0.2 0.2 0.2 0.2 0.2 0.2

Coventry 0.1 0.0 0.1 0.4 0.2 0.3 0.3 0.5 0.4 0.3 0.3 1.1

Plymouth 1.6 1.5 0.9 0.9 0.8 0.6 0.6 0.9 0.8 1.0 1.2 1.2

Sandwell 0.1 0.2 0.5 0.3 0.2 0.1 0.1 0.1 0.1 0.4 0.3 0.3

Middlesbrough 0.6 0.4 0.6 0.2 0.1 0.1 0.3 0.2 0.2 - - -

Sunderland 0.1 0.1 0.1 0.1 0.1 0.0 0.1 0.1 0.0 - - -

Leicester 0.9 0.4 0.5 0.5 0.4 0.3 0.4 0.7 0.6 0.5 0.6 0.5

Avg. above 10 0.5 0.6 0.5 0.5 0.3 0.3 0.3 0.4 0.4 0.5+ 0.5

+ 0.6

+

NE Lincolnshire 0.2 0.5 0.5 0.4 0.2 0.1 0.1 0.2 0.2 0.2 0.2 0.3

* NB These rates do not take into account that many people do not approach the local authority directly, including most rough sleepers + Based on 8 comparator areas as data missing for Middlesbrough and Sunderland X Not complete coverage in 2014/15 and 2015/16

5.5.1 Public Health Outcomes Framework Indicators One of the indicators (1.15ii) within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to households in temporary accommodation. A screenshot of this indicator, taken from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015), is shown Figure 6. This report is updated regularly as and when new data are released. The full report may be downloaded from www.hullcc.gov.uk/pls/hullpublichealth/.





Figure 6: Public Health Outcomes Framework Indicator 1.15ii Statutory homelessness – households in temporary accommodation




5.6 Homeless People NOT Accepted as Statutorily Homeless People who are not accepted as being statutorily homeless often have considerable health needs and require a comprehensive package of care. Information in this section is derived from data supplied by direct access hostels and data about rough sleepers. 5.6.1 Annual Estimate of Rough Sleepers Each autumn, every local authority has to provide the Government with either a rough sleeper count or an estimate of numbers of rough sleepers. The estimated number of rough sleepers for 2010 to 2016 are given in Table 31. The rate in Hull is lower than England. 72% of the 326 local authorities providing an estimate of rough sleepers produced estimates of fewer than 15 rough sleepers in 2016. The number of rough sleepers does vary across the year, as shown in Figure 7 for Hull. The underlying data are given in the APPENDIX on page 166. Table 31: Rate of rough sleeping per 1,000 households

Year

Number and rate of rough sleeping per 1,000 households*

Hull England London Rest of England

N Rate N Rate N Rate N Rate

2010 7 1,768 415 1,353

2011 15 2,181 446 1,735

2012 10 2,309 557 1,752

2013 13 2,414 543 1,871

2014 10 2,744 742 2,002

2015 23 3,569 940 2,629

2016 15 0.13 4,134 0.18 964 0.27 3,170 0.16

Figure 7: Number of rough sleepers in Hull by month, 2014/15 to 2016/17

0

5

10

15

20

25

30

35

40

45

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2014/15 2015/16 2016/17




The Centre for Assessment and Emergency Accommodation (Futures), provided by Humbercare, opened in Summer 2014 and provides a comprehensive assessment facility. The service was commissioned to provide longer term temporary accommodation and emergency beds to ensure no one sleeps rough over winter. During 2016/17 the Centre for Assessment and Emergency Accommodation had 249 different clients, of whom 202 completed an assessment. Of these 202 that completed an assessment:

76% of users were male, 23% female, 1% transgender (an increase in female clients from 15% in 2014/15)

The average age was 36 years, with 19% under 25 years, 44% aged 25-39 years, 27% aged 40-49 years, 8% aged 50-59 years and 2% aged 60-69 years

111 out of 202 users were verified rough sleepers

Just over half of people approaching Futures has some contact with services: o 93 had no previous contact (46%)

- a large increase since 2014/15 (25%) due to the centre booking clients in direct from Hospital/Prison/Housing Options to prevent rough sleeping

o 60 had limited contact with services (30%) o 42 had regular contact with services (21%) o 7 not known (3%)

95% were White British -

64% of users identified mental health needs, but only 44% had a formal diagnosis

12% had physical health needs – this large increase from 12% in 2014/15 is currently being investigated. The main ailments were:

o Joint/bones/muscle problems (41%) o Fainting/blackouts/epilepsy (40%) o Chest pain/breathing problems (35%) o Circulation problems and blood clots (27%) o Problems with feet (19%) o Dental issues (16%) o Diabetes (15%) o Liver problems (15%)

50% of users had drug use issues or were in recovery The Emmaus Outreach provides a unique approach to dealing with rough sleeping as it trains those who have been formerly homeless to deliver a rough sleeper support service under the coordination and supervision of a paid team member. Working with a range of agencies and statutory services, the team complete an initial assessment of all rough sleepers. The service started in July 2016, and between July 2016 and March 2017 the service received 130 referrals, 53 of whom have been supported in obtaining a hostel placement or housing. Of these 130 referrals, the assessments showed that 75% displayed low to moderate mental health issues and 23% had moderate to high mental health issues. 85% of clients assessed were binge drinkers and 15% were dependent drinkers. This service has been funded for a further year, during which health outcomes will be monitored.




5.6.2 Health and Other Services for Homeless People There are no specific health services for homeless people, but people at risk of rough sleeping tend to use the City Health Care Partnerships Quays Service. Of the 283 people of no fixed abode using accident and emergency services in 2016 where GP practice was known, 102 (36%) indicated that their GP practice was the Quays. Of the 605 people of no fixed abode using accident and emergency services in 2016 108 (18%) were admitted into hospital, with a further 129 being referred to their GP. An outreach service is also provided to hostels, with this service operated by City Health Care Partnership. Humber Foundation Trust Mental Health Crisis Team also provide a range of services utilised by homeless people who have no fixed abode, are rough sleepers or are resident in hostels. Health Watch Kingston-upon-Hull carried out some research into the needs of homeless people during 2014/15 which supported a Health Watch England special enquiry into the needs of homeless people. Following focus groups with staff and volunteers working with homeless people, the main issues identified were

Difficulties with registering with services due to the need to have official identification and/or a permanent address

Many homeless people not accessing routine health checks such as smear testing and breast screening

Difficulty in accessing mental health services and referrals not being made to drug and alcohol services by mental health services where service users experience dual diagnosis

5.6.3 Use of Accident and Emergency Services Many homeless people and potential rough sleepers make considerable use of Accident and Emergency Services. The rough sleeper provision was expanded over the winter 2013/14, while the new Centre for Assessment and Emergency Accommodation, which was commissioned to ensure that people receive comprehensive assessments of their needs, opened in the summer of 2014. Trends in A&E attendances by homeless people (no fixed abode/unknown abode) are shown by month in Figure 8. The underlying data are given in the APPENDIX on page 167. The numbers of homeless people (of no fixed abode or unknown abode) attending Accident and Emergency are shown by month for 2016 in Figure 8. Between April and August 2016 the majority of homeless people using A&E were aged 25-40 years, while in the Autumn and Winter months the majority of homeless people attending A&E were aged 40+ years. The underlying data are given in the APPENDIX on page 167.




Figure 8: Monthly homeless (no fixed abode / unknown) A&E activity 2012/13 to 2016/17

Figure 9: Age of people approaching A&E classified as no fixed abode, 2016

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In 2016 there were 605 Accident and Emergency visits by people classified as having no fixed above, of which 90 (15%) were due to poisoning, including overdoses and 23 (4%) were due to psychiatric conditions. In 240 cases (40%) no medical diagnosis was recorded, as shown in Table 32. Table 32: Number of A&E visits in 2016 by people classified as having no fixed abode where no medical diagnosis was recorded

Primary Diagnosis Description Number Percentage (out of all 605 visits)

Nothing abnormal detected 14 2.3

Diagnosis not classifiable 65 10.7

Social problem 8 1.3

Unknown 153 25.3

Total 240 39.7

During 2016, among the 605 visits to Accident and Emergency where the persons was classified as of no fixed abode, 171 visits (28.3%) required no follow up treatment; 106 (17.5%) left A&E prior to receiving any treatment; 15 visits (2.5%) resulted in people refusing any treatment. 5.6.4 Housing Services for Homeless People The information on homelessness focuses on people who are at risk of being homeless but in planning to meet their needs, the supply of appropriate accommodation and services must to be taken into account. In view of their past history, for many people who have a multiplicity of needs, consideration needs to be given to all the services that these people may require not just their accommodation needs. This is especially the case in respect of those people who are rough sleeping or at risk of rough sleeping and who are not classified as being “statutorily homeless”. Specific services have been commissioned as part of the housing related support contract by Adult Social Care and these provide for 204 places of supported housing for single people and 42 places for homeless families. An additional 588 units of housing related support have been commissioned covering services for people with mental health problems, learning disability domestic violence, young people, physical disability, rehabilitation of offenders and a floating support service for BME groups. At May 2017, there were 1,498 claims for supported exempt housing benefit as care and support provided by an eligible landlord (excluding provision for older people) – the reason why people needed care and support includes, but is not restricted to, homelessness.




5.6.5 Cost of Homelessness to Public Services A recent report published by the Lankelly Chase Foundation “Hard Edges- Mapping severe and multiple disadvantage” (Bramley, Fitzpatrick et al. 2015) examines the links between homelessness, substance misuse and criminal justice systems in England, with poverty an almost universal, and mental ill-health a very common, complicating factor. The report indicates that Hull ranks as 6th amongst English local authorities for severe multiple deprivation based on data from 2010/11 relating to homelessness, substance misuse and criminal justice. The research suggest that the annual public expenditure cost for a person with severe multiple deprivation is around £19,000 compared to £4,600 per year for an average adult. Homeless Link research from 2013 indicates the cost to public funds is £26,000 per year for each homeless person (Homelessness Link 2013). National research from 2012 shows homeless people attend A&E six times as frequently as non homeless people (largely due to fewer being registered with GP practices) and are four times as likely to be admitted to hospital, and tend to stay three times as long in hospital. This contributes to secondary health care costs for homeless people, at more than £2,100 per person per year, almost four times higher than the £525 per person per year for the general population (Deloitte Centre for Health Solutions 2012).




6 ENVIRONMENT

6.1 Land Use Data is available on land use from Neighbourhood Statistics (Office for National Statistics 2015). The most recent data are from 2005, and are presented in thousands of square metres. Due to changes in underlying data sources, the 2005 land use statistics cannot be compared to those from 2001. Figure 10 shows the 2005 land use statistics for Hull. One third of the land forming Hull is classified as green space (34%), with further fifth classified as domestic gardens (21%). The areas classified as containing buildings cover 15% of Hull (9% domestic buildings and 6% non-domestic buildings) while the areas classified as roads cover almost as much (13%). Figure 10: Land use across Hull 2005, m2 (000s) and percentages

Domestic Buildings, 6163,

9%Non Domestic

Buildings, 4619, 6%

Road, 9373, 13%

Path, 1178, 2%

Rail, 411, 1%

Domestic Gardens,

14809, 21%

Greenspace, 24761, 34%

Water, 1781, 2%

Other Land Uses, 8838,

12%




6.1.1 Utilisation of Outdoor Space for Exercise or Health Reasons The percentage of survey respondents (from Natural England’s Monitor of Engagement with the Natural Environment (MENE) survey) using outdoor spaces for health or exercise reasons are shown Table 33 in for Hull and comparators. In 2015-16 the percentage utilising outdoor space for exercise or health reasons in Hull was 18.0% (95% confidence interval: 14.0% to 22.0%), similar to England, the Yorkshire and Humber region and the average of the ten comparator local authorities. This represented a large increase on the 11.7% for Hull in 2011-12, when the percentage for Hull was 2.4 percentage points lower than for England. Table 33: Percentage of survey respondents visiting the natural environment for exercise or health reasons in the last 7 days, for Hull and comparators

Area

Percentage of survey* respondents visiting the natural environment for exercise or health reasons in past 7 days

Mar 2013- Feb 2014

Mar 2014- Feb 2015

Mar 2015- Feb 2016

England 17.1 (16.7, 17.6) 17.9 (17.4, 18.4) 17.9 (17.4, 18.4)

Hull 13.0 ( 9.5, 16.4) 14.3 (10.8, 17.8) 18.0 (14.0, 22.0)

Yorkshire & Humber 18.3 (17.0, 19.5) 19.4 (18.0, 20.8) 17.5 (16.2, 18.9)

Wolverhampton 15.5 (10.5, 20.5) 35.4 (18.1, 52.6) 27.6 (21.6, 33.7)

Salford 9.5 ( 2.9, 16.1) 14.6 ( 8.4, 20.8) 21.5 (14.0, 29.0)

Derby 11.1 ( 7.3, 14.8) 11.9 ( 6.2, 17.6) 20.7 (14.7, 26.6)

Stoke-on-Trent 21.0 (16.0, 26.0) 15.2 (10.7, 19.6) 12.6 ( 8.0, 17.2)

Coventry 13.7 (10.5, 16.8) 14.8 (11.5, 18.1) 15.1 (11.8, 18.4)

Plymouth 13.6 ( 7.9, 19.3) 31.7 (11.1, 52.2) 18.2 (12.8, 23.5)

Sandwell 11.5 ( 6.1, 17.0) 12.4 ( 7.7, 17.1) 18.2 (12.3, 24.1)

Middlesbrough 17.0 (10.0, 24.0) 23.5 (14.8, 32.1) 19.5 (10.6, 28.4)

Sunderland 15.6 ( 8.8, 22.3) 21.1 (12.4, 29.8) 17.2 ( 9.2, 25.2)

Leicester 12.0 ( 8.1, 15.9) 13.1 ( 9.0, 17.2) 12.0 ( 7.9, 16.0)

Average of above 10 14.1 (10.2, 19.0) 15.5 (11.1, 21.2) 17.6 (13.3, 22.9)

NE Lincolnshire 17.8 (10.3, 25.3) 17.1 (10.9, 23.4) 22.0 (14.6, 29.4) *Monitor of Engagement with the Natural Environment (MENE) survey, Natural England.

6.1.1.1 Public Health Outcomes Framework Indicator One of the indicators (1.16) within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to the use of outdoor space for exercise or health reasons. A screenshot from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015) for indicator 1.16 Utilisation of outdoor space for exercise / health reasons is shown in Figure 11. This report is updated regularly as and when new data are released, available at www.hullcc.gov.uk/pls/hullpublichealth/.





Figure 11: Public Health Outcomes Framework Indicator 1.16 Utilisation of outdoor space for exercise / health reasons




6.2 Climate Change Climate change influences the weather in terms of temperature, precipitation and the frequency of extreme weather conditions. It can also affect air pollution and sea levels heights. Climate change and unsustainable use of resources affects the most vulnerable in this country for example through higher fuel bills and in other countries through soil degradation affecting farming, food production and the reduction in the availability of water. It can also affect ecosystems. Severe weather conditions include rising intensity of storms, forest fires, droughts, flooding and heat waves. There is also an increased risk of dangerous feedbacks and abrupt, large-scale shifts in the climate systems. There have been major floods in Hull previously, and there is the risk that serious flooding can re-occur. Furthermore, due to deprivation levels, resilience and ability to cope with flooding and other climate changes could be more difficult in Hull compared to other less deprived geographical areas. The information contained in the future climate projections identified in Hull’s Environment and Climate Change Strategy 2010-2020 (Kingston-upon-Hull’s Climate Change 2010-2010: A Low Carbon Framework for Hull) show that Hull will experience changes in its climate. The City therefore needs to identify what these likely impacts will be so we can anticipate changes and adapt to them minimising the negative outcomes for the City. These impacts fall into two areas that of extreme weather events such as the floods in 2007 and the heat wave in 2003 and incremental change brought about as we move towards warmer wetter winters and hotter dryer summers which will see changes in plant and animal habitats and the demands for services and goods. These local changes are set within global environmental, social and economic changes linked to climate change that will see natural resource depletion and increased population movement. Climate change affects health and wellbeing in a number of ways. Severe weather conditions generally affect the youngest, oldest and poorest / most vulnerable more than other groups. There could be increases in the cases of heat-related illness and deaths (relating to both cold and hot temperatures / weather). Increased temperatures particular in the average summer temperature could influence sunburn, heat stress, food-related illnesses and spread of disease. Although, it could also mean people undertake more exercise with increased outdoor activities in parks and public spaces in warmer weather. Increased precipitation and an increase in severe weather conditions increase the risk of flooding, which seriously affects the health and wellbeing of the individuals affected as well as those in the neighbourhood. Problems could be further exacerbated financially though lack of insurance or higher insurance premiums. Capacity of waste water treatment plans and sewers could be affected which could influence health. Wetter winters increases issues for damp in buildings and housing, and higher temperatures increases demand for air conditioning which results in an increase in carbon dioxide emissions. Air pollution can exacerbate existing medical




conditions in particular those that are respiratory or cardiovascular conditions. It can also affect mortality and premature death. There are not just negative impacts resulting from climate change but also opportunities arising from the switch to a low carbon economy, which the city of Hull is in a unique position to take advantage of this. Renewable energy has been identified as a key growth cluster for the city, within Hull’s City Plan, demonstrating the opportunities within the green economy that will replace the current carbon economy. Further information is provided within Hull’s Environment and Climate Change Strategy 2010-2020.

6.3 Air Pollution 6.3.1 Modelled Estimates of Levels of Air Pollution One of the indicators within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to mortality from air pollution (see section 6.3.2 on page 76). As part of the Department for Environment, Food and Rural Affairs’ (DEFRA) obligations under the Ambient Air Quality Directive (2008/50/EC), annual assessments of air quality in the UK has been undertaken involving data for population-weighted anthropogenic PM2.5. This produces a modelled estimates of population exposure to PM2.5 across the UK, calibrated using measured concentrations taken from DEFRA’s Automatic Urban and Rural Network (http://uk-air.defra.gov.uk/interactive-map). DEFRA has produced detailed modelling for 2008, 2010, 2015 and 2020 ((Department for Environment Food and Rural Affairs 2010)), and has used linear extrapolation to produced estimates for the years in between. The data produced refers to air pollution levels within one kilometre grid squares. Figure 12 illustrates the concentrations of NO2μg/m3. From Wikipedia (http://en.wikipedia.org/wiki/Nitrogen_dioxide), the “most prominent sources of NO2 are internal combustion engines, thermal power stations and, to a lesser extent, pulp mills.” The highest concentrations occur along the A63 dual carriageway, near the docks, as well as the A1033, the main route through Hull’s industrial area that straddles the River Hull. High concentrations are also found along the A63 as it passes through the industrial areas of Myton and St Andrews, along the A1079, the main road from Hull to Beverley, as well as the industrial areas of Marfleet and the Sutton Fields Industrial area (see Hull JSNA Toolkit: Geographical Area for a map of the main roads in Hull).


http://uk-air.defra.gov.uk/interactive-map

http://en.wikipedia.org/wiki/Nitrogen_dioxide



Figure 12: Modelled mean annual concentrations of NO2 μg/m3 for 2015

The modelled concentrations of NOx across Hull show a slightly different pattern relative to the NO2 concentrations (Figure 13). “The major source of NOx production from nitrogen-bearing fuels such as certain coals and oil is the conversion of fuel bound nitrogen to NOx during combustion. During combustion, the nitrogen bound in the fuel is released as a free radical and ultimately forms free N2, or NO. Fuel NOx can contribute as much as 50% of total emissions when combusting oil and as much as 80% when combusting coal” (http://en.wikipedia.org/wiki/NOx). As a result, the highest concentrations of NOx occur around the industrial areas following the river which runs through the centre of Hull from south to north, and areas around Marfleet ward and the docks, and not along the arterial routes like the A1079.


http://en.wikipedia.org/wiki/NOx



Figure 13: Modelled mean annual concentrations of NOx μg/m3 for 2015

“Atmospheric particulate matter – also known as particulate matter (PM) or particulates – is microscopic solid or liquid matter suspended in the Earth's atmosphere. The term aerosol commonly refers to the particulate/air mixture, as opposed to the particulate matter alone. . . . Some sources of particulate matter can be man-made or natural. Some particulates occur naturally, originating from volcanoes, dust storms, forest and grassland fires, living vegetation and sea spray. Human activities, such as the burning of fossil fuels in vehicles, power plants and various industrial processes also generate significant amounts of particulates. Coal combustion in developing countries is the primary method for heating homes and supplying energy. Because salt spray over the oceans is the overwhelmingly most common form of particulate in the atmosphere,


http://en.wikipedia.org/wiki/Aerosol



anthropogenic aerosols – those made by human activities – currently account for about 10% of the total amount of aerosols in our atmosphere” (http://en.wikipedia.org/wiki/Particulates#Sources_of_atmospheric_particulate_matter). PM10 is the mass (in micrograms) per cubic metre of air of individual particles with an aerodynamic diameter generally less than 10 micrometres, and Figure 14 illustrates the modelled levels of PM10 across Hull. The main concentrations are along the main roads and the industrial areas of Hull. Figure 14: Modelled mean annual concentrations of PM10 μg/m3 for 2015


http://en.wikipedia.org/wiki/Particulates#Sources_of_atmospheric_particulate_matter



PM2.5 is the mass (in micrograms) per cubic metre of air of individual particles with an aerodynamic diameter generally less than 2.5 micrometres. Figure 15 illustrates the levels of PM2.5 across Hull. As PM10 and PM2.5 essentially measure the concentration of individual particulates within the air, the distribution of the concentrations are similar. It is likely that where the concentrations of larger particulates (less than 10 micrometres in diameter) are highest, the concentrations of smaller particulates (less than 2.5 micrometres in diameter) would also be higher. In fact, as Figure 15 shows, although again concentrated along the main roads and the industrial areas of Hull, there are fewer points with high levels of PM2.5. Figure 15: Modelled mean annual concentrations of PM2.5 μg/m3 for 2015




6.3.2 Mortality From Air Pollution One of the indicators within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to air pollution. It is defined as the mortality effect of anthropogenic particulate air pollution (measured as fine particulate matter, PM2.5) per 100,000 population. PM2.5 is the mass (in micrograms) per cubic metre of air of individual particles with an aerodynamic diameter generally less than 2.5 micrometres. PM2.5 is also known as fine particulate matter. The mortality burden is to be expressed as attributable deaths and associated years of life lost. Attributable deaths are obtained by multiplying local PM2.5 data (population-weighted modelled background athropogenic PM2.5 concentrations, to be supplied by DEFRA) by annual deaths for persons aged 30+ years, and the Committee on the Medical Effects of Air Pollutants (COMEAP) recommended relative risk of 6% increase in mortality per 10μg/m3 PM2.5. Years of life lost associated with these attributable deaths are then calculated (by summing age-specific life expectancies for each attributable death). Mortality data is readily available from the Office for National Statistics. Data on the resident population can be used to express the burden per 100,000 people. The modelled background PM2.5 data published nationally by DEFRA (Department for Environment Food and Rural Affairs 2010) could be extended to include population-weighted figures. The estimated fractions of mortality that may be attributable to particulate air pollution are provided in Table 34 for Hull and comparators. The attributable fraction presented are based on the COMEAP estimate of a relative risk of death of 1.06 for each 10μg/m3 PM2.5., as well as a 75% plausibility interval for the relative risk of 1.01 to 1.12 as recommended by COMEAP. The estimated fraction of mortality attributable to particulate air pollution in Hull in 2015 was 4.8%, a decrease on the estimated fraction of 5.7% for 2013 and 2014. The 75% plausibility intervals (supplied on the PHOF dataset for 2010 to 2012 only) are very wide, and would be wide for 2015. While around one in twenty deaths are estimated to be attributable to particulate air pollution, the effect on life expectancy is somewhat smaller. COMEAP estimated that if all man-made particulate pollution were removed, this would lead to an increase in life expectancy of around 6 months (ranging from 1 to 12 months), with each 1μg/m3 decrease in PM2.5 leading to an average life expectancy gain of around 20 days (ranging from 3 to 40 days) (Committee on the Medical Effects of Air Pollutants 2010). To put this into context, the effect on life expectancy of continued smoking is 7 years on average.




Table 34: Estimated fraction of mortality attributable to particulate air pollution, Hull and comparator areas, 2010-2015

Area Estimated fraction of mortality attributable to particulate air pollution (75% plausibility

interval for 2010-2012 only)

2010 2011 2012 2013 2014 2015

England 5.6 (1.0, 10.6) 5.4 (0.9, 10.2) 5.1 (0.9, 9.6) 5.3 5.1 4.7

Hull 5.9 (1.0, 11.2) 5.6 (1.0, 10.6) 5.4 (0.9, 10.2) 5.7 5.7 4.8

Yorkshire & Humber 5.3 (0.9, 10.0) 5.0 (0.9, 9.5) 4.9 (0.9, 9.3) 5.1 4.9 4.3

Wolverhampton 5.8 (1.0, 11.0) 5.4 (0.9, 10.2) 5.3 (0.9, 10.0) 5.5 5.4 5.0

Salford 5.9 (1.0, 11.2) 5.5 (1.0, 10.4) 5.2 (0.9, 9.8) 5.3 5.2 4.3

Derby 6.1 (1.1, 11.5) 5.6 (1.0, 10.6) 5.5 (1.0, 10.4) 5.7 5.6 5.1

Stoke-on-Trent 5.6 (1.0, 10.6) 5.2 (0.9, 9.8) 4.9 (0.9, 9.3) 5.2 5.0 4.4

Coventry 6.2 (1.1, 11.7) 5.8 (1.0, 11.0) 5.5 (1.0, 10.4) 5.7 5.5 5.0

Plymouth 4.5 (0.8, 8.5) 4.3 (0.8, 8.1) 4.0 (0.7, 7.6) 4.2 4.0 5.4

Sandwell 6.9 (1.2, 13.0) 6.2 (1.1, 11.7) 6.0 (1.1, 11.3) 6.1 6.0 5.9

Middlesbrough 5.0 (0.9, 9.5) 4.4 (0.8, 8.3) 4.4 (0.8, 8.3) 4.4 4.5 3.7

Sunderland 5.0 (0.9, 9.5) 4.3 (0.8, 8.1) 4.4 (0.8, 8.3) 4.5 4.5 3.7

Leicester 6.6 (1.2, 12.5) 6.2 (1.1, 11.7) 5.9 (1.0, 11.2) 6.0 5.9 5.4

NE Lincolnshire 5.6 (1.0, 10.6) 5.0 (0.9, 9.5) 5.0 (0.9, 9.5) 5.4 5.4 5.7

6.3.2.1 Public Health Outcomes Framework Indicators One of the indicators (3.01) within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to air pollution, specifically the fraction of mortality attributable to particulate air pollution. Figure 16 is a screenshot from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015) is showing indicator 3.01 Fraction of mortality attributable to particulate air pollution.

This report is updated regularly as and when new data are released, available at www.hullcc.gov.uk/pls/hullpublichealth/.





Figure 16: Public Health Outcomes Framework Indicator 3.01 Fraction of mortality attributable to particulate air pollution




6.4 Noise Pollution There are a number of direct and indirect links between exposure to noise and health and well being outcomes. Exposure to noise can cause disturbance and interfere with activities, leading to annoyance and increased stress. Furthermore, there is increasing evidence that long term exposure to high levels of noise can cause direct health effects such as heart attacks and other health issues. The World Health Organisation states:

“Excessive noise seriously harms human health and interferes with people’s daily activities at school, at work, at home and during leisure time. It can disturb sleep, cause cardiovascular and psychophysiological effects, reduce performance and provoke annoyance responses and changes in social behaviour. Traffic noise alone is harmful to the health of almost every third person in the WHO European Region. One in five Europeans is regularly exposed to sound levels at night that could significantly damage health.”

(http://www.euro.who.int/en/health-topics/environment-and-health/noise/noise).

6.4.1 Public Health Outcomes Framework Indicators One of the indicators within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to noise pollution with three sub-indicators: the number of complaints about noise; percentage of population exposed to transport noise above 65 dB(A) during the daytime; percentage of the population exposed to transport noise above 55 dB(A) during the night time. Within this section are tables of data from www.phoutcomes.info, as well as screenshots from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015), of indicators 1.14i Percentage of population affected by noise – number of complaints (Table 35 and Figure 17 within section 6.4.2);1.14ii The percentage of the population exposed to road, rail and air transport noise of 65dB(A) or more during the daytime (Table 36 and Figure 18 within section 6.4.3); and 1.14ii The percentage of the population exposed to road, rail and air transport noise of 55dB(A) or more during the night –time (Table 36 and Figure 19 within section 6.4.3). This report is updated regularly as and when new data are released. The full report may be downloaded from www.hullcc.gov.uk/pls/hullpublichealth/.


http://www.euro.who.int/en/health-topics/environment-and-health/noise/noise

http://www.phoutcomes.info/




6.4.2 1.14i – Number of Complaints The number of complaints about noise per 1,000 population, for Hull and comparators, are shown in Table 35 for 2010/11(baseline) and for 2012/13 to 2014/15. In 2010/11 the number of complaints about noise in Hull was 6.9 per 1,000 population (95% confidence interval: 6.6 to 7.2), increasing to 13.4 complaints per 1,000 population (95% CI: 13.4 to 14.3) in 2014/15. The gap between Hull and England deteriorated over this period from -0.9 per 1,000 population in 2010/11 to 6.3 per 1,000 population in 2014/15. In 2014/15 the number of complaints about noise per 1,000 population in Hull was double that for the Yorkshire and Humber region, having been the same in 2010/11. In 2014/15 the number of complaints about noise per 1,000 population in Hull was higher than for all but one comparator, having been in the mid range of the comparator areas in 2010/11. Table 35: Number of complaints about noise per 1,000 population, Hull and comparator areas, 2010/11, 2012/13 – 2014/15

Area Number of complaints about noise per 1,000 population

2010/11 2012/13 2013/14 2014/15

England 7.8 ( 7.8, 7.8) 7.5 ( 7.5, 7.5) 7.4 ( 7.3, 7.4) 7.1 ( 7.1, 7.2)

Hull 6.9 ( 6.6, 7.2) 14.3 (13.9, 14.8) 13.9 (13.4, 14.3) 13.4 (13.0, 13.9)

Yks. & Humber 6.9 ( 6.8, 6.9) 6.7 ( 6.6, 6.8) 6.5 ( 6.5, 6.6) 6.5 ( 6.4, 6.5)

Wolverhampton 15.3 (14.8, 15.8) 11.4 (11.0, 11.9) 11.1 (10.7, 11.5) 7.7 ( 7.3, 8.0)

Salford 3.9 ( 3.7, 4.2) 3.5 ( 3.2, 3.7) 4.2 ( 4.0, 4.5) 4.0 ( 3.8, 4.3)

Derby 3.9 ( 3.6, 4.1) 3.9 ( 3.6, 4.1) 3.7 ( 3.5, 4.0) 3.4 ( 3.2, 3.7)

Stoke-on-Trent 14.9 (14.4, 15.4) 10.1 ( 9.7, 10.5) 7.5 ( 7.1, 7.8) 7.4 ( 7.0, 7.7)

Plymouth 5.9 ( 5.6, 6.2) 5.7 ( 5.4, 6.0) 5.4 ( 5.1, 5.7) 19.5 (19.0, 20.0)

Coventry 13.4 (13.0, 13.8) 21.5 (21.0, 22.1) 20.5 (20.0, 21.0) 5.5 ( 5.2, 5.8)

Sandwell 3.4 ( 3.2, 3.6) 3.3 ( 3.1, 3.5) 3.4 ( 3.2, 3.6) 3.1 ( 2.9, 3.3)

Middlesbrough 12.1 (11.6, 12.7) 9.3 ( 8.8, 9.9) 8.9 ( 8.4, 9.4) 8.3 ( 7.8, 8.7)

Sunderland 3.6 ( 3.4, 3.8) 3.6 ( 3.4, 3.8) 3.7 ( 3.5, 3.9) 3.4 ( 3.2, 3.6)

Leicester 9.0 ( 8.7, 9.3) 6.8 (6.5, 7.1) 6.5 ( 6.3, 6.8) 7.1 ( 6.9, 7.4)

Avg. above 10 8.3 ( 8.0, 8.7) 8.1 ( 7.7, 8.4) 7.7 ( 7.3, 8.0) 7.2 ( 6.9, 7.5)

NE Lincolnshire 5.8 ( 5.4, 6.2) 5.5 ( 5.1, 5.8) 5.2 ( 4.9, 5.6) 5.0 ( 4.7, 5.4)




Figure 17: Public Health Outcomes Framework Indicator 1.14i Percentage of population affected by noise – number of complaints




6.4.3 1.14ii and 1.14iii – Exposure To Transport Noise of 65db(A) or More

During Daytime; 55db(A) or More During The Night-time The percentage of the population exposed to road, rail or air transport noise at higher than 65dB(A) during the daytime, or above 55dB(A) during the night-time are shown in Table 36 for Hull and comparator areas, based on modelled data. In 2006-07 the percentage of population exposed to daytime transport noise in Hull was 2.3%, rising to 2.4% in 2011, while the percentage population exposed to night-time transport noise in Hull was 3.7%, decreasing to 2.8% in 2011. In each case the percentage in Hull was lower than for England, although with the gaps between them decreasing between 2006/07 and 2011.. The percentages of the population exposed to daytime or night-time transport noise in Hull remained lower than for the Yorkshire and Humber region in both 2006/07 and 2011, with the percentages among the lowest of the comparator areas in 2006/07 and 2011 both for daytime transport noise and night-time transport noise. Table 36: Percentage of population exposed to road, rail or air transport noise of 65dB(A) or more during the day-time; 55dB(A) or more during the night-time, Hull and comparator areas 2006/07 and 2011

Area

Percentage of population exposed to road. Rail or air transport noise of . . . .

. . . 65dB(A) or more during the daytime

. . . 55dB(A) or more during the night-time

2006-07 2011 2006-07 2011

England 5.4 5.2 12.8 8.0

Hull 2.3 2.4 3.7 2.8

Yorks. & Humber 3.3 4.0 7.8 6.2

Wolverhampton 4.3 4.8 5.6 6.7

Salford 12.7 11.1 42.8 22.7

Derby 5.6 4.6 9.3 6.1

Stoke-on-Trent 3.2 5.4 5.3 6.8

Coventry 3.1 2.3 4.5 4.5

Plymouth 4.1 2.4 7.0 3.8

Sandwell 5.9 6.2 7.7 13.4

Middlesbrough 2.2 1.1 4.5 2.4

Sunderland 3.4 3.4 5.7 5.0

Leicester 4.5 4.7 7.6 6.6

Avg. above 10 4.9 4.7 9.6 7.9

NE Lincolnshire 1.9 3.6 3.1 5.0




Figure 18: Public Health Outcomes Framework Indicator 1.14ii The percentage of the population exposed to road, rail and air transport noise of 65dB(A) or more during the daytime




Figure 19: Public Health Outcomes Framework Indicator 1.14iii The percentage of the population exposed to road, rail and air transport noise of 55dB(A) or more during the night-time




6.5 Sustainable Development Management Plans One of the indicators (3.06) within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012) relates to public sector organisations have a board approved sustainable development management plan. Table 37 shows the percentage of NHS organisations with a board approved sustainable development management plan, for Hull and comparators. Hull consistently had one of the highest percentages of comparator areas. The percentage of NHS organisations reporting they have a board approved sustainable development management plan has decreased in recent years, primarily due to the restructuring of the NHS and the creation of new commissioning organisations. One result of this is a low proportion of some organisations types confirming that they have a Sustainable Development Management Plan in place. Therefore direct comparisons with previous years may not be valid. Table 37: NHS organisations with a sustainable development management plan

Area

NHS organisations with a board approved sustainable development management plan

Financial year

2012/13 2013/14 2014/15 2015/16

England 59.0 (55.9, 62.1) 41.6 (38.7, 44.6) 56.5 (53.2, 59.8) 66.2 (62.9, 69.2)

Hull 80.0 (37.6, 96.4) 57.1 (25.0, 84.2) 25.0 ( 4.6, 69.9) 25.0 ( 4.6, 69.9)

Yorks. & Humber 83.1 (73.7, 89.7) 48.5 (38.9, 58.2) 48.1 (37.4, 58.9) 67.1 (56.1, 76.4)

Wolverhampton 40.0 (11.8, 76.9) 40.0 (11.8, 76.9) 50.0 (15.0, 85.0) 75.0 (30.1, 95.4)

Salford 60.0 (23.1, 88.2) 33.3 ( 9.7, 70.0) 75.0 (30.1, 95.4) 50.0 (15.0, 85.0)

Derby 60.0 (23.1, 88.2) 20.0 ( 3.6, 62.4) 75.0 (30.1, 95.4) 75.0 (30.1, 95.4)

Stoke-on-Trent 66.7 (30.0, 90.3) 33.3 ( 9.7, 70.0) 60.0 (23.1, 88.2) 40.0 (11.8, 76.9)

Coventry 60.0 (23.1, 88.2) 60.0 (23.1, 88.2) 100.0 (51.0, 100.0) 75.0 (30.1, 95.4)

Plymouth 50.0 (15.0, 85.0) 33.3 ( 9.7, 70.0) 50.0 (15.0, 85.0) 66.7 (20.8, 93.9)

Sandwell 40.0 (11.8, 76.9) 40.0 (11.8, 76.9) 50.0 (15.0, 85.0) 75.0 (30.1, 95.4)

Middlesbrough 80.0 (37.6, 96.4) 20.0 ( 3.6, 62.4) 100.0 (51.0, 100.0) 75.0 (30.1, 95.4)

Sunderland 66.7 (30.0, 90.3) 50.0 (18.8, 81.2) 80.0 (37.6, 96.4) 80.0 (37.6, 96.4)

Leicester 20.0 ( 3.6, 62.4) 0.0 ( 0.0, 43.4) 0.0 ( 0.0, 49.0) 50.0 (15.0, 85.0)

Avg. of above 10 54.9 (20.1, 85.5) 33.3 ( 9.1, 71.4) 64.3 (23.6, 91.3) 65.9 (24.3, 92.0)

NE Lincolnshire 100.0 (51.0, 100.0) 16.7 ( 3.0, 56.4) 33.3 (6.1, 79.2) 66.7 (20.8, 93.9)

6.5.1 Public Health Outcomes Framework Indicators Figure 20 is a screenshot from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015) showing indicator 3.06 Public sector organisations with a board approved sustainable development management plan.

This report is updated regularly as and when new data are released. The full report may be downloaded from www.hullcc.gov.uk/pls/hullpublichealth/.





Figure 20: Public Health Outcomes Framework Indicator 3.06 Public sector organisations with a board approved sustainable development management plan




7 SOCIAL CARE Projecting Adult Needs and Service Information (PANSI) provides information on a number of indicators relating to social care (Oxford Brookes University and Institute of Public Care 2012). Most of the information is available for Hull and some information for Hull’s comparators. See section 7.11 on page 118. Two of the indicators, which are also indicators within the public health outcomes framework published in January 2012 (Department of Health 2012; Department of Health 2012), relating to the proportion of adults in settled accommodation who have learning disabilities and with secondary mental health services are given Hull JSNA Toolkit: Mental Health. Another indicator from the public health outcomes framework is the gap in the employment rate between those in contact with secondary mental health services and the general population. This is also provided in Hull JSNA Toolkit: Mental Health.

7.1 Registered Deaf or Hard of Hearing Table 38 gives the number of people registered as deaf and hard of hearing by age as at 31st March 2010. Note that the numbers deaf by age do not necessarily add to the “all ages” total as this includes people whose ages are unknown. This dataset was produced every three years, but data collection was discontinued in 2011, so the 2010 figures shown in Table 38 are the most recent that are available. Table 38: Number of people registered deaf or hard of hearing as at 31st March 2010

Area People registered as deaf or hard of hearing

People registered as deaf by age

All ages 0-17 18-64 65-74 75+

England 212,900 56,360 2,160 30,100 6,700 17,370

Hull 870 710 20 320 105 265

Yorkshire & Humber 20,130 6,410 280 3,575 790 1,765

Middlesbrough 1,125 270 10 185 20 55

South Tyneside 170 95 * 55 25 10

Sunderland 2,055 230 20 145 25 40

Salford 1,490 215 5 155 25 30

Derby 1,570 865 20 530 80 230

Leicester 2,325 405 20 280 25 75

Stoke-on-Trent* 645 210 * 125 40 45

Coventry 335 105 * 60 20 20

Sandwell 1,555 465 15 225 50 175

Wolverhampton 1,055 310 30 210 30 40

Plymouth 405 220 15 160 25 20

N E Lincolnshire 310 165 10 110 15 25

*Fewer than five individuals.




7.2 Registered Blind or Partially Sighted Table 39 gives the number of people registered as blind and partially sighted, and numbers with additional disabilities as at 31st March 2014. The rates are produced sing the mid-year 2013 population estimates, as the 2014 population estimates will not be released until summer 2015. Table 39: Number of people registered blind or partially sighted as at 31st March 2014

Group Numbers (or rate per 1,000 population)

Hull England Yorkshire & Humber

Mid-year 2013 population 257,589 53,865,817 5,337,710

Blind

Total 765 143, 385 14,035

0 to 4 yrs 5 735 90

5 to 17 yrs 35 3,540 380

18 to 49 yrs 125 19,570 2,125

50 to 64 yrs 120 17,580 1,705

65 to 74 yrs 85 14,040 1,355

75 yrs or over 400 87,920 8,380

Unknown age 0 0 0

Rate per 1,000 population 2.97 2.66 2.63

Partially sighted

Total 935 147,715 16,820

0 to 4 yrs 0 630 80

5 to 17 yrs 25 4,630 540

18 to 49 yrs 160 18,210 2,165

50 to 64 yrs 135 15,400 1,740

65 to 74 yrs 105 14,565 1,765

75 yrs or over 510 94,280 10,625

Unknown 0 0 0


Number of registered blind people with an additional disability by category of disability

Total 230 49,925 5,310

Mental health problem 10 2,495 200

Learning disability 10 4,335 515

Physical disability 195 30,105 3,700

Deaf with speech 5 2,370 220

Deaf without speech 0 1,175 30

Hard of hearing 10 9,440 645


Number of registered partially sighted people with an additional disability by category of disability

Total 370 51,225 6,430

Mental health problem 25 2,865 270

Learning disability 15 3,140 370

Physical disability 320 33,505 4,850

Deaf with speech 5 1,425 190

Deaf without speech 0 645 10

Hard of hearing 5 9,645 735





7.3 In Receipt of Social Care Table 40 gives the total numbers receiving social care and the numbers receiving social care in the community in Hull for 2016/17. Table 40: Number of people receiving social care, 2016/17

Primary Support Reason

Numbers receiving social care

Total receiving social care in the

community 18-64 65+ Total

Physical Disability 1,953 6,962 8,915 8,190

Mental Health 185 659 844 436

Learning Disability Support 664 95 759 630

Substance Misuse Support 10 5 15 11

OVP 44 107 151 144

Total 2,856 7,828 10,684 9,411

7.4 Social Care Clients Receiving Self Directed Support From the Information Centre, Table 41 gives the numbers receiving self-directed support for 2009/10 to 2010/11 as well as the percentage receiving self-directed support as a percentage of clients aged 18 or over) receiving community based services and carers receiving carer’s specific services (carers may be under 18 but are caring for an adult aged 18 or over)6. Table 41: Social care clients receiving self directed support, 2009/10 to 2010/11 Local authority

Social care clients receiving self-directed support (index)

Percentage receiving self-directed support as a percentage

of those receiving community-based services and carers receiving carer's specific

services

2009/10 2010/11 2009/10 2010/11

England 216,845 446,730 13.0 29.2

Yorkshire & Humber 24,155 54,650 13.6 32.9

Hull 580 3,435 6.2 36.8

Wolverhampton 1,050 1,830 16.5 34.3

Salford 1,845 3,445 19.1 35.2

Derby 1,050 2,045 13.9 26.1

Stoke on Trent 995 3,355 9.6 34.5

Coventry 1,610 2,970 21.0 33.3

6 This was National Indicator 130 (NI130).




Local authority

Social care clients receiving self-directed support (index)

Percentage receiving self-directed support as a percentage

of those receiving community-based services and carers receiving carer's specific

services

2009/10 2010/11 2009/10 2010/11

Plymouth 1,750 2,260 15.9 30.3

Sandwell 1,275 2,190 11.0 26.3

Middlesbrough 575 980 7.2 13.1

Sunderland 820 2,155 7.4 31.8

Leicester 1,270 2,395 16.5 30.6

NE Lincolnshire 885 2,275 11.9 35.2

7.5 Carers Receiving Needs Assessment or Review and a Specific Carer’s Service or Advice and Information

From the Information Centre, Table 42 gives the number of carers receiving support or information as a percentage of the people receiving a community-based service within that financial year7. Table 42: Carers receiving support, 2008/09 to 2010/11 Local authority The number of carers whose needs were assessed

or reviewed by the council in a year who received a specific carer's service, or advice and information in the same year as a percentage of people receiving a

community based service in the year

2008/09 2009/10 2010/11

England 23.1 26.4 28.3

Yorkshire & Humber 20.1 25.6 29.2

Hull 32.3 34.4 43.4

Wolverhampton 20.1 27.1 34.1

Salford 29.2 32.6 33.8

Derby 11.2 26.6 28.3

Stoke on Trent 18.2 21.8 20.2

Coventry 20.5 21.7 12.6

Plymouth 22.7 22.7 29.9

Sandwell 15.9 20.1 21.6

Middlesbrough 28.8 29.8 22.7

Sunderland 54.1 56.5 54.1

Leicester 19.9 29.6 26.8

NE Lincolnshire 16.6 22.0 30.8





7.6 New Social Care Clients In 2013/14, 3,780 assessments of people not already in receipt of a service were carried out, and around 80% went on to receive a specific service as a result of that assessment (Table 43). Table 44 gives the number of new clients assessed for social care in 2013/14 by client type. Table 43: Number of new clients assessed for social care by service assessment, 2015/16 and 2016/17

Assessment/service 2015/16 2016/17

18-64 65+ Total 18-64 65+ Total

Some or all (New) services intended or already started

1,027 3,293 4,320 788 2,395 3,183

No New Services 146 538 684 99 308 407

Declined 30 208 238 15 88 103

Other 1 1 2 1 1

Total 1,204 4,040 5,244 902 2,792 3,694

Table 44: Number of new clients receiving social care by type of disability, 2015/16 and 2016/17

Primary Support Reason 2015/16 2016/17

18-64 65+ Total 18-64 65+ Total

Physical Disability 1,071 3,558 4,629 812 2,552 3,364

Mental Health 36 204 240 22 159 181

Learning Disability Support 59 16 75 47 8 55

Substance Misuse Support 3 3 1 3 4

OVP 45 65 110 77 84 161

Sum: 1,214 3,843 5,057 959 2,806 3,765

7.7 Admissions to Residential Care Homes During 2011/12 to 2013/14, the number of local authority supported permanent admissions to residential care, nursing care and adult placements has remained between 340 and 380, or a rate of between 15 and 20 per 10,000 population aged 18+. Of these the majority (around 80% during 2013/14) were in the physical disability client group (Table 45).




Table 45: Local Authority funded admissions to residential and nursing care in Hull, 2015/16 and 2016/17

Primary Support Reason

Number of local authority funded admissions to residential and

nursing care

2015/16 2016/17

Access and Mobility Only 6 2

Learning Disability Support 6 7

Mental Health Support 28 35

Personal Care Support 286 287

Support for Visual Impairment - 1

Support for Dual Impairment 2 -

Support for Social Isolation or Other Support 4 3

Support with Memory and Cognition 29 47

Not recorded - 11

Grand Total 361 393

7.8 Safeguarding Adults From the experimental statistics associated with the Abuse of Vulnerable Adults in England 2012-13 report (Health and Social Care Information Centre 2014) In 2012/13, there were 685 adult safeguarding alerts reported (34 per 10,000 population aged 18+ years). Of these, 385 became safeguarding referrals (190 among those aged 18-64 years and 195 among those aged 65+ years).

7.9 Satisfaction with Services and Sufficient Support 7.9.1 Parental Experience of Services for Disabled Children A survey of parents of disabled children commissioned by the Department for Children, Schools and Families was conducted during 2008/09 and 2009/10 to obtain user perspective on healthcare. The aim was that this indicator would be based on a minimum sample of 200 parents of disabled children in each local area8. The overall

8 This was National Indicator 54 (NI54), but the information is no longer collected.




indicator score was based on an average of 15 sub indicators which each cover one of the five elements of the core offer across three broad service sectors; health, care and family support and education. Good performance was categorised by a high score in relation to the national baseline (for all areas) and in relation to 2008-09 data. In 2009/10, hull obtained the lowest score of its comparators (Table 46) denoting poor performance (no information was available in Hull for 2008/09). However, it is not known how representative the survey sample was, and it is possible from surveying methods or responder bias that people who had a poor experience were more willing to take part, but there is no reason to suppose that any potential responder bias was worse in Hull. Table 46: Parental experience of services for disabled children, 2009/10

Local authority Parental satisfaction score (%), 2009/10

Hull 57

Wolverhampton 64

Salford 62

Derby 63

Stoke on Trent 61

Plymouth 61

Coventry 61

Sandwell 61

Middlesbrough 65

Sunderland 62

Leicester 60

North East Lincolnshire 63

7.9.2 Quality of Life Improvement following Equipment and Minor Adaptations Within the local authority Equipment and Minor Adaptations Survey 2009/10, people were asked “how has the equipment/minor adaptation affected the quality of life?” Table 47 gives the percentage reporting that the modifications had made quality of life “much better” for Hull and comparators.




Table 47: Quality of life improvement with equipment or minor adaptations, 2009/10

Local authority Percentage reporting equipment or minor adaptations has made quality of life “much better”, 2009/10

Hull 70.9

Yorkshire & Humber 69.9

Wolverhampton 70.5

Salford 71.1

Derby 65.7

Stoke on Trent 70.3

Coventry 74.6

Plymouth 68.9

Sandwell 67.1

Middlesbrough 68.4

Sunderland 71.0

Leicester 62.7

North East Lincolnshire 64.7

7.9.3 Sufficient Support from Local Services to Manage Long-Term Conditions From the GP Patient Survey, patients with long-term conditions were asked if they had enough support from local services or organisations to manage their long-term health condition(s)9. Table 48 gives the percentages with sufficient support for Hull and comparator areas for 2015-16, as published in July 2016, based on data collection during July – September 2015 and January – March 2016. Table 48: Sufficient support to manage long-term conditions, 2015-16

Local authority Sufficient support from local services to manage long-term conditions, number

and percentage

Number %

England 245,663 63.1

Hull 1,290 62.5

Wolverhampton 1,110 60.2

Salford 1,149 66.8

Stoke on Trent 1,383 66.3

South Tees* 1,507 68.1

Sunderland 1,426 65.1

Leicester 1,280 59.6

North East Lincolnshire 754 59.9

*Middlesbrough and Redcar & Cleveland local authorities combined





7.9.4 Sufficient Support to Live Independently at Home From the local authority Place Survey 2008, people were asked the extent to which older people receive the support they need to live independently at home10. Table 49 gives the percentages of those surveyed who expressed an opinion and believed that older people did receive the support they need to live independently at home for as long as possible. The Place Survey was discontinued after the change of government in 2010, so the 2008 Place Survey was the last Place Survey. Table 49: Sufficient support to live independently at home for as long as possible, 2008

Local authority Sufficient support to live independently at home for as long

as possible, 2008 (%)

Hull 33.3

Yorkshire & Humber 32.7

Coventry 30.5

Derby 33.0

Leicester 31.5

Middlesbrough 36.3

Plymouth 27.9

Salford 32.7

Sandwell 30.3

Stoke on Trent 29.8

Sunderland 36.2

Wolverhampton 32.4

North East Lincolnshire 36.7

10

This was National Indicator 139 (NI139).




7.10 Adult Social Care Outcomes Framework 2016/17 A series of measures are collected as part of the Adult Social Care Framework (ASCOF). From the Handbook of definitions 2013/14 (Department of Health 2013) “the purpose of the ASCOF is three-fold:

• Locally, the ASCOF supports councils to improve the quality of care and support. By providing robust, nationally comparable information on the outcomes and experiences of local people, the ASCOF supports meaningful comparisons between councils, helping to identify priorities for local improvement and stimulating the sharing of learning and best practice;

• The ASCOF fosters greater transparency in the delivery of adult social care, supporting local people to hold their council to account for the quality of the services they provide. A key mechanism for this is through councils’ local accounts, where the ASCOF is already being used as a robust evidence base to support councils’ reporting of their progress and priorities to local people; and,

• Nationally, the ASCOF measures the performance of the adult social care system as a whole and its success in delivering high-quality, personalised care and support. The framework will support Ministers in discharging their accountability to the public and Parliament for the adult social care system and will inform and support national policy development.”

For 2016/2017 there were 25 indicators populated with data for 2016/17, as well as two which have not been updated with 2016/17 data, ranged across four domains as shown in Table 50. As from January 2016 indicators 1F and 1H are both derived from the Mental Health Services Dataset (MHSDS). These two indicators are suspended for the 2016/17 ASCOF due to completeness and data quality issues; data for these two indicators are therefore taken from the 2015/16 ASCOF. The indicators for domain 1 are shown in section 7.10.1, the indicators for domain 2 in section 7.10.2, the indicators for domain 3 in section 7.10.3 and the indicators for domain 4 are shown in section 7.10.4.




Table 50: List of Adult Social Care domains and indicators populated for Hull for 2016/17

Domain and indicator Data source

Domain 1: Enhancing quality of life for people with care and support needs

1A Social care-related quality of life (score out of 24) Adult Social Care Survey (ASCS)

1B Proportion of people who use services who have control over their daily life (%)

ASCS

1C(1a) Proportion of people using social care receiving self-directed support (%)

Short and Long Term Support (SALT)

1C(1b) Proportion of carers receiving self-directed support (%) SALT

1C(2A) Proportion of people using social care receiving direct payments (%)

SALT

1C(2b) Proportion of carers receiving direct payments for support direct to carer (%)

SALT

1D Carer reported quality of life score Personal Social Services Survey of Adult Carers (SACE)

1E Proportion of adults with a learning disability in paid employment (%)

SALT

1F Proportion of adults in contact with secondary mental health services in paid employment (%)

Mental Health Services Dataset (MHSDS) (2015/16)

1G Proportion of adults with learning disabilities who live in their own home or with their family (%)

SALT

1H Proportion of adults in contact with secondary mental health services who live independently, with or without support (%)

MHSDS (2015/16)

1I(1) Proportion of people who use services who reported that they have as much social contact as they would like (%)

ASCS

1I(2) Proportion of carers who reported that they have as much social contact as they would like (%)

SACE

Domain 2: Delaying and reducing the need for care and support

2A(1) Long-term support needs of younger adults (aged 18-64) met by admission to residential and nursing care homes, per 100,000 population

SALT, Office for National Statistics (ONS)

2A(2) Long-term support needs of older adults (aged 65 and over) met by admission to residential and nursing care homes, per 100,000 population

SALT, ONS

2B(1) The proportion of older people (aged 65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services (%)

SALT




Domain and indicator Data source

2B(2) The proportion of older people (aged 65 and over) who received reablement/rehabilitation services after discharge from hospital (%)

SALT, Hospital Episode Statistics (HES)

2C(1) Delayed transfers of care from hospital, per 100,000 population

Delayed Transfers of Care (DToC), ONS

2C(2) Delayed transfers of care from hospital that are attributable to adult social care, per 100,000 population

DToC, ONS

2D The outcome of short-term services: sequel to service (%)

SALT

Domain 3: Ensuring that people have a positive experience of care and support

3A Overall satisfaction of people who use services with their care and support (%)

ASCS

3B Overall satisfaction of carers with social services (%) SACE

3C Proportion of carers who report that they have been included or consulted in discussion about the person they care for (%)

SACE

3D(1) Proportion of people who use services who find it easy to find information about services (%)

ASCS

3D(2) Proportion of carers who find it easy to find information about services (%)

SACE

Domain 4: Safeguarding adults who circumstances make them vulnerable and protecting from avoidable harm

4A Proportion of people who use services who feel safe (%)

ASCS

4B Proportion of people who use services who say that those services have made them feel safe and secure (%)

ASCS

7.10.1 ASCOF Domain 1: Enhancing Quality of Life For People With Care and

Support Needs Social care-related quality of life was reported in indicator 1A as the sum of responses to eight questions in the Adult Social Care Survey divided by the number of respondents to provide an average for each geographical area. The maximum score is 24. The results for Hull and comparator areas are shown in Figure 21. The social care-related quality of life score for Hull was higher than for England and the Yorkshire and Humber region, and was similar to many comparator local authorities. The underlying data are given in the APPENDIX on page 172.




Figure 21: ASCOF 1A - Social care-related quality of life score, 2016/17

Indicator 1B is the proportion of people who use services who have control over their daily life. This is an indicator of the degree to which care and support provided is personalised to, and closely matches, the needs and wishes of the individuals receiving the care. Data is derived from the Adult Social Care survey. The data for Hull and comparator areas are shown in Figure 22. The proportion of respondents in Hull that felt they had control over their daily life was similar to England and the Yorkshire and Humber region as was as many comparator local authorities. The underlying data are given in the APPENDIX on page 172.




Figure 22: ASCOF 1B - The proportion of people who use services who have control over their daily life, 2016/17

Indicators 1C(1A) and 1C(1B) are the proportion of people who use services who receive self-directed support and the proportion of carers who receive self directed support respectively, and include all who receive a personal budget, direct payments or part direct payments. Indicators 1C(2A) and 1C(2B) are the proportion of people who use services who receive direct payments and the proportion of carers who receive direct payments respectively. These indicators are included as the use of personal budgets and direct payments are believed to have a positive impact on well-being, through increased choice and control, making people happier with the services they receive (Glendinning, Challis et al. 2008; Glendinning, Arksey et al. 2009). The data for Hull and comparator areas are shown in Figure 23 and Figure 24 for social care uses and cares respectively who receive self-directed support, and in Figure 25 and Figure 26 for social care uses and cares respectively who receive direct payments. At 99%, the proportion of social care users in Hull who receive self-directed support was higher than England and the Yorkshire and Humber region, and higher than half the comparator local authorities. The proportion of carers in Hull receiving self-directed support (100%) was much higher than for England, the Yorkshire and Humber region and five of the ten comparator local authorities. The proportion of social care users in Hull who receive direct payments was higher than for England or the Yorkshire and Humber region, but in the middle of the range of comparator local authorities. The proportion of carers in Hull receiving directed payments (100%) was much higher than for England, the Yorkshire and Humber region and six out of the ten comparator local authorities. The underlying data are given in the APPENDIX on page 172.




Figure 23: ASCOF 1C(1A) – The proportion of people who use services who receive self-directed support, 2016/17

Figure 24: ASCOF 1C(1B) – The proportion of carers who receive self-directed support, 2016/17




Figure 25: ASCOF 1C(2A) – The proportion of people who use services who receive direct payments, 2016/17

Figure 26: ASCOF 1C(2B) – The proportion of carers who receive direct payments, 2016/17




Carer-reported quality of life, from the 2016/17 Carers Survey, was reported in indicator 1D as the sum of responses to six questions in the Carers Survey divided by the number of respondents to provide an average for each geographical area. The maximum score is 12. The Carers Survey is a biennial survey, with the next survey being conducted during 2016/17, therefore the 2014/15 results are presented, for Hull and comparator areas, in Figure 27. The carer-reported quality of life score for Hull was a little lower higher than for England, significantly lower than for the Yorkshire and Humber region, and in the middle of the range of comparator local authorities. The underlying data are given in the APPENDIX on page 173. Figure 27: ASCOF 1D – Carer-reported quality of life score, 2016/17

Figure 28 shows indicator 1E Proportion of adults with a learning disability in paid employment for Hull and comparator areas, while Figure 29 shows indicator 1F Proportion of adults in contact with secondary mental health services in paid employment for Hull and comparator areas. These indicators are used by the Public Health Outcomes Framework to calculate the gap in employment rates between adults in contact with secondary mental health services, and the overall employment rate (see Hull JSNA Toolkit: Mental Health and Learning Disabilities). At less than 1% the employment rate in Hull among adults with a learning disability in 2016/17 (Figure 28) was much lower than for England and the Yorkshire and Humber region, as well as lower than all but one of the comparator local authorities. At less than 5%, the employment rate in Hull of adults in contact with secondary mental health services in 2015/16 (Figure 29) was lower than for England, the Yorkshire and Humber region and most of the comparator local authorities. The underlying data are given in the APPENDIX on page 173.




Figure 28: ASCOF 1E – The proportion of adults with a learning disability in paid employment, 2016/17

Figure 29: ASCOF 1F – The proportion of adults in contact with secondary mental health services in paid employment, 2015/16

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Indicator 1G Proportion of adults with learning disabilities who live in their own homes or with their family, and indicator 1H Proportion of adults in contact with secondary mental health services who live independently, with or without support, are shown in Figure 30 and Figure 31 respectively, for Hull and comparator areas. These indicators also feature in the Public Health Outcomes Framework (see Hull JSNA Toolkit: Mental Health and Learning Disabilities). Three-quarters (75%) of adults with learning disabilities in Hull were living in their own home or with their family in 2016/17, very similar to England (76%) and only a little lower than the Yorkshire and Humber region (79%). It was also lower than six out of the ten comparator local authorities and North East Lincolnshire (Figure 30). A similar proportion of adults in contact with secondary mental health services were living independently in Hull in 2015/16 (73%), as shown in Figure 31. This proportion was higher than for England (59%) and the Yorkshire and Humber region (65%), but similar to many of the ten comparator local authorities but higher than North East Lincolnshire. The underlying data are given in the APPENDIX on page 173. Figure 30: ASCOF 1G – The proportion of adults with a learning disability who live in their own home or with their family, 2016/17




Figure 31: ASCOF 1H – The proportion of adults in contact with secondary mental health services living independently, with or without support, 2015/16

Indicator 1I(1) records the proportions of respondents in the Adult Social Care Survey who reported that they had as much social contact as they would like. At 53% the proportion of service users in Hull who reported that they had as much social contact as they would like was higher than for England (45%) and the Yorkshire and Humber region (46%), as well as higher than each of the ten comparator local authorities and North East Lincolnshire (Figure 32). The underlying data are given in the APPENDIX on page 174. Indicator 1I(2) records the proportions of respondents in the 2016/17 Carers’ Survey who reported that they had as much social contact as they would like. At 32% the proportion of carers in Hull who reported that they had as much social contact as they would like was lower than for England (36%) and the Yorkshire and Humber region (39%), as well as in the middle of the range of the ten comparator local authorities (25% to 46%) but lower than North East Lincolnshire (Figure 33). The underlying data are given in the APPENDIX on page 174.

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Figure 32: ASCOF 1I(1) Proportion of people who use services who reported that they had as much social contact as they would like, 2016/17

Figure 33: ASCOF 1I(2) Proportion of carers who reported that they had as much social contact as they would like, 2016/17




7.10.2 ASCOF Domain 2: Delaying and Reducing the Need For Care and Support

Indicator 2A(1) and 2A(2) relate to long term support needs of adults met by admission into residential or nursing care homes, for adults aged 18 to 64 years and 65+ years respectively. The handbook of definitions (Department of Health 2013) says that the rationale behind this indicator was “avoiding permanent placements in residential and nursing care homes is a good measure of delaying dependency, and the inclusion of this measure in the framework supports local health and social care services to work together to reduce avoidable admissions. Research suggests that, where possible, people prefer to stay in their own home rather than move into residential care.” Therefore it seems that a lower rate of admissions is seen as desirable, provided that the delays in admissions were not detrimental to the health and wellbeing The rate of long term admissions into residential or nursing care homes of younger adults (aged 18 to 64) and older people (aged 65+) per 100,000 population are shown in Figure 34 and Figure 35 respectively for Hull and comparator areas. At 17 per 100,000 the rate among younger adults in Hull was higher than England and the Yorkshire and Humber region (13 and 14 per 100,000 respectively), but in the middle of the range of comparator local authorities (9.7 to 25.6 per 100,000). At 919 per 100,000 the rate among older people in Hull was much higher than England and the Yorkshire and Humber region (611 and 658 per 100,000), and higher than nine of the ten comparator local authorities. The underlying data are given in the APPENDIX on page 175. Figure 34: ASCOF 2A(1) – Long term support needs of younger adults (aged 16-64) met by admission to residential and nursing care homes per 100,000 population, 2016/17




Figure 35: ASCOF 2A(2) – Long term support needs of older adults (aged 65 and over) met by admission to residential and nursing care homes per 100,000 population, 2016/17

Indicators 2B(1) and 2B(2) relate to people aged 65 and over who were offered reablement or rehabilitation services upon discharge from hospital, with indicator 2B(1) measuring the effectiveness of these services and indictor 2B(2) measuring the coverage of these services. From Figure 36 it can be seen that 90% of Hull residents aged 65 years and over discharged from hospital into reablement or rehabilitation services in 2016/17 remained in their own homes 91 days after discharged from hospital, higher than England (83%), the Yorkshire and Humber region (83%) and eight out of the ten comparator local authorities, but lower than North East Lincolnshire. From Figure 37 it can be seen that 2.4% of Hull residents aged 65 years and over were offered reablement or rehabilitation services upon discharge from hospital during 2016/17, a little lower than for England and the Yorkshire and Humber region (2.7% and 2.6% respectively). The percentage in Hull offered reablement or rehabilitation services was lower than six of the ten comparator local authorities, although a little higher than for North East Lincolnshire. The underlying data for Figure 36 and Figure 37 are given in the APPENDIX on page 175.




Figure 36: ASCOF 2B(1) – The proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into reablement/rehabilitation services, 2016/17

Figure 37: ASCOF 2B(2) – The proportion of older people (65 and over) who received reablement/rehabilitation services after discharge from hospital, 2016/17




Indicator 2C(1) relates to delayed transfer of care from hospital of adults aged 18+ years, while indicator 2C(2) relates to those delayed transfers of care that were attributable to adult social care services. A delayed transfer of care occurs when a patient is ready for a transfer from a hospital bed but is still occupying a hospital bed, with a patient being deemed ready to be transferred is a clinical decision has been made that the patient is ready and a multi-disciplinary team decision has been made to transfer the patient and the patient is safe to discharge/transfer. Delyaed transfers of care are included in the numerator for indicator 2C(2) if the delayed transfer of care is attributable to social care or jointly to social care and the NHS. Figure 38 shows the rate of all delayed transfers of cares of adults per 100,000 population during 2016/17 for Hull and comparator areas. At 13.4 per 100,000 the rate of delayed transfers of care in Hull was a little lower than England but higher than the Yorkshire and Humber region (14.9 and 12.3 per 100,000 respectively), as well as being lower than four of the ten comparator local authorities, although twice as high as North East Lincolnshire. Figure 39 shows the rate of delayed transfers of cares attributable to social care of adults per 100,000 population during 2016/17 for Hull and comparator areas. At 6.1 per 100,000 the rate of delayed transfers of care attributable to social care in Hull was similar England, but lower than the Yorkshire and Humber region (4.8 per 100,000), and was in the middle of the range for comparator local authorities (0.4 to 15.5 per 100,000). The underlying data for Figure 38 and Figure 39 are given in the APPENDIX on page 175. Figure 38: ASCOF 2C(1) – Delayed transfer of care from hospital per 100,000 population, 2016/17




Figure 39: ASCOF 2C(2) – Delayed transfers of care from hospital which are attributable to adult social care per 100,000 population, 2016/17

Indicator 2D measures the proportion of new service users that received a short term service during the year where the sequel to that service was either no ongoing support or support of a lower level. Figure 40 shows the proportion of new service users that received a short term service during the year where the sequel to that service was either no ongoing support or support of a lower level, for Hull and comparator areas during 2016/17. For Hull the percentage was 47%, which was much lower than England (78%) and the Yorkshire and Humber region (70%), as well as lower than all but one of the ten comparator local authorities and lower than for North East Lincolnshire. The underlying data are given in the APPENDIX on page 175.




Figure 40: ASCOF 2D – The outcome of short term services: sequel to services, 2016/17

7.10.3 ASCOF Domain 3: Ensuring That People Have a Positive Experience of

Care and Support Indicator 3A measures the overall level of satisfaction with the care and support services that service users receive. Respondents in the Adult Social Care Survey answering “I am extremely satisfied” or “I am very satisfied” to the question “Overall, how satisfied or dissatisfied are you with the care and support you receive?”, together with respondents in the Easy Read Adult Social Care Survey answering “I am very happy with the way staff help me, it’s really good” to the question “How happy are you with the way staff help you?”, form the numerator for this indicator. The results for Hull and comparator areas are shown in Figure 41. At 66%, the proportion of service users in Hull satisfied with the care and support they receive was similar to England (65%), the Yorkshire and Humber region (65%), and in the middle of the range of the ten comparator local authorities (62% to 73%) but higher than North East Lincolnshire. The underlying data are given in the APPENDIX on page 176. Indicator 3B measures the overall level of satisfaction with the care and support services that carers and the person they care for receive. This indicator is derived from the 2016/17 Carers' Survey question “Overall, how satisfied or dissatisfied are you with the support or services you and the person you care for have received from Social Services in the last 12 months?” with this biennial survey last conducted during 2014/15, and is shown in for Hull and comparator areas. Overall, just over one third of carers in Hull (37%) were satisfied, a little lower than for England (39%) and the Yorkshire and




Humber region (41%), but was in the middle of the range of the ten comparator local authorities (28% to 55%) and was similar to North East Lincolnshire (38%). The underlying data are given in the APPENDIX on page 176. Figure 41: ASCOF 3A – Overall satisfaction of people who use services with their care and support, 2016/17

Figure 42: ASCOF 3B – Overall satisfaction of carers with social services, 2016/17




Indicator 3C is also derived from the 2016/17 Carers' Survey and records the proportion of carers reporting that they have been included or consulted in discussion about the person they care for, with results for Hull and comparators shown in Figure 43. 68% of carers in Hull felt they had been included or consulted in discussions about the person they care for, lower than England (71%) and the Yorkshire and Humber region (74%), similar to many of the ten comparator local authorities (range 63% to 81%) and North East Lincolnshire. The underlying data are given in the APPENDIX on page 176. Figure 43: ASCOF 3C – The proportion of carers who report that they have been included or consulted in discussion about the person they care for, 2016/17

Derived from the Adult Social Care Survey question “In the past year, have you generally found it easy or difficult to find information and advice about support, services or benefits?”, indicator 3D(1) is the proportion of respondents who find it easy (that is very easy or fairly easy) to find information about services. This indicator is shown in Figure 44 for Hull and comparator areas. Differences between areas were mostly relatively small, with around three-quarters answering positively in most areas. Similarly, indicator 3D(2) is derived from the same question, but asked in the 2016/17 Carers’ Survey, and measures the proportion of carers who find it easy to find information about services. This indicator is shown in for Hull and comparator areas. More than two thirds of carers in Hull during 2016/17 found it easy to find information about services (68%), only slightly higher than for England (64%) and the Yorkshire and Humber region (66%), higher than eight of the ten comparator local authorities, but a little lower than North East Lincolnshire.




The underlying data for Figure 44 and Figure 45 are given in the APPENDIX on page 176. Figure 44: ASCOF 3D(1) – The proportion of people who use services who find it easy to find information about services, 2016/17

Figure 45: ASCOF 3D(2) – The proportion of carers who find it easy to find information about services, 2016/17




7.10.4 ASCOF Domain 4: Safeguarding Adults Whose Circumstances Make Them Vulnerable and Protecting From Avoidable Harm

From the Adult Social Care Survey indicator 4A is the proportion of people who use services who feel as safe as they want, while indicator 4B is the proportion of people who use services who say that those services have made them feel safe and secure. The proportions of service users reporting they feel as safe as they want to be from the 2016/17 Adult Social Care Survey are shown in Figure 46 for Hull and comparators. More than two thirds of respondents in Hull reported feeling as safe as they want (70%), similar to England and the Yorkshire and Humber region, as well as similar to many of the ten comparator local authorities and North East Lincolnshire. The proportion of respondents in Adult Social Care Survey who answered “Yes” to the question “Do care and support services help you in feeling safe?” are shown in Figure 47 for Hull and comparator areas. Three-quarters of respondents in Hull reported that care and support services helped them in feeling safe (75%), higher than England (70%) and the Yorkshire and Humber region (69%), as well as higher than eight of the ten comparator local authorities and North East Lincolnshire. The underlying data for Figure 46 and Figure 47 are given in the APPENDIX on page 177. Figure 46: ASCOF 4A – The proportion of people who use services who feel safe, 2016/17




Figure 47: ASCOF 4B – The proportion of people who use services who say that those services have made them feel safe and secure, 2016/17

7.11 Projected Future Need Among Those Aged 18-64 Years Predictions of future social care need in relation to substance abuse, mental health, learning disabilities and physical disabilities are available on PANSI (www.pansi.org.uk) to 2030 for Hull for persons aged 18-64 years and on POPPI (www.poppi.org.uk) for persons aged 65+ years. Further information relating to the needs of people aged 65+ years is also available in Hull JSNA Toolkit: Older People. 7.11.1 Substance Abuse Table 51 gives the current estimates and predictions of future needs to 2035 are given for those aged 18-64 years from Projecting Adult Needs and Service Information (PANSI) system (www.pansi.org.uk) for alcohol dependence and drug dependence. The underlying prevalence estimates were derived from the Adult Psychiatric Morbidity Survey (Health and Social Care Information Centre 2009). Harmful drinking denotes the most hazardous use of alcohol, at which damage to health is likely. One possible outcome of harmful drinking is alcohol dependence, a cluster of behavioural, cognitive, and physiological phenomena that typically include a strong desire to consume alcohol, and difficulties in controlling drinking. It should be noted that a survey of the household population such as this is likely to under-represent dependent


http://www.pansi.org.uk/

http://www.poppi.org.uk/




adults, who are more likely to be homeless or in an institutional setting. Moreover, problem drinkers who do live in private households may, like problem drug users, be less available, able or willing to participate in surveys. Drug misuse has been defined as the use of a substance for purposes not consistent with legal or medical guidelines. In a small proportion of users, this may lead to dependence, a cluster of behavioural, cognitive, and physiological phenomena, such as a sense of need or dependence, impaired capacity to control substance-taking behaviour and persistent use despite evidence of harm. Table 51: PANSI – population projections to 2035 for those aged 18-64 years in Hull with alcohol and drug dependence

Dependence Gender Projected numbers of Hull residents aged 18-64 years

with alcohol and drug dependence

2017 2020 2025 2030 2035

Alcohol

Males 7,273 7,256 7,169 7,160 7,143

Females 2,656 2,623 2,574 2,541 2,515

Total 9,930 9,879 9,743 9,701 9,657

Drugs

Males 3,762 3,753 3,708 3,704 3,695

Females 1,851 1,828 1,794 1,771 1,753

Total 5,613 5,581 5,502 5,474 5,447

7.11.2 Mental Health Table 52 gives the current estimates and predictions of future needs to 2035 are given for those aged 18-64 years from PANSI (www.pansi.org.uk) for common mental health conditions. The underlying prevalence estimates are derived from the Adult Psychiatric Morbidity Survey (Health and Social Care Information Centre 2009). PANSI state that “Common mental disorders (CMDs) are mental conditions that cause marked emotional distress and interfere with daily function, but do not usually affect insight or cognition. They comprise different types of depression and anxiety, and include obsessive compulsive disorder. The report found that 19.7% of women and 12.5% of men surveyed met the diagnostic criteria for at least one CMD. Personality disorders are longstanding, ingrained distortions of personality that interfere with the ability to make and sustain relationships. Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are two types with particular public and mental health policy relevance. ASPD is characterised by disregard for and violation of the rights of others. People with ASPD have a pattern of aggressive and irresponsible behaviour which emerges in childhood or early adolescence. They account for a disproportionately large proportion of crime and violence committed. ASPD was present in 0.3% of adults aged 18 or over (0.6% of men and 0.1% of women). BPD is characterised by high levels of personal and emotional instability associated with significant impairment. People with BPD have severe





difficulties with sustaining relationships, and self-harm and suicidal behaviour is common. The overall prevalence of BPD was similar to that of ASPD, at 0.4% of adults aged 16 or over (0.3% of men, 0.6% of women). Psychoses are disorders that produce disturbances in thinking and perception severe enough to distort perception of reality. The main types are schizophrenia and affective psychosis, such as bi-polar disorder. The overall prevalence of psychotic disorder was found to be 0.4% (0.3% of men, 0.5% of women). In both men and women the highest prevalence was observed in those aged 35 to 44 years (0.7% and 1.1% respectively). The age standardised prevalence of psychotic disorder was significantly higher among black men (3.1%) than men from other ethnic groups (0.2%of white men, no cases observed among men in the South Asian or ‘other’ ethnic group). There was no significant variation by ethnicity among women. Psychiatric comorbidity - or meeting the diagnostic criteria for two or more psychiatric disorders - is known to be associated with increased severity of symptoms, longer duration, greater functional disability and increased use of health services. Disorders included the most common mental disorders (namely anxiety and depressive disorders) as well as: psychotic disorder; antisocial and borderline personality disorders; eating disorder; posttraumatic stress disorder (PTSD); attention deficit hyperactivity disorder (ADHD); alcohol and drug dependency; and problem behaviours such as problem gambling and suicide attempts. Just under a quarter of adults (23.0%) met the criteria or screened positive for at least one of the psychiatric conditions under study. Of those with at least one condition: 68.7% met the criteria for only one condition, 19.1% met the criteria for two conditions and 12.2% met the criteria for three or more conditions. Numbers of identified conditions were not significantly different for men and women.” Table 52: PANSI – population projections to 2035 for those aged 18-64 years in Hull with common mental health problems

Gender Mental health condition

Projected numbers of Hull residents aged 18-64 years with common mental

health problems

2017 2020 2025 2030 2035

Males

Common mental health disorder

10,450 10,425 10,300 10,288 10,263

Borderline personality disorder 251 250 247 247 246

Antisocial personality disorder 502 500 494 494 493

Psychotic disorder 251 250 247 247 246

Two or more psychiatric disorders

5,768 5,755 5,686 5,679 5,665

Females

Common mental health disorder

15,859 15,662 15,366 15,169 15,011

Borderline personality disorder 483 477 468 462 457

Antisocial personality disorder 81 80 78 77 76

Psychotic disorder 403 398 390 385 381

Two or more psychiatric disorders

6,038 5,963 5,850 5,775 5,715




7.11.3 Learning Disabilities Table 53 gives the estimated number and population projections for those aged 18+ years in Hull who are expected to have learning disabilities. Table 54 gives the estimated number and population projections for those aged 18+ years in Hull who are expected to have moderate or severe learning disabilities, and therefore likely to be in receipt of services. There were 1,457 patients aged 18+ years on the GP registers for learning disability for 2015/16. It is possible that the definitions differ, but if the figures in Table 54 then this suggests that the majority of people with moderate or severe learning disability might be diagnosed as such and included on the GP disease registers, along with some of the people who have milder forms of learning disability. These predictions are based on prevalence rates in a report by Emerson and Hatton (Emerson and Hatton 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. Using prevalence estimates from the Improving Health and Lives Learning Disabilities Observatory and Emerson (Emerson, Hatton et al. 2010), it is estimated that the prevalence of autism amongst adults with learning disability was between 20% and 33%. Thus if it is estimated that 4,851 have a learning disability in Hull, then it is estimated that between 970 and 1,601 of these people have autism. Table 53: POPPI and PANSI – population projections to 2035 for those aged 18+ years in Hull with learning disabilities Age (years) Projected numbers of Hull residents aged 18+ years with

learning disabilities

2017 2020 2025 2030 2035

18-24 768 721 704 783 785

25-34 1,041 1,038 989 916 944

35-44 777 781 838 870 838

45-54 791 754 690 680 729

55-64 657 696 713 673 612

65-74 473 497 508 566 588

75-84 251 259 313 348 367

85+ 94 98 111 126 167

Total 18-64 4,034 3,990 3,933 3,923 3,909

Total 65+ 817 855 932 1,039 1,122

Total 18+ 4,851 4,845 4,864 4,962 5,030




Table 54: POPPI and PANSI – population projections to 2035 for those aged 18+ years in Hull with moderate or severe learning disabilities

Age (years) Projected numbers of Hull residents aged 18+ with moderate

or severe learning disabilities

2017 2020 2025 2030 2035

18-24 177 167 165 185 186

25-34 223 223 212 197 203

35-44 195 196 211 219 211

45-54 178 170 155 155 167

55-64 143 152 154 145 131

65-74 77 80 82 92 95

75-84 26 27 33 35 37

85+ 9 9 10 12 15

Total 18-64 916 907 897 901 898

Total 65+ 112 116 125 139 147

Total 18+ 1,028 1,023 1,022 1,040 1,046

7.11.4 Physical Disabilities Table 55 gives the projected numbers with a moderate or serious physical disability for 2017, 2020, 2025, 2030 and 2035 among Hull residents aged 18-64 years. This table is based on the prevalence data for moderate and serious disability by age and sex included in the Health Survey for England, 2001 (Bajekal, Primatesta et al. 2003). The prevalence rates have been applied to ONS population projections of the 18 to 64 population to give estimated numbers predicted to have a moderate or serious physical disability to 2030. Table 55: Projected numbers with moderate or severe physical disabilities in Hull to 2035 among those aged 18-64 years

Severity of physical disability

Age (years) Projected numbers of Hull residents aged 18-64 years with moderate or serious physical

disabilities

2017 2020 2025 2030 2035

Moderate

18-24 1,164 1,095 1,070 1,193 1,197

25-34 1,756 1,751 1,667 1,546 1,592

35-44 1,770 1,775 1,898 1,966 1,887

45-54 3,279 3,114 2,832 2,784 2,968

55-64 4,306 4,559 4,679 4,410 4,008

Total 18-64 12,274 12,294 12,147 11,899 11,652




Severity of physical disability

Age (years) Projected numbers of Hull residents aged 18-64 years with moderate or serious physical

disabilities

2017 2020 2025 2030 2035

Serious

18-24 227 214 209 233 234

25-34 167 167 159 147 152

35-44 537 539 576 597 573

45-54 913 867 788 775 826

55-64 1,676 1,775 1,821 1,717 1,560

Total 18-64 3,520 3,561 3,554 3,468 3,345

Moderate or serious

18-24 1,391 1,309 1,279 1,426 1,431

25-34 1,923 1,918 1,826 1,693 1,744

35-44 2,307 2,314 2,474 2,563 2,460

45-54 4,192 3,981 3,620 3,559 3,794

55-64 5,982 6,334 6,500 6,127 5,568

Total 18-64 15,794 15,855 15,701 15,367 14,997

Table 56 gives the projected numbers with a moderate or serious personal care disability, and hence potentially requiring social care, for 2017, 2020, 2025, 2030 and 2035 among Hull residents aged 18-64 years. This table is based on the prevalence data on adults with physical disabilities requiring personal care by age and sex in the Health Survey for England, 2001 (Bajekal, Primatesta et al. 2003). These include: getting in and out of bed, getting in and out of a chair, dressing, washing, feeding, and use of the toilet. A moderate personal care disability means the task can be performed with some difficulty; a severe personal care disability means that the task requires someone else to help. The prevalence rates have been applied to ONS population projections of the 18 to 64 population to give estimated numbers predicted to have a moderate or serious physical disability and requiring personal care, to 2035.




Table 56: Projected future social need care for physical health in Hull to 2035 for those aged 18-64 years Severity of personal care disability

Age Projected numbers of Hull residents aged 18-64 years with a personal care disability

2017 2020 2025 2030 2035

Moderate

18-24 170 160 157 175 175

25-34 585 584 556 515 531

35-44 916 919 983 1018 977

45-54 1,656 1,573 1,431 1,406 1,499

55-64 2,543 2,693 2,763 2,605 2,367

Total 18-64 5,870 5,929 5,890 5,719 5,549

Serious

18-24 114 107 104 116 117

25-34 167 167 159 147 152

35-44 190 190 203 211 202

45-54 372 353 321 316 337

55-64 491 520 534 503 457

Total 18-64 1,334 1,337 1,321 1,293 1,265

Moderate or serious

18-24 284 267 261 291 292

25-34 752 751 715 662 683

35-44 1106 1109 1186 1229 1179

45-54 2028 1926 1752 1722 1836

55-64 3034 3213 3297 3108 2824

Total 18-64 7,205 7,266 7,211 7,012 6,814




7.12 Looked After Children The Department for Education provides local authority level data on looked after children (www.education.gov.uk/rsgateway/DB/SFR/). All data is rounded to the nearest 5. At 31st March 2014, there were 640 looked after children in Hull; this equates to 117 per 10,000 children aged under 18, the second highest rate that there has been during the past 5 years. It is also the highest rate in the Yorkshire & the Humber region, being 80% higher than the rate for the region (65 per 10,000 under 18 year olds) and 95% higher than the rate for England (60 per 10,000 under 18 year olds). Of these 640 looked after children in Hull the majority were subject to full care orders (57%) or interim care orders (6%). Around three-quarters (73%) of the 640 looked after children were within foster placements at 31st March 2014. The demographic of looked after children at 31st March 2011 included slightly more boys than girls (55% compared to 45%), with the most prevalent age group being those aged 10-15 (34%). The overwhelming majority of the 640 looked after children in Hull as at 31st March 2014 were of white ethnic origin (94%). Of the 640 children being looked after at 31 March 2014, 495 (77%) had been looked after for a period of 12 months or more. Further details relating to health, substance abuse, offending and education is available on these 495 children:

The majority had received routine healthcare interventions – 92% of children were up to date with their immunisations, 90% had their teeth checked by a dentist and 95% had received an annual health check assessment. All children aged 5 or under were up to date with their development assessments.

2.4% of the 495 children looked after for more than 12 months Ten were identified as having a substance misuse problem during the year.

Twenty-five (8.8% ) children aged 10 or over who had been looked after continuously for twelve months or more had been convicted or subject to a final warning or reprimand during the 2013/14 financial year.

A total of 345 of these children were of school age as at 31st March 2014. Of these, 56% had special educational needs (SEN); 37% without a statement and 19% with a statement. In 2014, of the 50 children who had been looked after continuously for twelve months or more who were eligible and entered for GCSEs, one third achieved 5 GCSEs graded A*-C. In 2013, of the 315 looked-after children eligible for full-time schooling, 9.2% had received at least one fixed exclusion.


http://www.education.gov.uk/rsgateway/DB/SFR/



7.13 Social Isolation Among Social Care Users and Their Carers One of the indicators from the Public Health Outcomes Framework (PHOF) which was published in January 2012 (Department of Health 2012; Department of Health 2012) relates to social isolation among social care users and adult carers. Further information about the PHOF is given within section 10.7.3 on page 154. Screenshots from the latest Public Health Outcomes Framework report produced by Hull Public Health Sciences (Porter 2015) are shown in this section for the two sub-indicators relating to this indicator (social isolation among social care users and social isolation among their carers). This report is updated regularly as and when new data are released. The full report may be downloaded from www.hullcc.gov.uk/pls/hullpublichealth/. 7.13.1 Social Care Users Table 57 gives the percentage of respondents to the Adult Social Care Users Survey who responded to the question "Thinking about how much contact you've had with people you like, which of the following statements best describes your social situation?" with the answer "I have as much social contact I want with people I like". For the most recent period 2015/16, the percentage in Hull was significantly higher than for England, the Yorkshire and Humber region and the average of the ten comparator local authorities, being higher than each of the comparators. Figure 48 gives the latest screenshot from the local PHOF analysis for this sub-indicator.





Table 57: Percentage of adult social care users who have as much social contact they want with people they like

Geographical area

Adult social care users who have as much social contact they want with people they like (%)

2012/13 2013/14 2014/15 2015/16

England 43.2 (42.7, 43.7) 44.5 (44.1, 44.9) 44.8 (44.4, 45.2) 45.4 (45.0, 45.8)

Hull 48.5 (43.7, 53.3) 44.5 (40.0, 49.0) 47.1 (43.0, 51.2) 54.2 (49.7, 58.6)

Yrks. & Humber 45.4 (44.1, 46.7) 44.2 (43.0, 45.4) 45.7 (44.5, 46.9) 46.0 (44.8, 47.2)

Wolverhampton 46.3 (41.8, 50.8) 45.2 (40.2, 50.2) 52.6 (47.6, 57.6) 50.8 (45.6, 56.0)

Salford 37.5 (33.3, 41.7) 38.0 (35.4, 40.6) 39.5 (36.8, 42.2) 40.7 (37.6, 43.8)

Derby 45.9 (41.1, 50.7) 46.0 (41.6, 50.4) 42.7 (38.3, 47.1) 42.2 (37.2, 47.3)

Stoke-on-Trent 43.3 (38.5, 48.1) 41.4 (36.5, 46.3) 39.1 (34.5, 43.7) 39.3 (34.5, 44.3)

Coventry 44.9 (40.3, 49.5) 47.7 (42.8, 52.6) 43.1 (38.1, 48.1) 47.7 (42.5, 52.9)

Plymouth 48.7 (43.6, 53.8) 43.8 (39.0, 48.6) 46.4 (41.9, 50.9) 47.5 (42.7, 52.4)

Sandwell 44.4 (39.2, 49.6) 47.5 (42.9, 52.1) 51.5 (47.1, 55.9) 51.4 (47.4, 55.4)

Middlesbrough 42.6 (36.9, 48.3) 52.4 (48.5, 56.3) 51.7 (46.8, 56.6) 52.2 (48.0, 56.4)

Sunderland 45.3 (40.6, 50.0) 53.1 (49.2, 57.0) 48.4 (44.5, 52.3) 47.8 (43.8, 51.9)

Leicester 38.6 (34.5, 42.7) 39.0 (35.3, 42.7) 35.6 (31.9, 39.3) 37.2 (33.4, 41.1)

Avg. above 10 43.4 (38.5, 48.3) 44.3 (40.1, 48.7) 44.1 (39.7, 48.5) 45.2 (41.0, 49.6)

NE Lincolnshire 42.8 (37.0, 48.6) 47.8 (42.9, 52.7) 40.4 (35.2, 45.6) 46.3 (40.8, 51.9)




Figure 48: Public Health Outcomes Framework indicator 1.18i Social isolation among adult social care users




7.13.2 Adult Carers Table 58 gives the percentage of respondents to the Personal Social Services Carers Survey who responded to the question “Thinking about how much contact you have had with people you like, which of the following best describes your social situation?” with the answer “I have as much social contact I want with people I like”. The percentage of adult carers taking part in the survey who have enough contact with others is similar to the average of other geographical comparator areas. Figure 49 gives the latest screenshot from the local PHOF analysis for this sub-indicator. Table 58: Percentage of adult carers who have as much social contact they want with people they like

Geographical area

Adult carers who have as much social contact they want with people they like, % (95% confidence interval)

2012/13 2014/15

England 41.3 (40.9, 41.7) 38.5 (38.0, 39.0)

Hull 38.2 (33.9, 42.5) 38.5 (33.6, 43.4)

Yrks. & Humber 44.4 (43.3, 45.5) 40.5 (39.3, 41.7)

Wolverhampton 33.2 (29.2, 37.2) 32.1 (28.7, 35.5)

Salford 40.0 (37.2, 42.8) 37.6 (34.9, 40.3)

Derby 36.9 (32.6, 41.2) 33.5 (29.7, 37.3)

Stoke-on-Trent 41.7 (37.5, 45.9) 48.0 (43.3, 52.7)

Coventry 35.2 (31.6, 38.8) 38.4 (33.9, 42.9)

Plymouth 36.5 (32.7, 40.3) 33.2 (28.3, 38.1)

Sandwell 40.2 (36.5, 43.9) 45.7 (40.6, 50.8)

Middlesbrough 47.1 (42.5, 51.7) 40.0 (34.7, 45.3)

Sunderland 40.6 (36.8, 44.4) 40.7 (36.6, 44.8)

Leicester 32.0 (28.1, 35.9) 31.9 (28.2, 35.6)

Avg. above 10 38.4 (33.9, 43.2) 37.9 (33.1, 42.9)

NE Lincolnshire 46.8 (41.9, 51.7) 43.8 (39.1, 48.5)




Figure 49: Public Health Outcomes Framework indicator 1.18ii Social isolation among adult carers




8 PUBLIC HEALTH OUTCOMES FRAMEWORK Further information about the Public Health Outcomes Framework (PHOF) which was published in January 2012 (Department of Health 2012; Department of Health 2012) is given within section 10.7.3 on page 154.

8.1 1.06 – Adults With a Learning Disability and Adults in Contact with Secondary Mental Health Service in Appropriate Accommodation

One of the PHOF indicators relates to adults with a learning disability and adults in contact with secondary mental health services being in stable and appropriate accommodation (see Hull JSNA Toolkit: Mental Health and Learning Disabilities available at www.hullcc.gov.uk/pls/hullpublichealth/).

8.2 1.10 - Killed or Seriously Injured on Roads One of the PHOF indicators relates to the number of people killed or injured on the roads per 100,000 population. Further information is given within Hull JSNA Toolkit: Accidents available at www.hullcc.gov.uk/pls/hullpublichealth/.

8.3 1.14 – Exposure to Noise One of the PHOF indicators relates to exposure to excess noise, with three sub-indicators, with further information given in section 6.4 on page 79. Sub-indicator 1.14i relates to the number of complaints about noise per 1,000 population. Table 35 gives the number of complaints about noise per 1,000 population for Hull and comparator areas, while Figure 17 gives the latest screenshot from the local PHOF analysis for this indicator (Porter 2015). Sub-indicators 1.14ii and 1.14iii relate to the percentage of the population that is affected by excessive transport noise during the daytime and at night-time. Table 36 gives the percentage of the population affected by excessive transport noise for Hull and comparator areas, while Figure 18 and Figure 19 give the latest screenshots from the local PHOF analysis (Porter 2015) excessive transport noise in the daytime and the night-time respectively.

8.4 1.15 – Statutory Homelessness One of the PHOF indicators relates to statutory homelessness, with two sub-indicators, with further information given in section 5.2 on page 49. Indicator 1.15i relates to the number of households accepted as statutorily homeless per 1,000 total households,






while sub-indicator 1.15ii relates to the number of households living in temporary accommodation per 1,000 total households. Figure 4 and Figure 6 give the latest screenshots from the local PHOF analysis for sub- indicators 1.15i and 1.15ii respectively (Porter 2015).

8.5 1.16 – Utilisation of Outdoor Space for Exercise or Health Reasons

One of the PHOF indicators relates to a measure of the use of outdoor spaces for exercise or health reasons. Further information is given in section 6.1.1 on page 68. Table 33 gives the survey percentages for Hull and comparator areas, while Figure 11 gives the latest screenshot from the local PHOF analysis for this indicator (Porter 2015).

8.6 1.17 – Fuel Poverty One of the PHOF indicators relates to a measure of relative fuel poverty of households. Further information is given in section 4.3.2 on page 23. Table 2 gives the percentages in fuel poverty for Hull and comparator areas. Figure 1 gives the latest screenshot from the local PHOF analysis for this indicator (Porter 2015), while Figure 2 shows the percentage of households spending 10% or more of their income on fuel, by lower layer super output area.

8.7 1.18 – Social Isolation Among Social Care Users and Their Carers

One of the PHOF indicators relates to the social isolation among social care users and adult carers, and further information is given in section 7.13 on page 126. Table 57 gives the percentage of respondents to the Adult Social Care Users Survey who responded to the question "Thinking about how much contact you've had with people you like, which of the following statements best describes your social situation?" with the answer "I have as much social contact I want with people I like". Table 58 presents the equivalent information from respondents to the Personal Social Services Carers Survey. Figure 48 and Figure 49 give the latest screenshots from the local PHOF analysis for these two sub-indicators.

8.8 1.19 – Older People’s Perception of Community Safety One of the PHOF indicators relates to the perception of community safety among those aged 65+ years, although currently the data has only been released for England and not for each local authority. Further information is given within Hull JSNA Toolkit: Older People, available at www.hullcc.gov.uk/pls/hullpublichealth/.





8.9 3.01 – Mortality Attributable to Air Pollution One of the PHOF indicators relates to mortality attributable to air pollution. Further information is given in section 6.3.2 on page 76. Table 34 gives the estimated fraction of mortality attributable to air pollution for Hull and comparator areas, while Figure 16 gives the latest screenshot from the local PHOF analysis for this indicator (Porter 2015).

8.10 3.06 – Public Sector Organisations With Sustainable Development Plans

One of the PHOF indicators relates to NHS organisations with a board approved sustainable development policy. Further information is given in section 6.5 on page 85. Table 37 gives the percentages for Hull and comparator areas, while Figure 20 gives the latest screenshot from the local PHOF analysis for this indicator (Porter 2015).

8.11 3.07 – Comprehensive, Agreed Inter-Agency Public Health Incident Plans

One of the PHOF indicators relates to having comprehensive, agreed inter-agency public health incident plans. However, the definition for this indicator has not yet been finalised and as a result no national or local information on this indicator is available.




9 REFERENCES Bajekal, M., P. Primatesta, et al. (2003). Health Survey for England 2001. London,

Department of Health. Bramley, G., S. Fitzpatrick, et al. (2015). Hard edges: mapping severe and multiple

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Communities and Local Government (2011). Housing, live tables. www.communities.gov.uk. London, Communities and Local Government.

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Department for Environment Food and Rural Affairs (2010). Download current versions of background maps for years 2008 to 2020 (NOx, NO2, PM10 and PM2.5). http://laqm.defra.gov.uk/maps/maps2008.html#anch5. London, Department for Environment Food and Rural Affairs.

Department of Energy and Climate Change (2014). 2012 sub-regional fuel poverty data: low income high costs indicator. https://www.gov.uk/government/statistics/2012-sub-regional-fuel-poverty-data-low-income-high-costs-indicator. London, Department of Energy and Climate Change.

Department of Health (2012). Improving outcomes and supporting transparency. Part 1: A public health outcomes framework for England, 2013-2016. London, Department of Health.

Department of Health (2012). Improving outcomes and supporting transparency. Part 2: Summary technical specifications of public health indicators, January 2012. London, Department of Health.

Department of Health (2013). The Adult Social Care Framework 2013/14 Handbook of Definitions. London, Department of Health.

Economic and Social Data Service (2008). General Household Survey. www.esds.ac.uk. Essex and Manchester, Economic and Social Data Service.

Emerson, E. and C. Hatton (2004). Estimating the current need/demand for supports for people with learning disabilities in England. www.lancs.ac.uk. Lancaster, Institute for Health Research, Lancester University.

Emerson, E., C. Hatton, et al. (2010). People with learning disabilities in England 2010. www.improvinghealthandlives.org.uk. London, Improving Health and Lives: Learning Disabilities Observatory.

Glendinning, C., H. Arksey, et al. (2009). Indicidual Budgets Pilot Projects: Impact and outcomes for carers. York, Social Policy Research Unit, University of York.


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http://www.gov.uk/government/statistics/2012-sub-regional-fuel-poverty-data-low-income-high-costs-indicator

http://www.esds.ac.uk/

http://www.lancs.ac.uk/

http://www.improvinghealthandlives.org.uk/



Glendinning, C., D. Challis, et al. (2008). Evaluation of the Individual Budgets Pilot Programme: Final Report. York, Social Policy Research Unit, University of York.

Health and Social Care Information Centre (2009). Adult Psychiatric Morbidity in England - 2007, Results of a household survey. London, Health and Social Care Information Centre.

Health and Social Care Information Centre (2014). Abuse of Vulnerable Adults in England 2012-13. Leeds, Health and Social Care Information Centre www.hscic.gov.uk.

Health Survey for England (2008). Health Survey for England. www.ic.nhs.uk. London, Economic and Social Data Service.

Homeless Link (2013). Survey of Needs and Provision (http://www.homeless.org.uk/sites/default/files/site-attachments/SNAP2013_Full_Report.pdf), Homeless Link

Homelessness Link. (2013). "Understanding Homelessness: Impact of homelssness." Retrieved 20/05/2015, 2015.

Hull City Council (2011). Housing and Neighbourhood Renewal Strategy 2011-2016. Hull, Hull City Council. www.hullcc.gov.uk.

Hull City Council (2013). Hull Strategic Housing Market Assessment. Hull, Hull City Council.

Hull City Council and NHS Hull Clinical Commissioning Group (2014). Hull - Healthier together. Health and Wellbeing Strategy 2014-2020. Hull, Health and Wellbeing Board.

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Information Centre for Health and Social Care (2010). Statistics on NHS Stop Smoking Services England, April 2009 – March 2010. www.ic.nhs.uk. London, Information Centre for Health and Social Care.

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Public Health England (2015). Public Health Outcomes Framework data tool. www.phoutcomes.info/. London, Public Health England.







10 APPENDIX

10.1 Data Sources The data sources for each table and figure included within this report are listed in section 10.10 on page 178. Local and national data is available from the NHS Digital Information Portal (https://indicators.hscic.gov.uk/webview/) which was previously the NHS Information Centre Indicator Portal and prior to that the Compendium (of Clinical and Health Indicators). The information provided is quite varied, such as resident population estimates, information from the Quality and Outcomes Framework (GP disease and quality of care registers), age-specific and indirectly and directly standardised mortality rates for the main causes of death, cancer incidence, screening uptake rates, number of births, fertility rates, hospital episode statistics, standardised admission or procedural rates for a limited number of diseases or procedures, etc. The NHS Digital Indicator Portal provides information for different geographical areas (national – England, regional, and at local authority and/or CCG level). Some information, particularly mortality rates, is usually provided for males and females separately and combined, and for different age groups. The standardised mortality rates are generally provided for all ages and for those aged under 75 years, with (indirectly) standardised mortality ratios (SMRs) standardised to the English population and the directly standardised mortality rates standardised to the 2013 European Standard Population. This report generally uses the mortality rates from the NHS Digital Indicator Portal when presenting information for Hull overall, because these are the nationally recognised figures and it is also useful to have the equivalent comparison information for England, the local region and comparator areas. It is possible to also produce locally estimated figures. Occasionally, these figures differ very slightly from the nationally produced figures. A number of other datasets and reports are available from the NHS Digital (http://content.digital.nhs.uk/home). For indicators within the Public Health Outcomes Framework (PHOF), England and the local authority level data can be downloaded at www.phoutcomes.info. The Excel data file also contains a “meta data” worksheet which contains information about the definition of the indicator and the data sources. In some indicators, reference is made to nationally available data which is available at geographical areas smaller than local authorities. For other indicators, it is possible to calculate the indicator at different geographical area using local data (e.g. using hospital records or mortality data). A number of other datasets and reports are available from the Information Centre (www.ic.nhs.uk), including vaccination data (Information Centre for Health and Social Care 2011) and Stop Smoking Service data (Information Centre for Health and Social Care 2010).


https://indicators.hscic.gov.uk/webview/

http://content.digital.nhs.uk/home





Information from the 2011 Census is available for different geographical areas from http://neighbourhood.statistics.gov.uk and www.nomisweb.co.uk/census/2011. Information relating to the Index of Multiple Deprivation 2015 was downloaded from the Communities and Local Government website (Communities and Local Government 2015). ACORN and Health ACORN classifications at postcode and output area level were purchased from CACI (www.caci.co.uk/insite). Customer profile types (housing types) were obtained from Hull City Council who derived the profiles. The prevalence from the Quality and Outcomes Framework (QOF) GP disease registers (see section 10.5 on page 142 for more information) have been taken from Excel files downloaded from the Information Centre (Information Centre for Health and Social Care 2010). The GP registration file was available on the Primary Care Information System (PCIS), previously known as Open Exeter (Connecting for Health, 2009). This file included individual level data on all people registered with GPs within the Hull and East Riding of Yorkshire PCTs (plus a few practices outwith this area). The file included gender, date of birth, GP information and the postcode of the residence, and was merged with the NHS postcode lookup file so that other geographical information was available (e.g. lower layer super output areas). From this file, an estimate of the resident population could be derived for subpopulations of Hull, such as the number of residents based on ward or deprivation scores (derived from the Index of Multiple Deprivation 2015 score assigned to the lower layer super output area (LLSOA) geography which includes the residents’ postcodes, see Hull JSNA Toolkit: Deprivation and Associated Measures and section 3.4 on page 15 for more information about deprivation scores). However, since 2013, individual-level population data has not been available. Aggregated data is still available for each primary care practice11, and has been used in some local analyses in particular analyses involving the registered or patient population of Hull such as the analysis of the QOF GP disease registers. For local analyses which require an estimate of the resident population, figures from the Office for National Statistics have been used who produce estimates at ward and LLSOA level as well as for Hull overall. Their estimates are produced for each gender separately and by single year of age. Breast and cervical cancer screening uptake rates are also available from PCIS at practice level. The Public Health Mortality Files (PHMF) and the Public Health Birth Files (PHBF) are both available to PCTs and more recently Public Health analysts at the local authority from the Office for National Statistics (most recently via the Primary Care Mortality Database). These files contain individual records for all deaths and births respectively in Hull. The age, gender and postcode of each individual are included in the file. The PHMF includes the date of death, underlying cause of death and place of death. The PHMF has been used for analyses involving the calculation of the number of deaths from specific causes as well as the calculation of standardised rates when mortality

11

For all primary care practices in England, the number of registered patients by gender and single year of age is available, as well as the total number of registered patients living in each LLSOA.


http://neighbourhood.statistics.gov.uk/

http://www.nomisweb.co.uk/census/2011

http://www.caci.co.uk/insite



information has been presented for wards and other local geographical areas, or by deprivation quintiles. For these analyses, resident population estimates were derived from the GP registration file mentioned above (Connecting for Health, 2009). In some cases, the estimate for Hull has been presented, but this will not be the same as the figure produced in the NHS Information Centre Indicator Portal due to the differing population estimates. In these circumstances, the figure from the NHS Information Centre Indicator Portal should be used in preference to any locally derived figures. Using the resident population estimate from the GP registration file tends to produce a slightly higher life expectancy estimate and a slightly lower directly standardised mortality rate compared to the NHS Information Centre Indicator Portal, because the local population estimate (from the GP file) is slightly higher than ONS’s estimate. Patient level data for daycase and inpatient admissions was obtained from local Hospital Episode Statistics (Office for National Statistics 2009; Information Centre for Health and Social Care 2014). Prior to April 2013, the HES dataset was provided by colleagues in the Performance team of NHS Hull. The file included patient’s gender, date of birth, dates of admission and discharge, primary and secondary causes of admission and information on any surgical procedures undertaken as well as the type of admission (daycase, elective or emergency). For more information about Hospital Episode Statistics data, see section 10.4 on page 142. Projected population estimates were obtained from the Office for National Statistics (ONS) from www.statistics.gov.uk. Local information on the prevalence of lifestyle and behavioural risk factors and measures of social capital was obtained from local surveys (see section 10.3 on page 140). National prevalence information was obtained from the General Lifestyle Survey (previously General Household Survey) (Economic and Social Data Service 2008), the Health Survey for England (Health Survey for England 2008) or Integrated Household Survey (Office for National Statistics 2013). Alternatively, for indicators within the Public Health Outcomes Framework, the data from the PHOF data tool was used (Public Health England 2015) or data from sources quotes from within the “metadata” worksheet within Excel data file downloaded from the PHOF data tool website. Information relating to housing was obtained online from the Housing Live Tables (Communities and Local Government 2011). Population projections relating to older people were obtained from the Projecting Older People Population Information System (POPPI) website (see www.poppi.org.uk). Social care information was obtained from Projecting Adult Needs and Service Information (PANSI) (Oxford Brookes University and Institute of Public Care 2012). Yorkshire & the Humber Public Health Observatory Programme Budgeting and Marginal Analysis toolkit was available from www.yhpho.org.uk.


http://www.statistics.gov.uk/


http://www.yhpho.org.uk/



10.2 Synthetic or Modelled Estimates Synthetic or modelled estimates have been generated nationally, particularly in relation to estimating the prevalence of behavioural and lifestyle risk factors at local authority level. They are not based on ‘real’ data, but the estimates have been generated from a statistical model. There are a number of reasons why they can be misleading such as the poor quality or narrow focus of the original research, statistical problems with the model such as ‘over-fitting’ a model or lack of testing of the model, there are often problems with generalisability of the model, and there is often lack of transparency so it is not possible to assess the quality of the underlying research or the model or know when the model might be updated. Furthermore, just because the factors included in the model change (e.g. age distribution or number of benefit claimants), it does not necessarily mean that this will have a direct influence on the value obtained when the model is updated. The synthetic estimates that have been generated to estimate the smoking prevalence in Hull are misleading. Further more detailed discussion of the problems with synthetic estimates is available in the JSNA Toolkit: Glossary report. A further detailed document on this specific topic available at www.hullcc.gov.uk/pls/hullpublichealth/.

10.3 Local Surveys In order to have an impact on reducing inequity in health and preventing disease rather than just treating disease, it is necessary to influence people’s attitudes and behaviours towards health, and in order to accomplish this it is necessary to have knowledge about health-related attitudes and behaviours and people’s perceptions towards their health, as well as the prevalence of risk factors, such as smoking, and prevalence of diseases and medical conditions. National data are available for some health and lifestyle issues from nationally conducted surveys, but since this covers the whole of England, historically relatively few people within the local area have participate in the survey but more recently the numbers within each local authority are much larger. Information from these national surveys is useful as local results can be compared with national results (usually for England), e.g. prevalence of smoking, prevalence of alcohol consumption or general health status. However, in many cases different questions and response categories, and differences in the survey designs, mean that it is not straightforward to compare the results directly.





A number of local quantitative and qualitative surveys have been conducted as follows:

Adult Health and Lifestyle Surveys o 2003 o 2007 o 2009 o 2011-12 o 2014

Adult Black and Minority Ethnic Health and Lifestyle Surveys o 2007 o 2012

Young People Health and Lifestyle Surveys o 2002 o 2008-09 o 2012 o 2016

Veterans’ Health and Lifestyle Survey 2009

Social Capital Surveys o 2004 o 2009 o (2007, 2011-12 and 2014 Adult Health and Lifestyle Surveys also

contained some questions on social capital)

Qualitative and Social Marketing Research o Attitudes to Health Focus Groups 2007 o Reflector Groups Following 2007 Adult Health and Lifestyle Survey o Reflector Groups Following 2008-09 Young People Health and Lifestyle

Survey o Reflector Groups Following 2011-12 Adult Health and Lifestyle Survey o Reflector Groups Following 2012 Young People Health and Lifestyle

Survey Further information about each of these local surveys and all the survey reports can be found at www.hullcc.gov.uk/pls/hullpublichealth/ Further (less detailed) information about each survey is also given in the Hull JSNA Toolkit: Summaries and Information, and some of the other Hull JSNA Toolkit reports where local survey data is presented, for example, those reports reporting health status or the prevalence of risk factors.





Some other quantitative and qualitative surveys, and patient and public involvement projects have also been conducted by colleagues in NHS Hull as follows:

Other Surveys o 5-A-DAY Survey 2004 o Community Groups Physical Activity Survey 2006-09 (see Hull JSNA

Toolkit: Physical Activity for more information)

Patient and Public Involvement Projects o Membership o Listening Exercise “We’re All Ears”

Further information about these other surveys and patient and public involvement projects are given within the Hull JSNA Toolkit Release 4 report. A number of other research projects have examined attitudes towards risk factors and diseases for the purposes of informing local social marketing projects, and these are mentioned within the specific Hull JSNA Toolkit documents, e.g. Chronic Obstructive Pulmonary Disease, Breastfeeding.

10.4 Hospital Episode Statistics Hospital Episode Statistics (HES) refers to the data generated during a stay in hospital. Inpatient admission rates provide useful information about the general level of illness and the use of hospital services within geographical areas. Although many factors influence admission rates so findings should be interpreted cautiously with regard to assessing the general level of illness. A detailed discussion of this and a list of various factors which can influence the hospital admission rate are given in the JSNA Toolkit: Glossary document. These documents also explain the difference between “clinician episodes” and hospital stays.

10.5 Quality and Outcomes Framework As part of the General Medical Services contract implemented in April 2004, the Quality Outcomes and Framework (QOF) was set out as a means for practices to measure achievement against a set of clinical and other indicators that reflected the quality of care provided to their patients. As part of QOF, practices obtained funds for producing and maintaining disease registers for specific diseases. The data from these registers have been used to measure diagnosed prevalence of disease within each of the Hull JSNA Toolkit disease-specific reports. These prevalence estimates are not adjusted in any way for the patient population, and practices with a relatively high percentage of elderly patients or patients living in the most deprived areas will tend to have a higher prevalence of disease. Other factors which can influence the practice prevalence rates and further information about QOF are given within the JSNA Toolkit: Glossary report.




10.6 General Practice Groupings 10.6.1 Background The general practices in Hull differ with regard to their registered population in terms of deprivation and age of patients (and other characteristics). When assessing different characteristics of a practice in terms of health need, such as the prevalence of diagnosed disease, hospital admission rates or mortality rates, it is generally more useful to consider if a particular practice has a higher or lower prevalence or rate in relation to other similar Hull practices (comparing like-with-like12) rather than compare each practice with the Hull average or a national figure. The Index of Multiple Deprivation 2015 has been used to measure deprivation (see Hull JSNA Toolkit: Deprivation and Associated Measures and section 3.4 on page 15 for more information). Nationally, a deprivation score has been assigned to each of the lower layer super output areas (LLSOAs) within Hull. On average, 1,500 residents live in each of the 166 LLSOAs in Hull. This IMD 2015 score has been determined for each registered patient based on their postcode (and which of the 166 LLSOA they live within). There is an assumption that the average deprivation score for the LLSOA is representative for each registered patient and this might not be the case (the patients registered at a specific practice may be more deprived than the average for their area – see Hull JSNA Toolkit: Deprivation and Associated Measures for more information). The age distribution of all the patients registered with a practice is also known, so it is possible to calculate the average deprivation scores and average ages of the patients for each Hull practice. 10.6.2 Historical Groupings The primary care groups were originally defined using the IMD 2007 using the population as at April 2010 to calculate the average IMD score and average age of the patients and practices were grouped into eight different groups (in JSNA Toolkit Release 4). However, the local CCG preferred a four peer comparison groups with a small number of practices assigned to the same group for practical reasons, e.g. the practices share the same practice manager13. In 2013, these four groupings were derived from the average IMD 2010 score and average age of their patients to group practices into four different groups (least deprived, most deprived, middle deprivation group with younger population, middle deprivation group with older population).

12

Theoretically it is possible to group practices using more characteristics than deprivation and age, however, as the number of characteristics increase, in practice, it becomes much more difficult to group the practices into similar groups. 13

The Clinical Commissioning Group (CCG) asked if practices could be grouped into four different groups with certain practices included in the same group as the practice manager was the same, and they did not want to produce different ‘peer group’ reports if their practices were in two or more peer groups.




In November 2015, a new Index of Multiple Deprivation 2015 was published (see Hull JSNA Toolkit: Deprivation and Associated Measures and section 3.4 on page 15 for more information), and the local CCG were forming their own groups of practices for different purposes. Their groups were based on economies of scale, and were based on which practices were currently working together or which practices might work together in the future. Thus their groupings were more geographically based. Within the JSNA Toolkit reports, the reason for grouping practices was different, so a different set of groupings were produced using the GP registration file for April 2015. The public health deprivation primary care groupings were also calculated for practices that had since closed using the latest available population and deprivation information at the time, which might have been for example, based on the IMD 2007 and population data from the GP registration file as at October 2008. 10.6.3 Current Groupings Since then April 2015 and October 2017, the number of general practices in Hull has drastically decreased from 57 practices to 40 practices with a number of practices working together and ultimately merging into larger practices. In October 2017, new data was released by NHS Digital which gave the number of patients registered at each practice in England by single year of age (with the final category being 95+ years) for males and females separately and combined, and the number of patients living in each LLSOA who are registered with a specific practice for each practice in England. So it was necessary to update the deprivation groupings given the change in the number of practices in Hull. In practice, a small number of mergers had taken place or were currently happening, but clinical systems had not yet merged. This meant that there were 45 practices in Hull in the national GP registration file for October 2017 rather than 40 practices. As these were due to be merged fully, and future reporting at practice level was required, the GP registered population estimates for these practices were combined into a single record. This applied to five practices in Hull with practices B81692 (The Quays), Y00955 (Riverside Medical Centre), Y02896 (Story Street Practice and Walk In Centre) having separate records in the national file, but had merged with B81017 (Kingston Medical Group) so were combined into a single record (B81017). Practice Y01200 (The Calvert Practice) had a separate record in the national file, but had merged with B81675 (CHCP) so was combined with that practice into a single record (B81675). Practice B81682 (Longhill Health Centre) had a separate record in the national file, but had merged with B81008 (East Hull Family Practice) so was combined with that practice into a single record (B81008). As these five practices and others that had recently merged existed during the financial year 2016/17, there were also more than 40 individual practices for the QOF data for 2016/17. The data for practices that had subsequently merged were combined so that the QOF has been presented for 40 practices in Hull.




As data from some practices which had closed were merged with data from other practices to form the groups, it did not make sense to attempt to assign closed practices to the deprivation groups as their data had already been used to define the group for their current practice. There was also a question as to whether the group for a closed practice should be the same as the practice it has since merged with or whether it should be based on its deprivation data just prior to closure. Using either method would have been confusing, so it was decided not to assign deprivation groups to practices which had closed prior to October 2017. The October 2017 public health deprivation primary care groupings are based on the average IMD 2015 scores and not the average age of the patients. It can be seen that within Figure 50, the average age of the patients does not differ greatly except for practices with an average deprivation score under 30 or so. Thus, to simplify the primary care groupings, it was decided to simply group on deprivation alone. As five groupings have generally been used in other analyses such as those relating to deprivation, it was decided to use five primary care groups. In total, there were 297,237 patients registered with the 40 practices in Hull. If the practices were combined into five groups with approximately the same number of patients, then ideally there should be as close as possible to 59,447 patients registered to practices within each of the five deprivation groups. The 40 practices were sorted in order of deprivation, and the practice population were summed starting from the least deprived practice. For instance, the sum of the registered populations for the first nine least deprived practices was 53,439 patients and for the first ten least deprived practices the total registered population was 65,712. For each successive more deprived group, there was also a decision whether to use the number smaller or larger than 59,447 and both were used to examine potential groups. Sixteen different combinations of deprivation groupings were examined, and the combination where the total list size of the five groups was the most similar was chosen as the final ordering. This did mean that the differences in the average deprivation score for practices which were in adjacent groups could be very similar. It would have been difficult to group based on ‘different’ deprivation values and obtain similar sized groups in terms total registered population. The cut-off values for the average IMD score were chosen to be 29, 36.3, 42 and 48.4. This meant that average IMD scores ranged from 17.3 to 28.7 for group A (least deprived group), from 29.5 to 36.3 for group B, from 36.4 to 41.0 for group C, from 42.8 to 48.3 for group D and from 48.4 to 55.5 for group E (most deprived group). There were nine practices assigned to group A, six to group B, eight to group C, nine to group D and eight to group E. Table 59 and Figure 51 give the assigned groups for each practice based on the average deprivation score of their registered patients. In the figure, larger ‘dots’ represent practices with larger practice populations.




Figure 52 illustrates the same information as Figure 51 but the different CCG practice groups are also shown together with the average deprivation and scores of the CCG group totals. CCG practice groups are shown with a different border colour. Table 60 gives the CCG practice groups which relate to practices that are currently working together. The list relates to the current practice structure as at February 2018. Table 61 gives the total list sizes, average age of the registered patients and average IMD 2015 scores for the five CCG practice groups. A map illustrating the location of general practices in Hull is given In Hull JSNA Toolkit: Geographical Area.




Figure 50: Average deprivation score and average age of registered patients for each general practice as at October 2017

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Index of Multiple Deprivation 2015 score (averaged over all patients)




Figure 51: Average deprivation score and average age of registered patients for each general practice as at October 2017 and assignment to peer groups (based on deprivation alone)

Group A Group B Group C Group D Group E

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Figure 52: Average deprivation score and average age of registered patients for each general practice as at October 2017 and assignment to peer groups (based on deprivation alone) with average age and deprivation scores for each CCG practice shown (CCG practice groupings illustrated by colour of border of diamond)

Group A Group B Group C Group D Group E

Hull GPCollaborative

Hull HealthForward

ModalityCity HealthFederation

Medicas

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Average Index of Multiple Deprivation 2015 score of patients




Table 59: Average deprivation score and average age of registered patients for each general practice as at October 2017 and assignment to peer groups (based on deprivation alone)

Practice List size (Oct 17)

Average age

Average IMD score

Group N CCG grouping (as at

February 2018)

B81021: Faith House Surgery 7,585 42.48 28.31 A 1 Modality

B81035: The Avenues Medical Centre 6,348 42.12 23.35 A 2 Hull Health Forward

B81056: The Springhead Medical Centre 16,853 41.09 17.29 A 3 Modality

B81075: Hastings Medical Centre 2,424 46.96 25.85 A 4 Hull Health Forward

B81085: Haxby - Burnbrae 4,755 44.04 28.20 A 5 Hull GP Collaborative

B81095: Dr Cook (Field View) 3,637 46.16 27.88 A 6 Modality

B81097: Holderness Health Open Door 1,711 45.32 28.67 A 7 Hull Health Forward

B81104: Dr Nayar (Newland Health Centre) 6,831 26.98 23.82 A 8 Hull Health Forward

B81635: Dr Jaiveloo's Practice 3,295 44.84 19.76 A 9 Hull Health Forward

B81020: Sutton Manor Surgery 7,389 41.74 31.93 B 1 Hull GP Collaborative

B81038: The Oaks Medical Centre 7,443 42.10 36.29 B 2 Hull Health Forward

B81048: The Newland Group 15,047 37.10 31.87 B 3 Modality

B81049: New Hall Surgery 9,637 38.59 33.49 B 4 Modality

B81052: Dr Musil & Dr Queenan 6,233 37.14 35.76 B 5 Hull Health Forward

Y02747: Haxby - Kingswood & Orchard Park 12,273 30.95 29.50 B 6 Hull GP Collaborative

B81008: East Hull Family Practice 26,751 38.88 38.88 C 1 Medicas

B81011: Kingston Health (Hull) 9,139 39.87 38.30 C 2 Hull Health Forward

B81066: Dr Chowdhury's Practice 2,449 40.11 39.12 C 3 Hull Health Forward

B81074: CHP Ltd - Southcoates 3,052 42.50 38.51 C 4 City Health Federation

B81080: Dr Malczewski's Practice 2,089 41.52 41.01 C 5 Hull GP Collaborative

B81616: Dr Hendow's Practice 2,597 40.20 40.47 C 6 Hull GP Collaborative

B81645: East Park 3,713 38.36 36.41 C 7 City Health Federation

B81675: Calvert / Newington 10,953 35.78 39.51 C 8 City Health Federation

B81002: Dr Kumar-Choudhary's Practice 3,399 37.05 48.11 D 1 City Health Federation

B81027: St Andrews Group Practice 9,788 38.64 48.33 D 2 Modality




Practice List size (Oct 17)

Average age

Average IMD score

Group N CCG grouping (as at

February 2018)

B81047: Wolseley Medical Centre 7,053 39.52 45.90 D 3 Hull Health Forward

B81053: Diadem Medical Practice 12,095 39.42 42.83 D 4 Modality

B81054: Dr Varma (Clifton House) 8,884 42.52 43.79 D 5 Hull Health Forward

B81058: Sydenham House Group Practice 7,860 40.21 45.47 D 6 Hull Health Forward

B81112: James Alexander Practice 7,331 37.32 44.91 D 7 Hull GP Collaborative

B81631: Raut Partnership 4,837 36.28 45.88 D 8 Hull GP Collaborative

Y02344: Northpoint - Humber FT 3,173 36.48 47.63 D 9 Hull GP Collaborative

B81017: City Centre 15,027 35.41 54.15 E 1 City Health Federation

B81018: Orchard 2000 - Bransholme 8,675 36.37 55.47 E 2 Hull GP Collaborative

B81032: Wilberforce Surgery 3,391 37.07 51.29 E 3 Hull Health Forward

B81040: Marfleet Group Practice 14,476 37.70 50.26 E 4 Medicas

B81046: Bridge Group 9,042 37.56 55.24 E 5 Hull GP Collaborative

B81089: CHP Ltd - Marfleet 3,356 38.66 52.62 E 6 City Health Federation

B81119: Dr Koshy's Practice 4,655 36.08 48.43 E 7 Hull GP Collaborative

B81688: Dr Gopal's Practice 1,991 35.16 48.57 E 8 Hull GP Collaborative




Table 60: CCG practice groupings as at February 2018

CCG practice grouping (Feb18)

Practice code

Practice name List size (Oct 17)

Average age

Average IMD score

Group

Hull GP Collaborative

B81018 Orchard 2000 - Bransholme 8,675 36.37 55.47 E

B81020 Sutton Manor Surgery 7,389 41.74 31.93 B

B81046 Bridge Group 9,042 37.56 55.24 E

B81080 Dr Malczewski's Practice 2,089 41.52 41.01 C

B81085 Haxby - Burnbrae 4,755 44.04 28.20 A

B81112 James Alexander Practice 7,331 37.32 44.91 D

B81119 Dr Koshy's Practice 4,655 36.08 48.43 E

B81616 Dr Hendow's Practice 2,597 40.20 40.47 C

B81631 Raut Partnership 4,837 36.28 45.88 D

B81688 Dr Gopal's Practice 1,991 35.16 48.57 E

Y02344 Northpoint - Humber FT 3,173 36.48 47.63 D

Y02747 Haxby - Kingswood & Orchard Park 12,273 30.95 29.50 B

Hull Health Forward

B81011 Kingston Health (Hull) 9,139 39.87 38.30 C

B81032 Wilberforce Surgery 3,391 37.07 51.29 E

B81035 The Avenues Medical Centre 6,348 42.12 23.35 A

B81038 The Oaks Medical Centre 7,443 42.10 36.29 B

B81047 Wolseley Medical Centre 7,053 39.52 45.90 D

B81052 Dr Musil & Dr Queenan 6,233 37.14 35.76 B

B81054 Dr Varma (Clifton House) 8,884 42.52 43.79 D

B81058 Sydenham House Group Practice 7,860 40.21 45.47 D

B81066 Dr Chowdhury's Practice 2,449 40.11 39.12 C

B81075 Hastings Medical Centre 2,424 46.96 25.85 A

B81097 Holderness Health Open Door 1,711 45.32 28.67 A

B81104 Dr Nayar (Newland Health Centre) 6,831 26.98 23.82 A

B81635 Dr Jaiveloo's Practice 3,295 44.84 19.76 A




CCG practice grouping (Feb18)

Practice code

Practice name List size (Oct 17)

Average age

Average IMD score

Group

Modality

B81021 Faith House Surgery 7,585 42.48 28.31 A

B81027 St Andrews Group Practice 9,788 38.64 48.33 D

B81048 The Newland Group 15,047 37.10 31.87 B

B81049 New Hall Surgery 9,637 38.59 33.49 B

B81053 Diadem Medical Practice 12,095 39.42 42.83 D

B81056 The Springhead Medical Centre 16,853 41.09 17.29 A

B81095 Dr Cook (Field View) 3,637 46.16 27.88 A

City Health Federation

B81002 Dr Kumar-Choudhary's Practice 3,399 37.05 48.11 D

B81017 City Centre 15,027 35.41 54.15 E

B81074 CHP Ltd - Southcoates 3,052 42.50 38.51 C

B81089 CHP Ltd - Marfleet 3,356 38.66 52.62 E

B81645 East Park 3,713 38.36 36.41 C

B81675 Calvert / Newington 10,953 35.78 39.51 C

Medicas B81008 East Hull Family Practice 26,751 38.88 38.88 C

B81040 Marfleet Group Practice 14,476 37.70 50.26 E




Table 61: CCG practice grouping characteristics, October 2017

CCG practice grouping (Feb 18)

Number of practices

List size (Oct 17)

Average age of patients

Average IMD score of patients

Hull GP Collaborative 12 68,807 37.01 42.55

Hull Health Forward 13 73,061 39.65 36.56

Modality 7 74,642 39.76 32.17

City Health Federation 6 39,500 36.76 46.57

Medicas 2 41,227 38.47 42.88

Total 40 297,237 38.52 40.75

10.7 Outcome Measures, Performance Targets and Progress Towards Targets

10.7.1 Historical Indicators, Outcome Measures and Targets Further information about historical outcome measures and targets, and progress towards historical targets is given in the JSNA Toolkit Release 4. 10.7.2 Problems Associated With Some Outcome Measures Further information about some of the problems associated with specific measures, such as using life expectancy and the all age all cause mortality rate as outcome measures are given in Hull JSNA Toolkit: Mortality report. 10.7.3 Public Health Outcomes Framework 10.7.3.1 Introduction The current key indicators for public health are those specified in the Public Health Outcomes Framework (PHOF) which was published in January 2012 (Department of Health 2012; Department of Health 2012). From the Introduction to the Public Health Outcomes Framework 2013 to 2016 document produced in January 201214, “The responsibility to improve and protect our health lies with us all – government, local communities and with ourselves as individuals. There are many factors that influence public health over the course of a

14

https://www.gov.uk/government/publications/healthy-lives-healthy-people-improving-outcomes-and-supporting-transparency






lifetime. They all need to be understood and acted upon. Integrating public health into local government will allow that to happen – services will be planned and delivered in the context of the broader social determinants of health, like poverty, education, housing, employment, crime and pollution. The NHS, social care, the voluntary sector and communities will all work together to make this happen. The new Public Health Outcomes Framework (PHOF) that has been published is in three parts. Part 1 introduces the overarching vision for public health, the outcomes we want to achieve and the indicators that will help us understand how well we are improving and protecting health. Part 2 specifies all the technical details we can currently supply for each public health indicator and indicates where we will conduct further work to fully specify all indicators. Part 3 consists of the impact assessment and equalities impact assessment.” The vision for the PHOF is “to improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest”. There are two overarching outcomes to “increase healthy life expectancy and to reduce differences in life expectancy and healthy life expectancy between communities.” There are also four domains:

“Domain 1 – Improving the wider determinants of health o Objective: improvements against wider factors that affect health and

wellbeing, and health inequalities.

Domain 2 – Health improvement o Objective: people are helped to life healthier lifestyles, make healthy

choices and reduce health inequalities

Domain 3 – Health protection o Objective: the population’s health is protected from major incidents and

other threats, while reducing health inequalities

Domain 4 – Healthcare public health and preventing premature mortality o Objective: reduced numbers of people living with preventable ill health and

people dying prematurely, while reducing the gap between communities.” A small number of the PHOF outcomes are still under development, but where data is available it has been published nationally on www.phoutcomes.info. A number of the indicators also have sub-indicators, and data has been published males and females separately in addition to main indicator for some of the indicators. There are approximately 200 indicators or sub-indicators. A list of the main indicators is available in Table 62 in section 10.7.3.3. Local analysis of the PHOF indicators is available at www.hullcc.gov.uk/pls/hullpublichealth/ as well as in Hull’s JSNA Toolkit documents specified in Table 62. 10.7.3.2 National Profile for Hull and “Tartan Rug” Nationally, profiles for each local authority have been produced and can be downloaded from www.phoutcomes.info. These are referred to as ‘tartan rugs’ as each indicator is colour coded for the local authority depending on whether its value is statistically significantly higher or lower than England’s value. Pale blue is used where the local







authority’s value is significantly higher than England’s, amber where there is no significant difference, and dark blue where the local authority’s value is significantly lower than England’s. 10.7.3.3 Local Analysis A local analysis of indicators within the PHOF has been undertaken. The following documents have been produced:

Each indicator summarised on single row on a single table

Each indicator summarised on single page of a document

Performance card summarising key local PHOF outcome measures Examples of the three reports are given in Figure 53, Figure 54 and Figure 55. There are three different local ‘summaries’ available for the PHOF indictors. One document summaries the information in the form of a table with one indicator or sub-indicator per line within a table. One document summarises the information for each indicator on a single page. The final ‘performance card’ document summaries a small number of indicators for PHOF indicators within the Hull – Healthier Together: Health and Wellbeing Board Strategy 2014-2020 (Hull City Council and NHS Hull Clinical Commissioning Group 2014) for three separate outcome groups: (i) the best start in life; (ii) healthier, longer, happy lives, and (iii) safe and independent lives. For the first document, the table contains the following information on each indicator: indicator number; name of the indicator; latest period; preferred direction of the indicator (i.e. whether an increase or decrease in the indicator denotes improvement); latest values of the indicator for both Hull and England; Hull’s ranking out of 12 comparators; ‘tartan rug colour’; and whether the trends, national inequalities gap and local inequalities gap have improved over time or not. The ‘tartan rug’ colour is given indicating whether the value of the indicator for Hull is statistically significantly higher (pale blue), statistically significantly lower (dark blue) or similar (amber) compared to England. A significant lower indicator might denote a worse situation for some indicators whereas for other indicators a significantly higher indicator might denote a worse situation. . Therefore, for the local ‘tartan rug’, whether the value of Hull’s indicator is ‘worse’, ‘identical’ or ‘better’ than England has also been noted. Although the ‘tartan rug’ colour may differ for one or two indicators within this report from those published nationally as within this document they are based on overlapping or non-overlapping 95% confidence intervals, and the ‘tartan rug’ colours might be determined differently for those published nationally. Another document summarises each indicator on a single page. The summary text information is similar to that within the summary table, but five charts are also included on the ‘one page per indicator’ report (depending on available data). The five charts are: (1) trends in the total number of people affected / who have the indicator in Hull




compared to the numbers that would have the indicator if Hull had the same prevalence as England; (2) the latest figures for Hull and its comparator geographical areas; (2) trends over time for Hull; (3) trends over time for Hull and England together with projected future trends assuming linear trends continue; (4) differences among the five local deprivation quintiles/fifths (based on the Index of Multiple Deprivation 2010) over time; and (5) latest data for the 23 wards in Hull. Within these documents, the comparator areas used for Hull are Coventry, Derby City, Leicester City, Middlesbrough, North East Lincolnshire, Plymouth, Salford, Sandwell, Stoke-on-Trent, Sunderland and Wolverhampton. The scorecard contains a single figure showing the trends over time, the baseline and latest values of the indicator for Hull and England, the ‘tartan’ rug colour and whether the trends and national and local inequalities gaps have improved over time or not. These documents are all available at www.hullcc.gov.uk/pls/hullpublichealth/. Figure 53: Example of local PHOF analysis – summary table





Figure 54: Example of local PHOF analysis – one page per indicator




Figure 55: Example of local PHOF analysis – performance ‘scorecard’

Information relating to each specific outcome measure has also been included within the JSNA Toolkit documents. Table 62 details which JSNA Toolkit documents gives more information for each of the PHOF indicators.




Table 62: List of which JSNA Toolkit documents include information on each of the Public Health Outcomes Framework indicators Domain and indicator Hull JSNA Toolkit:

Indicators corresponding to overarching outcomes

0.1 Healthy life expectancy Life Expectancy

0.2 Differences in life expectancy and healthy life expectancy between communities

Life Expectancy

Domain 1: Improving the wider determinants of health

1.01 Children in poverty Deprivation and Associated Measures

1.02 School readiness Deprivation and Associated Measures

1.03 Pupil absence Deprivation and Associated Measures

1.04 First-time entrants to the youth justice system Deprivation and Associated Measures

1.05 16-18 year olds not in education, employment or training (NEETS)

Deprivation and Associated Measures

1.06 People with mental illness or disability in settled accommodation

Mental Health

1.07 People in prison who have a mental illness or significant mental illness*

Mental Health

1.08 Employment for those with a long-term health condition including those with a learning difficulty / disability or mental illness

Mental Health

1.09 Sickness absence rate Deprivation and Associated Measures

1.10 Killed or seriously injured casualties on England’s roads Accidents

1.11 Domestic abuse Deprivation and Associated Measures

1.12 Violent crime (including sexual violence) Deprivation and Associated Measures

1.13 Re-offending Deprivation and Associated Measures

1.14 The percentage of the population affected by noise Housing, Environment and Social Care

1.15 Statutory homelessness Housing, Environment and Social Care

1.16 Utilisation of green spaces for exercise / health reasons Housing, Environment and Social Care

1.17 Fuel poverty Deprivation and Associated Measures

1.18 Social isolation among adult social care users and their carers Housing, Environment and Social Care

1.19 Older people’s perception of community safety** Mental Health

Domain 2. Health improvement

2.01 Low birth weight of term babies Children and Young People

2.02 Breastfeeding Children and Young People




Domain and indicator Hull JSNA Toolkit:

2.03 Smoking status at time of delivery Smoking

2.04 Under 18 conceptions Sexual Health

2.05 Child development at 2-2.5 years Children and Young People

2.06 Excess weight in 4-5 and 10-11 year olds Overweight and Obesity

2.07 Hospital admissions caused by unintentional and deliberate injuries in children

Accidents

2.08 Emotional wellbeing of looked-after children Children and Young People

2.09 Smoking prevalence – 15 year olds Smoking

2.10 Hospital admissions as a result of self-harm Mental Health

2.11 Diet Diet

2.12 Excess weight in adults Overweight and Obesity

2.13 Proportion of physically active and inactive adults Physical Activity

2.14 Smoking prevalence – adult (over 18s) Smoking

2.15 Successful completion of drug treatment Drug and Substance Abuse

2.16 People entering prison with substance dependence issues who are previously not known to community treatment

Drug and Substance Abuse

2.17 Recorded diabetes Diabetes

2.18 Alcohol-related admissions to hospital Alcohol Consumption

2.19 Cancer diagnosed at stage 1 and 2 Cancer

2.20 Cancer screening coverage Screening

2.21 Access to non-cancer screening programmes Screening

2.22 Take up of the NHS Health Check Programme – by those eligible

Screening

2.23 Self-reported wellbeing Mental Health

2.24 Falls and injuries in the over 65s Older People

Domain 3. Health protection

3.01 Air pollution Housing, Environment and Social Care

3.02 Chlamydia diagnoses (15-24 year olds) Sexual Health

3.03 Population vaccination coverage Vaccinations and Immunisations

3.04 People presenting with HIV at a late state of infection Sexual Health

3.05 Treatment completion for tuberculosis Infectious Diseases

3.06 Public sector organisations with board-approved sustainable development management plans

Housing, Environment and Social Care

Domain 4. Healthcare public health and preventing premature mortality

4.01 Infant mortality Mortality

4.02 Tooth decay in children aged 5 years Dental Health

4.03 Mortality from causes considered preventable Mortality

4.04 Mortality from all cardiovascular disease All Circulatory Disease

4.05 Mortality from cancer All Cancers

4.06 Mortality from liver disease Digestive Diseases

4.07 Mortality from respiratory disease All Respiratory Disease

4.08 Mortality from communicable diseases Infectious Disease

4.09 Excess under 75 mortality in adults with serious mental health Mental Health

4.10 Suicide Mental Health

4.11 Emergency re-admissions within 30 days of discharge from hospital

Inpatient Hospital Admissions




Domain and indicator Hull JSNA Toolkit:

4.12 Preventable sight loss General Health, Disabilities, Caring and Use of Services

4.13 Health-related quality of life for older people Older People

4.14 Hip fractures in over 65s Older People

4.15 Excess winter deaths Mortality

4.16 Dementia and its impacts Mental Health

*No data published at local authority level. **Indicator removed from PHOF, however, included in local analysis template as one of the sub-indicators is an indicator within the local Health and Wellbeing Board Strategy.

10.8 Statistical and Epidemiological Methods and Terms Knowledge of these statistical methods is essential for many tables and figures in order to interpret the information correctly. More detailed information on these topics is also given within the Hull JSNA Toolkit: Glossary document, including other topics not covered here, e.g. variation, incidence and prevalence, health scores and scales, etc.

There is also a statistical presentation on www.hullcc.gov.uk/pls/hullpublichealth/ which covers the following topics (with detailed ‘notes’ pages):

What is statistics?

Variability

Confidence intervals

Problems of small numbers

Standardisation

Causality

Questions to ask (when examining/interpreting data/statistics) This document also gives examples of variability in relation to numbers surveyed and the implication on the width of confidence intervals. Another document on www.hullcc.gov.uk/pls/hullpublichealth/ provides more detailed information on standardisation, including worked examples of both indirect and direct standardisation.

10.8.1 Confounding, Effect Modification and Interaction Confounding occurs when another factor (or factors) influences the association of interest. This occurs when this other factor is associated with both the risk factor of interest and the outcome of interest. Age, gender and deprivation are frequently confounders. Failure to take into account or consider confounders when examining






associations can lead to biased results – known as confounding bias. Therefore, it is important to adjust for, or consider confounders when interpreting statistical and epidemiological data. It is also possible that one factor modifies the effect of one factor on another (effect modification). For example, it could be that there is a strong association between two factors at younger ages, but at older ages the association could disappear. Age is modifying the association between the two factors of interest. Interaction between two different factors can also occur which influence the relationship with another factor. For example, there could be twice the risk of developing a disease for a smoker compared to a non-smoker, and twice the risk of developing the same disease if the person is overweight compared to someone who is within the ‘desirable’ weight category, but for an overweight smoker the risk of developing the disease may be ten times greater than a person who is a non-smoker and not overweight.

10.8.2 Confidence Intervals A confidence interval (CI), calculated using statistical methods, gives a range of likely values for the parameter of interest. Since one cannot generally survey all people for all years within all geographical areas of interest, it is common practice to obtain necessary data from a sample of the population. However, different samples will result in different estimates for the measure of interest due to natural variation of measurement data (assuming all other influences remain constant). Therefore, it is useful to have a range of values for the measure of interest (e.g. percentage or mean, difference between two means or measure of risk, etc) rather than a single value to get an idea of the range of likely values. The usual CI calculated is the 95% CI, in which we are 95% confident that the interval obtained (from the sample) will contain the true underlying measure of interest (of your population of interest). Interpreting confidence intervals is an essential to interpreting statistical and epidemiological data. Interpretation also needs to be considered in relation to clinical significance. When dealing with small numbers of events (see section 10.8.3 on page 163), it is very important to consider the implications of this and present and assess the width of CIs to determine how much confidence there is in the estimate presented. If there is too much variability or the numbers are too small, and the confidence intervals are wide, then it is not possible to present any conclusions, and it is possible that findings could be misleading with incorrect assumptions being drawn.

10.8.3 Small Number of Events When comparing the mortality rates for specific relatively rare cancers, for example, skin cancer, differences in the mortality rates can occur which appear to be large, but are




actually only based on a very small number of deaths. This can lead to incorrect conclusions being drawn. Therefore, it is important to consider the confidence (see section 10.8.2 on page 163) of the estimate before drawing conclusions.

10.8.4 Percentiles, Quartiles, Quintiles and Medians Percentiles divide a distribution of ordered numerical values into groups. The 10th percentile is the value of a numerical variable for which 10% of the people or sample of values fall below. For example, if from a survey of employees at a particular company the 10th percentile for annual income is £10,000, then this would mean that 10% of the employees for this particular company were earning £10,000 or less (and 90% were earning £10,000 or more). Deciles, quintiles and quartiles are alternative names for specific percentiles. Deciles divide the observations into 10 groups (tenths) as illustrated in the example above which present one of these (10%). The quintiles divide the sample or observations or people into five groups (fifths) whereas the quartiles divide the observations into four groups. The median is the name given to the middle quartile or 50th percentile.

10.8.5 Standardisation The prevalence of ill-health, risk factors and disease and mortality within a particular population will depend on the age and gender structure of that population (as well as many other factors such as deprivation). In terms of the provision of resources in relation to the prevalence of ill-health, disease and risk factors in the population, it is most helpful to report on the prevalence without taking into account the age and gender distribution of the population. This is because it is necessary to treat and have the provision to treat the existing population, regardless of the age and gender structure. However, if one wishes to assess whether one population has an excess rate of disease or if there is a difference in the prevalence of disease among different levels of deprivation, it is necessary to take the age and gender structure into consideration. Otherwise any differences found may be simply due to differences in the age and gender structure of the different populations, and not due to the factor of interest, e.g. deprivation. The age and gender structure can be taken into consideration by using standardisation. Two different methods are used to standardise: direct15 or indirect16 standardisation.

15

Involves applying the age/gender specific rates of disease/prevalence of a risk factor observed in the study (e.g. Hull) population to a ‘standard’ population. For direct standardisation, the ‘standard’ population is generally the 2013 European Standard Population. The resulting directly standardised (mortality) rate (DSR) is frequently given as the number of deaths per 10,000 or 10,000 population. 16

Involves applying the age/gender specific rates of disease/prevalence of a risk factor observed in the ‘standard’ population to the study (e.g. Hull) population. For indirect standardisation, the ‘standard’ population is generally England (latest mortality rates). This results in a standardised mortality (or morbidity) ratio with 100 denoting the same mortality (morbidity) rate as England after adjusting for the differences in the age/gender structure of the local study population and a value of more than 100




10.8.6 Moving Average A moving average is an average or mean value over a number of years, with the years ‘moving’ over time. A three-year moving average is very common (where the value presented is the mean value over three years). A moving average is very useful in summarising data where the number of events are small on an annual basis and there are potentially large fluctuations in the rate of events. Calculating the moving average smoothes out the fluctuations and makes interpretation easier so that the overall trend can be better seen.

10.8.7 Significance Testing It is often useful to compare a particular summary parameter (for instance, mean, median, measure of risk) among different groups. Since there is natural variation associated with virtually all measurements and since we generally only have a sample and have not measured the entire population, it is necessary to distinguish between differences which are close enough together to be explained by chance and differences which are ‘unlikely’ to be explained by chance. Such a comparison can be undertaken using a statistical test which takes into the account chance variation. However, even if a difference is statistically significant, the differences might not be sufficiently large enough to be of clinical importance.

denoting increased mortality relative to England (e.g. an SMR of 150 denotes a mortality rate 50% higher than England after adjusting for the age/gender structure of the local population).




10.9 Underlying Data for Figures Fuel Poverty There are too many data points for Figure 2 to present the underlying data in tables. Hull City Council Customer Profiles There are too many data points for Figure 3 to present the underlying data in tables. Trends in homelessness acceptances for Hull The underlying data for Figure 5 are given in the table below.

Quarter

Homelessness acceptances 2011-2014

Number of cases:

Accepted Intentionally

homeless No priority

need Not

homeless Ineligible

Jan - Mar 11 116 10 93 8 0

Apr - Jun 11 153 10 54 5 0

Jul - Sep11 127 13 52 3 0

Oct - Dec 11 109 8 30 3 0

Jan - Mar 12 136 14 69 3 0

Apr - Jun 12 129 13 65 3 0

Jul - Sep12 161 9 80 2 0

Oct - Dec 12 136 11 65 5 0

Jan - Mar 13 141 8 78 4 0

Apr - Jun 13 96 9 64 5 0

Jul - Sep13 107 24 74 8 0

Oct - Dec 13 80 6 43 4 0

Jan - Mar 14 65 4 51 0 0

Apr - Jun 14 116 8 38 0 0

Jul - Sep14 117 9 34 4 0

Oct - Dec 14 90 9 35 2 0

Jan - Mar 15 88 8 37 2 0

Apr - Jun 15 65 8 31 0 0

Jul - Sep15 114 10 39 3 0

Oct - Dec 15 93 4 49 1 0

Jan - Mar 16 127 11 45 0 1

Apr - Jun 16 129 4 40 1 0

Jul - Sep 16 113 9 32 1 0

Oct - Dec 16 86 12 41 4 0

Jan - Mar 17 108 13 32 0 4




Rough sleepers by month, 2014/15 to 2016/17 financial years The underlying data for Figure 7 are shown in the table below.

Month

Financial year

2014/15 2015/16 2016/17

April 15 7 22

May 12 10 23

June 19 - 20

July 20 39 28

August 15 21 29

September 17 22 27

October 23 20 29

November 19 23 15

December 18 24 11

January 8 16 20

February 8 5 25

March 7 24 24

A&E activity where patient has no fixed abode 2012/13 to 2014/15 The underlying data for Figure 8 are given in the table below.

Month

A&E activity where patient has no fixed abode

Financial year

2012/13 2013/14 2014/15 2015/16 2016/17

April 50 34 39 38 37

May 48 55 63 39 49

June 41 47 52 32 47

July 44 48 55 14 59

August 53 41 48 19 58

September 49 60 81 13 71

October 103 62 53 15 51

November 59 55 69 27 43

December 103 50 51 40 63

January 76 41 37 42 45

February 44 41 25 39 49

March 63 30 52 46 51

Age at attendance at A&E where patient has no fixed abode 2012/13 to 2014/15 The underlying data for Figure 9 are given in the table below.




Month

Age at attendance at A&E (where of no fixed abode)

Total

<25 25-40 >40 Not

known

January 6 20 11 4 41

February 6 20 12 3 41

March 10 5 15 0 30

April 10 11 12 3 36

May 8 13 19 13 53

June 6 19 20 4 49

July 3 22 26 3 54

August 6 10 28 4 48

September 6 43 27 2 78

October 9 21 14 3 47

November 7 41 18 4 70

December 4 24 15 2 45

Total 2014 81 249 217 45 592

Land use The underlying data for Figure 10 is given within the figure itself. Air pollution The following map and table give the underlying data for Figure 12, Figure 13, Figure 14 and Figure 15. The modelled pollution estimates for each xy coordinate are given in the table for each ‘reference’ point (see map).




Ref X, Y

coordinate (in 1000s)

PM 2.5 PM 10 NOx NO2

2011 2015 2011 2015 2011 2015 2011 2015

1 5085, 4355 11.1 10.5 17.9 17.3 20.6 18.7 14.9 13.7

2 5095, 4355 11.5 10.9 19.0 18.4 22.1 20.2 15.8 14.7

3 5105, 4355 11.1 10.5 17.2 16.6 22.5 20.6 16.0 14.9

4 5085, 4345 12.1 11.4 19.8 19.0 27.9 25.1 19.4 17.8

5 5095, 4345 12.0 11.3 19.4 18.7 26.3 23.9 18.4 17.0

6 5105, 4345 11.8 11.1 18.6 17.9 27.4 25.1 19.0 17.7

7 5115, 4345 12.2 11.5 19.3 18.6 26.0 23.6 18.2 16.7

8 5065, 4335 11.2 10.5 16.7 16.0 24.3 22.3 17.2 16.0

9 5075, 4335 11.6 10.9 17.3 16.5 27.4 25.1 19.1 17.8

10 5085, 4335 11.8 11.0 17.7 16.9 28.9 26.2 20.0 18.5

11 5095, 4335 12.5 11.7 19.4 18.6 32.8 29.5 22.2 20.4

12 5105, 4335 12.8 11.8 20.0 19.2 35.3 31.5 23.4 21.5

13 5115, 4335 12.4 11.6 18.5 17.8 33.7 30.2 22.6 20.8

14 5125, 4335 11.9 11.2 18.3 17.6 29.1 26.3 20.0 18.4

15 5065, 4325 11.3 10.6 16.7 16.0 26.2 24.1 18.4 17.2

16 5075, 4325 11.5 10.8 17.0 16.3 28.0 25.6 19.5 18.1

17 5085, 4325 11.9 11.2 17.7 16.9 31.5 28.4 21.5 19.8

18 5095, 4325 13.7 12.6 20.3 19.2 46.4 39.8 29.2 26.0

19 5105, 4325 14.3 13.4 21.8 20.9 52.1 44.2 31.7 28.1

20 5115, 4325 12.8 11.9 18.9 18.0 40.0 35.4 26.0 23.6




Ref X, Y



2011 2015 2011 2015 2011 2015 2011 2015

21 5125, 4325 12.1 11.4 17.8 17.1 34.0 30.8 22.8 21.1

22 5135, 4325 11.9 11.2 17.8 17.1 32.0 29.2 21.7 20.2

23 5145, 4325 12.1 11.4 18.2 17.4 33.1 30.4 22.4 21.0

24 5065, 4315 11.5 10.8 17.1 16.3 27.8 25.3 19.4 17.9

25 5075, 4315 11.7 10.9 17.4 16.6 30.3 27.6 20.8 19.3

26 5085, 4315 12.5 11.6 18.6 17.7 35.6 32.2 23.8 22.0

27 5095, 4315 13.6 12.4 20.7 19.4 44.5 38.2 28.2 25.2

28 5105, 4315 13.3 12.4 20.0 19.0 42.5 37.4 27.3 24.7

29 5115, 4315 12.7 11.9 19.0 18.2 39.6 35.6 25.8 23.7

30 5125, 4315 12.7 11.9 18.9 18.0 37.8 34.2 24.9 23.1

31 5135, 4315 12.5 11.7 18.5 17.7 37.2 33.9 24.6 23.0

32 5145, 4315 12.1 11.2 18.2 17.5 33.7 31.0 22.7 21.2

33 5055, 4305 11.4 10.7 17.1 16.4 26.0 23.7 18.2 16.9

34 5065, 4305 12.2 11.4 18.1 17.2 34.2 29.9 22.9 20.6

35 5075, 4305 11.8 11.0 17.4 16.6 30.5 27.5 20.9 19.2

36 5085, 4305 12.5 11.7 18.4 17.6 35.8 32.4 23.9 22.1

37 5095, 4305 13.4 12.4 20.3 19.1 41.8 36.6 26.9 24.4

38 5105, 4305 13.8 12.8 20.4 19.3 47.4 41.8 29.7 27.1

39 5115, 4305 13.6 12.7 20.2 19.3 45.8 40.9 29.0 26.7

40 5125, 4305 13.2 12.4 20.1 19.2 41.7 37.8 27.0 25.0

41 5135, 4305 12.4 11.6 18.2 17.4 38.6 35.2 25.3 23.6

42 5145, 4305 12.1 11.4 17.8 17.0 36.0 32.7 23.8 22.1

43 5155, 4305 12.2 11.6 19.4 18.7 34.4 31.1 22.9 21.1

44 5055, 4295 11.5 10.9 17.5 16.8 27.2 25.0 19.0 17.7

45 5065, 4295 11.6 11.0 17.5 16.7 28.7 26.2 19.9 18.5

46 5075, 4295 11.9 11.2 17.7 17.0 31.7 28.9 21.6 20.1

47 5085, 4295 12.8 11.9 19.1 18.1 39.4 35.2 25.8 23.6

48 5095, 4295 14.2 13.1 21.2 19.9 49.8 43.9 31.1 28.3

49 5105, 4295 16.1 14.8 24.1 22.8 59.2 51.4 35.0 31.7

50 5115, 4295 14.7 13.7 22.1 21.1 52.9 46.6 32.5 29.6

51 5125, 4295 13.4 12.6 20.0 19.2 46.9 41.9 29.4 27.0

52 5135, 4295 13.2 12.4 19.9 19.1 47.7 42.8 29.6 27.3

53 5145, 4295 13.3 12.3 19.7 18.5 49.7 44.2 30.4 27.9

54 5155, 4295 13.4 12.5 20.9 20.1 46.1 40.8 28.7 26.2

55 5055, 4285 11.6 10.9 17.4 16.7 28.6 26.3 19.9 18.6

56 5065, 4285 12.0 11.2 17.8 17.1 31.9 29.1 21.8 20.2

57 5075, 4285 12.6 11.7 19.0 18.1 36.9 33.1 24.5 22.5

58 5085, 4285 13.7 12.6 20.9 19.9 45.2 40.6 28.9 26.7

59 5095, 4285 13.9 12.8 20.7 19.5 46.5 41.6 29.6 27.2

60 5105, 4285 14.7 13.6 22.5 21.4 52.0 45.6 31.8 28.9

61 5115, 4285 12.5 11.8 18.3 17.5 42.2 38.2 26.9 25.0

62 5125, 4285 12.9 12.2 18.3 17.6 58.7 54.9 34.2 32.7




Ref X, Y



2011 2015 2011 2015 2011 2015 2011 2015

63 5135, 4285 12.4 11.8 17.4 16.8 55.6 52.5 32.8 31.5

64 5145, 4285 12.1 11.5 17.1 16.5 49.6 46.0 30.1 28.5

65 5155, 4285 12.0 11.4 17.9 17.2 44.4 40.7 27.8 26.0

66 5045, 4275 11.4 10.8 17.3 16.6 26.9 24.7 18.8 17.5

67 5055, 4275 11.5 10.9 17.5 16.8 27.9 25.5 19.5 18.1

68 5065, 4275 12.4 11.6 18.8 18.0 35.8 32.0 23.9 21.9

69 5075, 4275 14.7 13.5 22.2 20.9 52.1 44.9 32.3 28.9

70 5085, 4275 13.9 13.0 21.3 20.2 44.6 38.7 28.7 25.8

71 5095, 4275 11.8 11.1 17.4 16.6 34.2 30.8 22.9 21.1

72 5105, 4275 11.6 11.0 16.9 16.3 36.1 33.0 23.7 22.1

73 5045, 4265 12.2 11.5 19.1 18.4 31.3 27.8 21.5 19.5

74 5055, 4265 12.2 11.5 18.9 18.2 31.2 27.9 21.4 19.5

75 5065, 4265 12.1 11.5 18.7 18.0 31.6 28.1 21.6 19.6

76 5075, 4265 12.2 11.5 18.3 17.6 34.1 30.5 23.0 21.0

77 5085, 4265 11.2 10.6 16.5 15.9 29.1 26.3 20.0 18.4

78 5055, 4255 10.8 10.3 16.0 15.4 24.5 22.4 17.3 16.0




Adult Social Care Outcomes Framework 2016/17 Domain 1 indicators 1A to 1C The underlying data for Figure 21, Figure 22, Figure 23, Figure 24, Figure 25 and Figure 26 from the 2016/17 Adult Social Care Outcomes Framework, are given in the table below.

Area

Adult Social Care Framework 2016/17 Domain 1 indicators (1A-1C)

1A 1B 1C(1A) 1C(1B) 1C(2A) 1C(2B)

Social care-related quality

of life score

Proportion of people who use

services who have control over their daily life (%)

Proportion of people who use services who receive self-directed support (%)

Proportion of carers

who receive self-directed support (%)

Proportion of people who use services who receive

direct payments (%)

Proportion of carers

who receive direct

payments (%)

England 19.1 (19.1, 19.1) 77.7 (77.3, 78.1) 89.4 83.1 28.3 74.3

Hull 19.7 (19.4, 20.0) 79.0 (75.8, 82.2) 98.9 100.0 32.7 100.0

Yks. & Humber 19.1 (19.0, 19.2) 77.4 (76.4, 78.4) 88.1 70.4 25.7 64.5

Wolverhampton 19.2 (18.8, 19.6) 74.2 (70.0, 78.4) 87.0 23.4 19.6 23.4

Salford 18.4 (18.1, 18.7) 75.2 (72.3, 78.1) 74.9 78.8 11.9 78.8

Derby 19.4 (19.0, 19.8) 79.0 (75.4, 82.6) 100.0 100.0 47.7 100.0

Stoke-on-Trent 19.7 (19.3, 20.1) 82.3 (78.8, 85.8) 48.5 30.3 26.8 30.3

Coventry 19.4 (19.0, 19.8) 79.6 (75.8, 83.4) 87.9 32.8 23.5 32.8

Plymouth 19.5 (19.2, 19.8) 80.9 (77.5, 84.3) 95.7 100.0 24.2 100.0

Sandwell 19.9 (19.6, 20.2) 80.1 (76.6, 83.6) 99.0 100.0 34.1 100.0

Middlesbrough 19.8 (19.5, 20.1) 85.3 (82.2, 88.4) 100.0 100.0 38.3 27.6

Sunderland 19.6 (19.3, 19.9) 80.1 (77.0, 83.2) 98.3 71.3 20.1 71.3

Leicester 18.5 (18.0, 19.0) 76.2 (71.4, 81.0) 99.7 100.0 46.8 100.0

NE Lincolnshire 19.2 (18.7, 19.7) 80.2 (75.3, 85.1) 95.1 91.9 23.0 44.5




Adult Social Care Outcomes Framework 2016/17 Domain 1 indicators 1D to 1H The underlying data for Figure 27, Figure 28, Figure 29, Figure 30 and Figure 31 from the 2016/17 Adult Social Care Outcomes Framework, are given in the table below.

Area

Adult Social Care Framework 2016/17 Domain 1 indicators (1D to 1H)

1D 1E 1F* 1G 1H*

Carer-reported quality of life

The proportion of adults with a

learning disability in paid

employment (%)

The proportion of adults in contact with secondary mental health

services in paid employment (%)

The proportion of adults with a

learning disability who live in their

own home or with their family (%)

The proportion of adults in contact with secondary mental health services living independently, with or without

support (%)

England 7.7 (7.7, 7.7) 5.7 6.7 76.2 58.6

Hull 7.5 (7.2, 7.8) 0.9 6.8 74.8 73.4

Yks. & Humber 8.0 (7.9, 8.1) 6.7 8.2 79.4 64.7

Wolverhampton 7.0 (6.8, 7.2) 2.4 6.9 59.9 79.7

Salford 7.8 (7.6, 8.0) 3.6 5.7 92.5 74.6

Derby 7.4 (7.1, 7.7) 4.6 6.9 81.5 81.3

Stoke-on-Trent 7.7 (7.4, 8.0) 3.5 9.8 63.4 75.4

Coventry 7.2 (6.9, 7.5) 5.0 12.2 78.0 70.6

Plymouth 7.1 (6.9, 7.3) 5.7 4.7 53.4 59.3

Sandwell 6.9 (6.6, 7.2) 0.1 5.4 80.4 69.7

Middlesbrough 8.6 (8.3, 8.9) 2.1 3.0 80.2 73.1

Sunderland 7.9 (7.6, 8.2) 5.7 4.1 82.0 41.4

Leicester 7.2 (6.9, 7.5) 4.7 2.9 74.4 62.3

NE Lincolnshire 8.0 (7.7, 8.3) 16.0 7.4 87.8 66.2




Adult Social Care Outcomes Framework 2016/17 Domain 1 indicators 1I(1) and 1I(2) The underlying data for Figure 32 and Figure 33, from the 2016/17 Adult Social Care Outcomes Framework, are given in the table below.

Area

Adult Social Care Framework 2016/17 Domain 1 indicators (1I(1) and 1I(2))

1I(1) 1I(2)

The proportion of people who use services who

reported that they had as much social contact as

they would like (%)

The proportion of carers who reported that they had as much social contact as

they would like (%)

England 45.4 (45.0, 45.8) 35.5 (35.0, 36.0)

Hull 52.8 (49.0, 56.6) 32.0 (27.6, 36.4)

Yks. & Humber 45.6 (44.5, 46.7) 38.7 (37.4, 40.0)

Wolverhampton 50.9 (46.0, 55.8) 25.2 (21.7, 28.7)

Salford 43.8 (40.6, 47.0) 37.4 (34.3, 40.5)

Derby 48.1 (43.6, 52.6) 33.8 (29.1, 38.5)

Stoke-on-Trent 50.7 (46.1, 55.3) 38.1 (33.3, 42.9)

Coventry 51.8 (47.1, 56.5) 31.5 (26.8, 36.2)

Plymouth 46.2 (42.0, 50.4) 26.7 (22.6, 30.8)

Sandwell 52.1 (47.9, 56.3) 31.0 (26.6, 35.4)

Middlesbrough 49.4 (45.0, 53.8) 46.2 (41.3, 51.1)

Sunderland 50.2 (46.4, 54.0) 39.9 (35.2, 44.6)

Leicester 35.9 (30.3, 41.5) 31.0 (26.1, 35.9)

NE Lincolnshire 47.5 (41.3, 53.7) 40.3 (35.5, 45.1)




Adult Social Care Outcomes Framework 2016/17 Domain 2 indicators The underlying data for Figure 34, Figure 35, Figure 36, Figure 37, Figure 38, Figure 39 and Figure 40, from the 2016/17 Adult Social Care Outcomes Framework, are given in the table below.

Area

Adult Social Care Framework 2016/17 Domain 2 indicators

2A(1) 2A(2) 2B(1) 2B(2) 2C(1) 2C(2) 2D

Long term support needs met by admission to

residential and nursing care homes, per 100,000

population

Proportion of older people (aged 65 and over) still at

home 91 days after discharge

from hospital into reablement/

rehabilitation services (%)

Proportion of older people (aged 65 and

over) who received

reablement/ rehabilitation services after

discharge from hospital (%)

Delayed transfers of care from hospital

per 100,000 population

The outcome of short-

term services: sequel to service

Younger adults

(aged 18 to 64)

Older adults (aged 65 and

over) All

Attributable to social

care

England 12.8 611 82.5 2.7 14.9 6.3 77.8

Hull 16.9 919 90.1 2.4 13.4 6.1 47.0

Yks. & Humber 13.8 658 83.4 2.6 12.3 4.8 69.7

Wolverhampton 15.5 895 74.5 1.6 17.5 12.4 84.2

Salford 13.9 967 79.6 6.4 11.6 5.4 44.3

Derby 13.5 572 88.9 2.3 6.9 1.6 78.7

Stoke-on-Trent 17.6 702 84.4 0.6 46.1 15.5 88.4

Coventry 15.0 608 85.2 1.5 22.5 5.7 66.9

Plymouth 9.7 461 84.9 4.1 21.6 8.9 92.5

Sandwell 14.4 837 64.1 3.7 8.4 4.4 60.0

Middlesbrough 25.6 905 90.9 4.2 12.2 4.0 75.7

Sunderland 21.6 909 79.7 5.4 1.7 0.4 86.6

Leicester 17.8 692 91.3 3.1 8.9 2.9 61.9

NE Lincolnshire 11.8 648 93.1 2.0 6.9 2.0 69.2




Adult Social Care Outcomes Framework 2016/17 Domain 3 indicators The underlying data for Figure 41, Figure 42, Figure 43, Figure 44 and Figure 45 from the 2016/17 Adult Social Care Outcomes Framework are given in the table below.

Area


3A 3B* 3C* 3D(1) 3D(2)*

Overall satisfaction of

people who use services with their care and support (%)

Overall satisfaction of

carers with social services

(%)

Proportion of carers who report

that they have been included or

consulted in discussion about the person they

care for (%)

The proportion of people who use

services who find it easy to find

information about support (%)

The proportion of carers who find it

easy to find information about

support (%)

England 64.7 (64.3, 65.1) 39.0 (38.4, 39.6) 70.6 (70.1, 71.1) 73.5 (73.0, 74.0) 64.2 (63.6, 64.8)

Hull 65.6 (62.0, 69.2) 36.5 (30.9, 42.1) 68.0 (62.3, 73.7) 75.4 (71.1, 79.7) 67.8 (62.3, 73.3)

Yorkshire & Humber 64.6 (63.5, 65.7) 41.3 (39.7, 42.9) 71.4 (70.0, 72.8) 72.6 (71.3, 73.9) 66.4 (64.7, 68.1)

Wolverhampton 62.7 (57.9, 67.5) 31.0 (26.5, 35.5) 66.5 (61.6, 71.4) 76.2 (71.2, 81.2) 63.6 (58.7, 68.5)

Salford 62.8 (59.6, 66.0) 42.7 (39.0, 46.4) 79.6 (76.0, 83.2) 74.3 (70.6, 78.0) 70.6 (66.7, 74.5)

Derby 68.1 (64.1, 72.1) 28.3 (22.3, 34.3) 68.9 (62.6, 75.2) 70.4 (65.6, 75.2) 63.4 (57.1, 69.7)

Stoke-on-Trent 69.1 (64.8, 73.4) 41.2 (35.3, 47.1) 71.9 (66.2, 77.6) 73.4 (68.6, 78.2) 57.0 (50.2, 63.8)

Coventry 62.0 (57.5, 66.5) 34.3 (28.9, 39.7) 68.6 (63.2, 74.0) 69.4 (64.0, 74.8) 59.5 (53.5, 65.5)

Plymouth 68.8 (65.0, 72.6) 33.6 (27.8, 39.4) 62.5 (56.9, 68.1) 77.3 (73.0, 81.6) 58.5 (52.9, 64.1)

Sandwell 63.1 (59.0, 67.2) 39.1 (33.5, 44.7) 69.8 (64.2, 75.4) 84.2 (80.5, 87.9) 57.1 (50.6, 63.6)

Middlesbrough 73.4 (69.5, 77.3) 55.0 (49.4, 60.6) 80.5 (75.8, 85.2) 78.3 (74.1, 82.5) 73.1 (67.3, 78.9)

Sunderland 71.3 (67.7, 74.9) 43.3 (38.1, 48.5) 73.8 (69.0, 78.6) 77.3 (73.1, 81.5) 65.2 (59.3, 71.1)

Leicester 65.6 (60.0, 71.2) 43.5 (37.9, 49.1) 70.7 (65.1, 76.3) 67.4 (61.0, 73.8) 57.3 (50.6, 64.0)

NE Lincolnshire 57.6 (51.4, 63.8) 38.0 (32.7, 43.3) 71.8 (66.3, 77.3) 73.8 (66.8, 80.8) 71.9 (66.0, 77.8)




Adult Social Care Outcomes Framework 2016/17 Domain 4 indicators The underlying data for Figure 46 and Figure 47, from the 2016/17 Adult Social Care Outcomes Framework, are given in the table below.

Area


4A 4B

The proportion of people who use services who

feel safe (%)

The proportion of people who use services who say that those services

have made them feel safe and secure (%)

England 70.1 (69.7, 70.5) 86.4 (86.1, 86.7)

Hull 75.1 (71.8, 78.4) 92.3 (90.2, 94.4)

Yorkshire and the Humber 69.1 (68.1, 70.1) 86.6 (85.8, 87.4)

Wolverhampton 72.8 (68.7, 76.9) 84.7 (81.5, 87.9)

Salford 65.2 (62.2, 68.2) 88.0 (86.0, 90.0)

Derby 72.1 (68.2, 76.0) 82.8 (79.7, 85.9)

Stoke-on-Trent 71.5 (67.4, 75.6) 86.3 (83.1, 89.5)

Coventry 74.8 (70.8, 78.8) 88.5 (85.6, 91.4)

Plymouth 72.2 (68.5, 75.9) 92.8 (90.6, 95.0)

Sandwell 78.2 (74.6, 81.8) 90.2 (87.6, 92.8)

Middlesbrough 71.6 (67.7, 75.5) 90.1 (87.4, 92.8)

Sunderland 78.6 (75.4, 81.8) 92.7 (90.7, 94.7)

Leicester 65.4 (60.0, 70.8) 77.6 (72.9, 82.3)

North East Lincolnshire 67.3 (62.3, 72.3) 85.9 (83.1, 88.7)




10.10 Time Period for Information, Date Last Updated and Source for Each Table and Figure

The data refer to the dates or years as indicated (Q refers to quarters generally based on financial years so April-June is referred to as Q1). Where dates or years are in brackets after the specified dates, it means that the data was applied to the specified time period by applying rates from the dates or years in brackets. For example, [2012-2035 (2012)] might be the population predicted for the years 2012-2035 from the population estimate of 2012. For example, [2007 (2013)] might be the prevalence of diabetes estimated for the Hull population for the year 2013 from national prevalence figures from the year 2007, i.e. national prevalence estimates for the year 2007 were applied to the most recent population estimates for Hull (2013). Where a range of years is given, the data may be either combined from a number of years (particularly if the event is relatively rare and small numbers might be a problem) or the data is presented over a period of time to assess the trend over time. Where there is a source in brackets, this is generally secondary such as the source of data for the prevalence which was then applied to local population estimates or national age-specific mortality rates which were then applied to local data to calculate a standardised mortality ratio, etc. Further information about data sources is also given in section 10.1 on page 137.

Reference Description of source

ASCOF Adult Social Care Outcomes Framework (see http://ascof.hscic.gov.uk/)

ASS-CAR Adult Social Care Combined Activity Returns (see https://nascis.hscic.gov.uk/)

Census 2001 and 2011 Census (generally via Neighbourhood Statistics (Office for National Statistics 2015) or via NHS Information Centre Indicator Portal (Information Centre for Health and Social Care 2012)

CLG Department for Communities and Local Government

DECC Department of Energy and Climate Change

DCSF Department for Children, Schools and Families

DEFRA-AP Department for Environment, Food and Rural Affairs (air pollution data) (Department for Environment Food and Rural Affairs 2010)

GP-PS GP Patient Survey (see http://results.gp-patient.co.uk)

HCC (Adults) Hull city Council Adult Social Care Performance Team

Housing Housing live tables (Communities and Local Government 2011)

HSCIC Health and Social Care Information Centre

HYCSU (A&E) Data on accident and emergency activity provided by Humber and Yorkshire Commissioning Support Unit

NASCIS National Adult Social Care Information Service (see https://nascis.hscic.gov.uk/)

NS Neighbourhood Statistics (Office for National Statistics 2015)

ONS-HPSSA Office for National Statistics - House Price Statistics for Small Areas

PANSI Projecting Adult Needs and Service Information (see www.pansi.org.uk)

PHOF Public Health Outcomes Framework (Public Health England 2015)


http://ascof.hscic.gov.uk/

https://nascis.hscic.gov.uk/

http://results.gp-patient.co.uk/

https://nascis.hscic.gov.uk/




Reference Description of source

POPPI Projecting Older People Population Information System (see www.poppi.org.uk)

RSSt Rough Sleeping Statistics (www.gov.uk/government/collections/homelessness-statistics)

SNAP Survey of Needs and Provision, Homeless Link website (www.homeless.org.uk))

10.10.1 Tables

Reference Page Data time period Last updated

Data source(s)

Table 1 22 2011 Jan 15 Census

Table 2 24 2011 – 2014 May 17 PHOF

Table 3 27 2014 May 17 DECC





Table 8 35 1994 – 2016 May 17 Housing (live table 100)

Table 9 37 1991-92 – 2015-16 May 17 Housing (live tables 1,006 – 1,008)

Table 10 37 2015/16 May 17 Housing (live table 253)

Table 11 38 2005 – 2016 May 17 Housing (live tables 581 and 582) /

ONS-HPSSA

Table 12 39 1997 – 2015 May 17 Housing (live tables 576 and 577)

Table 13 40 2013 – 2018 May 15 Hull City Council

Table 14 41 1998/99 – 2015/16 May 17 Housing (live table 702)



Table 17 44 1979/80 – 2016/17 May 17 Housing (live tables 648, 691,692)

Table 18 45 2010/11 Jan 15 Housing (live table 652)


Table 20 47 2014, 2039 May 17 Housing (live table 414)



Table 23 50 2015/16 May 17 Housing (live table 784)






Table 29 58 March 2015 May 15 Hull City Council


Table 31 61 2010 – 2016 May 17 RSSt

Table 32 65 2016 May 17 HYCSU (A&E) Table 33 68 2013/14 – 2015/16 May 17 PHOF

Table 34 77 2010 – 2015 May 17 PHOF

Table 35 80 2010/11 – 2014/15 May 17 PHOF



http://www.gov.uk/government/collections/homelessness-statistics

http://www.homeless.org.uk/




Data source(s)

Table 36 82 2006/07, 2011 May 17 PHOF

Table 37 85 2012/13 – 2015/16 Mar 17 PHOF

Table 38 87 31/03/2010 Mar 12 HSCIC

Table 39 88 31/03/2014 Jan 15 HSCIC

Table 40 89 2016/17 Jun 17 HCC (Adults)

Table 41 89 2009/10 – 2010/11 Jan 15 HSCIC

Table 42 90 2009/09 – 2010/11 Jan 15 HSCIC

Table 43 91 2015/16 – 2016/17 Jun 17 HCC (Adults)



Table 46 93 2009/10 Mar 12 DCSF

Table 47 94 2009/10 Mar 12 HSCIC

Table 48 94 2015-16 Jun 17 GP-PS

Table 49 95 2008 Mar 12 CLG

Table 50 97 2016/17 Dec 17 ASCOF

Table 51 119 2017 – 2035 (2009) Oct 17 PANSI (Health and Social Care Information

Centre 2009)

Table 52 120 2017 – 2035 (2009) Oct 17 PANSI (Health and Social Care Information

Centre 2009) Table 53 121 2017 – 2035 (2004) Oct 17 PANSI / POPPI (Emerson and Hatton 2004)

Table 54 121 2017 – 2035 (2004) Oct 17 PANSI / POPPI (Emerson and Hatton 2004)

Table 55 122 2017 – 2035 (2001, 2003)

Oct 17 PANSI (Bajekal, Primatesta et al. 2003)

Table 56 124 2017 – 2035 (2001, 2003)

Oct 17 PANSI (Bajekal, Primatesta et al. 2003)

Table 57 127 2012/13 – 2015/16 May 17 PHOF

Table 58 129 2012/13 – 2014/15 May 17 PHOF

10.10.2 Figures Reference Page Data time period Last

updated Data source(s)

Figure 1 25 2011 – 2014 May 17 PHOF

Figure 2 26 2014 May 17 DECC

Figure 3 48 2011 Apr 15 Hull City Council / Census

Figure 4 52 2004/05 – 2015/16 May 17 PHOF

Figure 5 57 2011 – 2017 May 17 Hull City Council

Figure 6 60 2004/05 – 2015/16 May 17 PHOF

Figure 8 64 2012/13 – 2016/17 May 17 HYCSU (A&E)

Figure 9 64 2016 May 17 HYCSU (A&E)

Figure 10 67 2005 Mar 12 NS

Figure 11 69 2011/12 – 2015/16 May 17 PHOF

Figure 12 72 2015 Jan 15 DEFRA-AP








Data source(s)

Figure 16 77 2010 – 2015 May 17 PHOF

Figure 17 81 2010/11 – 2014/15 May 17 PHOF

Figure 18 83 2006/07, 2011 May 17 PHOF

Figure 19 84 2006/07, 2011 May 17 PHOF

Figure 20 86 2010/11 – 2015/16 May 17 PHOF

Figure 21 99 2016/17 Dec 17 ASCOF








Figure 29 104 2015/16 May 17 ASCOF


Figure 31 106 2015/16 May 17 ASCOF

















Figure 48 128 2010/11 – 2015/16 May 17 PHOF

Figure 49 130 2012/13 – 2014/15 May 17 PHOF




11 INDEX Abbreviations ...................................... 14 Accident and Emergency no fixed abode

........................................................ 63 Acknowledgements ............................ 13 Adult Social Care Outcomes Framework

........................................ See ASCOF Affordability of housing ....................... 38 Affordable housing .............................. 40 Air pollution ........................ See Pollution Appendix........................................... 137 ASCOF ............................................... 96

accommodation learning disabilities .................... 105 mental health ............................. 105

delayed transfer of care ................ 111 direct payments ............................. 100 feeling safe .................................... 117 permanent admission into care ..... 108 quality of life .................................... 98 reablement .................................... 109 rehabilitation .................................. 109 satisfied with care received ........... 113 self-directed support ..................... 100 social contacts .............................. 106

Autistic spectrum disorder ................ 121 Bed-spaces

homeless people ............................. 65 Benchmarking

general practices ........................... 143 Blind

numbers in Hull ............................... 88 BME

social care ....................................... 89 Caring for others

support ............................................ 90 Climate change ................................... 70 Clinical significance .................. 163, 165 Comparator areas ............................... 16 Confidence intervals ........................... 14

explained ....................................... 163 Confounding

explained ....................................... 162 Contents page ...................................... 3

Data sources ...................................... 15 for each table/figure ...................... 178 general .......................................... 137

Data underlying figures .................... 166 Date last updated

tables and figures ......................... 178 Daycases ....... See Inpatient admissions Deaf

numbers in Hull ............................... 87 Decent homes standard ..................... 21 Delayed transfer of care ................... 111 Deprivation ......................................... 15

IMD ................................................. 15 Index of multiple deprivation ........... 15

Direct payments ............................... 100 Direct standardisation

explained ...................................... 164 Directly standardised mortality rate .. See

DSR Disease registers .................... See QOF DSR

explained ...................................... 164 Effect modification

explained ...................................... 162 Environment ....................................... 67 Explanation of terms........................... 14 Feeling safe ...................................... 117 Figures

data sources ................................. 180 date last updated .......................... 180 underlying data ............................. 166

Fuel poverty ....................................... 23 Future needs ................. See Projections General practice

benchmarking ............................... 143 groupings ...................................... 143

Glossary ............................................. 14 GP disease registers ............... See QOF GP patient survey ............................... 94 Grouping of general practices .......... 143 Homelessness .................................... 49

A&E ................................................ 63 bed-spaces ..................................... 65




cost to public services ..................... 66 health and other services ................ 63 non-statutory ................................... 61 prevented or relieved ...................... 55 rough sleepers ................................ 61 statutory .......................................... 49

Public Health Outcomes Framework ................................................. 51

reasons ........................................ 53 temporary accommodation

Public Health Outcomes Framework ................................................. 59

temporary accommodation .............. 59 Hospital episode statistics

explained ....................................... 142 Housing .............................................. 18

affordability ...................................... 38 affordable ........................................ 40 decent homes standard .................. 21 homelessness ................................. 49

A&E ............................................. 63 bed-spaces .................................. 65 cost to public services ................. 66 health and other services ............ 63 non-statutory ............................... 61 prevented or relieved ................... 55 rough sleepers ............................. 61 statutory ....................................... 49

Public Health Outcomes Framework ........................... 51

reasons .................................... 53 temporary accommodation

Public Health Outcomes Framework ........................... 59

temporary accommodation .......... 59 lettings............................................. 40 local authority expenditure and

income ......................................... 45 prices .............................................. 38 prices relative to earnings ............... 38 projections ....................................... 46 rents ................................................ 40 social housing sales ........................ 44 stock................................................ 35 tenancies ......................................... 40 types ............................................... 31 waiting lists ...................................... 42

IMD differences in

mortality ................. See Deprivation prevalence ............. See Deprivation risk factors .............. See Deprivation

lower layer super output level ......... 15 national ranks ................................. 15 quintiles .......................................... 15

Independence (to live at home) .......... 95 Index of multiple deprivation ......See IMD Indicators ............................... 17, 96, 154 Indirect standardisation

explained ...................................... 164 Inpatient admissions

data explained .............................. 142 Interaction

explained ...................................... 162 Introduction ........................................ 13 Land use ............................................ 67 Learning disabilities

social care projected future need ................ 121

social care future need ................. 121 LLSOAs .............................................. 15 Local surveys ................................... 140 Long term conditions

support ............................................ 94 Looked after children ........................ 125 Median

explained ...................................... 164 Mental health

social care projected future need ................ 119

social care future need ................. 119 Modelled estimates .................... 14, 140 Mortality

air pollution ..................................... 76 Moving average

explained ...................................... 165 No fixed abode

attendance at A&E .......................... 63 Noise pollution ................... See Pollution Non-statutory homelessness .............. 61 Nursing care homes

admissions ...................................... 91 Outcome measures .................... 17, 154 Percentiles




explained ....................................... 164 Performance targets ......................... 154 Permanent admission into care ........ 108 PHOF ................................. 17, 131, 154

local analysis ................................. 156 national profile ............................... 155 social isolation

adult carers ................................ 129 social care users ....................... 126

statutory homelessness .................. 51 tartan rug ....................................... 155 temporary accommodation .............. 59

Physical disabilities social care

projected future need................. 122 social care future need .................. 122

Pollution air .................................................... 71 mortality .......................................... 76 noise ............................................... 79

Poverty ............................................... 23 Predicted numbers ........ See Projections Prevalence

registers ............................... See QOF Primary care survey ............................ 94 Projected household estimates ........... 46 Projections

social care needs .......................... 118 learning disabilities .................... 121 mental health ............................. 119 physical disabilities .................... 122 substance abuse ....................... 118

Public Health Outcomes Framework See PHOF

P-values explained ....................................... 165

QMAS explained ....................................... 142

QOF ........................Also see Prevalence explained ....................................... 142 problems with comparing GPs ...... 142

Quality and outcomes framework ..... See QOF

Quality of life ....................................... 98 Quartiles

explained ....................................... 164 Quintiles

explained ...................................... 164 Reablement ...................................... 109 References ....................................... 134 Rehabilitation ................................... 109 Residential care homes

admissions ...................................... 91 Rough sleepers .................................. 61 Safeguarding adults ........................... 92 Satisfaction

social care ...................................... 92 Satisfied with care received .............. 113 Self-directed support ........................ 100 Significance testing

explained ...................................... 165 Small numbers ................................... 14

problem explained ........................ 163 SMR

explained ...................................... 164 Social care ......................................... 87

admission to residential care homes91 blind ................................................ 88 deaf ................................................. 87 in receipt of ..................................... 89 learning disabilities

projected future need ................ 121 mental health

projected future need ................ 119 new clients ...................................... 91 physical disabilities

projected future need ................ 122 projected future need .................... 118 safeguarding adults ........................ 92 satisfaction ...................................... 92 self directed support ....................... 89 substance abuse

projected future need ................ 118 Social contacts ................................. 106 Sources of data .........................137, 178 Standardisation .................................. 14

explained ...................................... 164 Standardised mortality ratio ..... See SMR Statistical methods ............................. 14 Statistical terms .................................. 14 Statistics

problem of small numbers explained .................................................. 163

statutory homelessness ...................... 49




Statutory homelessness Public Health Outcomes Framework

.................................................... 51 reasons ........................................... 53

Substance abuse social care

projected future need................. 118 social care future need .................. 118

Summary .............................................. 7 Support ............................................... 94

for carers ......................................... 90 to live at home ................................. 95

Surveys local .............................................. 140

Synthetic estimates .................... 14, 140 Tables

data sources ................................. 179 date last updated .......................... 179

Targets ............................................. 154 mortality from air pollution ............... 76

Tartan rug ......................................... 155 Technical information ......................... 14

Temporary accommodation ................ 59 Public Health Outcomes Framework

.................................................... 59 Testing significance

explained ...................................... 165 Three year period data

explained ...................................... 165 Types of housing ................................ 31 Uncertainty

problem of small numbers explained .................................................. 163

Underlying data for figures ............... 166 Updated tables/figures

data sources ................................. 178 date last updated .......................... 178

Use of land ......................................... 67 Variability ............................................ 14

and small numbers ....................... 163 Waiting lists for housing ..................... 42 Young people

looked after children ..................... 125


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