The Royal Borough of Kingston upon Thames is located in South West London and shares borders with Richmond, Surrey, Merton, Sutton and Wandsworth. It has the third smallest population of any borough in London (after the City of London and Kensington and Chelsea)1.
Population
In 2014 the estimated population of the borough was 169,958 2.This is the number of residents that RBK is responsible for providing statutory services to. This is known as the resident population. The Kingston Clinical Commissioning Group is responsible for providing healthcare to people registered with Kingston GPs. This number as of March 2015 was 199,666 which is a difference of 29,708 more than the resident population. The largest difference between the two sets of populations is shown between the ages of 35-54 years 3.
The overall resident population is predicted to increase steadily in future years: by 5.7% between 2014 and 2019, and by 10.6% between 2019 and 2024. As is the case elsewhere, the increase in the number of older people will have a major impact on delivering health and social care services. Those aged 90 or more will increase by 10.1% between 2013 and 2018 and by 19.7% between 2018 and 20233.
On average each year over 1,000 people die in Kingston and there are over 2,000 births4.
Ethnicity
The population of Kingston has become more ethnically diverse, with Black, Asian and Minority Ethnic (BAME) groups increasing from 16% of the total population in 2001 to 28.8% in 2014 with an expected further rise to 36.9% by 20291. The percentage of the Kingston BAME population declines with age comprising 38.5% of children aged 0-4 years and only 4.5% of older people aged 90 years and over. The three largest BAME populations in Kingston as identified by the 2011 Census were Indian (6,325), Sri Lankan (4,012) and Korean (3,408) 5. This pattern remains in 2014 with the largest BAME populations being Other Asian (18,341), Other (7,543) and Indian (7,085)1.
People from BME communities are mostly under 65, in the future the older demographic will gradually reflect the diversity seen in younger age groups6.
The health of BAME populations is affected by a range of issues including the delivery and take up of services, differences in culture and lifestyle, discrimination and differing biological susceptibility to some diseases.
Older People
The population of older people aged 65 or more constitutes 13.2% of the total resident population of Kingston1.
The ageing of the population has important implications for the health and social care system. Depending on the health of an individual, an older person can spend a number of years in poor health and it is during this period that they can require extensive health and social care interventions.
The number of older people living alone continues to increase. The percentage of all households which consist of someone aged over 65 living alone in Kingston in 2013 was 11.3% which is slightly above the London average (10.2%)7.
Over half (51.9%, 5,000 people) of the population aged 75 and over live alone in Kingston8; almost two thirds of these are women9. The numbers of people aged 75 and over living alone is projected to rise to 8,128 by 20307.
There are 756 people aged 65 or over living in a care home in Kingston with or without nursing8. This is projected to rise to 1,200 by 2030.
Falls are the leading cause of non-fatal hospitalised injuries. 30% of people older than 65 and 50% of people older than 80 are falling at least once a year10. In Kingston, the number of older people predicted to have a fall in Kingston is likely to increase by 27% in people aged 65-69, 46.7% in people aged 70-74 and 60.6% in people aged 75 and between 2014 and 203011. A large proportion of those who fall suffer moderate to severe injuries that reduce mobility as well as independence and increase the risk of premature death.
The rate of hip fracture among those aged 65 and over in Kingston (2013/14) is 573 per 100,000; higher than the London rate (530 per 100,000) but lower than the national rate of 580 per 100,00012.
People with Physical Disabilities
People with physical disabilities should have the same access to services and opportunities as non-disabled people. Commissioners need to be committed to supporting disabled people to live their lives the way they want to. The number of people aged 65 and over predicted to have moderate or severe visual impairment in Kingston is 1,98013. With regards to hearing impairment, 9,537 people aged 65 and over are predicted to have a moderate or severe hearing impairment whilst 264 people in this age range would be predicted to have a profound hearing loss11.
People with learning disabilities
People with learning disabilities face many issues in receiving the care they require. Although they are more at risk of ill health than the general population, they are less likely to either seek or receive appropriate care. In addition, they may suffer from diagnostic overshadowing where symptoms they may have are put down to their ‘learning disability’ and so are not investigated appropriately. This population group is also one of the most vulnerable to abuse and exploitation. Extrapolating from national prevalence data it would be expected that there would be approximately 3,183 adults with a learning disability resident in Kingston with a further 685 with a moderate or severe learning disability and hence likely to be in receipt of services8.
Adults and Older People with Mental Health problems
Mental health problems are very common. It is estimated that around 21,000 residents aged 16 and over in Kingston suffer from a common mental health disorder (including anxiety, depression, panic disorder and obsessive compulsive disorder) 14. In many cases the most appropriate treatment for these conditions will be talking therapies, and this has been recognised by the Improving Access to Psychological Therapies programme.
It is estimated that there are 11,928 people in Kingston aged over 16 with mixed anxiety and depressive disorder, 5,831 with generalised anxiety disorder, 3,048 with depressive episodes, 1,855 with phobia, 1,569 with obsessive compulsive disorder and 1,456 with panic disorder15.
Very many fewer people will have psychotic disorders; 444 people aged 18-64 in Kingston have a psychotic disorder8 and the number of adults estimated to have schizophrenia in Kingston is 2267. The prevalence of psychoses recorded in Kingston general practices (0.8%) is lower that the London average of 1%7.
Dementia is a progressive condition that predominantly affects older people. It causes a decline in mental ability which affects memory, thinking, concentration, problem solving and perception. Kingston and Richmond have one of the highest life expectancies in England and, as a result, nearly half these patients over 75 have dementia which is double the national average16. The number of people with dementia in Kingston in 2014 was estimated at 1,600 and this is expected to increase to 1,800 by 202017.
Depression is very common in older people and it is estimated that 1,942 people in Kingston aged 65 and over will suffer from this condition in 201418. This will include two in five people living in care homes19. In many cases the depression is not diagnosed and even when diagnosed may not be treated appropriately.
Carers
In Kingston, as with the rest of the UK, more young people with disabilities survive to live a full life and in addition people are living longer, many with long-term conditions or complex health needs. Coupled with this, the shift towards independent living and care at home means that a greater emphasis is put on informal carers who need assistance so they can be able to support the person they care for.
Within Kingston 5.9% of the population provide at least one hour of unpaid care a week. This is less than England (6.5%) but similar to London. Over 1,600 people provide 20-49 hours on unpaid care per week and over 2,300 people in Kingston provided 50 hours or more. There were 990 young carers (under 24) and 2,518 older people providing care at the time of the 2011 census13.
Households and Housing
There are approximately 63,639 households in Kingston according to the 2011 Census. The amount of owner-occupied dwellings in Kingston has reduced from 71% in 2001 to 64% in 2011. Consequently, the number of privately rented households has increased within this same timescale20. Social housing in Kingston (rented from a housing association or local authority) makes up a lower proportion of the housing stock than the London or England averages.
Over a third (36.2%) of houses in Kingston are owned with a mortgage or loan, over a quarter (27.9%) are owned outright, 21% are rented privately and 8.3% are rented from council15. Projections from the GLA show that the number of lone parent households is set to increase by over 1,000 to 5,757 in Kingston between 2011 and 2026. Couple households are projected to remain roughly static, whilst one person households are also forecast to increase. This trend for household types is also typical across London21.
The average house price in Kingston was £426,440 in May 2015 compared to £475,961 for London18. The cost of renting a property is also high in Kingston, with the average monthly rent for a two – bedroom property costing £1,200 between April 2012 to March 2013. This is slightly lower than the average rent in London of £1,34319.
There were 204 households accepted as homeless and in priority need in 201422. The rate of households accepted as homeless and in priority need per 1000 households has increased from 2.59 in 2012 to 3.04 in 201418.
Economy and employment
Kingston’s economy has broadly grown up around its retail sector. Kingston town centre is still the largest retail centre in London outside the West End and dominates the South West London sector.
Kingston has a higher proportion of the 16-64 population in employment (82%) than London and England (77% and 78% respectively) 18.
Local unemployment (measured by the Jobseekers Allowance claimant count) was 1.4% in May 2015; this was lower than the London rate of 2.6%18. In April 2014 the three wards with the highest proportion of benefit claimants in Kingston were Norbiton at 2.8%, Chessington South at 2.1% and Beverley at 2.0%23.
The highest rates of youth unemployment (people aged 16–24) in April 2014 was seen in Norbiton (5.6%) followed by Chessington North and Hook (5.1%) and Chessington South (4.9%)22.
Substance Misuse
Drug users are encouraged to attend treatment sessions, as this has shown that attendees use less illegal drugs, commit less crime, improve their health and mange their lives better, which in turn benefits the wider community. Preventing drop out and keeping people in treatment long enough to benefit contributes to these improved outcomes. Kingston’s performance in 2012 as measured by successful completion of drug treatment was below the London average for both opiate (8.0% compared with 9.6%) and non opiate drug users (28.4% compared with 34.7%)24.
There are 283 adult drug users recorded as being in effective treatment in Kingston; 215 of which are opiate users and 68 non-opiate users25. Between 2011 and 2012 there was a decrease in opiate use by 5% and an increase in non-opiate use by 19%26.
In 2014 there are 6,623 people aged 18-64 predicted to alcohol dependence in Kingston and 3,756 people age 18-64 to be dependent on drugs27.
Socioeconomic Groups
The ONS annual population survey showed 79.1% of the Kingston population are economically active, 75.3% are in employment, 62.6% are employees, 12.5% are self-employed and 4.9% are unemployed28.
In 2011 working residents from Kingston were more likely to be employed in a professional occupation or as a manager, director or senior official (38%) than those from London (35%) and England (28%) in general. In line with this, the proportion of Kingston residents employed in elementary occupations (7%) was lower than London (10%) and England (11%)29.
Residents in Kingston have a higher level of qualifications on average than the rest of London and England, 41% of Kingston’s working age population are qualified to NVQ4 or above (which includes university degrees), compared to 38% in London and 27% in England30.
1.1% of the Kingston population are on the Jobseekers claimant count as of April 2015, compared to 2.1% of London and 1.9% of England31.
5.3% of Kingston receives main out-of-work benefits as of February 2015 compared to 9.1% in London and 9.4% in England32.
Crime
Kingston’s total number of offences between April 2013 to March 2014 was 61 per 1,000 people compared to 90 per 1,000 for London. A 2013 survey of Kingston residents (Your Kingston Your Say) found that 92% felt safe in Kingston during the day and 62% felt safe in Kingston at night33.
From October 2011 to September 2012, 5.2% of all crimes in Kingston were related to drug misuse (Crime Mapping Data Tables, Met Police October 2013) – and Kingston was ranked fifth out of the 32 London Boroughs for this indicator (with one being the lowest level of crime) 34.
Local Environment
Air pollution is still a significant public health problem with a wide range of health impacts that reduce life expectancy and increase illness, especially respiratory and cardiovascular disease.
People in Kingston produce 59,145 tonnes of household waste per year (2012-13 figures). Residual household waste was 488kg per household in 2013. Of this 46% is either reused, recycled or composted, compared to 34% in London and 42% in England. 14.8% of municipal waste in Kingston is landfilled as of 2013.
CO2 per capita emissions in Kingston (4.6 tonnes in 2011) are consistently below the average for London (4.9) and the UK (6.7). This is principally due to Kingston’s much lower rate of industrial and commercial emissions. The per capita rate of CO2 emissions from road transport (1.3) is higher than the London average (1.0) but lower than that for the UK (1.9), reflecting the borough’s suburban character.
Overall health and areas experiencing inequality
People in Kingston are more healthy overall than the national or London population (measured using a variety of measures including life expectancy which is greater than the England average by 1.9 years for Kingston men and 1.4 years for Kingston women), which is as expected given the overall affluence of the area28. The 2015 Indices of Deprivation ranks Kingston 278 out of 326 local authorities in England (where 1 = most deprived), making Kingston the second least deprived borough in London after Richmond upon Thames. However, these overall figures mask stark differences between local areas. The wards with the worst health experience are, as would be expected, those that are most deprived. People living in Tudor have the highest life expectancy in Kingston (85.9 years) whilst those living in Norbiton have the lowest (78.8 years). Male life expectancy ranged from 77.1 years in Norbiton to 84.1 years in Tudor. Female life expectancy was also lowest in Norbiton (80.5 years) but highest in Old Malden (87.4 years) 36.
Closing the gap between those with the best and worst projected health outcomes (whilst still improving health outcomes for all) means that tackling the wider determinants of health associated with people living in areas of multiple deprivations is vital.
Fuel poverty affects the most vulnerable, often the elderly and those already having difficulty making ends meet. Poor energy efficiency, high energy costs and inadequate basic income are three of the main risk factors for fuel poverty. A higher proportion of residents in Kingston receiving income based benefits were living in a home with a low energy efficiency rating (18%) than those in London (14%) or England (12%)37.
The percentage of households experiencing fuel poverty in Kingston is estimated to be 9.4% which equates to 6,020 households. This compares with previous figures from 2010 (9.9%) and 2012 (8.9%). In comparison, London had a rate of 8.9% and England 10.4% in 201238. It is estimated that Kingston’s vulnerable individuals in fuel poverty are over 75s (869 people), under 5s (1,314 children) and those with limiting long term illness (1,917 people) 39.
Prevention
The prevention of ill health and disease and keeping the Kingston population as healthy as possible for as long as possible are key tasks for partners in Kingston.
Smoking is the leading cause of health inequality and one in two people will die from their habit from a variety of diseases including coronary heart disease, strokes and many types of cancer. In addition many smokers will suffer from chronic diseases, which require high levels of input from both health and social care services.
The prevalence of smoking in Kingston in 2013 was at 16.8% is less than the London average of 17.3% and less than the England average of 18.4%40. The prevalence of smoking among adults in Kingston has however increased from 15.1% in 2012 to 16.8% in 2013 whilst the regional and national prevalence’s declined during the same period from (18.0% to 17.3%) and (19.5% to 18.4%) respectively. Smoking is highly associated with deprivation. Given the need to address health inequalities and reduce activity generated by smoking related illnesses, reducing the number of people who smoke in Kingston is one of the highest local health priorities. In 2012-13 the rate of maternal smoking in Kingston (4.8%) was lower than regional (5.7%) and national (12.7%) rates41.
Obesity is a risk factor for a wide range of diseases (including diabetes, coronary heart disease, stroke and osteoarthritis) that consume significant health service resources. In Kingston 6% of Reception children (aged 4-5years) and 15.4% of Year 6 children (aged 10-11 years) are obese. By year 6, 28.5% of children in Kingston are above a healthy weight and at an increased risk of health complications in later life42. Although the prevalence of overweight and obese children in Kingston is below the national and London average, there is a still a doubling in prevalence of obesity between Reception and Year 6 in Kingston, that is also seen nationally. As obese children tend to become obese adults it is important to intervene in childhood. More than half of all adults are now either overweight or obese. In Kingston this percentage is 45.8%, a little less than the London average of 57.3%. Investment in interventions to reduce obesity will reduce demands on health and social care in the future43. Alcohol abuse causes a wide range of health problems including liver disease, accidents, cardiovascular disease and mental health problems. The percentage of adults aged over 16 who are estimated to binge drink in Kingston (16%) is higher than the London average (14%) although lower than the national average (20%)43. 23% of women in Kingston and 27% of men in Kingston have an alcoholic drink 2-3 times a week, 22% of women and 16% of men in Kingston never drink alcohol44.
People who have a physically active lifestyle have a 20-35% lower risk of cardiovascular disease (coronary heart disease and stroke) compared to those who have a sedentary lifestyle. Regular physical activity is also associated with a reduced risk of diabetes, obesity, osteoporosis, colon and breast cancer. It is also associated with improved mental health. The percentage of active adults in Kingston (60.6%) is comparable to regional and national averages45.
The NHS Health Check programme was introduced in Kingston in 2009 to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. In 2013-14, 18.2% of the eligible population in Kingston received the check, more than double the national rate (9.0%)42.
There is good evidence demonstrating the short and long term health benefits of breastfeeding both for mothers and infants. The percentage of Kingston mothers who breastfed their babies in the first 48 hours after delivery and also who totally or partially breastfed at 6-8 weeks post delivery is higher than the national average. For the latter indicator the Kingston percentage is 76%, compared with the national rate of 47.2%46. Breastfeeding prevalence remains significantly lower in more deprived areas in the borough47.
Childhood immunisations are one of the most cost effective public health interventions. Immunisation rates in Kingston are generally higher than the London average. However the uptake rate for the flu vaccine for over 65’s was significantly lower in Kingston (67.5%) than both London (69.2%) and the national averages (72.7%)48.
Physical health
The physical health of people in Kingston reflects the overall affluence of the area with a lower prevalence of many diseases than London as a whole. This pattern does not apply in the areas experiencing inequality, as defined by the Index of Multiple Deprivation.
Cardiovascular disease (CVD) which includes heart attacks and strokes is one of the major causes of death in Kingston. It causes 27.5% of deaths at all ages and 21.8% of deaths in people aged under 7549. In 2013 the number of deaths due to cancer in England for the first time exceeded the number of deaths due to circulatory disease, while in Kingston circulatory disease remained the most common cause of death.
Cancers account for 26.8% of all deaths in Kingston but are responsible for 44.4% of deaths in people aged less than 7540. Around one in 70 people in Kingston are living with cancer. Prostate cancer is the most common type of cancer in Kingston in men, while breast cancer is the most common type in women. Lung cancer is relatively common in both men and women, and because survival with the disease is low, it is Kingston’s biggest cancer killer50. Screening programmes are in place for breast, cervical and colon cancers.
The third main cause of deaths is respiratory disease (which includes pneumonia, bronchitis, emphysema and chronic obstructive pulmonary disease). These diseases cause 13.9% of all deaths and 6.9% of deaths in people aged under 7540.
All three major causes of death have preventable risk factors which include smoking, diet, exercise and excess alcohol consumption. Action to address these should be prioritised alongside evidence based treatment for people with or at high risk of the conditions.
Diabetes is a risk factor for both cardiovascular and renal disease and diabetic complications result in considerable morbidity and have a detrimental impact on quality of life. The prevalence of detected diabetes in general practice increased in Kingston from 4.5% in 2010-11 to 4.6% in 2011-12 whilst the national prevalence increased from 5.5% to 5.8% during the same period51. As of March 2015 there were 7,887 people on the disease register with diabetes in Kingston, making up 3.9% of the practice prevalence which compares to a national prevalence of 8.1%40. The modelled prevalence of the condition in Kingston is 6.9%39. Addressing levels of obesity in the population is the key action needed to halt the rise in diabetes.
Controlling the spread of sexually transmitted infections is a priority for Kingston due to its high student population. Kingston has the 13th lowest rate of acute STIs (chlamydia, gonorrhoea, warts and syphilis) in London. Men have higher rates of STIs than women. Londoners aged between 15 and 24 years account for 41% of all Londoners diagnosed with an acute STI in 2012. In Kingston 42% of diagnoses of acute STIs were in young people aged 15-24 years52. In 2013, Kingston has the eighth lowest rate of new HIV infections with a new HIV diagnosis per 100,000 population among people aged 15 or above in Kingston at 7.2, compared to 36.5 in London and 12.3 in England.
Most liver disease is preventable and key risk factors are alcohol consumption and obesity prevalence, which are both amenable to public health interventions. The directly standardised mortality rate from liver disease in Kingston is slightly higher than the national average, but this does not reach statistical significance, and the mortality rate from liver disease that is considered preventable is similar to national rates41.
Palliative care is a vital component of healthcare. The aim should be for all people to have a dignified, controlled and peaceful end to their life in a location of their own choosing. The percentage of Kingston residents who die at home is 18.3% compared to 20.3% nationally. At present many people die in acute hospitals which are usually not the most appropriate location for the provision of end of life care41.